OP-ED

Why “Liking” Your Plan Is Not the Point

In recent weeks, President Barack Obama has been appropriately raked over the coals for saying, multiple times, “If you like your health care plan, you’ll be able to keep it.” He shouldn’t have said it. The problem is, he shouldn’t have said it for entirely different reasons than most Americans think.

Let’s begin with a basic question: What does it mean to “like” one’s plan? And what is the value of this statement? All of this came to a head at an October 30 Congressional hearing with the Secretary of the Department of Health and Human Services, Kathleen Sebelius.

At the hearing, in a cantankerous challenge to Sebelius’s credibility, Tennessee Rep. Marsha Blackburn highlighted two constituents, Mark and Lucinda, who “like their plans,” but were being told they could not keep them because of the Patient Protection and Affordable Care Act (ACA), so-called “Obamacare.” A long-entrenched individualist rhetoric provided the framework for Blackburn’s point, namely that we should allow Mark and Lucinda to keep their plans in the name of individual freedom, just because they “like” them.

For purposes of argument, let’s assume that what Mark and Lucinda’s insurers are saying—that the cancellations are a result of the ACA—is true. But, as we do this, let’s also keep in mind that just because insurers claim premium hikes and cancellations are because of the ACA doesn’t mean that it’s true. In fact, it seems to be true only rarely and, even then, often as a half-truth.

But, anyway, let’s assume it is true. The question then becomes: why is it true? The problem is that this individual freedom is made possible by the assurances of a social safety net. This brings us back to the existential foundation of the ACA, namely that the choice to not carry health insurance—or to carry poor health insurance that individuals may find out, at some point, doesn’t cover something important—simply dumps those individuals into social institutions such as emergency rooms and local care centers, and does so in an extremely wasteful way. This returns us to the problem we started with and a question of whether or not ACA opponents are concerned with solving the problem of building a sustainable health care system.

In other words, Blackburn’s logic, as inspirational as it might be to some, bathed as it is in the rhetoric of freedom, is not premised on an analysis or understanding of health insurance, but deference to Mark and Lucinda to make their own choices, consequences be damned.

Two points need to be made in this regard. The first is that the very logic of health insurance is that customers (who will become patients) do not know what their needs will be. There is imperfect, asymmetrical knowledge on health markets, as health economists have long recognized (Kenneth Arrow wrote the classic health economics statement of this argument in 1963 while George Akerlof, Michael Spence, and Joseph Stiglitz won a Nobel Prize in Economics for hashing out the more complete theory).

Mark and Lucinda’s happiness with their plans is premised on fleeting and incomplete knowledge. They are not seers. Whether or not one “likes” one’s substandard health plan is therefore of little use. The purpose of the ACA’s essential health benefits requirements—the source of the restructuring of American health insurance plans and a key reason why some plans have to go—is that they are based on experience of the health needs of a broader population. They are the outcome of evidence-based considerations, grounded in clinical expertise and data, not just about what Mark and Lucinda need (or think they need) now, but what they are likely to need in the future. In this light, a key question is this: will they “like” their plans when they find out? Either way, “liking” one’s health insurance plan is not rhetoric that we would be wise to take (at least too) seriously. It would be foolish to mold our policy around it.

A second important point is this: If ever there was a need for a bit of paternalism, some regulation on the front end, it is health insurance. Unless, of course, one is willing to go the path carved out by Rep. Ron Paul, who noted in a much-discussed moment at a 2011 Republican presidential primary debate that, “Freedom is all about taking your own risks.” Paul’s protestations of freedom aside, risk pooling is all about minimizing risk when it comes to something as high stakes and socially consequential as access to medical care. Happily for the ideal of a social contract, a majority of Americans have rejected the idea that we will simply “let people die,” which Paul’s audience that night seemed to sanction. Luckily, these people do not tend to make policy, at least not yet.

Let’s connect the dots more directly: for years large numbers of Americans have been unable to keep plans just because they “like” them. The ACA did not invent this phenomenon. As Timothy Jost has noted, in fact, that it is quite the opposite, as the ACA is “quite specific” in asserting that “Nothing in this Act . . . shall be construed to require that an individual terminate coverage . . . in which such individual was enrolled on the date of enactment of this Act.” The public, moreover, would be surprised to learn that this promise has been kept since the ACA is not responsible for the canceled plans, at least not in a direct way. Perhaps out of naïveté, Obama assumed that insurers would start to phase in the ACA’s essential benefits packages rather than bring new customers onto new plans that didn’t pass muster and wouldn’t be phased in under the new rules. For political reasons, Obama took responsibility, but he shouldn’t have.

Instead, insurers kept selling plans that they knew did not qualify and would not be grandfathered in. These are new plans established after the passage of the ACA. While some pro-ACA commentators have been fast to make this point, the seriousness of these unethical actions on the part of insurance companies seem to have fallen on deaf ears.  Even worse, they seem to have “forgotten” to notify their customers of this important fact, leaving them to find out only at the end of 2013. Accordingly, to watch Fox News and to see the Democrats’ capitulation to the “like your plan, keep your plan” meme is to enter into a bizarre world in which it is the ACA—and not health care insurers—that introduced volatility into American health care.

In the pre-ACA years, however, insurers would regularly cancel plans, raise premiums, and increase customer responsibilities in cost-sharing arrangements. State insurance regulators served as a drag on these practices, but they could never contain them. The political story here, then, is that the ACA provided fantastic cover for already established practices. Predictably, and cynically, insurers and their anti-ACA confederates have exploited the ability to blame the maladies of private health care on the ACA, even when doing so stretch the bounds of credulity.

It is easy to understand why not taking what customers “like” too seriously would be politically controversial. As the pro-choice movement has long known, the rhetoric of unbridled choice is powerful. And, of course, who doesn’t like spending the least amount possible? (A major problem, of course, is that as a society we spend more than other nations and get much less in return in measurable health outcomes. But the politics of the ACA tend to play out on the level of the individual, so the “social question” is rarely posed.) But suppose in spending the least amount individuals become dependent upon a system that eventually they find, at some unforeseen point, to exclude something they really need. The ACA insists upon evidence-based benefits, not a laundry list of wants or likes. Obama showed grit in taking on his own constituencies—especially unions—and insisting that the wastefulness of those plans—so called “Cadillac” plans—be addressed. More care is not better care, and may sometimes lead to worse outcomes.

Similarly, insufficient care shifts costs to society. As everybody from the Heritage Foundation to former Massachusetts Governor Mitt Romney to supporters of the ACA have noted, is that at that moment the problem becomes social. In other words—and here’s a juicy ideological inconsistency—the failure to go the route of the ACA encourages free-riding. Where are the conservatives crying foul over a system that encourages free-riding and even moral hazard? Isn’t moral hazard a close relative of simply responding to the preferences—the likes and dislikes—of individuals? The ACA is trying—even if in a non-ideal way—to balance all of this out.

Again: some plans do have to go. Allowing Americans to pay for substandard plans is not a responsible policy option. But the trickier cases are those in which insureds say their plans are equal to or better than the ACA-sanctioned ones but are being canceled anyway, or are experiencing skyrocketing premiums. There are only two possible reasons for these situations, both the responsibility of health insurance companies: either they established them after the ACA was passed, knowing full-well that they would not be grandfathered in, or they are canceling them and raising rates because they can use the ACA as a smokescreen. Either way, the reason why so many Americans cannot keep these plans—even if they “like” them—has nothing to do with President Obama’s promise. It is a symptom of the state of American political culture that the health insurance industry has made it out of this process unscathed and even bestowed with a renewed moral force.

Commentators have noted the fact that only a comparatively small percentage of Americans are substantively impacted by these cancellations. But these still number in millions. Nonetheless, there is a critical question here of who, exactly, should be responsible for rectifying the situation. In a more optimal political environment, we would start by establishing a commission to investigate the health insurance companies themselves.

This only highlights the importance of establishing effective oversight on the side of consumers, perhaps along the lines of the newly minted Consumer Financial Protection Bureau, established to watch the banking industry. This shouldn’t be controversial: the ACA is, indeed, a boon for American health providers and the various businesses that stand to gain from expanded consumer base. The health care industry should welcome a chance to prove that they are and will be good faith actors, especially considering the benefits they are likely to reap. As I’ve noted, however, one major curiosity of contemporary health care discourse is the absence of any sustained criticism or scrutiny of health care providers—especially by the ACA’s critics.

But this important work shouldn’t take us off the trail of the “like it, keep it” meme. The way the media has behaved in the wake of public perceptions that Obama lied in making his promise says much about the quality of our political discourse and very little about the ACA itself. If we are to move forward seriously with the important work of ensuring that all Americans have access to affordable, quality health care, we will need a more pointed discussion about the nature of health policy. If we are going to use social policy to empower private companies, then we must scrutinize their behaviors. Whether we have this kind of vigilance in us is a major question. What is clear, however, is that the childish discourse of “liking” something—so common in the age of Facebook—is simply not helpful.

Daniel Skinner, Ph.D is a professor of health policy at Ohio University’s Heritage College of Osteopathic Medicine, Dublin, OH. You can follow him on Twitter at @danielrskinner or email him at skinnerd@ohio.edu.

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34 replies »

  1. In a free market insurance companies are responsible to their customers. Choice is the major driver of innovation and cost, which is why cross-state purchase of health insurance would be a positive development.

  2. “I would “like” not to have to depend on insurance in the first place.”

    Seems to be lots of “concierge” docs out there where you can pay a monthly membership for unlimited need-them-or-not access. Go for it.

    But you’ll also have to pay monthly insurance premiums.

  3. I would “like” not to have to depend on insurance in the first place. Then I can see my doctor and not have to worry about filling out numerous idiotic forms, the doctor can spend her time on a history and physical exam without wasting time on an inadequate EHR system. She and I can discuss reasonable treatment options and plans based on current scientific evidence and discuss pros and cons of costs, etc., not be tied to what the insurance company or the government feels is in my best interest.

  4. How ludicrous a title of a post, much less the content that follow!

    Only pure partisan platitudes would come up with such a disingenuous and dishonest rationalization. Sure, people want to spend $10,000 or more a year for insurance coverage they detest and deplore.

    Is this how stupid and vain the Obama administration and their cronies have become to attempt to brainwash Americans to buy the snakeoil they have been erroneously selling these past near 4 years now?!

    Got, to listen to the failed rhetoric of Repugnocants back in the early 2000s why we had to bomb and invade another country for no valid reason, now we have to put up with our own alleged representatives basically doing the same in a figurative manner to their own citizens, bomb by forcing these inappropriate and unchallengable demands for more money, then invade by making us give all this personal information that will let them invade us whenever the rulers, er, representatives want to harass and disrupt us.

    See how it is meaningless to pick a side of a polluted aisle of a one party system of Republocrats who do the same thing when in power?! I keep having to remind those with a brain and autonomous thought from it, there are more registered independents now than either side of ‘Craps vs ‘Cants. We can start to put an end to their duopoly and disruption of our society. But, don’t look to spread the message among these threads, so absorb it and find people who think and act, not those who just stink and crap! End of rant!

  5. Most people “like” their coverage because of access and costs, not quality. The average American’s basis of judging healthcare in a third party payer system is a sophomoric and subjective algorithm whose numerator is
    ( access+beside manner+convenience) – (third party UR intervention+how many people in the waiting room looked like they were in a lower socio economic income bracket than me ) divided by my personal out of pocket costs. This tends to promote poor consumerism, over treatment, fraud, and enormous variability in unit costs based on the perception that “more is better” and that a university hospital ER must be the best place to get stitches.

    Outcomes/cost for the entire episode of care should be the basis of judging care. “If you dont like your insurance” should be supplanted by “if you dont like your value based outcomes”…

  6. “Like” really may have not been the best term for it. First of all, you get a plan based on your needs, not wants. You may “like” your plan because it can get you by but are you “satisfied” with it and is it sufficient for your needs? This goes to show how simple statements can have a huge impact on the entire message.

  7. “what is your point to your endless rhetorical comments?”

    From Wkipedia:

    “Rhetoric is the art of discourse, an art that aims to improve the capability of writers or speakers that attempt to inform, persuade, or motivate particular audiences in specific situations.[1] As a subject of formal study and a productive civic practice, rhetoric has played a central role in the Western tradition.[2] Its best known definition comes from Aristotle, who considers it a counterpart of both logic and politics, and calls it “the faculty of observing in any given case the available means of persuasion.”[3] Rhetorics typically provide heuristics for understanding, discovering, and developing arguments for particular situations, such as Aristotle’s three persuasive audience appeals, logos, pathos, and ethos. The five canons of rhetoric, which trace the traditional tasks in designing a persuasive speech, were first codified in classical Rome: invention, arrangement, style, memory, and delivery. Along with grammar and logic (or dialectic—see Martianus Capella), rhetoric is one of the three ancient arts of discourse.”

    Thank you for the complement MD.

    They’re only endless if you wish to read them, something I have mostly stopped doing for your pointless points.

  8. Thanks for clarifying. Then what is your point to your endless rhetorical comments?

  9. Peter1,

    My point was merely to question the supposedly pure motives that the author believes were behind coverage mandates. I think that employers and to a lesser degree insurance companies probably have a pretty good idea of what employees/consumers want.

    Obviously insurance companies’ motives are not pure either and I am sure that they lobbied heavily for what they wanted in the ACA.

    What kind of coverage to put in a policy is a balancing act; each new requirement means a new cost to be added. My opinion is that health insurance should be more like car insurance/car warranties. These pay for serious problems like crashes and blown motors, but oil changes, tires, and tuneups are not covered. Hence most office visits, screening exams, birth control and Viagra would disappear from coverage. Heart attacks, cancer, broken legs would remain in the policy.

    The rest of it seems to me to be off topic.

  10. “You clearly have a pre-existing problem.”

    MD, I don’t have a pre-exist nor do I qualify for a subsidy. I pay the full bore.

  11. There is a tendency to blame the mandates for maternity, contraception, pediatric dental, et. al. for the tremendous increase in insurance premiums.

    This may not be whole story. I have read some studies which show that mandates add five or ten per cent to premiums in the individual market.

    Instead the real cost driver is guaranteed issue and not excluding pre-existing conditions.

    In the old individual market in 45 states, the insurers could exclude the sick and charge very low rates to healthy persons. Rather like a 35 year old getting $500,000 of term life insurance for $50 a month. By the time the healthy 35 year old had serious health problems, he/she was on another company’s policy or on Medicare.

    It might have been better to have left the heavily-underwritten individual market alone, and offered a tax-funded high risk pool for their people who were always declined. Capretta estimated that this would cost $100 billion a year, which could be funded by a combination of payroll and income taxes.

    The result would be that a healthy person with an HSA and a catastrophic policy would not be hit with a 300% premium increase. Instead he/she would pay an extra $500-$1000 a year in higher taxes.

    Also, wealthy seniors and those Americans with generous employer plans would also be paying higher taxes. I rather like that concept myself.

    But this would be on budget, and it would not pay for itself, and would not obviously reward some of the Obama constituencies. Some Republicans would just plain vote against it because of higher taxes.

  12. Peter1,

    You clearly have a pre-existing problem. Sorry about that. Medicaid and Medicare ARE gifts…not rights.

    The taking from the making is sinking the ship, shich is insane.

    All will have coverage and none will have care.

  13. “These brave and wise experts – mostly with Ph.Ds – sitting around a table and doing what is right for the common man. Surely, this must be the basis for deciding which benefits are “essential”.”

    Legacy, what process do insurance companies and employers use to decide what’s “essential”? Do you think they have more affinity for the common man? Do you think less education makes one “smarter”?

    I agree that the designers of this legislation did not go far enough up the income ladder to determine “subsidies” or the consequences of using the subsidy design, but that would have meant greater cost to taxpayers – which is you. Would you be willing to pay more in taxes for a broader inclusion?

  14. ” …. the ACA’s essential health benefits requirements …… are based on experience of the health needs of a broader population. They are the outcome of evidence-based considerations, grounded in clinical expertise and data …”

    Reading these words of Daniel Skinner almost brought tears to my eyes. These brave and wise experts – mostly with Ph.Ds – sitting around a table and doing what is right for the common man. Surely, this must be the basis for deciding which benefits are “essential”.

    But then other troubling thoughts crossed my mind. With 17% of the economy at stake, large companies; insurance, software, pharmacy, etc. large unions and associations; hospital employees, nurses, pharmacists and doctors must all have been trying to get to the trough. Sending lobbyists and making “campaign contributions” (bribes) to make sure that; optometrists, acupuncturists, physical therapists, nurse midwives, etc weren’t cut out of the deal probably kept the firms on K Street pretty busy.

    So which story is true? Probably a combination of both. But when what “Mark and Lucinda” like is compared to what resulted from the second process rather than the first, their likes seem much more valid.

    Of course I can’t prove that the ACA was created more by the second process than by the first. The only thing I can say is the proprietary nature of EMR data suggests the second, not the first.

  15. “We could also raise income taxes on all Americans by a per cent or two, in order to fund high risk insurance pools on a federal basis.”

    Bob, I would favor a mix of sales and income tax. There are a “tremendous” amount of for cash unreported income people and I’d bet most of those are uninsured. They expect services but don’t want to pay for them.

  16. Prof. Skinner is correct that the funding of care for the uninsired is a problem, and ‘free riders’ are a problem.

    The question is whether the ACA is the right solution.

    According to a detailed study by Jack Hadley, the amount of uncompensated care in hospitals is in the $35-$40 billion range.
    Some of these expenses have been covered for years by state funds and the Medicare DSH payments.,

    If 30 million adults are uninsured, we could have made each of them pay extra income taxes, and funneled that money to safety net institutions.

    We could also raise income taxes on all Americans by a per cent or two, in order to fund high risk insurance pools on a federal basis.

    In this way, the persons now complaining about the ACA would be left alone as far as their insurance goes. Their tax bill would go up very slightly.

    Now I do not say that this would have been easy to pass. There are both Republicans and Democrats who would oppose any tax increases whatsoever.

    It is worth noting that conservatives like James Capretta and John Goodman and Avik Roy and John Cochrane are all on record for favoring some version of what I just described, which involves direct taxes and on-budget spending rather than endless tinkering and supervision of private insurance.

    One anecdote, somewhat off my point: Ron Paul’s campaign manager was uninsured, and died of cancer with $400,000 in medical debts. Some of his crown really would let the uninsured die,

    The danger of the ACA is that its cure may be worse than the disease,

  17. Not putting it on insurers at all. They certainly benefited though. The whole bill was architected by the dems and all blame falls squarely upon their shoulders.

    And I think it’s going to cost them big come midterms.

  18. Ach, what burden more heavy, than having to decide for people, over their objections and protests, what is really “for their own good”? It is an exercise calling for the utmost nobility of thought and purpose.

  19. Be that as it may, those who believe they have been deceived and misled aren’t going to be placated by invitations to make insurers, yet again, their “whipping boy.” The “winners” here are part of the Democratic base. Many of the “losers” are going to be jumping off the “hope and change” bandwagon. They aren’t going to be impressed with theories that the insurers deviously manipulated the Democrats into passing the ACA (if that’s what you’re suggesting.)

  20. Peter:

    The need for bailouts like TARP and S&L is directly due to the fact that Congress (both parties) do not do their jobs properly, which again is due to lobbying.

    The House and the Senate both have banking/finance committees equally comprised of Dems and Repubs, but Congress has failed miserably in their responsibility to maintain a stable economy as evidenced by the boom and bust of the last three bubbles.

    They either did not enforce existing sound regulations, repealed sound regulations or did not create new regulations as needed.

    So look at the trend…

    IPOs/LBOs/S&L – 80s, tech – 90s, mortgages – 00s

    Each bubble is worse than the prior one and the worst of all bubbles (govt. debt) that has existed the entire duration of the other 3 has yet to crash and it will.

    Regardless of ACA’s intent – we need to get HC costs under control along with various other problems if we are to have a stable country. Unless people stop drinking the Kool-Aid their party of choice is feeding them no positive change will occur.

  21. Peter:

    I fully admit the old system had big problems and things like medicare are not sustainable. So the right thing is to fix this even if gradually. ACA does not do this it makes it worse.

    I never said 5-10% HC cost increases per annum were good or justifiable rather it’s easier to take a 5-10% cost increase than 50-100% in a year. So what will ACA do to address the very high cost of medicine, which is directly related to the lobbying and malfeasance of the large players?

    And you’re right – not easy to do politically because the US is controlled by lobbyists. I think the economy will have to get badly hurt before change will come = I don’t have a good answer for you.

    However, the 80% of the population not represented in DC perhaps needs its own lobbyists. Maybe we should start a lobbying group or association that represents the middle class ala if you can’t beat the lobbyists join them.

    The idea would be to bring moderation and sanity to DC and not screw the poor or rich in the process – balance.

    You are 100% correct on Med Part D and it largely seems to work in the short-term because it was debt financed. Long term that bill will come due.

    I thought, perhaps I’m wrong, that the express purpose of ACA was to cover the uninsured, those with pre-existing conditions, etc. and fix the problem of runway health costs.

  22. Archon:

    Of course it will not bring joy to those adversely affected nor should it. I was trying to emphasize that ACA is a boon to large HC players at the expense of the middle class.

    How much the lower income demographic benefits is unclear given that 20% of the population is already on medicaid.

    And it’s the middle class in any society that brings stability and this is gradually being eroded in the US. Brazil and China both have large instability problems as the middle class is too small. In fact, China will be ripe for revolution if we see a severe global recession.

  23. I cheerfully stand corrected on that point. Still, I doubt that the prospect of insurer profitability will joy the hearts of those who are being adversely affected by Obamacare.

  24. So rather than try to flim-flam them with convoluted sophistries, why don’t we just tell them that they are a thorough, worthless lot?

    Really ought to be some way to take the vote away from them.

  25. Adam, it’s a “gift” if you have pre-exist or get a subsidy. Is Medicaid a gift? Is Medicare a gift? What would you like?

  26. “we are forcing a broad segment of the Middle Class (those who don’t qualify for subsidies) to fund the medical expenses of the indigent and uninsurable.”

    Showing some “compassion” are we?

  27. “The problem with ACA is that it is economically unsound in that households live on budgets.”

    BC, how was the “old” system “economically” sound? Except the option to not buy or buy junk “false security” policies and then eventually need charity care.

    “While a problem, most households were able to absorb a 5-10% bump in insurance per annum under the old system.”

    Really, where is your justification for that – rising wages of 5-10% per year? That 5-10% was compounded by the way.

    “ACA’ biggest failing is that it does nothing to control the high and ever increasing costs of medicine as it allows pharma, insurance, device OEMs and trial lawyers to continue to gouge the system.”

    Agreed, but tell me how to achieve that politically?

    “In fact, ACA is the largest govt. giveaway to private industry since TARP”

    How large was/is Med Part D?

    TARP – “…..significantly less than the taxpayers’ cost of the savings and loan crisis of the late 1980s”

    See how banks get to “redistribute” income. Top down is always “redistribution” while bottom up is sound economic principle.

    “I’m all for fixing our broken medical system, but ACA’s not it.”

    It was never intended to “fix” more than uninsured and uninsurable. It’s doing that but leaves out many who are being burdened by the ridiculous income levels. We all know that a family making $65k per year can buy a Mercedes Benz – unsubsidized (sarcasm), but Teslas and Volts (and corporate jets) are subsidized, because lord knows those buyers need the break.

  28. Archon:

    “As for insurers profiting from this scheme…..”

    The market doesn’t share your point of view.

    http://www.cnbc.com/id/101202791

    “bellwether health-care stocks such as Aetna, Cigna, UnitedHealth and Gilead are all trading within shouting distance of 52-week highs”

    To the extent that insurers get hit due to small/large corporate mandate delay you can bet they will get a TARP like bailout to cover any losses.

  29. Nice spin, but any way you try to cut it, you can’t conceal the fact that, under the banner of “social justice,” we are forcing a broad segment of the Middle Class (those who don’t qualify for subsidies) to fund the medical expenses of the indigent and uninsurable. You really think they are going to blame the insurers, and not the politicians who passed the ACA, for concealing this from them?

    As for insurers profiting from this scheme, who, given the actuarial uncertainties of the exchanges, would be brainless enough to put any substantial part of their retirement savings into health insurer equities?

  30. Central planners will never understand why us proles aren’t screaming thanks for their gift (the ACA) to us.

  31. The problem with ACA is that it is economically unsound in that households live on budgets. The vast majority of people above the subsidy line are going to have much more expensive health costs and in truth some that receive a partial subsidy may also have more expensive health costs. Unlike the Fed, a household cannot “quantitatively ease” their income to a higher level.

    While a problem, most households were able to absorb a 5-10% bump in insurance per annum under the old system. But it is very difficult for most and impossible for some to absorb an increase of 50-100% in one or two years.

    It’s not just the individual market, but employees of small and large businesses are going to get hit as well, which is precisely why their participation has been pushed pass the midterms.

    ACA’ biggest failing is that it does nothing to control the high and ever increasing costs of medicine as it allows pharma, insurance, device OEMs and trial lawyers to continue to gouge the system.

    In fact, ACA is the largest govt. giveaway to private industry since TARP and the invasion of Iraq. Not surprisingly it has been sold in the same way – “it’s all for the good of the people.”

    Make no mistake, the United States is run by special interests and until this is reined in we will firmly remain on a path to economic ruin.

    I’m all for fixing our broken medical system, but ACA’s not it.

  32. “the seriousness of these unethical actions on the part of insurance companies seem to have fallen on deaf ears. ”

    But insurance only owes its allegiance to its investors, it does not have a responsibility to the insured – they have demonstrated this over and over again.

    These “like my planers” only liked the price, and did not “like” provisions in the ACA plans that created larger pools so that they now pay for universal pregnancy coverage for instance. It’s the continued raising of premiums that angers policy holders – something they were very familiar with before the ACA.

    The Obama administration seemed to promise lower prices because of the larger pool the ACA would create (at least hospitals would no longer need to spread the load of charity care) and they did a lousy job of “selling” the reason for broader coverage. Obama had failed (yet again) to do his job effectively and completely.

    Will we ever get relief from exponential increases in premiums? That’s the crux of these policy issues. So far, not.

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