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A fine piece last Wednesday by Politicoâs Carrie Budoff Brown dissects what political prognosticators from Bill Clinton to Obama pollster Joel Berenson had predicted about the ultimate acceptance of health reform legislation. âRarely have so many political strategists been so wrong about something so big,â she writes. âAt the six-month mark, the law remains a riddle for political analysts, lawmakers and the White House.â
Riddle? Not really. Months ago the public sensed a bait and switch, and the media werenât helping them out. The seeds of the public schizophrenia over reform were sown during the presidential campaign, when candidates Obama and Clinton talked about universal health care, making it seem that the country was on the verge of adopting a true national health insurance system like the rest of the developed world.
Thatâs not what they had in mind, and universal health care morphed into universal coverage provided by private carriers. Then the pols and the press discarded that term when the rationale for reform became insurance market reformâa snoozer for sure.
The constant bashing of insurance companies by the president, his health secretary Kathleen Sebelius, and advocacy groups did not compute with the public. Many Americans have had wicked experiences with insurersâbut if they are so evil, why give them twenty-five million new customers? At the gut level, that didnât make sense, and media explanations about bringing everyone into the risk pool didnât resonate. But probing further would bring up the nasty, controversial subject of the individual mandateâthe requirement that everyone have insurance. The pols were not eager to talk about the central feature of the legislation, and the press didnât discuss it much either.
If they did, that might have raised another better-to-ignore topic, affordability: whether middle income folks would really be able to afford a policy they will be required to buy, even with government tax credits to help pay the premium. Last week I interviewed twenty-eight-year old Michelle Zywicki in the Waupaca, Wisconsin public library. She doesnât earn much working twenty hours a week at Dollar General, and canât find a full time job. She has no insurance. Zywicki heard she would have to pay a fine for not buying insurance which she cannot afford.
Because her income is low, I told her, she probably would get large subsidies when the mandate took effect. âWhy hasnât anyone told me that?â she shot back angrily. âIâve tried to read articles and they put me to sleep.â Somehow, dear colleagues, weâve missed with herâand probably millions more in her shoes.
The presidentâs equivocation on the public option allowed its large number of supporters to believe it was possible to create an alternative to private insurance, only to have their hopes dashed when it became clear the mighty stakeholders didnât want it, and so the pols threw it under the bus. Nancy Pelosi herself kept telling reporters that the House bill would have a strong public option, perhaps knowing all along it wouldnât make the final cut. To the public, Pelosiâs remarks came across as just another politicianâs flimflam.
A month ago in Columbia, Missouri, holding one of my periodic town hall meetings, I talked to fifty-six-year-old Charles Paxton, who told me: âWhen they started it, I was for the law. By the time they got it done, I thought it was not a good idea. There were way too many compromises made to get it passed. You know itâs not going to do what it should.â What news there was of the presidentâs deal making with insurance companies, doctors, hospitals, and drug companies didnât sit well with people who thought those days were over.
Republicans have exploited this distrust that is likely to intensify as more people learn about the mandate. âI donât like the fact people will be forced to buy insurance,â said Hannah Spratt, a University of Missouri sophomore who is not spending her time watching Glenn Beck. Robert Hanna in Lincoln, Nebraska, told me he would never vote for a Democrat ever again, because the president âsaid he wouldnât sign a bill that would increase the deficit and include illegal aliens which the bill does.â The GOP message had gotten through.
Shortly after Congress passed the law in March, with the polls showing deep public skepticism, David Axelrod told ABC News: âI think as the American people become familiar with what this program is and what it isnât, theyâre going to be very, very happy with it.â
Seniors with super high drug expenses were supposed to like the $250 rebate, but it is the proverbial drop in the bucket for those whose drug expenses mount in the thousands, and those who remember that the idea of allowing the government to negotiate with drug makers to bring prices down, too, was thrown under the bus. Even though young adults can now get coverage under their parentsâ insurance, some are finding thatâs not as easy as it sounds.
Others are learning that the law has consequences they weren’t told about. The president said many times people could keep the insurance they had if they liked it. Reform would not affect them. Lifting the lifetime cap, for example, affects only those with catastrophic expenses which most people don’t have. Instead, those whose medical expenses are low are now seeing their premiums rise to cover the additional risk the country’s for-profit insurers must now assume for lifting the cap and other new provisions the law calls for.
In late summer, at a road show cum pep rally in Philadelphia organized by Families USA, the groupâs deputy director, Kathleen Stoll, told the crowd, mostly seniors, âthere has been a lot of misinformation about Medicare and itâs very frustrating.â But the bait and switch continued. I donât remember hearing the mandate mentioned, but Stoll did promise âweâll see insurance more affordable.â
Politicoâs Budoff Brown tells us that the Dems are running for cover, reporting that Senate Democrats up for reelection, like Californiaâs Barbara Boxer and Coloradoâs Michael Bennet, donât even mention the law in the health sections of their campaign websites, and donât take credit for its passage. Obama himself, she reported, does mention the law, âbut itâs usually just a few lines wedged between the economy and the financial regulatory overhaul.â Howâs that for leadership?
A few years ago, speaking at the annual meeting of the Association of Health Care Journalists, Don Barlett, of the esteemed reporting team of Barlett and Steele, told journalists that we are lying to our readers. I donât know that weâve lied as much as ignored parts of the story that mattered to people. My town halls show that there are large segments of the public that still donât know about the law, and others donât know what or who to believe.
Campaign Desk repeatedly noted that stories about how reform would affect ordinary people were MIA. âThereâs a real danger reform will pass without families knowing whatâs in store for them, financially speaking,â I wrote. How can we expect the results to be any different?
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