Try Something Different, Dems. Like Actual Defense of the ACA. There’s Nothing to Lose But Loss Itself. Really.
Reader Alex Bollinger posted this this morning in the Comments thread to this post of mine from yesterday:
Not only would low-info voters benefit from actually knowing that the ACA is doing good, but a few lefties could use a reminder that it’s not just a neoliberal gift to the insurance industry.
I responded:
Yes, Alex. Exactly. It surprises me that the insurance industry hasn’t been sponsoring pro-ACA, anti-AFP-disinformation ads. I realize that it would involve implicitly acknowledging that their past policies–e.g., denying individual-market coverage to anyone who had even a minor preexisting condition–but they’re in real danger of losing the single-payer war (or at least the public-option) war.
Back last December, after it had become clear that many of the state Blue Cross companies–which had by far the largest market share of the individual market in many, many states–was taking obscene advantage of the ACA (and then the healthcare.com debacle) to imply to policyholders of canceled plans that their only option was a very high-priced plan, I wrote here in AB that they were presuming that single-payer or at least the public option could not become a real possibility as a result. And by the very end of the year, after several pundits began making the same point, and it looked like the issue could really take off, the industry apparently did recognize it; it did stop the deceit.
What everyone seems to forget is that until last fall, the wingnut argument, including in the court challenges, was “Freedom! Liberty!” You never hear that anymore. Now all you hear is that premiums and out-of-pocket caps are too high and provider networks are too narrow.
Um. Single-payer would take care of those things. So maybe sometime before November the industry will realize that it’s very much in its interest to counter the AFP with a massive ad campaign. Call it survival instinct.
And, who knows? Maybe by the time the insurance industry realizes that the AFP ads need to be countered with an ad campaign of hard-hitting refutations and real-people stories, the Dems will have figured that out, too. I never got this idea of addressing the ACA with generic we-need-to-fix-rather-than-repeal it, and hope that that nullifies the law’s unpopularity as a political problem.
The way to nullify the law’s unpopularity as a political problem is to make the law popular. And all that would take is a good ad campaign.
Please, no more generic keep-and-fix. Please, now, specific refutations and explanations from actual real people . And, fix? A public option, maybe?
Seriously, Dems. Go for it. There’s nothing to lose but loss itself.
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I added this as an update to yesterday’s post, but I think it deserves a post all its own, in addition.
Many Dems have been acting like two year olds throughout this entire process. They wanted something different immediately and since they did not get it they started pouting.
They refuse to realize the harmful effects their actions are causing despite the fact they find themselves on the same side as the Koch Brothers.
Really scary.
Thanks for the shout out!
But anyway, I don’t think that insurance companies are actually worried about single payer/public option, or, if they are, they shouldn’t be. With a Republican House that won’t even bring up decent legislation for a vote and a Senate that can’t even confirm judicial nominees without changing its own rules, the public option probably won’t get through. The Senate is likely to tilt further to the right after the next elections and the House isn’t going to switch Dem (just a prediction).
My guess is the health insurance industry is planning the same kind of strategy that has been used in other areas like financial regulation and reproductive freedom: death by a thousand small cuts. They’ll start fights for seemingly innocuous rule changes in the courts, state legislatures, and Congress (after Obama leaves the White House), and eventually water down the regulations within the ACA so that the individual mandate is the only part left intact. This was my prediction when the bill was being passed, since the US has always been better at setting up social insurance programs than at maintaining regulatory regimes. Which is probably why they aren’t going to run ads in favor of the ACA any time soon: the insurance industry will always need some public opposition to “improve” the ACA.
As for the Dems, I agree. They just always take poll numbers as states of nature determined exogenously. Most people don’t like Obamacare? I’d better run against it, because there’s no chance that my constituents could change their beliefs if presented with a counter-argument!
Republicans, on the other hand, see polling as witchcraft to be ignored (see Romney’s “unskewed” polls) and keep on pushing a less and less broadly appealing agenda. It’s not necessarily better, but it does have its advantages.
It seems to me Democrats in achievable races can do themselves a world of good by (1) simply mentioning the words “public option” (in debates, ads and promotional material), and recommending simply that we revive discussion of it as a way to bring down costs and help solve any problems in ACA, and (2) make the specific proposal that people between 50 and 65 who lose their employer-based health insurance have the option to buy into Medicare. I can’t imagine the latter proposal being anything but enormously popular, while both, along with other traditional Democratic positions like supporting minimum wage increases and direct job creation through infrastructure repair and modernization, would help generate the enthusiasm of the Democratic base that does the work of getting out the vote. It’s turnout that Democrats need, and if candidates are wishy-washy they won’t get turnout — not only because voters will be turned off, but also because their GOTV support will be weaker.
It’s this dependence on the Democratic base for the work that generates turnout that the Obama people and most Beltway-oriented, Village-think Democrats have forgotten. Moderates and centrists don’t do that kind of work. The 2010 debacle — the worst mid-term in modern history after what seemed to be a game-changing outpouring of voter enthusiasm in 2008 — demonstrated clearly what Rahm Emanuel’s open contempt for the Democratic base cost the party, and it created the deadlock that has cost the country dearly.
I have to add that I do not understand why Democrats have not run a campaign based on the premise that if you think you don’t like the law you at least should be sure you know what’s in it. Here is what’s in it, and why, and now that you understand them, which of those things do you think should be eliminated?
Basic defense of the law — aggressive, in-your-face defense, that is, not apologetic defense — is the necessary groundwork for a let’s-fix-it position. For a Democrat, of course, a public option is a minimum proposal for how to fix it. Single-payer is too pie-in-the-sky, and besides, do Americans in general really know what the words “single-payer” mean?
I think if you ask a lot of Republican voters to describe how healthcare should work, they will describe something close to single payer.
We need a catchy tune to get thngs going, something that harkens back to an era when the youth of America were more involved with everyday politics.
Come on all you young women and men,
uncle sam needs your help again!
he got himself into a terrible jam,
with that whopper ’bout keeping your plan.
And its one , two, three ….what the hell are we pay’in for,
Obama he don’t give a damn, that broken record just says yes-we-can!
And its five, six, seven, eight give us some more of them mandates,
we ain’t got a dime to pay the rent, but whoopee we’re all gotta buy
if we can just reach out to these younger folks and make them understand their sacred duty to purchase health insurance at inflated prices so that the older folks can pay less, we might get them to see the mandate not as an imposition, but rather as an opportunity to serve their country.
We need to aggressively tell the youth that yes-we-can regulate their economic decisions, says so right there in PPACA, yes sirree.
And while were are at it, place a large boot in the ass of that good for nothing “when fascism comes to America” crowd.
Across the board buy into Medicare/Medicaid for a single payer system IS the way to sell it. Most everyone in America believes Medicare works well, even Republicans.
Michael Hansberry: Is the CD out yet? Excellent comment, btw!
The fix…
At the suggestion of run75441 on this blog, I recently read two excellent books, Maggie Mahar’s “Money Driven Medicine,” and Phillip Longman’s “Best Care Anywhere.”
The big “take away” for me was the revelation that the most effective health care delivery system in the US is, hands down, the Veteran’s Administration.
This bit of information has “legs.” I have already run this past some right-of-center acquaintances, with an initial, unsurprising, result, disbelief; but when backed up with facts and data, begrudging interest.
The information that the health insurance industry, and the fee-for-service health care providers do not want the public to understand is that the most effective health care system in the US, is a single payer system that is driven by results rather than fee-for-services.
Linus:
I assumed you picked up on Longman’s and Noah’s wives and their revelations. For example, Longman’s wife taking her charts into the bathroom so she could read them undisturbed.
Hansberry,
Do you understand the fact that your complaint about the young paying for the old(actually healthy paying for the unhealthy) is the basis of every insurance policy in the history of man?
That the vast majority of the civilized world(at least to some extent) employs this system in order to control costs?
Strange, how people never need insurance until they need it.
FWIW, My son has been a VA research analyst for several years. he sent me this brief reply to Linus’s comment.
“I’ve read Best Care Anywhere, it’s famous around VA. I mostly agree and encourage others to read it. The major benefit that VA brings, according to BCA, is the electronic medical record that exists on one unified system across the country, which greatly reduces errors.”
I have never agreed with the general idea that the government does anything worse than does big business. I’ve worked long periods in both settings. A bureaucracy is much the same no matter the label at the top of the chart. One big difference is that in the private sector the decision makers get paid far better than in public employment and are driven by profitability at the expense of all other considerations. In the public sector the decision makers know that they have to make do with less, in regards to both personal financial reward and budgetary issues for their agencies. Still both public and private agencies are manned by people and there is no evidence that the best and the brightest go in for private employment. Certainly the assumption that those driven by personal financial reward and profitability will err on the side of what’s best for the business over the consumer is not unwarranted.
Jack, I think it would be great if your son could write up a detailed post for AB on his observations. He could use a pseudonym, if he wished.
I’m especially interested in the electronic medical records issue. I was completely unaware of the issue until the fall of 2010, when a friend of mine was writing a journal article about it for publication, was really busy and overcommitted time-wise, and asked me if I could assist her in drafting the article. I read a ton of background stuff on it and ended up actually writing portions of the article. (I had never heard of ICD-9 and ICD-10 before, but sure knew a lot about them by the time the final draft of the article was finished.) The controversy at the time–and I believe it still is–concerns whether the huge expense of the changeover from ICD-9 to ICD-10 was really, as promised, going to dramatically improve healthcare outcomes and lower costs.
Bev,
Not sure that he would have enough interest in publicizing his own ideas and account to do so. I had sent him a link to this discussion. If he follows it he’ll read what you’ve said and maybe follow up. We’ll see. He’s hard to prompt.
Hi, Alex. I completely agree with you–how could I not?–that single-payer or even an individual-market public option would be impossible to enact in the next Congress. I think, though, that within the next four or five years, it could become a very hot issue, and might well be raised even during the 2016 presidential campaign.
I think we’re at a point now at which political and policy causes and ideas that are presumptively improbable as taking hold are actually taking hold. The high-profile pols and most members of Congress are forever behind the curve–Dems and Repubs, alike. Which is why dramatically-increased inequality and starkly reduced socio-economic mobility has, to the pols’ and pundits’ great surprise–become and issue. Occupy Wall Street sparked it.
Economic populism is very big among Millenials, and I think it has the potential to control the outcome of congressional elections even this year, if the Dems are willing to put it out-front. I think there are a lot of white working-class people–women, especially, but not just women–who may decide not to vote, because, for them, culturally, voting means voting Republican, and some who will, for the first time in decades or the first time in their lives, vote Democratic, given a really effective Dem campaign. This certainly is true in the upper Midwest. If I recall correctly, Paul Ryan’s hometown of Janesville, WI went for Obama in 2012.
I wish the Dems would detach themselves from Obama and campaign left of him rather than right of him. All you have to do is look at Rand Paul’s popularity among younger and working-class Republicans, based largely on his anti-Security-State, anti-militarist, and anti-tough-on-crime stances, to see that, culturally, we really HAVE reached a political inflection point.
Yeah, I understand, Jack.
EMichael, what Hansbury is saying is that employer-based healthcare insurance premiums should not be the same for the young and the healthy as they are for the middle-aged or non-healthy. It’s Communism–Communism, I tell you!–that the young-uns are forced to subsidize insurance for the middle-aged, and the only reason it’s been going on so long is that Franklin Roosevelt, Lyndon Johnson, and Barack Obama have held guns to the heads of all those Fortune 500 CEOs and corporate board members.
I completely agree with him that it’s high time that this stop! Which is why I dearly hope that the Repubs propose legislation prohibiting it and make it a campaign issue this year. 🙂
Jack,
While the VistA system is certainly key to the efficacy of the VA, there is one more important factor… VA physicians are salaried, they have no incentive to over treat and over prescribe. This does not simply result in cost saving, but, there is a potential harmful effect in over treatment.
I am not sure how this information can be used in the defense of the PPACA, but it has to be concerning for those with a vested interest is maintaining an insurance based system, and a fee-for-services model.
Beverly Mann —
Will the DCCC — I assume that’s the main source of funding for possible House winners — let Democratic candidates run a genuinely economic populist campaign, one to the left of Obama? It seems to me DCCC money comes with strings attached, namely commercials written by perennial DC Democratic-insider consultants. It seems like a tight circle devoted to positioning for advantage in the post-presidency, and crossing the Obama people would not be the way to go. The consultants can be dense as hell, and decidely un-nimble, when it comes to promoting Democrats in local elections.
No to your question.
I also think smart Democrats in areas that lean pro-business while often going for centrist Democrats (in Presidential election years, that is) can frame populist policies in pro-business terms. What business needs is demand, and that means getting people back to work earning incomes and improving incomes for the people who have jobs. Thus, opposing minimum wage increases is actually stupid and anti-business, because low incomes keep down demand for the goods and services businesses offer. Only the populists (a word that cannot be used, of course) are actually pro-business.
Don’t have a cow, Mann,
Five year plans a new deals, wrapped in golden change!
From PPACA: The requirement regulates activity that is commercial and economic in nature: economic and financial decisions about how and when health care is paid for, and when health insurance is purchased.
That line from PPACA might be sweet music to your ears, Mann, but it don’t play well with the young’uns.
Yeah, especially the young’uns who can now stay on their parents’ insurance until they’re 26, and the young’uns who break a leg or have a preexisting medical condition or who have a parent who is going bankrupt paying medical bills.
There is a simple explanation of why people liked their crappy health insurance
Eli and Ms. Rabett are moving on in years, and although they have excellent health insurance through Eli’s employer, they had some health problems last year. As part of the insurance company’s efforts to reduce costs, it provides receipts for each claim, and gee, the Bunnies had a lot last year, over 50 of them and some were large. When you get old, Mom Rabett used to say, your social life becomes visits to the doctors.
Neither Eli nor Ms. Rabett are feeling guilty about this, between what Eli paid and Eli’s employer paid, they were only about a grand shy of covering the insurance company’s costs of a bit less than $17,000. Moreover, in previous years the Rabett family and Eli’s employer has provided a ton more money in health insurance payments than in health insurance costs. That, after all is what insurance is for.
However, in shifting through the bills to figure out if there were enough costs to take the medical exemption (no, and this is excellent) Eli was able to see the discount that the insurance company got from the docs and the hospitals. The total discount was a bit north of $28,000.
Consider the following question: Why are so many people unhappy about losing crappy high co-pay/deductable health insurance?
If these policies access insurance company discounts, then just the fact of running the claims through an insurance company yields a 28,000/(28000+17,000) = 62% discount on what you would have paid walking through the docs door. In that sense ANY health insurance is better than none.
Moreover, unless you can negotiate ~60% discounts with the hospitals and docs you use, health savings accounts are a disaster.
Good health insurance is best of course, and to win the folks who lost their “non insurance” they have to be told that their total costs still will include the discounts.