Obamacare– Fear-Mongers Poison Minds; Hatred Blinds

Judith Mayer Lynn, uninsured and battling breast cancer, should be a fan of the Affordable Care Act. Instead, Bloomberg  reports, she know little about it. When Bloomberg interviewed the 56-year-old she was unaware of subsidies in the law that will help people like her buy coverage in 2014,. “Lynn didn’t know the Affordable Care Act requiresthat insurers to pay for prescription drugs, hospital stays and other services she’s spent the last two years scrimping to afford. Nor did she realize she can no longer be denied a policy due to her illness”.

When told of the benefits, “Lynn remained unconvinced, skeptical of insurers and government alike. ‘It’s a joke,’ she said. ‘There’s going to be loopholes in all of these provisions.’”

If you showed Lynn the list of “essential benefits” that insurers will have to include in the policies they sell to people like her, could you persuade her to read the list—and explain where she saw the holes? Probably not. Her mind is closed.

In an interview at an Access to Healthcare office in Las Vegas, Lynn said she was unaware of those benefits — and didn’t trust Obama to produce them anyway.

                                            The Poison: Hatred

Perhaps I shouldn’t be surprised. We live in a nation where in 2009,  a U.S. Congressman felt free to shout out “You Lie” during a  televised presidential speech to a joint session of Congress.   

(President Obama had just said that the legislation would not mandate coverage for undocumented immigrants. This is, of course, correct.  South Carolina Rep. Joe Wilson (R) later apologized.)

Yet that didn’t stop another Congressional Republican from calling out the President earlier this month. In a scathing speech on the floor of the House, Rep. Jim Bridenstine (R-OK) derided President Obama as a “dishonest, incompetent, vengeful liar” who lacks a “moral compass.” Bridenstine cited HHS Secretary Kathleen Sebelius’ efforts to promote enrollment in the Affordable Care Act as one reason that President Obama is “not fit to lead.”

Bridenstine didn’t apologize. Instead, the next day he told a talk show host that he had “gotten great encouragement” for his remarks from fellow Republicans. /

I have followed U.S. politics for many years. Never have I seen a president so hated—not Nixon, not LBJ at the height of the War in Vietnam..

       Politicians Are Not Alone in Teaching Americans Not to Trust Obamacare

Lynn recalls one of her surgeons telling her that he was leaving the business because the health-care law dictates what he can charge patients. This, Bloomberg notes, is “something the legislation doesn’t do. “

Why would a surgeon claim that the Affordable Care Act will be setting his rates? Presumably he reads newspapers.  How could he be so uninformed?

“There is a lot of distrust,” Sherri Rice, chief executive officer at Access to Healthcare explains. When her nonprofit group began asking members about the ACA last month, about half knew little about its provisions and another quarter were “furious” about it, she told Bloomberg.

Such anger makes it difficult to think clearly—or take in information.  This may explain why Lynn’s surgeon thinks that under the ACA he will be told what he can charge patients. Perhaps he, too, is so “furious” that the facts don’t register. Hatred blinds.

 

                                             Educating the Public

The Brookings Institute’s Henry J. Aaron is one of many who blames the Obama administration for not doing a better job of educating the public.  “We haven’t seen a lot of energy from the administration on public education. They ceded the field to those who were largely hostile to the bill to frame it in the public’s mind.”

                                                    “Framing” 

Aaron is right that Obamacare’s opponents have “framed” the issue.  They have outspent supporters by 5-to-1 on TV ads, according to advertising analyst Kantar Media.  But their idea of “framing” is to define an idea with a catchphrase. If some facts don’t fit into the frame, they are ignored explains linguistics professor George Lakoff.  The “frame” becomes a lens through which conservatives invite us to see policy issues. For example, Laskoff observes, the phrase “tax relief” creates a context, signaling that taxes are bad; this is why we need “relief.”

 “Obamacare” is, itself a frame, which suggests that that the Affordable Care Act will create a “nanny-state,” with the president becoming a national nanny who will tell us what we must do.

When you are lying, repetition is important. (Hitler knew that.)  Laskoff points to a speech by Rick Santorum where he repeatedly refers to the President “not listening to the voice of the American people” (14 times) “because he knows better than you” (5 times), and is using the Government to run your lives by taking away your “rights” (10 times), and “freedoms.”(12 times“Death panel” became one of the most successful frames.

Conservatives favor  sound-bites that are short, snappy and click shut like a box. Like advertising slogans, they are designed to make people stop thinking.

More progressive formulations encourage thought. Often, they raise questions: is health care a “right”, a “privilege”, or a “moral responsibility”—something that, we as a civilized society, we owe to each other?

“Individual responsibility” is a phrase that conservatives favor. Each of us is responsible for ourselves. Period.

By contrast “shared responsibility” opens the mind to consider the possibility that employers, employees,  government and the health care industry itself should share in funding universal healthcare.                                               

                                                    Television Ads

It is difficult to explain Obamacare in a one-minute TV ad because health care reform turns on the details–thousands of details. And often, these are interlocking details: you cannot understand one without understanding the next paragraph in the legislation.

For example: If you are self-employed, unemployed or work for an employer who does not offer benefits you will be able to purchase your own coverage in the Exchanges—marketplaces  where insures will be regulated and won’t be able to charge you more if you suffer from a pre-existing condition. If you earn less than $4600, you will be eligible for a government subsidy in the form of a tax credit that will help you pay the premium.

That is just one fact—and it I took me a full paragraph to convey who will be eligible for a tax credit .

But the definition also raises questions. For example a reader might well ask: ” If I have to wait until I get a tax credit (when I pay my 2014 taxes in April of 2015) how will I pay the premiums on my insurance at the beginning of 2014?”

The answer is that the IRS will forward the money to your insurer in 2014, estimating how large your subsidy should be based on your 2013 income.

Then when you file your 2013 taxes in 2014, you and the government will settle up. If your 2014 income turned out to be lower than expected, the government may have underestimated your subsidy, and will owe you money. If, on the other hand, you earned more than expected, the subsidy may have been larger than it should have been, and you will owe the government money.

To me, this sounds fair. But, it doesn’t fit into a soundbite. I spend two paragraphs explaining it. IIf a reader were skimming a newspaper story he might not take those two paragraphs —especially if he already had heard conservatives “frame” the idea that you might own the government money as  a “tax credit trap.”  Redstate.com suggests that the tax credit is a trick which will leave many Americans with what redstate.com calls “surprise tax bills” in the spring of 2015.  

Suddenly the tax credit doesn’t sound like such a good deal–unless you took the time to read the full explanation..

       HHS Says it Will Kick Up the Campaign to Explain Reform In October –When it Has the Facts –and the Public Is Ready to Act

 Let’s return to the idea to the idea  that the  Obama administration  has been too slow in educating the public.  “For the last couple of years, the Obama administration has done too little to explain what was in the law, and to mobilize support,” says Henry Aaron.

But Bloomberg reports, in April of 2013 U.S. health secretary Kathleen Sebelius “offered a different take on timng: “’It didn’t make sense for the U.S. to contact the uninsured long before they can actually sign up for coverage.’”

I think Sebelius may well be right. Americans are not interested in poring over the many details of Obamacare when it seems a distant possibility.  (Polls show that Conservative diatribes have convinced many that the law already has been repealed.)   

People will be much more interested in listening to the facts about the ACA in October, when it is becomes clear that the law is a reality, and that they are faced with a decision. Should I sign up for insurance?

Right now Republicans are telling them that, under reform coverage will be unaffordable. Often they throw out numbers like “30% increases.”

Here the fear-mongers are speculating about the cost of insurance premiums in the Exchanges where individuals buy their own insurance.  But keep in mind, only a small minority of Americans will purchase coverage in these Exchanges

The majority of  Americans work for large companies and are offered tax benefits at work. The Congressional Budget Office tells us that  Obamacare will have a “negligible” effect on  their premiums.

                             Premiums in the Exchanges– Stll An Unknown

As for premiums in the individual Exchanges, today we have hard numbers for only a few states. In most cases Democrats cannot tell you exactly how much your coverage will cost in 2014 if you buy your own insurance. And we have very little information on how much small businesses will pay in their separate SHOP Exchanges.  This makes it difficult to rebut claims that premiums will skyrocket.

 Individual premiums  depend on your age, your sex, your income, where you live—and how insurers decide to price their products.  They will be competing for market share, and will be trying to calculate how to price their product to attract young, healthy customers.

Much will depends on where you live. In states like New York, insurers alreay have to folow most of the regulations in the ACA. For instance, they can’t charge more if a patients suffers from a pre-existing conditions.  As a result, it is unlikely that individuals buying their own insurance will pay more than they do today; in most cases, they will pay less. In addition, many will be eligible for subsidies. .

On the other hand, if the customer is a healthy 30-year-old male who lives in a state where insurers are  allowed to charge women three times as much as they would charge a man  for exactly the same policy, and where they can  charge someone suffering from a pre-existing condition four times as much, the 30-year old male may well be asked to shell out significantly more than he does  today.

This is because, under reform, he, his sister, and his diabetic mother will find themselves on a level playing field: Insurers won’t be able to gouge his sister or his mother.

(Put that way, reform doesn’t sound so bad for the “Bros.” does it? Even a progressive can use hot-button words to “frame” an issue.)

But not how many words I needed to explain the variables that will determine whether your premiums will go up or down in the Exchanges.

 It’s much, much easier just to scream “sticker shock.”

          In October, the Administration Will be Able to Offer Specifics

In the fall, progressives will have an easier task. They will be able to say: “Here in North Carolina an individual will be able to choose from a menu of five plans that range in price from $____to $____a year.  Here are the details on the co-pays and deductibles.  You will notice that in the plans where premiums are lower, co-pays are higher. Butin all of these plans your total out-of-pocket spending will be- capped at $6500 a year—no matter which plan you choose, or how much care you need.”

Armed with this information,  reform’s supporters will be able to answer the false claims that you are hearing today. (This is why the fear mongers are now becoming louder and increasingly hysterical—as we approach October they know their days are numbered.)

“Enroll America”  also will be able to point out that:  “different plans use different provider networks—you will find a list of their networks here. Some plans charge more because they think that you will pay more for their networks of hospitals and doctors. But they may be wrong: some customers will choose one of the less expensive plans.”

In October, progressives also will be able to will put premiums in the contexct of subsidies, and explain that “If you are single and earn X, you will receive a government subsidy of $______ . If you are a 40-year-old couple with one child earning Y, you will receive a tax credit of $_____. Subtract that from a premium of Z, and you will owe just $__________

When Obamacare’s supporters have hard numbers, and can spell out what reform will mean for YOU and your family, uninsured, self-employed and unemployed Americans will be much more eager to learn about the details of healthcare reform. This is when they will be ready for a crash course in Obamacare.

         Educating the Public: Reaching Out at the Right Time, Oct. 2013- March 2014

As Joanne Peters, an HHS spokeswoman told Bloomberg: “ Our outreach will kick into high gear this summer leading into the fall, when we’ll be talking to Americans across the country to prepare them to enroll in coverage beginning October 1. Our deliberative tactics build on the lessons we’ve learned, including reaching people with the right message at the right time, when it’s time for them to act.”

You want outreach and communications with real intensity in the six months when people can go online and sign up,” adds Tara McGuinness a White House spokeswoman, referring to the open enrollment period that begins in October 2013 and runs through March 2014. In six months, “Enroll America” should be able to get the facts out there to most of the people who, at that point, will want to hear more about how “Obamacare” might help them.  

Granted, reformers still will have to contend with the lasting effects of the conservative campaign to plant seeds of suspicion. That crusade began in 2009.  That’s four years of misinformation and outright lies.

Nevertheless in October of 2014, when “Enroll America” has the facts on pricing, I am hopeful that mainstream journalists will at last feel able and willing to call misinformation what it is: “a lie.”

 

23 thoughts on “Obamacare– Fear-Mongers Poison Minds; Hatred Blinds

  1. I still wish the administration had done a better job explaining the law once it was passed rather than allowing the right to define it.
    I also wish the administration would consider multi-employer plans, something it still fails to do. Instead we are treated like employers (we are not) and insurers (we are not) and we are being subjected to the per life tax which is being used to subsidize commercial insurance companies (which we are not). It is bewildering to a group of working people who supported Obama in ’08 and ’12 and now find they can’t get the time of day. The Roofers and Waterproofers are calling for repeal. There has to be a better way.

  2. Martha–

    Welcome to HealthBeat!

    I have to say that I still wish that the American public had done a better job of reading about and taking in information about the ACA.

    Even mainstreamews papers have published a huge amount of excellent information. I think of the columns that Ezra Klein and Sarah Kliff have written in the Washington Post (which have been widely reprinted),
    and a great many excellent blogs.
    The Kaiser Family Foundation also has published a least a hundred outstanding briefs–all readily availabe on Google. And Healthcare.gov will answer almost any question you have.
    I realize that some unions want multi-employer plans to fulfill the requirement that they offer comprehensive health insurance– even if those plan sdon’t cover employees’ dependent children.
    This simply is not fair. Under the umbrella of “shared reponsbility” all companies should have to cover children, even if their union has managed to negotiate something else with employers,
    Yes, unons supported Obama–and this is great.
    Butt this does not mean that unionized companies should be exempt from “sharing responsibilty” with all of us to make sure that all Americans (and their children) have access to affordable, comprehensive healthcare.

    • Maggie:

      I think you are misunderstanding the problem. First: most of the multies do cover families. But the real rub is that it is not clear that these plans will even be considered qualified by HHS even if the coverage is comprehensive. Then there is the fact that we are being taxed as if we were a commercial carrier but not benefitting from the tax because we are not a commercial carrier.
      The Roofers wanted their plan to qualify to be listed on the exchange–for their members to be able to access subsidies to pay premiums to that plan. I stop short of that because their plan is not available to the public. The problem I have is that the administration does not seem to be interested in dealing with a set of plans which cover PART time employees who are cobbling together a living. These employers contribute to these plans and if enough is contributed the employee qualifies for coverage. My concern is with the folks who will churn back and forth. If they fall short of qualifying I would like them to be able to use the contributions to offset their cost of going to the exchange. That would save the employees AND the government money. HHS won’t even talk about it because (according to our representatives) they don’t want to look like they are “doing unions a favor.” This is not about unions. This is about ERISA protected plans that benefit workers on whose behalf employers are contributing in good faith. In my view this is a weakness in what is generally a good law.

  3. Martha–

    You’re right– I don’t know very much about this issue.
    Thanks for getting back to me.
    A couple of questions: Are you saying that the unions want part-timers to be able to use their contributions to the unions to offset their costs when they buy policies on the Exchanges?
    I can see why the government wouldn’t approve letting union dues be deducted from the cost of premiums. (Why should commercial insurance companies pay union dues?)
    Also you indicate that some plans don’t cover families, but even if they were comprehensive, the govt might not consider them qualified– Why?
    Clearly they have to cover dependent children and meet all of the other regs to be considered comprehensive, but if they do that–and are open to the public– I would imagine that the government would consider them qualified. Do you have examples of cases where comprhensive union plans that are open to the public are not approved by HHS?
    Finally, I agree with you– the Roofers cannot use the Exchanges (cutting the union’s administrative costs etc.) unless they are open to non-union members.

    It would seem to me that unions that are doing a good job of providing comprehensive insurance to their workers (that meets the govt definiton of affordable) should just continue what they’re doing and not worry about the Exchanges.
    If they are not providing comprehensive ,affordable insurance, their members will be able to go to the Exchanges, where they are eligible for subsidies, and buy their own insurance.
    In that case, I can imagine that some union members would drop out of the union–assuming one of the benfits of paying union dues is the insurance. But I don’t think HHS can make special rules to make sure unions don’t lose members who want better insurance than the unions now provide. . .
    Again, I haven’t studied this subject, so I may well be missing something.

  4. Oh, my, I am doing a terrible job of explaining this. First contributions: Contributions are agreed-upon amounts paid into a benefit fund by employers. They are not union dues; they are unrelated to union dues. The funds are separate entities governed by ERISA and they have boards of trustees made comprising an equal number of employer representative and employee representatives. The trustees set the qualification levels (how much you need in contributions to qualify for coverage) and the benefit levels. I am an employee trustee (and a rank-and-file worker). Taft-Hartley multi-employer funds were set up in the mid 20th century to address the problem of workers who move from job to job. A typical jobber is a construction worker who works on a site and then moves on to another job when that one is complete. Another type is an entertainment worker. Almost no one in that business works full time and most also go from job to job (film to film, show to show). Not only do we move from job to job but, unlike the construction worker, almost none of us work full time for any one employer for any length of time. In a typical week I might work for Disney, Radio City Music Hall, several Broadway shows and a record label. None is full time but I am able to cobble a living together by working for all of them. These funds make it possible for actors, dancers and musicians to qualify for employer-sponsored health care EVEN THOUGH we are not full time for anyone.

    Now to the problem of being qualified. There is almost no language in the statute that covers our funds. The government does not know what to do with us. We are not open to the public (just as the General Motors’ plan is not) but we offer coverage just like they do. The W2 reporting has been a headache because our employers don’t know what our coverage is because they do not set the coverage—they just contribute to the fund for a bunch of part-time people. According to Paul Van de Water’s testimony on May 9, large employers who are self insured are exempt from the insurance tax. I understand the need for the tax; it is to smooth out the new costs of covering everyone, regardless of health. But we are not a large employer, we are a benefit fund and we are self insured and we are subject to the tax. That baffles me; we are certainly not going to get the benefit of the tax. It is just going to drain the fund, making less available to pay benefits. We are not looking to be on the exchange. While I disagree with the Roofers’ position, I think you are mis-characterizing what they are asking for. They want their folks who fall short of their plan to be able to access federal subsidies to qualify for their plan (not qualifying usually happens because someone is underemployed). This would not save them administrative costs. But I think it is wrong to ask for federal money to subsidize someone’s qualifying for a plan that is not open to the general public.

    I would like to see this: When someone is underemployed and not qualifying for the coverage, the statute has them going to the exchange and very likely getting a subsidy. I would like to see that person be able to use the employer contributions put in the fund on their behalf (not union dues) to offset the cost of buying insurance on the exchange. This would help the employee, save the government from subsidizing another person, would use the money for the purpose it is intended and it would keep our employers contributing to our fund, which is good because that is how they are sharing the responsibility. But we have been told no, no, no.

    Another note: you do NOT get health insurance by paying union dues. The issue is not one of losing union members, the issue is losing these employers who have been sharing the responsibility of covering these folks and may decide that since they don’t have to cover them (because they are part time) they just won’t bother at all.

    • Martha–
      Clearly, I (and no doubt a great many other people) know next to nothing about this problem.

      I wonder if you know someone who is a an expert in this area who might want to write a guest-post for HealthBeat?

      • Maggie:

        Wow! That would be great. I would love to see that here. I will have to think about that. Right now, I am as close to an “expert” as anyone in my immediate community thinks. But I am nowhere near expert. I can ask the folks who are acting as consultants on our plan. There are two law firms and a Segal Company representative. The International Foundations of Employee Benefit Plans (IFEBP) is a non-profit expert on this subject and I have attended two of their conferences on the ACA. The National Coordinating Committee for Multiemployer Plans is our lobbying mouthpiece. Our fund (the musicians) is in a somewhat different category, as I said because of the episodic nature of our employment, the number of employers we interact with simultaneously and the generally shaky economic fortunes of many of our members (including myself).
        If I find someone, should I contact you at the email from which I get your alerts?

        • Martha–

          I’m glad you’re interested.

          Clearly it’s a pretty complicated topic, and most people know little or nothing about it.

          I think the person who writes the post needs to be someone who knows a great deal–so much that he can come out the other side and explain it clearly and simply to people who know little. This probably means someone who is accustomed to talking to people who know little– maybe your lobbying organization? (As long as they don’t fudge facts. . . )

          You can reach me at maggiemahar2@gmail.com Just Put in the headline “From Martha– about a guest-post on unions and reform)
          I get hundreds of emails, many of them junk, and skim the headlines pretty quickly.

  5. “I have followed U.S. politics for many years. Never have I seen a president so hated—not Nixon, not LBJ at the height of the War in Vietnam..”

    Were you comatose from 2001-2009?

    • Bush was liked by many– far better liked than LBJ, for instance, or Nixon.

      GWB was the guy many Americans wanted to have a beer with.
      And no legislator would have stood up on the floor of the House and called him a liar–
      not even when he lied about “weapons of mass destruction” and dragged us into a war.

      Perhaps you weren’t actively involved in politics in the 60s and 70s–I think younger Americans
      just don’t realize how much things have changed. Back then, Democrats and Republicans actually worked together on many issues. For example, they almost put together good health reform legislation during the Nixon administration.
      Then Watergate hit the headlines, and the deal fell apart.

      The expression on Mitch McConnell’s fact when the talks about “that man in the White House” is something I have never seen– with the exception of how extreme Southern conservatives felt about the Civil Rights Act.

      • I think a good chunk of the difference is the Internet. Yes, here we are chatting about healthcare policy. And that’s good. But the culture of instant communications and debate also privileges hyper-partisanship, and few media outlets see any benefit in doing detailed think pieces; the 24-hour news cycle does not encourage them. It’s the current version of “if it bleeds, it leads (or ledes).” I remember the 60s well; I wonder what they would have been like had the Internet existed. Even more interesting, I expect.

        And I agree that the Kaiser Foundation stuff has been consistently useful.

        • Chris-

          Good to hear from you.

          I agree that the Internet is a mixed blessing. It’s good to know that people all over the world are able to access information on the Internet– but . . . Much of that information is, at best, muddled, at worst simply not true. In my first book BUll! I wrote about the “Information Bomb” that hit toward the end of the 20th century. Too much information, too little knowledge. Too many pseudo-facts torn out of context, too little analylsis.

          Much of this has to do with our short attention spans. When I first began writing this blog, I as repeatedly told, you can’t write such long posts! Posts have to be short. (As if the form had already been perfected. In my view, blog-posts are an evolving form.
          I would be the first to admit that I can be wordy. (If I had more time I could polish and tighten the posts, but there are only so many hours in a day.) When writing a book, I do re-write and tighten, re-write and tighten. This is why it took three years, workign 24/7 to write each of my books. But I view blog-posts as less permanent–more like a newspaper story that you will later use to wrap fish.
          So I just try to explain as much as I can, as clearly as I can, as often as I can– largely in an effort to counter all of this misinformation out there.

          I can only imagine the ‘Sixties with the Internet. Maybe Bob Dylan would have written a blog? No doubt we would have had posts from the jungles of Vietnam. Think Joan Dideon online.

          Yes, the Kaiser Family Foundation’s briefs are accurate and extremely informative. Sometimes if I want all of hte fact on something I simple Google “Kaiser Family Foundation” and the topic (for instance “tax credits for small employers” or “Medicaid Expansion.”
          It’s a quick easy way to cut through all of the junk that will otherwise come up on Google. (I like Google; it’s a great resource, but another example of the Infomation Bomb.

  6. Very nice touch to lace race in there. Well done.

    Perhaps it is the fact that I was not actively involved in the 60’s and 70’s. But I doubt it. I think the significant congressional majorities that Democrats enjoyed probably had something to do with Nixon working “together” with Democrats.

    • Alex–

      Unfortunately, race (and racism) is at the root of many of the ugliest incidents in American History. Do you remember mothers stoning small African-American chldren getting onto school buses in Boston? (They were being bussed to white schools. I saw this on televison at the time.)

      I would add that it wasn’t just that Democrats had a majority that Nixon needed to work with if he wanted to accomplish something. (And he did. For instance, he opened China)
      I would also say that there were more statesmen on the Democratic side for him to work with– experienced, intelligent pols like Mitchell.
      .
      And Nixon himself was extremely intelligent–unlike some recent presidents.
      He was paranoid, very anxious, and what shrinks would probably call “a borderline personality.” (See the book Nixon Agonistes) But someone like Robert Kennedy could work with him –and almost get health care reform done.

      If only . . . It would have been so much less expensive back then, and spending never would have gotten to where it is now.

      The Republicans in Congress today don’t possess the intelligence of a Richard Nixon, a Bob Dole, or so many others that I can think of from that era. In the 1990s, those REpublicans were driven out of the party.

      Meanwhile, many of the best legislators on the Democratic side have either died (Ted Kennedy, Mo Udall, Hubert Humphrey) or given up ( Bill Bradley, Jay Rockefeller, so many others.

  7. I experience this ignorance regarding the ACA all day long as I see my optometry patients. In fact, yesterday I had a grandmother make appointments for her two grandchildren for eye exams. Both grandchildren were on Medicaid. As she made the appointments she started railing against Obamacare and how it going to ruin our healthcare system! I have gotten to the point where I am too tired and frustrated to try to educate these people. They watch Fox News and get so brainwashed!

    • Jim–
      Thanks very much for commenting. Your story says it all. Some of the people who will benefit most from Obamacare have been brainwashed by “news” sources such as FOX>

      Here’s the scarey thing: more than one doctor has told me that if you go into the doctors’ lounge in most hospitals, you will find the TV is turned to FOX. One physician told me that “On more than one occcasion I have simply gone over and changed it to CNN.”

      No wonder some doctors don’t understand what is actually in the ACA

  8. Maggie, your lack of introspection and self awareness are extraordinary.
    You really, really believe only one side of this debate lies, distorts, and uses slogans?! Perhaps you missed — the war on women, if you like your health plan you can keep your health plan, we’ll cut your insurance premiums by $2,500.
    I wonder why you can’t tout ObamaCare without denigrating people who think it is a bad idea that won’t work.

    • Greg-

      Much has been written on conservative “framing” of issues– by conservatives as well as progressives. (Conservatives have written
      about it explaining to other conservatives how to do it to have the greatest effect.) I didn’t invent the idea.

      In the interests of full disclosure, you might have indicated that you are a senior fellow at the conservative Heartland Insitute, have worked at the Cato Insitute, etc. When conservative health-care reform foe David McKalip, sent out a racist email that showed President Obama as a witch doctor, you defended him as a “rock-solid patriot” This was reported here http://thinkprogress.org/politics/2009/10/05/62974/mccaughey-cites-mckalip/?mobile=nc
      In one of your Consumer briefs you wrote about “Rick Scott’s valiant $5 million investment in “Conservatives for Patient Rights“http://www.johnbiver.com/2009/05/14/obamacare-and-flat-footed-republicans/

      You don’t mention where that $5 million came from. It is part of the money he received when he was asked to stepped down as CEO of HCA–right after HCA was accused of the largest Medicare fraud in U.S. history. Whistle-blowers told the FBI that Scott ran the operation– defrauding Medicare (the hospitals kept two sets of books), bribing doctors to send patients to HCA etc.
      In 2009 you wrote a post for the American Spectator defending Sarah Palin’s widely denounced claim that health-care reform would lead to “death panels.”
      ( http://tpmmuckraker.talkingpointsmemo.com/2009/10/top_health-care_reform_foe_racist_emailer_is_rock.php)

      Let me be clear: just as you are a conservative, I am a progressive and have taken the other side on all of these issues.
      I find the witch-doctor picture–which was sent not just to one person but to a list-serv—particularly offensive. You, on the other hand said there was “funny stuff scrawled on the top” of the picture.

      Now to respond to your specific points
      Regarding the President’s suggestion, in 2008, the cost of a family’s healthcare would fall by an average of $2500:
      As Ezra Klein recently noted on Bloomberg.com since then “the savings are actually
      materializing. Over e-mail, (David) Cutler pointed out that in January 2009, the Centers for Medicare and Medicaid Services projected that national health spending would equal 19.3 percent of gross domestic product in 2016. Their 2012 projection cuts the 2016 estimate to 18.3 percent.
      “One percent of GDP turns out to be — surprise — $2,470 for a family of four given expected GDP that year,” Cutler wrote, “or basically $2,500.”

      The reduction isn’t, as Obama promised, in insurance premiums. It’s the cumulative savings across all health-care spending. That’s the measure that, in the long run, really matters. When wonks talk about “bending the cost curve,” that’s what’s being bent”.
      the growth in health care spending has fallen– by an average of $2,500 per U.S. family.

      Moreover, the 2014 rates announced for the California & Oregon Exchange are down by at least $2,000 when you compare them to the average rate what an individual would have paid this year if she or he bought equally comprehensive insurance in the individual market.

      You might argue that you don’t want such comprehensive insurance. But the rest of us want you to have it because we understand that no one
      knows what might happpen tomorrow-you could hit by a truck, diagnosed with cancer, or discover that your wife or girlfriend is unexpectedly pregnant.
      If you (and your partner) don’t have comprehensive insurance, the rest of us will wind up paying for you.
      This is why we all need to contribute to the larger pool so that we can pool the risk–and so that everyone has equal protection.

      The war on women is, I’m afraid, a reality, though those three words don’t begin to sum up what has happened in terms of attempts to change the abortion law, efforts to prevent the ACA from offering free contraception, protests that because insurers will no longer be able to charge women more than a man (for exactly the same policy and without maternity benefits) that this is unfair to young men,
      rape in the U.S. military–with commanding officers look the other way and some Congressmen insisting that these commanding officers should be overseeing these rape cases . . . I could go on..
      Regarding “if you like your health plan you can keep your health plan.” For most Americans, this is true The majority of Americans under 65 have employer-sponosred healthcare through a large company. Those plans will stay basically the same. Large corporations do not plan to cancel them. And the CBO says that the ACA will have very little effect on premiums.

      Finally, on this blog we avoid personal attacks. (“Maggie, your lack of . . .) Please keep in mind that in the future: if your comment contains a personal attack it will be deleted. You might feel that in the comments above I am attacking you, but I am merely reporting what you have done and said (with links).

      I am not generalizing about your character. I leave it to my reasons to draw their own conclusions.

  9. I have to disagree with you Maggie–There’s nothing progressive about basing health care on a for-profit, corporation’s product.

    The real progressive position is single payer.

    • Lou–

      Single-payer exists in only two countries:Canada and the UK. They do not have the best care in the developed world. You’ll find the besgt care in Germany, France, Denmark, Sweden, Norway, the Netherlands, . . .

      All of the rest of Europe does what we are doing: they use insurers but they regulate them.
      In Europe many of those insurerse are non-profit.
      And lo-and-behold, under the Affordable Care ACt the insurers in our Exchanges will also be non-profits. (The for-profit
      companies are boycotting the Exchanges becuase they know that under the regulations they won’t be able to make the
      profits they want. This tells you how tight (and good) the regulations are.

      This is what I have long predicted: we will wind up with a system where non-profits flourish and non-profit insurers and
      the government offer nearly all of the care. As the chariman of Aetna has admitted, his business model is disappearing.

      Even now, for-profit insurers act mainly as “back offices” for large corporations that self-insure. (The large employer takes the financial risk. )

  10. One important nuance about multi-employer health and pension plans that Martha didn’t discuss is that they operate under a doctrine called “last man standing.” This means that when companies go out of business, their liabilities are absorbed by the remaining companies in the plan which, of course, raises the required contribution that those remaining employers must make to the fund to sustain it financially. This is an especially big deal for the pension plans because retirees cannot be laid off and accounts for why United Parcel Service agreed to pay $6 billion into the Teamsters multi-employer plan to escape further contributions and to replace it with a plan exclusively for its own employees instead.

    To the extent that the more comprehensive benefits required by Obamacare raise the contributions that employers must make to these funds it will raise their costs, require them to increase employee contributions, reduce their ability to raise wages, cause them to shrink employment or grow more slowly or even go out of business altogether. That doesn’t mean that health reform is not a worthwhile endeavor but it does suggest that there are downside risks that the left would rather downplay or not talk about at all.

    • Barry, what you are referring to sounds like it relates more to a pension plan with a defined benefit. In our health plan if an employer goes out of business (happens all tge time), the contributions for its employees stop. Because the level of benefits is determined by the level of contributions, these folks fall off the plan unless they are also working for another employer who is making contributions. Our employers are not required to maintain any level of benefits. They may be required via CBA to maintain a contribution level, but if they go out of business theyre done, and no one else is responsible. Now a defined pension plan: that is something else. That is out of my ken.

  11. Barry–

    Since Obamacare requires more comprehensive coverage, employers that continue to offer insurance (and for the time being most will) will be buying better coverage in a more efficient system.
    We have already seen that health care inflation is flattening–in the Medicare population as we well as in the private sector.
    Medicare patients were not hit hard by the recession; they have no major reason to cut back on care.
    But hospitals are beginning to cut waste, and some doctors are becoming more aware of costs.
    Before long, I’m quite sure the govt wil begin to control
    drug prices and device prices.
    Overall, this will mean some loss of wealth among health care corporations. But I don’t think other corporations will find themselves paying premiums that are rising much higher than CPI.
    Meanwhile, individual families will no longer be vulnerable to bankruptcy, losing their homes etc. due to huge health bills.
    As for employment– in the future that is going to have to come more and more from the government. There are so many things that need to be done that only government can do– better schools subsidized, high quality chld care, universal pre-K, adress the environment, global warming,
    clean energy, cleaner cities and parks.
    More and more we need to become a service economy
    that contributes to the wealth of the nation by providing the services that we truly need.
    In a global economy other countires can manufacture things as well or better than we do at a much lower price because cost-of-living is so much lower. And labor prices in places like China are beginning to create a true middle-class. This is good, for China, and for rest of the world.