Wednesday, December 15, 2010

Is This All They Got?

Writing in the September 15 Washington Post about the legal challenges to the Affordable Care Act (ACA), Attorney General Holder and HHS Secretary Sebelius once again turned to the Administration's now familiar health reform rhetoric.

By now, observers have come to recognise the White House's standard and adaptable boilerplate: open with a heart breaking anecdote about a victim unable to afford treatment for their curable condition. Follow with some framed statistics about the uninsured and runaway health care costs. Get in the usual dig at evil health insurers run amok. Lump opponents to the Administration in with the crackpots that want to dismantle anti-Social Security and roll back civil rights. Close with the reasonableness of Team Obama and a call to bipartisan collaboration.

Good boilerplate can be adapted to any argument including the latest threat to the ACA. Opponents to the individual mandate argue that the U.S. Constitution's Commerce Clause does not grant Congress the power to compel Americans to purchase health insurance in a private market. The retort in the Washington Post? Use the opening "victim" anecdote to portray what could happen if the individual mandate is rolled back. State that the uninsured and runaway cost statistics are the result of not having an individual mandate in place. Portray the individual mandate as a way of bringing insurers under control. Lump the mandate's attackers with other extremists. Close with the observation that the mandate's opponents would make better use of their time by working with the White House.

On and on.

The Disease Management Care Blog thinks the article interesting for what it didn't do:

1. It didn't reach into the heartland and is going unread by persons outside that beltway.

2. It didn't offer up an easily grasped and Constitutionally sound counter argument, other than electing to go without insurance is a form of commerce that eventually harms everyone. Rather, it spent far more verbiage portraying the mandate as the fair thing to do. They have a point, but since when were U.S. laws about fairness?

3. It didn't attack the health insurers until the seventh paragraph and even then it was rather mild. This may be bad news for the Administration, which rode voter anger against the industry to garner political support. That won't work anymore and bodes ill in the continuing Administration battle for support outside their base.

4. Finally, it failed to adequately explain how making everyone buy insurance will lower the price of insurance and simultaneously control health care costs. While the Disease Management Care Blog believes the concept of risk pooling is within the reach of most voters, they'll then have no problem also discerning that spreading unrestrained health care costs over more people will do little to ease exploding debt levels.

The DMCB hopes this is the usual public relations posturing and that some real work, negotiating, learning and dialogue is going on behind the scenes. If this is all the Administration has, health reform may be in real trouble.


Michelle W said...

As I wrote on Tuesday, I find it interesting that the law's name has been shortened to the "Affordable Care Act" or ACA when even the law's most ardent supports admit it doesn't contain that many cost saving measures; it's main strengths are supposed to be in consumer protections (like rules against recision and the establishment of medical loss ratios). I suppose the shortening is partly in response to the law's full name or even "PPACA" being such a mouthful, but still, why put the focus on the weaker part of the law?

Cody L. Custis said...

Let me add one final bit of rhetorical analysis. I love the car insurance analogies. The problem is that health insurance is a long way from car insurance.
For car insurance, risky drivers (such as those with bad credit, or those who get DUIs) pay more. For health insurance, risky individuals pay the same amount.
For car insurance, companies compete and advertise during the Super Bowl. For health insurance, companies are restricted by state laws, which give insurers regional monopoly power.
For car insurance, individuals purchase their own plans, based on their own needs. For health insurance, individuals get it from the employer, who may have never heard of a high-deductable plan.
For car insurance, individuals pay for most routine costs, and some never file a claim. For health insurance, individuals file many claims each year.
I’m amazed that the political left keeps using the car insurance analogy, since the right calls for the reforms to move health insurance to car insurance.