Trivial Pursuit

Revolutionary. There’s no other word that more aptly describes the health reform that was just enacted. It will affect everyone. Every employee. Everyone on Medicare. Everyone on Medicaid. It will even affect those who choose to remain uninsured. It will give the federal government enormous control over a sector that spends one out of every six dollars in our economy. Once fully phased in, the ten-year costs will approach $2.5 trillion — and maybe more.

Given all that, does anyone find the way the president talks about health care these days a bit strange? As I said in my post at National Review and at the National Journal Health Blog, the president and most Democrats in Congress are focused on the minutia. Consider these fairly routine stump speech phrases:

  • “Insurers will not be able to drop your coverage after you get sick.” True enough. But this practice has been illegal for the last decade-and-a-half under a federal law called HIPAA. It’s as though the White House went back through the books, found a law it liked, and chose to pass it again!
  • “There will be no more lifetime caps on health insurance benefits.” Good news, no doubt, for the 1/100th of 1% of the population who bumps up against them.
  • “If you have a 26-year-old dependent child who can’t get health insurance elsewhere, you will be able to cover him on your own health plan.” Well, okay. But how many 26-year-olds have this problem? NCPA employees can buy insurance for their children more cheaply in the individual market than we can in the group market.
  •  “If you have a child or adopt a child, your insurer will not be able to exclude him because of a pre-existing condition.” Don’t most states already require this? And isn’t it standard insurance practice anyway?
  • “In four years, no insurer will be able to discriminate against anyone because of a pre-existing condition.” True enough. But more than 90% of everyone in the United States with health insurance is already in a plan that can’t exclude people because of pre-existing conditions. And for the other 10%, only a small fraction faces serious problems.

I could go on, but I think you get the picture. For the people who have the problems just described, the problems are real and sometimes tragic. But they represent a minute fraction of the overall set of problems ObamaCare is designed to address.

Anything You Want, You Got It

The rhetoric the president is using these days is radically different from the rhetoric he used only a few months back in making the case for reform. Does anyone remember the president saying that 47 million people have inadequate access to care? Or, that for 300 million Americans, costs are too high? Or that quality is too low? What happened to all those problems?

I have a theory. Although the president says he doesn’t pay attention to public opinion polls or focus groups, I think that is all he is paying attention to these days. I imagine the focus groups went something like this:

“Okay, we know you all don’t like this big bill, but is there any part of it you do like?….Even a small sliver?….What about 26-year-olds?….Could we see a show of hands on that provision?…..Okay!…..We have a winner!…..Tell the speech writers to put that up near the top, Joe.”

Also, I don’t think there is anything new about this strategy. Barack Obama’s approach to health care has always been poll-driven. During the Democratic Party’s presidential primary, Obama (along with every other serious candidate) repeated the “universal coverage” mantra over and over again. Presumably, this is what the party’s base wanted to hear.

But after his primary victory, we never heard the words “universal coverage” again — at least not that I recall. Instead, “cost” and “quality” became the reasons for reform that appealed to general voters.

Today, however, the polls are clear. People do not believe that ObamaCare will solve the problems of rising costs and inadequate quality. In fact, they believe it will make those problems worse.

Although people do believe that ObamaCare will insure a large number of the uninsured, the president faces a huge credibility problem on this score as well. Where are the 32 million newly-insured people going to get additional health care? The very reform that will spend several hundred billion dollars a year on health insurance spends not one dime to train new doctors and nurses or build even a single new hospital!

So, Obama is talking about “insurance reform” issues, because this is the only area where he has any credibility left. He is playing trivial pursuit, because those are the only cards he has left to play.

Comments (18)

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  1. Brian Williams. says:

    The polls may be clear enough today. People don’t think Obamacare will work.

    I’m guessing the Ministry of Truth will solve this problem by helping us learn to love and revere Obamacare.

  2. Karen says:

    Thanks for synthesizing the arguments and stressing HIPAA. I was ready to throw my shoe at the t.v. everytime I heard someone mention “pre-existing” condition because I work with benefits every day in my job and I know HIPAA took care of this long ago. You are doing a fantastic job educating — and re-educating the American public. Keep up the good work. Can you get yourself on television to stress these things or is the mainstream media not interested?

  3. Pepper Kay says:

    I don’t believe obamacare will be loved and revered, rather we will be so busy fighting our way out of bankruptcy that we will have concerns other than ‘loving and revering’ anything.

    My children and their children will be paying for obamacare for the rest of their lives and wonder why, as they are not going to beneifti one bit from this monstrous revision of the health care industry.

    This is a disaster in the making. The only question left to answer is: how soon ?

  4. Richard Salomone says:

    The health law is the first phase of impairing the delivery of health insurance by the private market. You have to weaken the market’s capacity to price risk then exclaim total disgust when premiums go up and design more changes to the law moving in the direction of a one zsize fits all government plan. We already have Medicare and if you believed in a rational liberal you might have expected them to simply expand the Medicare system and require health insurers to file their plans for the newly minted insureds with the CMS. Well, no. Congress and the President decided to use the law to make public utilities out of health insuers and make agents out of the states in expanding Medicaid. Over a year spent in health care reform and we get a nation divided and a people outraged not only over the product but the process of turning us into beneficiaries of a government benefit instead of insureds with valid contractual rights regulated by government.

  5. Joe S. says:

    Good post. Right on the mark.

  6. Vicki says:

    I agree totally. This is “trivial pursuit” and it’s trying to give people whatever they want — or more precisely, telling people whatever they want to hear.

  7. Ken says:

    It’s hard for me to believe that Obama thinks he is going to get away with this.

  8. Donald F Mackintosh says:

    Obama and his cronies have mastered the “art” of telling people what they think they want to hear. Unfortunately, many believe it all. Your comments are right on target and need to be distributed to the PBS/MSNBC/etc. folks.

    What’s going on in the White House and Congress is not only mind boggling, it is absolutely scary. Hopefully, some changes will result from the November elections but what’s done between now and then will be very difficult,if not impossible, to unravel. Godspeed to those that can have an impact and avert total disaster.

  9. Don Levit says:

    I have come to realize it is not what you know that counts.
    When I was growing up I had learned that “knowledge was power.”
    Now, I realize that knowledge is knowledge, a virtue for its own sake.
    Power is money, as in corporate special interests, corporate welfare.
    This appears to be a private industry giveaway, an insurers’ paradise, a present from the taxpayers.
    However, the eventual result seems to be a single payor system , with insurers serving as administrators, not risk takers, like we have in Medicare and Medicaid.
    If I am right, where is the logic behind sustainable reform?
    Don Levit

  10. Devon Herrick says:

    Most of the so-called “reforms” only apply to the individual market. Most of these ideas have already been tried failed; causing premiums to skyrocket, prompting healthy enrollees to bail — decimating the individual market in the process. The only new element is the individual mandate (and weak employer mandate) that is supposed to (somehow) make everything work perfectly despite decades of economic theory taht suggests otherwise.

  11. Chris Ewin, MD says:

    It’s not just COST and QUALITY that should appeal to the general voter.
    The ACCESS problem will soon be staggering as more PCP’s (estimated 46%) leave their practices…They can throw all the money at training new physicians..but it takes 10 years and even then..they are wet behind the ears….

  12. Blakle Woodard says:

    John –

    You are a great American, as is Dr. Chris Ewin, a true health care innovator, who also left a comment to your column. I have sold a heck of a lot more health insurance in my life than either you or President Obama, but now I suppose the president is the Insurance Agent in Chief.

    There is one area that you and NCPA need to do a lot more education: Pre-existing conditions. Just this week the Fort Worth Star-Telegram quoted two local Republican congressman, Dr. Michael Burgess and Joe Barton, as saying they want to repeal the health law but would retain the ban on pre-existing condition exclusions. John, pre-existing condition exclusion limitations are an absolute actuarial necessity of any voluntary insurance program, be it for healthcare, life, disability, auto, home, etc. Absent an exclusion on pre-existing conditions, no one would buy insurance until they had a claim.

    Even the Republicans don’t get this right and continually denounce pre-existing condition exclusions.

  13. Steven Pettit says:

    John-Thank you for continuing to spread the truth around, it’s a welcome change. I can’t tell you how many times I have wanted to toss the TV out the window listening to these people who couldn’t find the truth with a flashlight.
    Steven Pettit
    IQHSA.com

  14. Nancy says:

    Good post. Right on the mark. I’ve come to expect that from your Health Alerts.

  15. Beverly Gossage says:

    Blake,you are absolutely right!
    I might add that I don’t believe 30 million more will be insured. Many of those will pay the fine and others will avoid detection.

  16. Charles Johnsen says:

    Pre-existing, free care, non citizen, etc. All of these are tiny problems compared to the monster “solution” of Big Bro Care, aka Orwell’s 1984. Even today these laws (can’t deny care, must cover knee scrapes, etc.) are shifting costs to those who pay for care and insurance with their own money. If Congress is so sure these are good things, then they should pay for them and not force us to pay for them through the back door. The Constitution has, after all, a provision about “takings,” government take property without fair market value.

  17. Gail Wilensky says:

    You are making a point that I have been making for some time. Republicans should say–yes we agree with most of the insurance “reforms”…for the most part, they were only issues for people in the individual insurance market (and then only in some states)…affecting potentially as many as 17 million but not the 165 million in group insurance. Now let’s focus on where the money is being spent and the power is being exercised….There’s a reason that the Dems keep focusing on the other…
    Sometimes I wonder about our guys…