ObamaCare Train Wreck on the Twitter: Administration PR Team Launches Google Hangout to Online Derision, Part II

In Part I, we looked at the first Google hangout organized by HHS, with Julie Bataille, Director of CMS’ Office of Communications, and Kristin Rowe-Finkbeiner, Executive Director/CEO and Co-Founder of MomsRising, at #HCgovHangout. We concluded, after categorizing and color coding the twitter stream, that the event was a public relations debacle. Today, we’re going to color code the transcript, helpfully provided, on virtually no notice, by the transcriber: Bataille and Rowe-Finkbeiner in their own words. Let’s break out our color-coding Magic Markers…..

I’m going to color code the transcript using the same scheme I used for Obama’s April 30 presser on health care, with a definitional change: Vast swaths of the transcript are bathos in Webster’s second sense: Trite and sentimental. So I changed the definition of Bathos to include that sense. I also expanded the definition of Secular Religion.

Category Note
Secular religion A mish-mash of phrases from the Framers, Lincoln and MLK echoes, and so forth, in addition to Motherhood and Apple Pie
Bathos Bathos is 1. an abrupt transition in style from the exalted to the commonplace; or 2. triteness (for example, MBA-speak), sentimentalism
Neo-liberal catchphrase “Free market,” “innovation,” “hard choices” etc.
Populism “Our most vulnerable citizens”
Bipartisan shibboleth “The troops,” for example
Dead metaphors/cliche “Ring the changes on,” “take up the cudgel for,” “toe the line,” “ride roughshod over,” etc. (Orwell)
Sheer nonsense Word salad
Falsehood or truthiness A terminological inexactitude
Blank screen Placeholder material onto which the audience may project what they like. The phrase comes from Obama’s famous remark in the preface of the second of his two autobiographies: “I serve as a blank screen on which people of vastly different political stripes project their own views.”
Equivocation Lawyerly parsing and weasel wording
Boilerplate “Ladies and gentleman,” and so forth.

Here’s the transcript. My comments are footnotes:

Julie Bataille: Hi everyone. It’s great to be here with you to kick off our first healthcare.gov hangout. I’m Julie Bataille, the communications director at the Center for Medicare and Medicaid Services here at the Department of Health and Human Services.

Millions of Americans are already benefiting from benefits and protections available to them from the Affordable Care Act including free preventive care and savings on prescription drugs. The new health insurance marketplace is an important part of the healthcare law, and it means that soon there will be a new place for individuals, families and small businesses to get more affordable health insurance, even if you get sick or lose a job. I hope you’ll find this a good discussion today, and if you have questions we’re following right now on Twitter, so please tweet us using the hashtag #HCgovHangout.

We know that these issues are especially important to families. Nobody plans to get sick or hurt, but one accident or injury can wipe out a person’s savings or leave them with a lot of debt. And they’re important to my guest today, the executive director of MomsRising, Kristin Rowe-Finkbeiner. Kristin, thank you so much for joining us today.

Kristin Rowe-Finkbeiner: Thank you so much for having me here today. It is a delight to be here. With more than a million members, MomsRising is mobilizing grassroots actions to help ensure healthcare coverage for all. And we are working hard to make sure that everybody has a chance1 to get access to healthcare coverage. Moving forward, would you like to share some thoughts?

1. Simply not true.

Julie Bataille: Well, I was just going to say, Kristin, I’m so excited that you are the guest today for our first healthcare.gov hangout. As a mom myself, I know how important these issues are for our families and how much of a difference we make in the healthcare decisions that take place around kitchen tables, and these conversations I think can be especially meaningful as people need to understand what’s ahead and what the options will be available to them.

Kristin Rowe-Finkbeiner: Thank you. At MomsRising, we are making sure that there are provisions available to women, to children and to families, and this is such an important conversation1. To pick up what Julie just said, we take on the most critical issues facing parents across the nation by mobilizing massive grassroots actions to bring forward the voices and real-world experiences of women and mothers straight to our nation’s leaders, to amplify women’s voices and issues in the national media, to accelerate grassroots impact on Capitol Hill and at state capitals across the country, and to hold corporations accountable for the fair treatment of women and mothers. We know that moms are often the decision-makers in the family when it comes to healthcare, and we recently heard from one MomsRising member who has a very important story to share because she is looking for coverage herself.

We heard from Angela. She’s from Arizona, and she wrote, “I am a mother of four who has been uninsured for the past two years. After my divorce, my children remained insured but I lost my health coverage and couldn’t find any affordable options for myself. Thankfully,” she wrote, “I am in good health and rarely see the doctor. I prefer,” she said, “to treat myself rather than seek out-of-pocket medical care that may take years for me to pay off.” However, it’s not far from her mind that if God forbid she’s in an accident or one day she finds a lump, her young family could be financially ruined forever.2

1. “Conversation” has a special meaning for the Democratic nomenklatura: It’s a scripted event where an authority figure dispenses talking points. “Conversation” is an especially important word since it obscures the power relations involved by implying all the parties are equals, when they clearly are not, “moms” together or not.
2. Angela’s story, as told, implies little about policy. One might (just conceivably) redress her situation with a complicated Rube Goldberg device like ObamaCare. Or one might consider subsidized catastrophic coverage with other services paid in cash. Or one might consider single payer Medicare for All.

Julie Bataille: You know, it’s stories1 like that that really bring meaning to the work that we are doing here at HHS and really bring to life the new benefits and protections that are going to be available to people, and I think the more we can do to make concrete those stories and who can benefit, the better we will do in terms of raising awareness and helping people understand their options. Starting October 1st, the new health insurance marketplace will give anyone who is uninsured or who buys their own coverage a whole new way to shop for insurance. Coverage begins on January 1, 2014. And it’s the only place where you can get lower costs on monthly premiums and out-of-pocket expenses2 or see if you qualify for Medicaid or the children’s health insurance program. To give you a better idea of what the health insurance marketplace is all about, here’s a short3 video that covers some of the key features4 of it:

1. “Stories” is another word with a special meaning for the Democratic nomenklatura. A “story” is a personal narrative that supports the talking points in a “conversation.” The conversion narratives in the 2008 Obama campaign are the canonical example. Stories are generally “shared.”
2. No, it isn’t.
3. And stale, month-old.
4. One key (mis)feature the video doesn’t cover is how many applications will be done on paper because “the marketplace” can’t handle them; the current estimate is one-third.

[VIDEO] You can do all the things you do with more peace of mind, less worry, and more financial security when you know you’ve got health insurance. And now everyone will be able to find health insurance at the health insurance marketplace 1. It’s an on-line shopping site where you shop for health insurance that fits you with low-cost and even zero-premium plans2 for those whose income qualifies. If you or your family are uninsured or just looking for better coverage, you can see your options all in one place with one application3. It’s a place to compare a wide range of quality health insurance plans, to review them all side by side, and choose the one that’s right for you. You’ll find information4 clear and easy to understand. You’ll explore the marketplace at your own pace. You can compare prices and benefits, see an explanation of what a premium is and what a plan will cost you every month5 before you make a choice, and every plan will cover you with comprehensive benefits, from your visits to the doctor at a hospital, to your prescriptions, to screenings for cancer and other conditions, and no plan can turn you away6 even if you already have an illness or condition. The health insurance marketplace , part of the healthcare law, opening October 1st. You can learn more right here [HealthCare.gov/marketplace ], right now, and be ready for the new world of health insurance shopping.

1. Untrue. As above, one-third of applications are expected to be paper-based.
2. And co-pays and deductibles? Come on. I don’t want marketing sleaze from my own government, for pity’s sake. Are these people so cognitively captured they think they’re an insurance company? (And who would want to be one?)
3. Untrue. Trivially, it’s not true because if it were, there would be no need to the navigators, the help lines, and all that. Less trivially, the online options most definitely do not fit all possible cases. Just try figuring out what your options are if you’re the spouse with the grandfathered insurance plan, for example.
4. Equivocal: It’s information that’s not there at all that is the concern.
5. Equivocal: It’s not clear from the wording whether “cost you” means the plan only, or the net after subsidies and tax credits. Only if the latter is true will the “Marketplace” be truly useful.
6. Equivocal: The insurance company can treat small technical errors on your application as fraud and rescind your policy (“rescission”).

Julie Bataille: So, Kristin, as we tell people about the new health insurance marketplace , I’d really love to hear your perspective and why you and MomsRising think something like this is so important.

Kristin Rowe-Finkbeiner: Let’s face it. Worrying about our children never ends. We’re still moms even when our kids grow up, and one thing that’s important to note is that moms worry about our 3-year-olds, we worry about our 23-year-olds, and we even worry about 53-year-olds1. So moms have an important role to play when it comes to healthcare coverage. We’re the only ones who can say things like, “If you’re going to do that 360 on your motorcycle, you might want to insure more than that bike.” In fact, this morning while discussing healthcare over coffee2, a motorcyclist said, “You need to clarify that you need to insure your entire body, not just your head.” Right? This is important3. So moms have an important thing to say here, and of course ensuring that young adults have health coverage is important for more than just motorcyclists. It’s important for everyone’s wellness.4 It’s also important for everyone’s financial security, and financial security for moms and their families comes from having healthcare. That’s why we are5 grateful, we’re excited, and we’re waiting for the full implication [sic] of the Affordable Care Act, and we are excited that already young adults up to age 26 can now stay on their parents’ health insurance.6

1. So why not 63-year-olds? I don’t think Rowe-Finkbeiner’s being ageist, here; rather, she realizes that a 63-year-old has pretty good odds of making it through the nightmare of private health insurance to Medicare. So why not Medicare for all, then? Including not just the 3-year-olds, but the newborn? Don’t moms want the very best for their children in all the phases of their life?
2. Oh, come on.
3. The Worldle shows how important the word “important” is to the messaging; here Rowe-Finkbeiner punches it twice.
4. Wellness sounds great. It’s not clear that wellness programs are supported by anything more than anecdotal evidence.
5. Anaphora: Obama’s favorite rhetorical form. “We are… we’re… we’re…. we are.”
6. The whole passage is interesting for the way it shifts from universal concerns (3-year-olds, 23-year-olds, 53-year-olds) to actuarial targeting (“ensuring that young adults have health coverage”) to everyone (wellness) to the delivery of constituent services (“young adults up to age 26”).

At MomsRising we hear from people every day who are thankful for these provisions. Members like Tracy Munoz(?), who shared this quote. She shared, “My young adult son1 is taking a year off from school. He has to pay back school loans from his first year of school and he is working full-time with a small business. He simply can’t afford health insurance on his own and we simply can’t afford to pay it for him. So adding him onto my policy until he’s 26 years old due to the passage of health reform was an insurance security blanket that all of us needed at a time when I have not had a pay increase in the past two years. He is fortunate enough to be relatively healthy, but my husband and I need to have that burden of him being uninsured and possibly having an accident or getting sick off of our shoulders.2

1. Note, once again, the actuarial targeting that belies the idea that the ObamaCare rollout is really for everyone.
2. Of course, I’m happy for the Munoz family. That said, it’s curious that a program that’s been in existence for three years flogs this single success story over and over again.

Julie Bataille: Thanks, Kristin. You know, we do hear stories like that all the time, and that’s why I am so excited for what’s to come and for how many more people can benefit from these new opportunities. Already we see more than 3 million young people now have coverage on their parents’ health insurance plans and soon if they’re not covered on their parents’ plan, they will have new options to get coverage through the health insurance marketplace . So now’s the time to get ready.

And we’ve got some new customer service channels available to help consumers begin doing that. Healthcare.gov is the online home of the health insurance marketplace . For Spanish speakers, Cuidado de Salud is available as well. Right now these websites have educational information, videos and personalized checklists1 to answer your questions about the marketplace . We’ve got live webchat available 24-7, and we want to hear from you. We know how many of you are active on social media channels, so you’ll find easy ways to share information with your friends and family, and you can sign up for e-mails and text updates to hear from us over time. And no matter if you access our site on a smartphone, a tablet or a laptop2, we’re going to be able to display content appropriately in a way that will make sense to you. Over the summer we’ll continue to add new features and information to our site and across our channel, much of it in response to feedback we hear directly from consumers. And come October 1st, you’ll be able to fill out a single application to find out if you qualify for lower costs on monthly health insurance premiums or out-of-pocket costs, and then you can choose health plans that are available in your area.

1. The bottom line is there’s a boatload of information but the one thing we actually need to know is missing: How much will we end up paying, net?
2. Note the platforms are ordered generationally, young to old.
3. Untrue. Not only (see above) will 30% of applications be paper-based, Obama (delaying software development) decided there would be two forms: One 3-page form, for individuals, and a second, 12-page form for families. Moreover, if the family has more than two people, the form needs to be filled out on paper. How are busy moms with kids going to feel about standing in front of a copy machine?

We also just opened the toll-free phone hotline. Consumers can now call 1-800-318-2596 to speak with a trained1 customer service representative. Twenty-four hours a day 7 days a week representatives are available in English and in Spanish. We have a TTY line and there’s a language line to help consumers in over 150 languages.

1. Trained for what? The hangout took place July 8. HHS dropped the 606-page document that gives the rules for the “Marketplace” on July 5. The scripts can’t possibly be written, so what useful information can possibly be conveyed by this panoply of sources?

We know consumers may choose to access information1 in a variety of ways so they’ll be helped in person for those who want that option too. Just today, in fact, HHS announced funding for community health centers to provide health [insurance information] for people who want to enroll in the marketplace as you may want to do it at in-person locations. There are more than 1,200 health centers across the country delivering care in over 9,000 communities. This is just one of several ways you can find in-person assistance in your local community.

1. As above, the rules for the “Marketplace” were released on July 5. So what’s the funding good for?

We’ll have all those resources and information available for you on our website by October 1st. We want to make sure everyone is ready for October because we know there’s a real link between health coverage and good health, just like the stories Kristin shared with us, and because we know that the lack of health insurance can mean real insecurity for so many working families .

Better than anything I could say, I’d like to share with you another story, a short video of a young1 woman we met from Philadelphia who’s looking for new health insurance options right now. Here’s Jamie’s story.

1. Note actuarial targeting.

[Hilariously, embedding is “Disabled by Request.” Don’t they want the video to propagate? And it’s a government video, so it’s paid for with my money. Why can’t I embed my own video? However, the transcriber comes to our rescue:]

[VIDEO]My name is Jamie Hocking(?) and I’m 271 years old. My friends and I all have this theory that you should have to work a service job for at least two years so that you know how to act in public. I’ve been working at a coffee shop for the last 4½ years. I’ve never made more than 20 grand in a year. I don’t really have a plan. That’s not a great thing to have to admit to anybody, but that’s just not how my life has worked out. 2 I graduated college. Every time I get sick, I get, you know, if it can’t be fixed with like Advil, Nyquil and like a good night’s sleep, I don’t really have a solution for it. I don’t know what I would do if I could very ill or very injured. Honestly, I haven’t been to a doctor since my 11th grade physical. Between all of the obligations I already have, like utilities and rent and student loan payments, within my budget there’s no way I can afford healthcare. If something bad happened to me, if I were in an accident or I developed some kind of serious illness, there’s no possible way I could afford it. I don’t have that kind of savings. My savings would be gone in an instant. I have no plan. I can’t afford a plan. Life with health insurance would offer comfort and stability and safety.3

1. Note actuarial targeting.
2. All thanks to Obama’s successfully implemented policy of permanently high disemployment, fully supported by the political class as a whole.
3. Needless to say, I think Jamie deserves help as a matter of common humanity and simple decency. It’s just that I think everybody deserves the same level of care, as in a single payer Medicare for All system. ObamaCare clearly does not share this ethical view.

Julie Bataille: Janie’s story is one of many that you may know about. Please share your story with us today. Post on our Facebook page, visit our social media channel, and tell us why health insurance is important to you and your family. These stories make new benefits real to people and they illustrate the promise of the Affordable Care Act. With that in mind, I’d like to ask Kristin to say a few words before we begin taking questions.

Kristin Rowe-Finkbeiner: Thank you so much, Julie. I know that all of us at MomsRising want to see the full promise of the Affordable Care Act become a reality, and for that to happen we all have to step up to the plate. We need to talk with one another.1 We need to get the word out, and we need to discuss this with the young people in our lives2, because when it comes to making big decisions like buying health insurance, it’s important to have someone to talk to and that someone is typically a mom3. And now we’d be happy to open us up to take your questions online.

1. See comment on “conversation,” above.
2. Note actuarial targeting. The 3-year-olds and 53-year-olds are no longer relevant.
3. I guess I’d rather talk to somebody who actually knows the field. Better yet, health care should be a right, and all these “conversations” wouldn’t have to take place at all. Of course, the Democratic and “progressive” nomenklatura couldn’t turn the training materials, the presentations, the websites, or the marketing collateral into walking around money. So there’s that.

Julie Bataille: So we’re going to take questions right now from the Twitter feed that we’ve had going live all morning1. We’re so grateful to all of you for joining us today for our first ever conversation. Our first question is from a lifelong educator in Georgia2, and he’s asking us, “If our state, Georgia, doesn’t have an exchange, can we use the federal government exchange?” Well, yes, absolutely. In fact, you can use healthcare.gov to apply for coverage, compare your options and enroll.3 In fact, I’d encourage you to go there today. To just start some educational information, sign up for our listserv so we can keep you updated as we make progress towards the beginning of open enrollment.

1. Actually, people are so hungry for information they’d been asking questions since the #HCgovHangout hash tag went up, not just the “morning” of the hangout.
2. We quoted Life Long educator in Part I; he was unable to find the Hangout because CMS publicized the wrong URL. However, he’d asked his question early, like many of us.
3. Equivocation: Not if the questioner has to use a paper form, as 30% of applicants (see above) will probably do, if their family is larger than two, for example. Also, not “can.” Rather, “should be able to.”

Our next question is Kristin from Seattle – not this Kristin from Seattle – but Kristin asks us, “How will the new health insurance exchanges work with COBRA offered through current or former employers?” You know, that’s actually a great question. And much of what we’re seeing across our customer service channels so far is individual questions and people’s experiences who are looking for information that’s relevant to them.1 In terms of COBRA and folks who have COBRA, you’ve really got two primary options. There is COBRA and then you can certainly seek out a marketplace plan. Remember, coverage begins January 1st, so check out your options beginning in the fall, see which is better for you, the existing COBRA coverage or if you’d rather switch to a marketplace plan, and then take advantage of doing that. Make sure to contact your COBRA officials for particular information and coverage terminations and questions, but please know that both are options for you.2

1. Imagine that! (But people are sharing their “experiences” on citizen customer service channels? WTF?)
2. Well done, and backed up in twitter with a link. Although I’m no COBRA expert; perhaps there are details I’m missing. Readers?

Our next question actually comes from a blogger. A young student named Crystal1 asked us, “What about full health insurance for full-time students attending college or university? Those folks that are 21 or older? How am I impacted?” Well, Kristin, you may want to add something here from what you’ve heard from MomsRising, but I would2 say for anyone who is under the age of 26, please remember you are eligible to still stay on your parents’ plan3. If that’s not an option for you and your particular family, please know the marketplace would be a great alternative for you, and beginning October 1st you’ll be able to go there to complete an application and check out the options that may be right for you.

1. Note actuarial targeting.
2. The “Beltway subjunctive.” You would? Well, are you?
3. Again with the parents’ plan!

NOTE Crystal’s question is not a tweet. A Google search (2013-07-12, 2:00PM EST) on “full health insurance for full-time students attending college” yields this post only, so I can’t supply a link to “Crystal’s” blog.

Kristin Rowe-Finkbeiner: And I think one of the things that’s exciting and important about this is that there is one-stop shopping1. You can go to healthcare.gov, you can find out what your opportunities regardless of whether your state does or doesn’t have a marketplace 2.

1. No. Again, 30% will be paper. And what kind of “one-stop shopping” experience requires umpty-million support channels, anyhow?
2. I’m not sure about this. If Rowe-Finkbeiner is really saying that the state and Federal exchanges will have identical information, what’s the point of having state exchanges at all?

Julie Bataille: And, you know, I’m actually really glad you said that. One of the things that is so important to us and much of the feedback that we have heard from people as we’re developing our customer service channel is to make sure the information is written in a way that they can understand, make sure that we simplify this as much as possible, so please know we are really taking that to heart and all the work that we are doing is really to design a consumer-friendly1 process and be able to provide people information in a way that they will understand, in a way that they can quickly and easily navigate the entire process.

1. Perhaps this is oldthink, but when I interact with the State, I think of myself as a citizen, not a “consumer.” The cognitive capture implicit in “consumer” really concerns me.

So now we go to Elena from Chicago. She is asking us, “What is the minimum income for an uninsured working person to qualify for a government subsidy to buy health insurance through the new exchange?” Elena, thank you so much for asking that question. What I would tell you1 is that the vast majority of people who are uninsured who seek coverage through the marketplace will be able to take advantage of lower costs on their monthly premiums. What that means on average is that if an individual makes up to about $45,000, or for a family of four who make up to $94,000, they will be able to see savings off of either their monthly premium or their out-of-pocket cost.2

1. The Beltway Subjunctive, again, here as a prelude to an equivocal non-answer.
2. Elena’s asking for the “minimum.” Bataille gives the maximum. I’m guessing — I suppose I should tweet her…. But that seems invasive… But if Elena is Elena Joan Rebollar, she’s retired, and if she’s thinking like some of us, she’s asking for the minimum for a subsidy because she doesn’t want to be forced into Medicaid, because Medicaid will levy claims against her estate.

I think we’ve got time for one more question and this comes to us from Lambert [lambert blushes modestly], who is worried about the fact that “The only computer access I have is very slow and is at the library. Will I be able to apply for Obamacare?”1 Absolutely, Lambert. We are making sure to take care of you. You should know that first of all our new website loads really quick2, so even if you’ve got a slow connection, hopefully we’re helping you out, but we’re also mindful of the fact that people may not have internet access in their home. We just announced a partnership with libraries3 so that across the country people will be able to use them for actual enrollment destinations and access to computers in the fall, but also know that we’ve made sure that channels are available for however you may choose to access us. So call our toll-free hotline. If you’re not interested in applying online, you can go to one of those in-person assisters, in fact a community health center, or we’ll have navigators and other forms of local help available. And remember, you can always download and complete the application that you’ll find online and mail it into us4. The options are available for you. You can choose how to access us, apply and enroll, and we certainly encourage you to do that.

1. Lest it be thought I’m blogging from the library, a group of us put several questions together, and I had someone else’s situation in mind.
2. True. Looking under the hood, there’s a lot of JavaScript, however.
3. Here’s detail on the program. There seems to be some frothing and stamping on this from the Republican nomenklatura, but never mind them. My concern: I want reference librarians to remain just that, and not turn into an insurance sales force, or even non-profit navigators. Librarians have tax forms, but they don’t actually help people fill them out. The administration has already tried to turn reporters into insurance sales people, so let’s hope that bad idea doesn’t turn into a precedent for librarians, or everyone else they have dealings with.
4. So much for “one stop shopping.”

In closing, we don’t have time1 for any more questions for Twitter. We certainly appreciate all those we’ve gotten. Please know that we will continue to use our social channels over the course of this afternoon and in the coming days and months2 to be responsive to your questions, to continue this conversation. We’re really looking forward to that.

Thank you so much, Kristin, for joining our first hangout. As a mom3 it was really important for me to have you join us for this. And we’re really excited to be really engaging in this conversation as we move forward. Thanks to all of you for joining us today. We look forward to hearing from you, understanding your stories, and we’ll talk to you soon. Thanks so much.

1. Because you filled all the time with low-value information!
2. HHS staff (presumably) did continue to answer questions in the twitter stream, which is praiseworthy.
3. See, e.g. Not that I’m against moms, mkay?

* * *


Above is a Wordle of the transcript (with “Kristin” and “Julie” omitted). Note the prominence of “Marketplace.” Conclusions:

1. ObamaCare is a stone market state solution, and always has been. It’s designed to install rentiers at the heart of the American health care system, forever. Anybody who said that ObamaCare was a step on the road to, say, single payer was delusional or lying.

2. Despite lip service to universality, it’s quite clear that this presentation is optimized to solve the actuarial problems that any insurance program has: The healthy young need to be successfully sold on the program to subsidize those who were once healthy and once young; there’s no notion here that health care might be a right, or should be guaranteed universally to all citizens. Hence the youth market as “actuarial target.” (And surprise! The olds can use the twitter just like they took over Facebook….)

3. For this English major manqué, the contrast between color coding Obama and color-coding these speakers is vast: Obama’s textured language when speaking formally is lost; and his ornate lying and conning when speaking informally are also lost. Here, by contrast, there are vast swatches of doubleplusgood duckspeaking, boilerplate, and a few easily debunkable falsehoods. But the speakers have their talking points to hammer and they stay on message, quite successfully; I hadn’t realized how pervasive “marketplace” was until I made the Wordle. They almost got me! And I hope that by drawing attention to “conversation” and “story,” I’ve helped inoculate a few readers against styles of Democratic discourse, which although more subtle (at least to me; perhaps it makes a true conservative’s back teeth itch) can be just as destructive as Republican discourse, and, I ask you, why not?

4. Finally, I have to say that I’m rather chuffed that my question was answered. I would have preferred, however, to get an answer to this question:

Or possibly this:

Or this:

Perhaps next week….

UPDATE 2013-07-12 Minor copy edits.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. Old Hickory

    This is f***ing brilliant. I’ve already “shared” the definitions of “conversations” and “stories” with some of my friends who are “moms.”

    1. nonclassical

      …my wife (one who makes decisions on healthcare?!) has already (R.N. in Europe) determined we will be retiring Europe, entirely due to healthPROFIT debacle-profiteering attack upon homeowner property here, when health begins to deteriorate (which it will for all)…

  2. Cynthia

    I still don’t get the need to convince people, sell people on the idea they should buy an ObamaCare product. A good product sells itself. Anytime a new product comes out that is useful and/or attractive, whether it is affordable or not, people buy it. They lined up on the street when the latest iPhone came out. If the ACA has such a great line of insurance products to sell to the American people, especially if they are truly affordable as the ObamaCare sales and marketing team claims that they are, just publish the information and people will be eager to buy one of these products.

    I’ve noticed that there are a lot of hidden costs in these products in terms of deductibles and co-pays. Eliminate these hidden costs and people will be less reluctant to buy an ObamaCare product. Oh, but that will never happen. All of these hidden costs are how the insurance industry turns a profit. Needless to say, profit by deception has a very short half-life; but apparently, the Obama Administration is totally clueless to this fact.

    1. ambrit

      Dear Cynthia;
      Though I appreciate the irony of your comment, your use of the phrase, “…profit by deception has a very short half-life…” leaves much to worry about.
      First, “short half-life” assumes that this scheme is designed to go on forever, sort of like, say, Social Security. With the prevalence of short term thinking in general among our elites today, short half-lives are more than good enough to get the goal of looting done.
      Second, irony aside, the tone of your comment assumes a modicum of decency in the class of people responsible for this debacle. Allow me to assure you, no such sentiment is allowed in the halls of the Overlords/ladies.
      Third, the hidden assumption in the “short half-life” comment is that there will be a viable alternative available; a hidden hand, free market argument if you will. The exact opposite is the fact here. This scheme is a mandate. What you are offered is it; no alternate universes need apply. Since the exchanges are drawing from the very same pool of defective, dare I say criminal, insurance policies that propelled us into this crisis, where is the remedy? It’s exactly like the old joke; “How would you like to be executed. You have a choice; hanging, electrocution, firing squad, Mongolian Horse Racing, or ACA Exchange.”
      I’m beginning to appreciate the forces that gave rise to the Chinese Cultural Revolution.

      1. nonclassical

        so, Ambrit, in your rush to castigate government, are you also condemning Social Security and Medicare??

        If not, please focus on the subject at hand only-no (repubLIEcon) bashing of government without documentation of specifics involved…I can document that Americans love their Medicare-Social Security…

        1. ambrit

          Dear nonclassical;
          It seems we have a mixup here.
          My use of Social Security as counterpoint to the ACA is not meant to be an exercise in the art of guilt by association. Quite the opposite; it is meant to be an example of what the ACA could have been, but is not. The rest of the paragraph serves to give reasons for that juxtaposition. Social Security and Medicare were enacted by Administrations, indeed, nations, that took the concept of Governance seriously. Todays Dog and Pony show, by comparison, is run by people who mistake Management for Public Service.
          I too have hard evidence for the popularity of those two programs; my wife participates in both. Each is demonstrably superior in all ways to the upcoming Graft scheme disguised as a Medical Insurance Program. Indeed, any sane, public spirited person would concur wholeheartedly with Mr. Strethers call for “Medicare for All.” I certainly do.
          Finally, I am indeed castigating the present iteration of government. It is constantly proving by example that it isn’t a pimple on the backside of its illustrious predecessors. (By which I mean anyone before the Arch Fiend Ronald Reagan. Even the much reviled Dick Nixon had a real sense of history. Who could seriously expect the present occupant of the White House to have the grace to resign and steal away into the night when confronted with the proof of his misdeeds. Not I for one.)
          For the record, I grew up in a house with an Anglo Scots mother, and an English Trades Unionist father.

    2. Doug Terpstra

      Perceptive comment, Cynthia (Ambrit too). The free-“marketplace” label is worse than farce, no matter how many times they repeat it (20x-plus!). First, as Lambert notes, insurance is not health care. Second, health care can never fit the model of free-market competition because price discovery is impossible given the priesthood level of expertise involved and the many layers of gatekeepers. Third, the mandate to buy racketeers’ defective-by-design product makes Obamacare a manifestly deceitful attempt to mask naked extortion by a fascist state.

      Thanks to Lambert for great analysis and for crafting a suitably innocuous question to ensure it would be aired. (Still on dial-up?). Yes, they will take care of you.

      The “hangout” (what a hip term) was embarrassing to watch, like a poorly-rehearsed infomercial by amateur actors with shifty eyes (teleprompter jitters?). I felt a little sorry for Rowe-Finkbeiner, who looked like she wanted to crawl out of her skin.

  3. Dee

    Salutations to our overlords at the NSA.

    And a thousand thanks to the insurance salesman in chief and his minions for patronizing women who have children. Just for the record, we don’t all think of ourselves as “moms.”


  4. jake chase

    Lambert, I hereby retract every snarky comment I ever directed at you. I don’t know how you managed this, and I particularly admire your lexicon. The whole thing is perfect, although I must confess I didn’t bother with the parts you didn’t highlight.

    Incidentally, I never trust a woman with three names. If she doesn’t know who she is, how are the rest of us supposed to figure it out?

    1. Jim Haygood


      What, you don’t think minimum-wage Walmart workers are going to trust a woman with a hideously mismatched double-barreled surname?

      Your cynicism saddens me, Jake.

    2. craazyman

      faaahk, I hope youze guys are too cynical. This stuff toasts me to charcoal. I go MEGO after 20 seconds so there’s no way I’d ever figrue it out. I’d rather take 2 mg xanax and a few shots of Jack Daniels and if that doesn’t cure me I’ll die.

      Just signing up is gonna kill people. It’ll solve the actuarial problem, since the sick and the older folks will die more easily from frustration, confusion, exhaustion, mental paralysis and trauma than tough young kids.

      If they find out you have to sign up for this you might get rejected for the insurance, due to the health risk.

      The only way it;ll work is if you wake up one day and somehow you got signed up while you were sleeping. I guess that’s the Public Option though.

      I’d die after 20 minutes if I had to sign up for this stuff. I can’t even go to the Post Office anymore. One look at the line and it’s over. Taht’s one good thing about email, anyway. You don’t have to go to the post office. But I like the mail carriers so it’s no knock on them.

  5. Jim Haygood

    ‘Absolutely, Lambert. We are making sure to take care of you.’

    Errr … is that a promise or a threat? Sounds like they’ve reserved you a first-class seat on the cattle cars that will trundle off folks being ‘sent to the exchanges.’ Kristin and Julie would describe your ride as ‘free transportation,’ noting the lovely scenery along the way.

    All their harping on ‘moms’ is a transparent ploy to appeal to what is perceived as an important Democratic-leaning voting demographic, adult women. This is not health care marketing; it’s a ‘get out the vote’ effort.

    Real commercial advertisers make implicit appeals to target audiences. But in the lowest-common-denominator world of politics, the cloyingly phony appeals to moms and families (too bad they omitted ponies and kittens) just stick to your face. Oof, I need a kleenex!

    There’s really no need to write parodies of the rich, irony-proof self-parody delivered by these two articulate, malicious, elitist airheads. But based on his eviscerating footnotes, one suspects that Lambert could rip these clowns to shreds:

    ‘Well, Crystal, please remember that many of us are eligible to still stay on our parents’ plan. If that’s not an option for you and your particular family, please know the marketplace would be a great alternative for the rest of us, and beginning October 1st we’ll be able to go there to complete an application and check out the options that are right for us!

    ‘This is all anaphora, Crystal, and since you’re a young student, you probably don’t know what that is. But when we grow up, we discover that when something sounds too good to be true, it probably is! Ha ha and ta ta, dearie!’

    1. Ms G

      Great post. Especially this: “Kristin and Julie would describe your ride as ‘free transportation,’ noting the lovely scenery along the way.”

      And I agree with all the others that Lambert is doing a superb, original and effective job exposing the Great Con that is ObamaFrankenCare. There aren’t many who even bother to focus on things like the ACA application debacle, the ACA IT debacle and, here, the ObamaCare Insurance Saleslady Show. Who are then able to wield sharp and close textual analysis against this material to expose this grotesque disgrace of a sleazy sale campaign for the .01%.

  6. aletheia33

    on just skimming the piece– (will read carefully later)

    i’ve noticed the community health center has a role in ACA. it is the place they suggest on their website (www.healthcare.gov) that you go if you cannot afford any health insurance. and if you are online, you can locate one “near you” at this link:


    also in response to lambert’s library computer query, they say: ”If you’re not interested in applying online, you can go to one of those in-person assisters, in fact a community health center, or we’ll have navigators and other forms of local help available.”

    i guess if your income is so low you can’t afford health insurance, you already know where your nearest community health center is and don’t need to go online (if you are not interested in applying online) to find it. “there will be navigators and other forms of local help available.”

    there is one (1) community health center in my county of 521 square miles. the community health center is in a town 24.8 miles away from my town, a 30-minute drive. i am in a very rural state; maybe other states have more than 1 per county?

    …actually, i think (?) the http://www.healthcare.gov website is just for states where the feds are implementing the ACA–not my state. so presumably, all the states the feds are implementing have community health centers “near you.”

    oh and by the way OT, shelter for those needing it is drying up in my county due to the sequester. local orgs. are requesting donations of tents and sleeping bags to help fill the gap.

    1. ambrit

      Dear Sto;
      I didn’t know that Kumbayah, a Gullah word from the coastal islands of the Carolinas incidentally, really meant “come buy insurance”! What will those rascallions get up to next?

        1. Ms G

          Joyfully chiming in: “Kum bayah Insurance!”

          Genius Ambrit!

          And … ObamaCare Discount Coupons available at a Walmart near you! Can be redeemed on any exchange. [Small print. Offer not valid in all states. Discount only redeemable in HC Marketplace Units. HCMU have not yet been defined.]

      1. cjames

        I f*cking love the commentors on NC, i get more laughs and useful info from people here than any other site i ever did done read. Kum buy ahhh..ah crap we just got screwed by Obamascammadingdong. Lambert this single post just convinced me to give you a donation. Epic.

        I gotta say, i just got a crappy job with a major corporation, and the “conversation” sounds EXACTLY like the training materials that i had to complete to “teach” me about fraud and business ethics and so on, with slides o of people supposedly”conversing” around their kitchen table, which is to say, not anything close to how people actually talk to each other. What a joke. I wonder what the marketing budget for this sham of a health- oops i mean sick-care reform debacle is? A gigantic waste of money for sure, comparable only to the famous color coded threat level from Homeland spycurity that was months in the making from the geniuses in our increasingly dysfunctional gubmint brain-trust train wreck

  7. Yancey Ward

    Lambert Strether,

    The last two essays were brilliant in ways few essay can ever manage.

  8. just me


    1. Perhaps this is oldthink, but when I interact with the State, I think of myself as a citizen, not a “consumer.” The cognitive capture implicit in “consumer” really concerns me.
    h/t Lambert


    This scheme is a mandate. What you are offered is it; no alternate universes need apply. Since the exchanges are drawing from the very same pool of defective, dare I say criminal, insurance policies that propelled us into this crisis, where is the remedy?”
    h/t Ambrit

    Welcome to the Total Colonies of America. #pwned #shame

  9. Observer

    Wow. What a lot of patronizing superblahblahzo for the illiterate unwashed masses. Lambert’s unanswered questions must have been too intelligent for acknowledgement. Thanks for the piece, Lambert; your radar for the painfully absurd is unerring as always.

  10. Ms G

    The generic supermarket where Mom Rising goes shopping for a defective and overpriced ObamaCare insurance product seems apt as a proxy for this “Marketplace” business. Because the product is the kind of worthless, poorly made, overpriced at any price that an Obama Insurance Product is.

    They should change it to the Exchange Supermarket. Or better, and more accurately, the Exchange 99c Store [crap for the 99% that you pay for with money you barely have.]

  11. jrs

    The parents plan stuff is pretty class based isn’t it? So … what if your parents don’t have health insurance… what if your parents dont’ want to help you out? But no good upper middle class correctly socialized parent …

  12. Ms G

    Lambert, nitting picks. “In part I we looked that …” shd be “looked at” … I’m sure you noticed already. Just thinking of the archives :)

  13. aletheia33

    ”My friends and I all have this theory that you should have to work a service job for at least two years so that you know how to act in public.”

    has anyone here ever met someone for whom this was true? this sounds like pure BS to me.

    young college graduates take these jobs because they can’t find anything else, or they just want to get by for a year or so while they figure out what they want to do next. not to learn how to act in public. plus when she started this job she was 22 and 1/2 years old–a little old to just be starting on learning that. this “story” doesn’t hang together much.

    1. jrs

      People are given all kinds of advice, grow up in all kinds of weird environments and families etc.. But if she was actually given this advice whoever told her it did her a GREAT disservice. Because pretty much noone believes this, it has nothing to do with how the world works, and getting into service work if you could have tried for something better paying pretty much amounts to lifetime career suicide – so your young and can’t pay for healthcare now, that stinks, but what’s it going to be like in a few decades?

      1. nonclassical

        …a full liberal arts education can be achieved by studying Adam Curtis’ BBC historical videos:





  14. nonclassical

    ..of course some may not comprehend what a liberal arts education has to do with historical documentation-leading to consideration of “future context”…

  15. marcos

    Very well done. My only quibble would be with:

    ‘Populism “Our most vulnerable citizens”’

    When the totem “most vulnerable” is invoked by the Democrat nomenklatura, who are about as far away from being the “most vulnerable” as you can get, that is an appeal to liberal white guilt used to deflect populist demands for political inclusion into the immediate need to care for the “most vulnerable.”

    This device takes populist demands for structural or even systemic change off of the table which clears the way for the expansion of the set of “most vulnerable” as the system continues to put families through the neoliberal meat grinder. The pittance dedicated to providing public social services to the “most vulnerable” does not increase per capita as fast as the number of the “most vulnerable” does.

    This device has fallen on hard times along with the precariat whose reservoirs of liberal white guilt have long since evaporated with their economic security.

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