• Getting two things off my chest: President Obama edition

    Here’s a standard debate trick I’ve encountered. I point out some bit of illogical reasoning or falsehood by an Obamacare opponent. Then someone chimes in with, “Well Obama said, ‘If you like your plan you can keep it‘ and ‘The typical family’s premium will fall by $2,500.‘ What foolishness!” The implication here is that because some Obamacare supporter — Obama himself! — said something foolish, that “balances out” foolishness on the other side.

    It’s a cheap trick. And it doesn’t work, logically.

    The problem is that the situation isn’t Obama debating some fool, it’s me pointing out one foolish thing someone said. Doing so doesn’t negate the foolishness on the other side. Nor does it imply endorsement of Obama’s silly statements. A reasonable person rejects silliness on both sides.

    So, for the record, those two things Obama said, approximately quoted above, were foolish things to have said. If either are true in any sense, it’s only in a very tortured, speculative way that almost nobody would understand. In my view, he should not have said them, and nobody should endorse them.

    Let’s start with “if you like your plan you can keep it.” This is never, uniformly true. Plans change every year, even in the years before Obamacare was conceived. The truth is, if you like your plan, there’s a good chance it will change. That’s just as true, if not more so, under Obamacare. I do not endorse or defend this statement.

    What Obama might have more plausibly have said is that Obamacare makes only minor or modest changes to coverage for the vast majority of Americans. Where it makes the biggest change is for the minority of Americans who cannot obtain affordable coverage today. That I could defend, though I am sure others would still contest it.

    Next, what about family premiums falling by $2,500? Sorry, no. OK, maybe — maybe maybe — adjusted for benefits, accounting for subsidies, and relative to the counterfactual trend, it might, possibly be true. But this is not how most reasonable Americans would interpret the statement. What’s true is that, in absolute terms, health care gets more expensive every year. Bending the cost curve is not reducing the absolute level of cost. And it remains to be seen if and how much Obamacare will bend that curve. I do not endorse or defend this statement.

    What Obama might have said is that health plans will offer more benefits with fewer loopholes. Though this is not costless, costs will be shared in an equitable manner, with subsidies for low-income individuals and higher taxes for those who can afford them. Meanwhile, the law will attempt to slow the growth of health costs, but more is likely needed on that front. That I could defend, though I am sure others would still contest it.

    Obama said some foolish things. That does not mean I, as a supporter of the law (with acknowledgement of its trade-offs and limitations) need to accept them. Nor do you. Let’s debate things we actually disagree about, not waste time arguing over silly things we both should reject. Meanwhile, President Obama and his surrogates, please stop saying these things. They sound foolish because, under reasonable interpretations, they are.

    @afrakt

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    • To be fair though, the “if you like your health plan you can keep it” was really a critical statement to get a lot of people on board in supporting the ACA. So to say it is a silly statement in retrospect is one thing, but at the time there were an awful lot of people who took it very seriously and trusted it. So this is more of a big deal. I agree they should stop saying stuff like this but they can’t “unsay” it now.

      The premium issue people should have seen through but again, people should have to parse a president’s statements like that when he is deliberately trying to keep things simple to garner support. Statements like this, when they turn out to be inaccurate or not the whole truth, do severe damage to his and the administration’s credibility.

      And I am basically a supporter of the ACA!

      • I think that is a fair point, and is pretty much what Austin said. Since I have run a medium sized medical group for may years, I tend to be fairly uncritical about this kind of stuff. In reality, about 97% of people wont have to change. If you can hit 97% of your goal, that is usually pretty good. (We have had to change our carrier 19 out of the last 25 years to hold down costs, so I never really saw much benefit in the idea of keeping your insurance if you want.) However, I also know the value in not over promising and the hit you take to your reputation if you do. Bad move on Obama’s part.

        Steve

        • Steve:
          You bring up some excellent points. Generally, people change insurers every 3-5 years, whether individual or group. With open enrollment every year, we will probably continue to see this type of activity.
          Just imagine how costly it is for an insurer to have to replace its entire customer base every 3-5 years.
          The insurer we are forming will make decisions a lot easier, for over time, our patented product will be considerably cheaper, whether you are sick or healthy, young or old.
          Don Levit

      • No, it was written into the bill, until later GOP amendments removed it.

        SEC. 2703. GUARANTEED RENEWABILITY OF COVERAGE.

        `(a) In General- Except as provided in this section, if a health insurance issuer offers health insurance coverage in the individual or group market, the issuer must renew or continue in force such coverage at the option of the plan sponsor or the individual, as applicable.

    • I think it’s worth pointing out that, at least in the case of ‘if you like your plan you can keep it,’ it’s not just ‘foolish’ it’s an outright and blatant falsehood (the $2,500 prediction, while ludicrous in many ways, can be chalked up to complete ignorance and wild optimism easily enough).

      Either the president simply didn’t know what the law that bears his name (unofficially, at least) included, which is bad enough, or he was saying things that he knew were false. That tortured reasoning that you say could plausibly arrive at something resembling the truth only holds up until the date the law permitted grandfathering of existing plans (July 1, 2010 or therebouts? not sure). After that, even as President Obama was saying the same thing for public consumption, “if you like your plan you can keep it,” it was false, because if I purchased an individual plan after the grandfathering cutoff date that wasn’t Obamacare compliant, that plan was going to be eliminated because of Obamacare.

      So, it wasn’t a ‘foolish’ thing to say, it was blatantly false, and there’s no way to spin that.

      • Maybe “if you like your plan you can keep it” wasn’t such a dumb thing to say. Maybe Obama assumed people would like good plans and dislike bad plans. I think he underestimated the extent to which people might like low cost, low benefit plans if they’d never needed to rely on them.

        My insurance, for example, provides a measly $5,000 benefit for prostheses of any kind. As far as I can tell, this isn’t going to go very far if I were to lose a body part. But, since I’ve never needed this particular benefit, the limits haven’t bothered me. And, in fact, I didn’t notice them when signing up.

      • Okay, prove it’s a lie, then. Here’s the original provision in the original Affordable Care Act :

        SEC. 2703. GUARANTEED RENEWABILITY OF COVERAGE.

        `(a) In General- Except as provided in this section, if a health insurance issuer offers health insurance coverage in the individual or group market, the issuer must renew or continue in force such coverage at the option of the plan sponsor or the individual, as applicable.

        This section was removed by amendment by the GOP.

        You call it a blatant lie, but was it? You’ll need to come up with exact dates when he said it. If they were in the last few days before the bill passed, then you have a point, and he lied. Blatant lying is a pretty strong charge. Now prove it.

      • In the absence of a button – thumbs up!

    • actually, some of the premiums sounded ridiculously low. Not sure what they actually covered. But they seem to cover what people wanted covered, not what Obamacare wanted to cover. Obamacare is: charge low risk (young and healthy people) more to pay for sick people (mostly older ) While some premiums were low, now paying > $ 1000 per months sounds more than any household can afford. Obamacare did take aways the right of people to decide about their healthcare coverage. Government knows what is good for you pal.

    • It may have been a political statement, but the ACA does allow grandfathered plans (those in existence before 2010 that haven’t significantly changed) to stay around.

      So when President Obama made these statements in 2009, they were valid.

      Then we have the “ACA 1.0” plans, that were too good to be true for those of us that could qualify for them.

      Would have been more honest for the President to have acknowledged these interim health plans. But that level of detail is rarely found in politics.

      • No, they weren’t valid even then – employers change plans all the time, whether you like the one you are covered under or not – to imply that the ACA provided that, under it, you could, indeed, keep a plan you liked was disingenuous, to say the least – I called my Dem rep on that years ago, literally, and got the “well of course, if your employer changes ,,,” and i said, no, you didn’t tell folks that, you are telling them they can keep it, period …

        This law was inaugurated with all sorts of lies by omission – so what else is new under this administration ,,, Can’t wait to see how he will spin the Grand Betrayal on Med/SS …

        • Respectively disagree with your dismissal of the 2010 grandfathering laws.

          Anyone who’s had health insurance for any length of time KNOWS that the plans will be tweaked, whether employer or privately insurer provided.

          Modifying is different than cancelling.

          For you to expect the 2010 ACA grandfathering laws to change the whole core of health insurance is pretty naive.

    • He said it in response to an assertion that Obamacare was going to force you to change everything, force you to leave your precious doctor, kill your mother and ruin the world. It was a casually true response to insanity.

      And it’s true. Obamacare (which is what he was talking about) does not mandate that you change your plan. He did not say that nothing would ever change again. It was obvious to anyone that, if contraception is required and your plan doesn’t have it, it has to change to get it.

      We should not require ever statement by the President (or anyone) to include the full chapter of explanation for partisan dummies.

      • Here is a key point I don’t see anyone making: it is generally the insurer’s choice whether to call a plan “the same” when a few benefits change. Plans change benefits all the time. If the changes aren’t large in terms of cost or scale, insurers typically do not discontinue a plan, they adjust their pricing at renewal time.

        For some reason, a lot of insurers have decided to go the route of regarding the addition of some benefits as enough to discontinue the old plan. Why? How many of the benefits really changed on these plans, and why did the insurers choose to regard the new plan as a replacement rather than an upgrade? I have not seen any analysis of this question. Does anyone have an explanation?

        • Good question, Jonathan.
          By declaring the plan a new plan, they can close the block on the old plan.
          Those remaining see premium increases as the block dwindles.
          That happened to me, and I was being charged 40% higher rates than the Texas Risk Pool.
          The good news is that theACA bans closing blocks. An insurer’s business has to be in one pool. It was the smartest provision of the ACA, in my opinion.
          Don Levit

        • There is an AP story that insurance companies decided that it was easier administratively to cancel policies rather than change them and in some states were directed by state insurance commissioners to issue cancellation notices.

    • Okay. You refer to the two statements as “foolish,” and you refer to them as “lies.” Those words are at the heart of your rant above, and I’m not sure either applies to either complaint.

      Let’s start with the statement about families saving $2500. There are two problems with the contention that this is somehow a “lie.” The first is, the statement came during his 2008 campaign. Here’s the only reference to this quote that I could find. http://youtu.be/15E7goj7Fmo Note the date. He was referring to the heath insurance plan he was campaigning on, not the Affordable Care Act. I know some people threw an “LOL” out there when I noted the difference, but it’s purely ignorant to claim that all health care plans are the same.

      Obama’s campaign proposal was far broader than the ACA, and included a much broader public option and much stricter price controls. It also would have insured virtually 100% of us. The ACA, on the other hand, was written by Democrats in Congress and was cribbed from an old Heritage Foundation counterproposal to Hillarycare in 1993. Even the original bill was less broad than the plan he was talking about during his campaign. Therefore, referring to this as a “lie” is, perhaps ironically.

      I would even argue that, even if he was referring to the ACA (he wasn’t), it still wouldn’t be a lie. Before the ACA passed, the average premium for a family plan was just under $15,000, and inflation for health insurance premiums was averaging just over 10% over the previous decade, and over the previous 3 years, it had averaged 12%. Since the provisions regarding costs and profits have gone into effect, inflation is down to less than 4%. Do the math. At a 10% inflation rate, premiums would have hit an average $21,000 within 5 years. At a 4% rate, they’d be $18,250. Of course, if you check the exchanges, you’d find it difficult to find premiums that come close to the $15,000 per year families were paying before. Add the out-of-pocket maximums are far lower than they used to be, and the family premiums for bronze plans and the subsidies for families who make less than $76,000 per year, and the savings for most people are already far more than $2,500, anyway. And that doesn’t even take into account annual and lifetime maximums, and the coverage denials.

      Put simply, there is no way a reasonable person can see that statement as a “lie,” let alone “foolish.”

      Now, about the other alleged “lie” about keeping your plan. Well…

      Whether or not it was a lie would greatly depend on when he said it, first of all. The original version of the ACA had a provision requiring health insurance plans to keep their current policies in place for those who wanted them, as long as they met the minimum criteria set by the ACA. This provision – and about 200 other provisions – were killed by Republicans who had no intention of voting for the bill in the first place.

      So, if the statement was made before the bill was amended to eliminate that provision, it wasn’t a lie. Also, whether it was a lie depends on circumstances. Did the insurance companies promise Obama they’d keep those policies available and change their minds? Did they just decide the old policies were unworkable under the new framework? In other words, a campaign promise that doesn’t work out isn’t necessarily a lie. You need a lot more evidence than just “he said it, and it isn’t so” to maintain that something is a lie.

      Even if it was a lie, so what? It’s not a major lie, and it helped get the bill passed. And when compared to the lies the Republicans were telling to kill it, it’s a bit disproportional, don’t you think? Compare this one to “death panels” or “health care rationing,” or even “socialized medicine.” Those ARE lies, without question. It’s not in the least bit clear that Obama “lied” at all.

      The problem with your entire diatribe is, it assumes purity, which is impossible in politics. Like it or not, sometimes they have to fudge a little to get good laws passed. Go read up on some of the BS that was thrown around in the Social Security and Medicare debates, to get those passed. Obama is a saint compared to FDR and LBJ.

      And THIS is why you can’t have “debates” on Twitter.

      • You lost me at “lie”. Which sentence of my post uses that word?

      • Amazing how far some folks will go to convince others their deceptive neo-lib Pres was/is open or transparent about anything ….

        It is pretty well accepted that the public option was a throw away provision from the get go – easily tossed out as a “compromise” to Reps, inreturn for what, precisely?

        When he took SP “off the table” and wouldn’t even entertain discussion of, let alone advocacy for, it he revealed where he was coming from and he did that even before he sealed the Dem nomination ….

    • I always interpretted “you can keep your plan” as “the law doesnt take your plan away* “, which is true. the *fine print being “your employer can still change theplan, but thats your employeres fault, not the law’s”

      • Yeah, sort of like the fine print on CC agreements or mortgages – and we all agree, those aren’t deceptive, now don’t we?

        • Do you seriously believe that the President meant something other than what Bob said.? Does anyone believe that he was trying to say something about the insurance market in general and not just the impact of the law on health insurance?

    • Well, Austin may not have said so, but I am happy to call it a lie. It was obviously that.

      As Milt so helpfully put it “Even if it was a lie, so what?”.

      Milt: Obama did not just say it during the 2008 campaign, or before the ACA passed, or before any subsequent Congressional action. The White House is sticking with this line now, in October 2013.

      Why must people who support Obama overall, or the goals of the ACA, deny that the law that actually passed is a mess?

      Unconstitutional mandate that states expand Medicaid.
      Likely exclusion of participants in the federal exchanges from subsidies.
      Many people too POOR to get subsidies.
      Lies about the ability to keep insurance.
      The prospect of tax penalties on people who cannot comply with the coverage requirements.
      The prospect that people whose policies have been cancelled by the ACA regulations may not be able to find affordable policies at all, and may not be able to find anything in time through the exchange.

      You don’t have to hate the ACA to see these problems. But there is a strange doublethink at work. First deny the problem, then say “Even if it was a lie, so what?”, Then blame the Republicans for problems in a law passed soley with Democratic support.

      It was a noble goal, It was incredibly complicated. After nearly endless debate and compromise, it was hastily passed when dissatisfaction with the law lost the Democratic Senate seat in MA. There were lots of problems in it, but it was too late to fix them. Now the country has to live with this mess.

      • Well, i don’t think it even started as a “noble goal” – guaranteeing customers to private insures while failing to cover all doesn’t strike me as particularly “noble”, but I do quite agree with the rest of your post ,,,,

    • I wrote about this issue about a month ago when Michelle Malkin was complaining about Obama having lied when her plan died.
      http://dahliaremler.wordpress.com/2013/09/29/if-my-health-plan-died-did-obama-lie-sort-of-but-it-died-for-a-good-cause/

      My answer to whether he lied was yes, no and yes. Yes: Private insurers open, close and change plans anyway. No: if a private insurer offers a plan, you are free to choose it. And he really did need to say that. Yes: it was obvious that all the enormous regulations would affect insurers’ decisions about what plans to offer, how to price, etc. But what is he supposed to do when explaining complex stuff in sound bites?
      What surprises me on this round of discussion is how much everyone is talking about the essential health benefits as a direct reason for some plans ending or becoming more expensive rather than selection. Of course, plans with limited benefits were cheaper for selection reasons too: healthy people were more willing to buy them and so the plan paid out less for them on eveything, not just saving from what they did not cover.

    • Don Levitt is right that there is some insurer greed going on here.

      How hard would it be to add pediatric dental coverage, chem dep coverage, and higher lifetime and annual maximums, and preventive care, and just raise the prices of current plans in the individual market?

      People would still be mad, but at least they would not receive a letter telling them that their plan was being terminated.

      Two possibilities come to mind:

      a. a deliberate attempt by insurers to sabotage the ACA with these letters?

      or

      b. a stupid provision in the ACA law that requires non compliant plans to be closed down

      I am just guessing. Comments?

    • …”I have been in this business for 40 years. I know junk health insurance when I see it and I know “Cadillac” health insurance when I see it.

      Right now I have “Cadillac” health insurance. I can access every provider in the national Blue Cross network––about every doc and hospital in America––without a referral and without higher deductibles and co-pays. I value that given my travels and my belief that who your provider is makes a big difference. Want to go to Mayo? No problem. Want to go to the Cleveland Clinic? No problem. Need to get to Queens in Honolulu? No problem.

      So, I get this letter from my health plan. It says I can’t keep my current coverage because my plan isn’t good enough under Obamacare rules. It tells me to go to the exchange or their website and pick a new plan before January 1 or I will lose coverage.

      First, the best I can get in a Blue Cross network plan are HMOs or HMO/Point-of-Service plans. In the core network those plans offer, I would have to go to fewer providers than I can go to now in the MD/DC/VA market. And, the core network has no providers beyond my area. I can go to the broader Blues network but only if I pay another big deductible for out-of-network coverage.” …

      Rest at: http://healthpolicyandmarket.blogspot.com/2013/10/mr-president-i-like-my-health-insurance.html?spref=tw

    • Bob:

      I can’t speak to any particular plans but my guess is that it is not the direct costs of these expanded benefits. It’s either s real selection issue with old plans having particularly healthy clientele or just insurers worried about selection. Kathy Swartz had found that insurers often overreact to some past diagnoses. Perhaps they are overreacting now but in good faith.

    • See Paul Waldman’s article in The American Prospect on “Time to investigate those insurance company letters.”

      Carriers are grabbing a chance to push their customers into more expensive plans.

      Obama is going to regret not having a public option!!! Private insurers are treacherous.

    • fraud in the inducement n. the use of deceit or trick to cause someone to act to his/her disadvantage, such as signing an agreement or deeding away real property. The heart of this type of fraud is misleading the other party as to the facts upon which he/she will base his/her decision to act. Example: “there will be tax advantages to you if you let me take title to your property,” or “you don’t have to read the rest of the contract–it is just routine legal language” but actually includes a balloon payment.

      http://legal-dictionary.thefreedictionary.com/fraud+in+the+inducement

    • Political statements usually ignore exceptions to a general rule and the percentage of people who like their policy who will lose their insurance because of ACA is very small. First, the individual market a small percentage of the overall market, Second, If you judge by how people behave, most people in the individual market don’t particularly like their coverage. Sixty-five percent of those in the individual market leave the individual market in less than a year. Eighty-five percent of those who leave the individual market do so because they get employer-sponsored insurance (70%) or public insurance (15%).

      Some people like their insurance, until they get a better offer.

      http://content.healthaffairs.org/content/23/6/210.full.pdf+html

    • So Obama “fibbed”, or ” wasn’t entirely clear about” about being able to keep one’s policy – what else has he “fibbed” or “not been entirely clear about”? Methinks we are about to find out and there will be many more posts trying to “explain” why he wasn’t “fibbing” about this that and the other ,,,

      When you have a plan that requires 2000+ pages from the get go (vs a plan, SP, of 18-30 pages, depending on the print) followed by a website as bollixed up as the legislation, what do you expect …

    • Who ever thought everybody would be so in love with their junk insurance? They’re not.

      This complete nonsense of focusing on the president’s overly broad statement is serving one purpose at least.

      A whole lotta folks just realized their insurance is junk, and they’re in a game of Russian roulette praying the bullet of medical bankruptcy doesn’t destroy their underinsured derrieres.

      On to the next fake scandal….

    • The individual market up until now has been a kind of casino — persons could buy cheap insurance or no insurance, and take the chance that they would not get sick this year.

      The ACA assumes that health care is not the place to gamble. It is based on a hard paternalism.

      There is a structural conflict in America between individualism and paternalism. We sure see it here.