“A Market Of Systematic Discrimination”: President Obama Shouldn’t Apologize For Blowing Up The Terrible Individual Market
Last night, NBC’s Chuck Todd asked President Obama about the people losing their health insurance despite his promise that “anyone who likes their plan can keep it.” (See the video and read the transcript here.)
“I am sorry that they are finding themselves in this situation based on assurances they got from me,” Obama replied.
The answer is a bit of a dodge. People aren’t finding themselves in this situation based on the president’s promises. They’re finding themselves in this situation based on his policy. And Obama isn’t apologizing for the policy.
“Before the law was passed, a lot of these plans, people thought they had insurance coverage,” he said. “And then they’d find out that they had huge out of pocket expenses. Or women were being charged more than men. If you had preexisting conditions, you just couldn’t get it at all.”
Obama was wrong to promise that everyone who liked their insurance could keep it. For a small minority of Americans, that flatly isn’t true. But the real sin would’ve been leaving the individual insurance market alone.
The individual market — which serves five percent of the population, and which is where the disruptions are happening — is a horror show. It’s a market where healthy people benefit from systematic discrimination against the sick, where young people benefit from systematic discrimination against the old, where men benefit from systematic discrimination against women, and where insurers benefit from systematic discrimination against the uninformed.
The result, all too often, is a market where the people who need insurance most can’t get it, and the people who do get insurance find it doesn’t cover them when it’s most necessary. All that is why the individual market shows much lower levels of satisfaction than, well, every other insurance market:
(Graph by Jon Cohn)
Those numbers, of course, don’t include the people who couldn’t get insurance because they were deemed too sick. Consumer Reports put it unusually bluntly:
Individual insurance is a nightmare for consumers: more costly than the equivalent job-based coverage, and for those in less-than-perfect health, unaffordable at best and unavailable at worst. Moreover, the lack of effective consumer protections in most states allows insurers to sell plans with ‘affordable’ premiums whose skimpy coverage can leave people who get very sick with the added burden of ruinous medical debt.
Jonathan Cohn puts a human face on it:
One from my files was about a South Floridian mother of two named Jacqueline Reuss. She had what she thought was a comprehensive policy, but it didn’t cover the tests her doctors ordered when they found a growth and feared it was ovarian cancer. The reason? Her insurer decided, belatedly, that a previous episode of “dysfunctional uterine bleeding”—basically, an irregular menstrual period—was a pre-existing condition that disqualified her from coverage for future gynecological problems. She was fine medically. The growth was benign. But she had a $15,000 bill (on top of her other medical expenses) and no way to get new insurance.
This is a market that desperately needs to be fixed. And Obamacare goes a way toward fixing it. It basically makes the individual market more like the group markets. That means that the sick don’t get charged more than the well, and the old aren’t charged more than three times as much as the young, and women aren’t charged more than men, and insurance plans that don’t actually cover you when you get sick no longer exist. But the transition disrupts today’s arrangements.
(Interestingly, recent Republican plans have focused on disrupting the employer market by ending, limiting, or restructuring the tax exclusion for employer-based plans. There’s an extremely good case to be made that that needs to be done, but it means much more disruption for a much larger number of people. Obamacare’s focus on disrupting the individual market — and only the individual market — is a more modest approach to health-care reform.)
There’s been an outpouring of sympathy for the people in the individual market who will see their plans changed. As well there should be. Some of them will be better off, but some won’t be.
But, worryingly, the impassioned defense of the beneficiaries of the status quo isn’t leavened with sympathy for the people suffering now. The people who can’t buy health insurance for any price, or can’t get it at a price they can afford, or do get it only to find themselves bankrupted by medical expenses anyway have been left out of the sudden outpouring of concern.
If people have a better way to fix the individual market — one that has no losers — then it’s time for them to propose it. But it’s very strange to sympathize with the people who’ve benefited from the noxious practices of the individual market while dismissing the sick people who’ve been victimized by it.
Obama is rightly taking flack for making a promise he wasn’t going to keep, and he’s right to apologize for it. But he shouldn’t apologize for blowing up the individual market. It needed to be done.
By: Ezra Klein and Evan Soltas, WonkBook, The Washington Post, November
“Radicalism For The Sake Of Radicalism”: Four Years Later, The Tea Party Has Learned Nothing
The Tea Party is no longer a brand-new movement in American politics. So, more than four years in, what do they appear to have learned? How about: nothing. And they seem to want it that way.
Certainly that appears to be the case with the Tea Party as an electoral force. Oh, Tea Partyers will remind you – they’ve won some. Ted Cruz in Texas, Mike Lee in Utah, Ron Johnson in Wisconsin – all True Conservatives in good standing (at least last I looked; these things can change rapidly), all solid winners in their election bids. It’s hardly the case that nominating a Tea Party candidate is guaranteed to turn a win into a loss.
But three election cycles in, it’s pretty clear that nominating a candidate favored by Tea Partyers over what they consider “establishment” candidates is a formula for risking Republican disaster. And that it’s not going to change any time soon.
So it was for Christine O’Donnell and Sharron Angle in 2010. So it was with Todd Akin and Richard Mourdock in 2012. And so it’s likely to be with the 2014 crop.
The thing is, four years is plenty of time to develop solid, seasoned candidates. Indeed, once upon a time Marco Rubio was one of those solid, seasoned candidates. Rubio was a successful Florida Republican who had risen rapidly to become speaker of the Florida House; he then adopted the emerging Tea Party and went on to easily win an open U.S. Senate seat. But Rubio’s Tea Party credentials were tarnished because he actually tried to legislate on immigration; while it’s much too early to declare his career in trouble and it wouldn’t be surprising if he still ran a solid race for the Republican presidential nomination, it’s also very easy to imagine him having to fend off a Tea Party primary of his own if he runs for reelection instead of the White House in 2016.
So what do Republicans have for 2014? Matt Bevin, taking on Mitch McConnell in Kentucky, is a first-time candidate; should he win, Republicans would probably lose that seat. In Georgia, Paul Braun in particular is thought by many to be a particularly weak candidate, capable of losing that open seat to Democrat Michelle Nunn if he emerges as the nominee. In Louisiana, Republicans had settled on a solid candidate to challenge Mary Landrieu, but Tea Partyer Rob Maness has jumped in with plenty of serious organizational support.
Granted, this early in the cycle, none of these candidates has (to my knowledge, at least) managed to embarrass himself by orating on rape. Nor have any of them yet revealed themselves as certified non-witches. Indeed, it’s so early that I don’t even know if they have a history of having said crazy things – although I suspect that Mississippi Tea Party candidate Chris McDaniel, a former talk radio host, has furnished enough for a fat opposition research file.
Still, it appears to be no more distinguished of a crop than the 2010 and 2012 versions, and I strongly suspect they will begin to generate equally baroque sound bites as soon as the public portion of the campaign season begins. After all, we just had birther Dean Young, who provided plenty of entertainment if you enjoy politicians saying crazy things, come close to knocking off mainstream conservative Bradley Byrne in the Alabama 1 special election.
There’s nothing about being conservative, even extremely conservative, that would necessarily generate bad candidates. But it’s a mistake to interpret Tea Partyism as simply about being more conservative than mainstream Republicans. Instead, in practice, it’s basically turned out to be a cross between radicalism for the sake of radicalism, along with an extreme suspicion of elites. Which in turn has made it rather easy for hucksters and scam artists to convince Tea Party voters and activists that solid conservatives are really squishes and RINOs. There are no issue positions one can cling to that will prevent those charges; accusations of being insufficiently “conservative” in this atmosphere, to these voters, are impossible to refute.
Indeed, as we’ve seen with Ted Cruz, the very reaction to crazy things that Tea Party politicians say really is the best proof that they are actually True Conservatives.
Which doesn’t mean that Democrats are about to win a Senate seat in Mississippi (although they would be smart to at least get a plausible candidate on the ballot, just in case). But it does mean that we can expect more of the same from Tea Party candidates – perhaps even worse, since by this cycle, perhaps, raving against rape will be too old hat to get condemned by Rachel Maddow, and therefore not sufficient to establish one’s True Conservative credentials.
And therefore, expect Republicans to continue to give away elections they could have won – and to prove incapable of governing in many cases when they do win. The dysfunctional Republican Party isn’t getting better any time soon.
By: Jonathan Bernstein, The Nation, November 9, 2013
“Bringing Actual Facts To Bear”: The Truth Is, Obamacare Is Working
The Obamacare website might still not be working, but journalists are. All across the country, as Republicans try to highlight tragic tales of Americans losing their current health insurance and allegedly stuck with more expensive options, journalists are coming to the rescue. In case after case, journalists investigated these stories and called the policyholders and combed the insurance exchange websites to bring actual facts to bear in our public debate about Obamacare.
Here are just some of the mythical stories journalists have helped dispel — and the lessons we can learn from them about the reality of the Affordable Care Act:
Deborah Cavallaro was making the rounds on television complaining about how her current insurance plan was canceled under Obamacare. So Los Angeles Times columnist Michael Hiltzik talked to her. Her current plan cost $293 per month but had a deductible of $5,000 per year and out-of-pocket annual limits of $8,500. Also, the current plan covered just two doctor’s visits per year.
But in the California insurance exchange, which Hiltzik helped Cavallaro check, she could get a “silver” plan for $333 per month — $40 more than she’s currently paying. But the new plan has only a $2,000 deductible and maximum out-of-pocket expenses at $6,350. Plus all doctor visits would be covered. Hiltzik writes, “Is that better than her current plan? Yes, by a mile.”
Dianne Barrette also popped up on television on a CBS news report in which she lamented that her $54-per-month insurance plan had been canceled under Obamacare. But Nancy Metcalf at Consumer Reports investigated Barrette’s story and found that her current policy was a “textbook example of a junk plan that isn’t real health insurance at all.” According to Metcalf, if Barrette had ever tried to use her insurance for anything more than a sporadic doctor’s visit, “she would have ended up with tens or hundreds of thousands of dollars of medical debt.”
The plan, for instance, only pays for hospitalization in cases of “complications of pregnancy.” Instead, Metcalf found that Barrette could get a “silver” plan in the state insurance exchange for $165 per month that would actually cover Barrette in the case of any sort of serious or even moderate illness. Which is the very definition of insurance, isn’t it?
Edie Littlefield Sundby, a stage-four gallbladder cancer survivor, published an op-ed in the Wall Street Journal blaming the Affordable Care Act for her canceled insurance policy. In her essay, Littlefield wrote that because of Obamacare, “I have been forced to give up a world-class health plan.” But, according to Igor Volsky of Think Progress, Sundby’s insurer, United Healthcare, “dropped her coverage because they’ve struggled to compete in California’s individual health care market for years and didn’t want to pay for sicker patients like Sundby.”
Earlier this year, United, which has publicly supported the Affordable Care Act, announced that it would pull out of the individual market in California. A company representative said it withdrew because its individual plans have never had a huge presence in the state. According to United, and in compliance with state law, the company won’t be able to re-enter the California individual market until 2017.
By then though, competitors will get stuck with sicker patients like Sundby signing up in the first wave of Obamacare. This means that companies like United can cover cheaper patients if it decides to go back to the California individual insurance market.
According to a report by Dylan Scott at Talking Points Memo, a Seattle woman named Donna received a cancellation letter from her insurance company regarding her current plan. The letter steered Donna and her family into a more expensive option and said, “If you’re happy with this plan, do nothing.” The letter made no mention of the Washington State insurance exchange, where Donna could find plenty of other more affordable choices, because the company wanted a convenient excuse to jack up Donna’s rates.
Had Donna “done nothing,” she would have ended up spending about $1,000 more per month on insurance than the cost of insurance she ultimately chose through the Obamacare exchange. In fact, the practice of trying to mislead customers has become so widespread that Washington state regulators issued a consumer alert to customers.
This is just the tip of the iceberg. Republicans who have been desperate from the very beginning to destroy Obamacare at any cost, regardless of facts or the urgent health care crisis facing America, will continue to dig up stories of people supposedly harmed by the law. And journalists will hopefully continue to investigate these allegations, helping us all sort fact from fiction.
In the meantime, there’s a side benefit to all this: If you are one of the small fraction of Americans who currently relies on the individual insurance market and has seen your current policy canceled, call a journalist — like one of those in the stories above. Reporters all across the country are hungry for real-life stories about how Obamacare is working.
Plus, most reporters have access to high-speed Internet. If you can’t get through to the Obamacare exchange site, there’s a journalist standing by willing to help you navigate the exchange options and explore your pros and cons in terms of costs and benefits. The website might still be glitchy, but old-fashioned shoe-leather reporting is as reliable as ever.
By: Sally Kohn, Special To CNN, November 8, 2013
“The Kicking Mules Vs The Lying Turtle”: The GOP Civil War Is Now Basically Between Mitch McConnell And The Tea Party
There will not be another government shutdown, says Senate Minority Leader Mitch McConnell (R-KY).
“It was a strategy that I said both publicly and privately could not work, and did not work,” McConnell told The Wall Street Journal‘s Peggy Noonan.
“All it succeeded in doing was taking attention off of Obamacare for 16 days,” he added. “And scaring the public and tanking our brand—our party brand. One of my favorite old Kentucky sayings is that there’s no education in the second kick of a mule. It ain’t gonna happen again.”
This sounds as if he’s vowing to compromise when the resolution funding the government and the debt ceiling issue come up again early in 2014.
And to the Tea Party, that only means one thing: Treason!
The leader knows what the Tea Party thinks of him and he’s ready to take them on, along with his Tea Party challenger, Matt Bevin.
“They’ve been told the reason we can’t get to better outcomes than we’ve gotten is not because the Democrats control the Senate and the White House but because Republicans have been insufficiently feisty,” he told Noonan. “Well, that’s just not true, and I think that the folks that I have difficulty with are the leaders of some of these groups who basically mislead them for profit. . . . They raise money . . . take their cut and spend it.”
And in case that wasn’t clear enough, he called out the Senate Conservatives Fund, one of the key supporters behind Senator Ted Cruz (R-TX) and the plot to defund Obamacare that forced the shutdown.
“That’s the one I’m prepared to be specific about,” he said, adding that the group “has elected more Democrats than the Democratic Senatorial Committee over the last three cycles.”
Tea Party hero Erick Erickson responded to McConnell’s comments on Friday with “Question for Mitch McConnell: Will Any Reporter Ask It?”
The Red State editor-in-chief states that “the Senate Conservatives Fund has only helped nominate two Tea Party candidates, who went on to lose the general election.” In contrast, he points out, “On the other hand, Mitch McConnell supported Rick Berg, Denny Rehberg, Carly Fiorina, Linda McMahon, George Allen, and Tommy Thompson. All lost to Democrats.”
This leads to Erickson’s question: “So some enterprising reporter should ask Mitch McConnell this question: Given that the Senate Conservatives Fund has a better record than Mitch McConnell of getting Republicans elected to the Senate, shouldn’t he be supporting Matt Bevin?”
McConnell has successfully been able to persuade Ted Cruz to stay out of primaries. But the Tea Party, Erickson and the Senate Conservatives Fund are going all in. We’ll see who gets shut down this time.
By: Jason Sattler, The National Memo, November 8, 2013
“Very Well-Insured Critics”: Serving The Smug, Shortsighted, Dopes And Demagogues, Obamacare Will Be There Even For Its Enemies
Obamacare’s enemies are right about the disastrous Web site launch and the president’s misleading mantra about “keeping your plan.” I’m furious at the White House myself for having botched these technical and messaging challenges — issues that anyone could have seen coming three years ago and whose amateur handling has given needless ammunition to the foes of expanded health coverage.
But for those of us who think the health security the Affordable Care Act provides marks a fundamental advance in America’s social contract, these White House failures don’t come close to the vices of Obamacare’s adversaries. Let’s just say it: To judge by their behavior, the Affordable Care Act’s enemies couldn’t care less about helping millions of low-income workers achieve health security, and every time they open their mouths, it shows.
When conservatives rant about the latest mess-ups attending the rollout, they never add the obvious empathetic refrain. It would be simple, really. They’d just need to preface or append to their daily attack a line like this: “Of course we all agree we need to find ways to get poor workers secure health coverage that protects their family from ruin in the event of serious illness.”
That’s all it would take. But they don’t say that. None of them. At least none that I can hear. A single omission might seem an oversight. A few might be a sign of distraction. But when day after day you wait in vain to hear such empathy amid the torrent of anti-Obamacare venom being spewed, you realize something bigger psychologically is at work.
Obamacare foes are more than just angry with the “lying” and the bungling they disdain. They are Very Well-Insured People. We all know about “VIPs.” Well, these are VWIPs. Or at least, a certain conservative species of VWIP.
For many on the right, being a VWIP seems to bring with it a certain blindness. They see the Web site comedy of errors and cry (rightly) “incompetence!” They see some people who have to change their health plan and cry (with some fairness) “liar!”
But that’s all they see. What they don’t see is nearly 50 million uninsured Americans, 20 million or so of whom stand to have relatively desperate lives made immeasurably more secure thanks to this law. These Americans will finally know what it’s like to go to bed at night certain that they can’t be wiped out financially by illness — and that free or affordable preventive care may help their loved ones uncover disease while there’s a chance for a cure.
Obamacare’s well-insured critics don’t see these Americans at all. And they seem unable to imagine what it would feel like to be one of them.
I want to be careful here. I know this isn’t the outlook of every Republican or conservative. John Kasich’s Medicaid expansion makes him the most prominent exception (though even Kasich can’t see the benefit for many Ohioans of Obamacare’s big private insurance expansion). Meanwhile, in yet another case in which your zip code seals your fate in the United States, millions of citizens who could have had Medicaid coverage will remain vulnerable, abandoned by well-insured GOP governors who think their job involves tending to well-insured GOP voters.
Poor uninsured workers didn’t make U.S. health care the costliest, most inefficient system on the planet. But these workers are the ones who suffer most under it. And VWIPs on the right don’t care.
New rule (as Bill Maher would say): Politicians and pundits who bash Obamacare should have displayed under their talking head or byline the source of their own coverage. Let’s caption Ted Cruz in flashing neon that reads, “Enjoys Gold-Plated Health Coverage from Goldman Sachs Spousal Plan.” Let’s have the subtitles for John Boehner and Eric Cantor read, “Has Never Worried About Going Broke From Illness A Day in His Life Thanks To Federal Government Insurance.”
And let Obamacare supporters begin their response to absurd claims that “Obamacare is the enemy” with this simple line: “Spoken like a Very Well-Insured Person.” (I’ve tried this on radio and TV — not only is it accurate, but it feels great to say so, too.)
My wife and I discovered we were uninsurable in the individual market in 2003. It was scary. And we’re the lucky ones — bona fide members of the Lower Upper Class with the wherewithal to maneuver to protect our family (and with access to the New York Times Magazine to write about the experience).
Obama said, “If you like your plan, you can keep it.”
The Very Well-Insured Obamacare critic effectively says to the uninsured, “If you enjoy being vulnerable to financial ruin or death from serious illness, under our plan you can keep that, too.”
Both of these positions are wrong.
But which, at the end of the day, seems more like a hanging offense?
The irony is that Obamacare’s protections will be there even for its enemies if, God forbid, they (or someone they love) find themselves sick, unattached to a large employer and looking for coverage in the individual market. I suppose that’s the beauty of the rule of law — it serves the smug and the shortsighted, the dopes and the demagogues along with the rest of us. Might be a more just world if it didn’t now and then, but them’s the breaks.
By: Matt Miller, Opinion Writer, The Washington Post, November 6, 2013
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