Obama & Company

Millenson_122k_3 The late great newspaper columnist Mike Royko suggested that Chicago’s motto be changed from “Urbs in Horto” (“City in a Garden”) to “Ubi Est Mea” (“Where’s Mine?”). Unfortunately, Barack Obama and his Chicago political brain trust remembered this basic lesson when it came to cutting deals with Congress, but completely forgot it when communicating with actual members of the public on health care reform.

As a result, the fragile flower of reform may not have been completely plucked, but the manure dumped on it in Massachusetts was not meant as fertilizer.

Throughout this process, Obama and his Chicago-bred advisers have been intent on avoiding the mistakes that sunk reform during the Clinton administration. But their diagnosis was flawed. Yes, Bill and Hillary stiff-armed both the special interests and their Republican opponents, falsely believing that public opinion polls showing widespread support immunized them from the insidious need for compromise. But while the Obama administration cut early deals with doctors, hospitals, insurers and the pharmaceutical companies, attempts to bring moderate Republicans into the fold conspicuously failed.

When the inevitable counter-attack on reform emerged, it made the infamous “Harry and Louise” ads of the early 1990s look like a C-SPAN broadcast of a CPA convention.

It shouldn’t have a surprise: within just a few weeks of Obama taking office last year, opponents of provisions in the stimulus bill funding government research comparing the effectiveness of various medical interventions compared the effort to Nazi euthanasia policies What was surprising is that the Obama administration failed to realize that the campaign of deliberate distortions that successfully alienated the American public from the Clinton plan needed to be countered with plain-talking to the American public — as White House press secretary Robert Gibbs belatedly acknowledged only after the Massachusetts senate debacle was clear.

Put aside for a moment the analysis about widespread voter anger and look specifically at health care. Americans don’t hate big government; they hate big government when it’s not bestowing benefits on them. Asked by the Kaiser Family Foundation Tracking Poll whether they thought Congress passing health care reform would make them or their own family better off, worse off or have no effect, the number saying “Better off” stayed relatively stable, rising slightly from 38 percent in February, 2009 to 42 percent in November. But the percentage saying “worse off” soared from only 11 percent in February to 31 percent by last summer, declining slightly to 24 percent by November. Most of those who started off saying “no difference” defected to the “worse off” side.

Moreover, when you break down the numbers by party affiliation, the number of Republicans saying “worse off” started at only 22 percent — a surprisingly bipartisan beginning – before jumping to 61 percent by summer and nudging down to 54 percent by November. Just 11 percent of the critical independents, meanwhile, began by thinking that health care reform would make them worse off, but that percentage more than tripled by summer to 36 percent, before dropping to 29 percent in November. Even Democratic discontent, while modest, still went from a mere 3 percent to 11 percent in summer, before dropping to 7 percent.

Those numbers track my personal experience talking with many friends and neighbors in Chicago about the reform bill. They are confused and scared about warnings on cost, cost and more cost , yet seem ignorant of reform provisions that would actually save them money. So, for example, a well-read lawyer friend ranted about the way the health insurance benefits at his small family firm would be taxed as a “Cadillac plan” because illness by a few members had driven up the premiums. When I pointed out that the ban on pre-existing conditions could actually drive down his premiums so that he wouldn’t be paying so much money for a little bit of bad luck, he was completely dumbfounded; the thought had never occurred to him.

The poll results are even more disconcerting when you realize that they come at a time when one-seventh of the nation has no health insurance, many more have inadequate policies and unemployment remains high. In Massachusetts, however, with its universal coverage, even that thin veneer of “Where’s mine?” support for Obama’s plan disappears. Massachusetts voters are already paying taxes for universal coverage at home. Why subsidize “big government” that’s not giving anything to me?

In the movie, “The Untouchables,” federal agent Jim Malone famously explains how you bring down Al Capone and his gang: “They pull a knife, you pull a gun. He sends one of yours to the hospital, you send one of his to the morgue. That’s the Chicago way!”

The Republican right-wing pulled out the knives, guns and the lead pipe connected to the kitchen sink. The Democrats retaliated with Martha Coakley. Obama and the Democrats can either love their enemies like, say, one-term president Jimmy Carter, or they can practice the Chicago Way.

18 replies »

  1. not all time must be spent effectivly. Liberal dogma is like a first person shooter video game, come here blow up some lefty whack jobs for an hour then back to reality.
    Social inteligence and grace are highly overrated, I prefer my praticle inteligence any day. My outburst are very well targeted I might add, only people making inaccurate assumptions or passing propoganda as fact get nailed.
    For example, not knowing what I do for a living you shouldn’t have assumed I was an insurance broker and then proceed to disparage me based on your assumptions of insurance brokers. Then after telling you I am not an insurance broker you again label me an insurance broker and proceed to attack that nobel profession slanderously.
    I’m quit capable of engaging in pleasant and inteligent conversation as long as the other party sticks to facts. We live in a short attention span world, not to mention Matt is a stickler on keeping post short, blowing someone up is a very effective way of drawing attention to their lies. I could write 20 paragraphs with meticulous links to supporting documentation and your average person would never read it. Call so and so a bleepidy bleep followed by a quick retort and just about everyone but bev M.D. will take notice.
    Conservatives got our asses handed to us for decades becuase we always loss the media war. It didn’t matter if we where right people beleived what they heard in 30 second spots on the news. To counter that we need to grab attention, make the point, then repeat ad naseum. Sadly it is effective.
    I remember, what seems like years ago, when this HCR debate first started there use to be a dozen people on here that would post on a daily basis insurance companies had 30% profit margins and getting rid of them would pay for everything and a pony. At first I would politely correct them and link to this or that showing they where incorrect. No effect what so ever. Start calling a few of them out as brainless twits to stupid to read a fortune cookie and people took notice. Arguments where made, facts became undisputed and when was the last time you saw somone on here claim insurance companies pocket 30%?
    Now that we have that out of the way lets discuss how you beleive no pre ex coupled with a weak penalty for not buying insurance will not lead to skyrocketing cost. FYI, TennCare and numerous other “pools” have offered no pre-ex policies with no tax and last no more then a couple years. $750 is not going to be the elixor to cure adverse selection. My “opinion” why am I wrong?

  2. Nate,
    If you want to advertise for your business that “blows up the status quo” – whatever it actually is – it would help if you described what you are actually offering.
    The only conclusion that is reasonable based on the 30+ of your posts that I have read is that you are a person with knowledge of the insurance industry spending quite a bit of time commenting on this blog, but unfortunately lacking sufficient social intelligence and grace to avoid outbursts like the one you just hastily typed, which unfortunately ends up nullifying your entire commenting effort … you don’t need a physician to tell you that this is not an effective use of your time.

  3. “and you seem to be more interested in preserving the status quo than fight for possible alternatives.”
    Being unpopular I now know no one cares, but in light of my profession this is a supremly ironic statement. My career and business is built on blowing up the status quo. My entire sales pitch is individuals and companies breaking the mold and exiting the status quo.
    Apparently I have been so successful, where’s the payoff, that I am now the status quo? The insurection has become the establishment, I would have expected to notice when it happened.

  4. rbar, seeing as how I am not a broker I don’t feel I can answer your question in the way you had hoped. Nor can I imagine what healthcare experience you have that would begin to compare to mine. Maybe if you would pay more attention to what I do you could frame these request properly????
    Prior to a number of them being made illegal a sizeable reduction in premium for living a healthy life is the most obvious. This applies to both group and individual plans. Now that “underwriting” is illegal other methods must be found. Charitable contributions to an individual to apply to their premium are one I am working on. Waiver of co-pays and deductibles to the limit we are allowed.
    Under HSAs and well designed HRAs allowing healthy employees to retain unused money is very powerful. Personally I am a huge fan of busgeting $x to contribute to someones healthcare. If they live a healthy lifestyle and don’t use that money then when they retire they should get it.
    Under our current system I would argue we actually penalize the healthy and those making an effort to stay healthy by making them over subsidize those that aren’t making an effort. This is a common trend in the country where the unemployed, those on welfare, those that bought ARM loans, and other people showing less effort are rewarded over those that are doing things right.
    “If you are talking about health care cost explosion, the status quo breaks the bank, and you seem to be more interested in preserving the status quo than fight for possible alternatives.”
    I know your a smart person so statements like this really puzzle me. What is your professional background that provides you the knowledge to make this statement?
    Our current private insurance system is sustainable. Our current public systems are not. The status quo is the result of 45 years of HRC, starting with Medicare. I challenge you to argue how not passing more reform, which created the problem, will break the system faster then not passing more poorly designed reform. Haveing worked 20 years in the financial delivery of healthcare I know first hand what the proposed legislation will do. Proposed HRC shoots the current system with crack.
    You don’t need to be a very bright person to know that telling a person you are guaranteed the right to buy insurance no matter how sick you are but not requiring them to pay premium when they are healthy will break the system. The fine for not having insurance is $750. Insurance cost around $3600+ community rated. What do you think makes up that difference of $2850? It is very simple, if everyone paid the fine instead of buying insurance, then exercised their right to guaranteed coverage only when their claims exceeded $3600 what do you think will happen. If every insured person has more then $3600 in claims then there wont be any money to pay the claims.
    do you see the glaring error in your argument now? Every time you open your mouth you insert foot. Why is it you feel the need to comment on things you don’t understand? If you don’t know what my profession is then don’t comment on it. If you can’t comprehend the negative results of insurance lacking moral risk then don’t comment. The issue isn’t my self perceived popularity but your insistance on making crap up and talking out your a$$. if you don’t know then don’t talk, that simple. Or ask a question instead of making a statement. You comment on my profession 2-3 times and still don’t know what it is. That makes all the sense as me ragging on you for being a terrible candy striper, I assume this is the actual healthcare experience you refer to, why don’t you wear the cute uniforms like you use to? Would it hurt you ladies to stay and chat a little instead of always txt’n in your cell phones. Sometimes rbar I think we would be better off if we just got rid of all your candy stripers and hired someone to do the work.

  5. Nate,
    Your comments seems much more idealistic than mine, and mine, by the way, are supported by actual health care experience, not insurance brokering (you overestimate your popularity when you assume that everyone knows or is even interested what exactly you do for a living).
    Tell me exactly
    1) how do you/the companies you represent can offer financial incentives to persons with a healthy lifestyle – I am truly interested in financial incentives for healthy living.
    2) financial incentives for healthy living was NOT your argument – you talked about guaranteed access to subsidized insurance “breaking the bank”. If you are talking about health care cost explosion, the status quo breaks the bank, and you seem to be more interested in preserving the status quo than fight for possible alternatives.
    By the way, your profession or business appears to make you cantancerous and/or deeply unhappy, as you invectives suggest. That does not make you look smarter.

  6. “Americans don’t hate big government; they hate big government when it’s not bestowing benefits on them.”
    Another fact, Americans actually like taxes, just other peoples.

  7. Gary does that include all those enrolled in Medicare and Medicaid? only 25% of the population, maybe less is insured by insurance companies. Not sure what you would accomplish i that minority all dropped coverage

  8. What would Happen if the majority of Americans told Insurance Companies to get screwed.Everyone drop Insurance and stop the entitlement payments. I don’t know this to be true ,but I bet, some large scaling back would appear in the Industry.
    It is an illusion of Insurance,that they are in control of our Health.They are permitted this hold on us only because their members fear the consequences. I think that fear is a much greater motivator than money. Money has always been insurance Crutch.

  9. Oh, and I fully agree with the main thrust of this post. It is remarkable how much bipartisanship-seeking still emanates from Democratic party moderates, when their opponents essentially want to eliminate them and undermine any efforts to govern. As the recent example in Alabama shows, even conversion to being a Republican isn’t enough.
    I can’t tell yet whether I like Alan Grayson (D FL) or whether he is ultimately a good tactician, but one thing is clear: the man knows how to take the fight to the enemy.

  10. this jd is where us evil free marketers can save the day if left alone to do our job.
    Individuals are willing to change their behavior today for a polutry sum of $x.
    The long term savings of those changes are significant, say $y.
    If only there was some way to fund x wih the promised return of y….

  11. It’s OK, Nate. We lost hope with you and the right a while ago.
    That said, when you don’t stray from the mechanics of insurance and launch into the blame game, as I’ve said before, you often have good insights.
    You are certainly right that a few bucks now is better able to trigger action for many people than the prospect of even a few years of life in the distant future. Sad, but true. It doesn’t have anything to do with being specifically “money motivated,” though. To use decision theory jargon, it has to do with time discounting of future rewards, which is a quasi-rational or irrational feature of human cognition.
    Amusing study here.
    wiki article on time preference.
    Wiki article on temporal discounting.

  12. wow rbar expected better of you, I’m really losing hope with the entire left this year. For starters before you start arguments with what I do you might want to actually get a clue what I do. Lessons the chance you end up looking like an idiot.
    In my “profession” I actually target the sickest of the sick. Healthy groups that have low insurance premiums aren’t usually interested in my services. Sick groups paying an arm and leg on the other hand are much more receptive to my solutions. The rest of your argument was just as inteligent and factual as your intro.
    Your second paragraph is typical idealist with no exposure to reality or actual experience. When ever we sell lifestyle change we have the best luck with personal finance. Telling someone they will live longer tells them they can wait and start next year. Telling them they will save $500 this year gets their attention. Over the years we have worked with a lot of truck drivers, hardly the affluent and educated as you describe. They are very money motivated though.

  13. Nate,
    That’s exactly the problem with your profession:
    you want to sell insurance to healthy people and avoid any losses … and then you seriously complain about medicare costs, a third party payor that covers people who are actually sick and need health care services big time.
    “The other is with guaranteed access to subsidized insurance why take care of yourself, they have removed any financial reward for healthy living.” I don’t think you seriously believe that. Show me the Americans who live healthy for financial reasons. The healthy lifestyle people tend to be educated and affluent, while the sedentary fast food people are lower middle class to poor, be it for reasons of affordability of a healthy lifestyle (healty food, time and opportunity to do sports) or for cultural reasons.

  14. not sure what you do for a living Michael but it sure doesn’t include knowledge of insurance.
    “When I pointed out that the ban on pre-existing conditions could actually drive down his premiums”
    There has never been a single analysis or study to even suggest this as a possible outcome let alone substantiate it. It is guaranteed without doubt that the pre-ex laws as written will increase small group premiums by double digits.
    John’s example of gaming the system is just one reason it will break the bank. The other is with guaranteed access to subsidized insurance why take care of yourself, they have removed any financial reward for healthy living.
    “The Republican right-wing pulled out the knives, guns and the lead pipe connected to the kitchen sink.”
    AKA Facts, common sense, and better alternatives, arch nemisis of liberals since the beginning of time.

  15. How would the “ban on pre-existing conditions” reduce costs at his small, family-owned firm? My family business will drop coverage and pay the $750 per head fine, wait until one of us gets sick, and then apply for the guaranteed coverage with a “ban on pre-existing conditions,” and get a big subsidy. I suppose our premiums will go down, but “costs” will be just as high or higher, as borne by society. But I suppose you are just looking at the individual’s unenlightened self-interest.

  16. Brilliant advice. Lose a series of electoral tests, and the advice is fight harder, or dirtier, I’m not sure. All to avoid the self-reflection that would strike at the core progressive delusion, which is that when the people reject your scheme, they just didn’t have it explained in small enough words.