Competition for the hearts and minds of the voters in 2014 has begun with a bang—the opening salvo in the conservatives’ pre-election fight against Obamacare. This week, Americans for Prosperity, a group that espouses small government and is funded by the Koch Brothers, aimed directly at something near and dear to many Americans: the ability to choose their own doctors.

Choice became an issue way back in the 1990s, when the Clinton plan was kicking around, and more recently in the debate over the Affordable Care Act. Remember when the president said that if you liked your doctors with his plan you could keep them? So it’s not surprising that Americans for Prosperity would choose that as a theme for an anti-Obamacare TV commercial, which is running in Virginia and Ohio but soon to go national. Tim Phillips, president of Americans for Prosperity said, “Too often we fell into a broad-based ideological argument, and I think we failed to get at ‘Look at what they’re doing and how it impacts you.’” Sounds good, no? That’s what we’ve been preaching to journalists for some time, in fact, an honest look at how the thing works.

But on that score, the commercial fails. It is clever. It does contain a kernel of truth but overall it’s misleading and deceptive.

We hear from Julie, a young mother whose son started having seizures two years ago. She’s convincing and is every mother. The medical care he got “meant the world” to me, she says. (What mom wouldn’t say that if her kid got good treatment?)

Then comes the pitch—hardly subtle. Her brush with the health system prompted Julie to pay more attention, she tells us. “I have some questions about Obamacare. If we can’t pick our own doctor, how do I know my family’s going to get the medical care we need? Can I really trust the folks in Washington with my family’s health care? I think we all deserve some answers.”

Yes, we do. And a good place to start is setting the record straight about this ad.

Whether you can choose your doctor is a function of the insurance plan you have, not a function of Obamacare. While it’s true that Obamacare requires you to buy insurance, it does not say you can’t select who you want to treat you, as the ad implies.
Since the issue of doctor choice first surfaced years ago, changes in the insurance market that began well before anybody dreamed up the Affordable Care Act have meant that, in reality, millions of Americans are not always free to choose their physicians, a fact that made Obama’s remarks during the campaign somewhat disingenuous.

Over the past two decades, as insurers have increasingly selected networks of providers who give them the best discounts on the prices they charge for services, patients have not always had access to the doctors of their choice. If you go out of network to choose one you really want, insurers make you pay coinsurance and copayments and higher deductibles to do that. They make it financially advantageous to pick the doctors they’ve selected, even if there are problems with using them. One patient I recently met complained that her insurance plan allowed a limited choice of a pediatric specialist her daughter needed for a rare condition, and none was located near here home. Luckily, she said, she could switch insurers. For many, that’s not always possible.

As we’ve reported, this trend will continue under Obamacare, and apart from it, with insurers offering narrower and narrower networks to extract even higher discounts—all in an effort to keep premiums from going through the proverbial roof.

It was good to see the media challenge the Americans for Prosperity commercial, which is running on cable and network channels shows watched by women and on such popular programs as Good Morning America, Chopped, and Law & Order. Christopher Flavelle, a member of the Bloomberg View editorial board, pushed back hard, noting that Julie makes “cunningly deceptive assertions about the law, disguised as questions,” and noted how insurers restrict consumers’ ability to pick out-of-network doctors. He attacked Julie’s question about whether she can trust Washington with her family’s healthcare:

Obamacare doesn’t empower anyone in government to dictate the health-care services people receive. It’s a catchy fiction and conservatives have done a good job of repeating it in the face of all evidence.

Steve Koff, Washington bureau chief for the Cleveland Plain Dealer reported that the ad was running in Ohio and tackled the questions Julie posed. He got the point about insurance companies, and noted that employers who provide coverage for their workers, which is the case for most Americans, actually pick the insurance—a point often overlooked in the spin to demonize insurance companies. Employers are the ones that want to lower their costs.

In the commercial, Julie asks, “What am I getting in exchange for higher premiums and a smaller paycheck?” Koff gave this one a reality check by providing context. Premiums have gone up three times as much as wages since 2002, and in Ohio, Julie may well see higher premiums under Obamacare. But we don’t know yet. She’ll have to wait until later, when the state announces rates for next year in the new healthcare insurance shopping exchanges that open in October, or, if she is insured via her employer, like 160 million other Americans, when that employer announces new premiums for 2014.

A viewer would have to be highly knowledgeable about healthcare to cut through the fog this ad lays down, as its makers surely know. In his piece, Flavelle noted the work of philosopher Harry Frankfurt, who said the goal of political advertising isn’t deceiving your audience about what is true or false so much as making the distinction so confusing as to be irrelevant. “By that definition,” Flavelle wrote, “this latest AFP campaign is a work of art.” Indeed it is, with more “artwork” to come.

Follow @USProjectCJR for more posts from Trudy Lieberman and the rest of the United States Project team, including our work on healthcare issues and public health at The Second Opinion. And for Trudy’s resource guide to covering the ins and outs of buying insurance on the state exchanges, see Open Wide, from CJR’s new July/August issue.


Related stories:

Untangling Obamacare: What’s behind the rate increases?

Medicare Uncovered: the insurers’ latest campaign

Medicare Uncovered: Cost cutting? We can’t have that!

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.