Health Insurance Reform?

Krauthammer needs to separate what he would like to happen from what will actually take place.

http://www.political-buzz.com/

Thanks so much for continuing to cover this, KT.

86% satisfied? I think that when your poll numbers start looking like election returns in Libya that you have to doubt the poll or that, at the very least, there's something else going on.

Here's what I think is the somewhat subtle problem here. The question isn't whether or not people are satisfied with their current health insurance, it should be whether or not they believe that their current health insurance, or even the current healthcare system, is despite its flaws, the best of what's possible.

That would tell us how effective defenders of the status quo are being in arguing that all alternatives to private insurance are somehow worse than what we have now and it would also tell us not whether these results are evidence that people like what they have or that they have learned to live with it.

My guess is that people don't "like" their health insurers or their plans but that they have been convinced that they're getting the best plan the free market will provide.

The link to the poll is broken.

Eighty-nine percent of respondents said they were currently covered by some kind of health insurance, and of that group 86% said they were "very" or "somewhat" satisfied with their plan

I know it isn't a game changer but since both you and Joe have cited this poll number, we need to make clear that the 86% is of people with insurance. The Actual percentage of happy respondents in general is 76%.

@KT: Can the President find his message?

Not directed specifically at you, Karen - your coverage of this has been good - but the question should be, "Can the US people find the President's message?"...See, there's a layer of obfuscation, dis- and mis-information, and opinion between the President and me that never seems (or maybe never wants) to get any clearer. Until the dirty filter of the mainstream media decides to clean itself out, I don't think that message will get out to the general public.

Now, this is not the same as 'passing along the President's message uncritically'...but an honest, intelligent assessment of the message without bias and made without all the journalistic stylings intended to protect against the accusation of bias.

Is that possible?

As the debate over healthcare reform in Congress continues, a new Time Magazine Poll finds that most Americans (55%) support a major reform of the healthcare system over making just minor adjustments (43%).

I wonder if lagging support is not because BHO is trying to do too much but too little.

Actually I don't wonder.

But one challenge there is that these people--86% of them in our latest poll--are satisfied with what they have.
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This is meaningless. I'm "happy" with my insurance as well, but I've never really tested it. It's like saying I'm happy with a car I bought but only drive around the block once a month. What matters is what happens when I really need it. And I won't know about that until I do. And I won't know if they will find a way to kick me off the rolls until I need real $$ from them, because that is when they do it. Clearly, when half of all bankruptcies (over 750,000) in our country each year are medical related, and most of those people have insurance, and this simply doesn't happen in other advanced countries, then our insurance "system" that 86% like, actually is terrible.
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I understand Obama's frustration as re. the messaging on this. The problems are so bloody obvious, but too many people are easily persuadable/frightenend by fallacious arguments.

I think people here need to come to grips with the "I've got mine" attitude that is inherent in American politics. If you've been denied coverage for a major problem or if you avoid medical care because you can't afford it or (worse yet) because you don't want anyone to be able to find out if there IS something wrong with you or if you've already declared bankruptcy then you know just how effed up our current system is.

But that list is still a small subset of Americans. Just because people are being devastated doesn't mean that most people are heavily invested in making things right.

interesting the frame of this is how amny people are "happy" with the status quo.

The poll also shows --

As the debate over healthcare reform in Congress continues, a new Time Magazine Poll finds that most Americans (55%) support a major reform of the healthcare system over making just minor adjustments (43%).

80% support

Provides coverage for almost all Americans, even if
the government needs to subsidize healthcare for
those who can't afford it?

63% support

Creates a government sponsored public health
insurance option to compete with private
health insurance plans?

56% support.

Heck even Single Payer has more support than oppose 49-46

So what to think? People are satisfied with their coverage but know the system stinks.

Another variation of "Congress stinks except for my guy"

Maybe if President Obama wants to find his message, he should take pointers from Sgt. James Crowley. In his news conference Thursday, Crowley -- who is not a professional public speaker -- was crisp, clear, concise & courteous. His answers to questions were direct & unequivocal.

Nuance is nice but brevity is better -- especially when trying to convey complex concepts to us unwashed masses.

If there was a "teachable moment" in the brewhaha, Crowley's presser may have delivered it.

The Constant Weader at http://www.RealityChex.com

The problem isn't the President's message. The problem is the President's POLICIES.

At the end of the day (or, more literally, by the end of the year), the Democrats will likely pass some form of health care package. The President will sign it. And the American people will, by and large, be extremely disappointed. If not immediately, then within 2 or 4 years, when the voters return to the polls. It will cost $1 trillion and most Americans will only see modest changes in their health care experiences.

Obama wants to take credit for PROCESS not POLICY. He wants to be able to say "I got it done". The fact that "it" is a giant smelly turd? Not his fault. When people don't like the substance of the legislation, he can point the finger at Congress.

But that is a lot harder to do if Obama sets himself up a salesperson for the legislation on the merits.

Thanks, KT.…well, if we're not going to you-know-what (hint: starts with “single” but we can't say THAT in corporate media), insurance reform is mandatory: (repeat talking points) no coverage denial / pre-existing, no claims denials, rate caps, no medical decisions (practicing medicine without license).

But as for…“The phrase 'health insurance reform' is indeed an effort to tailor his message to the concerns of people who have coverage--who are, after all, the vast majority in this country. But one challenge there is that these people--86% of them in our latest poll--are satisfied with what they have.”

…maybe they're satisfied until they have to use it. Then, good luck. Literally.

Krauthammer's right: Obama is retreating from the rhetoric of meaningful, systemic reform, but not because people don't want it --we do

The Public Favors Health Care
for All

62 percent say it's the federal
government's responsibility to
“guarantee health care for all”
(January, 2006 New York
Times/CBS News poll)

69 percent say it's the federal
government's responsibility to
“make sure all Americans have health care coverage”
(November 2006 Gallup poll)

67 percent favor the US
government guaranteeing “health
insurance for all citizens” even if
that means repealing most of
“recent tax cuts” (August 2003
Pew Research Center poll)

, but because the recent "slipping" polling data cited once again shows that Americans don't trust Congress to get the job done, or to look out for peoples' interests. People don't trust a legislative problem-solving process that looks complicated, because that means that the simple problem they actually care about isn't getting solved...and it isn't. Obama has not been instrumental in giving people what we want. He has retreated from the rhetoric of his campaign, which promised inviolable, inexpensive health care for all Americans.

Obama notes:

"Some of these other issues, when it comes to the discussion we just had about delivery systems, get more complicated. "

Yes, Mr. President. It gets more complicated because, more and more, you're selling the American people a worthless boondoggle that keeps everybody but us from getting a simple, powerful reform proposal that does away with the current system...and we are not invested in the current system at all, despite the disconnected Beltway press corps' misreading after misreading of polls.

People don't care about losing their insurance, they care about losing their access to the doctor of their choice. 80% are not satisfied with the health insurance they involuntarily receive from their employers --that choice of insurance is out of their control, and they don't like that fact-- but are satisfied that they can see the doctor that they trust when they need to.

It goes like this:

Q: John or Jane Q Public, are you satisfied with your current health care?

A: Yes, I trust my doctor. He/she even gives me free samples of expensive prescription medicine sometimes! My doctor has healed me, and I've felt better. I need my doctor; my doctor cares about me.

Q: John or Jane Q Public, do you trust health insurance companies --even the one your employer currently uses-- to continue to provide you with access to your trusted doctor, or to life-saving treatments if you or your family needed it?

A: Hell no. The insurance companies and their onerous, frightening paperwork are often standing between me and my doctor. I'm confronted by the scene of my doctor's staff arguing with them over payments every time I visit the office. I'm afraid that my doctor will say I need something expensive, and then the insurance won't pay --in fact, I feel relieved when everything goes right, and I just pay my co-pay...which keeps going up and up, by the way. I don't even want to think about what would happen if I lost my job.

Q: Do you want the government to guarantee that you and everybody you know can see your trusted doctors, and that you can get whatever treatment you need, no matter what your situation --without going bankrupt, and without the fear of the cost to you going up beyond your means? Should all Americans get this benefit?

A: Yes, that would be perfect.

That's the problem Obama faces. We want health care reform on those simple terms, but that's not what we're getting (at least in this stage of the process). As Duncan Black said yesterday:

Just What Am I Supporting Again?

It's difficult to sell a plan when a plan doesn't really exist. I don't think people really care about the details, but they do want to be convinced that what will be delivered to them is as good or better than what they currently can get at roughly the same price or less. It would be easy to sell a plan if they could say things like, "Under this plan, all people will be able to buy affordable comprehensive insurance which cannot be taken away." But they can't actually say that at the moment.

Exactly.

It would be easy to sell a plan that people want if one existed. Instead, we have what insurance companies want, although not exactly what they would like to have in a perfect world (for them). That's the problem: that peoples' interests and the insurance companies' interests are diametrically opposed, but both parties are nominally treated by the legislature (and the political press corps, by the way) as equally (at least publicly, in terms of rhetoric) valid constituencies to be represented and protected. That's the meaning of "compromise".

The more compromise between opposing interests, the more complicated the "solution". The more complicated the solution, the more one of those interested parties (us) doesn't trust the Congress to produce a good outcome (for us). The more we don't trust that a good outcome is forthcoming, the more we don't trust the President to protect us from Congress doing something really bad that might screw things up for us even worse than they are now...like putting in some regulation somewhere that completely prevents us from seeing the doctor we trust, or getting the treatment we need (and is a colossal waste of money, and a goldmine for fraud and abuse).

The President is finding getting the message right to be difficult, because we're getting sold a bill of goods by a corrupt Congress, and everybody knows that. That's what "complicated" means.

When Obama states

"I do think that some of the insurance reform proposals are easier for people to understand."

, he means "...and I'm referring to those parts of the reform proposals that aren't as likely to f*ck them, of course."

The more Obama strays (or is lead away by a bipartisan coalition in Congress) from this simple solution statement:

"Under this plan, all people will be able to buy affordable comprehensive insurance that guarantees them their trusted doctor, and which cannot be taken away."

, the more we'll see a President in retreat and defeat, who is concerned primarily about the message, selling a worthless compromise to a confused, dissatisfied public, and trumpeting "getting something passed" as a substitute for a simple, popular plan that really solves our problems.

…oh, and Karen, in Michael's beer garden party heard around the world thread last night, I asked him to ask a question for you at next WH press conf. so he can take the hit instead of you – which senators are under biggest cash influence from insurance cos. and what are Obama and Sebelius doing to bring them under heel? Then I suggested he put a paper bag over his head and sit down fast (as not to be identified). Now this is teamwork.

Operation over, now on to recovery. Health care system was great - will see about the health insurance system. Although as I noted, I am on the seniors plan that the RNC is working as an Obama bad.

I still want congress critters to have their insurance stopped and each of them have to buy on the open market. Let them see what it's like.

I'd be fine wi' th' term "Health Insurance Reform" were it real, an' connected t' th' rest o' health care reform...were it presented as th' first step an' foundation needed fer real reform, bu' it won't be.
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It be just another empty brandin' attempt a' coverin' up th' head-slop we're goin' t' be served fer dinner when this be all over.
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REAL health insurance reform' o' course, would be t' start th' transition t' (ye know wha'), bu' tha' be (ye know where), so we shouldn'a be (doin' ye know wha') askin' any questions 'r talkin' 'bout it!
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YARR!

An' 'ow nice o' Kate t' obedient' stick t' wha' "th' parties" placed "on' th' table", an no' look a' anythin' else - SHE be knowin' how not t' be wastin' 'er time, too!
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Too bad fer us...
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YARR!

KT: There is nothing inherently wrong with posting the views of Obama critics like Krauthammer. Whatever your metaphor of choice (e.g. blind squirrel, stopped clock, stars aligned), Krauthammer seems to have penned a rare column that bears a passing familiarity with reality.

But where you throw your own credibility (and gullibility) into question is where you simply cut and paste his thoughts without providing any editorial context of who Krauthammer is. He is an arch-partisan who is lives (or at least remains undead) in order to tell us all why all news is good for Republicans and bad for Democrats.

If Obama had backed truly game-changing health care reform, Krauthammer would have written that it was bad for Obama that he was giving more than lip service to liberals.

If Obama had scrapped health care reform until his next term, Krauthammer would tell us all how Obama lacked the vision thing of Reagan.

All news is bad for Obama. Always.

KT, I read the interview in its entirety - very good work and excellent questions I must say. I didn't get the impression that he was admitting that he isn't doing as good a job as he wished: what I got from the answer to the question you asked about polls (to which I am assuming you refer) is that he understands the case very clearly, is frustrated that he hasn't been able to get the case clearly across a lot of which he ascribes to the media wanting to frame the issue in a conventional way. I think this is where his - I want to say innocence but that seems wrong - let's call it general belief in the good nature of people let's him down. He can't imagine why people would rather continue to have 47 million people (or however many there are) uninsured when to cover them would be relatively simple (in policy terms, not in political terms).

I think the frustration is that he hasn't been able to get his message across without it being distorted, muted or otherwise bashed into submission by the media's conventional wisdom feature.

Every time I hear the President speak about this issue, I have no complaints about his lack of clarity or his lack of guidance to Congress. He explains the issues in a manner clearer than anyone else I have heard on this subject. I guess what I share with him is my deep and abiding lack of comprehension that people are swayed by the whole "this is socialised medicine" or "government will get in the way" mob. I won't deign to call them arguments cos all they really are are sloganeering. How can people come to a view on a matter so serious as healthcare by slogans alone - it is not breakfast cereal, for God's sake!

Whaterver happened to the words "community rating"?

They were central to the health care debate during the election, but have since disappeared.

Without "community rating", Obama's so-called insurance reforms are meaningless. It make no difference if you can't exclude pre-existing conditions unless rates are "community" based -- and you can't have a workable "community rating" system unless there is a strong mandate that ensures everyone has coverage.

Mo' money mo' problems.

"At the same time, the group (Blue Dogs) has set a record pace for fundraising this year through its political action committee, surpassing other congressional leadership PACs in collecting more than $1.1 million through June. More than half the money came from the health-care, insurance and financial services industries, marking a notable surge in donations from those sectors compared with earlier years, according to an analysis by the Center for Public Integrity"

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/30/AR2009073004267.html?hpid=topnews

I currently have health insurance, and I'd say that I'm "satisfied with it," but what I'm not remotely satisfied with is that if my company went under or had a bad quarter or cut my division or decided coverage was just too expensive, I'd be tossed into the individual market, where I'd be hard-pressed to afford coverage for myself and my family.

So while I'm "satisfied with" my current plan, I'm not in any way "satisfied with" the overall system. I'm sure that a lot of people would agree, and that seems like a pretty large problem with the 86% statistic.

From the Commentariat at Steve Benen's Washington Monthly spot:

Dems need to reframe this as "Health Insurance Reform" not "Health Care Reform." The latter is scary to people because most people like their doctor and actual health care delivery system, but everybody hates the way the current health insurance system works. If Dems made it clear they were reforming the way health care is paid for, not how it is delivered, I think the GOP scare tactics would fall flat.

Posted by: Doug-E-Fresh on July 30, 2009 at 3:54 PM |

Paul Lukasiak:

It make no difference if you can't exclude pre-existing conditions unless rates are "community" based -- and you can't have a workable "community rating" system unless there is a strong mandate that ensures everyone has coverage.

Yes.

From Obama's sales pitch site:

THE SECURITY YOU GET from health insurance reform:

* No Discrimination for Pre-Existing Conditions

* Insurance companies will be prohibited from refusing you coverage because of your medical history.

* No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays

* Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

* No Cost-Sharing for Preventive Care

* Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

* No Dropping of Coverage for Seriously Ill

* Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

* No Gender Discrimination

* Insurance companies will be prohibited from charging you more because of your gender.

* No Annual or Lifetime Caps on Coverage

* Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

* Extended Coverage for Young Adults

* Children would continue to be eligible for family coverage through the age of 26.

* Guaranteed Insurance Renewal

* Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.

This sounds like bait and switch. It sounds like "coverage" is being used interchangeably with "affordable coverage", but those are two different things entirely.

The pitch goes on and on about guaranteeing coverage:

"No Discrimination for Pre-Existing Conditions"

(notice how this bullet doesn't specify that the prohibited "Discrimination" is related to the price charged for insurance, as in this bullet "Insurance companies will be prohibited from charging you more because of your gender."

"Insurance companies must fully cover..."

"No Dropping of Coverage..."

"...prohibited from dropping or watering down insurance coverage..."

"...prevented from placing annual or lifetime caps on the coverage..."

"eligible for family coverage"

So where does it say that the health insurance premiums are guaranteed not to be impossibly expensive for me to pay?

Let's see, we've got "Guaranteed Insurance Renewal", but that's not the same as "Guaranteed Insurance Renewal at an affordable rate".

We've got "Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. ", but where does it say that they're prohibited from renewing the policy at a premium nobody (except the very well off) can afford?

Oh! This looks promising:

"No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays"

But wait...there's no mention of "Premiums", is there? Shouldn't that be "No Exorbitant Out-of-Pocket Expenses, Deductibles, Co-Pays or Premiums"?

What's the point of guaranteed --mandated, even-- coverage, if the insurance companies are still free to charge whatever premiums they like?

Where's the guarantee against insurance companies simply practicing a different form of rescission, one that focuses on retroactively recovering re-set premiums after somebody gets sick?

Let's say that a loved one in your family gets frighteningly ill:

What would normally happen is that your insurance company would try as hard as possible within the letter of their contract to retroactively drop coverage, and therefore deny payment.

The Obama sales pitch deals with that by specifying "Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill."...Or does it?

What if, instead of retroactively dropping coverage, insurance companies work just as hard to retroactively raise premiums? What if the same result happens to people who find themselves in this position, but through different means? What if the insurance company can still deny payment, because they now claim that you owe them the difference between what you paid every month and the premiums that they would have charged you had they known about your potential risk of payout --the exact same mechanism that they use to deny coverage after the fact?

What if they then don't renew your policy because they've literally complied with Obama's decree "Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full."? What stops the retroactive leverage from now becoming premiums and not coverage?

What's changed, except the language?

It seems that "THE SECURITY YOU GET from health insurance reform" is very carefully designed not to interfere with the "free market principle" that insurers can charge whatever they want whenever they want to, and so can still manipulate the system to their bottom line benefit. It seems that this is a game of semantics at the very highest level.

This is exactly what we do not need. We don't need a recalculated sales pitch that touts whatever gets passed by carefully hiding its deficiencies with sugary sales-speak.

We need the actual, simple passage and implementation of real reform, i.e.:

"Under this plan, all people will be able to buy affordable comprehensive insurance that guarantees them their trusted doctor, and which cannot be taken away."