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Selective Health Care Populism

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Anyone who participated in blog comments sections back in the previous decade knows that there was an inevitable response to criticisms of the Bush administration: “Republicans keep winning elections neener-neener.”  This was true until it wasn’t, as well as being irrelevant to the criticisms.  As Jon Chait argues, with virtually all of their empirical predictions about the ACA having proven to be spectacularly wrong, all that critics of the ACA have are public opinion surveys:

This is the reality that the entire Republican Party has failed to come to grips with. The American health-care system before Obamacare was an utter disaster — the most expensive in the world and also the only one that denied access to millions of its own citizens. Obamacare set out to change those things, and it has worked.

There is one remaining indictment of the law that Tanner makes, and it’s true. “The law remains extraordinarily unpopular, with opponents topping supporters by nearly 11 percentage points, according to the latest Real Clear Politics average,” he argues. It is notable that opponents of Obamacare have fixated on the law’s poor polling. In a recent column, Reason’s Peter Suderman quibbles halfheartedly with the law’s demonstrable success in carrying out its goals — suggesting that the astonishing drop in medical inflation may be owed to outside forces — before reveling for six paragraphs in his major point, which is continued lack of public approval. “Obamacare is simply not well liked,” he concludes, “This is the political reality — and President Obama still refuses to embrace it.”

It is telling that, having lost every substantive argument about the law’s operation, their sole remaining refuge is an argument about its perception. It’s true: Their lies got halfway around the world before the truth could get its pants on. Indeed, if you google most of the factual disputes I discuss above, you’ll get a lot more hits from conservatives making hysterical and false predictions than you will find from reports showing those predictions failed to come true. Those myths still hold enormous sway over public opinion. Far more Americans believe Obamacare has death panels, which is false, than believe its costs have come in under projections, which is true. Conservatives have won the propaganda war over Obamacare. The trouble is that they think this is an indictment of Obamacare, when in fact it’s an indictment of them.

As Chait says, it’s not an accident that much conservative criticism has focused on assertions that the ACA would fail on its own terms. The position of most American conservatives on health care — i.e. that in 2009 too many people had insurance and the insurance that many people did have was too good — is not only morally barbarous but would make the ACA look more popular than free beer in comparison. And in this sense, while the argument that the ACA is unpopular is unusually true for an anti-ACA talking point, it’s still very misleading. Preserving or expanding the ACA remains more popular than cutting it back or rescinding it. The ACA is the least popular health care proposal on offer except for all the others. Which is yet another reason for why Obama is not going to embrace Peter Suderman’s “reality.”

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  • rm

    Supreme Court just ignored precedent and made it impossible for the Feds to force states to follow the law and pay adequate Medicaid reimbursements.

    Which is not encouraging.

    I think the Republican playbook is still “sabotage the ACA and say the law failed.”

    • Murc

      I’ve been waiting for a post on that for awhile, actually, because that decision was both utterly jaw-dropping and seems like it’s a strong precursor to a 5-4 pro-Moops opinion coming right at us.

      Although to be fair, it’s actually the exact opposite of what you claim; as I understand things, the Supremes ruled that only the Feds can force states to follow the law and pay adequate Medicaid reimbursements. That is, private citizens and providers have zero standing, the Federal government has to file suit.

      • humanoid.panda

        This might be a 5:4 decision, but given the composition of minority and majority (Kennedy joined 3 liberals in minority; Breyer 4 conservatives in majority) I wouldn’t read it as precursor to any future cases.

      • Denverite

        The op ed in TPM was wildly overstated. Armstrong only was at odds with precedent if you take a hugely broad view of “precedent” to be “cases that were sorta kinda similar.” And while I think the question of whether the Supremacy Clause conveys an implicit right of action is an interesting one, Scalia’s conclusion that it doesn’t is in no way crazy or outside the bounds of existing legal theory.

        Plus, in the Medicaid context, a world in which any provider who thinks that he or she is being shortchanged by Medicaid rates can run to federal court to order the state agency to pay more money would be flat-out unworkable. Medicaid agencies construct their budgets very, very carefully, and oftentimes increasing one rate means cutting another. There’s just no way a court is equipped to make those sorts of decisions.

        (Incidentally, it’s also not the case that providers can’t challenge the rates as too low. In all states that I’m aware of, rates are set through the rulemaking process, and those providers can always file an administrative challenge — which would have the benefit of being decided by the agency in charge of balancing its Medicaid reimbursements. It is likely that providers could also go to state court, either on judicial review of the foregoing administrative challenge, or as an affirmative lawsuit.)

        • rm

          Good to know, thank you.

          Back when TPM was Josh’s personal blog, he was so understated in the face of extreme events. Now the site is hyperbolic clickbait.

    • DAS

      I agree with you about the Republican playbook being “sabotage the ACA and say the law failed”. That is why the GOP is not actually going to make anything but a “for show” effort to actually overturn the ACA. The GOP wants the ACA to be a miserable failure so they can win elections campaigning against it; if the ACA is not actually a law on the books, then that limits* their ability to campaign against the ACA.

      * as some will not doubt point out, it doesn’t stop that ability: the GOP was able to campaign against “Hillary-care” which wasn’t actually passed.

    • Joe_JP

      If such is the playbook, Breyer joining the majority there (on narrower grounds) and Kennedy in the dissent makes that a curious example of the trend.

      The “precedent” in this area to my understanding is in flux and there has been for years now a battle over just what it covers. The battle continues.

      http://www.scotusblog.com/2015/04/foreclosing-equitable-relief-under-medicaid-act/#more-226639

      • Denverite

        The “precedent” in this area to my understanding is in flux and there has been for years now a battle over just what it covers. The battle continues.

        Yes, and see above. A world in which Medicaid rates are set by federal courts through provider lawsuits outside of the regulatory process isn’t a feasible one.

  • DrDick

    This really reveals the central nature of the polling data that conservatives routinely use to support their positions and policies. Public opposition to progressive policies and politicians is largely based on ignorance and misinformation, especially the rightwing demonization of the term “liberal.” When you ask people whether they prefer liberal or conservative policies, they tend to favor the latter, but when you ask them to evaluation the actual policies without labeling them, the overwhelmingly favor progressive policies, often by60-70%.

    • Bufflars

      This should be repeated in every story about how unpopular Obamacare is. People really like every factual component of the law, but if you bundle them together and call it “Obamacare”, people all of a sudden hate it. I wonder why that is…

      • advocatethis

        And the thing is that Suderman and his ilk know this. They know that they are making a hollow argument, but since that’s the best that they’ve got at this point they go with it, rather than reexamining their premises and concluding that maybe they were wrong about the whole thing. I know it’s way too much for them to admit that they’re wrong, but couldn’t they even just shut up about ACA now and move on to something else they can be less spectacularly wrong about?

  • You would think by now that people would have noticed the lack of death panels. I mean, as soon as the first granny gets put on the ice floe, there would be massive publicity, no?

    • Todd

      As with Hussein’s WMD program, the lack of evidence is really evidence of a massive WMD program. The death panels are probably mobile, in some sort of unmarked van-type vehicle, never parking in the same spot. Here, look at these photos from 5 years ago.

      • I mean, as soon as the first granny gets put on the ice floe, there would be massive publicity, no?

        As with Hussein’s WMD program, the lack of evidence is really evidence of a massive WMD program.

        The absence of evidence is not evidence of absence!

        It is a good comparison, though, because a huge chunk of the population still thinks we found weapons (hey, somebody’s gonna buy that Judy Miller book) and I’ll bet plenty, come 2016 and later, will still believe there are death panels, skyrocketing costs, etc.

      • Hogan

        And Obama has refused to cooperate with the UN inspec–oh wait.

        • I look forward to my UN colonoscopy.

  • divadab

    It’s a structural problem, similar to re-legalization of cannabis – the majority of people are not affected by the issue and are guided rather by propaganda than by personal experience.

    And the propaganda is powerful and pervasive – and so irresponsible and full of lies and half-truths – that it perpetually dupes over a third of its target. The third you can fool all the time, you know, your average Faux News watcher. The whole edifice of the MSM is the most sophisticated mind control apparatus ever devised – on one level it’s necessary herd control, but I just shake my head at the apparent stupidity of its dupes. It’s hard not to feel utter contempt for the people who take TV “news” seriously – but I suppose in a complicated world fraying at the edges, it is comfortable to just surrender your brain than resist and think for yourself.

    • furikawari

      I would say that it is not just the right-wing propaganda that reinforces this. Any change that an insurance company wants to make–network, drug coverage, whatever–is going to get an explanation to the policyholder as “Obamacare made us do it.” Whatever the actual provisions of the law, and its pro-competitive benefits, most people covered at work are only going to interact with the brand when their insurance company does something negative to them, and then blames it on Obamacare. Add that doctors or work HR folks may be intermediating between the insurance company and the employee and there is now someone that you trust (more) telling you that Obamacare is at fault.

      As an example of the deflection that insurance companies will willfully engage in, my car insurance company tried to raise my rate by 33% this year. When I called to complain, what they told me was “it’s due to inflation.” I s*** you not, the CSR asked me if I had seen the price of a loaf of bread lately.

      I would hope that people don’t take what their insurance companies tell them at face value. But I don’t put a lot of faith that the hope will be borne out.

      • DAS

        The law didn’t even need to pass for this to happen: I remember while Hillary Clinton was working on health care reform during the Clinton presidency,health insurance companies would routinely screw people and then claim they had to change their policies in order to prepare for HillaryCare

  • joe from Lowell

    If there’s anyone who has the right to complain about people adhering to an unpopular policy line, it’s a writer at a libertarian magazine.

    Wait, what?

    • Barry_D

      Seconded. If the editors and writers at Reason ever succeeded in laying out their goals to the average American, it be the best thing for the Democratic Party in decades.

  • SgtGymBunny

    Well, framing opposition/dissatisfaction to Obamacare as something that is only happening on the right doesn’t really help either. To my understanding there are those on the left who feel it didn’t go far enough with the public/single payer option and that it was a giveaway for the insurance companies. I cringe when people point to the general dissatisfaction polling numbers as evidence of that the right is unanimously “winning” the public relations war on Obamacare.

    • Murc

      This is my understanding as well; from what I’ve seen and heard, all of those “X% of people hate the ACA” stats include a lot of people who hate it because it don’t go far enough.

      • joe from Lowell

        In this ORC poll, the “oppose/too liberal” is consistently about 3x the “oppose/not liberal enough” number, which is in the low teens.

        Chart here, but older data.

        • sam

          it’s still a distinction that should be made though. I’m savvy enough about how these statistics are used that I will support the ACA through thick and thin and enthusiastically endorse it in any poll, even though I’d much prefer single-payer. but if specifically asked about single payer, I’m not going to lie.

          • DrDick

            Right, and the fact remains that, while less than ideal, the current law is a huge improvement over what we had.

        • SgtGymBunny

          You’re right, but what sam said. They’re still fudging the numbers up, which is disingenuous.

          • joe from Lowell

            Right, I’m not disagreeing with anyone. I just thought real numbers would help.

    • Barry_D

      “To my understanding there are those on the left who feel it didn’t go far enough with the public/single payer option and that it was a giveaway for the insurance companies. ”

      Do you realize that that opposition is strikingly different from right-wing opinion?

  • sam

    The thing that drives me the most crazy is when people I know complain about how “Obamacare” has made it impossible for them to find a health plan, or how’s done X horrible thing or Y horrible thing, when “horrible thing” was something that the insurance companies have ALWAYS done to people, but now we can conveniently blame said long-standing practice on the gubmint.

    I have one neighborhood acquaintance who is a self-described “crazy libertarian”. He’s a semi-retired ex-hedge fund guy living off of investments (I know, rough life), so he actually needs to self insure. He’s decided to go without and pay the penalty, because, according to him, the health insurance broker he went to told him that there were only two providers in NY, neither of which his PCP took. I looked at him and said “what the hell are you talking about” and pulled up the New York State of Health website on my phone, were I proceeded to show him the dozens of providers and hundreds of plans and tiers available in New York City.

    Unfortunately, I didn’t run into him and have this conversation until after the open enrollment period was over, so he got screwed by what appears to be an unscrupulous broker (my own theory? said broker was getting kickbacks from a small number of providers to steer people in that direction), combined with his own political antipathy towards the requirements which led to, quite frankly, a lack of engagement on his part until it was too late. But unscrupulous brokers existed before the ACA – now they just have a bigger pool of people to prey on.

    • Murc

      Does open enrollment being over actually matter? You need to sign up during it to get subsidies, but my understanding is that if you don’t qualify for subsidies, which this guy wouldn’t, you can go and buy coverage anytime you want for the same rates as anyone else.

      Or am I wrong about that?

      • Denverite

        Or am I wrong about that?

        Yes. Plans don’t have to sell to you outside of the enrollment window.

        • Murc

          Interesting. Can they CHOSE to sell to you outside the enrollment window?

          • Denverite

            Yes.

        • john fremont

          Long time reader, first time commenter. Insurance companies are required to offer a policy outside of open enrollment only if you have a Qualified Life Event. These include new residency within the state, relocation from Native American reservation, birth or adoption of child, change of employment status etc. I went through this last year. My employer failed to make payments on my Healthcare benefit elections at work after I returned off of long term disability of which I was paying into a COBRA policy as required by FMLA. The insurance company canceled my insurance after I did not make a payment after the 90 day grace period allowed on COBRA payments. I thought my company had put me back on the company plan since I was back on full time. My employer failed to notify the insurance company that I was off of disability. My plan was canceled after open enrollment. With a preexisting condition and no Qualified Life Event , no insurer would sell me a policy in Colorado. I went without insurance last year because no insurer would cover me and paid the Obama care penalty this tax season.

    • muddy

      More likely than a crooked broker is that the guy never looked into it at all, because he “already knew” the answers.

      • sam

        Oh, I’m sure that, given this guy’s particular political leanings, he was steering into the “Obamacare sucks” answer that he already had in his head, and didn’t do any independent navigation, but he had enough information about the two healthcare providers that his broker had offered him that I’m pretty sure he wasn’t making the broker piece of it up (and he and I have a friendly, neighborly, enough relationship that largely involves sitting at our local coffee joint and arguing in a very friendly manner for hours on end about politics that I’m not sure why he’d lie to me about that).

        Also, I’m pretty sure you’re stuck with the penalty if you don’t get a plan by the end of the open enrollment period, even if you get one later. That’s the big stick in the subsidy-carrot/penalty-stick of Obamacare. So once he decided he was paying the penalty (which, given his finances, was actually going to be several thousand dollars), he wasn’t going to go out and pay for insurance on top of that.

    • Denverite

      There’s nothing illegal about being an exclusive agent. That’s been allowed forever (and is still allowed — there’s CMS guidance specifically on this).

      However, if he represented that his principal was the only carrier in town, that’s likely fraud.

      • Murc

        Or if this broker represented that he was a NAVIGATOR and not a broker.

      • sam

        Yeah – I tried to guide him to that conclusion as well.

  • Joe_JP

    ACA set forth to change those things. “Obamacare” continues to make it harder to move past this just being about “Obama” or about the Democrats in particular. Medicare or Medicaid is a national thing. It isn’t just tied to a certain President or political party.

    When the current craziness about Moops invading Spain etc. is over — and this too shall pass — a more neutral word is likely to be used, just as “same sex” or “gay” marriage will drop off and just be another sort of “marriage.”

    • Lee Rudolph

      Medicare or Medicaid is a national thing. It isn’t just tied to a certain President or political party.

      Wait. You mean Medicare and Medicaid weren’t imposed on us by the Medicis?

      Man, talk about a poison pill.

      • DAS

        I find your ideas intriguing and would like to subscribe to your newsletter.

      • StuckinOz

        It was Medicicare that refused to pay for Michelangelo’s carpal tunnel surgery. Said it was a pre-existing condition.

  • Srsly Dad Y

    What amazes me most is that people don’t appreciate how epic it is that you can’t be denied coverage due to a preexisting condition. (I mean, in the sense that “can’t” means it isn’t legal.) I understand the three-legged stool, but I still sort of can’t believe we actually enacted that, and yet a lot of upper-middle-class people are oblivious and truly think the ACA did nothing for them and their families.

    • Denverite

      It’s because most people get insurance through their employers, and it’s been illegal for quite a while for group carriers to exclude preexisting conditions for people who have maintained coverage. Throw in that one spouse losing his or her job is a qualifying event for opting into the second spouse’s employer-provided coverage, and you’ve got a situation where most working-age adults weren’t really affected by preexisting coverage exclusions (except in the sense that they were under the threat of losing their coverage if they lost their job).

      • Srsly Dad Y

        I’m sure you’re right about that. But it seems to me that most extended, upper-middle-class families I know include at least one divorced person and one person with depression or a cancer history or diabetes. For AARP-eligible single people in the private sector, it’s a life-altering benefit.

      • Aimai

        I don’t think people with employer sponsored health care are as ignorant of the facts as you think, Denverite. Most people can remember the extreme excitement they felt the first time they could register in one of those employer “open enrollment” periods and not be denied, and many things could still be denied coverage once you had disclosed them. You could get health insurance, but you couldn’t get coverage for your cancer or whatever. Meanwhile (for example) I have a very young daughter with Asthma. Like a lot of parents I worried endlessly that although she was covered under our health insurance as a child, when she grew up she might be uninsurable as an adult because the asthma was a “pre-existing condition.”

        But I agree that because of the nature of the insurance market–that is that a large new crop of people enters it for the first time every year–the rising young people probably don’t grasp how different the ACA makes the world they see when they go to get health insurance. They probably don’t know that their parents, aunts, and uncles went without insurance at all for years and years.

        • Denverite

          I didn’t say people were ignorant. Just not fully appreciative of the preexisting condition sea change because for most of them, they haven’t been subjected to it before. (Obviously a lot have.)

  • Davis

    Someone at the Weekly Standard is weeping over how the poor are screwed by the ACA. An exemption from buying insurance is available to people who don’t make enough to file a return, but you have to file a return to get the exemption! However, from the ACA website:

    “If you are not required to file a tax return and don’t want to file a return, you do not need to file a return solely to report your coverage or to claim an exemption.”

    The lies just keep coming. A correction will be forthcoming right after Bill Kristol admits he’s been wrong about everything.

    • NonyNony

      right after Bill Kristol admits he’s been wrong about everything.

      Bill Kristol cannot be allowed to admit he’s been wrong about everything.

      Bill Kristol is wrong about everything. He’s a unique individual who is actually immune to the maxim that a “stopped clock is right twice a day”. If Kristol were a stopped clock he’d be a clock that somehow managed to get stopped on “26 o’clock” or possibly “250 degrees Fahrenheit” or “17 dollars and 36 cents”.

      So if he ever admits that he is wrong about everything I’m pretty sure a paradox that size would break the universe. If he were to ever attempt it we’d either all cease to exist instantly or we’d have proof of time travel as every future time traveler came to that moment specifically to prevent him from destroying time and space.

      So for the good of the universe, he’s not allowed to say anything about being wrong about something – unless somehow that statement is also wrong. It’s purely for safety reasons (it doesn’t mean anyone needs to listen to him, though, unless they’re looking for some kind of a device that somehow tells you where not to go – like the opposite of a compass.)

    • Scott Lemieux

      We talked about that this weekend.

      • Davis

        Missed it. I was away. Plus it was an opportunity to get in a Kristol dig.

    • UserGoogol

      Poor people probably should file anyway, since they can qualify for EITC or they might be entitled to refunds.

      It’s really frustrating how anti-tax people hold up the act of filing taxes as being this huge bureaucratic burden on people. Yes it’s annoying and a bit intimidating, but if you don’t have complicated deductions to worry about (and if you’re poor, you shouldn’t) you’re just filling numbers into boxes. Also, free e-Filing services are pretty easy to qualify for.

  • ralphdibny

    I was at the bus stop the other day, chatting with another parent. She was complaining about how little she sees her daughter, what with her long drive to the restaurant where she works and the odd hours she works. Plus, she doesn’t get as many hours as she used to, so she’s having trouble paying the rent, thanks to Obamacare.

    In other words, opposition to the ACA isn’t just about health care, and never has been. It’s about shifting the blame for the increasingly precarious position of working-class Americans from corporations to the government.

    • JustRuss

      I wonder how far we are from “Obamacare crashed the economy in 2008”. 2016 seems a bit too soon, wouldn’t surprise me to the Republicans try it in 2020.

      • Louisiana Republicans already blame Obama for the terrible federal response to Hurricane Katrina in 2005. I guess the theory hasn’t made it into the Daily Caller yet.

    • DAS

      This might be true though: her employer will give her fewer hours so the employer doesn’t have to pay for her health insurance. Her landlord, however, may have decided to provide health insurance for his/her employees and hence has extra costs, passed onto tenants as increased rents.

      Moreover, the young woman in question has likely had her health care costs increase because of the ACA. As a healthy young person, she likely figured all she needed was major medical (i.e. actual health insurance which cost her maybe $1500 at most) and maybe went to a community clinic in case of something more minor. OTOH, according to the Health Insurance Marketplace calculator from the Henry Kaiser foundation, a single young adult making $25000/year would only receive about $100 in subsidies and thus a bronze plan would cost about $1900/year. And when you make $25K/year, $400 is a big chunk of change.

      But yes. Opposition to ACA isn’t just about the ACA itself. It’s about a number of things (including, as muddy points out below, Teahadis saying “IGMFY”) including the precarious position of working class individuals in our society.

  • muddy

    Being that the Teahadis age range is pretty high, probably a great deal of the ones saying the ACA is terrible are people that have Medicare already. IGMFY

  • We all heard last November how Mitch McConnell convinced Kentucky voters that the Obamacare they loved was not Obamacare but something he had personally provided them (one of Lundergan Grimes’s many failure, of course, was not disputing him). Right now in Tennessee the Medicaid expansion which seemed to have failed earlier in the year is getting a second chance by being redefined as having no relation to the ACA, although it obviously is part of the ACA.

    • rm

      Grimes ran the most effective campaign I’ve ever seen running for KY Sec of State. She ran one of the most horrible running for Senate. Wonder who was running each campaign.

      And, yeah, the defining moment of ACA in Kentucky was a reporter interviewing customers at the KYnect state marketplace sign-up at the State Fair and getting the quote “it’s gotta be better than Obamacare.”

  • Rob in CT

    It’s true: Their lies got halfway around the world before the truth could get its pants on.

    Being willing to say stuff like this flat out is one of the reasons I like Jon Chait, warts and all.

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