Thursday, October 31, 2013

I'M AGAINST HEALTH CARE FUFKINISM

What Salon's Alex Pareene wants Democrats to do with regard to Obamacare is pretty much what promo guy Artie Fufkin did after a disastrous Spinal Tap autograph session that drew no fans:





Pareene writes:
The immediate political problem is that the president spent a bunch of time saying "if you like your plan, you can keep it," and now there are literally thousands of people who can go in front of television cameras and say that's not true. That's a bad look! ...

So what is to be done? Democrats who aren't Obama should already be working on easy-to-grasp proposals to "reform" the ACA -- to make it more public and less private. The immediate priority -- and progressives running for office in 2014 and 2016 should practice saying this out loud -- is fixing Obamacare. Not just the website, but the coverage gaps, the ways insurance companies will continue to exploit people and rip them off, and the potential for the cost burden on middle class people to grow.

Liberal Democrats need to propose real, old-fashioned liberal solutions to the real problems of the ACA. Things like federalizing Medicaid, to take care of people in states where the expansion has been blocked, and lowering the Medicare eligibility age. And they need to reintroduce the public option. None of that is attainable now, but it could be in the near future. That whole package ought to be pushed for by unions and by activists in primary elections. The message needs to be nakedly populist -- "make Obamacare work for you instead of the insurance companies" ... And Democrats in Congress ought to begin seriously agitating for Medicare-for-all, both because it is the correct policy, and because doing so will make everything else seem more "reasonable."
Look, I'm all for the reforms he talks about, up to and very much including Medicare for All -- but if Democrats walk around saying "Mea culpa, mea culpa" about Obamacare, the public is not going to take them seriously when they propose alternatives, because they're effectively saying, Yes we screwed the pooch on Obamacare -- so if you want it fixed, trust us. How plausible is that message going to be?

Here's my alternative: Yes, admit that the site is a mess. Yes, don't try to deny that the "you can keep it" message was a mistake. But go on the offense regarding the "cancellations" narrative. Challenge the notion that all of these people are being cut adrift -- because they aren't.

Have you seen Michael Hiltzik's story in the L.A. Times? He watched a woman from the Los Angeles suburbs named Deborah Cavallaro make the media rounds bewailing the loss of her health plan. So he got in touch with her and found out some information about what she's losing. Here's what he found out:
Her current plan, from Anthem Blue Cross, is a catastrophic coverage plan for which she pays $293 a month as an individual policyholder. It requires her to pay a deductible of $5,000 a year and limits her out-of-pocket costs to $8,500 a year. Her plan also limits her to two doctor visits a year, for which she shoulders a copay of $40 each. After that, she pays the whole cost of subsequent visits.

This fits the very definition of a nonconforming plan under Obamacare. The deductible and out-of-pocket maximums are too high, the provisions for doctor visits too skimpy.
To my mind, it fits the definition of an insane plan for a woman who is Cavallaro's age -- 60. I'm 54, and a number of annoying medical problems are sneaking up on me. I can imagine being forced to buy a policy that covers only two doctor visits a year, but I can't imagine it not being a risk.

Hiltzik learns what her alternatives actually are:
As for a replacement plan, she says she was quoted $478 a month by her insurance broker, but that's a lot more than she'll really be paying. Cavallaro told me she hasn't checked the website of Covered California, the state's health plan exchange, herself. I did so while we talked.

Here's what I found. I won't divulge her current income, which is personal, but this year it qualifies her for a hefty federal premium subsidy.

At her age, she's eligible for a good "silver" plan for $333 a month after the subsidy -- $40 a month more than she's paying now. But the plan is much better than her current plan -- the deductible is $2,000, not $5,000. The maximum out-of-pocket expense is $6,350, not $8,500. Her co-pays would be $45 for a primary care visit and $65 for a specialty visit -- but all visits would be covered, not just two.

Is that better than her current plan? Yes, by a mile.

If she wanted to pay less, Cavallaro could opt for lesser coverage in a "bronze" plan. She could buy one from the California exchange for as little as $194 a month. From Anthem, it's $256, or $444 a year less than she's paying now. That buys her a $5,000 deductible (the same as she's paying today) but the out-of-pocket limit is lower, $6,350. Office visits would be $60 for primary care and $70 for specialties, but again with no limit on the number of visits. Factor in the premium savings, and it's hard to deny that she's still ahead.
Forget "Democrats who aren't Obama" -- do you know what Obama should do? He should meet personally with someone who's experienced a policy cancellation, or he should arrange to have Secretary Sebelius do so. This should be in a state like California that's fully cooperating with the law. An Obamacare navigator should go along, and after the meeting, the individual and the navigator should sit down and work through the options. And then we should find out if the angry policy holder is still angry.

Obamacare isn't as good a system as Medicare for All -- but nobody's ever going to listen to any Democrat on health care again if Democrats agree that Obamacare is a train wreck, and never point out that it can work out well for a lot of people who think it can't.

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ALSO: Pareene asserts that 7 to 12 million people will "get their policies canceled and then get asked to pay more," but the link he offers as evidence only gives that an estimate of the number of likely cancellation notices. I assume most will be asked to pay more, but how many will need to pay significantly more after the subsidies kick in? It would be good to know that. (And I add "significantly" because you do realize that premiums used to go up even before Obama was president, right?)

3 comments:

Four Bs said...

Let's not let reality get in the way of an opportunity for some omni-directional snark.

flipyrwhig said...

I like your idea of a publicity offensive involving taking the pissed-off people through the new system. Because it seems to me like what this whole brouhaha mostly reveals is that no one thinks about what insurance is or how it's supposed to work. I'll count myself among them! This is why states have state minimum coverage for car insurance, too, and I wish someone on the Dem side would bring that up.

Victor said...

Also too, keep Bush's Medicare Part D fustercluck of a rollout front and center in the MSM.

EVERY Democrat, when questioned by the MSM, needs to say, "Yes, and Bush's Part D was an even unholier mess! And many of the same Republicans who tried to repeal PPACA over 40 times, and are screaming about the implementation, begged us - US, the Demcorats - for help!
And we didn't say 'NO!' like they are to us, and the American people!!! Check the record - you're a newsperson - check it!"

Back then, for almost 2 weeks, I spent pretty much every free moment from my job in NC trying to figure out what was best for my elderly parents in NY!

And while there may not have been any friendly navigators then - like there are now - but the other party wasn't trying to throw nitro-covered sand in the gears, either!!!