Paul Krugman
Paul Krugman

Does anyone remember the “reformicons”? A couple of years back there was much talk about a new generation of Republicans who would, it was claimed, move their party off its cruel and mindless agenda of tax cuts for the rich and pain for the poor, bringing back the intellectual seriousness that supposedly used to characterize the conservative movement.

But the rise of the reformicons never happened. What we got instead was the (further) rise of the decepticons — not the evil robots from the movies, but conservatives who keep scaling new heights of dishonesty in their attempt to sell their reverse-Robin Hood agenda.

Consider, in particular, Republican leaders’ strategy on health care. At this point, everything they say involves either demonstrably dishonest claims about Obamacare or wild misrepresentations of their proposed replacement, which would — surprise — cut taxes for the rich while inflicting harsh punishment on the poor and working class, including millions of Trump supporters. In fact, there’s so much deception that I can’t cover it all. But here are a few low points.

Despite encountering some significant problems, the Affordable Care Act has, as promised, extended health insurance to millions of Americans who wouldn’t have had it otherwise, at a fairly modest cost. In states that have implemented the act as it was intended, expanding Medicaid, the percentage of nonelderly residents without insurance has fallen by more than half since 2010.

And these numbers translate into dramatic positive impacts on real lives. A few days ago the Indiana G.O.P. asked residents to share their “Obamacare horror stories”; what it got instead were thousands of testimonials from people whom the A.C.A. has saved from financial ruin or even death.

How do Republicans argue against this success? You can get a good overview by looking at the Twitter feed of Tom Price, President Trump’s secretary of health and human services — a feed that is, in its own way, almost as horrifying as that of the tweeter in chief. Price points repeatedly to two misleading numbers.

First, he points to the fact that fewer people than expected have signed up on the exchanges — Obamacare’s insurance marketplaces — and portrays this as a sign of dire failure. But a lot of this shortfall is the result of good news: Fewer employers than predicted chose to drop coverage and shift their workers onto exchange plans. So exchange enrollment has come in below forecast, but it mostly consists of people who wouldn’t otherwise have been insured — and as I said, there have been large gains in overall coverage.

Second, he points to the 28 million U.S. residents who remain uninsured as if this were some huge, unanticipated failure. But nobody expected Obamacare to cover everyone; indeed, the Congressional Budget Office always projected that more than 20 million people would, for various reasons, be left out. And you have to wonder how Price can look himself in the mirror after condemning the A.C.A. for missing some people when his own party’s plans would vastly increase the number of uninsured.

Which brings us to Republicans’ efforts to obscure the nature of their own plans.

The main story here is very simple: In order to free up money for tax cuts, G.O.P. plans would drastically cut Medicaid spending relative to current law, and they would also cut insurance subsidies, making private insurance unaffordable for many people not eligible for Medicaid.

Republicans could try to make a case for this policy shift; they could try to explain why tax cuts for a wealthy few are more important than health care for tens of millions. Instead, however, they’re engaging in shameless denial.

On one side, they claim that a cut is not a cut, because dollar spending on Medicaid would still rise over time. What about the need to spend more to keep up with the needs of an aging population? (Most Medicaid spending goes to the elderly or disabled.) La, la, la, we can’t hear you.

On the other side — even I was shocked by this one — senior Republicans like Paul Ryan dismiss declines in the number of people with coverage as no big deal, because they would represent voluntary choices not to buy insurance.

How is this supposed to apply to the 15 million people the C.B.O. predicts would lose Medicaid? Wouldn’t many people drop coverage, not as an exercise in personal freedom, but in response to what the Kaiser Family Foundation estimates would be an average 74 percent increase in after-tax premiums? Never mind.

O.K., so the selling of Trumpcare is deeply dishonest. But isn’t that what politics is always like? No. Political spin used to have its limits: Politicians who wanted to be taken seriously wouldn’t go around claiming that up is down and black is white.

Yet today’s Republicans hardly ever do anything else. It’s not just Donald Trump: The whole G.O.P. has become a post-truth party. And I see no sign that it will ever improve.