OP-ED

How Obama Botched and Bungled the Health Reform Message

While it’s comforting to just blame the GOP for the unhappiness with health reform threatening the president’s re-election, the truth is that Barack Obama repeatedly botched, bungled and bobbled the health reform message. There were three big mistakes:

The Passionless Play

While Candidate Obama proclaimed a passionate moral commitment to fix American health care, President Obama delved into legislative details.

When a Baptist minister at a nationally televised town hall asked in mid-2009 whether reform would cause his benefits to be taxed due to “government taking over health care,” Candidate Obama might have replied that 22,000 of the minister’s neighbors die each year because they lack any benefits at all. Instead, President Obama’s three-part reply recapped his plans for tax code fairness.

While Republicans railed about mythical “death panels,” and angry Tea Party demonstrators held signs showing Obama with a Hitler moustache, the president opted to leave emotion to his opponents. The former grassroots organizer who inspired a million people of all ages and ethnicities to flock to Washington for his inauguration never once tried to mobilize ordinary Americans to demand a basic right available in all other industrialized nations. In fact, he hasn’t even mobilized the nearly 50 million uninsured, who have no more favorable opinion about the new law than those with health insurance!

When CNN captured a sobbing middle-aged woman telling Sen. Tom Coburn (R-OK) of her husband’s brain tumor, only to get the reply, “Government is not the answer,” the president might have helped all Americans feel her pain. He did nothing of the sort. The public face of “Obamacare” was never a mother, father, spouse or child, but, just as the Republicans wished, it remained…Obama.

The Friend (or Enemy) of the People

Hard as it is to recall, a New York Times-CBS News poll in mid-2009 showed nearly three-quarters of Americans supported universal coverage through a government-administered plan like Medicare. But the survey also revealed “considerable unease about the impact of heightened government involvement on…the quality of the respondents’ own medical care.”

That unease surfaced even in the heart of liberal Chicago, at a Second City show satirizing the new president. A doctor tells a woman her diagnosis gives her only three months to live. When she pleads for help, the doctor tells her the good news is that Obama’s health reform plan means she’s scheduled for her next visit just six months from now. The parking lot was packed with “Obama ’08” stickers, but the audience still broke out in laughter.

The comedy worked because it connected with real feelings. GOP consultant Frank Luntz soon urged Republicans to stress quality-of-care concerns. Obama and team remained tone deaf. Three years later, the same Times-CBS poll showed only one in five Americans thought the ACA would help them personally. A full third expected their quality of care to worsen, and just 17 percent expected it would get better.

In fact, though the individual mandate to buy insurance has received the most attention, the ACA is filled with provisions to improve care quality and individuals’ care. But for many middle-class voters, the answer to, “What’s in health reform for me?” was allowed to become, “Nothing good.”

The Caricatured Crusader.

When GOP leaders decided to just say no to Obamacare, they were honest about their political calculus. The polarization worked.

The number of Republicans saying reform would make their lives “worse off” started at only 22 percent in early 2009, according to the Kaiser Family Foundation (KFF) tracking poll, before jumping to 61 percent that summer. Just 11 percent of the critical independents began by thinking that health care reform would make them worse off, but that percentage more than tripled by summer to 36 percent.

In early 2010, the White House posted a list detailing which proposals by which Republicans had echoes in the ACA. That the mandate had originated in the conservative Heritage Foundation was nowhere to be found. Nor did the White House note that the GOP’s 2008 presidential platform had called for coordinated care and other changes almost identical to ACA provisions. In the event, none of this information was used to respond to the GOP attacks that helped sweep out Democratic candidates in the 2010 election tsunami.

It was only this past March that the administration, acting as if the Supreme Court’s ACA hearing was a political pep rally, sprang into action. It activated supporters, talked up the ACA’s Republican roots and rolled out press releases touting the law’s benefits for average Americans. It was too little, too late.

A 2009 report by the Institute of Medicine concluded that the consequences of a lack of access to medical care include “needless illness, suffering, and even death,” with the victims frequently being children. Yet health reform’s opponents have managed to switch the discussion from dead kids to the Constitution’s commerce clause. All the while, Barack Obama has flailed and failed to convince the American people that “Obamacare” is change they can believe in.

Michael Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of Management and the author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age. This post originally appeared in The Huffington Post.

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o カナダグース 店舗 目Hope TybergAuthBillbob hertz Recent comment authors
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o カナダグース 店舗 目
Guest

私はよく分からない理由正確な理由が、この私のために遅いサイト信じられないほど非常に極端ロードしています。 問題の問題か、ある他の誰がこのをしている問題は私の最後に? 後で後でと問題がまだ存在するかどうか私は戻ってチェックします。

Hope Tyberg
Guest

Algo que se puede aprender de valor de cada entrada del blog y es hilo de los comentarios.

Peter1
Guest
Peter1

“They add no value to the system.” Bill, doctors (self employed) add no value to the system? Hospitals add no value to the system? “At some point it would make sense to incorporate.” It usually makes sense to incorporate. Heard of an “S” corp? Millions of them, but none are what I would consider, “entrepreneurs”. They don’t create anything but for themselves – no jobs, no investment, just personal income with the protection of limited liability . Entrepreneurs usually create waves, others just ride them – as a single self employed you’re riding a wave. “The average person who may… Read more »

bob hertz
Guest

I am not sure if your last comment on education was ironic or serious, but either way you have hit on a very core issue — namely, what costs are the responsbility of society and what costs are the responsibility of the individual? Most areas of American life have pretty good clarity on this classic question. The public pays for the fire department with taxes, but you have to buy your own fire insurance and sprinkler systems. Taxes pay for public libraries, but if you want to own a book or get it fast you have to buy it yourself.… Read more »

bob hertz
Guest

Buying health insurance across state lines, at the present time, is beneficial primarily to men under age 45 in states like New York and Massachusetts. There is a very specific reason. Those states require individual health policies to cover pregnancy. This causes all premiums to go up. Pregnancy is the most common cause of hospitalization under age 65. Whereas that man can go to Idaho and buy a policy without maternity coverage. That might save him $400 a month, which is a lot. This is not a trivial issue, but at the same time it is not the silver bullet… Read more »

Peter1
Guest
Peter1

“Whereas that man can go to Idaho and buy a policy without maternity coverage. That might save him $400 a month, which is a lot.”

What might a policy in Idaho with pregnancy coverage cost? Surely with less risk spread it would quite expensive?

About 75% of property taxes go to support schools. We’ve never had kids, don’t plan to as do most people over 50. I’d love to be able to opt out of paying to educate other peoples kids.

Bill
Guest
Bill

It raises interesting questions. I use a payroll service that charges a very reasonable monthly rate. This initial rate stays the same for the first five employees (if I had employees), in any state in the US. The complexities of state-by-state payroll laws would appear to fall in line with the thinking of the report you cite, and yet this company is able to continue to offer their service at a low price. Conversely, applying this model to Amazon would surely make book and other merchandise pricing skyrocket there because of compliance costs. So, are we saying we are able… Read more »

John Ballard
Guest

Oh I don’t think it has as much to do with regulations as the byzantine webs of contract arrangements and network configurations holding together the insurance people and the actual health care providers. I figured out a few years ago that health care billing (unlike whatever business you probably have) is not based on ordinary accounting. It’s more along the lines of “throw a bunch of sh** against the wall and see what sticks.” Unlike the Amazon inventory, healthcare isn’t something to be purchased on line and delivered by UPS. Here’s a post I put together recently about the crazy… Read more »

John Ballard
Guest

I don’t think you’ll need to shop out of state to find lower health care costs. I bet you can find wide swings within a fifty mile radius. With the right PCP for advise, you and a few others might think about becoming your own health care co-op. It my be feasible to keep a concierge practice on retainer.
http://en.wikipedia.org/wiki/Concierge_medicine

(I’m going to bed Good night.)

Bill
Guest
Bill

John,

I’ll check out your blog and the co-op idea. Thanks.

Have a good night.

Bill
Guest
Bill

Peter1:

I’m used to the type of disdain you exhibit towards the self-employed and micro-businesses. We’re a legitimate work force of professionals, my friend.

My point is that entrepreneurship should be encouraged through a level playing field vis-a-vis health insurance costs. There are a host of jobs that can be done working from home, and most would agree the side effect of fewer cars on the road would be a good thing.

John Ballard
Guest

Save me the pity party, Bill, and quit trying to game the system. Self-employed individuals and whatever you are calling microbusinesses have been popping up in America in good times and bad since before group insurance came about, and it’s still happening. One of the forgotten objectives of the Bush administration (which never happened) was tweaking the tax codes to uncouple health care from business altogether. http://www.aei.org/article/society-and-culture/poverty/tax-reform-and-health-insurance/ When auto makers pay more for health care than for steel, or Starbucks pays more for coffee than group insurance — it’s time to take a few bricks off the wagon. Your “micro-business”… Read more »

Bill
Guest
Bill

Thanks for the advice, John! Know of a higher deductible plan than the $10,000 one I already have? Geez, if it weren’t for expert advice like yours, what would I do?

No, you’re right. That’s not disdainful at all.

Microbusinesses = companies with 10 or fewer employees

Uncoupling health from business is exactly what I’m talking about. Pooling risk across states lines among 22 million self-employed seems a good start, and makes a lot more sense than a government takeover of the entire system.

Or better yet, how about an actual market of 300 million Americans shopping for insurance across state lines?

John Ballard
Guest

That “across state lines” trope is simply that — a trope. The reality is that insurance is crafted in the several states in accordance with each state’s very different regulations. A recent study indicates that operating in several states has the unwanted result of driving up premiums. http://www.insurancejournal.com/news/national/2012/05/08/246688.htm The study compared the regulatory compliance costs of 85 insurance companies doing business in multiple states with 147 multi-state RRGs and found that traditional insurance companies have significantly higher compliance costs because of those multiple regulations. For instance, he found that the average traditional insurance company in his sample spends $187,000 a… Read more »

Peter1
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Peter1

“My point is that entrepreneurship should be encouraged through a level playing field vis-a-vis health insurance costs.” Why just a level playing field for “entrepreneurship”? Why not everybody? “Everything else about Obamacare is noise.” Even being able to deduct 100% of your self-employed health costs? “as Obama-care will compel folks to buy comprehensive policies, premiums will actually grow.” So, pooling risk across state lines will lower costs and pooling risk across the entire country will raise premiums? A mandate will bring in a large pool of the healthy and young which will spread risk – even for you. When people… Read more »

Bill
Guest
Bill

“Why just a level playing field for “entrepreneurship”? Why not everybody?” Because the playing field is quite obviously tilted in favor of public and private unions and employees working for major corporations. For them, there is no healthcare crisis. Why would we devote energy to an area where there is no problem to begin with? We should take steps to facilitate access to affordable health through work, not government subsidies. We need to make it easy for anybody to start a company or work for themselves. Say what the GOP will about wealthy job creators, but the fact is that… Read more »

Peter1
Guest
Peter1

“We need to make it easy for anybody to start a company or work for themselves.” I guess you’d enjoy the increased price competition then? Working for yourself is about risk. The “market” is supposed to reward risk takers. “We should take steps to facilitate access to affordable health through work” I agree, affordable health care IS the issue, but that would mean significant price reductions from providers – many of which are self employed – like you. Would you like to take income away from them for your benefit? “that’s why we should start with entrepreneurs” Please don’t confuse… Read more »

Bill
Guest
Bill

“Would you like to take income away from them for your benefit?” Yes, absolutely. And not for my benefit but everybody’s. They add no value to the system. “Please don’t confuse being self employed and no employees like yourself with being an “entrepreneur”. ” I respectfully disagree. A successful self-employed could just as easily start by farming work out to others as his/her business grows. At some point it would make sense to incorporate. You are right about risk/reward. Your instinct about significant capital outlays being a prerequisite to entrepreneurship is wrong, though. In fact, if you make that a… Read more »

Bill
Guest
Bill

Here in NH, the state employs roughly 10,000 full-time staff who pay very little for their health. I confirmed the exact amount by submitting an inquiry to http://www.nh.gov/transparentnh/, asking how much they pay. I would tell you, but there is a strongly worded confidentiality clause in the email from the Admin Dept that says I can’t. So, despite the high irony of ‘confidential transparency,’ what I can tell you is this. As a self-employed person who is also self-insured in NH, I pay over 90% more per annum than they do. Next. As part of the same inquiry, I asked… Read more »

Peter1
Guest
Peter1

“I pay over 90% more per annum than they do.”

You would probably pay 90% more than any employed person (public or private) who gets their health insurance paid (tax free) by their employer.

Bill, as a self employed person how much of that 90% do you deduct from your federal/state taxes on your return?

“There is a need to recognize self-employed and micro-businesses as contributors to the economy.”

How, by giving them more tax breaks?

bob hertz
Guest

Good points, John. For over 20 years, Medicare explicitly allowed hospitals to amortize the cost of new facilities inside the reimbursements for care. In other words, the feds paid hospitals to expand.

The result is that the fixed costs of US hospitals are about $600 billion a year.
Even if all the waste and corruption that you cite is flushed out, and it should be, the fixed costs might be $525 billion a year.

You are proposing some good ways to cut the fat, but I fear we might have to cut into bone as well to keep Medicare afloat.

John Ballard
Guest

Thanks. One of my pet peeves after looking closely at the big picture for about eight years (I am a retired cafeteria manager, but my post-retirement life has been with senior care which as you know furnishes the biggest revenue stream for health care) is the status of what is euphemistically called “non-profits.” As far as I can tell, the operational and accounting practices of not-for-profit operations would quickly cause crash and burn results in the for-profit market. But thanks to their tax status there is no reason to be what for-profit operations call good business and ordinary people like… Read more »

John Ballard
Guest

Excellent point. The question of where the money comes from is a sticky one, indeed. As you point out, both Social Security and Medicare/Medicaid have designated payroll taxes which seem to be generating two really big revenue streams. Tweaking Social Security would be fairly straightforward but the GOP continues to salivate every time they look at all those dollars actually going to beneficiaries without first being skinned by brokers and bankers so the same old privatization schemes keep getting pushed. Medicare is a different story. I am of the opinion that there is enough money for health care, but not… Read more »

bob hertz
Guest

I missed this dialogue when it was “viral,”. but let me add a valuable poiint belatedly. One reason that Obama did not push harder for the PPACA is that the funding for it was sneaky in the first place. If the Dems had said in 2009, “We want to expand Medicaid to16 million people, and we want to subsidize 20 million others who get no employer benefits, and this will cost $150 billion a year, and we should raise income taxes by 2%………………..” this would have been an honest proposal. But their judgement was that it would never pass. Instead… Read more »

DeterminedMD
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DeterminedMD

Face it, PPACA as a whole is not about America, just a party’s self serving interests. I am sick of the posturing and lack of invested debate to redo this legislation better than round 1. And frankly, if the constituents of Pelosi’s district can’t figure out by now she is lame and useless as a representative and Party fixture, can’t wait for that earthquake to wake them up!!!

Sorry, not wishing death and destruction, just a f—-g wake up call to literally jolt them into seeing 70% of America does not embrace their mind frames!

Munira Alhouti
Guest
Munira Alhouti

In my pinion Obama new health care will give his community better chance to live their life. People will be eligable for health insurance without looking for their pre-existing sickness. Most of Middle class people do not recognize the important of having health insurance in their life . Off course the health insurance will more expensive then it used to be ,but people will have coverage for their health.

Peter1
Guest
Peter1

“Unlimited benefit? I suggest you lay off the questions and go read a little. Your suffering Michael knowledge deficency. Medicare is no where close to unlimited. Medicare wouldn’t even come close to qualifying as creditable coverage under PPACA.”

Then you would want Medicare to cover and pay for more coverage? You’re sending mixed signals Nate. Either Medicare needs to cut costs or it needs to cover more so that it’s not accused of using a death panel mentality.

You haven’t answered my question Nate. Should Medicare pay for transplants on 70-80 year olds since you oppose the use of “death panels”?

Michael Millenson
Guest

For the origins of the death panel term and debate (not how it came to be used), see The New York Times: http://www.nytimes.com/2010/12/26/us/politics/26death.html?pagewanted=all

For a nice discussion of the concept of the Angel of Death in various cultures (not including the actuarial, alas), see Wikipedia: http://en.wikipedia.org/wiki/Death_%28personification%29

And for a commentary on the propaganda on this issue, see: http://blog.seattlepi.com/williamhare/2010/12/31/republican-right-silent-on-real-arizona-health-care-death-panel/

Nate Ogden
Guest
Nate Ogden

NY Times, Wikipedia, Seattle PI, that is quit the echo chamber you have going there. No wonder your understanding was so limited. What you have is the liberal political framing of the issue, not the issue. Which raises an interesting philosophical question along the lines of a tree in the forest. If a discussion happens outside the liberal main stream media does it really exist? Apparently Michael thinks not. Thank you for the NY Times link as it actually reenforces what the argument was from the beginning; “When a proposal to encourage end-of-life planning touched off a political storm over… Read more »

Peter1
Guest
Peter1

“Do 70 and 80 year olds need transplants though? If you can afford one and choose to spend your money that way then go ahead.”

But that’s not what you are arguing. Should Medicare be paying for them? I think your answer should be yes, because otherwise you will argue “death panel”.

Nate Ogden
Guest
Nate Ogden

if the person buys and pays for a policy that covers them then yes. The problem with Medicare is people don’t contribute a fraction of what they spend. It’s a ponzi scheme built on increasing population paying the claims of earlier beneficiares. I forget the exact ratio of what people pay in plus interest and what they take out but if it was a private company they would have been shut down years ago. I don’t think its right seniors paid for a policy that covers X and are now getting 20 times X. At the expense of the grandkids… Read more »

John Ballard
Guest

Nate, with these two very clearly written paragraphs you have summarized the entire discussion about Medicare and Social Security. My guess is that a large number of people, maybe even a majority, would agree completely with what you have said. Having said that, however, I can only speak for myself when I say I disagree with that argument. I realize you will not agree with what I am about to say, and will very likely not grasp the point altogether, but I’s saying it in the simplest words I can find. These two programs, Medicare and Social Security, are NOT,… Read more »

Nate Ogden
Guest
Nate Ogden

There was a recent study on how people of different political persuasions grasp the concepts of the other party. Not surprising the results. http://www.american.com/archive/2012/april/liberals-or-conservatives-who2019s-really-close-minded I understand the concept of social contracts. I even agree that we need social contracts and in places they serve a purpose and belong. I also believe there are two sides to social contracts just like there are at least two side to all contracts. Contracts are based on consideration, those receiving benefits under these contracts have not fulfilled their end of the consideration. Merely being born into the country or moving into it, legally or… Read more »

Peter1
Guest
Peter1

“I don’t think its right seniors paid for a policy that covers X and are now getting 20 times X. At the expense of the grandkids and the future.” Isn’t that the fake fear mongering of those screaming “death panels” when they say the govmet is taking away your/my benefit (unlimited use) so that constitutes a death panel yet those same screamers (such as yourself) don’t want to pay for unlimited use and are just using it as a red herring created from invented facts. Tell us which way you want it Nate. Either you want to control costs or… Read more »

Nate Ogden
Guest
Nate Ogden

Unlimited benefit? I suggest you lay off the questions and go read a little. Your suffering Michael knowledge deficency. Medicare is no where close to unlimited. Medicare wouldn’t even come close to qualifying as creditable coverage under PPACA.

John Ballard
Guest

Well, Nate, I gave it my best shot. We can’t even agree to disagree. At least I tried. As for the link to the AEI piece, I’m not surprised that a Conservative living in New York, encircled by Liberals, would quietly come to the conclusion that he understood both sides but those around him would never grasp where he was coming from. As a Liberal having grown up in the South, surrounded by Conservatives (the people around me have elected Newt Gingrich, Bob Barr, Herman Cain, the late Larry McDonald, Lester Maddox, and a laundry list of other less well… Read more »

Nate Ogden
Guest
Nate Ogden

Thought you might enjoy this read John

http://volokh.com/2012/05/01/bleeding-heart-libertarianism-and-social-justice/

Different perspective on social contracts/justice and how just about every ideology supports them. The question is not that conservatives are opposed as most liberals like to argue but to the degree and what the public owes to society.

John Ballard
Guest

Thanks, Nate. Been there. Done that. Discussions like that no longer interest me. My career in the food business managing the working poor gave me a first-hand look at what it means to be at the bottom of the social and economic ladders. (Growing up in the South also helped shape my thoughts.) And it’s not a place where most people pecking on keyboards would want to be. Lincoln said the Lord must have loved the common man — He made so many of them. For all of human history the ratio of rich and poor has not changed a… Read more »

DeterminedMD
Guest
DeterminedMD

I fully agree with Nate on this. Selfishness and narcissism are the operating words these days with boomers especially, and it will doom this society a lot sooner than those in denial will come to realize. I am at peace that I will not see a dime from Social Security, that I paid for my parents and inlaws to get theirs and they were the supports I appreciated in their time. For boomers, and I am one of them mind you, they as a group can stick it where it don’t shine! See Carlin 1996 show, Back in Town, near… Read more »