Did President Obama “Lie” When He Said “If You Like the Policy You Have, You Can Keep It”? Context Is Everything

How many times have you heard that the President of the United State “lied” to the American people when he said “If you like the policy you have, you can keep it?”  Even some liberals have swallowed this Republican talking point.

In December, Politifact, the Tampa Times Pulitzer-prize-winning online fact-checker, went so far as to name Obama’s  statement “the lie of the year.”

Since then, the story has generated headlines like this one: ““Reporter Asks Obama, “What’s It Like to Be Called Liar of the Year?” 

What most people don’t recall is that in 2008 m when President Obama first uttered those fateful words, Politifact—the very same fact-checking organization– graded his statement as “True.”

What is going on here?

                          Context: Who Was Obama’s Audience?

It should come as no surprise that Obamacare’s opponents ripped the president’s original statement out of context. This was easy to do because so few people remember the third Obama/McCain debate that took place in Hempstead, New York, on Oct. 15, 2008.  During this debate then-Senator Obama uttered the words that would haunt him: “you can keep your plan.”  

A transcript of the debate reveals what he meant. In response to a question from the debate’s moderator, Obama laid out a thumbnail sketch of healthcare reform:  “Here’s what my plan does. If you have health insurance, then you don’t have to do anything. If you’ve got health insurance through your employer, you can keep your health insurance, keep your choice of doctor, keep your plan.”

Obama had said something similar in his second debate with McCain a week earlier, in Nashville Tennessee.  “If you’ve got health care already, and probably the majority of you do, then you can keep your plan if you are satisfied with it. You can keep your choice of doctor.”

Few remember that when Obama assured Americans that the Affordable Care Act would not interfere with the benefits they had, he was addressing “the majority” of insured Americans–people who worked for large companies that offered comprehensive coverage.  More than two-thirds of the American work-force is employed by firms with more than 100 workers, and at the time, 99% of large companies offered health benefits.  He was not talking to the 5% of Americans who purchased their own coverage in the individual market, or the 17% who were covered by a small firm. (Only 35% of the U.S. work-force is employed by small companies and less than half of those firms offer health insurance.)

                 Context: What Was the Issue Obama and McCain Were Addressing?

In  2008 when Americans who had good health benefits at work heard the phrase “healthcare reform,” many worried that this would mean a “government takeover” that would eliminate their employer-sponsored plans. In short, they feared a single-payer system. Obama was trying to reassure them that this wouldn’t happen.

At the time, Politifact understood that this was the concern that Obama was addressing.  Here is what Politifact’s Angie Holan wrote in October of 2008:

Obama is accurately describing his health care plan here. He advocates a program that seeks to build on the current system, rather than dismantling it and starting over. People who want to keep their current insurance should be able to do that under Obama’s plan. His description of his plan is accurate, and we rate his statement True.”

                                         “You Can Keep Your Doctor”

 The next year, in a speech before a joint session of Congress, Obama elaborated on the theme: “If you are among the hundreds of millions of Americans who already have health insurance through your job . . .  nothing in this plan will require you or your employer to change the coverage or the doctor you have.”

Once again, Politifact commented on Obama’s pledge: “We concluded that nothing in Obama’s proposal proactively forced such changes, and the bill is clearly intended to leave much of the current health care system in place. So we rated the claim True.”

In other words, the Affordable Care Act would not force employers to narrow their provider networks.  But  as The New Republic’s Jon Cohn has pointed out, over the next five years (2008-2013), many  would decide to tighten those networks, in part because research revealed that employees and customers preferred lower premiums, even if that meant giving up pricey providers.  The ACA did not cause that change; it was happening before the legislation passed. 

                                          “You Can Keep Your Plan If You Like It’

In 2008, “like” was the operative word.

Obama knew that the vast majority of Americans who worked for a large company and had employer-based insurance were happy with it.  After all, even today, their employers pay an average of 75% of the premium for family coverage and 80% when insuring an individual.

By contrast, nearly one-third of employees at small firms who sign up for a family plan must pay more than half of the premium out of their own pockets. In the individual and small group markets, families also often face steep deductibles.  And because individuals and small business owners have little leverage when negotiating with insurers, benefits can be sketchy. A recent survey from the Center for Health Research and Transformation shows that 45% of those who had bought a policy in the individual market rated it “fair or poor”;  82% of those with employer sponsored coverage called it “excellent” or “good.”

Back in 2008, Obama, like everyone involved in health care reform, knew just how dysfunctional the individual market was. Consumer Reports described it, quite rightly, as “the wild West of insurance”:  

“Individual insurance is a nightmare for consumers: more costly than the equivalent job-based coverage, and for those in less-than-perfect health, unaffordable at best and unavailable at worst. Moreover, the lack of effective consumer protections in most states allows insurers to sell plans with ‘affordable’ premiums whose skimpy coverage can leave people who get very sick with the added burden of ruinous medical debt.” Indeed more than half of the plans sold in the individual market cover less than 60% of health care costs.

Customers might be “satisfied” with the price—but only, Consumer Reports warned, if they never got sick: “There’s no free lunch when it comes to insurance. . . . So if your insurance was a bargain, chances are good it doesn’t cover very much. . . .  If you don’t see a medical service specifically mentioned in the policy, assume it’s not covered. We reviewed policies that didn’t cover prescriptions and chemotherapy, but didn’t say so anywhere in the policy document—not even in the section labeled ‘What is not covered.’

My guess is that it didn’t occur to Senator Obama that a great many Americans who had  “bare bones” insurance had never taken a close look at what the policy did and did not cover. They just knew that it was cheap. This is why they thought they “liked it”—until they tried to use it to cover a serious problem.

Most often, they didn’t keep the plan long enough to find out how skimpy it was. Pre-Obamacare carriers selling  policies in the small group and individual markets companies regularly hiked premiums and canceled policies. This is why only 17% of the individual market’s customers managed to hold onto a plan for more than two years.  In other words, even if the ACA had never passed, only a tiny number would have been able to “keep the  policy” they had in 2008.   This is something that those who blame Obamacare for “plans cancelled” in 2013 never mention.

              In 2013  Politifact Acknowledges: “Sound Bites are Treacherous”

 When I called  Angie Holan, who wrote both the 2008 and the 2013 reviews of President Obama’s promise she was candid: “When Politifact rates something “Lie of the Year,”  she explained, that doesn’t  mean it is the biggest whopper of the year: “It’s not the most inaccurate statement. It’s the one that has the biggest influence.”

Holan also pointed out that in her 2013 review she did not suggest that the president set out to deceive the public. Rather, she wrote that “boiling down the complicated health care law to a sound bite proved treacherous, even for its promoter-in-chief.” This is  true.

Over the years, President Obama let “You can keep your plan” became a one-liner. “Minnpost’s” Eric Black puts his finger on the problem: “It’s an oversimplification  . . . . I personally observe a very high bar before I call something a lie,” he adds. “The word is thrown around too easily.”

I agree: Obama didn’t lie. He over-simplified.

Nevertheless, when Obama turned his pledge into a sound-bite he made an enormous mistake.  It is all but impossible to sum up any part of the Affordable Care Act in one sentence without leaving out critical details. When you are talking about something as complicated as health care reform, it is inevitable that one-liners will mislead your audience.

Arguably, a sensible listener might have realized that the President of the United States could not guarantee that his insurer would never send him a notice telling him that his policy was no longer available.  (As noted, pre-Obamacare, carriers had been doing this on a regular basis, both in the individual and small group markets. ) Nor could the president force a doctor to stick with a patient’s insurance plan. Physicians frequently drop out of insurance networks, for a variety of reasons.

But when voters are listening to politicians, most don’t think about the one-liners –they just swallow them whole.

                                 What the President Should Have Said

Roosevelt senior fellow Richard Krisch suggests that “the more accurate message would have been, ‘If you have good insurance and you like it, you can keep it.’

But if Obama had qualified his statement as Krisch suggests ,that would have raised a question in a listener’s mind: “Exactly  what is “good” insurance”? The candidate would not  have had a chance to answer that question. This was a debate, and Tom Brokaw, the moderator was constantly reminding both Obama and McCain that they were exceeding their time limits.

Others have made different suggestions. On Yahoo.com/questions someone asks: “Why didn’t Obama just say: If you like your plan you can keep it if it conforms to the rules?

The website offers an answer: “Americans don’t do nuance.”

Very true.

Moreover, “if it conforms to the rules”  raises more questions: “What rules?”

An accurate response would require at least two paragraphs of explanation, describing “essential benefits,” caps on out of pocket spending, free preventive care, and the many other ACA regulations that prevent insurers from gouging patients.

The fact is that Americans have little tolerance for detailed explanation.  That is why they like the slogans that many conservatives favor brief and to the point, they fit on a bumper sticker.  Typically they are very clear– even if not true.  “Obama lied” is a good example of a Republican talking point. “Government takeover” is another catchy phrase.

Unfortunately, some liberals have suggested that healthcare reformers should follow their opponent’s example: “Frame the issue,” they say. “Make it punchy.”

But the truth is that such rhetoric functions like an ad:  it aims to “sell” a point of view.  It is not meant to provoke thought; it cuts off thought.  The ad-man wants just one response: “No question, I’ll buy it.”

Such rhetoric is not designed to educate. It aims to obfuscate. This is what reform’s opponents need to do; their goal is to confuse the issue, and conceal the benefits of Obamcare. By contrast reformers have little to hide: their goal should be to explain the full truth about the Affordable Care Act– even though that means asking their audience to pause, listen and think.

Bill Clinton is the one politician I can think of who knows how to hold an audience’s attention while delving into wonkish details.  He  insists that they pay attention:  “Listen to me now . . . [pause ].”  Or “This is important. . .” [pause]–yet avoids sounding like a college professor.  Relaxed and disarming, he’s not delivering a “speech”; he’s talking to his audience.

David Kusnet, Clinton’s  chief speech-writer from 1992 to 1994 explains: “By improvising so often, and using so few freeze-dried and focus-grouped applause lines, Clinton continues to keep his speeches fresh, friendly and factual in the hope that his listeners will open their minds to what he says.”

Exactly. Clinton opens minds; he persuades an audience to think

President Obama got into trouble because he turned his own message onto one of those applause lines — a  “meme,” that would “go viral” on the Internet.

                                         Obama’s Mea Culpa

If the president did not lie, you might wonder, then why did he apologize for misleading the public?

In fact, Obama did not apologize.  Granted, when NBC interviewed the president on Nov. 7 the network headlined the piece:  “Obama personally apologizes for Americans losing health coverage.” 

But as is so often the case, the headline wasn’t  true. Take a look at what the president actually said:

We weren’t as clear as we needed to be in terms of the changes that were taking place, and I want to do everything we can to make sure that people are finding themselves in a good position, a better position than they were before this law happened. And I am sorry that they are finding themselves in this situation based on assurances they got from me.”

The president is not saying that he promised the American people that they could keep policies that didn’t meet the Affordable Care Act’s standards for affordable protection.. He is saying that his wording wasn’t clear enough, and as a result, many Americans were blindsided when they received letters from their insurers. He is sorry for that.

Writing about the “mea culpa” the Washington Post’s Sarah Kliff makes an important point : “What Obama isn’t offering is an apology for the cancellation notices themselves. Eliminating certain health plans from the market — ones that the White House thinks are too skimpy — is a feature, not a bug, of the Affordable Care Act. ”    The idea was to make insurance coverage more robust — and that means cancelling policies that offer less thorough coverage.”

“There are lots of insurance policies, especially on the individual market, that are really bare bones. Some argue they shouldn’t even be called insurance coverage, because their coverage is too sparse to insure against financial ruin. The whole idea of the insurance expansion isn’t to get Americans to purchase anything called ‘insurance,’” Kliff adds. “ It’s to get them to purchase a specific kind of insurance, a plan that is relatively comprehensive and helps protect against financial ruin. If Americans were going to be required to buy a product, the reasoning goes, it should be one that can actually do some good.” .

In the NBC interview Obama goes on to try to  reassure his listeners that the majority of customers will be able to get better coverage—for less– in the Exchanges: “Keep in mind that most of the folks . . . who got these . . .  cancellation letters, they’ll be able to get better care at the same cost or cheaper in these new marketplaces. Because they’ll have more choice [and there will be] more competition. So– the majority of folks will end up being better off.”

“Of course, because the website’s not working right, they don’t necessarily know it right [now]” Obama acknowledges.  .  . “And it’s scary to them. And I am sorry that they– you know, are finding themselves in this situation, based on assurances they got from me. We’ve got to work hard to make sure that– they know– we hear ’em and that we’re going to do everything we can– to deal with folks who find themselves– in a tough position as a consequence of this.”

Here, the president’s sympathy is real. He is truly sorry that many Americans feel that they have been left in limbo. The have lost the policies they had, and don’t know whether they will be able to afford the insurance the Exchanges offer. President Obama understands that they feel betrayed

If only the websites had been functioning properly, people who received a “Dear John” letter from their insurer would have been able to look for a new policy right away. It was the uncertainty that left so many both anxious and angry. And the media stoked their fears.

                      Obama Does Apologize for the “Dysfunctional” Website

In his interview, President Obama does not say he is sorry that sub-par policies are being discontinued. He realizes that the majority who received the cancellation notices will be able to purchase better coverage for less in the Exchanges. (This would turn out to be true. We now know that, as of the end of December, 79% of the 3 million Americans who had enrolled in the Exchanges qualified for government subsidies. In addition, a new PwC Health Research Institute study reveals that, even before applying the subsidies, Exchange premiums have turned out be lower than premiums for comparable employer-based insurance. 

The president ends the interview with a heart-felt mea culpa: “I am deeply frustrated about how this website has not worked over the first couple of weeks. And, you know, I take responsibility for that.” Obama makes no bones about it: “The American people have been burned by– a website that has been dysfunctional.”

And he confesses that he should have done a better job of overseeing the project:  “If we had to do it all over again, that there would have been a whole lot more questions that were asked, in terms of how this thing is working.”

Here, Obama “owns” his mistake: “Ultimately, the buck stops with me. You know, I’m the president. This is my team. If it’s not working, it’s my job to get it fixed.”

 

12 thoughts on “Did President Obama “Lie” When He Said “If You Like the Policy You Have, You Can Keep It”? Context Is Everything

  1. Political opponents have managed to score some points on this issue, but it makes little sense when you actually think about it. People tend to forget about the part of Obama’s “If you like your plan/doctor you can keep it/him” promise that was clearly implied. Was he saying that the ACA was going to protect people, in all sorts of situations, from having to change doctors or insurance plans? Of course not. People generally understood that they wouldn’t necessarily be able to keep their plans or doctors if their employer decided to change insurance companies, or if they changed jobs or lost their job, or if they retired and went on Medicare, or if their doctor dropped out of their network, etc.

    What should have been understood, and what Obama stated several times (e.g., “what I’m saying is the government is not going to make you change plans under health reform”), was that the ACA itself was not going to force people to change plans or doctors. So, is the ACA “forcing” people to change plans or doctors? Or are providers, hospitals, insurance companies, and employers doing what they’ve done all along – making their own choices that affect the options available to health care consumers?

    It’s obvious that the pace of change in the health care market is being accelerated due to the ACA and it’s obvious that the ACA is causing insurance companies to make certain decisions about the plans they offer, especially in the individual market, but this is not the same as the government “forcing” insurance companies to send cancellation notices.

    People can cry “foul” and claim that those cancellation notices would not have been sent if not for the ACA, but the fact remains that all sorts of changes have been forced on consumers by health insurance companies, particularly in the individual market, since long before the ACA was enacted. And many of those changes were not beneficial to health care consumers.

  2. Jon–

    Thank you.

    Everything you say is true.

    It was foolish of President Obama to let his pledge become a sound-bite applause line.

    But it was just as foolish for any thinking person to actually think the president could guarantee that their insurance wouldn’t change.

    As you say, change was already happening.

    Did the ACA accelerate change? No doubt.

    But for the vast majority of Americans, the ACA’s changes will make healthcare better and more affordable.

    The same can not be said about many of the changes that were happening pre-Obamacare.

  3. Tax-Credits For Charity-Care?

    Local Funding of Medical Internships and Residencies?

    1. Medicine may shortly represent ~20% of our economy.

    2. “Not-for-profit” hospitals receive a tax-credit. Many pay their administrators far more than

    taxpayers pay President Obama.

    3. There is a doctor-shortage predicted in 2008 to reach 200,000 by 2020 according to Dr.

    Cooper, an internist at the University of Pennsylvania.

    4. Medical school costs $326,500 (all costs) in some cities. Graduating medical students face a

    competitive ratio of ~40,000 applicants (U.S + foreign graduates) for ~25,000 internships.

    5. Q. A: Should states offer doctors a tax-exemption for charity-care?

    Should the IRS do the same?

    Q. B: Should cities fund internships and residencies since Congress is apparently unwilling to

    do so? We are all patients.

    Q. C: If you were 18 and wanted to be a doctor, would you do so in this country at this time?

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

    HButler@post.Harvard.edu

    http://www.SemmelweisSociety.net

    ———

    Reference: “The Healing of America” by T. R. Reid

    • H–

      I wrote a long response to your comment, but then my computer closed down and I lost it.
      I am sorry.
      I will reply tomorrow or the next day.

      .

    • H–

      Medicine will not soon equal 20% of GDP. Healthcare inflation has slowed–both in the public sector and in the private sector, and we’re on our way to the point where the growth in healthcare spending will equal GDP growth of about 2%-3% a year. It won’t be easy but we have been making progress for the past 3 years.

      What not-for-profit hospitals pay their CEOs is exorbitant, but in this country most CEOs are grossly overpaid. And within the context of a hospital’s total budget, CEO pay is a tiny, tiny amount. The problem is the $$$ that hospitals pour into “amentities”–marble lobbies, artwork,
      private rooms with spa-like amenities, atriums, mahogany paneled conference rooms–not to mention cutting-edge equipment that every hospital does not need, and some of which has never been proven to be better or safer than older less expensive technology.
      Finally, non-profits get a tax break because, in theory, they do things for the community that for-profits are not likely to do–for instance, building and staffing clinics in poor neighborhoods. But a great many non-profits do not “give back” to the community to a degree that equals there enormous tax break. For this reason, one or two hospitals have lost their tax break, and going forward, I suspect we’ll be taking a closer look at what they do and don’t do.

      Cooper has been saying that there is a doctor shortage forever. There is no “doctor shortage”–rather doctors are maldistributed. Too few doctors in poor rural areas where few want to settle. See this piece I just wrote for the Guardian
      http://www.theguardian.com/commentisfree/2014/jan/28/obamacare-doctor-shortage-myth

      It’s not at all clear that everyone who either borrows the money or has the money to go to med school should win an internship. An internship is not a reward for taking financial risk–it’s a reward for demonstrating enough skill both in
      coursework and in clinical work that your advisers can recommend you.

      Doctors should not be given a tax break for doing their job. Charity care is part of hte job. (They took an oath to put their patients’ interest ahead of their own (financial) interest.
      In addition the lowest paid physicians (PCPs) earn an average of around $185,000. Half earn more. They don’t need a tax break. The folks who need tax breaks are the ones who children now go to bed hungry.
      That said, if a physician’s practice was made up largely of Medicaid patients and uninsured patients (in many cases immigrants who don’t have papers) and he earns less than, say $125,000, I think giving him a tax break would be a great idea. It also wouldn’t be terribly expensive because so very few doctors would qualify. (But they are out there, doing incredibly valuable work, and we, as a society, should help them.)
      We don’t need more internships. WE need more doctors “who will go where no one else will go{and more nurse practitioners. http://www.theguardian.com/commentisfree/2014/jan/28/obamacare-doctor-shortage-myth

      : If I were 18 I would definitely be intersted in becomign a doctor–especially under reform. It will be an exciting time. Specifically, I would want to work for an integrated health care system like Kaiser or Group Health Cooperate in Seattle. Physician satisfaction is high because doctors and other medical professionals work together in teams, collaborating to provide with is generally very good care. They’re on salary, and don’t have to worry about “running a business” Someone else does that. They just practice medicine. They don’t make as much money as the wealthiest doctors in private practice, but most say it’s a better, more satisfying life.

  4. Note to Jon:

    In California, I believe that the state insurance dept did in fact order private insurers to cancel existing plans.

    The purpose was to funnel some healthy, recently-underwritten policy owners into the ACA exchanges.

    The actual history of policy cancellations is complex.
    Because the Congress vested a lot of health care powers in the states, Obama had less control of this process than many think.

    This is not a huge item, but I wanted to get it on the record.

    • Bob–
      Non-compliant plans were cancelled because they did not comply with the law. They were illegal.

    • According to a Kaiser Health News article dated November 15, 2013, “Neither [the California Dept. of Insurance nor the Dept. of Managed Health Care] has the authority under state law to order insurance companies to rescind their cancellation notices.” See “California Considers Its Options On Canceled Insurance Plans.” Now, this doesn’t necessarily mean that those state agencies couldn’t make the insurance companies cancel their existing plans, but it implies otherwise (absent mutual benefits from contractual arrangements). More importantly, however, the same article quotes a state insurance industry lobbying group, the California Association of Health Plans, as saying that the state should “stay the course and transition people into more comprehensive policies.” That takes the air out of any argument that they were “forced” to cancel policies if their lobbying group actively supported the cancellations.

      The big picture, though, is that the PPACA has two main goals – patient protection (the “PP” part) and expanding the number of people with affordable insurance (the “AC” part), primarily through the Medicaid expansion and the exchange subsidies. So, consumers now benefit from greater protections from pre-existing condition denials, coverage caps, and rescission.

      The source for your article, CalWatchdog, also had an article about Occidental Petroleum moving to Texas from California in which they stated, “No doubt profitability will improve in Texas’ low-tax, pro-business environment, in contrast to California’s high-tax, anti-business climate. Texas has no version of AB32, the Global Warming Solutions Act of 2006 and other regulatory absurdities.” Clearly, they have a right-wing pro-business slant on things. I’ve come to expect anti-consumer, anti-environment, anti-worker advocacy from right-leaning sources.

      I’m continuously puzzled as to why so many people protect their abusers and abuse their protectors, but it sure is common these days. People no longer complain that the government “forced” automakers to put seat belts in cars or that the government “forces” polluters to refrain from dumping toxic chemicals in our rivers, but they still complain about insurance companies being “forced” to stop polluting the health insurance market with inferior products. Why can’t people accept the government’s role in protecting us from all sorts of things?

      • Jon–

        Thank you very much.
        And yes, the cancellations are all about protecting consumers.
        Also thanks for the head’s up about CalWatchdog

  5. Bob–

    I don’t where you got that info, but the state insurance dept. in Cal. did not “order” insurers to cancel existing plans.

    Evidence?

  6. My info comes from an article, “Covered California required health insurers to cancel plans”
    by Katy Grimes, 11-8-13, Cal Watchdog.com

    • Bob–

      The article makes it very clear that Covered California required health insurers to cancel NON-Compliant plans. In other words plans did not meet the ACA’s standards for consumer protection were cancelled. This was what HHS Kathleen Sebelius explained would happen in June 2010. California simply spelled it out in the contract with Exchange insurers. See my post on how no one tried to hide the fact that these plans would be cancelled.
      Katy Grimes is also wrong when she says that Obama “apologized” for the cancellations.
      He apologizes that the website wasn’t working well enough for people to immediately find new plans. He specifically did not apologize for cancelling these plans.