When President Obama said that if you like your health insurance, you can keep it, he was clearly taking some liberties with the strict truth.1 But as Ezra Klein points out this weekend, the reason he pressed this point so hard is that Americans have an understandable fear of losing their health insurance. And why not? You can lose it if you lose your job. Or if you lose access to Medicaid. Or if your insurance company decides to effectively eliminate your plan by jacking up its price. And that's not even counting the millions of people who don't have health coverage in the first place.
So, yes, it's true that Obama was wrong when he guaranteed that every single person could keep their current plan if they wanted to:
What Obamacare comes pretty close to guaranteeing, though, is that everyone who needs health insurance, or who wants health insurance, can get it.
It guarantees that if you lose the plan you liked — perhaps because you were fired from your job, or because you left your job to start a new business, or because your income made you ineligible for Medicaid — you'll have a choice of new plans you can purchase, you'll know that no insurer can turn you away, and you'll be able to get financial help if you need it. In states that accept the Medicaid expansion, it guarantees that anyone who makes less than 133 percent of poverty can get fully subsidized insurance.
Health insurance isn't such a fraught topic in countries such as Canada and France because people don't live in constant fear of losing their ability to get routine medical care. A decade from now, that will be true in the U.S., too. But it's not true yet, and paradoxically, that's one reason health reform is so difficult. The status quo has left people rightly fearful, and when people are afraid, change is even scarier.
Yep. I want to add one more point to this that doesn't get as much attention as it deserves: Hospitals routinely charge uninsured patients rates that are 3-4x higher than those paid by insured patients. A heart attack that gets billed—profitably!—to Blue Cross at $50,000, can end up costing you $200,000 if you're unlucky enough to suffer that heart attack while you're uninsured. Think about that: for decades, the health care industry has deliberately taken ruthless advantage of the very people who are the weakest and most vulnerable—those who are poor or unemployed—and seems to think that this is a perfectly decent and moral way to conduct business.
It's not. It's shameless and obscene. It's like kicking a beggar and stealing his coat just because you know the cops will never do anything about it.
This is something that Obamacare goes a long way toward fixing. If you're covered by private insurance through an exchange, you're not just protected against catastrophic illness. You're also protected against being charged outrageous rates for non-catastrophic problems—broken legs, asthma attacks, etc.—just because hospitals have the brute power to do so.
Because of Obamacare, you no longer have to fear being shut out of the insurance market. But that's not all. You no longer have to fear being gouged and possibly bankrupted because you've been shut out of the insurance market. Access to reasonable rates2 is one of the key benefits that Obamacare delivers to millions, and it deserves more attention.
1Though, let's be honest, not that big a liberty. The vast, vast majority of people will see little or no change in their coverage thanks to Obamacare, and of the ones who will, most will be able to buy similar or better coverage at a lower price. The problem of rate shock isn't an invented one, but it is a much exaggerated one.
2Reasonable by American standards, anyway.