Obama's Spin on Health Insurance Misses Key Points

Greg A. Hood, MD

Disclosures

March 14, 2014

In This Article

Is the President's Solution Realistic?

Continuing to accentuate the positive, the President promoted, "Healthcare costs overall are actually going up more slowly over the last 3 years than any time in the last 50." This assertion is supported by the Kaiser Family Foundation, with a caveat: "On another health policy topic that has been in the news, while national data shows that health care cost growth has slowed down in recent years, a majority of the public perceives that the country's health costs have been going up faster than usual."[3]

The unfortunate reality is that the budgets drawn up in kitchens across this country do not have the luxury of "Washington math." Inside "the Beltway," a slower pace of increase has been counted as a decrease, as a savings, by a consecutive number of administrations. Everywhere else, an increase is an increase, and Americans are feeling the squeeze. When the President asks people to cut their cable bill in order to buy health insurance on the exchange, he doesn't seem to realize the numbers of patients that I see who are already dropping cable in order to heat their homes or put food on the table.

The President very correctly points out the effect on the uninitiated of signing up for a policy when he states, "If you ever actually try to buy health insurance with an agent by yourself, it's a complicated process, and it actually takes a lot longer than signing up on healthcare.gov."

It is also true that it takes a lot longer to design an automobile engine than to buy a car and turn the key. Most Americans, even most physicians, don't want to be in the healthcare paperwork business. Public opinion poll results about (and participation in) the enrollment process are likely to continue to lag badly until the interface and process -- to the point of completion -- are greatly improved.

Mandates, Rule of Law, and Exceptions

President Obama was asked, "What can you say to those people who believe that health insurance still isn't affordable, and they're concerned that if they don't purchase it, they'll have to pay a penalty?" With breaking news on the day of the interview that the individual mandate looks to have been effectively gutted, it no longer appears that penalties will be enforceable.[4] Touching unintentionally on this budding controversy, which began to ripple through the nation even as this interview was being conducted, the President spoke to the existence of exemptions to the law.

Given that the administration has, this month, (quietly) included a vague and potentially broad exemption to the individual mandate -- the same mandate that Republicans have/had (over)committed themselves to repealing -- it may be appropriate to recall the words of Thomas Paine, who said, "Government, even in its best state, is but a necessary evil." That this is another in a long line of changes by "executive action" to an existing law without action by Congress[5,6] may cause some to understandably question where the Constitutional lines delineating power and responsibility for lawmaking lie.

Even for those who remain ideologically untroubled by such maneuvering, the mathematics of making healthcare finance work without a sustainable enrollment should cause one to acknowledge the consequences of reality, if not reality itself. That this week's surrender of most of the individual mandate was performed voluntarily by the same administration that fought for its survival all the way through the Supreme Court should speak clearly to the power of political realities.

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