Live and Let Lie: Allowing healthcare reform to speak for itself



On November 7th, President Obama sat down with NBC’s Chuck Todd to discuss allegations that he misled the American people by repeatedly promising that Americans would be able to keep their health insurance plans under the Affordable Care Act:

I am sorry that [Americans who have lost their insurance plans] are finding themselves in this situation based on assurances they got from me.

The president’s tepid apology seems to suggest that Americans were just not listening hard enough when he explained how the Affordable Care Act would work in practice. Indeed, Obama told supporters at a D.C rally earlier in the week that his statements had been mischaracterized by his opponents:

What we said was you could keep it if it has not changed since the law was passed.

This claim, however, does not square with videos showing the president promising at least 29 times that, “If you like your health-care plan, you will be able to keep your health-care plan, period.”

The truth is the president lied. Since the implementation of the Affordable Care Act, insurers have discontinued plans for approximately 12 million Americans because those plans did not meet the Act’s new minimum coverage requirements. The harder question is whether the controversy surrounding the president’s lie has obscured the merits of the Affordable Care Act, or whether, as its opponents argue, the lie is endemic of a reform that does not work.

The New York Time’s editorial board has taken the former position. In an op-ed, the board argued that Americans who have had their old plans cancelled should be grateful:

Indeed, in all the furor, people forget how terrible many of the soon-to-be-abandoned policies were. Some had deductibles as high as $10,000 or $25,000 and required large co-pays after that, and some didn’t cover hospital care.

The article points out that, under the Act, insurers must provide new plans for those enrollees who have had their old plans cancelled, and argues that these new plans will have more benefits and capped deductibles that will save individuals who suffer catastrophic illness or injury more money in the long-run.

Perhaps they are right. Perhaps Americans should look past the website rollout fumbles and the president’s lie and evaluate the Act by looking at whether it is achieving its stated objectives: to provide more Americans with health insurance and to lower health care costs overall.

To the first point, more Americans are eligible for health insurance today than they were before the Affordable Care Act was implemented. Even factoring in the 24 states in which Republican governors have refused to accept Act funding for Medicaid expansion, at least 19 million more Americans are now eligible for health insurance through federal subsidies and the Act’s mandate to insurers to offer plans to persons with preexisting conditions.

To the second point, well, that is where it gets tricky. On an individual level, premiums will decrease for the elderly and chronically sick, but probably increase for younger, healthier patients. This makes sense. It costs more for providers to treat the elderly and sick, and so to decrease the premiums for those populations, the Act places them in insurance pools with healthier Americans, whose premiums go up. Thus, in the short term, higher prices for some might be necessary to achieve coverage for all. Even still, the Kaiser Family Foundation projected that most people will actually pay less next year, while receiving more comprehensive coverage.

The key point for the administration is not that the reform will decrease every individual’s premiums right away. Premiums and other healthcare costs were skyrocketing in America long before the reform was implemented, despite the fact that millions of Americans received substandard care. Even before reform exchanges opened, CNBC reported that “medical bills are the biggest cause of US bankruptcies.” The administration intended the reform to provide more coverage in the short-term and reduce prices in the long-term by implementing cost-savings measures. David Cutler, the Otto Eckstein Professor of Applied Economics at Harvard University, explains why the Affordable Care Act will likely decrease costs in the long-term:

The act has a number of provisions designed to reduce spending growth. These include the “Cadillac tax” on expensive health insurance plans and a transition of medical care payments away from fee-for-service payment into value-based payments. Economists are virtually united in asserting that a combination of these demand and supply-side levers are the way to get a handle on a wasteful system…

What is most clear is that the current health care system is failing families, businesses and government. The Affordable Care Act is the most serious effort ever made to address the myriad flaws in health care today. If it works as intended, the health of our economy- as well as our people- will be much improved.

The problem is that components of the law—- most publicly, the online exchange roll-out—- have not been working as intended. But, according to CNN, the website’s usability has improved and the number of enrollees is increasing slowly but steadily.

This brings us back to the implications of the president’s lie. As Jon Stewart on the Daily Show pointed out, the president’s lie pales in comparison to the lies his opponents have rolled out when discussing health reform. The Affordable Care Act does not institute death panels. It does not force Americans to choose between buying health insurance and going to jail. And it will not add “trillions” of dollars to the country’s deficit.

In the face of such lies, the president’s credibility is arguably more integral in making sure reform remains in place so Americans can realize its long-term benefits. Indeed, CBS News political director John Dickerson argued that the president was headed toward a “credibility death spiral” due to problems with the reforms rollout. He added that such snafus could endanger the program’s success by dissuading individuals from signing up and providing ammunition for opponents who would like to see the law repealed.

Surprisingly, however, support for the Affordable Care Act has actually increased since its implementation. A Gallup poll conducted weeks after the disastrous exchange opening showed that 45% of Americans approve of the law, up from 41% in August.

So does the president’s lie really matter? Perhaps the administration and its opponents’ lies have cancelled each other out. Maybe, with the healthcare site finally functioning, people are starting to let the reform speak for itself.


  1. Premiums are shrinking. But, deductibles are rising.

    Rising deductibles will influence many consumers to question healthcare pricing. As a result, medical providers will have to lower costs.

  2. Excellent idea, Mark. It looks like the Affordable Care Act is finally “settled” and maybe the country is willing to give it a chance before trying to dismantle it.

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