A good idea, misleadingly sold

November 7, 2013
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There’s no way around it: President Obama wasn’t being honest when he kept saying that if you like your health insurance plan, you can keep it. He wasn’t just wrong; he knew he was wrong. He was overgeneralizing for the sake of the politics.

Yes, the reason people’s policies aren’t qualifying is that they’re kind of lousy policies. But that doesn’t get Obama off the hook for this. If the point was to eliminate cheap “train wreck” policies for healthy people who for whatever reason don’t have insurance through an employer, then its proponents should have said so and defended this on the merits.

Also not an excuse: the fact that the individual insurance market—where people are finding their policies being discontinued—is a small piece of the overall health-insurance pie. Its inadequacies are a big reason reform was needed; they’re also a big reason people with individual policies are worried about change. It’s not credible to dismiss all this as an outlier and suggest that Obamacare is actually about what it doesn’t do (overhaul the group insurance market) instead of what it does do (overhaul the individual insurance market).

In short, Obama was wrong to promise something he knew the law couldn’t deliver. And those of us who support the law were wrong not to be more attentive to this and call him on it at the time.

None of which is to say that Obamacare got the policy itself wrong here. It didn’t.

The Obamacare exchanges—the law’s centerpiece reform of the individual insurance market—are designed to improve quality of coverage and access to it, both major problems with the status quo. People are dangerously underinsured; others are denied coverage or priced out altogether. This is a moral problem, one Obamacare takes steps toward correcting. But doing this means that the cheap coverage offered to lower-risk people might get less cheap. That’s how insurance works: changes affect the group, not just individuals within it.

And as Ezra Klein put it, reform means changes. We could pass a law that actually does nothing that would make anyone’s current policy go away, but then the law wouldn’t do much of anything at all. Every health-insurance reform proposal, from either side of the aisle, has this disruptive effect. Obama’s at fault only for being dishonest about it.

The president sold the policy on terms Americans understand and appreciate all too well: what do I get? What will I lose? But insurance is by definition about the group, and higher costs somewhere within the group mean higher premiums elsewhere. There’s no real way around this—none, that is, short of removing health insurance from the realm of private enterprise, of profits and investors., and making it truly public. And we all know how Obamacare’s opponents feel about that idea, since they keep decrying it as if it were actually something that’s happening.

What the Obamacare exchanges do is tweak the individual market in the direction of the common good. People for whom the status quo isn’t that bad don’t always like this kind of thing. But it’s still the right thing to do.

And anyway, there are plenty of people who do like what the exchanges have to offer them as individuals. First, however, they have to find out what this is. The bungled healthcare.gov launch doesn’t help much here. But neither do the misleading letters insurers are sending—which among other things skip the crucial part about the subsidies Obamacare offers to help pay for better coverage—or the fact that the news media is falling down on the job.