Politics & Policy

Poll-Driven Policy

What happened to Obama's old promises about health-care reform?

Revolutionary. There’s no word that more aptly describes the health reform that was just enacted. It will affect everyone. Every employee. Everyone on Medicare. Everyone on Medicaid. It will even affect those who choose to remain uninsured. It will give the federal government enormous control over a sector in which one out of every six dollars in our economy is spent. Once fully phased in, the ten-year costs will approach $2.5 trillion — and maybe more.

Given all that, does anyone find the way the president talks about health care these days a bit strange? Consider these fairly routine stump-speech phrases:

“Insurers will not be able to drop your coverage after you get sick.” True enough. But this practice has been illegal for the last decade and a half under a federal law called HIPAA.

“If you have a 26-year-old dependent child who can’t get health insurance elsewhere, you will be able to cover him on your own health plan.” Well, okay. But how many 26-year-olds can’t find insurance, and need to enroll in their parents’ plan? Not many, I gather. When the White House finds one, I’m sure they will trot him out for the television cameras.

“There will be no more lifetime caps on health-insurance benefits.” Good news, no doubt, for the one-hundredth of a percent of the population that bumps up against them.

“If you have a child or adopt a child, your insurer will not be able to exclude him because of a pre-existing condition.” Most states already require this. And it’s standard practice anyway.

“In four years, no insurer will be able to discriminate against anyone because of a pre-existing condition.” True enough. But more than 90 percent of everyone in the United States with health insurance already can’t be excluded because of pre-existing conditions (again, HIPAA requires employers to take everyone with minimal waiting periods). And of the other 10 percent, only a small fraction faces serious problems.

I could go on, but I think you get the picture. For the people who have the problems just described, the problems are real and sometimes tragic. But they represent a minute part of the overall set of problems Obamacare is designed to address.

The rhetoric the president is using these days is radically different from the rhetoric he used only a few months back in making the case for reform. Does anyone remember the president saying that 47 million people have inadequate access to care? Or, that for 300 million Americans, costs are too high? Or that quality is too low? What happened to all those problems?

I have a theory. Although the president says he doesn’t pay attention to public-opinion polls or focus groups, I think that is all he is paying attention to these days. I imagine the focus groups went something like this: “Okay, we know you all don’t like this big bill, but is there any part of it you do like? . . . Even a small sliver? . . . What about 26-year-olds? . . . Could we see a show of hands on that provision? . . . Okay! . . . We have a winner! . . . Tell the speech writers to put that up near the top, Joe.”

Also, I don’t think there is anything new about this strategy. Barack Obama’s approach to health care has always been poll-driven. During the Democratic party’s presidential primary, Obama (along with every other serious candidate) repeated the “universal coverage” mantra over and over again. Presumably, this is what the party’s base wanted to hear.

But after his primary victory, we never heard the words “universal coverage” again — at least not that I recall. Instead, “cost” and “quality” became the reasons for reform, because they appealed to general voters.

Today, however, the polls are clear. People do not believe that Obamacare will solve the problems of rising costs and inadequate quality. In fact, they believe it will make those problems worse.

People believe that Obamacare will cover some of the uninsured, but they recognize that doing so will strain the systems existing resources. On this score, the president faces another credibility problem. Where are the 32 million newly insured people going to get health care? The very reform that will spend several hundred billion dollars a year on health insurance spends not one dime to train new doctors and nurses or build even a single new hospital!

Obama is talking about “insurance reform” issues because this is the only area where he has any credibility left.

– John C. Goodman is the President, CEO, and Kellye Wright Fellow at the National Center for Policy Analysis.


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