Wednesday, 19 March 2014

Did President Obama “Lie” When He Said “If You Like the Policy You Have, You Can Keep It”? Context Is Everything

How many times have you heard that the President of the United State “lied” to the American people when he said “If you like the policy you have, you can keep it?”  Even some liberals have swallowed this Republican talking point.

In December, Politifact, the Tampa Times Pulitzer-prize-winning online fact-checker, went so far as to name Obama’s  statement “the lie of the year.”

Since then, the story has generated headlines like this one: ““Reporter Asks Obama, “What’s It Like to Be Called Liar of the Year?” 

What most people don’t recall is that in 2008 m when President Obama first uttered those fateful words, Politifact—the very same fact-checking organization– graded his statement as “True.”

What is going on here?

It should come as no surprise that Obamacare’s opponents ripped the president’s original statement out of context. This was easy to do because so few people remember the third Obama/McCain debate that took place in Hempstead, New York, on Oct. 15, 2008.  During this debate then-Senator Obama uttered the words that would haunt him: “you can keep your plan.”  

A transcript of the debate reveals what he meant. In response to a question from the debate’s moderator, Obama laid out a thumbnail sketch of healthcare reform:  “Here’s what my plan does. If you have health insurance, then you don’t have to do anything. If you’ve got health insurance through your employer, you can keep your health insurance, keep your choice of doctor, keep your plan.”

Obama had said something similar in his second debate with McCain a week earlier, in Nashville Tennessee.  “If you’ve got health care already, and probably the majority of you do, then you can keep your plan if you are satisfied with it. You can keep your choice of doctor.”

Few remember that when Obama assured Americans that the Affordable Care Act would not interfere with the benefits they had, he was addressing “the majority” of insured Americans–people who worked for large companies that offered comprehensive coverage.  More than two-thirds of the American work-force is employed by firms with more than 100 workers, and at the time, 99% of large companies offered health benefits.  He was not talking to the 5% of Americans who purchased their own coverage in the individual market, or the 17% who were covered by a small firm. (Only 35% of the U.S. work-force is employed by small companies and less than half of those firms offer health insurance.)

In  2008 when Americans who had good health benefits at work heard the phrase “healthcare reform,” many worried that this would mean a “government takeover” that would eliminate their employer-sponsored plans. In short, they feared a single-payer system. Obama was trying to reassure them that this wouldn’t happen.

At the time, Politifact understood that this was the concern that Obama was addressing.  Here is what Politifact’s Angie Holan wrote in October of 2008:

“Obama is accurately describing his health care plan here. He advocates a program that seeks to build on the current system, rather than dismantling it and starting over. People who want to keep their current insurance should be able to do that under Obama’s plan. His description of his plan is accurate, and we rate his statement True.”

                                         ”You Can Keep Your Doctor”

 The next year, in a speech before a joint session of Congress, Obama elaborated on the theme: “If you are among the hundreds of millions of Americans who already have health insurance through your job . . .  nothing in this plan will require you or your employer to change the coverage or the doctor you have.”

Once again, Politifact commented on Obama’s pledge: “We concluded that nothing in Obama’s proposal proactively forced such changes, and the bill is clearly intended to leave much of the current health care system in place. So we rated the claim True.”

In other words, the Affordable Care Act would not force employers to narrow their provider networks.  But  as The New Republic’s Jon Cohn has pointed out, over the next five years (2008-2013), many  would decide to tighten those networks, in part because research revealed that employees and customers preferred lower premiums, even if that meant giving up pricey providers.  The ACA did not cause that change; it was happening before the legislation passed. 

In 2008, “like” was the operative word.

Obama knew that the vast majority of Americans who worked for a large company and had employer-based insurance were happy with it.  After all, even today, their employers pay an average of 75% of the premium for family coverage and 80% when insuring an individual.

By contrast, nearly one-third of employees at small firms who sign up for a family plan must pay more than half of the premium out of their own pockets. In the individual and small group markets, families also often face steep deductibles.  And because individuals and small business owners have little leverage when negotiating with insurers, benefits can be sketchy. A recent survey from the Center for Health Research and Transformation shows that 45% of those who had bought a policy in the individual market rated it “fair or poor”;  82% of those with employer sponsored coverage called it “excellent” or “good.”

Back in 2008, Obama, like everyone involved in health care reform, knew just how dysfunctional the individual market was. Consumer Reports described it, quite rightly, as “the wild West of insurance”:  

“Individual insurance is a nightmare for consumers: more costly than the equivalent job-based coverage, and for those in less-than-perfect health, unaffordable at best and unavailable at worst. Moreover, the lack of effective consumer protections in most states allows insurers to sell plans with ‘affordable’ premiums whose skimpy coverage can leave people who get very sick with the added burden of ruinous medical debt.” Indeed more than half of the plans sold in the individual market cover less than 60% of health care costs.

Customers might be “satisfied” with the price—but only, Consumer Reports warned, if they never got sick: “There’s no free lunch when it comes to insurance. . . . So if your insurance was a bargain, chances are good it doesn’t cover very much. . . .  If you don’t see a medical service specifically mentioned in the policy, assume it’s not covered. We reviewed policies that didn’t cover prescriptions and chemotherapy, but didn’t say so anywhere in the policy document—not even in the section labeled ‘What is not covered.’”

My guess is that it didn’t occur to Senator Obama that a great many Americans who had  “bare bones” insurance had never taken a close look at what the policy did and did not cover. They just knew that it was cheap. This is why they thought they “liked it”—until they tried to use it to cover a serious problem.

Most often, they didn’t keep the plan long enough to find out how skimpy it was. Pre-Obamacare carriers selling  policies in the small group and individual markets companies regularly hiked premiums and canceled policies. This is why only 17% of the individual market’s customers managed to hold onto a plan for more than two years.  In other words, even if the ACA had never passed, only a tiny number would have been able to “keep the  policy” they had in 2008.   This is something that those who blame Obamacare for “plans cancelled” in 2013 never mention.

 When I called  Angie Holan, who wrote both the 2008 and the 2013 reviews of President Obama’s promise she was candid: “When Politifact rates something “Lie of the Year,”  she explained, that doesn’t  mean it is the biggest whopper of the year: “It’s not the most inaccurate statement. It’s the one that has the biggest influence.”

Holan also pointed out that in her 2013 review she did not suggest that the president set out to deceive the public. Rather, she wrote that “boiling down the complicated health care law to a sound bite proved treacherous, even for its promoter-in-chief.” This is  true.

Over the years, President Obama let “You can keep your plan” became a one-liner. “Minnpost’s” Eric Black puts his finger on the problem: “It’s an oversimplification  . . . . I personally observe a very high bar before I call something a lie,” he adds. “The word is thrown around too easily.”

I agree: Obama didn’t lie. He over-simplified.

Nevertheless, when Obama turned his pledge into a sound-bite he made an enormous mistake.  It is all but impossible to sum up any part of the Affordable Care Act in one sentence without leaving out critical details. When you are talking about something as complicated as health care reform, it is inevitable that one-liners will mislead your audience.

Arguably, a sensible listener might have realized that the President of the United States could not guarantee that his insurer would never send him a notice telling him that his policy was no longer available.  (As noted, pre-Obamacare, carriers had been doing this on a regular basis, both in the individual and small group markets. ) Nor could the president force a doctor to stick with a patient’s insurance plan. Physicians frequently drop out of insurance networks, for a variety of reasons.

But when voters are listening to politicians, most don’t think about the one-liners –they just swallow them whole.

Roosevelt senior fellow Richard Krisch suggests that “the more accurate message would have been, ‘If you have good insurance and you like it, you can keep it.’”

But if Obama had qualified his statement as Krisch suggests ,that would have raised a question in a listener’s mind: “Exactly  what is “good” insurance”? The candidate would not  have had a chance to answer that question. This was a debate, and Tom Brokaw, the moderator was constantly reminding both Obama and McCain that they were exceeding their time limits.

Others have made different suggestions. On someone asks: “Why didn’t Obama just say: If you like your plan you can keep it if it conforms to the rules?

The website offers an answer: “Americans don’t do nuance.”

Very true.

Moreover, “if it conforms to the rules”  raises more questions: “What rules?”

An accurate response would require at least two paragraphs of explanation, describing “essential benefits,” caps on out of pocket spending, free preventive care, and the many other ACA regulations that prevent insurers from gouging patients.

The fact is that Americans have little tolerance for detailed explanation.  That is why they like the slogans that many conservatives favor brief and to the point, they fit on a bumper sticker.  Typically they are very clear– even if not true.  “Obama lied” is a good example of a Republican talking point. “Government takeover” is another catchy phrase.

Unfortunately, some liberals have suggested that healthcare reformers should follow their opponent’s example: “Frame the issue,” they say. “Make it punchy.”

But the truth is that such rhetoric functions like an ad:  it aims to “sell” a point of view.  It is not meant to provoke thought; it cuts off thought.  The ad-man wants just one response: “No question, I’ll buy it.”

Such rhetoric is not designed to educate. It aims to obfuscate. This is what reform’s opponents need to do; their goal is to confuse the issue, and conceal the benefits of Obamcare. By contrast reformers have little to hide: their goal should be to explain the full truth about the Affordable Care Act– even though that means asking their audience to pause, listen and think.

Bill Clinton is the one politician I can think of who knows how to hold an audience’s attention while delving into wonkish details.  He  insists that they pay attention:  ”Listen to me now . . . [pause ].”  Or “This is important. . .” [pause]–yet avoids sounding like a college professor.  Relaxed and disarming, he’s not delivering a “speech”; he’s talking to his audience.

David Kusnet, Clinton’s  chief speech-writer from 1992 to 1994 explains: “By improvising so often, and using so few freeze-dried and focus-grouped applause lines, Clinton continues to keep his speeches fresh, friendly and factual in the hope that his listeners will open their minds to what he says.”

Exactly. Clinton opens minds; he persuades an audience to think

President Obama got into trouble because he turned his own message onto one of those applause lines — a  “meme,” that would “go viral” on the Internet.

                                         Obama’s Mea Culpa

If the president did not lie, you might wonder, then why did he apologize for misleading the public?

In fact, Obama did not apologize.  Granted, when NBC interviewed the president on Nov. 7 the network headlined the piece:  “Obama personally apologizes for Americans losing health coverage.” 

But as is so often the case, the headline wasn’t  true. Take a look at what the president actually said:

We weren’t as clear as we needed to be in terms of the changes that were taking place, and I want to do everything we can to make sure that people are finding themselves in a good position, a better position than they were before this law happened. And I am sorry that they are finding themselves in this situation based on assurances they got from me.”

The president is not saying that he promised the American people that they could keep policies that didn’t meet the Affordable Care Act’s standards for affordable protection.. He is saying that his wording wasn’t clear enough, and as a result, many Americans were blindsided when they received letters from their insurers. He is sorry for that.

Writing about the “mea culpa” the Washington Post’s Sarah Kliff makes an important point : “What Obama isn’t offering is an apology for the cancellation notices themselves. Eliminating certain health plans from the market — ones that the White House thinks are too skimpy — is a feature, not a bug, of the Affordable Care Act. ”    The idea was to make insurance coverage more robust — and that means cancelling policies that offer less thorough coverage.”

“There are lots of insurance policies, especially on the individual market, that are really bare bones. Some argue they shouldn’t even be called insurance coverage, because their coverage is too sparse to insure against financial ruin. The whole idea of the insurance expansion isn’t to get Americans to purchase anything called ‘insurance,’” Kliff adds. “ It’s to get them to purchase a specific kind of insurance, a plan that is relatively comprehensive and helps protect against financial ruin. If Americans were going to be required to buy a product, the reasoning goes, it should be one that can actually do some good.” .

In the NBC interview Obama goes on to try to  reassure his listeners that the majority of customers will be able to get better coverage—for less– in the Exchanges: “Keep in mind that most of the folks . . . who got these . . .  cancellation letters, they’ll be able to get better care at the same cost or cheaper in these new marketplaces. Because they’ll have more choice [and there will be] more competition. So– the majority of folks will end up being better off.”

“Of course, because the website’s not working right, they don’t necessarily know it right [now]” Obama acknowledges.  .  . “And it’s scary to them. And I am sorry that they– you know, are finding themselves in this situation, based on assurances they got from me. We’ve got to work hard to make sure that– they know– we hear ‘em and that we’re going to do everything we can– to deal with folks who find themselves– in a tough position as a consequence of this.”

Here, the president’s sympathy is real. He is truly sorry that many Americans feel that they have been left in limbo. The have lost the policies they had, and don’t know whether they will be able to afford the insurance the Exchanges offer. President Obama understands that they feel betrayed

If only the websites had been functioning properly, people who received a “Dear John” letter from their insurer would have been able to look for a new policy right away. It was the uncertainty that left so many both anxious and angry. And the media stoked their fears.

In his interview, President Obama does not say he is sorry that sub-par policies are being discontinued. He realizes that the majority who received the cancellation notices will be able to purchase better coverage for less in the Exchanges. (This would turn out to be true. We now know that, as of the end of December, 79% of the 3 million Americans who had enrolled in the Exchanges qualified for government subsidies. In addition, a new PwC Health Research Institute study reveals that, even before applying the subsidies, Exchange premiums have turned out be lower than premiums for comparable employer-based insurance. 

The president ends the interview with a heart-felt mea culpa: “I am deeply frustrated about how this website has not worked over the first couple of weeks. And, you know, I take responsibility for that.” Obama makes no bones about it: “The American people have been burned by– a website that has been dysfunctional.”

And he confesses that he should have done a better job of overseeing the project:  “If we had to do it all over again, that there would have been a whole lot more questions that were asked, in terms of how this thing is working.”

Here, Obama “owns” his mistake: “Ultimately, the buck stops with me. You know, I’m the president. This is my team. If it’s not working, it’s my job to get it fixed.”

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