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Wednesday, October 26, 2016


“Discover the obvious,” Jonathan Cohn said on Monday.

Cohn is one of the nation’s foremost health care journalists and the keynote speaker of the journalism portion of “Hearsay or Fact: A Symposium on the Communication of the Affordable Care Act,” hosted by the Center for Healthcare Research and Transformation.

A senior editor at The New Republic and author of Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price, Cohn decided to use his time to give five rules about reporting on the Affordable Care Act (ACA). His first rule was an admission that people who follow the everyday tribulations related to Obamacare — like wonks in every field — often assume they don’t need to report on “the obvious” and thus fail to report on the issues that matter most to the public.

He pointed to the success of fellow panelist Stephen Brill’s Time magazine cover story “Bitter Pill: Why Medical Bills Are Killing Us” that illuminated the outrageous variation in medical prices and profits from one hospital and one patient to the next, a well-known fact to experts that came as a shock to many Americans.

What’s obvious to everyone about the debate over Obamacare is that the public is confused. Nearly two-thirds of Americans didn’t know in late September that the health care exchanges were opening on October 1 and 67 percent of the uninsured said “they don’t have enough information about the law to know how it will impact their families,” according to the Kaiser Health Tracking Poll. The uninsured, of course, make up this law’s key demographic. They are the people this law is designed to help most, and their participation in the health care marketplaces will determine if the law is a success.

Why are people so confused? Much of what should be “obvious” has become obscured — intentionally.

Democrats passed the ACA with only Democratic votes — and Joe Lieberman. Republicans have responded with an unprecedented effort to scare voters, starve implementation and sabotage the law, an effort that helped doom the launch of, which the White House has to own as a greater act of self-sabotage than anything Republicans could have pulled off themselves.

The political battle over the law has overwhelmed any pertinent policy discussion. So it’s no wonder that people can’t even agree on the basic premises that made health reform necessary and an improvement over the current system, with 56 percent of Americans saying they’ve heard more about the politics and the controversies of the law than any discussion of its practical impact.

Here are five “obvious” premises that every American needs to understand so we can begin to have a rational debate on health care reform.

Photo: BU Interactive News via Flickr

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Copyright 2013 The National Memo
  • nana4gj

    We should all agree that we all understand the goal of the ACA and the issues within our healthcare system that it seeks to address, which are, 1) to provide affordable access to health care for those who are not funded by health insurance or
    any other means, and for those who are under insured; 2 ) to achieve an outcome that reduces costs for health insurance, eventually, for everyone in the widened insurance pool, including the reduction of costs for non funded care, delivered with the most expensive resources in the most expensive settings, for the sickest, who will have less than ideal outcome.

    These costs are currently transferred to us by way of increased insurance premiums, resulting from hospitals attempting to defray the costs for non funded care through the negotiation of higher reimbursement rates from insurance companies, who then pass it on to us with higher premiums, resulting in an untenable vicious circle of escalating costs with not very good health outcomes and fewer people able to purchase or retain health insurance coverage plans, risking bankruptcy if they get sick. The ACA also contains many consumer protections that benefit everyone who relies on private health insurance, too numerous to mention here, but should be widely known by now.

    Medicare was born of the same need that Americans face today, the inability to purchase affordable, comprehensive care, instead of the scam and junk expensive policies, IF and when they were able to find a company to accept them. All Medicare products must conform to the federal mandates for coverage; they are the same, company to company, the only difference being in pricing. A company may offer more coverage, but not less. Many of the consumer protections in the ACA are the same as with Medicare, precisely because the federal government regulates the product, sales, advertising by private health insurance companies. They cannot sell us a junk policy with which to supplement or replace Medicare. They cannot pass off another plan to sell that is not identified as Medicare approved, or direct us to a site from which to purchase a plan that is not Medicare approved, or automatically replace our Medicare products with something that is not Medicare approved. They are trying to do this with ACA plans. They should know better how to partner with the government; they’ve done it for 1/2 a century already with Medicare. But, you give the private health insurance industry an inch and they try to take an arm.

    Republicans have pretty much discredited themselves as any kind of interested, concerned party, or of having any kind of expertise on the subject of healthcare, recently demonstrated in last week’s Congressional Hearings and in their willingness to shut down the government and threaten our national credit rating two weeks ago unless their publicly stated demand that the ACA be repealed or defunded was met.

    Their behaviors and words since healthcare reform debate began proves they are not credible partners. Now, because the website is not working, they think the entire program has failed.

    The insinuation made that the ACA has failed before it is actually implemented because the website is experiencing “failure to launch syndrome”, not so unusual an occurrence given the totality of the circumstances, is an expression of concern
    misplaced. The Medicare Part D Prescription Plan also experienced some failure to launch syndrome, but, worked well enough in spite of the built in shortcoming of that infamous “donut hole” and “gap period” during which there was no coverage whatsoever, while the nsured was required to continue making premium payments as well as 100% of drug costs. If we could live with that, until the “donut hole” and the
    “gap period” began to close by 50% with the ACA to date, and targeted for
    complete elimination by 2016, so many years after implementation of Part
    D, we can live with the potential shortcomings of the ACA until all politicians
    get serious and address the real and pressing needs of healthcare for the
    people of this country.

    Finally, they say charity will help those uninsured and underinsured. There is nothing to suggest or believe that reliance upon people and political parties who express disdain for those who cannot provide for themselves, insisting that charity will take care of these very same people, is something any one of us can trust as a “solution”, especially when existing “entitlements” of all kinds remain under
    constant threat of abolishment because those for whom they are intended are
    believed to be either “lazy” or otherwise unworthy, and when health care is
    believed to be a commodity instead of a Right for which every human being is

    • Allan Richardson

      When these people read “Gone with the Wind” and “A Christmas Carol” they read BACKWARDS to get what they consider a happy ending. The Union troops enslave the blacks and give them to plantation owners, and Scrooge learns the real meaning of Christmas is to cheat the poor, not help them.

      • nana4gj

        Oh, my…..exactly.

    • Dan045

      The ACA was passed with good intentions. Good intentions can’t even make a good website, and that’s the easiest part of this. Repealing the laws of math and economics will be the hard parts.