Friday, November 1, 2013

Would You Buy a Used Health Care System from This Man?

I'm still seeing rebuttals of the complaints about the Affordable Care Act, and I'm disturbed by the kinds of arguments they're using.  This is a paraphrase, but I think it accurately represents the gist of what I'm seeing.
A: The President said I could keep the health insurance policy I already have if I want to, but I just got a letter canceling it.  I'll have to pay a lot more for a replacement.
B: But your policy was crap insurance, so you shouldn't want to keep it.  The President is offering you something better, something you'll like much more, even if it costs you a little extra; but it will probably cost you less.
Notice that I'm not saying anything about the accuracy of certain claims here, either that A will have to pay more for a new policy, or B's assertion that the new policy won't cost much more, or will cost even less.  Those are important questions, to be sure.  It's hard to know what to make of the anecdotes the corporate media are pushing about people who say their individual policies have been canceled and the only policies they can find to replace them will cost much more.  As I wrote yesterday, some of those stories have been debunked, even by right-wing Fox News.  It'll take time to find out how true and representative these stories are, just as it will take time to evaluate the claims of Obama's apologists that people whose policies are canceled will be able to replace them for less, or for not much more money.

Meanwhile, though, I think it can fairly be said that B's rebuttal is a crooked salesman's defense: you don't really want what I promised to sell you, and what I'm substituting is much better, for only a little more than I said you would pay.  Even if it's true that the substituted product is better, and costs the same or less or only a little more than what the customer ordered, it's not what the customer ordered.  And that matters.

For those who want to know, this is not about me.  I'm on a group insurance plan through my former employer, and so far it appears that my policy hasn't been canceled.  In this post I'm evaluating claims other people are making about their situations.  I'm skeptical of the stories people are making about their options now that their policies have been canceled, but the fact remains that Obama lied when he said they'd be able to keep their policies.  The answers he and his apologists are giving to these complaints are dishonest, since they dodge the main issue.  And I doubt that they really know what kinds of experience people are mostly having on the exchanges, any more than I do.

Today Roy Edroso wrote an imagined and hopefully satirical version of the complaints of those who have had their policies canceled.  It's easy to dismiss the ignorance and frequent stupidity of the Republican base (as opposed to the elites who are our government's real base), but as I've argued before, the fact that the Republicans are stupid doesn't mean Democrats and especially Obama apologists like Edroso are smart.  Obama supporters are just as determined not to face reality about their guy as Republicans are about their side, just as prone to misrepresent Obama's critics from the left as the Right is to misrepresent Obama.  When Edroso dishonestly attacked Glenn Greenwald for pointing out that Ron Paul was right about a few things, he got his ass handed back to him on a platter, and could only whine that it was unfair that Greenwald was right, but only Edroso's own partisan blinders made him misread him.  But that was long ago, almost two years!  And Edroso continues to work his own side of the street, finding and delineating and giggling at the Stoopid of the American Right. Which is just fine -- it just shouldn't be mistaken for a serious discussion of the American political scene.

Something else emerges again in Edroso's post and the comments below it: the contempt for the Opponent.  Now, suppose that what I think (no less than Edroso and the ACA's other defenders) is true, that the people who've come forward to complain about Obamacare are stupid and lazy, and that if they really looked on their state exchanges they could find policies as good as or better than the ones that were canceled, without having to pay (very much more).  I wouldn't take this for granted, because of course what Obama and his posse say should not be taken as true, simply because they said it.  But again, suppose this time they're right.  Since we're talking about people who have individual policies and who therefore must have done some shopping to get them, they should be capable of watching out for their own interests to replace them.  (Not least because they tend to present themselves as canny, self-reliant individuals who don't need government handouts aside from the many government handouts they do get.)  But the same is going to be at least as true of the uninsured who'll be shopping on those same exchanges.  The Republicans dismiss the uninsured as stupid, feckless, lazy parasites who think that the world owes them a living; the Democrats dismiss those whose policies have been canceled as stupid, lazy, bigoted assholes who want the country run to suit them and only them.  Even if both sides are correct, access to health care should not be dependent on a person's intelligence.  Especially if, as the ACA defenders like to claim, health care is a human right.  That means that even people they (or I) don't respect have that same right.  If the Right are daunted by the complexity of the ACA website and the exchanges, surely so are the uninsured.  The process of signing up must be made as easy as possible for both groups.

Here's an analogy: I often help friends of mine with problems they have with Facebook and their e-mail, which they mostly access on their smartphones.  Usually I helped them set up those accounts to start with, so when they have trouble they tell me that they've been locked out of Facebook, they don't know why.  So I sit down with them and ask them to show me what happens when they try to log in.  Every time it turns out to be something trivial: they have tried to log in with the wrong e-mail account, or the wrong password, or they've gotten one character wrong in their password, or tried to write their e-mail address with spaces instead of periods between the names, and so on.  They haven't been blocked by Facebook at all; they just have trouble with the pickiness of computer systems.  Are they stupid?  No.  (The computers are.)  Ignorant?  Yes.  Am I a genius?  No.  I just have lots more experience with computers than they do.  So I get them sorted out -- until the next time.

The same is going to be true of people who are having trouble, for whatever reason, with the ACA.  It's likely that the software they had to navigate when they first got their policies was different than what they must deal with now, even if it were to get the same policies they've lost. The kind of people who are deriding them online are somewhat more computer-savvy, more at ease with filling out forms either virtual or paper, and so on.  But all that has to be taken into account when designing websites for services like this.  It can't be designed solely for smart, literate, computer-facile intellectuals and tech geeks; it has be designed for the doofuses, because doofuses are people too, whether they're poor uninsured Democrats or well-to-do Tea Party Republicans.  Is it really necessary to say that?  Evidently it is, and that's why I find most dispiriting about American political discourse today, even or especially by people who are nominally on my side.  Even if they are smarter than what they like to call the Reichtards and Rethugs, they're not as smart as they like to think.

P.S. I should admit that I'm feeling some personal anger, or at least pique, about all this.  I was one of the people who assured others that they would be able to keep their present policies under the ACA.  One of the others I assured was one of the people I mentioned above, who got a cancellation letter. As far as their original concerns went, I was half right: they believed that everybody would lose their existing policies and have to submit to Obama's brute will.  (Rather like those people who believe that when same-sex marriage is legal, all heterosexual marriages will be dissolved and everybody will have to gay-marry.)  It looks like people like me, on group policies, who constitute 80 percent of the American insured, will get to keep the insurance we already have.

But I've noticed some dissembling with the numbers by ACA defenders now, when they dismiss the complaints about canceled policies.  I've seen some saying that only about 5% of the population will face cancellations.  But when you consider that the people most affected by cancellations appear to be people with individual policies, who constitute about 14% of the population, you're talking about a plurality or even a majority of that group.  And in a country with 300 million people, 5 or 10 percent of the population is 15 to 30 million people -- not a negligible number.  Ironically, Atlantic writer Garance Franke-Ruta posted a piece today about the "squeaky-wheel problem in Obamacare coverage":
It's all well and good to argue that only a small fraction of Americans will see premium increases in the individual market, but most of those who are seeing them—and who also are subsidy-ineligible under Obamacare—are from the middle to upper-income part of the middle class. More than 40 percent of people in the individual market are there because they are self-employed or running a small business. They're entrepreneurial and independent-spirited by nature, and when they squeak, they make a lot of noise.

By contrast, I'll be shocked if we see nearly as much attention devoted to the personal stories of the tens of thousands of low-income people now getting insurance through Obamacare's Medicaid expansion. Instead, we get experts tut-tutting over whether the planned expansion that's intended to cover an additional 9 million near-poor people over the next year is going to be a burden on the states.
She has a point here.  I agree, the corporate media will be much less interested in stories about the low-income people getting insurance than in petit bourgeois white Republicans whose individual policies are canceled. They also aren't very interested in "those who are being denied Medicaid coverage because they happen to live in states where officials have decided not to participate in the expansion."  It's like predicting that the sun will rise tomorrow.  But all those stories should be told.  The irony is that Franke-Ruta was a member of the AIDS activist group ACT-UP, who knew a lot about squeaky wheels getting the oil.  (You can see her in the great documentary How to Survive a Plague.)  Since then she's become a fairly shameless Obamabot, whom I read mainly for her representation of that position.  The number of Americans with HIV/AIDS in the late Eighties and early Nineties was even smaller than those who will be affected by the cancellation of their individual policies, but they didn't think that meant their problems were of no consequence -- very much the opposite.  And while the right-wing Republicans are easy to despise (I, too, dislike them), they are still people and they have a right to make noise when their interests are affected, no less than poor uninsured people do.

That's the thing about government.  I can't remember who said that you have to remember that every person sees him or herself as the center of the universe, with interests that matter to him or her more than anyone else.  No one is dispensable to him or herself.  If a government ignores the interests of enough people, it will lose its legitimacy, and our government has been doing just that for the past several decades.  In a matter like health care, you can't take away from one group while giving to another: rather you must add the other group, so that the number of people protected increases.  I feel the same impulse to dismiss the worries of the aging white Right that so many liberals do, but even leaving ordinary basic humanity out of it, dismissing them is bad politics.  We've had enough bad politics, haven't we?