The Media’s One-Sided Coverage of Obamacare

Why does the media continue to insist on promoting the conservative meme that “Obamacare is a disaster”? Today Bloomberg ran a story headlined “Health-Care Law Support Hits New Low, Poll Shows

The piece begins: “Support for President Barack Obama’s signature health-care law has reached its nadir, according to a CNN/ORC International poll released today. The survey shows 62 percent of Americans opposing the law, the highest total since CNN began polling on the issue in March 2010. Just 35 percent favored it. The health-care law has been plagued by a faulty website, hindering efforts to log in and buy insurance, and by the revelation that millions of Americans could not keep their health insurance as Obama originally promised.”

It would be more accurate to say: “Support has been plagued by a faulty website—and a media determined to bury the good news while exaggerating the bad news.”

The very next sentence of the Bloomberg piece illustrates what I’m talking about: “Of those opposing the law, 15 percent said the legislation didn’t go far enough.” (If you actually look at the poll, you will find that pollsters were more explicit: 15% said the law was “not liberal enough.)  Bloomberg continues: ““Another 43 percent said the measure was too liberal based on Republican proposals such as the health-care measure championed by then-Gov. Mitt Romney in Massachusetts.”

Here is a more accurate, cleaerer  lead:  “50 percent of those polled either like the law (35% ) or think that it isn’t liberal enough (15%).”

It also is worth noting that the percent of people who think the ACA isn’t liberal enough is rising: in May 11% said the law wasn’t sufficiently progressive; last month 14% voiced that complaint. In other words, as more people learn about the details of Obamacare, more think that it’s too conservative.)

That’s quite different from the lead the reporter chose: “The survey shows 62 percent of Americans oppose the law.” Most readers would assume that means 62% are opposed to reform, when in fact 50% either support reform or would have liked a more progressive bill.

A balanced story would emphasize that the country remains deeply divided about the overhaul of our health care system. That should have been the headline: “Half of all Americans Support Legislation Sixteen percent thought they would be “better off” while 40% said they expected to be about the same.”Designed to Make U.S. Healthcare Better, More Equitable, and More Affordable.”

I would then  explain: “Many in that group would have liked a more radical solution: a single-payer system. The most recent CNN/ ORC International polls shows that the other half object to government intervention in our healthcare system. Some believe the government will make things worse, and that they will be among the losers.  Forty-two percent of those polled said they believed they would be worse off under the new system. 

It is worth noting that the law draws the greatest support from people 18-34 (38 %) and 51-64 (41%.)  Somehow most in the media are ignoring the fact that so many young Americans favor the law—perhaps because that would contradict assertions  that 20-somethings and 30-somethings won’t be signing up for insurance.

No surprise, better educated Americans support the law, while those with less education are far more likely to be suspicious. This supports the notion that people who have read more about the law, and understand some of the details are looking forward to reform. Others won’t be enthusiastic until the law takes effect—and actually begins to help them.

 How the Media Has Covered the Cancellations

Here is another example of the media feasting on bad news. In recent weeks newspapers have been filled with tales of hard-working Americans who report that their inexpensive coverage has been cancelled because it doesn’t meet Obamacare’s requirements. As a result, they are forced to shop in the Exchanges—and, there, we are told, “millions” will have to pay far more for insurance. Some will have to go without insuran

This is yet another example of how newspaper editors and television producers have swallowed the lies that reform’s opponents have been circulating—without asking many questions.

The truth is that the policies that are disappearing did not provide the consumer protection that most Americans want and need. Some policies don’t cover “essential benefits,” including hospital care, prescription drugs and maternity benefits. Other policies cap how much an insurer will pay out in a given year. Still others call for out-of-pocket payments that could easily bankrupt a middle-class family.

Nevertheless the media jumped on the cancellations as another example of the “Obamacare trainwreck”—exaggerating how many would be hurt, while totally ignoring how many will find far better insurance—at a lower price—in  the Exchanges.

Last week, the White House responded to the media firestorm over “policies cancelled” by announcing that Americans who have lost their low-cost insurance because it doesn’t meet Obamacare’s standards will be exempted, for one year, from the mandate that all Americans carry medical insurance. Under the new rule, people who have received cancellation notices can purchase the Catastrophic Plans that were originally designed for Americans under the age of 30—or they can decline to purchase insurance altogether. “

How did the media respond? “Obama Repeals Obamacare” the Wall Street Journal declared.”

                         Just How Many People Will Decide to Opt Out of Obamacare?  

The administration reports that  500,000 Americans will be affected by the change in the rules.    But Reuters has reported that “some experts estimate that up to five million Americans have had their plans cancelled. The Washington Post’s Ed Rogers claims that “millions of Americans” will go without insurance and, as a result, he gloats: “Obamacare just isn’t happening.”

We shouldn’t be surprised by the hyperbole. Ever since the story of cancelled policies broke, media reports have verged on hysteria.

Try Googling “cancelled policies” and “Obamacare.” More than 84 million headlines will pop up, some claiming that “because of Obamacare” as many as “100 million Americans” are losing the inexpensive coverage that they had purchased in the individual market, and will not be able to afford the insurance offered in the Obamacare Exchanges. This is flat-out not true. (Thanks to Ezra Klein for making this very clear.)

  Facts vs. Fiction

Here are the facts about the policies that are disappearing: Just 0.6% of all Americans under the age of 65 are losing the insurance that they purchased in the individual market, and will have to shell out more for coverage next year because the plans they purchased don’t live up to the ACA’s  regulations for “affordable patient protection.” But some will be perfectly happy to lay out more for better coverage. In an eye-opening study, Families USA notes: “Many would prefer new coverage options, even without subsidies. A recent survey shows that 45 percent of people in the individual market describe their insurance as ‘fair or poor,’ compared to 18 percent who have another form of coverage—including Medicaid.”

 The Numbers                                

Families USA does the math. First their researchers explain that only 5.3% of all Americans (15.2 million) are covered by policies they bought in the individual market. And not all of them received cancellation notices.

Secondly, among those who did get the dreaded letter, 71% of families will qualify for government subsidies that will help them buy much better coverage for less than they are paying now. The average tax credit will be worth $5,548.

What would you do: take the $5,548, or say, “No thanks, I’d rather let my family go without insurance”?

Granted, twenty-nine percent of those who are losing their policies earn too much to be eligible for a subsidy. But an estimated 15% to 30% of Americans who are insured in the individual market suffer from pre-existing conditions. Make no mistake:  these are folks who want coverage. That is why they braved a Wild West market where carriers regularly overcharged, refused to pay claims, jacked up premiums, spent 30% of those premiums on marketing, advertising, executive salaries and other “administrative costs” –and cancelled policies on a routine basis.

Finally, what the media ignores is that many would have lost their insurance even if Obamacare did not exist. Family USA reports that in the past, just 35% of the individual market’s customers managed to hold onto their coverage for a year. Typically, the carrier hiked premiums–and the customer dropped the coverage–or the company scrubbed the policy. Thus, in any given year, the majority of policy-holders were not able to “keep the insurance that they (supposedly) liked.”

Those who attack President Obama for “lying to them” have swallowed the much bigger lies that the media has been feeding to all of us. Roughly two-thirds of those cancelled policies would have disappeared by the end of this year—even if Obamacare had never passed Congress.

    The Bottom Line

Taking all of the facts into account, here is my back-of-the-envelope estimate: Somewhere between 500,000 and 1 million Americans might decide not to replace their cancelled policies. My guess is that, at most, another 500,000 will choose catastrophic insurance instead.

Why so few? I have written a post for Health Resources (www.healthinsurance.org) explaining the reasoning behind my numbers.

You will find it here –Just scroll down to “The Bottom Line”

26 thoughts on “The Media’s One-Sided Coverage of Obamacare

  1. Sadly though, for those healthy middle income individuals not quite eligible for Medicare, those who are trying to save for retirement, the premiums are exorbitant, the deductibles and out of pocket costs are outrageously high. If you don’t get a subsidy, the costs are prohibitive. All of which demonstrates that the Un-ACA is a windfall for insurance corporations, a massive transfer of wealth from people to corporations.

    • In the long run I don’t think the insurance companies will make as much as people think.

      But you are right that in some states, such as the ones that didn’t take the expansion or set up their own exchange, your comment is spot on.

      I live in North Carolina, and what you state is proving to be the truth for a friend of mine who would like to retire and can’t. Her husband doesn’t get insurance at his job (medical research), and the cost of insuring him and their daughter is prohibitive.

      • Lou–

        Let me add: what you say about insurers not paying a dime until you pay the deductible is simply a lie.

        If you look at the details of the plans you will see that many plans simply charge a co-pay for a doctor’s visit. You don’t have to pay down the deductible, you just pay perhaps $20 to see a PCP and $35 or $40 to see a specialist. This is before you have paid a penny of the deductible.

        In California, all plans give you at least two doctor’s visits before you pay a penny of the deductible.

        In many cases, you just pay a co-pay for medication–before you pay a penny of the deductible.

        If you are hospitalized as an in-patient, you pay have to pay down the deductible before the
        insurer pays–but deductibles can be as low as $1,500. Some plans carry a 0 deductible.

        If you think you are likely to wind up in the hospital, you would want to pick one of those plans.

        If you are relatively you and healthy, you might pick a plan with a $6350 deductible (That’s as high as they go. No one can be asked to pay more than $6350 total out of pocket.)

        I’m always very disappointed with the way supposedly liberal single-payer advocates generalize –and spread lies– without bothering to actually read the details of the ACA or the plans.

        • Maggie,

          Here’s what the Silver D policy says–“You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use.”

          This individual plan costs $485 per month or $5820 per year. There is a $5000 deductible/person and an out of pocket limit of $6350 per year.

          Not lying Maggie. This is the horrible expensive truth. I would be quite angry/sad/hurt if I had to take money out of my retirement funds, as you say you have to, in order to buy a policy. Not even to use it!

          • Lou–

            The policy you are referring to is one of thousands of policies in the Exchange.

            Rules vary widely, but most often you DO NOT have to pay the deductible before your insurance kicks in.

            See http://www.healthcare.gov

            Lou, I just Googled your name, and it became apparent just how many comments you have made on HealthBeat asserting things that just
            aren’t true. Here I am talking about facts, not opinions. As they say, everyone has a right to his own opinions, but not his own facts.

            I can’t let you use HealthBeat as a platform to spread misinformation.

      • Panacea–

        Panacea–

        You are right; the insurance companies are not making huge profits under Obamacare. The truth is that the regulations make it tough for them to make profits unless they do a good job of putting together networks of doctors and hospitals that offer high quality, efficient care. High quality means that outcomes are good, and that they manage chronic diseases so that people don’t land in a a hospital. It also means that they practice evidence-based medicine, and don’t overtreat.

        I checked North Carolina. I don’t know how old your friend’s husband is. So I first checked what insurance would
        cost if he were 40, and had a 17-year-old child. The two of them could be insured for about $350-
        400 a month. That’s not bad for two people.

        If he were 50, insurance would cost them $450-$500 a month.

        If your friend retired, and all three of them were trying to buy insurance in the Exchange, it would cost $850-900 a month–or more. (I’m assuming both husband and wife are

        Depending on the husband’s income, they might well qualify for a subsidy.

        But on the whole most families with children can’t make it on one income.

        That’s why your friend can’t retire. (In other words, I wouldn’t blame Obamacare)

        I understand that your friend would like to retire, but the purpose of Obamacare is not to subsidize early retirement.
        The purpose is to make sure that everyone has access to high quality care.

        From what you say, your friend is able to cover her husband daughter on her employer’s insurance. She’s lucky.

    • Lou–

      You are simply wrong.

      I have shoppped the Exchanges in many states.

      Middle-income individuals all get subsidies. (Middle income means “median income”– half of all Americans earn more, half earn less.)

      In fact the subsidies apply to people well over the median. The folks who don’t get subsidies are in the top 30%. When you earn more than 70% of your fellow Americans, you are not
      middle class.

      If you know how to read a balance sheet, you can see very clearly that health insurers are not making huge operating profits (profits made from selling insurance). After they pay for drugs and devices that are wildly overpriced, specialist services that in most cases are over-priced, and hospital care that is often over-priced, insurers make a small profit.

      This is why most of the major insurers are selling products in only a few Exchanges. The new regulations make it difficult for them to make the profits Wall Street wants.

      In addition , insurers, along with other health care industry companies,and individuals earning over $200,00 ($250,000 for families) are funding the subsidies.

      This is not a transfer of wealth from individuals to corporations; it’s a transfer of wealth from wealthy individuals (earning over $200,000) to median income and low-income individuals.

      Some wealthy health care practitioners will see their fees trimmed, as both Medicare and insurers stop paying for volume (paying more if the doctor does more) and begin paying for value (better outcomes at a lower price.)

      Finally, this is a transfer of wealth, not from people to corporations

  2. Lou–

    I am one of those median income individuals is not not quite eligible for Medicare. My husband is retired (and on Medicare) but our combined income (his SS, what I earn writing freelance and what I have been taking out of my IRA to make ends meet) means that we earn a little too much for me to qualify for a subsidy.

    But I’m not unhappy about what I will have to pay under the ACA. It is much less than what I am now paying under COBRA.

    The premiums are Not Prohibitive (lower than my COBRA insurance) and the deductibles are very reasonable–if you take the time to look at the Exchanges, and check out the details.

    A great many conservatives just don’t want to take the time to do that. They would prefer to believe what they hear on Fox–or in many reports in the mainstream media which has been burying the good news about Obamacare

    I will be writing about this soon.

    In the meantime–do youself a favor–check out your Exchange. The websites now work very well.

    (I’ve been using them for myself and for friends and readers in other states.)

    You may be surprised to find out what good and affordable care the Patient Protection and Affordable Care Act offers.

    Don’t worry if you didn’t make today’s deadline. That simply means that your new insurance won’t start Jan. 1–but it could still start Feb. 1

    • I am a health care practitioner Maggie, and have studied health policy for nearly 40 years. I have been following Obama’s travesty since 2009. I have looked at the exchanges. The costs are outrageous. What this country has needed for 30+ years is a single payer real system. What we have is extremely fragmented, duplicative, and terribly expensive.

      Plans most people can barely afford have huge deductibles and copays prior to the insurance corporation paying a dime! This is rapaciousness and nothing less. It is NOT affordable. That there have to be subsides says that the premiums are already unaffordable.

      Older people who are not quite eligible for Medicare want to be saving for retirement, not giving money to corporations for policies they can ill-afford, and can ill-afford to use.

      • Exactly.

        According to T.R. Reid, we are better than Slovenia.

        You do not have to favor Single Payer to oppose PPACA. There is no reason our several states cannot legislate control of medical insurance for each state. I believe that is what the 10th Amendment specifies. Remember what competition does: Supermarkets run on 4% profit.

        Actuaries know how many people are needed to insure fiscal safely. States or even cities, churches, synagogues, etc. could do this.

        Finally, since we grant tax-exemptions to “nonprofit” hospitals which are anything but nonprofit, we should grant tax-credits to doctors who give charity-care.

        HButler@post.Harvard.edu

        • H

          Unfortunately, in most Red States healthcare now discriminates against Minorities and Gays.
          In many Southern states an adult does not qualify for Medicaid–no matter how poor he is–unless he has children.
          That excludes most Gays.
          Secondly in most Southern states a great many poor Blacks do not qualify for Medicaid either because they don’t have children or because they
          are poor–but not poor enough.

          Do you know that when Medicare and Medicaid passed, Southern Congressmen insisted that doctors and hospitals be paid far less when
          caring for Medicaid patients than they would be paid when caring for Medicare patients? Those Congressmen knew that
          there would be many more black Medicaid patients than black Medicare patients. At that time relatively few blacks lived more than a couple of
          years past 65 — the vast majority did not live to 65.

          Finally, when Social Security first passed, at the last minute Southern Congressmen insisted that it exclude “agricultural workers” and
          “domestic workers” (i.e. servants). That effectively excluded many blacks. FDR was very unhappy about this, but knew
          that he could not get SS through Congress unless he agreed.

          And today, the “Red States” have refused to expand Medicaid.

          This is why we cannot leave health care reform to the States. Too many would discriminate against the poor and minorities.

          As a doctor in Texas once told me: “Our state has never cared about its poor and it never will!

          This is all very sad, but the majority of people in these states continue to elect politicians who feel no need to represent the poor.
          As voter demographics change, that will change. But for the time being, many states will continue to be held captive by
          these politicians.

          Finally, some states are much poorer than others. This is why we need federal funding to pay for health care reform and Medicaid expansion.

          Otherwise, poor states like Kentucky would have health care that was far inferior to what is available in wealthy states like Massachusetts.

          The healthcare you receive should not depend on whether you live in a poor or wealthy states. This is the United States of American.

          And if people in Massachusetts, California and New York are paying for healthcare in Texas, Florida, etc. that healthcare should be delivered in
          the egalitarian way that they believe is a democracy should provide. This means free contraception for all women, Medicaid for all, whether or not they have children,
          free preventive care for all children–of whatever race– pallilative care for anyone who needs it, etc. etc.

          I am afraid that some state politicians would object to some of these provisions , but in Congress the majority agree that this is what we, as a society, should provide under the AFfordable Care Act, and this is now the law of the land.

          Eventually all states will expand Medicaid because their hospitals, nursing homes, etc. need and want the federal dollars that will come with Medicaid expansion.

          In the end, health care is not about “states’ rights”–it’s about human rights.

    • We are all patients at the end of the day.

      The question naturally arises as to how much of our medical dollar “reaches the bedside” vs. how much stops off on “Mahogany Row” forever, including in our Medicare hospitals in some of which the administrator is paid 10 times what we pay our presidents. Similar questions arise for others whose salaries come from public sources, directly or indirectly, such as university presidents.

      https://www.google.com/search?sourceid=navclient&aq=hts&oq=Costs+of+Health+Care+Administration+in+the+United+States+and+Canada&ie=UTF-8&rlz=1T4ACGW_enUS567US567&q=Costs+of+Health+Care+Administration+in+the+United+States+and+Canada&gs_l=hp….0.0.0.25166………..0

      is from a Google-search for the work of Dr. Stephanie Woolhandler and Dr. David Himmelstein on Administrative Costs In American medicine.

      A similar conclusion is reached by T.R. Reid in his book, “The Healing of America” and his interviews on Utube.

      H. E. Butler III M.D., FACS

      HButler@post.Harvard.edu

      • H–

        Yes, many hospital CEO’s are overpaid. But put all of their salaries together and you are looking at a tiny fraction of what we spend on health care–Far, far, less than 1%.

        Woolhander and Himmelstein aren’t very good on the economics of healthcare.

        I began as a financial journalist and so am pretty good at analyzing the numbers. When you “follow the money” closely who can see where the waste is.

        One reason we don’t want Medicare for All (or single-payer) is because Medicare is very very wasteful. About $1 out of $3 is wasted on unnecessary and/or over-priced products and treatments. See the Dartmouth Atlas for research that goes back more than 20 years. (www.dartmouthatlas.org)

        W and H don’t talk much about overtreatment. Instead they exaggerate how much of our healthcare dollars go to insurance companies (it’s actually a small percentage.) The big money goes to doctors, drug-makers and device makers. (Some single-payer advocates acknowledge that this true. But the leaders of the single-payer movement are not open to criticism. AS one former
        single-payer doctor told me: “It’s my way or the highway.”

        We overpay our specialists. we grossly over-pay for medical devices, and we over pay for drugs. We overpay academic medical centers. There is also much fraud– particularly in for-profit nursing homes and for-profit hospitals.

        We also overpay hospitals for preventable mistakes. When a doctor removes the wrong leg (and this happens more often than you would believe) both he and the hospital are paid a second time to remove the correct leg. Surgical infections kill some people. In other cases they survive, but stay in the hospital longer and need a second operation. Again, both the hospital and doctor are paid a second time.

        Bedsore are actually the most expensive “preventable mistake.” In some cases they kill people. In other cases bed sores lead to much longer hospital stays– sometimes the patient never goes home. He is simply transferred to a nursing home where he is bedridden for the rest of his life.

        It is very easy to prevent bedsores by “turning patients” throughout the day. But hospitals that refuse to hire enough nurses to do the job let patients stay in one position for too long. This is how bedsores develop.

        Many single-payer advocates are reluctant to blame doctors and hospitals for the waste. Some like W and H are themselves doctors. They would rather blame insurance companies and
        administrators.

        If we expanded Medicare to cover everyone of all ages we could never afford it.

        We must reform Medicare first–then consider whether we want single-payer (Medicare for all.)

        But only after Medicare reduces overpayemnts and squeezes out waste. When Medicare spending is cut by 15% or 20% (adjusted for regular inflation) then we talk about
        Medicare for All. .

  3. Thanks
    So often media, which fills our visual world, reports whatever and we all believe,”what we see is what it is” to paraphrase Kahnemann.
    Medical costs skyrocket and all of us feel the pinch. What will happen to those performing health care if the aaca fails or if insurance does not cover costs?
    Frightening!

    • Richard

      Thank you very much. Yes, What we see on our TV and read in our newspapers is what we believe.

      But I have read the ACA law –all of it– more than once.

      It is designed to lower health care costs.

      Health care inflation has already begun to fall, as a result of the ACA.Medicare spending has slowed, and spending
      in the private sector has slowed as well. Premiums in the Exchanges are less than predicted by the
      Congressional Budget Office–and far lower than the fear-mongers predicted.

      Subsidies make insurance affordable for the vast majority of people.

      The ACA will forces hospitals to become safer and efficient. They will no longer be paid for preventable errors.
      More and more they will be paid for value, not volume. “Doing more”–more tests, more unnecessary surgeries and treatments will no
      longer be profitable. They will be paid for better outcomes. Doctors also will no longer be rewarded for overtreating.
      They will be rewarded for keeping patients well–and out of the hospital. That means doing a better job of managing chronic
      diseases like diabetes. It also means working together–in teams–with nurse practitioners. Docs now do many things that NPs
      could be doing. And Doctors will be practicing more e-medicine and telemedicine, rather than insisting that patients come in to
      fill routine prescription (and pay $140 for a doctor’s visit.) Medicare will pay the doc for the time it takes to respond to an email or take a
      phone call–but not $140.

      Some specialists will find that their incomes will fall (cardiologists and orthopods in particular) others will see incomes rise (family medicine if the doctors are good at
      creating medical homes that keep patients out of hospitals, palliative care specialists. . .) I hope that we’ll see insurance covering more physical therapy as an alternative to hip and knee replacements. (Talk to anyone who has undergone a knee replacement and rehab. They would happily do physical therapy instead.)

      And we’ll be paying less for drugs. In the Exchanges the co-pay for a generic is often 0. And I’m pretty sure that Medicare will begin negotiating with drug makers over
      the cost of new drugs. Insurers will follow Medicare’s lead.

      Under the ACA Medicare (&HHS) can make many decisions about what they will pay without going through Congress. This means that lobbyists will not be nearly as effective in
      blocking changes.

      Over the next 10 years we’ll see real progress in reining in costs. It’s already happening!

  4. What I find remarkable about this experience is that the Obama Administration failed so badly that it lost one of its most loyal constituencies – the media (not including WSJ, of course).

    The unstated goal of Obamacare was always to bring about a government-monopoly, single-payer, system. Had the enrollment gone well since October, the premiums still would have been too high and people lose their coverage. However, the Administration could have blamed the insurers and taken the next step.

    I think this will now be very difficult. Government control of health care is now exposed as a disaster, as it was not when big bites were taken in the 1960s, when health spending was so much smaller.

    • The media was dead set against Obamacare from the beginning.
      Here, I’m thinking in particular of journalists like Robert Pear at the New York Times.

      I’ve been reading what he was writing about Obamacare since 2009– before it was passed.

      I’ve also worked at the Times as an editor, and know how the sausage is made. (I understand why the Times swallowed the lies about
      “weapons of mass destruction” in Iraq.

      Why was the media opposed to Obamacare? Begin with newspapers. Do you have any idea how much of their ad revenue comes from hospitals?

      Hospitals didn’t want reform, because they didn’t want people questioning overtreatment–or their pricing..

      Then there is the fact that editors at national publications are by and large very well insured. They are afraid that if everyone has insurance,
      they will lose something they have now.. Doctor’s offices will be crowded. Overtreatment will be reduced. They will be told that before they have a hip replacement, they
      have to try physical therapy. They will be told that they don’t need heart surgery (about half of all “stent” operations reduce angina temporarily but don’t save lives)–instead they will be told that they need to change their diet and exercise.

      Look at the CNN poll that I write about in this post (I provide a link to the actual poll).

      It shows that poor, black people support Obamacare. Affluent white people are much more likely to be opposed to Obamacare. Many believe that they are now getting the best health care in the world– and that as we move toward universal healthcare for all, they will lose something–and/or it will cost them more. Television jouralists, producers, editors and even
      many reporters at our biggest most influential publications are “afflluent” (i.e. they earn more than 10%-20% of all Americans.)

      Poor black people do not run our networks or publish our newspapers.

      Of course not all are opposed to Obamacare. People like Ezra Klein have actually studied the legislation–understand it, and support it. There are also journalists like that at
      the Times (though they have to follow their editors’ directions). Some of the best at the Wall Street Journal were fired– or quit. Some very good people at Business Week quit a number of years ago. Finally , television news has been taken over by conservatives. Even Public Television is not what it once was.

      I’ve been a journalist for 30 years, and worked at Time Inc., the New York Times, Dow Jones (Barron’s) and know people who have worked at most of the major news organizations.

      There was a time (in the 1980s) when they all had facts-checkers. They haven’t had fact-checkers for 13 years. This is why people like Robert Pear can print so many conservative lies–and get away with it. Btw, I’m sure he believes them. He is not knowingly publishing lies. But there was a time when a fact-checker would have told him: “Actually that is not true. Here is the evidence.”

      I write about this in one of my books “Bull: A History of the Boom 1980-2012) In the late 1990s, the financial press became cheerleaders for a bubble that many people on Wall Street knew was going to burst. When it burst many middle-class people who got into the bull market toward the end lost money that they could not afford to lose. Meanwhile, the mutual fund companies were selling–and selling hard–in many cases lying to investors. When I told the editor-in-chief at the publication where I worked that I wanted to write about this,
      I was told “Maggie, we like the mutual fund companies. They are our friends!” He wouldn’t let me write the story.

      After a few years I quit, and ultimately began writing books. At that point, I couldn’t think of more than one magazine where I would be willing to work -except The New YOrker (The had fact-checkers–and still have them. I got a call from one of them a few weeks ago)

      Soon I’ll be writing here on HealthBeat about a story that ran in the Fort-Worth Star Telegram– and how the paper wound up publishing an inaccurate story. I interviewed the editor, the reporter, and
      several of the people quoted in the story. It’s eye-opening, but I’m afraid, typical of how unchecked, and untrue stores are fed to the public.

  5. This is starting off as a great exchange. Thanks!

    Obama’s team thought that everyone in the individual market had awful policies.

    So did I.
    We may have been wrong.

    It is hard to define what is an awful policy. If your premium is $100 a month and you don’t get sick,your policy seems great.

    This is a complex issue.Not suited for presidential soundbites.

    Last comment:
    Obama let the insurance carriers sell 5 million non compliant policies after 2010.
    this was a huge mistake.

    • Bob–

      If insurers were not allowed to sell those plans in 2010, they simply would have gotten out of the marketplace and a great many people would have had no insurance.

      Insurers needed time to figure out how to price compliant plans. Some would decide that they could afford to sell compliant plans– they would lose money.

      This is why the major for profit insurers are offering plans in so few Exchanges.

      Not all of the plans in the individual market were terrible. Some offered good coverage, but were Very expensive.

      I had such a plan– and paid roughly $650 a month for it.

      I live in New York, so I wasn’t paying extra because of my age or pre-existing conditions (In New York state, neither counted, even pre-Obamacare. But $650 a month is steep to insure one person.

      There were no decent plans in the individual market that were “affordable” for a median-income person.

  6. My understanding of what happened in New Jersey, Kentucky, and Washington in the 1980’s was this:

    the state established guaranteed issue, and then over about three years nearly all insurers left the individual market. They could not survive without stingy underwriting.

    I fear this may happen again.

  7. Bob–

    Sometimes I wonder whether you are trying to scare people!!!

    As I note above the large national insurers have already backed away from Obamacare (United, Aetna, etc.) They are participating in relatively few marketplaces. And we are discovering we don’t need them–or their over-priced, often sub-standard policies

    The Blues are active in most Exchanges–and some of their offerings are excellent., And they, along with various non-profits as well as new smaller insurers
    are stepping forward. There are enough carriers to provide real competition in most state Exchanges. This is why
    premiums are significantly lower than expected in almost
    all states.

    Finally, as I have been saying since 2010, after some of the large for-profits disappear from the reform marketplace suspect that we will get the public option that was killed by
    Connecticut SEnators Joe Lieberman (a.k.a. the Senator from Aetna) back then.

    Particularly in some states, we will need more players to create more competition.

    The public option will wind up competing with carriers like
    Geisinger, Kaiser Permanente, and the many new non-profits that will spring up–and, I hope, consolidate.

    I say, “I hope” because Larger insurers enjoy economies of scale that can keep prices down and they have more market clout when negotiating with hospitals.

    Some of them will follow the Kaiser model and buy hospitals, creating an “integrated system” where the folks who provide care and the folks who pay for it are part of one entity.

    In Europe virtually all insurers are non-profits, and the system is much less expensive than ours. Non-profits don’t have to worry about fulfilling investors’ expectations; they don’t pay their executives as much (though exec salaries are a small factor in total expenses, they do set a tone),
    and the best non-profits (like Group Health Cooperative of Seattle) are sincerely interested in keep their customers well (and out of the hospital) .

    Non-profits competing with a public option– this is what I see as the future of American Health care. But before we pass a public option, we need to reform Medicare, and cut what it pays for over-priced drugs, devices and treatments. I expect to see much of that happening before the end of this Obama administration.

    P.S. you may be wondering what will happen to Aetna, etc.?
    They will focus on other markets: they already are paying more attention to selling insurance in Asia; some will sell long-term healthcare . . . But as the CEO of Aetna said about a year ago: “our business, as we knew it, is over.”
    (I’m paraphrasing .)

  8. Bob–

    On new entrants to the insurance market, I just stumbled onto this: “The law has clearly encouraged the entry of new competitors. As many as a quarter of the companies vying to offer plans on the 19 exchanges run by the federal government are new to the market, federal officials said in a memo released last month.

    If the experience in Massachusetts is any guide, the fact that a plan is new and unknown might not keep it from becoming popular quickly. In that state, a relatively unknown insurer, Neighborhood Health Plan, captured a large market share. The Affordable Care Act “represents disruption,” said Kevin J. Counihan, who spent several years in Massachusetts helping to run its marketplace before coming to Connecticut to head its exchange.”
    http://www.cnbc.com/id/100821277

  9. I would love the see the public option return. In a world where all plans are guaranteed issue, the public option would not be saddled with all the high risk patients. In a world where all insurers receive some risk adjustment funds, and where many insureds are subsidized, the public option cannot be criticized as a tool of big government.

    I do wonder how this narrow network issue is going to play out. If a public option had Medicare’s network, it would rule the roost.

    From all that I read, the issue of narrow networks will have to be addressed.

  10. Bob–

    Narrow networks are here to stay.

    Maybe 5% of the population–or less– can afford the premiums needed to pay those hospitals and specialists that use their market clout and brand name to overcharge.

    At this point, 95% of individuals and employers buying insurance care most about price. They have no choice.

    Meanwhile more and more research shows no correlation between
    paying more and better care.
    Under the ACA, infection rates at these supposedly
    “primo” academic medical centers will be published — and more and more Americans will become skeptical about hte brand names. .

    Higher infection rates because patients are sicker?
    No a well-known doctor at a prestigious academic medical center explains: “The administration is terrified of the
    “rain-maker” doctor and so no one is allowed to tell them they must wash their hands” (or use check-lists, or. . .)
    The administration is afraid that rain-makers will take their
    wealthy, well-insured patients to other hospitals. Hospitals in NYC compete for these guys.

    Bottom line: as narrow networks continue to tighten, many of these providers will lower their prices. And as Medicare and insurers demand value for healthcare dollars, they will have to reduce errors & infections– and improve quality.

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