What did people think when they heard President Obama say that no one would have to give up their current health care arrangements if they preferred to keep them? This is not to excuse Obama, but anyone who knew anything at all about the two-year-long debate about health care reform should have known that what he said wasn’t true. This applies especially to the pundits and Republican politicians who now react with such horror and mock surprise.
The very heart of Obamacare—the point that was debated nightly through the 2012 election, was the “individual mandate.” Republican candidate Mitt Romney claimed to be so horrified by it that he would refuse to carry it out and would devote “day one” of his administration to starting the process of repeal. The fact that he had initiated something similar as governor of Massachusetts added to the fun.
If you’re going to require everyone to purchase health insurance, you’ve got to define what you mean by “health insurance.” In particular, you’ve got to have minimum standards. Obamacare, for example, forbids lifetime ceilings on how much your insurance company must pay out. This was no secret. Did people think they could get this added benefit for free? I’m afraid Obama encouraged them to think so. And Americans’ willingness to believe that they can get something for nothing remains the bane of our politics.
The Obama position was that if your insurance can run out just when you need it the most, it’s not insurance. You can argue the rights and wrongs of this, but it is inevitable that an insurance policy offering no lifetime ceiling will cost more that one that does have a lifetime ceiling. Ditto the other requirements in the reform law.
Presumably, no one would object to signing a new insurance policy that preserved all current benefits at a lower cost, or one that added benefits at the same cost. Most of the people who now claim to feel lied to are being asked to pay more for more benefits. This may include some they’ll never use (such as pregnancy services for people past middle age), but for most whose policies have been cancelled, what they’re offered instead is probably a superior product. That still leaves Obama telling an untruth—he said everyone could have the same policy if they wanted. In most cases, why they should want the same policy is a mystery.
Well, it’s not entirely mysterious. We’ve been here before. What killed Hillarycare—Bill Clinton’s 1994 health care reform plan, written by a commission led by his wife—was a drumbeat of accusations that if Hillarycare became law, you would not be able to keep your own doctor. This was true, in a way, but highly misleading. In fact, it was the beginning of the era of HMOs and PPOs—organizations that negotiated with health care providers on your behalf, to get a better price. But to make this work, you had to see a doctor on the list. HMOs and PPOs have evolved. Now you usually can see an “out of network” doctor if you want, but you have to pay more for it.
Whether it’s “you can keep your own doctor” or “you can keep your own insurance policy,” Hillarycare faltered and Obamacare is faltering because people are dishonest to themselves about change. They say they want it—they express outrage that they don’t have it—but when they’re threatened with it, they curl up into a ball and tell it to go away. They don’t want things to stay vaguely the same, and maybe a little better—which is what Obama probably thought he was saying. They want everything exactly the same.
That is impossible, and Obama was foolish as well as mendacious to promise it. Health care policy, like every policy, is a question of trade-offs. More of this means less of that. Include this benefit and pay for it, or don’t include it and save some money. If Obamacare survives this latest battle in the endless war over health care, the next battle will be over “pre-existing conditions.” Under the new law, insurance companies are supposed to smile and insure anyone who walks in the door—or is wheeled in—for the same price as if he or she jogged the ten miles from home and then loped up fifteen flights to the insurance office. I’m telling you now it cannot work, so don’t act shocked, shocked when it doesn’t.