Why Are So Many Americans Confused About Obamacare? How a Video Produced by CBS’ Washington Bureau Misled Millions –Part 1

For nearly four years, poll after poll has shown that the majority of Americans remain flummoxed by Obamacare.  Many are confused; some are afraid. They don’t know what the Affordable Care Act (ACA) says, and they don’t know how it will affect their lives

From the beginning, many in the media have blamed the White House.

Early in 2011, when a CBS poll showed that only 56% of Americans said the bill’s impact had not been explained well—or even “somewhat well”– CBS senior producer Ward Sloane summed up the prevailing view: “To me, that is a Monumental Failure by the Obama Administration. . . . [my emphasis]  And it opens up a big hole for the Republicans which they have driven through with, you know, several tanks.

Because Democrats had botched explaining the legislation, Sloane argued, Republicans “can say whatever they want about the healthcare bill … whether it’s true or not, and  . . . it will resonate . . .  People are afraid. People are afraid of things that they don’t understand and they don’t know. . . The Republicans are playing to this fear and they’re doing a masterful job.”

Sloane slid over the role that reporters might play in helping the public understand an enormous—and enormously important– piece of legislation.  If Republicans were spreading disinformation, shouldn’t news organizations like CBS try to separate fact from fiction?

Network and cable news shows are in our living rooms every evening. President Barack Obama and Health and Human Services Secretary Kathleen Sebelius are not. In speeches and in press conferences Obama and Sebelius can address a handful of questions, but they cannot explain the hundreds of interlocking details that will benefit millions of Americans. The public needs an independent, informed press that will dig into the major provisions of Obamacare and explain them, not once, but again and again.

There was just one problem: As Sloane suggested, the Republicans were doing “a masterful job” of misleading the public. What he didn’t take into account is that journalists are part of “the public.”

                      The Networks Spread Fear and Confusion

Fast forward two years to the fall of 2013.

Little has changed; most Americans still don’t understand the Affordable Care Act, and many are convinced that they have been betrayed by the president they elected.

Millions are now receiving letters from their insurers, telling them that they cannot renew their policies. The media blames the White House. According to NBC, CNN, CBS and Fox News, not only did the administration fail to warn the public that under Obamacare, some  insurance that didn’t meet the ACA’s standards would have to be replaced,  it  deliberately concealed this fact. http://mediamatters.org/research/2013/10/29/media-surprised-by-obamacares-effect-on-insuran/196652

NBC broke the story: “The administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans,”  yet Fox hissed, “they didn’t say a word.

This is simply not true. Back in June of 2010, Health and Human Services Secretary Kathleen Sebelius held a press conference to announce that, under Obamacare, millions would be moving to new plansAs I point out in this post, a HHS press release spelled out the numbers: “roughly 42 million people insured through small businesses  . . . along with “17 million who are covered in the individual health insurance market.”

Even Fox covered the press conference, complete with a video of Sebelius’ speech. But somehow, by 2013, amnesia had set in.

But what about the president’s promise that “if you like your plan, you can keep it”?  Wasn’t this proof that Obama had tried to hide the fact that millions of Americans would lose their insurance?

Obama first made that pledge in 2008, while debating John McCain. The context is crucial:  Obama was addressing “the majority” of Americans  (roughly 66% ) who worked for large companies  that paid 75% to 80% of their premiums –not the minority who purchased their own insurance in the individual marketplace (5%), nor the 17% who  were insured by small business owners.

As I have explained, at the time, Obama was trying to reassure Americans who worked for large corporations that they would be able to keep the generous benefits they enjoyed. Reform would not mean dismantling employer-based insurance, and moving everyone into a single-pay system.  But over time, Obama made a critical error; he let his pledge become a one-liner, making it easy for his opponents to rip that line out of context.

Meanwhile, few in the media seemed to feel that it was their job to put the president’s words in context, or to help clarify why certain policies could not be renewed.

“Explaining”–that was the administration’s job. The media’s job was to stir emotions and assign blame. Or, at least, that’s what many journalists seemed to think.

Before long, the news about “policies cancelled” inspired portraits of  “Obamacare’s victims,” people like  Debra Fishericks, a Virginia Beach grandmother  who was losing her insurance.

                              CBS Airs Debra Fishericks’ Story

After a CBS reporter interviewed Fishericks, the network’s Washington Bureau put together a video, headlined  Woman Battling Kidney Cancer Losing Company Health Plan Due To Obamacare.”   The Bureau then sent it to CBS affiliates nationwide.

WDBJ7, a CBS station in Roanoke, Virginia was among the first to run the video on November 24, 2013.

“We’ve heard about the computer glitches associated with the Affordable Care Act website.” observed WDBJ anchor Susan Bahorich. “Now, some are saying, you can add broken promises to the list of problems.

“CBS reporter Susan McGinnis visited a Virginia Beach woman who says her work insurance was fine –until ACA came along.”

McGinnis, a CBS Washington Bureau correspondent, narrates the tale:

“At her office in Virginia Beach, Debra Fishericks often sneaks a peek at her 3 year old grandson.”

“That’s my guy,” says Fishericks.

McGinnis sets up the story: “Debra is battling kidney cancer. During the 10 years she’s worked at Atkinson Realty, the company has provided group health insurance with manageable premiums.”

Betsy Atkinson, the owner of the real estate business, appears on the screen:  “We had great insurance. We had continuing care for our employees.”

“’Great’” McGinnis adds, “until owner Betsy Atkinson learned the policy would be terminated because it doesn’t meet the requirements of the Affordable Care Act.”

“On June 30, 2014, I will probably not be offering company insurance to my employees. I just can’t afford it’.

“Debra has scoured the website looking for a new policy,” McGinnis reports, referring to Healthcare.gov.  “So far,” she adds, “she cannot afford the premiums. “They just keep going up higher and higher when there is a pre-existing condition,” Fishericks explains

McGinnis wraps up the piece: “Debra hopes that eventually she will find a plan that fits her budget so that she can still makes trips to Indiana –to visit her grandson.”

“If I can’t go to see him—that’s the worst,” says Fishericks.

She begins to cry.

~~~~~~~~~~~~~~~~~~~~~~

Watching the video, I thought: “Oh no, not again.”

A month ago I wrote about Whitney Johnson,   a  26-year old suffering from MS who claimed that under Obamacare, she would have to pay $1,000 a month—or more—for insurance.  http://www.cwalac.org/cwblog/

When I read her story in the Ft. Worth Star-Telegram, I knew it couldn’t be true. Under the Affordable Care Act) insurers can no longer charge more because a customer suffers from a chronic disease. I had thought that this was one part of the ACA that everyone understood.

Apparently not.  In Fishericks’ video, the CBS correspondent tells viewers that a cancer patient who “has scoured the website . . . cannot afford the premiums” because, as the patient explains, “they just keep going up higher and higher when there is a pre-existing condition.”

I was stunned.  The reporter, Susan McGinnis, who later told me that she oversaw the piece, has been a Washington Correspondent at CBS News for three years–following an eight-year stint as an anchor on CBS Morning News. She is a seasoned journalist; yet she didn’t flag the fact that what Fishericks said couldn’t possibly be true.

Granted, McGinnis didn’t actually interview Fishericks; she just did the “stand up” narration in D.C. Another CBS reporter from the Washington Bureau went down to Virginia Beach. And apparently that reporter didn’t realize that under the ACA, insurers cannot jack up premiums because the customer has been diagnosed the cancer.

Finally, someone at CBS’ Washington Bureau must have edited the video.

I can understand why any one person might not have spotted the problem. We all make mistakes. But no one?

Let me be clear:  Fishericks had shopped the Exchange and honestly believed what she was saying. The problem is that no one at CBS corrected her.

Perhaps this was because after four years, the debate over health care reform had dissolved into sound bites, creating what Nancy Pelosi rightly called a “fog of controversy,” obscuring the facts about health care reform. Reporters were printing and parroting the fictions and half-truths that conservatives fed to the media. And in an era of cut-and-paste journalism, the myths became memes, iterated over and over again. Little wonder that many people—including journalists—didn’t know what to believe. This, I think, is one reason why no one at CBS caught the glaring error in Fisherwicks’s story.

Thus the network left viewers with the false impression that under the “Patient Protection and Affordable Care Act” a cancer patient may not be able to afford care.

                       CBS “Packages” the Piece, Millions See It

In late November, 50 CBS stations aired Fishericks story.  (Hat tip to the Franklin Forum  for this information) Within 48 hours, it began showing up in newspapers like Investors’ Business Daily  and The Weekly Standard .

Fishericks’ tale then was picked up by thousands of blogs. “Living Under Obamacare” (paid for by the National Republican Congressional Committee) and “republicansenate.gov” both featured it.

Google “Debra Fishericks,” and you will get over 13,000 results. In other words, the story got around.

Trouble is,  it wasn’t true. As Fishericks herself would tell me: “they got the whole story wrong.”

CBS Responds: “Nowhere Did We Report that She Would Be Denied Insurance” 

When I began fact-checking this story, I wanted to talk to the CBS reporter who went down to Virginia Beach and interviewed Fishericks.  Only she would know what questions she asked, and exactly what her source said.  I phoned McGinnis and asked for the name and phone number of the reporter who actually interviewed

McGinnis explained that while several reporters were involved in the project, she had been in charge. She wanted to take a look at the transcript, “talk to my bosses,” and look into the problem herself.

I asked if I could see the transcript of the full interview.

No, that wouldn’t be possible.

McGinnis and I then exchanged e-mails, and I spelled out what I found misleading:

McGinnis’ reply was cordial:

“I understand your point regarding the ACA and pre-existing conditions.”

“Our piece was aimed at illustrating a small business’ experience with the law . . . We were trying to illustrate what Debra was going through, what she understood, and how she felt. She was having trouble with the website, was getting no help, and her impression was that having a pre-existing condition could make insurance more costly for her.   

“Nowhere did we report that she would be denied coverage for a pre-existing condition, she was only worried about it. [my emphasis]

McGinnis was right– CBS didn’t say that Fishericks was denied coverage.  But that was not my complaint.

Fishericks had suggested that, in the Exchange, she would have to pay far more than she could afford because she was a cancer patient.

McGinnis still didn’t seem to understand that by leaving Fisherwick’s comment in the piece CBS was misleading its audience. Viewers would believe that, under Obamacare, if you’re sick, insurers  can gouge you.

In her e-mail McGinnis also insisted that reporters still have time to fact-check. Yet no one checked this piece. If they had, someone would have discovered another error: Fishericks was not “battling”cancer.

But I wouldn’t find that out until I talked to Fishericks for a third time at the end of the week.

      Under Obamacare, Will Cancer Patients Receive the Care They Need?

On January 8 I received a final email from McGinnis, conceding that: “the Affordable Care Act does indeed specify, in Section 1201, that . . .   a health plan cannot deny enrollment, or the plan’s benefits, to someone based on that person’s preexisting condition.

“However,” McGinnis  argued, “that certainly does not mean a plan has to include coverage for ongoing treatment that a patient started before obtaining coverage in an exchange plan on January 1, 2014.”

“Key to understanding this distinction” she added, “is that having ‘health coverage’ is not the same as actually obtaining ‘health care.’ The insurance plan has to take anyone who wants to enroll, regardless of their health status or health history – but they don’t have to provide the same treatments, the same doctors, or the same medications that a patient has been receiving.”

McGinnis seemed to have swallowed a rumor spread by so many “concerned trolls”:  Just because a carrier sells insurance to someone who is sick, that doesn’t mean that the insurer must continue the treatment the patient needs.

I understand that few reporters had time to actually read the 2000-page law. But ideally, reporters would have dug into the in-depth briefs published by groups such as the Kaiser Family Foundation, the Commonwealth Fund, or the Robert Wood Johnson Foundation. Concise and well-researched, these briefs corrected most of the misinformation about Obamacare floating around in what had become an increasingly toxic atmosphere.

But rather than concentrating on the policy, reporters tended to focus on the politics of health care reform.

I responded to McGinnis with the facts:

The ACA stipulates that insures must cover all “essential benefits.” As the American Cancer Society (ACS) explains, this includes “cancer treatment and follow-up.”  The ACS also points out that the law bans “dollar limits on how much the insurer will pay out for care,” and “gives patients “new rights to appeal claims that are denied by the insurer.”

That last point is important.

While the law does not guarantee that a patient can continue to see the same provider, if a patient or her doctor believe that only a particular hospital or specialist can provide the needed care, Obamacare strengthens the patient’s right to appeal.  

Under the ACA, if the case is urgent, the insurer must respond to the appeal within 72 hours.  If the carrier says “No,” the patient then has a right to an “external review” by an independent reviewer, and once again, the law calls for a speedy decision.

Similar regulations apply if an insurer doesn’t cover a needed medication..

How likely is it that a patient will win an appeal? A 2011 GAO study shows that even before Obamacare “between 39 and 59 percent of denials were reversed on internal appeal and an additional 23 to 54 percent were reversed or revised on external appeal.”  Today, a patient’s odds are significantly better. ht

McGinnis probably wasn’t aware of the new rules and, even if she has heard about them, she may have had doubts as to whether they would be effective. Fear-mongers on both the left and the right had planted seeds of suspicion, and by the fall of 2013, mainstream journalists were increasingly skeptical as to whether Obamacare would force insurers to do the right thing.

                           Fishericks: “They Got the Whole Story Wrong

After swapping e-mails with McGinnnis I wanted to talk to Fishericks; I called her at the Atkinson Real Estate Agency where she works as a receptionist.

No surprise, she wasn’t terribly enthusiastic about talking to me. She was at work, she explained, covering seven phone lines. But in a brief conversation she did convey a critical piece of information: the story that CBS aired was wrong—form beginning to end.

“I wrote them a letter” Fishericks told me. “And do you know what I got in return? Two words:  ‘Thank you.’”

Clearly she was angry.

But I could tell she didn’t want to continue the conversation. And I didn’t want to press my luck. I thanked her, and hung up.

I planned to call her again—when I had more information.

In part 2 of this post, I will discuss how and why the media wasn’t able to do a better job of lifting “the fog” of disinformation.

For one, our sound-bite culture makes it difficult to explain something as complicated  as the ACA to the public. As one observer notes: “Americans aren’t into nuance.”,

In the second part of this post, I’ll also report what CBS’ producers (including Ward Sloane, who now is Deputy Director of CBS’s Washington Bureau) had to say about  Fishericks’ story, why the Bureau ultimately removed the video from its server, and most importantly, what Debra Fishericks revealed in our final interview.

 

 

31 thoughts on “Why Are So Many Americans Confused About Obamacare? How a Video Produced by CBS’ Washington Bureau Misled Millions –Part 1

  1. I am anxiously waiting for part. 2. I can under stand Debra Fishericks reluctance to talk. I was once inverviewd by a New York Times reporter for an article that she was writing and what I told her did not match her preconceived idea that she was trying to pitch in her articel so she ignored most of what I told her and used some coments out of context.

  2. John–

    Yes, this has happened to me. And I’m a reporter!

    Wait until you see what Fishericks told me our last conversation.

  3. I wish you could get Fishericks on audio or video tape explaining what was wrong about the CBS piece on her.

    Also Maggie, if you were to simplify the ACA right now, what would you propose? Looking forward your part 2.

    • jonathanTX

      If I were to simplify the ACA right now . . . I wouldn’t.
      It’s too soon. And I don’t think it needs to be simplified.
      Granted it is a very complicated piece of legislation with many moving parts–but those parts support each other.
      Each of those details is helping some group of people.
      We will want to make changes to the ACA, but first we need to give it at least a year–to see what’s working and what isn’t.

      But I am very concerned about a couple of holes in the ACA–particularly the fact that in states that haven’t expanded
      Medicaid, some people earn too little to be eligible for a subsidy, because legislators assumed that they would be covered by Medicaid. But if we tried to fix that now (extending subsidies to everyone who falls between the crack) that would only encourage states not to expand Medicaid. Over the next year or so I think almost all of the states will agree to the expansion. At that point, we should consider extending subsidies in the one or two states that hold out.

      Glad you’re looking forward to part 2!

    • Rick–

      I’m sorry to hear that. I’ve done a lot of work, research and thinking about single-payer.
      Ezra Klein is right –see his post http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/13/what-liberals-get-wrong-about-single-payer/

      PNHP simply lies about many things. (I’ve interviewed the leaders and have analyzed their numbers.)
      .They are self-absorbed, self-involved, and
      not at all concerned about what happens to patients. They are zealots –“Stalinists” as one doctor who dropped out of their group long ago told me. But it’s the lying that I really mind.
      See my reply to “Jonathan” above dated 2/13 9:49 p.m.
      Don McCanne (also a single-payer advocate) does not agree with them on many things. Don is honest, and intelligent, but
      doesn’t understand the economics (He’s not an economists; he’s a doctor) and doesn’t fully appreciate the fact that our government is run by lobbyists and corporate corporations. This is not Sweden.
      We do not want the politicians who Americans elect running the only health care system in the country.
      Think back to the folks who have run the White House and Congress since 1980. Do you really want them deciding whether or not women should have free contraception? Or how much drug-makers should be allowed to charge for it? Or whether people have a right to die with dignity (rather than letting a hospital make a fortune by keeping them alive in an ICU for
      a couple of months.) In this country the line between church and state has been blurred. (IN this we are different from every other country in Western Europe as well as Canada.) Even the Italians don’t let the Catholic Church run their country. But a great many Christians in the U.S. would impose their religious beliefs on our health care system–and a
      great many politicians would help them.
      Finally, Americans do not think collectively. They think in terms of “me and my family.” This makes it easy for politicians to appeal to that way of thinking when making rules that discriminate against low income people, minorities and immigrants.
      Don McCAnne tells me that he doesn’t understand why some Americans dont’ seem to feel that everyone has a right to equal, high quality care. This is because McCAnne is a nice man, and probably doesn’t know many people who say –out loud–what many feel: I don’t want to share with other Americans. I just want to take care of me and mine. Every man for himself!

      Finally, I don’t know why you are fed up with the ACA. I’ve shopped many Exchanges for readers, and am finding excellent
      affordable plans.
      Granted, he ACA is far from perfect, and over time, as we see what works and what doesn’t, we will improve it.
      But Social Security was far from perfect from first conceived (SS didn’t cover blacks.) FDR knew it was the best he could do at the time. Medicare was far from perfect– it gave doctors and
      hospitals a blank check to charge whatever they wished–and they did. LBJ knew that to pass the law he would have to do that. The lobbyists representing the AMA and hospitals were that strong. LJ thought competition would keep a lid on prices–he was wrong. More doctors and more hospitals means higher prices.
      Because Medicare gave docs and hospitals a blank check, U.S. healthcare began to become extremely expensive. See my gook “Money-Driven Medicine”
      And Medicare still over-pays–though under the ACA it will be cutting payments to hospitals by 1% a year for 10 years–forcing them to become more efficient and more concerned about patient safety. (Preventable errors will become expensive for hospitals). It will also be cutting doctors’ fees in many areas. (Fees for in-office testing have already been cut. We know that when doctors buy the equipment so that they can make the profits on tests they order many, many more tests. And patients are put at risk. Cardiologists and orthopedic surgeons will be next. Way too much over-treatment.
      Meanwhile, we need to pay palliative care teams more. Over time, CMS will make progress. It has already become far more
      aggressive when it comes to hospital fraud. In NYC Lenox Hill has had to pay an enormous fine for pretending that patients were much sicker than they actually were–and charging Medicare more. (Lenox Hill is one of two non-profits in Manhattan that has paid these fines.)
      Both Medicare and private insurers will be moving away from “fee for service’–which encourages over-treatment. WE will be paying for “value” not volume. Provider systems that don’t produce better outcomes for less will lose money.

  4. Thank you for your response. I also believe that GOP governors sooner than later will fold on Medicaid expansion. Already you are seeing a couple of Dem gov candidates (Crist in FL, others in PA) running against GOP obstruction on this issue. At the end of the day, pressure from healthcare providers will force the GOP to bend or compromise on the expansion.

    • Jonathan–

      The piece by Klein is excellent.

      PNHP (Physicians For A Nantional Health Plan) has spent a great deal of effort and money lying about insurers and making them “the bogeymen” of U.S. healthcare. As Klein points out for-profit insurers have narrow profit margins.
      They are not the reason why U.S. health care is so expensive.
      It is so expensive for two reasons: a) we pay more for everything– including doctors and hospitals. (Even after adjusting for differences in cost of living and med school loans, most U.S. doctors make far more than docs in western Europe.
      b) Our doctors and hospitals overtreat. In this way they lift their incomes while putting patients at risk.

      PNHP wants to conceal these facts, so they try to pretend that insurers are to blame for high health care costs.
      As Ezra says they are an easy target– most people don’t like insurers. They blame them for high premiums. (Actually it’s the underlying cost of health care that has hiked premiums for the past 13 years.
      Most people want to like their doctors. (It’s too scarey to realize that your doctor may recommend an operation without giving you full info on risks and benefits. It’s too scarey to realize that your hospital cares more about its bottom line than it cares about patient safety. But the research shows that this is the case.

      Finally, as Atul Gawande has pointed out, trying to move the whole country to single-payer would be an “administrative nightmare” — as he puts it “people would die.” (Google Gawande and single-payer and New Yorker.)
      Think about how difficult it has been trying ot move a relatively small percentage of the population into the exchanges.
      A country this size cannot simply convert to single-payer. Nor would it save that much money.
      Medicare’s administrative costs look low because many other government agencies share in the administrative costs–and because Medicare is a “one size fits all” plan. This works fairly well for seniors–people over 65 have similar needs.
      The under 65 population has extremely diverse needs. Some need a low-deductible or no deductible plan (because they are chronically ill and likely to be hospitalized.) Some need high deductible plans with low premiums (because they are young and healthy.) Some need plans with low co-pays for “specialty medications” (because they suffer from cancer or MS). Many need subsidies. (And figuring who gets a subsidy and how much is an enormous administrative task–especially because over the course of a year people’s incomes go up and down.)
      Administering single-payer for everyone under 65 would cost far more than the Exchanges (which is considerable)
      Back of the envelope calculation: to pay for it, you would have to increase taxes for Americans earning more than median income (around $65,000 per family) by about 7% to 8% a year. For starters. (People earning under median income just can’t pay more than they are paying now. And there just are not enough truly wealthy people (earning over $200,000) to foot the bill for single-payer. (In single-payer countries taxes are much higher than they are here.)

  5. Thanks Maggie-

    Quote from Klein article to which I can relate-

    “There are few truly single-payer systems in the developed world. Canada has one, as does Taiwan. Most countries rely on many, many insurers. Germany, for instance, has more than 150 “sickness funds.” The Swiss and Dutch health systems look a lot like Obamacare’s health-insurance exchanges. In France, about 90 percent of citizens have supplementary health insurance. Sweden has moved from a single-payer system to one with private insurers. Yet all these countries pay vastly less for drugs, surgeries or doctor visits than Americans do.Why? Because in every case the government sets prices for health-care services and products. Insurers in Switzerland don’t negotiate drug prizes with Pfizer. The Swiss government simply sets its drug prices and lets Pfizer decide whether to sell in Switzerland — or not”

    Also agree that some in PNHP are irrational zealots.

    But I cannot bear reading more and more everyday about craven corruption at the criminal level in for profit US Medicine and also the problems with Obamacare.

    I believe that NO NATION on the planet has or may ever figure this all out? The triad of accessibility, quality and cost are always struggling to be in balance

    But in my heart it just seems unethical to “trade human flesh and human souls in the maketplace”? Obamacare was an attempt at a good start but I don’t believe our President and his advisors demonstrated enough knowledge or courage to get it right?

    Maybe Hillary will?

    Rick Lippin

    • Rick–

      I really don’t know what “problems with Obamacare”you are talking about.
      At this point it is doing quite well.
      Given the size of the project (no one has attempted anything this complicated on this scale ever before) I would say it’s doing remarkably well.
      The one major problem is that many states still have not expanded Medicaid, though with time that will happen.
      As for the knowledge of the people who drafted the legislation–Obama didn’t write it.
      Ted Kennedy and his staff were the driving forces behind the legislation and many of the idea go back to the time when Kennedy and Richard Nixon almost pulled off healthcare reform.
      The people I know who know the most about health care and healthcare reform (folks like Elliot Fisher, Don Berwick etc.) believe the ACA represents an excellent start.
      As I have said from the beginning, it will take at least 10 years to get health care reform to the point where we can call it a success.
      For it to work we’ll need to see an enormous change in our medical culture. Doctors will need to begin to see themselves as part of what Atul Gawande calls “the pit crew”
      (you can google his New Yorker article)—part of a team of medical professionals that includes nurses, NPs, PA, pharmacists,
      etc. working together, practicing patient-centered medicine.
      (Gawande understands what needs to be done as well as anyone.)
      As we change how we pay doctors and hospitals, they will be held accountable for outcomes.
      Finally, in terms of courage, I consider it a miracle that Obama, Pelosi and Reid got this legislation through Congress.
      During his first term in office, Obama made HCR his top priority–he was taking a huge risk that his first term would be his only term.
      As for single-payer in this country,
      as Ezra points out it would save very little money. The insurers are the ones making the money in our exorbitantly expensive system: drug-makers, device-makers, many doctors and private hospitals have been the ones who have been over-charging.

  6. Maggie

    I trust your views very much

    You wrote-“As for single-payer in this country-as Ezra points out it would save very little money. The insurers are the ones making the money in our exorbitantly expensive system: drug-makers, device-makers, many doctors and private hospitals have been the ones who have been over-charging” Is there a typo here? “insures are NOT”?

    Anyway your ten year projection to reach the point of ACA success will require a patient and mature culture which we seem not to have? – actually deadlines seems to be borderdering on the immediate because of an impending “catastrophe zeitgeist” moving through our culture? People are scared and want quick answers to often complex problems.

    As for me, unlike others. perhaps I am just exhausted from the corruption in HealthCare up to the criminal level which seems to be still tolerated?

    But I hope we can see the cup “1/2 full” as you seem to for which I greatly admire you

    Rick Lippin

    • Rick–

      Thanks much for your kind reply to my pretty grumpy reply to you.

      First, yes, I meant to say that insurers are Not the ones making the money.

      Secondly, yes, success in reforming health care will depend on a more “mature culture.” Today most Americans want quick answers. We are still a new–and immature-country.

      Despite that, over time, we have made great progress. We managed to pass and begin to implement civil rights legislation. (Implementation is still a work in progress.) Despite great obstacles, we have begun to give women equal rights. Still a cup half full, but I am here to say that I remember when the cup was nearly empty. I was part of a generation of women who were there in the beginning.
      Twenty years later, both my daughter and my son’s wife are living in a different world. I am so very happy for them.

  7. Maggie

    The ACA is indeed progress. But it is still subsidizing a lot of Medicare that is unnecssary at best and dangerous at worst

    I call this form of medical care “THE BiG LIE
    That is why I support Schroder, Hadler and Brownlee

    The ACA is moving in that direction of paying for quality outcomes but I will not live to see the dismantling of excessive and dangerous healthcare

    Rick Lippin

  8. Rick–

    Under the ACA PSA testing is not included on the list of preventive services that will be free.
    I call that an enormous victory. As you know PSA testing then leads to some very expensive procedures that can have serious side effects. And we have little proof that those procedures save lives.
    Yet a great many men (not to mention their urologists) are convinced that PSA testing
    is essential.
    The fact that the test is not on the preventive services list was a big victory for
    reducing ineffective treatments.
    Under the ACA we will see providers who
    practice evidence-based medicine rewarded. And we’ll see more “integrated” health systems like Kaiser P and Group Health Cooperative of Seattle where the insurer and the providers are part of one organization.
    That means that they share the same goal: keeping patients well.

  9. Good discussion above, I am glad that this blog seems to be working again.

    One historical footnote:

    When the ACA was passed in 2009, Nancy Pelosi knew full well that the final bill needed revisions. The Democrats thought that the bill would go to a conference committee.
    But the unexpected victory of Scott Brown in Mass meant that the bill might never then get out of the Senate.
    So Pelosi et al went to war with the Army they had!

    As for single payor:

    One real problem is that the corporations and government entities that pay for family coverage are subsidizing everyone else.

    Because Microsoft or the federal govt pays for family coverage, a spouse on their plan can go to work for Century 21 and not need insurance at all. A young person on the Microsoft plan can go to work for Dunkin Donuts.

    Under a single payer plan, Microsoft pays 10% of payroll and Century 21 pays 10% of payroll. There can be no exceptions.

    This is a boon to Microsoft, but could put Century 21 or Dunkin Donuts out of business.

    No one (including me) knows how to finesse such a massive change. This is why Gerald Friedman and Don McCanne seem somewhat out of touch.

    • Elder Care Lawyers–

      You are right: this a huge social program which will an effect on our entire medical culture.
      And it will impact a $2.8 trillion industry. Much money at stake.

      Little wonder that there is so much controversy.

      Nevertheless, when it comes to spreading half-truths and outright lies, Obamacare’s opponents have gone over the top–and some of the venom seems personal.

  10. Pingback: Angry Bear » Why Are So Many Americans Confused About Obamacare? How a Video Produced by CBS’ Washington Bureau Misled Millions –Part 1

      • Maggie:

        This post answers many question which I welcomed. Like many of the made-ups failures thrown out by the Republicans, Tea-baggers, and the naysayers; you get right to the heart of many things such as what was really said by Obama with regard to keeping your insurance and whether the PPACA will really cover your ailments like the old insurance did, “having ‘health coverage’ is not the same as actually obtaining ‘health care.” Unfortunately, the naysayers will still not believe even after reading the transcript and what Sebulis said also. It is necessary to refute what is being said out of contest.

        To those who opt for the taking of individual rights by mandating healthcare insurance?

        “Owners (private and public) telling people they have to sit in the back of the bus is not commercial or economic regulation and is ok? Owners telling gay people they can not be served in a restaurant because they are gay is not commercial or economic regulation and is ok? Owners of insurance companies telling people they can not have insurance because of a pre-existing condition leaving them little and/or lesser alternative than the majority is not commercial or economic regulation and is ok? What is the difference between private and public drawing a line of what it will accept and what it will not accept? There is a line of demarcation where the majority imposing its will upon the minority excluding them from the social and economic well being of the country is not acceptable. The government is bound by its election to represent the people as a whole even if the majority decides differently.

        It has been 20 years since Hillarycare and the healthcare industry and the healthcare insurance industry (even with its low profit margin) have done little to nothing to fix even the most minimal of problems with healthcare today. Why? Because selling services for fees is still profitable and it is passed on by the insurance companies. And if you do not have healthcare insurance, you do not get the discounted rate, you get the chargemaster rate. And if you pick the wrong hospital, you are subject to even higher charges because it happens to control the market in that area. It is a sad state of affairs and I have little sympathy.

        • run75411-

          Thank you. I agree with virtually everything you say.

          The only point where I disagree is regarding whether insurers have done anything to improve care.

          I would argue that the best Non-profit insurers (Kaiser Permanente, Health Group Cooperative in Seattle, etc.) have pioneered improving the quality of care,by making it more patient-centered, and emphasizing team work to ensure that care is coordinated.

          • Maggie:

            On the latter progressive insurance companies, you are correct; however, they are so few and far between.

            I called up Michigan BCBS to see if I could get catastrophic insurance as a just-in-case until I got another job or went on Medicare. The answer? “No! They would not underwrite me.”

            The objections and examples to the PPACA are specious and at times difficult to decipher. My own boss talked of his friend who may lose cancer treatment due to the PPACA. I pointed out to him that there was not enough detail for me to offer up a course of action other than appeal to the panel within the PPACA which was established just for such occurrence.

            As I have said, so few people know what the PPACA is about and the gentleman from Wyoming is probably tuned into the Fox News propaganda. Didn’t civilization end west of the Hudson?

  11. Pingback: If You Read One Thing Today, Pick an Article That Debunks An ACA “Horror Story”. Here Are Two…

  12. Pingback: The Doctor Weighs InHealth Wonk Review: In Like a Lion

    • Lisa —

      Yes, many believes that PSA testing will save their lives. But there is little or no medical evidence to support that belief