Patterico's Pontifications

9/2/2009

Is ObamaCare’s problem the brand instead of the plan?

Filed under: General — Karl @ 8:24 am

[Posted by Karl]

The Democrats’ attempted takeover of the US healthcare system continues a long, hard slog. The House leadership will try to recover from a brutal August recess with reassurances to moderates that the so-called “public option” is something way down the road, “something that would go into effect in 2013, only after benchmarks and pilot programs are studied.” On the other side of the Hill, Sen. Grassley claims that a bipartisan panel of key Senators have concluded that the “public option” has to go. That hasn’t stopped liberals from salivating over the notion that reconciliation would force Democrats to pursue the most heavy-handed version of the public option, despite Pres. Obama’s desire that reconciliation be a last resort.

Next week, Pres. Obama plans to list specific goals that any health insurance reform plan that arrives at his desk must achieve. He is also suggesting he is willing to stare down the progressive caucus if jettioning the government-run insurance plan will get him a bill. But Pres. Obama has talked about his preferences on “pay for” mechanisms and his ambivalence about the “public option” before, so this too may be more an attempt to calm Congress than real news.

Greg Sargent probably hopes that Pres. Obama’s latest attempt at selling healthcare reform will clear up the confusion people told CBS News they have on the issue. But Sargent has a larger, more interesting point:

This could be ominous not just for the prospects of good health care reform but also for Obama’s broader agenda: The new CBS News poll’s internals show confidence dropping fast in the idea that government can be an effective provider of health care coverage.

That’s problematic. It raises the question of whether the broader, renewed faith the public had in government when Obama took over is receding, perhaps dramatically.

Asked whether “government” or “private insurers” could do a better job of providing health care coverage, only 36% chose government — down a surprising 14 points from June.

Meanwhile, nearly half, or 47%, said government would do a worse job — up 13 points from June. Both of those are pretty big swings.

Allahpundit also touches on this point:

The fascinating, and potentially important, detail: When asked about specific provisions of ObamaCare — i.e. the public option, statutory ceilings on premiums, guaranteeing insurance irrespective of preexisting conditions, etc. — people are widely supportive. I don’t know how to explain that except to think that (a) public ignorance about the plan really is as bad as CBS claims, which doesn’t say much for The One’s vaunted communications skills, or (b) the country’s now reached such an anti-government fervor that they’re fatally suspicious of even those programs whose particulars they agree with in principle.

The poll numbers on the specifics can be misleading. For example, we know that support for the public option craters if you ask people to pay as little as $500 annually for it. And the polling on other health insurance reforms does not ask people about the individual mandate necessary to support them.

However, taking the poll numbers at face value, Sargent and Allahpundit raise an intriguing notion. The vast majority of the public — like the vast majority of Congress — have not read the bills pending on the Hill. Their opinions will necessarily be based on general impressions. Liberals no doubt think the public is confused or misled, even though the Democrats have unleashed a torrent of misinformation about their plans.

But the Democrats’ problem may be much deeper than that. The public has had just over seven months to judge the Obama administration and the Democrat-led Congress, and has been reminded of what the Democrats are about. They see the fantastically expensive stimulus package failed to stimulate the economy to date, and they are reminded of who the Democrats are. They hear Democrats gush with praise over the legislative record of the late Sen. Kennedy, and are reminded of who the Democrats are. They hear Pres. Obama try to reassure people by comparing the public option to the Post Office, and are reminded of who the Democrats are.

They are reminded of how government programs grow or die — and virtually never die. Bloggers like Rick Moran may think slippery slope arguments are unconvincing, but it is most people’s experience of government. Thus, they are inclined to believe that costs will not be controlled, that various provisions of the bills could well be Trojan Horses for worse things to come, and so on.

In short, the Democrats’ real problem may be their reputation as the party of big government. The GOP did not do well during the Bush administration, but the Democrats have made them look like pikers in short order. As Sargent’s fears, that problem would extend beyond ObamaCare — and be near-insoluble to boot.

–Karl

30 Responses to “Is ObamaCare’s problem the brand instead of the plan?”

  1. I agree wholeheartedly and have been saying similar things for months. Democrat plans always add up to new patronage jobs, plain and simple. If the Democrats think it’s important to grow a healthcare bureaucracy, then they only propose it at the expense of some other bureaucracy (like, the Education Department). If they want a kneecap-and-trade EPA job growth machine, they should find a way to cut federal job spending elsewhere in some other useless, counterproductive program that was some “last generation” fairy tale program, or just shut up, sit down and not propose the program at all. It’s simple: Spend less!

    MTF (17058c)

  2. It’s not just the Dem’s misinformation that’s dooming them per se, but their actual declarative statements regarding their true intentions. We have numerous instances of Congresspeople stating that the public option has to be enacted, despite the opposition among many of their own constituents, as well as clear intentions to gut the entire private insurance system/medical care in the process.

    They can’t obfuscate or deny what so many members have already flatly stated – and that’s what’s galling them, that citizens have the utter gall to actually stand up and oppose their plans publicly. This imperial POTUS and Congress will have a very short shelf life.

    Dmac (a93b13)

  3. BTW, I always thought the Hillary was remarkably tone – deaf on this things, but the current folks make her look like a real piker.

    Dmac (a93b13)

  4. “That’s problematic. It raises the question of whether the broader, renewed faith the public had in government when Obama took over is receding, perhaps dramatically.”

    Pay no attention to that $9 TRILLION deficit behind the curtain.

    If these guys are such GENIUSES, surely they can fix the deficit problem FIRST, and then cure whatever ails us after that.

    Travis Monitor (483b36)

  5. I don’t think people believe what the Democrats are saying about the bill. The left, as in Wash Monthly, thinks the Republicans are lying but, when you read what they say about the health reform, it’s obvious that they are telling two stories, one to the in-crowd and the other to the rubes who have to vote. I read Wash Monthly every day to see what their thought processes are like. Once in a while, like the other day, I can have a reasonable exchange with someone there but it usually deteriorates into another shouting session even if I stay cool. Here is an example.

    I posted a comment:

    You seem to miss the point but I’m sure you do get it. The HR3200 bill is a skeleton that will be filled in with thousands of regulations determining what the rules will be. There is simply no “there” there. The bill is not a program for health reform but a program for an enormous bureaucracy that will make rules voters will never get to vote on. That is why Republicans, if they know what is good for them, will oppose it.

    The public has lost trust in this administration and in Congress on this issue. That is why the legislation is an albatross now around the Democrats’ necks. They might ram something through but, the way this bill is structured, the taxes begin a couple of years before the health “reform.” The 2010 election will be determined largely on what the Democrats do now. If they ram something through, it will be repealed like catastrophic Coverage was repealed. Remember that one ?

    A wise course would be to start over but the left, as illustrated here, will not let them.

    Posted by: Mike K

    Unusually, one of the regulars responded in a civil tone.

    A wise course would be to start over but the left, as illustrated here, will not let them.

    Mike is right. If a modest bill with an insurance exchange that has a small public option to cover those presently uninsured is too much for the Republicans then the Democrats should go balls out and create a single-payer system that wipes out insurance companies and saves Americans craploads of money otherwise being wasted in bloated administrative costs, marketing expenditures, and profits for CEO’s.

    Mike has supported a single-payer system for years and has written about it on his blog. Mike, would you care to elaborate more on how we could design a single-payer system and gain Republican support, while convincing Americans of the wisdom of it?

    Posted by: trex

    The conversation continued, interrupted by the usual snarks but in a reasonable tone. Finally, though, we get to this:

    “Joe, you and I disagree on the desirability of the government setting all the rules.”

    That is what governments are for, to legislate and regulate. Private sectors do not create rules for themselves.

    The examples of what happened in Britain and Canada are utterly irrelevant. They had completely socialized health systems. No one is proposing that here. I’m afraid I have to ask: are you quite insane?

    “I don’t agree. That’s all.”

    That isn’t all. It’s not that you don’t agree, it’s that you lack a fundamental understanding of the proposals at hand, you are confusing basic concepts like government setting minimum performance standards for private health providers with systems in which private insurers didn’t even exist, and you’re even confused in general about the dynamics of reform and stumped that government must play a role — which it does in every system in the world!

    It’s sad to say, Mike, but you’ve really revealed your ignorance of this issue in this thread. I invited your opinion because I thought we might find agreement on this one issue. Instead I find you confused about the most basic concepts and facts.

    Just as a sad postscript to your disjointed ramblings here, southeast England is not “the only part of the UK with a positive GDP.” In fact, the GDP per capita there is not as high as it is in London, and although the area does well it has nothing to do with private health insurance and everything to do with infrastructure.

    London is in southeast England but he may not know that even though he is much, much more knowledgeable than I am. Ask him

    Health care in SE England is still a public health system with the ability to buy additional private insurance, something even more socialistic than the plan you’re opposing — and yet ironically it is one of the components through which the British have achieved a higher standard of living than the U.S. for the first time since the 19th century.

    Southeast England residents had a 30% rate of owning full coverage private health insurance the last time I checked. There are private hospitals there that have nothing to do with the NHS. I don’t think he knows that.

    You have it so backwards it’s not even funny. In point of fact, it’s depressing. If you’re the best that conservatives have to offer than they have nothing at all but screaming and distractions. You better hope that someone with even a rudimentary knowledge of the issues doesn’t show up at your talk or you’re going to be toast.

    Posted by: trex

    See ? There is no possibility of having a reasonable discussion with a lefty even if he sounds reasonable at first. Once you tell him that he has not convinced you of the merits of his case, he goes all stoner on you. You simply cannot have a discussion and agree to disagree. Even though I have had 40 years in medicine and a graduate degree from Dartmouth in health economics, I am ignorant and he knows all.

    We just have to defeat the Democrats plans and start over, maybe with a Republican majority or working majority.

    Mike K (2cf494)

  6. The problem for the Dems is that the public thinks Obamacare will negatively affect them in some way… and this fear isn’t based on the specifics but rather a feeling that the Dems are up to no good.

    The Dems can’t tailor their rebuttal around a single theme because there are a whole bunch of concerns, with some people focused on death panels and others on increased costs, waiting times, impact on the federal deficit, etc. A rule of advertising: you’re doomed if you try to convince the audience of more than one thing at a time.

    Of course, Obama could come out with a generic ‘trust us’… but does anybody think the public will accept that?

    steve sturm (369bc6)

  7. Mike K., you have the patience of Job. Unfortunately, the same fate in attempting to reason with the Left, you are being left to Satan’s torment by God 😉

    SPQR (8475fc)

  8. Partly it’s the Dem brand, but there is specific mistrust of Congressional leaders and especially Administration figures, particularly Obama himself.

    Once they demonstrated how stupid they think the public is, and how mendacious they are, the consequences were inevitable. Changing the packaging, promotion, etc. will get them nowhere, because few trust them to be honest now – and why should we? I would anticipate them to try to make the trojan horses and camel’s noses a bit more subtle, and their prevarications a bit less obvious, but I doubt they can overcome their own view of the public as doofuses.

    jodetoad (059c35)

  9. The problem is the general public approves of such things as “community rating” and forcing insurers to take all comers b/c the general public does not understand the costs that will create.

    The public intuitively understands that having gov’t run their healthcare will lead to less quality at a higher price.

    But, the public does not understand that regulating insurers even more than currently will lead to seriously increased premiums and/or less care.

    Instead, the public hears things like “the insurance companies shouldn’t be allowed to turn away someone who is sick” and say “that sounds nice.”

    Of course, that idea destroys the whole concept of insurance, as insurance, by definition is paying something now to reduce the risk of a future financially catastrophic occurence.

    Forcing an insurance company to take on someone who is already catasrophacly ill and pay for their medical care is not insuring against anything – it is forcing an insurance company to become everyone’s mommy and daddy and take care of them.

    Being able to purchase insurance when already sick is akin to me getting into a car wreck and then forcing Allstate to pay for the damage – even though I did not have Allstate insurnace when I had the wreck. They should not be able to turn me down because I had a wreck. How is that different than in healthcare?

    Same thing with community rating. People hear it and think “gee, that sounds nice.” However, it would drastically raise premiums on everyone.

    Again using the car insurance analogy, Instead of setting my car premium based on my driving history, my age, the kind of car I have, where I live, etc., the insurance company could only charge me the same as anyone else.

    In others words, if I had 2 dwi’s, 5 speeding tickets in 2 years, was 21, single, and drove a brand new corvette I would pay the same as a 45 year married father driving a 10-year-old sedan who had no tickets of any kind. What happens in such a situation is that the insurer has to raise premiums across the board, in effect charging me for the 18 year-old’s driving history.

    Community rating would do the same in health insurance. Everyone healthy’s rates would increase significantly to pay for the people who are currently ill and/or have questionable lifestyles / habits. I would pay the same premium as a gay male drug user who smokes 3 packs a day and has diabetes. Only his would be lower than it would normally be and mine would be higher. therefore, i would be subsidizing his lifestyle.

    That seems fair, doesn’t it?

    Monkeytoe (e66874)

  10. The public does indeed understand the care-killing effects of the various provisions of Obamacare. That’s why Palin’s evocation of “Death Panels” hit it big with voters; they understood instantly that a federal bureaucracy with control of payments to the medical provider will ultimately call the tune as to what care the voter will get. There will inevitably be instances where the voter wants and needs care won’t be able to buy it, because the provider either decides not to provide care for economic reasons related to the regulatory structure that governs the providers right to operate or is prohibited from delivering the needed care by regulatory fiat. Either way, the voter loses and it’s because of the government running the market.

    Lefties can bitch all they want that ObamaCare doesn’t have “Death Panels” written into the bill, but voters aren’t as stupid or as literal-minded as MSM pundits: they know that with the government spending the money instead of the voters, there will be big trouble.

    MTF (17058c)

  11. So the Barack Obama will give a speech about his dirty socialist health care scheme on the 9th, and he expects a finished bill on the 15th? What’s the hurry? Why is he in such a flustered dirty socialist womanish panic?

    Weirdo. Barack Obama needs to stop leering at our health care system like he wants a piece of it. It’s creepy.

    happyfeet (71f55e)

  12. The great and good Walter Williams has a relevant column today at townhall.com.

    Williams points out that, when it comes to estimating costs of new programs, the government does not have a particularly enviable track record.

    An exerpt:

    “At its start, in 1966, Medicare cost $3 billion. The House Ways and Means Committee, along with President Johnson, estimated that Medicare would cost an inflation-adjusted $12 billion by 1990. In 1990, Medicare topped $107 billion. That’s nine times Congress’ prediction. Today’s Medicare tab comes to $420 billion with no signs of leveling off. How much confidence can we have in any cost estimates by the White House or Congress?”

    The entire column can be found at http://townhall.com/columnists/WalterEWilliams/2009/09/02/washingtons_lies

    Bubba Maximus (456175)

  13. Good post.

    I think anyone with the slightest economic instinct realizes that we’ve lost a decades’ hard work and have no prospects to get started on recovery for 2-3 years. At that point inflation will be our breakfast.

    Not happy, Barry.

    gary gulrud (06aaa3)

  14. The problem is the general public approves of such things as “community rating” and forcing insurers to take all comers b/c the general public does not understand the costs that will create.

    At one time, community rating was OK. Those were the days when insurance was limited to insurable events and when most people had individual policies. Two trends changed that. One is the growth of prepaid care that was called insurance. The other was the growth of commercial insurance which went to employers and sold them policies that were cheaper because they covered big groups where the risks were averaged and employed people, as a group, are healthier than individuals. Once most workers got insurance through work, the individual policies had adverse selection. They were bought by less healthy people plus the whole prepaid care approach made insurance subject to all sorts of moral hazard.

    I watched this develop at the CMA over 20 years and sometimes wasted my breath telling them they would regret this someday. Doctors did a lot of this to themselves.

    I have tried to tell the lefties that doctors are dropping out of Medicare or refusing to take new patients because of red tape and low payment. They refuse to believe that a doctor would go to a pure cash market practice. It is a growing trend. Forcing everyone into a Medicare program and then wringing $500 billion out of it would accelerate this trend.

    Mike K (8df289)

  15. happyfeet asked:

    “So the Barack Obama will give a speech about his dirty socialist health care scheme on the 9th, and he expects a finished bill on the 15th? What’s the hurry?”

    Here’s why.

    When Bill Clinton gave his similar Save-the-Bill speech, his approval ratings shot up about ten points. For a week. Obama wants to take advantage of the jump in poll ratings to get a bill through the Senate.

    Pretty much any version of the bill will do, since Obama just has to get a bill into the reconciliation process to win, and there is a Senate bill that has been voted out already by five of six committees. He just needs the Baucus committee to finish, and then a bill can be moved on the floor. After it passes, the Senate bill moves to reconciliation with a Pelosi whipped House bill.

    Once it is in reconciliation the writing the real bill will start, as reconcilation representatives will be hand picked by Pelosi and Reid, and all that will stand between the president and the reality of an Obamacare monstrosity will then be “persuading” the Senate Parliamentarian to “do the right thing”. All before his anticipated post-speech bounce withers away.

    MTF (17058c)

  16. You know what really chaps my arse about these people? It says that implementation will not be until 2013. If it is a crisis, implementation should be in 2009, 2010 at the latest. But it isn’t a crisis. It is a political power play. They don’t want to risk the likelihood that passage of this will unsettle people and markets, and will have the potential to kick them in the teeth at the ballot box in 2010 and 2012. So, they take the cowardly way out, passing vague language to get it into conference where they can work outside of the pubic eye, and are f*cking so cowardly and craven that they will leave implementation until after Teh One has had a chance to stand for re-election. Plus, that will delay the implementation to the point where when it really starts kicking people in the teeth, Barcky will have finished his second term. They are cowards. /rant

    JD (0c1fee)

  17. I find it hard to believe that anyone who even has an ounce of honesty could claim that anything in the bill is “deficit neutral”.

    Monkeytoe (031d74)

  18. MTF — but the bump was fleeting and din’t last … The bill never passed. I doubt Obama doesn’t get the bump — Trust is not a renewable resource, and Obama has lost a lot with the lies he told in his townhalls.

    I just don’t think that many people see giving the ‘post office employees’ control over their living and dying is too well received even by the dumbest amongst us.

    The only ones it appeals to is the freebie crowd.

    Government run healthcare sucks on many accounts. All you have to do is look at what is going on in other countries.

    bill-tb (365bd9)

  19. “Is ObamaCare’s problem the brand instead of the plan?”

    Given how well people know the plan….

    imdw (603c39)

  20. MTF that’s a good point but I still think that for that kind of gambit to be successful Barack Obama would need the committed cooperation of an almost slavish dirty socialist media – like on the level of a NPR or Newsweek or CNN or CBS or… oh.

    Our little country is sorta screwed, huh?

    happyfeet (71f55e)

  21. What is really funny, in a sad way, is an article by David Brooks ands another Obama supporter in the NY Times today in which Brooks recommends a long article in the Atlantic Monthly that confirms to him that US health care is broken. I really doubt he read the article, certainly not to the end. The author, a businessman whose father died in a hospital after 5 weeks of ICU care, has written an article that I almost 100% agree with. I did a long post on my blog going through it point by point. What is sad and funny is that it refutes the entire Obama approach and yet these Obamabots are recommending it.

    Mike K (8df289)

  22. “The problem is the general public approves of such things as “community rating” and forcing insurers to take all comers b/c the general public does not understand the costs that will create.”

    You can point to examples of states such as New York, Massachusetts and Maine and compare insurance rates to neighboring states to get a sense of what guaranteed issue and community rating will do to prices, but of course the left wants to avoid those discussions at all costs.

    The new bogus health care bankruptcy studies seem to be the latest lefty talking point. If Warren Buffet filed for bankruptcy tomorrow with a $5,000 hospital bill still unpaid, he would be considered a medical bankruptcy. The methodology of this latest study is just as good as the last one. I think they were working with the people who put together the studies on Iraqi casualties for the Lancet.

    daleyrocks (718861)

  23. It is absolutely the brand and the brand is the government. I know people like to pretend that the country just got theirselves into an uproar over this healthcare plan but the anger has been building since the first “stimulus” last March. It grew ever louder with Bush’s 700B “bailout” of banks and then grew into a crescendo with the 787B in February. This is just the first time the media and blogs as a whole have given the ANGER and DISTRUST the attention it deserves.

    Jaded (2dcf17)

  24. Obama should have tackled heath care first, before he demonstrated to anyone paying attention that he is an irresponsible lying spendthrift.

    Rick Moran is a terrific signpost. I’ve yet to see anything written by him with which I agree. And I’m a conservative.

    Terry Gain (f3f8a5)

  25. Would it not be simpler just to impose price controls on health care to make it cheaper?

    Michael Ejercito (833607)

  26. “Would it not be simpler just to impose price controls on health care to make it cheaper?”

    Michael – Absolutely. Price controls are always a wonderful solution!!!!11ty!!!

    daleyrocks (718861)

  27. bill-tb said (and happyfeet also mentioned), that when Clinton gave his speech, the polls did change but not for long:

    “the bump was fleeting and din’t last … The bill never passed.”

    Nate Silver’s post talks a lot about the difference in timing between the two speeches, and mentions that Clinton both gave his speech and produced his desired bill much earlier in the legislative process than Obama has done. As Nate points out, coming in now, when the Senate is worn down, might well prove to be a strategic advantage for Obama since they might be in a mood to grasp at any semi-workable solution. Today, for example, comes news that the White House has been in intensive negotiations with Olympia Snowe on a phased approach bill. Obama will give his speech, and then the “bi-partisan” bill will be introduced to great fanfare. They are so close to winning already in the Senate that this latest campaign might be enough to put them over the top.

    The bill they are working on (conspiring?) still federalizes the entire process, it still builds an enormous administrative mandate and bureacracy, it still removes decision making from the individual, it still hands over control of your health and welfare to the post office, but it has a fig leaf phased approach built in (to give the market “a chance to correct itself”!!), allowing the president to appear moderate and bi-partisan.

    This speech can succeed. President Obama can succeed, especially since he’s working on an accelerated timetable. In fact, he probably will succeed at getting a bill. Congressional Republicans haven’t been our friends to the extant they need to be, and haven’t yet produced a workable coalition to fully defeat the evil monstrosity. It’s only the uproar from the people so far that has been able to keep this thing from already becoming an established fact. We are in a fight for our country’s future, and Obama hasn’t yet backed down, and the GOP hasn’t pulled their weight. Yet.

    Hey Boehner! Get in the fight! Hey McConnell, you’re in, but you have to get others. Come on Pawlenty, Romney, Palin, and everyone else interested in the preisdency. Start cranking it up. Get in front of the people, not behind them.

    MTF (17058c)

  28. Michael – Absolutely. Price controls are always a wonderful solution!!!!11ty!!!

    I heard that there might be side effects.

    Michael Ejercito (833607)

  29. Is Obama Retreating on the Public Option?…

    If so, it’s a pretty big victory for the people, but I don’t want to get my hopes up just to find it’s another head fake. However, it looks like an attempt at triangulation is afoot.
    Obama is considering detailing his health-care dem…

    Stop The ACLU (dae8af)


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