By Lambert Strether of Corrente.
More lies from Obama on ObamaCare? Film at 11! Naked Capitalism readers are already familiar with ObamaCare’s narrow networks, and how narrow networks restrict access to specialists for those thrown into ObamaCare’s shopping experience. Now it turns out that ObamaCare’s narrow networks apply specifically to cancer treatment, and that poor people with cancer will be less likely to be able to select policies that could save their lives. As we shall see, just because Obama’s Lies have grown more prolix and lawyerly doesn’t mean they’re any less Big.
“[OBAMA:] For the average person, many folks who don’t have health insurance initially, they’re going to have to make some choices. And they might end up having to switch doctors, in part because they’re saving money.”
Let’s parse out the words of our Insurance Salesman-in-Chief. (spoiler alert: The worst lies are #3 and #4.)
#1 “For the average person.” Averages are said, rightly, to mislead, as when Bill Gates walks into a bar and instantly raises the average income of everyone there. As we have pointed out in exhaustive detail, ObamaCare relentlessly creates second-class citizens, randomly, whether by income, employment, marital status, or jurisdiction. ObamaCare is a profoundly unjust program, and when Obama invokes the average, he conceals the injustice.
#2 “Who don’t have health insurance initially.” In fact, we don’t know how many people who’ve signed up for ObamaCare didn’t have health insurance ‘initially“; the numbers are soft.
#3 “They’re going to have to make some choices.” Trivially, yeah. That’s what the word “mandate” means. Obama’s verbiage conceals two issues, at least: First, as we’ll see below, the process “folks” (how I hate that Beltway locution) will use to make those choices lacks transparency and discriminates based on income.
#4 “In part because they’re saving money.” I bow in awe to the weasel wording of “in part.” Again, we’ll see more below, but NC readers will already have spotted that people may also have to switch doctors because of narrow networks, not just “saving money,” as Obama would have it.
Let’s break down lies #3 and #4 in more detail.
ObamaCare’s “Choices” Work Against The Poor
The ObamaCare marketplace is a neoliberal ideological construct (“because markets”); its vision of how life should be lived, and not a serious attempt at problem solving with public purpose in mind. (If it had been, the success of the Canadian single payer model in providing equal quality of care for much less money would be part of the discourse; it’s not.) As Corey Robin points out, neoliberals like Obama (“they’re going to have to make some choices”) see shopping as an unalloyed good:
In the neoliberal utopia, all of us are forced to spend an inordinate amount of time keeping track of each and every facet of our economic lives. That, in fact, is the openly declared goal: once we are made more cognizant of our money, where it comes from and where it goes, neoliberals believe we’ll be more responsible in spending and investing it. Of course, rich people have accountants, lawyers, personal assistants, and others to do this for them, so the argument doesn’t apply to them, but that’s another story for another day.
The dream is that we’d all have our gazillion individual accounts… and every day we’d check in to see how they’re doing, what needs attending to, what can be better invested elsewhere. It’s as if, in the neoliberal dream, we’re all retirees in Boca, with nothing better to do than to check in with our broker. … In real (or at least our preferred) life, we do have other, better things to do.
I’m one of those people who hates shopping and regards it as a tax on my time.
The issue, here, is that poor people are less able to pay ObamaCare’s tax on their time, and may end up with policies that are wrong for them, with lethal consequences:
For a new study released today in the Proceedings of the National Academy of Sciences, researchers asked 3,414 Americans a battery of questions about Obamacare. [T]hey also targeted a sub-set that could stand to benefit from the law: people who are eligible for Medicaid, the uninsured, or those who make between 100 and 400 percent of the poverty level and thus qualify for the subsidies to buy health insurance.
The results were bleak—just two-thirds of the overall respondents knew that they had to get health insurance this month or face a penalty. Just over half knew about the exchanges to buy health insurance through Healthcare.gov, and less than half knew there might be subsidies available to help them afford coverage.And less than a third knew about the finer points of the law, like the fact that plans must now offer certain required benefits or that people cannot be denied coverage because of pre-existing conditions.
“Clearly some of those most likely to be affected by the ACA were ill-prepared to navigate the new health insurance environment,” the researchers wrote.
Perversely, insured people and richer people had more knowledge about the ACA, and about how health insurance works in general, than did the uninsured. Knowledge about both the law and concepts such as premiums and deductibles increased with income.
Why would this be?
[Mollyann Brodie, a pollster for the Kaiser Family Foundation] points out that uninsured people are more likely to be poor, so they might be “working one or two jobs, trying to get their kids to school. They have complicated and stressful lives.” That, combined with negative news coverage, might explain the don’t-know-but-don’t-like phenomenon.
(Again, with single payer, as in Canada, ObamaCare’s “tax on time” wouldn’t exist, and the neo-liberals designing the program wouldn’t be making the assumption that every American has a personal accountant to wrangle their paperwork.) Quoting (once again) Wendell Potter on a real-life example of how Obama’s “tax on time” plays out:
And I also know that insurers benefit from the marketplace confusion that “choice and competition” can create. I can assure you that some insurers are counting on you becoming overwhelmed by all the choices and picking a plan that might appear at first glance to be a bargain. But beware: if you’re not careful and pick a plan without really kicking the tires, you very possibly will be buying something that could wind up costing you much more than you ever imagined if you get sick or injured.
That happened to my friend Donna Smith, who as executive director of the Health Care for All Colorado Foundation, knows more about health insurance than most of us. She spent quite a bit of time last fall on the Colorado exchange trying to figure out which plan would offer the best value for her and her husband. If she had to do it over again, she would have taken the additional step of calling the insurance companies directly after reviewing the plans they were offering on the exchange, just to be certain of what her out-of-pocket obligations would be if she had to be hospitalized during the year.
A cancer survivor, Donna knew there would be a chance she might get sick again and need expensive care [Rule #2]. It never occurred to her, though, that picking a gold or platinum level plan with a higher premium would likely have been better deal than the silver Kaiser Permanente plan she opted for and that seemed to be more affordable.
To make shopping for coverage even more challenging, Kaiser and most other insurers offer several silver plans on the Colorado exchange, so Donna had to spend time trying to figure out which silver plan would be the best deal.
Donna told me the she took the time to compare the monthly premiums, co-pays and annual deductibles of each of the silver plans before making her decision. “I felt that the one I chose offered the most coverage I could afford with my premium buying dollar,” she said.
Sure enough, within days after the plan went into effect on January 1, Donna got sick and was hospitalized for a week.
To her shock, she later found out some limitations of her coverage that made her overall financial responsibility much higher.
Smith was clearly very knowledgeable about health insurance, and she was able to pay ObamaCare’s “tax on time.” But what if she hadn’t been? Statistically, it’s clear that a large percentage of the poor people won’t be able to pay what Smith could pay; that some of them will not match ObamaCare policies to their health needs; and that some of them will die when they cannot get needed care. Because markets.
ObamaCare’s “Choices” May “Save Money” But There Are Lives It Will Not Save
The “tax on time” to make choices assumes that the choices given are fair, that the choices are clearly stated, and that the outcomes of the choices are not skewed. Unfortunately, none of this is true. Again, statistically, all of these failures — if failures they are — will have lethal consequences; it’s like ObamaCare is a giant maze that only some
rats animal models will be able to run, while random others are “sacrificed.”
First, under ObamaCare, your “choice” — your subsidy and the plans available to you — is based on a formula that’s not transparent. You have no way of verifying or reasoning about what bucket they throw you into!
Incorrect poverty-level guidelines are automatically telling what could be tens of thousands of eligible people they do not qualify for subsidized insurance.
The error in the federal marketplace primarily affects households with incomes just above the poverty line in states like Pennsylvania that have not expanded Medicaid. The mistake raises the price of their insurance by thousands of dollars, making insurance so unaffordable many may just give up and go without. …
It also highlights what some public policy experts say is a troubling lack of transparency in the marketplace’s eligibility determinations.
“It is almost impossible to work back from a decision and see what they did,” said Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities in Washington. Ideally, she said, a notice would say, “We have found that your income for 2014 will be X, and based on that income your tax credit will be Y.”
[T]he official determination letters simply state the amount of your tax credit and resulting insurance premium. “I would have no idea if it’s right or wrong,” Solomon said.
Second, under ObamaCare, this “choice” — the hospitals in your plan’s network — will often be described by insurance companies using deceptive language:
Melanie Lapidus, vice president for managed care at Barnes-Jewish Hospital in St. Louis, home to Siteman Cancer Center, said she doesn’t think patients realize the exchanges offer a more restrictive kind of private insurance.
Lapidus cited Anthem Blue Cross and Blue Shield, which includes Siteman in many of its plans outside the Missouri exchange, but none within the exchange.
“We have had many people say to us, `I picked Anthem because you guys are always in their products, and I assumed you would be in their exchange products,’” Lapidus said. “It’s still hard to tell who is in network and who is not.”
(Partly this is a “tax on time” issue, but it’s additionally a branding issue; the
rats animal models consumers citizens actually trusted the Anthem brand. Anthem, of course, is laughing all the way to the bank, where, having minimized its payouts, it will also deposit its massive subsidies.)
Third, and most lethally, all these strictures apply directly to cancer patients. Via CBS:
Cancer patients relieved that they can get insurance coverage because of the new health care law may be disappointed to learn that some the nation’s best cancer hospitals are off-limits.”
In all, only four of 19 nationally recognized comprehensive cancer centers that responded to AP’s survey said patients have access through all the insurance companies in their state exchange.”
“This is a marked deterioration of access to the premier cancer centers for people who are signing up for these plans,” [Dan Mendelson, CEO of the market research firm Avalere Health] said.”
By not including a top cancer center an insurer can cut costs. It may also shield itself from risk, delivering an implicit message to cancer survivors or people with a strong family history of the disease that they should look elsewhere.”
For now, the issue seems to be limited to the new insurance exchanges. But it could become a concern for Americans with job-based coverage too if employers turn to narrow networks.”
So, if you’re a
rats animal models consumers citizen with cancer, or with cancer concerns, and you’ve been forced onto the ObamaCare Marketplace (as opposed to being forced into Medicaid or having employer-based insurance) all you have to do for a successful shopping experience is:
1) Pay the tax on time to do your research, or
2) Pay the tax on time by having somebody else do your research, like your personal accountant.
3) Make sure you understand and document your eligibility for plans and subsidies in case you need to challenge ObamaCare’s eligibility determination later (or optimize your application).
4) Make sure you understand the cancer centers (if any) included in your plan’s narrow network.
5) Don’t allow insurance company branding to deceive you.
Oh, and hope the plan doesn’t change next year, so you don’t have to go through the same process all over again.
Of course, with a single payer system, none of these steps would be needed, but we can’t have single payer because markets, that being Rule 1 of Neoliberalism. And since a percentage of
rats animal models consumers citizens running the ObamaCare maze will, predictably enough, fail to get the plan (if any) that gives them the care they need, Go Die. That being Rule 2 of Neoliberalism.
But do enjoy your shopping experience!
 Hilariously, the solution the author of the Atlantic piece seems to suggest would only add additional layers of complexity to the complexity: Creating “health literacy” would require more marketing collateral, more training, more “explainers” (that is, more jobs for people very much like the author). A solution others suggest is to “nudge” people into getting coverage by putting the lowest priced plans at the top of the plan selection lists “to minimize the decision-making required.” Obviously, from the perspective of anybody who swore the Hippocratic oath, this proposal is vile and wrong and demands that ObamaCare be opposed (and its nudge theory advocates pilloried). I mean, shouldn’t people be “nudged” to select the best plan for their health needs, as opposed to the financial (and political) goals of the “progressive” program designers?
 In politics, this is called being “thrown under the bus.”