“Turning The Health Care Corner”: The Health Care Talking Points That “Everyone Knows” To Be True Are Due For An Update
Political journalism is sometimes criticized, fairly, for its “pack” mentality. Major news organizations wait for the conventional wisdom to organically take shape, and then the players stick to their scripts, reinforcing an agreed upon consensus. In practically no time at all, there are certain political facts that “everyone knows” to be true.
But soon after, that gets dull, the conventional wisdom invites skeptics, and contrarian instincts kick in. Maybe, the political world starts to wonder, those truths that “everyone knows” aren’t so true after all.
For the last several weeks, the consensus in establishment circles was that the Affordable Care Act’s open-enrollment period was not only a disaster, but a catastrophe that would destroy Obama’s presidency, the Democratic Party, the American health care system, and the very idea of progressive governance. Pundits could hardly contain their analogies – this was Obama’s Katrina, Obama’s Iraq, Obama’s Watergate, Obama’s Iran-Contra, and even Obama’s Bay of Pigs.
But the funny thing about narratives is that they’re sometimes fleeting. Ezra Klein suggests today that “Obamacare” may finally be “turning the corner.”
There are increasing reports that HealthCare.Gov is working better – perhaps much better – for consumers than it was a few short weeks ago. “Consumer advocates say it is becoming easier for people to sign up for coverage,” report Sandhya Somashekhar and Amy Goldstein in the Washington Post. “The truth is, the system is getting stronger as it recovers from its disastrous launch,” writes Sam Baker in the National Journal. Applying “was no problem at all, with no delays,” says Paul Krugman.
Reports from inside the health care bureaucracy are also turning towards optimism. People who knew the Web site was going to be a mess on Oct. 1st are, for the first time, beginning to think HealthCare.Gov might work. Data backs them up: By mid-November, the pace of enrollment in the federal exchanges had doubled from what it was in October.
The Obama administration is certainly acting like they believe the site has turned the corner. Somashekhar and Goldstein report that they’re “moving on to the outreach phase, which had taken a back seat as they grappled with the faulty Web site. Next week, the White House will host an insurance-oriented ‘youth summit’ aimed at people ages 18 to 35, an age group whose participation in the health-care law will be critical to its success.”
Why didn’t the White House do this sooner? Because officials didn’t much see the point in directing people to a website that didn’t work. If they’re increasing the website, it’s the result of greater optimism.
Perusing the news this morning, there are more than a few compelling pieces along these lines. The L.A. Times has a terrific article, for example, on “the Obamacare success stories you haven’t been hearing about.” NPR today highlighted some Californians who received cancelation notices – and are thrilled with the results. National Journal made the case yesterday that Obama not only can recover from the troubled rollout; he already has.
Moreover, Greg Sargent has a great piece noting that for all the talk about health care crushing Democrats, there’s a credible argument that the Republican position “is actually a political liability of its own.”
Yes, some of these pieces were written by center-left observers who may be predisposed to hope “Obamacare” succeeds, but note that we weren’t seeing any of these kinds of reports a few weeks ago when the feeding frenzy got underway. On the contrary, Ezra, Greg, and others were openly critical of the administration’s obvious mistakes and missteps as they unfolded.
The conventional wisdom won’t change quickly or easily, but you can almost see the consensus shifting in real time. There are some important issues the administration still needs to address, and failure very much remains an option. For that matter, if it’s a mistake to exaggerate the importance of every piece of bad ACA news, the law’s defenders must be equally cautious about exaggerating the importance of every positive development, too.
But for those stuck in the “Obamacare is and will remain a disaster” story, it’s time for a reality check. The system is improving, enrollment is increasing, more consumers are smiling, horror stories are failing, and health costs are shrinking.
The health care talking points that “everyone knows” to be true are due for an update.
By: Steve Benen, The Maddow Blog, November 26, 2013
“Stupid Obamacare!”: Profit Maximizing Private Insurance Companies Got You Down, Blame Obama
It has been said many times over the last few years that now that Democrats successfully passed a comprehensive overhaul of American health insurance, they own the health-care system, for good or ill. Every problem anyone has with health care will be blamed on Barack Obama, whether his reform had anything to do with it or not. Your kid got strep throat? It’s Obama’s fault! Doctor left a sponge in your chest cavity? Stupid Obama! Grandma died after a long illness at the age of 97? Damn you, Obama!
OK, so maybe it won’t be quite as bad as that, but pretty close. Here’s an instructive case in exactly how this plays out. Take a look at this article that ran in yesterday’s Washington Post, telling how in order to keep premiums down and attract customers, some insurers are limiting their networks. “As Americans have begun shopping for health plans on the insurance exchanges,” the article tells us, “they are discovering that insurers are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.”
So insurance companies—private actors seeking to maximize profit—are making decisions that some potential customers find less than perfectly appealing. The article itself is clear about why this is happening, but in the newspaper’s print edition, the subtitle read, “Exchanges Exclude Doctors, Hospitals.” Of course, that’s completely false. The exchanges haven’t excluded any doctors and hospitals, the insurance companies offering plans on the exchanges have made a decision to exclude them. The insurance companies are perfectly free to make a different decision, but they’ve decided not to.
So the newspaper runs this story, with the headline writers mistakenly portraying what for some small number of people is an unwelcome development as a decision made by the Obama administration. Conservatives will then take articles like this and others like it, and say, “See? Obama said you could keep your doctor! He lied! This law is a disaster!” Barack Obama never said that he’d forbid any insurance company from ever changing anyone’s policy or offering policies that provide something less than spectacularly gold-plated coverage at absurdly low prices. But now, every profit-maximizing decision by a corporation becomes Barack Obama’s fault.
The second component of Barack Obama coming to own all the problems with the health-care system is that with the rollout of the ACA, you suddenly have a lot of political reporters doing stories on health care, and many of them have only the thinnest understanding of the law. That limited understanding makes it easier for them to just focus on whatever negative things are happening in health care, blaming them on the ACA, and assuring themselves that they’ve been appropriately “tough” in their reporting.
There’s nothing wrong with reporters fully exploring all the changes our ever-evolving health-care system goes through, so long as they do it accurately. But you might notice that they are completely uninterested in the stories of people who are being helped by the Affordable Care Act. Harold Pollack estimates that there are over 10 million uninsured Americans who have significant medical issues like a cancer diagnosis or diabetes, and thus find it difficult or impossible to get insurance on the individual market under the pre-ACA system. These people will now be able to get reasonably priced insurance, which for many will be literally life-saving. But journalists find these people boring and not worth talking about. They’re much more interested in people who find something problematic in the new system, and they’re working hard to find every last one of those people’s stories and share them with the country. And that’s how Barack Obama ends up owning the health-care system.
By: Paul Waldman, Contributing Editor, The American Prospect, November 22, 2013
“Bringing His Own Bile To The Party”: Backwards Moron Richard Cohen Is Not Fooling Anybody
Before we proceed to today in the continuing saga of “What in God’s Name Are You Talking About, Richard Cohen?” here’s a warning — get your gag reflex ready.
In a typically rambling screed about… something, Cohen, who recently became the first man to connect the dots between Miley Cyrus’ MTV Video Music Awards performance and what he likes to call “the so-called Steubenville rape” that happened one full year earlier, Cohen unleashes some choice nonsense thoughts on “Chris Christie’s Tea Party Problem.” In it, he ostensibly looks at the New Jersey’s governor’s political future and declares that “At the moment, it is Cruz, not Christie, who has seized the imagination of Iowa Republicans.” He also lets loose a truly outstanding array of bizarre assessments of prominent political figures, calling Sarah Palin “the Alaska quitter who, I think, actually now lives in Arizona,” Rick Santorum a man who’s “neither cuddly nor moderate” and Christie “too Joisey for the tea party — too brash, as well.”
But the true kicker of the piece comes near the end, when he swerves away from concern trolling Chris Christie to laughably state “Today’s GOP is not racist” — a declaration that the antics of party members would seem to contradict –and to consider what must be “troubling” the Tea Party right now. “People with conventional views must repress a gag reflex when considering the mayor-elect of New York,” he writes, “a white man married to a black woman and with two biracial children. (Should I mention that Bill de Blasio’s wife, Chirlane McCray, used to be a lesbian?) This family represents the cultural changes that have enveloped parts — but not all — of America. To cultural conservatives, this doesn’t look like their country at all.”
Cohen would likely argue he’s just calling it like he sees it – reporting on incredibly offensive ideologies but not engaging in them himself. And hey, you want to suggest that political extremists might have a problem with a high profile mixed family? You might be right. Look how berserkers they went over that Cheerios commercial.
But we all know this isn’t Jon Stewart on “The Daily Show,” brightly announcing that “I think New York City might be ready for a charismatic biracial family with their own signature, synchronized dance moves.” This is Richard Cohen — a guy who thinks that “conventional” people would have a vomit response to a mixed marriage – and who then parenthetically throws in a little gay panic to boot. Because in his mind, being a backward moron is “conventional.”
This is a man who, let us never forget, has written creepily of the “sexual meritocracy” of older men and declared Clarence Thomas “condemned of being a man.” This is Richard Cohen, the writer who applauded Switzerland for it leniency toward Roman Polanski, who admitted, “There is no doubt that Polanski did what he did, which is have sex with a 13-year-old after plying her with booze” and then proceeded to dismissively refer to that girl as a “victim” in scare quotes. (Note to Cohen: Just like with the Steubenville case, this behavior is called rape.) The same man who, fascinatingly enough, has reportedly been reprimanded for “inappropriate behavior” toward a much younger colleague. This is a man who in July explained that he could “understand why [George] Zimmerman was suspicious” of Trayvon Martin, because the young man was “wearing a uniform we all recognize” and who lamented, “Where is the politician who will own up to the painful complexity of the problem and acknowledge the widespread fear of crime committed by young black males?” A man who thinks maybe there’s something to this whole torture thing. One who hasn’t quite worked it out about homosexuals either, who’s decided that prejudice is bad but thinks “Gays don’t get some sort of pass just because they’re gay.”
You can almost understand how a guy like Cohen, who was spent his entire career amply demonstrating that he has a boatload of issues around women, sex and race, really hit the jackpot with Chirlane McCray. My God, look at her, all seemingly normal and living under the same room as a white man. Did I mention she used to be lesbian? Because she totally was. Surely, Cohen wants the world to understand, some people might have a problem with this. Not him, no, he’s just observing. Maybe asking for a friend.
It’s almost sad – almost – to watch a bigot try to cloak himself in the guise of concerned citizen. But rest assured, nobody with a track record like Cohen can use the phrase “gag reflex” without bringing plenty of his own bile to the party. And his transparently ugly shtick is fooling no one.
By: Mary Elizabeth Williams, Salon, November 12, 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
“Let’s Take A Step Back”: Despite Crappy Journalism, Things That Are Still True About Health Care
It’s been a pretty intense month on the health-care front, what with the beginning of open enrollment for the new exchanges giving rise to lots of disingenuous fulminating from Republicans, not to mention a whole lot of crappy journalism. Any time a story dominates the news for a couple of weeks, there’s a temptation to believe that what’s happening now will change everything. So I thought it might be a good idea to take a step back and remind ourselves about some things that are still true about the Affordable Care Act and still true about health care in America.
Over the long term, the problems with Healthcare.gov won’t have much of an effect on the success or failure of the law.
Yes, it has been a huge screw-up, with both the administration and the contractors sharing responsibility. Yes, it has caused a lot of people trying to sign up for new insurance a lot of hassle. But it’s the thing everybody’s focused on now in part because it’s the only thing happening with the law, until January 1st when a whole bunch of the law’s other provisions also go into effect. The problems with the web site are finite and fixable, and five years from now all this will seem like a minor footnote in the whole story.
Even if everything works perfectly with the ACA, we’re going to have a very expensive system for a long time.
The law did many things to try to “bend the cost curve,” including things like rewarding hospitals for reducing their readmission rates so there isn’t such an incentive to just pile on the procedures. But the fundamental fact is that America’s health-care system is far and away the most expensive in the world—nearly twice as expensive as the average for OECD countries—and it will still be very expensive for the foreseeable future.
There are many reasons why, but what they come down to is that there are lots of actors—insurance companies, hospitals, doctors, device makers—who make ungodly amounts of money off our health-care system, and unwinding all their influence and the points at which costs get driven up is unfathomably complicated. Other countries’ systems were designed by asking how good care can be delivered to everyone at a cost the country can afford; our system, outside of the government parts like Medicare, was basically designed by asking how to make sure everybody except patients can make as much money as possible. At its heart, the ACA doesn’t question that fundamental premise. So the curve may bend, but it won’t bend too sharply, and it’s starting from a very high place.
The expansion of Medicaid is the most significant thing the law did to help uninsured Americans.
It’s easy to forget, with all this talk about people on the individual insurance market, that they make up a small portion of the country. The most meaningful part of the ACA was always its expansion of Medicaid, promising to finally give insurance to millions of Americans who can’t afford it. So far, people signing up for Medicaid are significantly outnumbering those signing up for new private insurance, which isn’t surprising, especially given Healthcare.gov’s problems. And every time a poor family signs up for Medicaid, it’s cause for celebration—they’ll be healthier and more secure, they’ll be more productive at work, and the whole community benefits.
The Republican sabotage campaign against the ACA is unprecedented in American history. You can’t blame every problem the law has or will have on Republican sabotage, but this isn’t hyperbole. It truly is something we’ve never seen (here’s a recap). The only thing that comes close is efforts in the South to resist the school desegregation mandated by Brown v. Board of Education. That isn’t an excuse for any failures of the Obama administration, but it has made everything harder.
Republicans criticizing the ACA have no idea what they’d do to improve the health-care system. If you ask them, they’ll say, “Um … tort reform?” There are a very small number of conservative health-care wonks out there (like the people who came up with the plan that became Romneycare which became Obamacare!), but their ideas are laughably small-bore. Republicans are essentially satisfied with the pre-ACA status quo, with 50 million uninsured Americans and skyrocketing costs. That doesn’t necessarily mean that any particular critique they make of the ACA is wrong by definition, but it’s good to keep in mind.
There’s still no good reason your job should determine your health coverage. The linking of health insurance and employment is an historical accident. When wages were frozen in World War II, companies began offering insurance as a way to attract better workers, unions began demanding it as part of contracts, and today around 80 percent of American get their coverage through their job. One of the best things the ACA does is eliminate the “job lock” this produces, by making it illegal for insurance companies to deny coverage based on pre-existing conditions. Now you can quit your job to start that business you’ve dreamed of without worrying about whether you can get insurance. But the link between employment and insurance is just one more layer of complication that makes our health care system such an absurd kludge. Which leads to…
A single-payer-plus system would have made this whole thing simpler. Conservatives may roll their eyes and say, “Are you still going on about that?” but it’s something we should indeed keep talking about. The Affordable Care Act brings us to a system that is much better than what we have now, but still far worse than what it could be. I’ll continue to reiterate that we could have a system that satisfies the desires of both liberals and conservatives, insures everyone, and does it without all the layers of complication we suffer through now. If we wanted to, we could transition over time to a system like they have in France, with a basic, government-provided single-payer plan that covers every citizen, combined with a market for supplemental private insurance. That would give us the universal coverage and security liberals like, the ability to buy as much insurance as you want from a private company that conservatives like, and the efficiency and cost savings we all ought to like.
Would that be a big change? Sure. But it’s essentially what America’s seniors already have, and it has been very successful. They have their government plan so there are virtually no uninsured seniors, and they can buy Medigap coverage to give them extra benefits.
The ACA could make it easier to transition to a system where all Americans enjoy the same privilege. The exchange marketplace could be transitioned to become the place everyone buys supplemental insurance. We now have a system where a significant chunk of the population—the elderly and poor—are on government plans, and you could widen their availability in both directions (down in age and up in income) and unify the benefits.
That’s a long-term project, but it could be the next big health-care reform (in 20 years or so). Obviously, the most important priority in the next year or two is implementing the ACA and determining what’s working and what isn’t so it can be tweaked and improved. But we shouldn’t forget about what comes next.
By: Paul Waldman, Contributing Editor, The American Prospect, November 1, 2013
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