Beverly Mann | December 16, 2013 9:40 pm



I’ve expected this for some time, and here it is: The Wall Street Journal reports that insurance companies are set to unleash hundreds of millions of dollars in advertising to entice potential customers on to the exchanges created by Obamacare. As the Journal puts it: Insurers … are capitalizing on an unprecedented opportunity in a shifting health-care market. Some seven million Americans are expected to buy health coverage on the new consumer exchanges, where people can compare insurance plans side by side. — Greg Sargent, Washington Post, this morning

Sargent goes on to say that these plans were long in the works but were delayed because of the dysfunction of the federal website. I assume that’s accurate, but elsewhere in Sargent’s column, in the form of two new polls are hints of why this project has taken on real urgency. One poll, by Pew, published today in USA Today, shows a dramatic drop in support for Obama and Obamacare among 18- to 29-year-olds, results similar to those in another recent poll. Undoubtedly, although this won’t occur to most pundits, this drop reflects fallout from the Snowden revelations and also anger at Obama’s less-than-progressive (and certainly less-than-energetic) agenda. But there also is this: Only 41% of members of this age group approve of “his signature health care policy, while 54% disapprove.”

But also there is this, from the other poll released this morning, taken for the Associated Press:

In the survey, nearly half of those with job-based or other private coverage say their policies will be changing next year – mostly for the worse. Nearly 4 in 5 (77 percent) blame the changes on the Affordable Care Act, even though the trend toward leaner coverage predates the law’s passage. Sixty-nine percent say their premiums will be going up, while 59 percent say annual deductibles or copayments are increasing.

Each time I read something of that sort I am struck momentarily by dismay that Obama has failed to tell the public, as often as is necessary to halt the effect of the disinformation, which as it happens is coming mainly from employers and … insurance companies. Something along the lines of: Gosh, folks, listening to these people, you’d almost think that your employee contributions, co-pays and deductibles had remained steady and fine until the fall of 2013. Maybe a few statistics would drive home the point.

But we are after all talking about Obama, not, say, a normal president. And Obama just doesn’t do refutations, much less refutations citing actual statistics.

But one of these days a genuine progressive who has been fighting in the congressional trenches for progressive legislation–Sherrod Brown, I hope, or maybe Jeff Merkley–will show signs of interest in running for president in 2016. And–who knows?–the press might even begin paying attention to what he (Elizabeth Warren is not going to run) says. And what he says will include specific refutations to employer and insurance company claims that Obamacare is to blame for what Obamacare is not to blame for. And then he’ll propose … the public option or even single-payer, leaving Obamacare in place until one of these now-quite-real options begins. And this time there will not be an absurdly long four-year delay before implementation.

I expect that the experience with Obamacare as sabotaged by Republican state legislators and governors and unremitting campaigns of disinformation, and by shortsighted insurance carriers engaged in their own campaign of deception and trickery toward their current premium holders, will make possible (in fact, likely) what was not possible when Obamacare was being drafted and negotiated.

Republicans and, almost certainly, nearly all mainstream pundits see the 2014 and 2016 political debate as between Obamacare repeal and Obamacare “fixes”. They don’t consider that the public will recognize a failure of Obamacare for what it is: a failure of “federalism” and, like the pre-Obamacare system, a failure also of the free market regarding healthcare. And they certainly don’t consider that many , many of the people who have turned against Obamacare now in large part because of the gamesmanship of employers and insurance companies–young people, and employees who’ve seen their employer-based insurance benefit deteriorate annually in key respects–are likely to elect candidates who propose to change the system dramatically, to add a public option or to convert the system to single-payer. They now know, after all, that the system really can be dramatically changed.

Employers would benefit from single-payer, if not from a public option, so they’re concerted scapegoating of Obamacare might serve their interest. But the insurance companies are drastically overplaying their hand. The Democrats have no competent spokesperson right now; that’s certainly true. But that is temporary; they likely soon will. Once this epiphany occurs to the insurance industry, they might start reining in their members in order to give Obamacare some chance to succeed. By then, though, it may well be too late, and the previously impossible will be on its way to fruition.

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UPDATE: In light of some of the comments to this post, I want to make clear that by single-payer I do not mean Medicare-for-all. Single-payer would be, in essence, “the public option” extended to everyone rather than limited to the 5% of people who have private healthcare insurance through the non-group (i.e., non-employer-provided) market. It is not tax-funded identical-for-all healthcare insurance, which is what Medicare is. I do think that eventually this country will have Medicare-for-all-type healthcare insurance, but not in the nearterm. If single-payer works well, then of course that would be the longterm solution, with no need for Medicare-for-all.

I also want to make a point, in light of EMichael’s comment, about federalism as it relates to Medicaid and, for that matter, any other federal social-safety-network program. Federalism has been a disaster for Obamacare, and the only reason it works under current pre-Obamacare Medicaid is that that program came into being and was effectuated before the hard-right turn of the Republican Party. The really weird but successful argument by rightwing governors and state attorneys general to the Supreme Court in the ACA litigation on the Medicaid-expansion provision in the ACA is that, well, y’know, now that traditional Medicaid has been a part of each state’s law for decades, and is popular, it would be politically impossible for state legislators to end that program–the result under the ACA as the statute was written, if a state refused to agree to the ACA Medicaid expansion. This, they argued–successfully!–meant that the ACA was effectively coercive of state legislators and therefore infringed upon state sovereignty. On that “ground,” the Supreme Court struck down that part of the Medicaid portion of the ACA.

That’s also known as the conservatives-having-their-cake-and-eating-it-to theory of constitutional law. The argument was so deeply hubristic that its actual success is stunning and outrageous. But I have no idea why anyone would think that federalism must be a part of a national healthcare insurance law. It does not.

As for whether or not the public will catch on that the main problems with the Obamacare-exchanges-and-private-policies part of the Act is a failure of the healthcare insurance market and of the healthcare market itself–a question that several commenters raised–well, that was what my post was about. Yes, the public will catch on, once the Dems have a smart, committed, knowledgeable and articulate spokesperson with a high enough national profile to educate them about it. I expect that that will happen fairly soon.