November 17, 2013

This Mess, this Mess: Obamacare

The other day, I got this email from President Obama. Yeah, we're buds, me and Barack.
Susan, I want to cut through the noise and talk with you directly about where we're headed in the fight for change.  That's why I'm getting on the phone with OFA supporters this Monday.  I have just over three years left as president -- and there's a lot left on my to-do list.  That's why I want to talk with you.  You're the ones putting in the time and effort to achieve real progress, and fighting to make the agenda Americans voted for last fall a reality. I know we all care about what we can get done together these next few years, so let's talk about how to make it happen.
Wow, I chuckled, he wants to talk to me personally? About the future? I think if he's going to try and make anything of his next three years, he has to learn some hard lessons about the first three, particularly from the Affordable Care Act (ACA), don't you agree?

First, a very important disclaimer: I work for a health insurance company that is in the middle of implementing the ACA, but I have no direct involvement in the implementation. And, I unequivocally do not speak for my company in this or any other post on this blog or in other social media. All opinions expressed by me are mine.

OK.  Let's talk about This Mess, This Mess (and yes, if you're channeling Faith Hill, you're on the right track).  Here's what I want to tell President Obama.

Mr. President, you have let the ACA slip through your fingers, certainly since you signed the bill in March 2010, but I believe you let it go even before then, when the most memorable phrase coming out of the days leading up to the bill-signing belonged not to you, but to Nancy Pelosi. Everyone remembers those unforgettable sixteen words:
But we have to pass the bill so that you can find out what's in it...
You and your administration did a horrible job responding to that statement, which became the rallying cry for the opposition.  You and your administration have done a horrible job of educating people about the bill; you have done a crappy job promoting it as a solution for many of the millions of uninsured who would rather have insurance than not; and worst of all, you have basically done nothing - NOTHING - to 'bend the curve' on the public narrative. You have relied on others to do these critical jobs for you - and that includes both professional fact checkers and investigative reporters, and little people like me who have at least been trying on your behalf to do just that - bend the curve.

First and foremost, you let the bill become 'Obamacare', you did not make the conversation focus on The Patient Protection and Affordable Care Act. Every time someone said 'Obamacare' in an interview with you or with anyone in your administration, the response should have included the words 'Affordable Care Act' or one of the two closely associated acronyms, PPACA or ACA.  

I mean, think about it. What business would let their most important product be known by a derogatory term, and not say anything about it? And sometimes use the derogatory term themselves, when talking about their own product?  You did that, Mr. President.

Or, name a business would stand idly by while their competition spent over $50M  slamming their most important product?  I think anyone would be hard-pressed to name one, don't you?  But you did that, Mr. President. You let the House of Representatives vote dozens and dozens of times to repeal the ACA, and spend my money doing it - and basically said nothing. That's unforgivable.

Second, you and your administration took the blame for everything whether it's actually in the bill or not, by offering barely a third-rate defense against the stuff that's been thrown at you. Need some examples?

Sarah Palin's death panels. The bill does not make granny stand before a panel of nameless bureaucrats to ask for health care services. It does not require or allow a lottery to determine who gets to live and who must die. What the bill does provide is coverage for conversations about end of life care and treatment, so that the doctors know what their patients want. What the bill does allow is evidence-based decisions on medical care which, by the way, all insurance companies currently do today through their utilization review programs, medical policy development, etc. What the bill does promote and reward is quality of care and outcomes, which is another thing that insurance companies - and Medicare - do today. Why wouldn't you come out and say that, and throw your support behind these ideas?

Employers cutting hours or changing programs. The ACA does not require companies to cut hours, hire part-time workers, change to high-deductible health plans (which pre-date the ACA, by the way), cut coverage for spouses of employees, lose their grandfather status, or anything of that nature.  Many of those changes are occurring because of our lingering economic situation, or as normal moves by businesses to try and control health care costs, or because insurance companies continue to innovate to meet a changing marketplace.  As with our tax law, labor laws, environmental laws, and such, there are ways to make changes that are good for business but bad for people. The ACA is no different. Why wouldn't you just come out and say that, and support what your program actually does?

House Republican 'uncertainty'. In all of the discussion leading up to the 40 or so votes by the House to repeal the ACA, the key word has been 'uncertainty'; it has become the mantra of John Boehner's shaky tenure as House Speaker.  Before the bill was passed, it posed too much uncertainty for business because they didn't know what would be in it. Once it got passed, it posed too much uncertainty because they hadn't read it. Once they read it, it posed too much uncertainty because they didn't know what it meant. As the bill's provisions got implemented, it posed too much uncertainty for some other convoluted reason. Why wouldn't you just come out and ask Speaker Boehner when there would be certainty?  And ask them why they wasted $50,000,000 of taxpayer money trying to prove a point, and what they would offer instead? There's certainly certainty in that question.

If you like your health plan/like your doctor, you can keep your health plan/keep your doctor. You and I know you said this dozens of times, because it got a good reaction from the crowd when you did. But you and I also know what you really meant, and that what you really meant is only now being expressed fully:
If your current insurance coverage offers you the minimum protections all Americans deserve -- hospitalization, preventative care and the like -- and does not artificially limit your coverage based on an arbitrary dollar figure, and doesn't penalize you if you have a pre-existing condition, you can keep your current plan. And if your insurance company doesn't change their participating provider list, you can keep your current doctors too.
But if you have crappy coverage, with its only redeeming feature being a low premium, you're going to have to change to something better. Because you deserve better than what you have today.
But you didn't come right out and say that, did you?  Nope, not until way too late, and by then the  the horses named BadPollNumbers, Negativity and LackofTrust were long out of the gate.  Like all politicians, you live and die by your sound bites. I think we know which side of that 'death panel' this one is on.

Third, you let a website ruin your program. and the ACA are not actually the same thing, but for all practical intents and purposes, they are now -- and you're not managing this at all well. 

I tried the website, even though I have insurance through my employer, because I wanted to know what all the shouting was about.  Did you do that, Mr. President, before it went live? Or after?

And before it went live, did anyone tell you that it wasn't going to work, or did they say everything was fine and things are ready to go? Are people afraid to tell you bad news? Or do you simply not care about the details? Regardless of which of those is the case, the person who needed to be front and center on October 1st, and regularly since then, was not Kathleen Sibelius, it was not Jay Carney, it was not anyone in Congress - it was you.

You need to get engaged, get involved, get it fixed. Period. And please, don't do that by changing the rules for states and insurance companies like mine, who have spent countless dollars trying to implement this as designed, in good faith.

The answer is not 'Go Backwards', Mr. President. The answer is 'Get a Backbone' and move forward.

Finally, you have allowed this to become a political conversation rather than a health insurance conversation.  You're not running for re-election, so you can pretty much say what you like (or not, as I've made apparent here).  And I know there are Democrats in the Senate and House who might want to run again, and they are scared as they watch your poll numbers and their own crash and the ACA unravel.

But the bottom line is, the ACA is not about political careers, it's about health insurance and health care. Because of term limits, you are in a unique position to make that point. And yes, you're going to anger members of your own party, and the other party will go bonkers, and media darlings will have a field day with you. But, ask yourself what's more important:
  • Politicians or health insurance?
  • Media coverage, or medical coverage?
  • Morally bankrupt political figures, or truly bankrupt Americans who cannot afford their medical bills?
  • Vulnerable politicians, or vulnerable Americans?
  • Affording politicians another chance, or the Affordable Care Act?
Start leading on this, Mr. President, and then maybe we can talk about your future. Oh - and don't call me Susan.

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