Dissents Of The Day

Andrew Sullivan —  Oct 30 2013 @ 12:21pm

President Obama Discusses Immigration Reform At The White House

A reader writes:

I’d like to push back a bit on your harsh criticism of the president as being dishonest in his statements selling the ACA to the American public. For starters, the man is a politician and anybody who expects complete honesty from politicians is just setting themselves up for constant disappointment. Secondly, he was attempting to sell something that he honestly believed was going to help the vast majority of Americans. Does anybody really think that the best way to go about that sale was to wonkishly explain every in-and-out and why it was better than the status quo for a large majority of the population? The details were out there for those who were curious, but most people needed a sound-byte to help them understand the plan and the one he used happened to be true for all but a few percent of them.

And of course because of the increased competition of the marketplaces and generous subsidies, a lot of people who are forced to switch plans will actually end up saving money while getting more comprehensive coverage. As an example (which I originally found via The Dish): Eric Stern found that multiple Hannity guests complaining about losing their private insurance will actually likely save a crapload of money buying on the exchange.

I’d also like to address Ross’s point that the ACA “cancels plans, and raises rates, for people who were doing their part to keep all of our costs low.”

I think this is a misunderstanding about what drives healthcare costs. It’s probably true that a lot of healthy people buying bare bones plans are saving themselves a bit of money in the short run. But, because of their minimal coverage, they are also probably under-consuming certain types of healthcare. Now that 1) makes them less healthy in the short term which is bad for them and might be bad for their productivity and 2) makes them less healthy in the long term which will likely result in them consuming more high cost healthcare later in life. This will result in greater lifetime health costs (and more tax payer spending on Medicare).

Contrary to what the right may think, the people who wrote the law didn’t just add in the minimum requirements because they like bossing people around. The intent was to improve health outcomes and lower costs in the long run.

Another is more blunt:

This “Odd Lies of Barack Obama” stunt really pisses me off, using the same line you used for Sarah Palin. You know that’s a load of crap.

My family now has health insurance. But a few years ago we didn’t, because we simply could not afford it. At that time in New Jersey the cheapest plan I could find for a 3-person family was around $800 a month (now it’s over $1,000/month). And it was such a limited, crappy plan that it didn’t even include coverage for chemotherapy (if you read the fine print). NO CHEMO. Now, I don’t know about you but in my mind the main reason to have health insurance is for disasters and life-threatening or chronic illnesses. I mean really, I don’t need to pay $800 a month so I can save 50 bucks on maybe 10-15 doctor visits a year for all three of us, or save a couple hundred bucks on a year’s worth of prescriptions. That’s insane. Yet it’s the business model that insurance companies used freely for years.

But no one in the GOP, including Chris Christie, gave a rat’s ass. Not too many in the media cared either. But Obama did. And he changed the system so that insurance companies can’t sell crap plans anymore. They have to meet a reasonable standard. Or fold. Wow, what a liar that Obama was. He didn’t mention that some insurance companies chasing in on shitty, rip-off plans were going to choose “die” instead of meeting reasonable standards. Well I don’t give a damn.

Seriously. How about “The Odd Lies of America” instead? How about the absolute lie for decades that we had a great health care system in this country. Because no system that is unaffordable to tens of millions of its citizens is anything more than horrible and appalling. And no system that allows insurance companies to sell plans that won’t help the client with a cataclysmic disease – and hides that information in the weeds – is anything but disgusting.

Another spins:

Just one quick point, which may help put this in perspective.  People who don’t currently have insurance cannot “keep” their plan either.  They have to “upgrade,” too.  Is this so different from the small minority of people who have a plan with holes in their coverage, who are forced to upgrade to a basic level of comprehensive coverage?

Another dives into more detail:

I find it difficult to get too excited about this, though it does seem evident that he either spoke the line without thinking through the implications, or knowingly and grossly oversimplified. Here’s why I don’t find it scandalous (albeit optically terrible right now):

1. It seemed evident to me at the time that he was primarily addressing concerns about employer-provided coverage and about keeping a plan that includes your favored doctor. This may or may not actually be the case, but that’s how I heard it. Yeah, I get that the quote itself is considerably broader, and nobody ought to be surprised that it’s been understood as a universal statement.

2. Health plans, as Frakt notes, churn extensively. Obviously Obama meant “… to the extent that your insurer continues to offer your plan.” No, seriously: this needs to be really obvious. Just because everyone is now blaming every price increase and coverage change on the ACA doesn’t mean it’s true.

3. The minimum coverage requirement was always going to require some plans to end; the question was only how many. Always. This, again, was obvious from the beginning.

4. He didn’t say “If you like your premium, you can keep it.” But that is what the upset is about, isn’t it? The upset certainly isn’t about the improved coverage, the lifting of annual and lifetime caps, the bar to medical underwriting, or the requirement that plans actually cover the drugs we might need.

5. I fundamentally disagree with the notion that it’d be just hunky-dory to let people stay on crap plans with high out-of-pocket maximums, little or no drug coverage, huge exclusions (like maternity and mental health care), etc. There are two problems allowing these crap plans to continue:

First, they are precisely the sort of under-coverage that’s likely to leave people back on the mercy of the emergency room and the bankruptcy court in the event of major illness. (Or pregnancy.) The point of all this is to end that. We can only end that by mandating that everyone buy coverage that actually covers your potential medical conditions and treatments. (Suppose, for example, that someone with a crap, limited-formulary plan contracted HIV. They might as well just go pre-register at the bankruptcy court.) The individual mandate isn’t just a mandate that you buy anything called “health insurance,” it’s a mandate that you buy adequate health insurance.

Second, allowing crap plans to persist would leave open the door to market failure through adverse selection. Those most likely to choose crap plans with lousy coverage would be the young and healthy. Expanding the risk pool doesn’t just mean we get everyone into the pool of insureds – it means we get everyone paying in as well, on a comparable basis. So, yeah … it’s a tax on the healthy to support the sick. But that’s what all insurance is.

(Photo: Win McNamee/Getty)