Ezra Klein sums it up well:
President Obama promised that “if you like your plan, you can keep it.” This is true for the vast majority of Americans, but the small fraction for whom it isn’t true still represent millions of people. Obama broke his promise to them. Worse, he made the promise cynically, knowing it would never be kept. He should’ve said “almost all Americans who like their plans can keep them.” But he knew that wouldn’t poll as well.
PolitiFact has compiled a list of 37 times Obama made that promise since his inauguration. For instance, on July 18, 2009, Obama said:
Under our proposals, if you like your doctor, you keep your doctor. If you like your current insurance, you keep that insurance. Period, end of story.
This week, Obama has not only changed his claim. He describes his new version as “what we said,” as if it’s what he’s been saying all along:
Now, if you have or had one of these plans before the Affordable Care Act came into law and you really liked that plan, what we said was you can keep it if it hasn’t changed since the law passed.
Now that’s just an insulting lie. We know that wasn’t what you said, dude. We’ve got video.
So it’s not surprising that the Daily Show weighed in:
Fred at Slactivist – one of my favorite blogs – writes that Obama isn’t being dishonest:
It’s true: “If you like your plan, you will be able to keep it.”
But what about those people whose old plans no longer exist in that same form because of the health reform law? Well, that’s only true for those old plans that were basically screwing over customers. The new law doesn’t let insurers do that anymore.
So, no, if your old plan was screwing you over, you won’t be able to keep it.
Here’s the “Gotcha” moment then: Ah, but what about people who liked getting screwed over by their old plans? They liked being ripped off, but they’re no longer allowed to be ripped off in quite that same way — therefore Obama was lying when he said “If you like your plan, you will be able to keep it.”
This is just weird.
“If you like your diet, you will be able to keep it.” But we’re no longer going to allow people to sell you a plate filled with broken glass and feces and call it lunch.
But I liked my broken glass and feces! If you won’t let me keep paying top-dollar for that, then you’re a liar!
Uh, no. Broken glass is not food, but crappy insurance plans are still “insurance plans,” as virtually all English speakers understand that phrase.
I hate seeing Democrats defend obvious Obama lies. Let’s just say it: He lied. That sucks. We should have a system that punishes politicians – ALL politicians – more for such clear-cut lies, especially when they’re repeated over and over.
This particular lie stands out because what he was promising was never possible (or even desirable, unless you think the status quo is 100% perfect and should never be changed). As Austin Fract writes:
Let’s start with “if you like your plan you can keep it.” This is never, uniformly true. Plans change every year, even in the years before Obamacare was conceived. The truth is, if you like your plan, there’s a good chance it will change. That’s just as true, if not more so, under Obamacare. I do not endorse or defend this statement.
What Obama might have more plausibly have said is that Obamacare makes only minor or modest changes to coverage for the vast majority of Americans.
Incidentally, I’ve yet to see anyone criticize Obamacare’s “Cadillac tax” provision in light of Obama’s repeated “if you like it, you can keep it” promise, and I don’t understand why.
But the idea behind the tax isn’t to raise money: It’s to change behavior. The hope is that it will pressure employers and workers to choose less-expensive plans. If it works, additional tax revenue will be generated less by so-called “Cadillac” plans subject to the excise tax than by employers delivering more of their workers’ compensation in the form of taxable wages and less in the form of expensive health-care benefits.
So if Obamacare works as designed, then many employers will not offer “Cadillac” plans to employees anymore – meaning that those employees lose the plans they liked, because of Obamacare. That’s another way Obamacare contradicts Obama’s silly “if you like it you can keep it” lie.
I think the Cadillac tax is a good idea, by the way. Presumably, so does Obama. But a politician offering a plan designed to force some people to change their health care has no business promising “if you like it, you can keep it” thirty-six friggin’ times.
I’ll close by quoting Conor Friedersdorf:
There are important ways in which every lie or misleading statement is not equal. If we compare the consequences of every Bush Administration misdirection prior to the Iraq War—a multi-trillion-dollar conflict that killed 5,000 Americans and tens of thousands of Iraqis—their deceit was orders of magnitude more damaging than, say, Clinton and his allies subverting a sexual-misconduct lawsuit while under oath. But there is one way in which all lies government officials tell are alike: To different degrees, they all subvert self-government by depriving Americans of accurate information as we make political judgments. They all diminish an almost depleted store of trust that’s needed for functional governance.
Do you think that was a lie Obama needed to make to get the ACA passed?
We do. See the U.S. Constitution, Article I, section 2 paragraph 5 and section 3 paragraphs 6 and 7, and Article II, section 4 paragraph 1.
The argument that the plans people are losing are substandard is bullshit as well. A man does not need an individual plan that covers abortion. A woman in her ’60’s doesn’t either. Plenty of these plans that are being eliminated are NOT substandard. The issue is that the ACA acts as though “one size fits all” – and it doesn’t. People are perfectly capable of making their own decisions as to what they need and what they don’t – but the government knows better.
Ezra Klein’s statement “This is true for the vast majority of Americans, but the small fraction for whom it isn’t true still represent millions of people.” should not go unchallenged, either. According to the CBO, anywhere from 93 million to 156 million people will be forced out of their healthcare plans over the next couple of years. See here and here. That’s not a few. These links also discuss the issue that people are being forced to get plans that have coverage they will never use on the basis that they are “substandard” without those coverages.
Yep, that’s right, RonF, only women should have to pay for abortion or materity care, sice men have nothing to do with these expenses.
When people make statements, we expect them to be true at the time they make them. We do not require that that same statement be true if it were uttered years in the future.
In 2009 Obama said that if you like your current plan, you will be able to keep it. That was, and continues to be, true. He did not say that if at some point in the future you cancel it and go off and get a different plan, you will be able to keep that one too.
Now, he did repeat his “if you already have healthcare, you don’t have to do anything” statement (or something similar) a couple of times after non-grandfathered policies were available. And yes, those particular statements were merely true for the vast majority of people; not for the tiny minority who had canceled their grandfathered policies and bought new, non-compliant policies. If you want to take the President to task for those particular statements, go right ahead. (But anybody who responds to big fat whoppers like “death panels” and “they’re gonna kill your granny” with statements that are merely 99.5% true and 0.5% lie, gets a pass in my book.)
Yes. If that guarantee hadn’t been given the ACA would never have passed. But “the ends justify the means” has long been a mantra in Chicago politics.
Decnavda, I’m not sure what you’re saying. The ACA requires that you get health insurance that covers services that you will never consume. Do you think that’s acceptable?
Joe B. has a point. If you have a grandfathered plan and had it before the cutoff and didn’t term that plan and the insurance company didn’t cancel or change that plan after the deadline, you don’t have to change your insurance plan.
I know one person who doesn’t need to change their individual plan.
No, I don’t. Obamacare passed on a pure party line vote. Democrats want to take a major step towards universal health care very, very, very much; it would have made no difference in Congress.
I think it’s a lie Obama told because people in his campaign thought it might be necessary to win against McCain, and later, against Romney. With hindsight, we can see that neither of those elections were close, and it’s not plausible that the lie changed the outcome. But although that’s clear in hindsight, I doubt it was clear from within the Obama campaign at the time; in the heat of the campaign, everything can look like it’ll be the one thing that turns out to be crucial.
The “having to pay for services you don’t need” argument is silly. Sorry, but it is. Plans that are cheap because they have huge coverage holes, such as not covering pediatric care (to pick a less inflammatory example), are very specifically designed to cherry-pick certain categories of customers, primarily those lacking that pesky and expensive organ known as a uterus. Under the ACA, insurers can’t do that, and that’s a good thing.
Yes, it was a dumb lie, or a dumb oversimplification if you want to be charitable. Obama should have known (or someone on his staff should have known and told him) he’d get bludgeoned with it. I am in the “if the political will for single payer had been there we wouldn’t be in this mess now” camp. But none of that changes the fact that the ACA was probably the best we could do, and it’s a hell of a lot better than what we had before, when you didn’t get to keep your individual plan if you had the nerve to get sick.
I don’t entirely agree. Hilarycare went down in flames because of the public outcry (and then Clinton lost the House and Senate shortly thereafter). Had middle-America foreseen this outcome, the pressure on the individual Democrats may not have made it such a lop-sided vote.
Hell, I did not expect my premiums would jump the amount that they have. I have been running a business for almost 8 years now and every year we have tweaked things here and there on the deductible, the plan, percantages, etc., and the premiums changed around $10/month per person (roughly 3-5%). Next month, they are jumping up approximately 15%. (So, yes, I get to keep my plan, but it is not the same plan anyway because it costs more.)
And, Republicans were very cynical about the timing of this law and the way it would not go into effect until next year (skewing the financial aspects of the law and avoiding the effects this law might have had on the election). They wanted to avoid Clinton’s mistake about telling people what was in it too early.
If we were experiencing this in October 2012, you can be sure Romney would have won, not to mention probably losing the Senate, as well.
Now, of course, it would have been “possible” for it still to pass in the face of great opposition from the public, but not very likely, I think.
Holy crap, some of those sentences are incomprehensible!
“They [Democrats, not the Republicans mentioned in the opening sentence] wanted to avoid Clinton’s mistake about telling people what was in it too early.”
“If we were experiencing this in October 2012, you can be sure Romney would have won, not to mention [Democrats, not Romney] probably losing the Senate, as well.”
Time to hit the bar, and let my body catch up to my brain!
Wow! That’s not how insurance costs have gone at my place of business. I always consider it a good year if we can keep increases below 10%. That’s 10%, not $10. Last year we had a 37% increase. THIRTY. SEVEN. PERCENT. This year it has dropped by 22%. (We got screwed last year. The renewal rate was a 73% increase – you read that correctly, seventy-three percent – and that set off red flags with all the competitor insurance companies. We protested to our carrier that their numbers couldn’t be right but they wouldn’t budge. So we wound up changing insurance carriers and required employee contributions for the first time ever so we could provide a group plan to our employees. This year’s decrease shows that we were correct about the numbers.)
We’re not an especially small company nor are we a large company – 60 employees. Over the years in order to keep premiums down we have slowly raised the deductible from $1k to $5k. Even with higher deductibles it has been a struggle to keep increases under 10%.
How have you kept your premiums so low? Are your employees primarily under 30? Has no employee (or their covered dependents) had a large claim in all those years?
I thought I was doing a damn good job. I’m going to have to reevaluate my performance.
In my company – with > 1000 employees – we have not had a rise in our health insurance for the last 3 years. HR has been pretty agressive in keeping costs controlled. This year – according to HR, as a consequence of the ACA – our insurance is going up, to the tune of > 5%.
Question, Ron. Do you mean that your contribution (if any) has not gone up or do you mean the premiums have not gone up?
Likewise, when you say that HR has kept costs down, does that mean they’ve somehow negotiated hard or that your benefits have gotten worse year to year (as Jut’s employees and Jake’s co-workers have)?
Average employer-based insurance rates have increased by more than 10% a year for more than a decade (nearly 200% since 1999). I’m pretty suspicious of “our rates never went up until nasty old ObamaCare showed up.”
“The “having to pay for services you don’t need” argument is silly. Sorry, but it is. Plans that are cheap because they have huge coverage holes, such as not covering pediatric care (to pick a less inflammatory example), are very specifically designed to cherry-pick certain categories of customers, primarily those lacking that pesky and expensive organ known as a uterus.”
Uteri get pediatric care? That is so weird. I always thought pediatric care was for children.
What I presume you are suggesting is that pediatric care coverage should be mandated for everyone, whether they are parents or not, and whether or not they intend to be parents.
The problem with this argument goes directly to the lie that Amp correctly and forthrightly spots in Obama’s rhetoric: he promised that individual choice would continue to be honored, but that promise was a lie.
If you want a policy that does not cover what other people think you should have, too bad – your choice is invalid. As Amp notes, it isn’t a choice of feces-and-glass that you’d have to be nuts to want; it’s a junior cheeseburger vs. the combo meal with large fries and a coke.
But it goes beyond that.
You don’t want or plan to have children? You can’t have children? Too bad – you’re going to pay for health care for the kids that you don’t have. Your life choice is invalid. Oh, you don’t have to actually have the kids – yet – but you’ll pay as though you had. (And no, this isn’t the same thing as paying school taxes even though you don’t have any kids – you pay those taxes because having an educated population benefits you whether or not your own kids go, and that benefit is an inseparable public good. Having kids be out there in the world, period, doesn’t benefit you in that way.)
You don’t use birth control, because you don’t like it or you’re a gay couple or you want kids desperately, or whatever other reason? Your choice is invalid.
You don’t believe in the psychiatric model of disease, and don’t want to go to a psychotherapist or a psychiatrist? Your choice is invalid.
And so on.
There is an argument to be made for a single-payer system where it is true and accepted as an implicit part of the system that your individual choices simply don’t matter in terms of what you are going to pay. Have no kids or a dozen, practice danger sports or knitting, go to every shrink appointment you can get scheduled or find solace in kittens and mint tea – regardless, you’ll just pay your allotment of tax or premium or whatever, and get the universal benefit everyone gets, and you’re done. Not my preference, but OK, at least it’s presented up front.
The lie of Obamacare was that individual choice would continue to matter – if you don’t want a heavy-bennie policy that gives all kinds of maternity time and well-baby visits and such, fine, no worries – keep the ‘antisocial bachelor’ plan you’re on and go in peace. If you want a cadillac plan that bankrupts you every year but has you delivered to the ER daily in a van made of Xanax, go for it – it’s your nickel.
But those choices aren’t valid anymore. You don’t get to make them anymore. You’ll take the plan that the government decides is “standard”, and you’ll like it.
Or not. It doesn’t really matter. Your choice doesn’t matter.
Obama sold his plan with a comprehensive set of promises: that there would be no loss of choice, no increase in cost (and in fact a decrease), an improvement in the number of people covered, and an improvement in the breadth of coverage offered. I said it then and I’ll say it again now: nobody on Earth can deliver that specific set of promises. One out of four is achievable, two out of four would be quite an accomplishment. It looks like we’re going to get number four, and none of the others. The first one is already an obvious lie, and two and three are just waiting for the data to confirm what intuition makes similarly obvious.
The “your life choice is invalid” bit seems a little much to me. It makes it sound like the choice to have/not have kids is what you mean, not the choice to buy health insurance that does/doesn’t cover pregnancy/birth control.
You may or may not be right about this. But the more relevant question is, do you benefit when the kids who are out there in the world have access to adequate health care?
Also, life choices have a way of not always going to plan. The whole point of insurance is that it’s very difficult to predict in advance what healthcare services you’re going to need. For example, unplanned pregnancies happen, and some of them get carried to term. A couple who thought for sure that they weren’t going to need maternity coverage may find themselves needing it anyway. The insurance company sure isn’t going to let them sign up for it after they find out they’re already expecting. So either they pay out of pocket or the cost gets absorbed by everyone else.
“But the more relevant question is, do you benefit when the kids who are out there in the world have access to adequate health care?”
You can answer this question yourself: how much of your income do you send out to charitable-care efforts working in the third world, where the quality and quantity of care is (broadly) abysmally lower than even the most underserved US community?
If (like most of us) the answer is “very little”, then you’ve answered your question: clearly not, or you would spend more on it. For the most part, people are willing to spend on things that identifiably benefit them (or whose absence would harm them). There’s a reason that it has been historically much easier to get people to agree to chip in to collectively pay for schools, than to collectively pay for health care.
If you’re an ignorant lout living next door, that’s likely to directly make me worse off. If you are dying of cancer next door (and I don’t have an emotional bond with you), that’s not likely to make any difference at all in my life.
“It makes it sound like the choice to have/not have kids is what you mean, not the choice to buy health insurance that does/doesn’t cover pregnancy/birth control.”
If the state doesn’t think you’re wise enough to decide for yourself what financial arrangements you should make to manage your life choices, what reason is there to believe that the state thinks you’re wise enough to decide for yourself what the underlying choices should be?
You’re either a free actor making your own choices, or you’re a subject. There’s not a lot of stable ground in the middle.
” So either they pay out of pocket or the cost gets absorbed by everyone else.”
Or they pay downstream, AFTER having the first-mistake-is-free coverage extended to them.
Having a healthy population benefits everyone. Smaller drain on emergency resources, more productive workforce from fewer developmental problems brought on through many causes (fetal alcohol syndrome, lead poisoning, etc, etc.) Fewer people calling out sick for communicable disease. Fewer amputations from complications of diabetes. And on and on. All of these things have impacts beyond the person most affected.
If the healthcare system could eliminate tobacco use tomorrow, we would reap the dividends for decades, in reduced lung cancer, emphysema, COPD, gum disease, and a host of other illnesses. It’s true that then people could not choose that lifestyle. But everyone would benefit from that particular lack of options.
Yes, if you are a developmentally typical XY male, you aren’t going to need coverage for uterine problems. Well, roughly the other half of the population out there isn’t going to have prostate problems. They’re also not going to need help with erectile dysfunction. There are lots of things some people might not need coverage for, but if everyone pitches in, then everything gets covered. So far, I have been fortunate enough to be very healthy, on the whole. If I had been participating in a single-payer system all my life, I would definitely be a net contributor. This does not bother me. I don’t feel put-upon; the fact that I am visiting the hospital less than the average bear strikes me as enough of a win that I would not then seek to pile on by making more difficult the health care of people less fortunate than I.
Even though I must participate in a system where healthcare is a product in order to get my healthcare, I don’t agree that it should be; it should be a benefit of being a citizen of one of the richest societies the human species has ever known, and of paying taxes to support that system.
Even health conditions which seem obvious in retrospect may not seem obvious at the time. If you had asked me if I were trans, twenty years ago, I would have said “no”, and my opinion would have been sincere, emphatic, and wrong. Now we all know that I am trans, and pre-Obamacare, completely uninsurable outside of an employer-provided plan.
(So much for MY entrepreneurial effort; I pretty much have to work for a corporation or the government, or marry someone who does. Way to go, free market idolators. You want to see an EXPLOSION of entrepreneurial activity? Make it so that entrepreneurs don’t need the boat anchor of a full-time job to get healthcare for their children. With the children and spouses covered, people would me MUCH freer to strike out on their own, to compete for wages, to work multiple jobs. How many times have you heard someone say, “I hate it here, but we need the benefits”? The market would become fundamentally more responsive and flexible.)
Obamacare now says you can’t be denied for pre-existing conditions, so once we get enough people to understand that being trans is not a choice and we get the arbitrary exclusions for all things trans-related removed from medical plans, I’ll be insurable again.
I will put up with a lot of crap to be, simply, insurable.
Maybe, if Republicans wanted people to not vote for Obamacare, they should have enacted simple regulations which levelled the playing field for all health providers, so that they had to compete in the market on price and efficiency, and not via tactics like cherry-picking customers (pre-existing conditions) and dumping unprofitable customers (rescission).
But, they didn’t. So someone else did it for them, in a way that they don’t like. I’d weep, but y’know, it’s not like they didn’t have their shot.
I, personally, don’t have anything resembling fine control over this train. All I can do is send letters to one of several hundred conductors. If they arrange matters so that I have to deal with bureaucratic idiocy and limits on my options in order to have ANY HEALTHCARE OPTIONS AT ALL, well, I’ll vote for that.
Maybe what the Republicans should do now, rather than figure out better ways to screw the unlucky, is figure out how to make sure that all Americans have actual, practicable access to modern healthcare. It’s a national embarrassment that we don’t.
I have to pay for health insurance that covers prostate cancer screenings and treatment, and I am PISSED OFF ABOUT IT.
Also, it covers tonsillectomies. I had a tonsillectomy years ago, when I was on my parents’ insurance, and I should not have to pay for insurance that covers a procedure I won’t need.
Meanwhile, the property taxes I pay by virtue of the rent I pay to my landlord go to pay for public schools, and I don’t even have kids.
I am telling you, this is an OUTRAGE.
You are a SUBJECT Elusis! A SUBJECT!
Really, probably better than being an object.
This argument makes no sense. By similar logic, it would follow that since people don’t donate much money to fund education charities working on the other side of the world, they don’t benefit from paying taxes to support the schools in their own community.
And not that this is relevant at all, but actually, I donate about 7% of my income to charities working in the developing world. Just because you don’t care about your fellow humans doesn’t mean nobody does.
I like to think I’m a verb. I like verbing things.
I’m a gerund.
“Having a healthy population benefits everyone.”
Yes, to a modest degree. But the health benefits the person who has it, much more than it benefits the people around them. (As opposed to education, which benefits other people very nearly as much as it benefits the recipient.)
“If the healthcare system could eliminate tobacco use tomorrow…everyone would benefit from that particular lack of options.”
Tobacco farmers? People who invested their life savings or family fortune in Philip Morris? Members of the Ojibwe tribe? A few million people worldwide who work in the industry? The approximately 5.5 trillion people who take a minute of relaxation with a coffin nail during a hard day? (Some of those people are taking seconds. )
It would be better for health outcomes overall, that’s certainly true. But “everyone” is a strong word. It often finds its way into discussions like this one, and too often – I do this myself – it’s shorthand for “everyone I like”.
I do not believe it is the healthcare system’s *place* to eliminate lifestyle choices. Educate – even evangelize – about risk and outcome, certainly. But there’s no logical stopping point. Yes, I know, the slippery slope is never as slippery as it seems…but once the doctor is telling you what you can or can’t do, it becomes harder to hold the line against that intrusion on free choice.
“Well, roughly the other half of the population out there isn’t going to have prostate problems. They’re also not going to need help with erectile dysfunction. There are lots of things some people might not need coverage for, but if everyone pitches in, then everything gets covered.”
A nice thought, but not true. If everyone pitches in, then (possibly) the maximum amount of things get covered – although the strong self-utility of health care might end up pushing an outcome where people aren’t willing to pay as much in single-payer taxes, in sum, as they were willing to pay for their own health care expenditures, in sum. But maximum and “everything” are, again, distinct. For example – and not to be a MRA whiner about it – erectile dysfunction and prostate problems are NOT included on the must-cover list, while gynecological functioning is.
I would be glad for you that you were now insurable, regardless of my view of the overall system, but from what you’re saying you still aren’t insurable, at least not for trans-related things. My understanding of single-payer systems is that many of them do cover trans-related health care, but that some do not. So it appears to be a function of culture and public attitudes, rather than a function of the system’s design.
“Maybe, if Republicans wanted people to not vote for Obamacare, they should have enacted simple regulations which levelled the playing field for all health providers, so that they had to compete in the market on price and efficiency, and not via tactics like cherry-picking customers (pre-existing conditions) and dumping unprofitable customers (rescission).”
Efficiency would seem obviously, if inhumanely, to entail exactly that type of optimizing-the-bottom-line behavior. I do agree though that pre-existing conditions and use of health care services ought not to foreclose a person from getting more needed care; unfortunately that is pretty fundamental to an insurance model. Once we know you have Chronic Creeping Awful Disease, it’s no longer insurance, it’s you getting a hell of a bargain. That’s one of the many reasons that insurance is not a good foundation for health care financing.
I’ll also agree that Republicans (and Democrats) should have engaged in some common-sense, competition-enhancing legislation. The Big Two in that department would be 1) ending the tax treatment of employer-sponsored care, so as to untie employment from health insurance and erase a whole host of stupidly perverse incentives and 2) invoking Congressional supremacy on interstate commerce, and permitting health insurers to offer policies across state lines. I’m a states-rights kind of guy, but I can see a pernicious set of market failures where it exists and letting the states set their own hobbyhorses into play was an ever-building disaster.
” So someone else did it for them, in a way that they don’t like.”
Except that they DIDN’T do it for them. Employer-sponsored plans still get special treatment, and competition across state lines is still not in play. Getting rid of prior-condition exclusions and such is good for consumers who have those exclusions, bad for everyone else, and – if done properly – neutral towards competitiveness between companies. Additionally, while competition between health care *financers* is all well and good, what is really desirable is competition between health care *providers*. Aetna doesn’t cure anybody, they just write checks. We might squeeze pennies out of them with appropriate regulatory regimes, but it’s the docs and clinics and hospitals who should be trying to deliver a high quality level on a lower budget. Instead they focus on quality of care (which is fine) and leave the money questions to the insurers, who of course are happy to fuck any and all comers. Another reason for insurance to not be the cornerstone of a model.
” If they arrange matters so that I have to deal with bureaucratic idiocy and limits on my options in order to have ANY HEALTHCARE OPTIONS AT ALL, well, I’ll vote for that.”
From what you’ve said, you don’t have the correct range of healthcare insurance options because of social prejudice against transfolk. Maybe I misunderstood? Trans-related healthcare issues aren’t on that list of must-cover items so I don’t see where Obamacare improves your position.
Also… you have a job. You can afford health insurance premiums. If you can afford the premiums, then why can’t you afford to stick money in the bank instead (if the insurance is doing nothing for you) and then pay cash? That’s a healthcare option, maybe not the ideal one or your favorite, but an option. Yes, paying cash is often the most expensive way to do things – yet another reason for insurance not to be the measure of all things. The more inconvenient and process-laden the payment method, the higher the price ought to (and in other markets, tends to) be. The person just laying down a stack of Benjamins ought to be the queen or king of the waiting room, but instead they’re the leper at the gate.
“Maybe what the Republicans should do now, rather than figure out better ways to screw the unlucky, is figure out how to make sure that all Americans have actual, practicable access to modern healthcare. It’s a national embarrassment that we don’t.”
So are you acknowledging that Obamacare doesn’t get us there? (Not trying for a gotcha, just trying to gauge whether you’re a single-payer-or-its-crap ideologue, or a this-will-fix-everything-IT WILL-IT WILL-I’M NOT LISTENING pragmatist along the lines of Amp.)
I agree that practical access to healthcare ought to be a priority. How about a system where the default is that people pay for their own routine care, that people insure at their discretion and choice against catastrophic major care that is needed, that the bottom quarter or so of the income distribution should be given health vouchers to give them the cash needed to cover routine care and some level of insurance or MSA/HSA funding, that the state governments should operate a level of public-service facilities intended mostly for the poor but open to all, with budgets set according to each state’s preferences for the level of such provision, and that the Federal government administer and disburse loan funds for people in need of unexpected care who do not have adequate insurance or means to cover it?
I went deeply into debt to get a college education (which paid off); I don’t see why the same kind of system couldn’t work for many health care needs. Of course, a system like that of interlocking networks of free agents wouldn’t put any power into the hands of Washington, and that is what is a national embarrassment…at least, to the people with itchy hands in Washington.
“I have to pay for health insurance that covers prostate cancer screenings and treatment, and I am PISSED OFF ABOUT IT.”
Well apparently you shouldn’t be. After all, you never know when you’re going to wake up and discover that you have grown a prostate, and then you’ll be very glad you have that mandated insurance.
“I had a tonsillectomy years ago, when I was on my parents’ insurance, and I should not have to pay for insurance that covers a procedure I won’t need.”
It’s funny, because you think it’s funny, and yet it is an absolutely crystal-clear truth about insurance; one does not buy insurance against things which cannot happen. You are being required to act in an economically foolish fashion, but since it spreads the costs around to everyone in a nice squishy liberal hug of equality, you are delighted, delighted to carry the additional premiums.
(Interestingly, the insurance companies ARE allowed to charge an individually higher premium for an *avoidable chosen* risk factor: if you’re a tobacco smoker, the insurers are allowed to Hoover your wallet like there’s no tomorrow. I guess some of us are more equal than others.)
“Meanwhile, the property taxes I pay by virtue of the rent I pay to my landlord go to pay for public schools, and I don’t even have kids.”
Hooray! How happy you must be. Since you’re (presumably) happy to be paying a collective toll for health care, most of which benefits other people exclusively and does little for you, you must be absolutely ECSTATIC to be paying a collective toll for schooling, a huge proportion of which comes directly back to you. Unless paying for things that actually do you good bothers your kindly sensibilities, I suppose. Well, maybe you an tear out important pages of the textbooks or something, so the little beggars don’t get one up on you by providing value for money.
“This argument makes no sense.”
You may not understand it, but that does not make it nonsensical. The claim is being made that spending on health care for other people has huge returns to the person contributing the money, period. I contrast this claim with the very small sums that most people actually contribute for health care for people not in their own country. The conclusion I am led to is that we gather some satisfaction from helping our neighbors and also some mild level of direct benefit (see Grace’s post), so we do see people willing to engage in things like single-payer that operates within their own nation. However when the people are distant, there is no direct benefit and the only incentive structure present is the altruistic warm-and-fuzzy one – and we see a correspondingly much reduced willingness to spend. Ergo, the claim of large intrinsic benefit regardless of the circumstance or location of the recipient of our help fails.
“I donate about 7% of my income to charities working in the developing world.”
I salute you, sir or madam, for being a member of the admirable tradition of giving freely for the welfare of distant strangers…
“Just because you don’t care about your fellow humans doesn’t mean nobody does.”
and then I humbly suggest that if you can jump to the conclusion that someone doesn’t *care* about people because they do not agree with you about the best way to *help* people, then your altruism seems to be a little bit tainted with self-righteousness. And since saying “you don’t care about your fellow humans”, sans the slightest evidence of same, is a dick thing to say, I’ll reciprocate: most forms of aid to the developing world are iatrogenic, this fact has become increasingly well-understood in the international aid community, and therefore your charitable contributions are hurting people and you know it, or should. Quit it.
“I’m a gerund.”
I’m disgerundled, myself.
Rob? Either provide a direct quote in which I actually say that I expect Obamacare to fix everything, or withdraw this statement, please.
“Having a healthy population benefits everyone.”
Nothing personal, Grace, but I could not care less if my health care decision benefit you in the least bit. My health decisions are made on almost entirely selfish bases: I want to enjoy a long life with Mrs. Gory and Baby Gory.
If anyone else benefits from my decisions, great, but their enjoyment of my continued presence on Earth, while understandable, has exactly no bearing on my decision-making process.
By the way, the same holds true for all of the bad health decisions I make.
And, from my point of view, your own health should be sufficient incentive for you to make responsible choices regarding your health care. My pleasure should be irrelevant to you. Don’t stay healthy on my account.
Yes, because we should all know enough about medicine to know whether or not what the doctor tells us is correct.
Yes, because we should all know enough about what our risk factors are and what our risk tolerance is to know what health insurance plan, if any, we should choose.
Yes, because we should all have earned enough money (or have a good enough employer) to have the most appropriate health insurance policy should we desire it.
I don’t think this covers all possibilities. Take, for example, people with type I diabetes or organ recipients; the cost of ongoing treatment can be very high, and yet it is neither catastrophic nor unexpected care–they need it day in, day out, for the rest of their lives. “Cash for everyday stuff, loans or insurance against unexpected large costs” assumes that health care falls into two modes, cheap maintenance and unexpected calamity. It doesn’t allow for expensive-but-constant levels of care that nonetheless leave the patients able to work normally (ie enough to be out of the income-limited government help, but not enough to really afford their treatment on their own).
I am not making the claim that our current system is particularly good at that either, though!
Jake, you don’t know enough about cars to know if the mechanic is cheating you, or enough about roofing to know whether the roof-repair guys are sticking it to you, or enough about farming to know if the veggies are fairly priced. In nearly every area of your economic functioning, you (and everyone else) are abysmally ignorant of the expert opinions that go into calculating which product or service or approach is optimal. All you know is what you like or don’t like, what your impression of the person giving you advice is, and what the cost is.
And yet armed with these flimsy and imperfect tools, you manage to keep a vehicle running without ruining your finances, your roof is sound and doesn’t often leak, and you regularly eat vegetables that don’t even give you a little bit of Toxic Vegetable Cancer. It’s almost as though there’s some kind of ‘clearinghouse’ or ‘market’ where the consumer can get a fair break for the most part because the limited analytical tools they start with are leveraged to the maximum extent, and the informed consumer can do very well. Maybe we should try one of those market dinguses for healthcare!
Amp, I withdraw the characterization that you think Obamacare is going to fix everything. You’re just unwilling to acknowledge any flaw in the legislation that doesn’t stem from it being not left-wing enough. You’ll criticize Obama for lying (in his mind, to get the law passed and/or to secure re-election) but you won’t accept that there’s any validity to the scathing right-wing, centrist, or non-partisan criticisms that have poured down it. I don’t think you’re dishonest, but I think it’s damn particular that I’m the one bitching about the law being a trillion-dollar giveaway to evil corporations. And hey, I’ve met you halfway at a number of points; some of the left-wing criticisms of the law are valid. Single-payer, much as I don’t want that, WOULD be better than this. That’s not an argument FOR single-payer, it’s just an argument about how bad the ACA is.
People in that circumstance should be expected to pay a significant fraction, but not a crippling fraction, of their earnings for life. If their earnings go to zero with dwindling health, then they fall into the charity basket. The lack of volition and choice that accompanies that basket should provide at least a moderate incentive to work as long as it is practical to do so, and to contribute what one can toward’s one’s bills for as long as it is practical to do so. Medicaid can be the payer of last resort for unfortunate folks in this situation; patient pays, then charity pays, then government pays.
but…. that’s ridiculous. Absofuckinglutely ridiculous.
I have graduate-level education in the sciences, including med school level classes at an actual medical school. I’m among the absolute top of informed consumers and I can tell you that my full understanding of medical treatments is a minuscule fraction of my understanding of things like auto mechanics, roofing, and vegetables.
That is for a plain and simple reasons: mechanics, roofers, and farmers are relatively fungible. That’s because cars, rooves (or “roofs” if you prefer), and vegetables are relatively fungible. Therefore it is possible to crowd-source and aggregate information for those things, without problem. Making the comparison even more bizarre, cars and rooves and veggies are generally very simple, so there is only so much information deficit you can have. Potato farming may or may not be complicated (it’s much less so than brain surgery) but potato purchasing is not very complicated. And so on.
The comparison to health care is so ridiculous that it is insensible. How can you make it with a straight face?
Here’s why that doesn’t work:
I can choose an auto mechanic based on the outcomes and reports of people other than me, because cars and car problems are relatively fungible and outcomes are relatively comprehensible. Also, what people want from a mechanic tends to be relatively consistent: did the car get fixed, or not? Therefore the reports and experiences of other people are a reasonably decent predictor of future performance by a mechanic.
i cannot do that for a physician, because
1) health problems are not fungible; a skill in one area may not translate to a skill in my problem area;
2) most people are even less educated than I am and are even less able to properly evaluate medical care, so their attempts to make unbiased evaluations of outcomes are even less likely than mine are to be reliable;
3) other people’s goals are probably vastly different than mine, and make a significant contribution to ratings without any way to distinguish their contribution;
4) there are no existing expert systems which can be relied on: those controlled by professionals are subject to regulatory capture and the remainder are vastly subject to gaming and worthless input;
5) therefore there is no reliable way to use the market to evaluate medical providers.
To illustrate with a specific example: The best NICUs have much higher death rates than midwives, because they take incredibly sick babies. Even the major medical birth centers can have higher death rates for similar reasons. In fact, one major way that midwives keep their problem rates so low is that they are supposed to avoid the problem births, which are handled by someone else. Truly understanding that in the context of selecting a birth provider requires an understanding of statistics and risk which very few people understand. How on earth would the market deal with that?
How do people hire lawyers? Not only is the subject matter similarly arcane, but unlike medicine where at least there is an appeal to empirical reality (“everyone treated with this powder dies/gets better”), in the law basic concepts can be upended and the entire landscape changed. Not every day, but often enough.
If human beings are capable of becoming [skilled profession X] then other human beings are capable of making reasonable judgments about suitablity and competence. The fact that roofing is less complex than medicine is irrelevant, because both are far beyond my knowledge; I am not assessing the roofer’s skill at his job or the doctor’s, because I don’t know how. Instead, I am assessing his or her presentation, their social reputation, subtle cues about success or failure, their apparent conformity to well-known realities of our knowledge base (doctors who say blood is actually cherry jello are probably incorrect), etc. The same kind of thing that I do when hiring a roofer.
G&W, there is a differential among human beings in terms of knowledge and intellect, but – in terms of your own policy preferences – you had better hope that the differential is not huge. Because a differential as huge as what you are claiming is not an argument for having the choices of a technocratic elite replace the choices of the common folk; Barack Obama is no smarter than you are, and if you’re too dumb to pick a GP then he is too dumb to pick one on your behalf.
No, a strong differential is an argument for a rule BY the ultra-skilled professionals. The doctors walk among us, dispensing their wisdom and giving us instructions, which – simple creatures that we are, unable to tell an apple from an aorta – we obey blindly and without recourse. Anybody who has ever actually met a doctor has probably been impressed by the person’s depth of knowledge and professional acumen, and also impressed that they made it into the office without being run over by a bus.
They’re just humans, lawyer man. You have not the slightest idea how to do my job, but that doesn’t mean that I get to make all your computer programming decisions for you, even if – even THOUGH – my decisions would be better than yours.
In most cases, one can evaluate a lawyer’s performance much more easily than a doctor’s. Public records are a great help. In cases where one can’t evaluate by public records (computer programmers, for example), word of mouth and recommendations are both more likely to be accurate and more likely not to be fatal or permanently disabling.
I remain unconvinced by your argument.
“in most cases, one can evaluate a lawyer’s performance much more easily than a doctor’s.”
…because unlike in medicine, where whether a treatment worked or not is totally concealed from human knowledge, in the law a special committee goes around affixing blue ribbons on the cases that were really well-argued?
You’ve been to the doctor, right? You can tell whether you’re dying or getting better?
With the “I shouldn’t have to pay for coverage I’m not going to use” argument, I keep thinking back to Matt Yglesias’s writing on cable unbundling:
OTOH, the cable companies probably will end up charging sports fans even more than the $60. And neither the cable companies nor health insurers have perfect knowledge of how much you’re willing to pay or exactly what part of their offerings that you do pay for that you’ll be using. Not signing up for certain types of coverage, such as maternity-related coverage, does provide the insurers an accurate signal that such coverage has little value to you (and of course they also know that they won’t be on the hook for any maternity-related health care you did end up having). On the other hand, for things such as prostate exams for people without prostates and tonsillectomies for people without tonsils, the insurance company already knows both that that coverage has no value to you and that you’re not going to use them, so opting out shouldn’t change what you’re charged for premiums.
This way of looking at it doesn’t really come down on one side or the other of the opt-out question, but it is a reminder that opting out might not have as big an effect of premiums as you’d expect.
The really skilled folks usually have good reputations, but not all of them. Worse yet, many of the people with good reputations are not especially skilled. And to a large degree, people rely on the attorney to judge and sell his/her own skill, which (to put it mildly) is an inherent reliance on attorney ethics which doesn’t always pay off for the client.
Sure, though they may potentially need to go through a huge cost to understand it, and the group of such other humans may be relatively small.
What of it?
But they’re NOT. You could learn to assess a roof in a relatively short time. The same is not true for medicine.
It’s the “same” only if you ignore all of the important differences which are the basis of the entire argument.
My policy preferences are based on my perception of reality, not my hopes for what reality would be.
I don’t think he’s any better at it.
I do think that there are people who are better at it (medical boards, for example, though they don’t always do a good job.) Some of those people are insurers, who generally have both some expertise in evaluation; access to information; and a shared incentive to use medical professionals who are relatively efficient.
Yes. Or by people who are specially trained in evaluating them, and who have the information to do so.
Well, I don’t. neither do most people on Alas, I suspect. But it would be a vast understatement to say that the Alas participants are unusually well educated and able to do those things. On average, most people do–unless they are stupid enough to fall for homeopathy and such.
Many of the doctors I know are some of the sharpest and smartest people I hang out with, which–again, since I lead a life of extraordinary educational privilege–is saying a lot.
I don’t know how to do your job. But I could probably evaluate your ability to produce a computer program in a limited area, at least within a reasonably accurate way, with a hell of a lot less training than you have. In other words, I can’t replace you but I could probably manage you. And the reverse is also probably true: in the context of a limited-area law practice, you could probably manage me if you needed to without going to law school first.
Yes, that comparison is more true than not.
Medical records are private, and there is zero ability to find out how a particular patient was treated (including the relevant things like “what their problem was” and “what the doctor did to try and fix it” and “what happened.”) Often you can’t even find those things out in the aggregate.
Law is (with rare exceptions) entirely public. If you want to, you can read the entire cases including all the filings, even for insanely personal shut like divorce and estate law. And there are large groups of lawyers and legal reporting magazines and blogs which make a point of doing exactly what you describe, whether “talking about people who made a brilliant legal argument” or “talking about people who screwed up.”
Jut, I hope this doesn’t come as a shock to you, but I am unsurprised. Over the years, Republicans and conservatives have made it crystal clear that they would not care if I starved to death or died in a fire.
I do not practice this callous indifference in my own life, but I recognize that I live in the world with it. I’m just careful to keep an eye on it and have a big stick at hand.
Earlier in my life, I actually voted Republican and had some pretty Libertarian views. But then I grew up, some, and decided that if I worked to lift everyone up, maybe I would deserve to be lifted up, too. So my wife and I decided to dedicate my professional life to doing sometimes-dangerous work for the public good.
Make no mistake: if your family and mine were suspended in a deathtrap, I’d save mine first. But then I’d also try to save yours.
My wishes for happiness and health to the Gory family,
Here is a decision by the 7th Circuit Federal Court of Appeals. The plaintiffs, devout Roman Catholics, sued for a preliminary injunction against enforcement of the requirement, with an eye towards seeking an exemption to the requirement of the ACA that they provide a healthcare plan that includes coverage for contraception and sterilization procedures on both constitutional and statutory grounds.
They lost in the Federal district court, that loss being noted on this blog IIRC. They appealed. The U.S. 7th Court of Appeals had a different opinion than the District Courts did.
Thanks for this post, Ampersand. I wrote about it at my blog a couple of times, and was thinking about doing an update with new examples of the defenses of Obama, but I think I’ll just link to yours instead.
I thought that Obama had lost a little traction among his fans because of the NSA revelations, and even the bellicosity towards Syria, but evidently not. Even some groups and people who’d been fairly critical of him lately have relapsed. As Nietzsche said, of necessity the party man becomes a liar.
“… of necessity the party man becomes a liar.”
On that theme, here’s a column from Michael Cohen in the New York Daily News. Gotta love the title:
Behind Obama’s lie, our own immaturity
We can’t handle the truth
So politicians don’t lie to us anymore. They give us “comforting assurances”. After all, what’s more important? Getting policy objectives achieved? Or telling the American people the truth and letting them have their say with their elected representatives based on facts? The answer for this guy seems to be obvious. President Obama and his administration knows better than we do what is best for us, so they are justified in lying to us in order to get their aims accomplished.
Holy shit. 1984 was supposed to be a warning. For these people it’s an instruction manual!
This is a blueprint on how to destroy democracy in America.
Yes, Ron, this is true. To give just one example from the other side of the barricades, the Iraq War was going to pay for itself with revenues from Iraqi oil/it would be a cakewalk.
This is the way politics has worked for decades. Read my lips, no new taxes. Must I continue? Politicians get elected by saying what the voters want to hear. Politicians get public support for their policies by saying what the public wants to hear. This is a fact older than I am.
Is it awful? Hell, yes. But this is what the voters respond to. Politicians may be power hungry dirtbags, but they’re not so dumb that they don’t know how to get elected. Until politicians are punished for lying by not getting elected/re-elected, this is the way it will be.
I don’t remember the President ever saying either of those things – if you can find a citation I’d love to see it.
That I do remember.
In his case it DID cost him and his party an election, IIRC. No bullshit about “comforting assurances” from the MSM then. And that’s the point here.
Find me an example where a previous President knowingly lied and then had someone in the MSM baldfacedly tell us that it was our fault because otherwise it would have kept the President from doing what was best for us.
Democracy doesn’t work. This is one of the reasons.
It’s also, Amp, one reason why I just can’t get worked up about potential discouragement of marginal voters. Oh no, a small contingent of people who have to be lied to and deceived by politicians before they’ll give their assent to some plan of the politicians’ that is itself a dishonest deception. Oh no. What a shocking betrayal of good governance.
“I don’t think democracy works. That’s why I support sabotaging it.”‘
I’m working to heighten the contradictions and bring about a wonderful revolution.
“Yes, because we should all know enough about medicine to know whether or not what the doctor tells us is correct…Yes, because we should all know enough about what our risk factors are and what our risk tolerance is to know what health insurance plan, if any, we should choose.”
Not intending to redredge the argument, but Jake, aren’t you an advocate of patients having more control over their pain meds?
I was reminded of this, and motivated to bring it up when random surfing produced one of Mandolin’s posts about depression, and you said (in regards to patients having a lot of information about their own conditions):
“I think doctors are getting used to the idea that the internet is there and loaded w/ info and that a moderately intelligent patient can locate good and accurate information.”
In your pain med thread in fact, you agreed with me (!) that basically deregulating pain meds was the answer – MorphineRUs stores downtown etc. – and in the same thread, you talk about inexperienced doctors and incorrect (because politically- not medically-driven) policies, etc.
So I guess I’m puzzled, Jake, at where you come down here. Do you think patients have the necessary wit to be effective proponents of their own interests in health decisions, or do you think they have to be told what’s best for them by the elite? I guess you could believe that we’re competent to decide whether we should get morphine or not but not to decide how the morphine should get paid for, but I would have a hard time making that argument with a straight face.
Not playing gotcha-ball, just noticing an apparent contradiction, and wondering what’s up.
RonF & Jake Squid,
I looked up the “pay for itself” bit:
So it appears that President Bush himself did not say it, but I think it’s fair to say that Donald Rumsfeld was speaking on Bush’s behalf.
The linking of “cakewalk” to George W. Bush is more questionable. The actual word “cakewalk” comes from a Washington Post editorial by Kenneth Adelman, a member of the Defense Policy Board during the George W. Bush administration. However,
On the Sunday before the opening “shock and awe” barrage, Vice-President Cheney said that the war would go “relatively quickly,” and that American troops would be “greeted as liberators.” He went on, when asked if the fighting might prove to be long, costly, and bloody, “Well, I don’t think it’s likely to unfold that way.”
This is substantially similar to the “cakewalk” claim. Again, George W. Bush may not have personally made that claim, but I think it’s fair to say that Cheney was speaking on his behalf.
Thanks, closetpuritan. I’ll read through that.
However, that misses the mark in two ways:
1) I see no evidence that the speakers had knowledge that what they said wasn’t true.
2) There were no apologists in the MSM that told us that it was our fault they lied to us because otherwise we would have stopped them from doing what was best for us.
Democracy works. It’s not particularly efficient, and it sure doesn’t guarantee a positive outcome for every member, but overall it works.
It’s one thing for leaders to make mistakes. It’s another thing to be corrupt – here in Chicago we see plenty of that. But when politicians in Chicago get caught lying no one tells us that they had to do it so that we would not keep them from doing what was best for us.
I’m not Jake, obviously, but Robert, surely any intelligent health financing system has to account for the fact that some people – quite a large number, in fact – are, given the choice, not going to make financial arrangements that cover their medical costs. Either because they don’t have the money, or because they didn’t plan well, or because they simply had bad luck.
Will that be 100% of people? No, but it’ll be a substantial number. It’s a larger number than the number of uninsured – if there’s one thing that recent news stories have made clear, its that there are a surprising number of educated people out there who are under the delusion that their $60 a month insurance will cover them in a crisis, when they in fact are virtually without coverage for all serious problems.
That’s reality – not everyone finances their own health care. Either you acknowledge that reality, or you don’t.
Your argument seems to be that if we acknowledge that reality, then we’re automatically claiming that no one in the world is capable of making their own decisions about pain management. You don’t provide even the slightest shred of logic or analysis to justify that enormous leap in logic.
The truth about pain management is, some people will be made worse off by pain medication being more freely available, because they are addicts who may end up accidentally overdosing. On the other hand, some people will be made better off, because they are in constant agony and need effective pain medicine. On the other hand, some will accidentally overdose. On the third or fourth hand, some who would have otherwise have committed suicide, won’t.
My strong preference is to come down on the side of treating pain whenever possible. I want to help addicts, but not at the cost of forcing people with serious pain conditions to live lives of unrelenting agony. We need to concentrate on other methods of treating addiction.
But that seems to me to have virtually nothing to do with the question of how to finance
painhealth treatment. If there is an analogy, I suppose it is this: Just as there will be some people who do not manage their own health care financing, there are going to be some people who are not capable of managing their own pain treatment. I certainly approve of having professionals available to manage those people’s care.
But where the analogy breaks down is this: There are lots of people who, given the choice, will do nothing about financing their future health care needs. Any health care financing system needs to address that reality.
In contrast, almost no one who needs pain management needs to be coerced to seek it, because their own bodies are already doing far more coercion than the government could ever manage.They may need assistance paying for it, and they may need help finding care – but given the choice, they want treatment.
For that reason, your analogy is completely inapt. The reasons some people need to be made to finance health care are completely, 100% different from the reasons some people need help with pain management.
I am, indeed, an advocate of patients having more control over their care. I am not an advocate of requiring all patients to be knowledgeable about their own risk factors or risk tolerance. I am not an advocate of patients being required to direct their medical care nor to create appropriate tables of personal risk factors vs risk tolerance. These things are not contradictory.
High Bush administration officials made literally hundreds of statements suggesting or stating that Iraq had WMD, or was collaborating with Al Qaeda, or both, and implied or stated that US intelligence showed this to be true. These were lies, and the speakers knew they were lies.
Since the MSM was largely a cheerleader for the Iraq War during the Bush administration, and almost never called them on their constant Iraq-related lies, of course few or no articles of the sort you describe were published. That the MSM is willing to call Obama on his lies (and is sort of piling on), but virtually never called Bush on his lies, is hardly a clear example of liberal bias in the media.
RonF: ” “Death panels” may be hyperbole, but the concept is there.”
Yeah, it is clear you give the least little shit about lying in politics. Sure.
I think there is actually a huge semantic difference between “If you like your plan, you can keep it [unless your insurance company changes it or your employer changes it out from under you],” and “No one anywhere will lose their plan, even if they like it.” I haven’t seen any clear citation to Obama saying the later.
The former is true for the overwhelming majority of us (Amp, admittedly, is an exception). RonF didn’t lose his plan, JutGory didn’t lose his plan, Jake Squid didn’t lose his plan, Robert didn’t lose his plan, I didn’t lose my plan. The average American didn’t lose their plan. A tiny minority of people with health insurance are forced to choose a new plan, despite liking their existing plan. A tiny minority of people are forced to get an actually more expensive plan. Within the context of political speech, that simplification is no “Smoking gun in the form of a mushroom cloud,” it isn’t even on the order of Sarah Palin’s “death panels” (a flat out lie, but at least it didn’t kill 800 thousand people), and RonF tells us that merely might have been hyperbole.
I agree that
But I don’t think it’s fair to credit Obama with implicitly saying [stuff between brackets], because the meaning of saying “period” – as Obama did multiple times – is to say “and there are no additional brackets or footnotes needed to modify my statement, it is true and complete as it is, period.”
Furthermore, a statement like this:
Actually does veer pretty close to saying “no one anywhere will lose their plan.”
Obama’s lie, I think, is akin to every Republican nominee for President since (and including) Ronald Reagan promising that they will cut taxes, increase military spending, and lower the deficit, without cutting Social Security or Medicare, all at the same time. (Being questioned about how he’d do this was, iirc, the context for Bush Sr.’s “read my lips: No new taxes” line). They are promising the impossible, and if they’re at all intelligent they know they’re promising something that’s impossible. So it is a lie.
But at the same time, the lie does reflect some of the person’s actual policy priorities. So it’s not just making up random viscous nonsense in order to demonize the opposition, like Palin’s “death panels” lie; there is sort of an actual policy statement mixed up with the lying.
My brackets are not intended to make explicit the implicit, they are intended to summarize what he explicitly said a few days after your quote:
June 23, 2009:
June 24, 2009:
This is something he said a lot of times. Sometimes he gave it the explicit context of the government is not going to take away anyone’s health insurance, but the insurance companies and your employers may. Sometimes he didn’t. I think most of this was intended to be directed at what effect will the ACA have on people who have employer based health insurance (the overwhelming majority of people with private insurance in the US), the “you” was not intended to be [if you are someone with a good individual plan, or someone in a state-backed high risk pool plan.]
Indeed, in his September address to Congress in 2009, he said:
So Obama made an overly strong statement, and then spent the next several weeks elucidating it and caveating it, and then used the more limited form of it in an address to Congress. Hardly something anyone should be “slammed for”. He may have repeated the overly strong form of it somewhere else, but at that point he had repeatedly provided caveats and context, so the strong form should be read in that context.
The Cadillac tax doesn’t get criticized because the Right Wing noise machine incorporates hatred for people who get good healthy insurance from their employers, as many of them are union or academics, and it is the RWNM driving the criticism.
And the Cadillac tax can’t be thrown at Obama’s statement for all the reasons I just listed: because Obama explicitly said that his statement wasn’t meant to say that your employer-provided health coverage wasn’t going to change, only that it wasn’t going to change by government diktat.
If my employer eventually cuts back on my health coverage rather than paying the excise tax, that is a choice on the part of my employer, not an order from the government. My employer could keep my coverage much the same and simply either (a) provide me extra health care benefits to cover the tax or (b) effectively cut my wages or decrease their growth by putting more of them into paying the tax. I’d probably prefer they just give me the money and increase my deductible, so that is probably what they’ll do. It will be a result of the ACA, but not imposed by the government, so pretty much what Obama said.
Charles S @61:
True, I just don’t know if I can keep it. When the Government passed a law that raised the cost of doing business, I did not suddenly find that I had new revenues to cover the expense. So, if I can afford it, I can keep it.
If not, I have a few options:
1) Drop coverage for my employees and force them onto the exchanges. Great for me; I would probably get a raise out of the deal because it is one less expense I would have.
2) Make them pay for part of the coverage. Right now, we cover 100% of the premiums. I could make them contribute 20% or 25%. Yeah, that is effectively a pay cut for my employees because their paychecks would shrink. Could be good for me; I might get a raise out of the deal, if their contributions exceed the amount of the increase.
3) Terminate an employee. The cost savings would more than cover the increase in premiums. I could probably pay myself more, but I bet that unlucky employee would feel a bit miffed. However, to paraphrase Rorschach: “Of course you must protect [Obama’s] new utopia. What’s one more body amongst the foundations?”
4) Bust my ass even more to raise revenues, even though I may not see my pay increase one penny for the effort. Don’t really like that plan…and I wouldn’t have all this free time to comment on Amp’s blog; I am sure he would miss my delightfully insightful commentary. But, Amp, it’s all Obama’s fault!
If nothing else, Obamacare may be the perfect crash-course in why conservatives dislike over-regulation by government. Government regulation imposes a cost on doing business. Many times, we don’t see it because it gets hidden in the price of goods. Here, the regulation forces the insurance companies to raise rates because they expect their costs to increase. They pass that on to me. If I cannot afford the increase, I have to make cuts (another concept the Government has difficulty grasping). I take none of the blame for this and do not blame the insurance companies. I blame the root cause of the increase: Obamacare.
This time, it is going to hit almost everybody, and the effects will be almost immediate. And, it probably won’t be pretty.
If CoverOregon had been up and running in time for us to be able to compare costs and make a decision, Obamacare would have been a great benefit to both the company I work for and most of the employees. By ceasing to offer health insurance and directing employees to the exchange (with assistance signing up from our broker), the company could control it’s costs by just upping salaries by our budgetary amount. The employees, in turn, would get better plans at a lower cost to them.
Just another example of how government over-regulation places undue and hidden costs on small business.
I guess we’ll just have to take those losses or pass them on to our employees or customers next year when CoverOregon is functional. It’s a sad, sad thing.
This just in (okay, a few hours ago):
Obama proposes to fix Obamacare so that its implosion won’t occur until after the mid-terms.
In related news, Pelosi wants the fix implemented immediately so she can find out what it is.
I think Kevin Drum’s take on this makes a lot of sense.
I agree with Myca, Kevin Drum is absolutely correct. See my example above @7.
My sister is being forced into a new plan, my cousin is on a grandfathered plan and will not have to get a new policy. This proposal effects my cousin not one little bit. If the insurance company for my sister doesn’t offer her her old policy, you know it wasn’t Obamacare forcing this. If the insurance company does allow her to renew her old policy, she’s happy. (Alternately, if the state doesn’t allow her insurance company to offer her the old policy, the state government is to blame).
It makes no sense at all.
Re-issue a canceled policy so that it can just get canceled next year?
Government acted; so the companies reacted; so the Government retracted; and, now, Government expects the companies to un-react. Hubris! Arrogance! Delusional! The News Flash is: people change their behavior in response to legislation and government action; politicians should figure that out.
If I were the insurance companies, I would say, “Fuck You! We did what you wanted. We can’t simply unwrite the replacement policies we already signed up. We can’t resurrect the canceled policies. And, why the fuck would we? Only to have them canceled again next year! Do you think we are idiots? We can’t simply wave a magic wand and attempt to alter reality the way you think you can.”
And, anyway, if these policies are “substandard” (whatever the heck that means-it does not live up to the “standard” they wanted), why extend them for a year? Why would Obama do that? Because he wants people to have crappy insurance? Because he hates us? Because he wants us to suffer and die?
No. It’s the elections-one of the reasons this law did not go into effect until after 2012. This is just the most cynical move he could make.
My guess, and this is only a guess, a theory, which is mine, is so that people have coverage on January 1st despite the colossal fuck up of the web site implementation.
I mean, I know that’s way, way out on the fringes of possibility, but, still. It’s my theory which is mine that I thought of.
Actually, Jake, I thought of that, too.
It is not just the elections.
After fighting with the Republicans and shutting down the government ( :) ) to make sure the law did not get delayed, he realized that the law would not be ready for another year.
The Republicans should hammer him on that too.
So, yes, I amend my statement. There are short-term and long-term reasons for him to back-track.
*high squeaky voice*
No. Ahem. Aheeemmm. This theory, which is mine, belongs to me because I thought of it.
Now I know how Leibniz felt.
I didn’t think the reference was that obscure. Ah, and so I age.
I got it.
See, Jut, even Robert got that!
I told you you should have used Wallace, instead!
We’re talking about the Monty Python brontosaurus theory, right?
Jake is, or was. I don’t know what the deuce anybody else is taking about, bunch of whippersnappers mumbling too quietly about things. Bring me my cane! Get off my lawn!
JutGory seems to be making actual science references. Wallace independently thought of natural selection after Darwin did. I had to look up Leibniz; Wikipedia says “Leibniz developed the infinitesimal calculus independently of Isaac Newton”.