“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
“Far-Reaching Consequences”: Obamacare, Mental Illness, And Guns
After years of delays, the Obama administration has released final regs aimed at implementing 2008 legislation requiring “parity” in insurance coverage of mental illness, as Jackie Calmes and Robert Pear of the New York Times report today:
The rules, which will apply to almost all forms of insurance, will have far-reaching consequences for many Americans. In the White House, the regulations are also seen as critical to President Obama’s program for curbing gun violence by addressing an issue on which there is bipartisan agreement: Making treatment more available to those with mental illness could reduce killings, including mass murders.
Remember gun violence?
In issuing the regulations, senior officials said, the administration will have acted on all 23 executive actions that the president and Vice President Joseph R. Biden Jr. announced early this year to reduce gun crimes after the Newtown, Conn., school massacre. In planning those actions, the administration anticipated that gun control legislation would fail in Congress as pressure from the gun lobby proved longer-lasting than the national trauma over the killings of first graders and their caretakers last Dec. 14.
But there’s another big piece of the puzzle that is necessary to make sure mental health benefits are available to the people most at risk of committing acts of violence: the Affordable Care Act. As Harold Pollack explained in a major article in the March/April 2013 issue of the Washington Monthly, the ACA’s Medicaid expansion alone is a really big deal for people with mental illness and/or addictions who are prone to violence:
Why do so many people at risk—many of them young low-income men—fail to receive appropriate mental health services? The most important single reason is this: most are categorically ineligible for Medicaid. These men are not custodial parents. They are not veterans. They have not (yet) been diagnosed with federally recognized disabilities. Many get into trouble because they have serious drug or alcohol disorders. Since 1996, substance use disorders are no longer qualifying conditions for federal disability programs….
This will begin to change in 2014. That’s when the ACA will start providing subsidies that will eventually reach thirty-three million Americans without health insurance. An estimated sixteen million will eventually be covered by expanded Medicaid to low-income Americans with incomes below 138 percent of the federal poverty line. That number will include the hundreds of thousands of mentally ill men cycling in and out of places like Chicago’s Cook County Jail and sleeping on grates in cities from Washington, D.C., to Seattle. For the first time, nearly all of these individuals (undocumented immigrants are the big exception) will gain access to regular health care. Moreover, if the law is properly implemented, these same individuals will gain access to mental health services that can reduce their propensity to commit violent acts.
So if you want some very good news about the impact of Obamacare, and some very bad consequences if it fails to be fully implemented, there you are.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, November 8, 2013
“What Really Matters”: Don’t Knock Obamacare Until You Try It
There has been a steady drumbeat of news stories about health insurance companies informing customers that their policies will be dropped or that they will face steep rate increases due to requirements of the Affordable Care Act.
This has opened the door to fair criticisms that President Obama wrongly stated that people would be able to keep their current insurance policies if they are happy with them, as this isn’t necessarily the case. However, the real question for individuals facing rate hikes or dropped coverage is whether there are insurance options provided through the exchanges, mandated by the new law, that these people would actual prefer, thanks to some combination of lower prices and more generous benefits. Obamacare might cause some to lose their current policy, but it also might provide them with options they would prefer. That is what really matters.
People should remember that the program provides subsidies for lower income individuals and families. At least in states that have accepted the very generous federal contribution, Obamacare also expands access to Medicaid. For many people who currently lack insurance, a group of people who tend to be poorer, Obamacare insurance policies will be free or relatively cheap.
The initial implementation of Obamacare has not gone smoothly. The key problem is website difficulties faced by people who are attempting to see just how much a plan will cost them, and whose attempts to actually sign up for a policy have been thwarted. We will see if these problems are fixed in a timely fashion, and whether other serious problems crop up.
But the program, as designed, is intended to lower prices for the vast majority of people on the individual insurance market, as well as to open it up to people who previously have been denied affordable coverage because of pre-existing medical conditions. Optimistically, increased competition could even lower prices for employer-based health plans.
Admittedly, such optimistic predictions might not come to pass. Over the next several months we will get a better idea of how many people manage to enroll, whether their coverage is adequate, and whether their overall medical costs, including premiums and out of pocket costs, fall. We might ultimately declare Obamacare a failure, and if that happens we should figure out a better way to expand access to affordable health insurance and care.
Despite the rhetoric from many conservatives, Obamacare isn’t the way most self-described liberals would reform our health care system. It is needlessly complicated, not guaranteed to reduce overall medical costs significantly and its subsidies, while significant, are too stingy. People with lower middle class incomes will still likely find the premiums to be a budgetary strain. At the very least, liberals would have included a government run “public option,” a Medicare-like program that would have competed with the private insurance.
But problems aside, people who are currently navigating the private insurance market –both those without health insurance currently and those who might be receiving scary policy and price change letters from their current insurance companies — should make sure to see just what their Obamacare options are. They might be pleasantly surprised.
By: Duncan Black, USA Today, November 5, 2013
“This Is Why We Need Obamacare”: Life And Death Is When You Need Care And Can’t Afford To Get It
The biggest health care crisis in America right now is not the inexcusably messy rollout of Obamacare.
No, far more serious is the kind of catastrophe facing people like Richard Streeter, 47, a truck driver and recreational vehicle repairman in Eugene, Ore. His problem isn’t Obamacare, but a tumor in his colon that may kill him because Obamacare didn’t come quite soon enough.
Streeter had health insurance for decades, but beginning in 2008 his employer no longer offered it as an option. He says he tried to buy individual health insurance but, as a lifelong smoker in his late 40s, couldn’t find anything affordable — so he took a terrible chance and did without.
At the beginning of this year, Streeter began to notice blood in his bowel movements and discomfort in his rectum. Because he didn’t have health insurance, he put off going to the doctor and reassured himself it was just irritation from sitting too many hours.
“I thought it was driving a truck and being on your keister all day,” he told me. Finally, the pain became excruciating, and he went to a cut-rate clinic where a doctor, without examining him, suggested it might be hemorrhoids.
By September, Streeter couldn’t stand the pain any longer. He went to another doctor, who suggested a colonoscopy. The cheapest provider he could find was Dr. J. Scott Gibson, a softhearted gastroenterologist who told him that if he didn’t have insurance he would do it for $300 down and $300 more whenever he had the money.
Streeter made the 100-mile drive to Dr. Gibson’s office in McMinnville, Ore. — and received devastating news. Dr. Gibson had found advanced colon cancer.
“It was heartbreaking to see the pain on his face,” Dr. Gibson told me. “It got me very angry with people who insist that Obamacare is a train wreck, when the real train wreck is what people are experiencing every day because they can’t afford care.”
Dr. Gibson says that Streeter is the second patient he has had this year who put off getting medical attention because of lack of health insurance and now has advanced colon cancer.
So, to those Republicans protesting Obamacare: You’re right that there are appalling problems with the website, but they will be fixed. Likewise, you’re right that President Obama misled voters when he said that everyone could keep their insurance plan because that’s now manifestly not true (although they will be able to get new and better plans, sometimes for less money).
But how about showing empathy also for a far larger and more desperate group: The nearly 50 million Americans without insurance who play health care Russian roulette as a result. FamiliesUSA, a health care advocacy group that supports Obamacare, estimated last year that an American dies every 20 minutes for lack of insurance.
It has been a year since my college roommate, Scott Androes, died of prostate cancer, in part because he didn’t have insurance and thus didn’t see a doctor promptly. Scott fully acknowledged that he had made a terrible mistake in economizing on insurance, but, in a civilized country, is this a mistake that people should die from?
“Website problems are a nuisance,” Dr. Gibson said. “Life and death is when you need care and can’t afford to get it.”
The Institute of Medicine and the National Research Council this year ranked the United States health care system last or near last in several categories among 17 countries studied. The Commonwealth Fund put the United States dead last of seven industrialized countries in health care performance. And Bloomberg journalists ranked the United States health care system No. 46 in efficiency worldwide, behind Romania and Iran.
The reason is simple: While some Americans get superb care, tens of millions without insurance get marginal care. That’s one reason life expectancy is relatively low in America, and child mortality is twice as high as in some European countries. Now that’s a scandal.
Yet about half the states are refusing to expand Medicaid to cover more uninsured people — because they don’t trust Obamacare and want it to fail. The result will be more catastrophes like Streeter’s.
“I am tired of being the messenger of death,” said Dr. Gibson. “Sometimes it’s unavoidable. But when people come in who might have been saved if they could have afforded care early on, then to have to tell them that they have a potentially fatal illness — I’m very tired of that.”
Streeter met with a radiologist on Thursday and is bracing for an arduous and impoverishing battle with the cancer. There’s just one bright spot: He signed up for health care insurance under Obamacare, to take effect on Jan. 1.
For him, the tragedy isn’t that the Obamacare rollout has been full of glitches, but that it may have come too late to save his life.
By: Nicholas D. Kristof, Op-Ed Contributor, The New York Times, November 2, 2013
“The Obamacare Bait And Switch”: America’s Beloved Health Insurance Industry Demonstrates Why We Needed Reform All Along
So here’s my advice: If you’re somebody who’s smoking hot about the Big Lie of the Affordable Care Act — you know, how President Obama told everybody that if they liked their current health insurance policy they could keep it — do yourself a favor. Avoid the county fair midway.
Because if you go, you’re apt to encounter a quick-handed scoundrel running a shell game, and that boy will take your money. Doubtless Obama should have said almost everybody could keep their current plan, or that 95 percent could, but he apparently found that too, um, subtle for the campaign trail.
So now old Mitt “47-percent” Romney gets to call him a liar.
But while your attention’s fixed on the president’s “mendacity,” and “paternalism,” to quote one characteristically overwrought scribe, America’s beloved health insurance industry is demonstrating exactly why we needed reform all along. Certain companies are taking advantage of the political confusion to sell people in the “individual market” far more expensive plans than they need and blame “Obamacare.”
As usual, the nation’s esteemed political media have gone along for the ride. CBS News, rapidly morphing into Fox News Lite, presented the heartbreaking tale of one Diane Barrette, a 56 year-old Floridian who got a letter from her insurance company cancelling her $54 a month policy and offering a replacement for $591 a month—a lot of money to her.
CBS correspondent Jan Crawford, deemed smart enough to cover the U.S. Supreme Court, took Barrette’s story at face value. The idea that health insurance worth having could be purchased at a monthly cost of less than a steak dinner apparently failed to arouse her reporter’s curiosity.
Poor Barrette choked up telling CBS her story, leading to several appearances on Fox News itself.
Had CBS done elementary due diligence, they’d have learned why Ms. Barrette’s plan was so cheap. Reporters who did learned that among other shortcomings, it didn’t cover hospitalization. In reality, she had no health insurance at all. A serious accident or illness might have bankrupted her—precisely the kind of ripoff the Affordable Care Act makes illegal.
Also, Barrette was taking the insurance company’s word about the cost of a replacement policy. Writing for BillMoyers.com, Joshua Holland ran her numbers through Kaiser Permanente’s subsidy calculator. With assistance from Obamacare, she can have a real policy covering preventive care and hospitalization for an out-of-pocket cost of $97 monthly, or a more generous “Silver” level plan for $209.
Now she calls it “a blessing in disguise.”
In short, CBS News couldn’t have gotten the story more backward had they tried. For its part, NBC News featured Los Angeles real estate agent Deborah Cavallaro, whose similar experience led her to conclude that “there’s nothing affordable about the Affordable Care Act.”
However, LA Times columnist Michael Hiltzik found that Cavallaro had simply failed to consult Covered California, the state’s health plan exchange. When he did so, he quickly found that “better plans than she has now are available for her to purchase today, some of them for less money.”
No doubt some among the three to five percent of Americans whose individual health care policies have been cancelled are experiencing genuine sticker shock. However, nobody should take his insurance company’s word at face value without double-checking—a task admittedly made harder by Healthcare.gov’s website meltdown.
See, when you read a story about a couple like Dean and Mary Lou Griffin of Chadd’s Ford, PA, who told the Associated Press they’d expected to be able to keep the policy they bought three years ago, what reporters aren’t asking is where they’d gotten that idea.
From President Obama? Possibly.
More likely, however, from an insurance broker. See, all providers have known about new coverage standards ever since the Affordable Care Act passed in March 2010. Since then some have clearly been “churning” the market, offering low-risk, healthy customers bargain policies they knew perfectly well would no longer pass muster come January 1, 2014.
So now come the inevitable cancellation letters, and guess what? If they were lucky—and health-wise the Griffins have been fortunate—here comes the bad news. “We’re buying insurance that we will never use and can’t possibly ever benefit from,” Dean Griffin complains. “We’re basically passing on a benefit to other people who are not otherwise able to buy basic insurance.”
Two thoughts: One, don’t get cocky, you never know.
Two, boo-hoo-hoo. You can afford it.
Meanwhile, Dylan Scott at Talking Points Memo has documented companies sending “misleading letters to consumers, trying to lock them into…more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces.” Authorities in four states have disciplined Humana affiliates for exactly that.
It’s a classic bait and switch: luring customers with unsustainably low rates, and then blaming the White House for their chicanery.
That’s basically why we needed Obamacare to begin with.
By: Gene Lyons, The National Memo, November 6, 2013
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