OBAMACARE ENROLLMENT (part 2) Who Will Remain Opposed to Obamacare in 2015? “Zero-Sum Thinking”

 

In 2015, I predict that Obamacare enrollment will soar, matching 2014’s success.

This may seem counter-intuitive. After all, in recent months, the public’s perception of Obamacare seems to have soured. The Henry J. Kaiser Foundation’s health care tracking poll for July reveals that 53% of those surveyed last month said they view the Affordable Care Act unfavorably—a jump of 8 percentage points since June.  July’s results mark the first time since January, that more than half of all Americans opposed the health reform law

Is this because people who have enrolled in the Exchanges are unhappy with the insurance they purchased?

No.

      Most People Who Signed Up for  Obamacare Are Happy

Just one month earlier a Kaiser Foundation poll showed that “71%” of those who have enrolled in insurance plans that comply with Obamacare’s rules “rate their coverage as excellent or good overall,” and “more than half (55%) say it is an excellent or good value for what they pay for it.”

This is in part because in the Exchanges, middle-income as well as low-income customers qualify for government assistance to help cover premiums. As a result, 87% of customers have received subsidies that come in the form of tax credits. 

Nearly six out of ten of Obamacare’s new customers were previously uninsured, Kaiser reports, while the remainder are “plan-switchers” – people who previously had individual market coverage and switched to new coverage after Jan. 1.  This group includes people who had their old policies cancelled as the ACA’s requirements kicked in, as well as people who switched for other reasons, including the availability of premium subsidies.

No surprise, customers who were forced to switch to a plan that meets Obamacare regulations are not as pleased as those who were previously uninsured. Yet nearly half of the “switchers” acknowledge that after using the tax credit, their new, more comprehensive Obamacare plan costs less than their old policy. This means that they are getting more for less. And I would predict that as they use their new policies ( and discover, for example, that preventive care is free)  many will become more enthusiastic.

Here is  the bottom line: “As a whole,” Kaiser observes, “enrollees are more likely than the public overall to have a favorable view of the ACA: they are roughly evenly split between positive and negative views (47% favorable vs. 43% unfavorable). By contrast, views among the general public are more negative than positive (38% favorable vs. 46% unfavorable.)

In other words, people who have had direct experience with Obamacare are more likely to support it. Those who have only read about reform are more likely to be opposed

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Polarized Politics Led To Cantor’s Defeat– and Cochran’s Victory. Why the “Uncommitted Center” Is So Important (Cantor part 2)

Please scroll down for Part 1 of this post. 

When House Majority leader Eric Cantor lost his seat to ultra-conservative David Brat, the Washington Post’s Ruth Marcus summed up the majority view among political pundits: “The episode offers a disturbing commentary about the poisonous, polarized state of American politics.”  

I cannot agree. I don’t think “polarization” is toxic.  To the contrary, as the poet William Blake once wrote “Without Contraries, No Progress.”  Conflict can clarify issues, and help us move forward.  Indeed, the clash of opinions is a time-honored way of testing their validity.

Do you remember the 1990s, a decade when it became difficult to tell the difference between Democrats and Republicans? While Republicans headed toward the far right, Democrats moved right of center. During his second term, Bill Clinton started to sound all too much like Ronald Reagan, as he set out to “reform welfare,” forcing single mothers to go to work, even though we weren’t offering them affordable day care. After leaving the White House, Clinton reclaimed his position as a stand-up liberal, but at the time, the distinction between Democrats and Republicans was badly blurred.

Today, the difference between the two parties is clear.  I wouldn’t say that Democrats are ultra-liberal, but conservatives have moved so far to the right that Democrats had no choice but to take a stand on critical issues including: global warming, gun control, the need to raise the minimum wage, and universal access to health care.

By contrast, in the 1990s, Congressional Democrats were “lukewarm” on health care reform. As  Paul Starr reports in his newest book, Remedy and Reaction, Senate Finance Committee chairman, Daniel Patrick Moynihan, Democrat of New York, actually stood up to say, “We don’t have a health care crisis.”

But by  2010,  the crisis was obvious, and Democrats came together. Pelosi and Harry Reid marshaled the votes, and Congress passed legislation which, while far from perfect, is solidly progressive: Low-income and middle-income Americans receive the subsidies they need; insurers can no longer discriminate against people suffering from pre-existing conditions, and preventive care–including contraception–is free.There is much more work to be done, but at last, we have begun.

Since then, Congressional Democrats have not had the votes to pass much-needed legislation in other areas.

But at least President Obama is no longer the compulsive compromiser that he appeared to be during his first term in office. I see this as progress.  As I have argued in the past, on some issues compromise is not an option.  Too much is at stake. 

On the ground,voters are as divided as their elected representatives.  Politically active Democrats have begun to move  left of center while Republican voters have become more conservative. The Pew Research report that I discussed in the first part of this post reveals that a decade ago, only 10% of politically engaged Republicans took a conservative stance on almost all issues. Today, 33% express consistently conservative views. At the other end of the political spectrum, almost forty  percent of committed Democrats are consistent liberals, up from just 8% in 1994. The overall share of Americans who express consistently conservative or constantly liberal opinions has doubled over the past two decades from 10% to 21%. .

“As a result,” Pew reports, “ideological overlap between the two parties has diminished. “Today, 92% of Republicans are to the right of the median Democrat, and 94% of Democrats are to the left of the median Republican.”. 

“Republicans and Democrats are more divided along ideological lines – and partisan antipathy is deeper and more extensive – than at any point in the last two decades. And a new survey of 10,000 adults nationwide finds that these divisions are greatest among those who are the most engaged and active in the political process.”

                                 Is Polarization A Threat to the Nation?

Most pundits are appalled.
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Cantor’s Defeat–Wittiest One-Liners

Eric Cantor’s shellacking has drawn much attention–perhaps two much commentary. (After all, this was just a primary.  I don’t think that it “Changes Everything.”)

That  said, here are my favorite comments on this event::

– “‘Brat Upsets Cantor’ . . . The headline sounds like a failed Bar Mitzvah” — Delaware Dem

On Tuesday night, Ezra Klein wrote:“John Boehner must be having an emotionally complicated evening.”

 

 

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Longevity and Long-Term Care: The Medical Crisis of the 21st Century : Part 2

Throughout the 20th century, most Americans saw “longevity” as a goal. If we took care of our bodies, we reasoned, we could “live longer and better.”

But in the 21st century, I suspect that some of us will learn to fear “longevity” the way we now fear cancer.

This is the second in a series of posts that will explore the anguish that some experience when they live into their late eighties and nineties–and how we, as a society, can address the hardships of “old, old age.”

                                           Senile Dementia   

Thanks to better diets, exercise, and advances in medical knowledge, more and more of us are living to four score and seven. But the downside is that in too many cases, our bodies are out-living our minds. As I note in the post below, since 2011, 40% of the increase in Medicare’s outlays can be attributed to spending on Alzheimer’s patients.

Why is the incidence of Alzheimer’s (AHD) spiraling? Because we are less likely to die of heart disease or strokes, millions of Americans are living long enough to be diagnosed with senile dementia. One could say that longevity is the proximate cause of Alzheimer’s.

Because women live longer than men, they are more likely to fall victim to AHD, the most common form of dementia. If a woman lives into her 60s her risk of being diagnosed with Alzheimer’s at some point over the rest of her life is 1 in 6. By contrast, for breast cancer, her risk is 1 in 13.  By 2050, the number of people age 65 and older suffering from Alzheimer’s may well triple, rising from 5 million to as many as 16 million.

Why then don’t we hear more about this scourge? Because at this point there is little or nothing that doctors can do to stop it. The Mayo Clinic’ website explains: while some drugs can “temporarily improve symptoms of memory loss and problems with thinking and reasoning . . .  these treatments don’t stop the underlying decline and death of brain cells. As more cells die, Alzheimer’s continues to progress.”

Last month Consumer Reports warned that “the overall results” for Alzheimer’s drugs “are far less encouraging than the ads portray. Most people who take them don’t experience a meaningful benefit.

More than half experience side effects. And they’re expensive, costing anywhere from $140 to more than $656 monthly..

Even a small benefit or chance of improvement might be worth it if Alzheimer’s drugs were risk free,” Consumer Reports observed. “But they are not. They can cause side effects such as insomnia, nausea, muscle cramps, diarrhea, and reduced appetite, all of which can be troublesome for people with dementia.” Occasionally, the drugs may cause more serious side effects such as internal bleeding and a slowed heart rate that could be potentially dangerous.

Meanwhile, the average Alzheimer’s patient lives 8 years—and 40% of those years are spent enduring the most severe, late stages of that disease. Some patients linger for 20 years. This is what makes Alzheimer’s so expensive.

                                The Need for Long-Term Care

At this point, we cannot cure senile dementia, but we can reduce the suffering that patients and their families endure by creating the long-term palliative care system that millions of baby-boomers and many of their parents will need. First, this means figuring out how to fund such a system. Medicare pays for some treatments, but it does not cover long-term care.

Up until now relatives have provided much of that care at home, but increasingly, the burden is becoming too great for aging spouses. And even if their children live close to home, daughters as well as sons have jobs that they cannot leave.

Medicaid will pay for nursing home care, but only after the patient and spouse spend down nearly all of their resources. (New laws now make it very difficult families to transfer assets to heirs when they see Alzheimer’s coming.) And even when families exhaust their assets, nursing homes and hospices often do not provide the combination of palliative care and skilled nursing that patients require.

Finally, and most importantly, we need to think about how to ease the path to death. Here, I am not talking about euthanasia. (In a later post, I will address  ”aid in dying” –a.k.a. “physician-assisted suicide”–and explain why some palliative care specialists have had second thoughts about that solution.)

In this post, I am focusing on reducing the fear, the panic, the overtreatment, and the medical flailing about that makes what I have called “the American way of dying” so traumatic. Death always will involve loss and suffering, but it does not have to be impossibly cruel, and it does not have to wreck families.
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The Next Plague: Alzheimer’s

In the 1970s and 1980s, a plague called AIDS swept through this country. Like a medieval scourge it was mysterious, incurable, and ruthless as it killed those who were far too young to die.

Now, baby-boomers have reason to fear a new scourge: It won’t cut them down in their youth, but if they dodge heart disease and beat cancer they may find themselves trapped in their bodies, watching their minds dissolve.

Did you know that a woman who is now 65 stands a 20% chance of dying of Alzheimer’s? (See Michael Kinsley’s essay in the New Yorker.)

On Bloomberg View Matthew C. Klein has put together a booklet of “visual data” titled: “How Americans Die.” These stunning interactive graphs will startle you. For instance, were you aware that suicide has recently become the leading cause of violent death in the U.S.?

But it is the pages devoted to Alzheimer’s here  and here that stopped me in my tracks.
I turns out that about 40% of the increase in Medicare spending since 2011 can be attributed to greater spending on Alzheimer’s treatment.(We don’t have reliable data on Alzheimer’s spending before that.) And that number is bound to climb.)

The Boomers will be the second generation to die of dementia, but the first to see it coming. 

These charts are terrifying but important. We need to begin thinking about how to cope with Alzheimer’s. Here, The Mayo Clinic outlines “What is On the Horizon for Alzheimer’s.

I’m not optimistic about a cure anytime in the foreseeable future. But we definitely need to think about how to care for the many who will be suffering from this dreadful disease.
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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.

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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.”

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Obamacare “Horror Stories”–Who Are These People? How Many of These Stories Are True? Part 1

No doubt you have seen or read stories about innocent Americans who have become casualties of Obamacare. The law that was supposed to help middle-class families is now asking them to pay unreasonable premiums and sky-high deductibles. In many cases, they had perfectly good coverage that has been cancelled because it didn’t meet the Affordable Care Act’s (ACA’s) “standards.”

Trouble is, some of these anecdotes  just aren’t true. When an unbiased  reporter begins to make some phone calls, they start to fall apart.

Nevertheless,  these tales of Americans harmed by Obamacare  are being promoted by various conservative groups–including the Republican National Committee.  An internal RNC memo provides advice on how to collect stories of “victims” and feed them to the press.

Knowing this, when I read the horror stories,  I can’t  help but wonder: have the folks who are quoted checked prices on their Exchange?  Do they know  whether they are eligible for government subsidies?   How many didn’t  even try to find out because they just don’t like the ACA?  Who are these people who step forward to  identify themselves victims of the trainwreck called Obmacare? Where did they come from? How did the reporters who wrote the stories find them?

Finally, and perhaps most importantly, are journalists  fact checking their tales? How many are just writing down whatever their sources tell them?

          A Young Mother Suffering From MS Searches For Insurance

A few weeks ago, I stumbled upon a story that ran in the Fort Worth Star Telegram on November 26. The lead is compelling:

“Whitney Johnson, an Arlington 26-year-old with multiple sclerosis, can’t afford to go without health insurance. Her life depends on it.

She gave birth to her first child Sept. 2 after undergoing a series of rigorous steroid treatments, surgeries and a plasma exchange that saved her life. She pays $325 a month for an individual insurance plan – a drop in the bucket compared with the cost of her plasma protein replacement therapy, which runs $40,000 a pop. She undergoes treatment every five weeks.

But now, with the Affordable Care Act in full swing, Johnson’s insurance is under threat.. . .

Recently, the story  explains, Johnson’s insurer sent her a letter saying that because her policy “does not comply with Obamacare” it will be cancelled Jan. 1, 2014. Initially she hoped that she might shift to her husband’s employer-based health plan  For $325 a month, it covers him and their son. But it  turns out that if Whitney were added the policy, their premium would triple.

Meanwhile, she “has been unable to access the federal health exchange website” the newspaper reports, “which has been hampered by technical problems.”

In a video talking about her experience,  Johnson claims  that when she began “trying to shop around ‘ outside the Exchange, “the rates went from $1,000 to $1,800 a month for not even close to the coverage that my previous  insurance had offered me.”

This is when I knew that there was something very wrong with Johnson’s story.

                        $1000 a Month To Insure a 26-Year- Old ???

Anyone who knows anything about Obamacare would realize that under the ACA, no 26-year-old would be asked to pay $12,000 a year – even if she had MS. Obamacare does not let insurers charge more because a customer suffers from a pre-existing condition. This rule applies to all new policies, whether they are sold inside or outside the exchanges.

And Johnson is just 26. In most exchanges, 20-somethings pay far less than older Americans.  I was certain that that she could get a much better deal. It didn’t take me long to find one.

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