Before the Affordable Care Act became the law of the land, people had two main attitudes about their health insurance. They either hated it, or they didn’t use it. This idea that there were a lot of people who liked their health insurance and wanted to keep it is largely a myth. At best, the vast majority of people were afraid of change, but that doesn’t mean that they thought they had great insurance or enjoyed the process of trying to get their insurer to pay their bills. In general, people hate paying for insurance and experience hassles when they try to use it. So, once the Democrats decided to push everyone into for-profit insurance, they pretty much took ownership of something most people experience negatively. Add to this that people will always want a bigger subsidy than they’re getting, a bad rollout of the exchanges, and a political opposition uniformly opposed to the bill and determined to highlight every flaw within it, and you have a recipe for a political drubbing. That’s why I think Teacher Ken is wildly optimistic when he declares that the benefits of the law will become clear by next November’s midterm elections. I do not believe that to be the case.
The only way to make that the case is for Democrats to very thoroughly follow Ryan Cooper’s advice and rally around the health care law in a relentless and single-minded way that can match the Republicans’ opposition.
I have further advice on this front. The fact that formerly uninsured people are getting insurance is not a very compelling rejoinder for someone who is having a negative experience with their health insurer. What’s compelling is a political party that constantly points to the benefits of the law, like annual caps, keeping your kids on your insurance, protections against having your insurance dropped, and limits on profit-taking. The way to promote this politically is to constantly talk about real people who would have been screwed without the reforms. Trot them out daily to talk about how their lives and livelihoods have been saved.
Secondly, the Dems should be introducing reforms that address areas where people are experiencing problems. These reforms won’t pass, but they can form a platform of sorts that will partially inoculate the party from criticism. After all, fixing a problem is better than repealing the whole law and having a solution is more appealing than having none.
If the Democrats do not pursue these two strategies and just rely on people discovering that the law is working, they will be slaughtered. They will be slaughtered because people hate health insurance.
All of the Republicans are against it.
Half of the Democrats are against it.
Some of them because of the mandate, or because it’s not single payer, or the public option, or the NHS/USA.
Some of them — ‘conservative’ Dems — because it exists at all.
So the end result is entirely predictable.
Teacher Ken is whistling past the graveyard. This is a winning issue for the GOP in 2014, and in today’s CNN/ORC poll, Christie leads Clinton, albeit within the MoE.
i predict that dems will not do exactly as you say, and also that dems will not get slaughtered.
I don’t see how the Democrats can get slaughtered, other than losing every single contested(notice that word!!) Senate race. Could the GOP pick up 20 more seats in the House? That’s even more unlikely than Steny Hoyer becoming Speaker in January 2015.
I would expect the Senate to flip.
Dems lose in LA, AR, SD, WV, MD. Then Joe “Nighthorse” Manchin decides he didn’t leave his party, his party left him.
Two years of government-by-veto and lame-duckitude isn’t going to do much for the Democratic candidate in ’16.
It doesn’t have to be popular, just a fact on the ground.
Rallying around a Republican-designed shit sandwich as the great achievement of the Democratic Party in the last 40 years is about as stupid an idea as one can invent within the Beltway bubble.
The next step is to start to get mandates for changes in health care and in Obamacare to put the Republicans on the defensive. Repeal is all they’ve got, and repeal is a nonstarter because of many things but the first one is called “pre-existing conditions”.
IMO the issue for 2014 is ending the use of co-pays and deductibles in all healthcare insurance. It is based on a fallacious economic theory that has proven over 30 years not to be true. Having skin in the game doesn’t lower overall health care costs nor does it lower the costs for particular individuals. It defers care to the point at which it becomes more expensive. It allows the fight between insurers and providers over payments to be shoved onto the patient. And everybody hates them. It also goes to the core of what is shit in the Heritage Foundation’s shit sandwich.
Just setting that as an objective by the end of the next Congress changes the conversation.
IMO the issue for 2014 is ending the use of co-pays and deductibles in all healthcare insurance. It is based on a fallacious economic theory that has proven over 30 years not to be true. Having skin in the game doesn’t lower overall health care costs nor does it lower the costs for particular individuals.
You’re exactly right. Who in their right mind likes going to the doctor’s office? I’ve never met a single person. The only people I ever knew that might had gone to the doctor’s office a lot were parents with young kids. I think we all know why. Parents don’t know what’s wrong and are worried. That’s pretty much it. Has anyone really had a pleasant experience at a doctor’s office? The waiting room is annoying and it’s never helped by the fact that you won’t get seen until at least 3pm even if you have a 2:30pm appointment.
what’s wrong with you guys? I guess you have healthcare, so all you can see is the flaws in the ACA, but for ppl previously without. There’s something called peace of mind that one isn’t going bankrupt or dying – and btw I know personally at least one person for whom the latter was how it played out.
Also,, something I haven’t read about anywhere, but I’m seeing the benefits of right now these days is the computerizing medical records as I’m currently involved in a situation that involves multiple locations and multiple offices/ hospitals and I cannot believe how easy that part of it has become vs. the olden days when one couldn’t get records much less get them sent/ faxed to the hospital/ clinic. And the long waiting time seems to be a things of the past too.
I have Medicare. Medicare Part B deducts $100 and change out of my Social Security. My Medicare Part D, which was deducted last year is this year an out-of-pocket expense of $30 for adequate coverage. My Medicare deductibles are such that they are essentially a major medical policy–even the Part B.
My wife will have to get Obamacare because she is not yet 65. Our current estimate is that a $8000 deductible policy will be $600 a month less any subsidies that are available. That is completely unpredictable because of what the NC legislature has done. She worked as a volunteer for OFA’s Home for the Holidays training program. To prep herself she tried to get signed up through the call center. After four tries she got completed except for validation and determination of available plans. Her experiences with the call center staff were not satisfactory. Nonetheless she went and trained folks in how the system was supposed to function when the IT issues were fixed.
The things you mention in the your first sentence is why repeal is a nonstarter. Please tell the Blue Dogs. How are they going to explain the fact that they voted against Obamacare?
The computerizing of medical records now has added data security concerns. And additional privacy concerns because of the actions of our national security and law enforcement officials.
And the failure of effective implementation of HIPAA 834 raises some serious questions about employer ability under “self-insured” plans to see the medical records of their employees.
I understand what you’re saying. And security concerns re: medical records is a problem because security concerns are a problem.
“The computerizing of medical records now has added data security concerns. And additional privacy concerns because of the actions of our national security and law enforcement officials.
And the failure of effective implementation of HIPAA 834 raises some serious questions about employer ability under “self-insured” plans to see the medical records of their employees.”
According to news reports, DHHS had to create a special version of HIPAA data transaction in order to implement the enrollment for Obamacare. That would not have been necessary if all insurance companies had in fact implemented a common HIPAA 834 data transaction; as you say, the mandate for them to do so is over a decade old. The significance of this is that insurance companies, instead of being able to take the DHHS enrollments without IT expense of their own then had to initiate projects to implement it before the launch of Obamacare. No doubt some of those companies dragged their feet or were incompetent enough to create chaos at the opening of Obamacare. DHHS had to supervise all of the participating insurance companies’ being ready to receive the enrollment forms. The number of insurers who reported invalid forms from healthcare.gov indicates to me that that the problem was not at healthcare.gov but the receiving communications code of HIPAA 834 at insurance companies.
The security and privacy concerns don’t arise from the ACA but from what the NSA did through the NIST to rig vulnerable standards for hardware and software security. The issue with employer-based insurance has to do with the fact that insurers consider the employer the customer, not the insured. And insurers who merely manage “self-insured” plans defer to employers even more.
Well, HIPA says my employer can look at my medical records but my wife can’t. That’s crazy. It’s such a n9ightmare that my account at my doctor is not allowed to have the same password as my wife’s account. The software sees that we are logging on from the same IP address and demands separate passwords as well as UserID’s. What next? Do we need separate IP addresses? i.e. separate internet provider accounts? Meanwhile all is available to the employer and I don’t not the NSA.
To my mind HIPA is a greater threat to the institution of marriage than gay marriage which is not a threat at all. What does it hurt us that someone else can get married? But the principal that husband and wife are not each other’s agents strikes directly at the heart of the institution.
There are some pretty substantial reasons for spouses and other family members generally not having access to medical records. Not all families are fully functional and there are some confidences that might appear even in the summary data of account information that might trigger violent or abusive repercussions if a spouse (and some cases a parent) found out. In cases of a teenage abortion with a parent’s permission, that parent might be a wife shielding a daughter from her husband, who might be a stepfather.
The problems with the online record access have less to do with HIPAA than with the way that providers and insurers choose to implement their systems.
I’m running into a lot of “progressives” who are dissing obamacare. It’s driving me nuts.
Obamacare is, in very real terms, a huge step forward for this country. People who don’t understand that either either grossly misinformed about its broad impact and many facets of reform, or aren’t affected directly by it, and are throwing stones from afar.
Six more months, this will all be obvious, but the information is out there now for those who choose to be informed.
You are opposed to making the elimination of deductibles and co-pays an issue in 2014?
I sure as shit don’t have health insurance. Haven’t had it in a while actually. But I think you’re missing my point. I wasn’t talking about the PPACA and whether it’s good or bad. I’m talking about deductibles and co-pays in general. I’m talking about the BS the Teahadists spew about heatlhcare/health insurance. I’m talking about the fact that most people I know, especially anyone under 50(unless they have small kids), doesn’t go to the doctor unless it’s absolutely necessary. I’d have to be really sick for a week before I’d even consider going to the GP. The point being that health care doesn’t work like a perfect market. Far from it.
A health insurance system based on well-regulated private insurance does not necessarily have to be a “shit sandwich”. Switzerland’s system works rather well. Single payer systems also have their own set of problems — my sister is a doctor in Canada and she could talk your ear off about the various injustices and stupidities of the single-payer system there.
No system is perfect. But running away from the ACA, or calling it a shit sandwich, is unhelpful and untrue. It is a vast improvement of the previous system. Boo is right that dems have to trumpet that clearly.
Dems must also push the fact that the republicans are standing, and have always stood, in the way of improvements to the system. Putting forward bills that improve the ACA is a good way to do that.
Unhelpful, and perhaps untrue. But it is the only acceptable truly progressive position.
Eeyores?
The problem is that people can experience the system directly. And that is what is going to determine how they vote about it. Democrats who trumpet it like it’s a major accomplishment in health care reform are going to look foolish. As foolish as Republicans who persist in calling for repeal.
As much as I respect people who work very hard in the health care field, I get a little tired of their complaints trying to balance out the fact that people are paying money they really cannot afford in order to let health care professionals live a quality lifestyle.
Switzerland is so regulated that it might as well be a single-payer system. What advantages are there to supporting multiple bureacracies?
The fundamental facts about the Canadian system that have mattered are that it covers everyone, has among the best outcomes in the world, and does it for half of the per-population cost of that in the US. The fact of the Canadian system means that there is $1 trillion of absolute waste (makework jobs) that could be wrung out of the US system and result in better overall health of people.
Yes, look forward. Don’t look back. And no need to use Nancy Pelosi’s description of Max Baucus’s bill as part of the public campaign. The public will know what it is for better or worse.
“Democrats who trumpet it like it’s a major accomplishment in health care reform are going to look foolish. “
We’ll see. I think its a major accomplishment and a major reform, and I think many will agree, although most do not now thanks to a number of factors, many of which will be ameliorated over time.
Of course the system could be improved in myriad ways. By all means continue to push for single payer. I wish you every success, and I agree that it would be an improvement. But you need not start the conversation by saying that the ACA is shit. That’s not helpful and it’s not true.
How many decades did it take to get even this much reform? Yeah, it’s a major accomplishment. A big effing deal, even.
My mom used to say that it’s not the effort, it’s the results that count.
Some day a playwright as good as Shakespeare is going to create a stunning play: The Tragedy of Max Baucus. The third and fourth acts will cover the period 2009 through 2010.
The Democrats need to make a series of ads with nothing but working class/working poor WHITE PEOPLE from Kentucky who now have health insurance.
Play these ads in every state where there’s a GOP Governor refusing to expand Medicaid and/or set up an exchange.
Then ask, how come these Americans are doing better than you, and answer it, because they have a Democratic Governor who actually cares if you live or die.
Yes, the Dems need to be this blunt.
Why use only WHITE people..
Because the working class/working poor Non-Whites in these states are crystal clear about why they are not being given a bridge to healthcare.
Is suspect they are doing that. It’s called the Alison Lundergan Grimes campaign. With some hard work and good luck, it will be Bye Bye Turtle.
Or they could follow the even worse strategy of trying to run away from it.
The truth that all Democrats have to understand is that Democrats own this whether they want to or not. Any attempt to deny this will just compound the difficulty. It will make you look weasely, even if you honestly didn’t like what was being enacted.
It makes no sense politically or from a policy POV to run away from the ACA. It’s terrifically important to fully embrace and trumpet the many, many portions of the law which are wildly popular, and terrifically important to trumpet some important undebatable factual results in order to respond to Republican talking points.
First among these are that total health care costs in the U.S. were going up around 8% per year before the ACA, and have been going up at 4% per year since the ACA. Second is that the law will reduce the Federal budget deficit and is strengthening Medicare’s balance sheet. Third is that in most states which are implementing the ACA in good faith, many people on the individual marketplace are finding that they are accessing better insurance for more reasonable prices. Fourth is that for around 80% of Americans, their employer-based plans are not changed by the ACA and are, in fact, made safer by the FACT that the Law is bending the cost curve.
Pointing out the tax breaks provided to individuals and businesses in order to help them afford health insurance is a cherry on top of the many bits of good news. For some odd reason, Democrats don’t talk about those tax cuts often enough.
They also need to hammer on highly popular provisions like the ban on exclusions for pre-existing conditions and being able to cover your kids on your employer policy until they’re 26. People who aren’t really paying attention don’t necessarily associate those things with Obamacare.
Completely in agreement here. There’s around a dozen ACA regulations that people love, but they need to be told overandoverandoverandoverandover again that they have the ACA to thank for those regulations.
Here’s a notorious signifier of the anti-Obamacare propaganda campaign’s undermining of public knowledge about the law, one which matches almost every public poll:
http://www.theatlantic.com/health/archive/2013/10/some-americans-say-they-support-the-affordable-car
e-act-but-not-obamacare/280165/
I could envision a series of ads with people saying “Thanks, President Obama!” for each of those provisions.
yes, and by all means the ads should call it Obamacare
“I couldn’t afford to see a doctor for my bursitis, and now I can.” (Raises hands above head) “Thanks Obama!”
Cut to a smiling president Obama: “You’re welcome.”
That’s a Presidential campaign commercial. I don’t see how that helps Democrats strengthen their hold on Congress.
Did they not think to use that last year? With the regulations that were immediately implemented, surely there were some bursitis sufferers who benefited.
The state of the health care system in January 2017 is what they will remember President Obama by.
The state of the health care system in Jaunary 2016 dictates whether it’s an issue in the 2016 Presidential election.
That is why we need to move forward and start fixing some stuff.
the candidates shouldn’t run away from Obama and the record of this democratic administration.
I agree completely, but they should not pretend that Obamacare is the greatest law ever. And like I said elsewhere, you message should be directed at the Democrats in Congress who voted against Obamacare. Mike McIntyre and Jared Polis come to mind.
gotta leave the President out of this.
the ads gotta be with all White people.
I agree. One might call it catering to their prejudices, but we want their votes, so we have to play up. Advertisers do this all the time.
Exactly my point. That means that maybe you don’t frame the issue as fixing Obamacare but taking the next step in health care reform.
My basic point of view on Obamacare: You don’t do victory laps with a quarter’s play left.
there is an election next year. the republicans are making it about Obamacare b/c they have nothing else. that’s why the victory laps
Reframe it as continuing health care reform then. Put them on the defensive with health care reforms that the public really wants. And ending the nickle-and-diming of deductibles and co-pays is one that I fully expect will have broad public support. Have the Republicans defending deductibles and co-pays.
They want to make it about Obamacare.
I want to make it about:
$15 minimum wage
20% increase in Social Security benefits
Elimination of deductibles and co-pays in all health care insurance
End to the nonsense of high-stakes testing in schools.
And if I were really brave, I’d add a jubilee on higher education debt.
People love Health Insurance. It’s the first thing they want to know about a job, even before the salary. People hate Insurance companies, not insurance.
Only smart ass rich Republicans hate buying insurance. Those Tea Party idiots protesting about having to buy insurance mostly already have insurance. They hate taxes too, but love public roads and idolize the military. They hate income government programs but love SS and Medicare. It’s called cognitive dissonance.
What people love is the idea that they will be part of a risk pool that will take care of their health care expenses. What they like about employer-based health insurance is that it’s a group policy in which the insurer rates a diverse group as an individual. The greater the mix of younger and older employees the better the pool. But employers have a nasty habit of laying off older employees to keep their insurance rating lower and the premiums less.
Single-payer is membership in a truly big pool in which there is no rating at all. The pool is actuarially managed by its total cost. A single-payer system is a monopsony; it has absolute pricing power compared to providers. That gives it the ability to control costs within the limits of political consent as expressed through Congress.
The US is one of the few countries in which fringe benefits outweigh salary in job negotiations.
Went to see the GI specialist today. He suspects possible cancer so he’s ordered a colonoscopy and gastroscopy (sic?). He also told me that I need prior approval from Blue Cross. This doctor is a licensed practitioner and a board certified specialist. Why should some insurance company clerk or manager have the power to over ride him?
Part of the insurance industry’s cost-control standard practices on behalf of their customers.
Reminds me of my Republican friend warning me that under Obamacare I’d be left to die to save money for the young.
I honestly wouldn’t mind (so much) if it was down to a choice between my life and young person’s life. When It’s a choice between my life and an insurance CEO’s bonus, I get downright revolutionary.
It’s not a real choice in the U.S. between one life or another, unless we allow politicians to make it that way. We’re the richest country in the world; we have the resources to care for everyone. But you probably know that, and your last point is spot-on. There’s a lot of skimmers in our current health system; we were never going to rip the bags of money out of their hands without a fight.
Oh, so maybe I’m NOT the only one bitching about it. 😉