Wonkbook: Obama shouldn’t apologize for blowing up the terrible individual market

November 8, 2013

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Brendan Smialowski/Getty Images
Brendan Smialowski/Getty Images

Last night, NBC's Chuck Todd asked President Obama about the people losing their health insurance despite his promise that "anyone who likes their plan can keep it." (See the video and read the transcript here.)

"I am sorry that they are finding themselves in this situation based on assurances they got from me," Obama replied.

The answer is a bit of a dodge. People aren't finding themselves in this situation based on the president's promises. They're finding themselves in this situation based on his policy. And Obama isn't apologizing for the policy.

"Before the law was passed, a lot of these plans, people thought they had insurance coverage," he said. "And then they'd find out that they had huge out of pocket expenses. Or women were being charged more than men. If you had preexisting conditions, you just couldn't get it at all."

Obama was wrong to promise that everyone who liked their insurance could keep it. For a small minority of Americans, that flatly isn't true. But the real sin would've been leaving the individual insurance market alone.

The individual market -- which serves five percent of the population, and which is where the disruptions are happening -- is a horror show. It's a market where healthy people benefit from systematic discrimination against the sick, where young people benefit from systematic discrimination against the old, where men benefit from systematic discrimination against women, and where insurers benefit from systematic discrimination against the uninformed.

The result, all too often, is a market where the people who need insurance most can't get it, and the people who do get insurance find it doesn't cover them when it's most necessary. All that is why the individual market shows much lower levels of satisfaction than, well, every other insurance market:


Graph via Jon Cohn

Those numbers, of course, don't include the people who couldn't get insurance because they were deemed too sick. Consumer Reports put it unusually bluntly:

Individual insurance is a nightmare for consumers: more costly than the equivalent job-based coverage, and for those in less-than-perfect health, unaffordable at best and unavailable at worst. Moreover, the lack of effective consumer protections in most states allows insurers to sell plans with ‘affordable’ premiums whose skimpy coverage can leave people who get very sick with the added burden of ruinous medical debt.

Jonathan Cohn puts a human face on it:

One from my files was about a South Floridian mother of two named Jacqueline Reuss. She had what she thought was a comprehensive policy, but it didn't cover the tests her doctors ordered when they found a growth and feared it was ovarian cancer. The reason? Her insurer decided, belatedly, that a previous episode of “dysfunctional uterine bleeding”—basically, an irregular menstrual period—was a pre-existing condition that disqualified her from coverage for future gynecological problems. She was fine medically. The growth was benign. But she had a $15,000 bill (on top of her other medical expenses) and no way to get new insurance.

This is a market that desperately needs to be fixed. And Obamacare goes a way toward fixing it. It basically makes the individual market more like the group markets. That means that the sick don't get charged more than the well, and the old aren't charged more than three times as much as the young, and women aren't charged more than men, and insurance plans that don't actually cover you when you get sick no longer exist. But the transition disrupts today's arrangements.

(Interestingly, recent Republican plans have focused on disrupting the employer market by ending, limiting, or restructuring the tax exclusion for employer-based plans. There's an extremely good case to be made that that needs to be done, but it means much more disruption for a much larger number of people. Obamacare's focus on disrupting the individual market -- and only the individual market -- is a more modest approach to health-care reform.)

There's been an outpouring of sympathy for the people in the individual market who will see their plans changed. As well there should be. Some of them will be better off, but some won't be.

But, worryingly, the impassioned defense of the beneficiaries of the status quo isn't leavened with sympathy for the people suffering now. The people who can't buy health insurance for any price, or can't get it at a price they can afford, or do get it only to find themselves bankrupted by medical expenses anyway have been left out of the sudden outpouring of concern.

If people have a better way to fix the individual market -- one that has no losers -- then it's time for them to propose it. But it's very strange to sympathize with the people who've benefited from the noxious practices of the individual market while dismissing the sick people who've been victimized by it.

Obama is rightly taking flack for making a promise he wasn't going to keep, and he's right to apologize for it. But he shouldn't apologize for blowing up the individual market. It needed to be done.

Wonkbook's Number of the Day: 6.6 million. That's how many days in lost work the Obama administration said in a brand-new report that the government shutdown cost the U.S.

Wonkbook's Quotation of the Day: “Let’s assume they got married. What difference would it make to me and my family? Zero. None. None,” said Sen. Harry Reid of two male neighbors he once had without realizing that they were gay. Read Jeremy W. Peters's fascinating look at changing Mormon attitudes towards homosexuality.

Wonkbook's Graph of the Day: How the U.S. minimum wage compares with ones abroad.

Wonkbook's Top 5 Stories: 1) doctor, doctor; 2) fiscal policy's economic mess; 3) how to help and hurt the poor; 4) all things must come to an ENDA; and 5) how easy is it to be green?

1) Top story: A doctor, a doctor, get Obamacare a doctor

Dems give White House tight deadline to fix Obamacare. "At the pleading of senior White House officials, Senate Democrats are holding off on demands to delay major aspects of the health care law until the Obama administration has the opportunity to fix the website problems that are thwarting enrollment in the program. Democratic senators facing reelection have a green light to bash the White House and call for certain legislative fixes. But they’ve been urged by senior administration officials not to insist on delaying the controversial law’s core: The mandate for individuals to purchase insurance coverage or face penalties." Manu Raju and Seung Min Kim in Politico.

@Goldfarb: Striking how fast White House switches from being defiant to contrite over Obamacare.

Obama’s former exchange czar defends the insurance cancellations. "'The people you commonly hear from don't mind having a policy below bronze, and don't want to pay for bronze or silver or gold. And as long as they stay healthy, that will be a good policy for them. What they don’t realize is they’re one step away from losing security if they do get sick. But right now, they're getting what feels like good coverage that, due to underwriting, is at a good rate.... Right now you have stories of people losing. But once the law goes into effect, and people have new health security, the stories will play in an opposite way. So you see this is, in the short-term, hurting the law, but the long-term factors here are very much in favor of the law. Assuming the Web site gets fixed.'" Sarah Kliff in The Washington Post.

Watch: Obama (kinda, sorta) apologizes to Americans losing their health planSarah Kliff in The Washington Post.

Uh-oh: Techies are finding new problems with HealthCare.gov. "Today's "Operational Update on the Health Insurance Marketplace" was not especially good news: As capacity problems at the start of HealthCare.gov get fixed, tech workers are finding new capacity problems later in the application process — ones that, up until now, they didn't know about." Sarah Kliff in The Washington Post.

@ByronYork: The simple question that will determine Obamacare's fate: Will it help more than it hurts, or hurt more than it helps? Looking iffy…

Meanwhile, in health policy: The FDA wants to eliminate trans fats. You can thank Mike Bloomberg for that. "The Food and Drug Administration announced earlier today that it will take steps to eliminate trans fats from the American food supply by no longer describing the heart-clogging ingredient as "generally recognized as safe," a label that allows food companies to use trans fat without specific FDA approval." Sarah Kliff in The Washington Post.

...And here come new rules on mental health. "The Obama administration will issue long awaited regulations Friday that require insurers to treat mental illness and addiction the same as physical illnesses, current and former lawmakers said. In testimony Thursday before a Senate Judiciary subcommittee, mental health advocate and former Rep. Patrick Kennedy (D-R.I.) said Health and Human Services Secretary Kathleen Sebelius would announce the action during a speech in Atlanta. Members of the panel familiar with the rule-making also said the regulations would be issued Friday." Ben Goad in The Hill.

Music recommendations interlude: The Seeburg 1000.

Top opinion

KLEIN: Do political campaigns even matter? "The result is that while most election narratives track the inputs of the campaign, Sides and Vavreck track the outputs. They know less than traditional political reporters about what the campaigns wanted to do but much more about what actually got done...Campaigns are less successful at persuading undecided voters than they are at encouraging their own partisans to grow more fierce. The manic charges and countercharges of an election mostly remind voters which side they were on to begin with." Ezra Klein in Bloomberg.

DAYEN: Congress is starving the agency that is supposed to prevent another meltdown. "While the rule-writing process is important — and Wall Street lobbyists have fought hard for exemptions and loopholes on derivatives rules — the lack of resources has made rules almost irrelevant, since the CFTC simply cannot enforce them. The agency is being hollowed out from the inside, yet another way that the financial industry can achieve its goal of gaining the freedom to ignore the law in pursuit of profit." David Dayen in The New Republic. 

FLEISCHER: House, pass ENDA. "Allowing people to be successful in their workplaces is an essential piece of individual opportunity and liberty. Working for a living is one of America’s freedoms. It’s a virtue to be encouraged — and supporting it is important to the future of the Republican Party. In an era in which the government often punishes hard work and individual success, this bill encourages it." Ari Fleischer in Politico.

BEQUETTE: Why we shouldn't even talk about any gun-control ideas ever. "I made a mistake by publishing the column. I thought it would generate a healthy exchange of ideas on gun rights. I miscalculated, pure and simple. I was wrong, and I ask your forgiveness.... [T]hese recent events have convinced me that I should advance that schedule immediately...Dick Metcalf has had a long and distinguished career as a gunwriter, but his association with “Guns & Ammo” has officially ended." Jim Bequette in Guns & Ammo.

KRUGMAN: The mutilated economy. "It’s pretty clear, however, that the blockbuster paper of the [IMF] conference will be one that focuses on the truly ugly: the evidence that by tolerating high unemployment we have inflicted huge damage on our long-run prospects...[O]ur seemingly endless slump has done long-term damage through multiple channels. The long-term unemployed eventually come to be seen as unemployable; business investment lags thanks to weak sales; new businesses don’t get started; and existing businesses skimp on research and development...What’s more, the authors — one of whom is the Federal Reserve Board’s director of research and statistics, so we’re not talking about obscure academics — put a number to these effects, and it’s terrifying. They suggest that economic weakness has already reduced America’s economic potential by around 7 percent." Paul Krugman in The New York Times.

BERNSTEIN: The cost of feckless policy. "It may seem as if these bouts of dysfunction we have been going through are painful while they last but forgotten once they are over.  The lesson I take from this paper is that in fact, policy neglect hurts not just for the short term, but also for years afterward.  The longer this period of weak job growth, elevated long-term unemployment, tepid G.D.P. growth, low capital investment and so on lasts, the more the distinction between cyclical and structural blurs and the more we shave off potential G.D.P. growth." Jared Bernstein in The New York Times.

GERSON: Evangelicals and immigration reform. "In the immigration reform debate, evangelicals have become a political prize claimed by restrictionists and reformers alike. Both sides have a case to make...Those who attend worship services more frequently are more likely to oppose same-sex marriage — tending toward the traditionally conservative position. But immigration provides a contrast. Those who attend worship services more frequently are less likely to see newcomers as a threat to American values. They tend toward the less typically conservative view." Michael Gerson in The Washington Post.

SIDES AND VAVRECK: Republicans haven't lost women. "We measured attention to contraception and abortion in 11,000 publications and media outlets in 2012, tracking the controversies about these issues. We then combined this information about news coverage with weekly polling from the presidential race. Our analysis showed that women’s attitudes toward Obama or Romney were no different when abortion and contraception were in the news, compared with when they weren’t. This was true for all women and specifically for those in their childbearing years." John Sides and Lynn Vavreck in Bloomberg.

Epistolary interlude: Letters from great minds.

2) Congress, having ran the car nearly out of gas, shoves on the emergency break

Here’s how the economy was doing before Congress decided to shut down the government. "When the numbers first flashed across data terminals across financial world, it looked like a solid win: Gross domestic product in the United States rose at a 2.8 percent annual rate in the July through September quarter, which looked as if it had beaten the 2 percent that analysts had forecast. Until one looked at the details, that is. The surprise improvement -- up from an average of 1.2 percent growth over the previous three quarters -- was driven by a buildup in business inventories." Neil Irwin in The Washington Post.

White House puts a price on the shutdown. "Lost work: 6.6 million days. Back-pay costs: $2 billion. Private-sector jobs lost: 120,000. Those are just some of the costs of the 16-day partial government shutdown that ended last month, the Obama administration said in a detailed report released Thursday...The most direct cost, the report said, is the $2 billion in back pay that will go to federal workers who were furloughed. Government agencies — from the sprawling State Department to the tiny Export-Import Bank — were ordered to send nonessential workers home, resulting in about 40 percent of civilian federal employees going off the clock." Annie Lowrey in The New York Times.

Read: The report behind the numbers.

Super Mario to the rescue: The ECB cuts interest rates. "[I]t wasn't the fundamentals that made the ECB's rate cut Thursday morning a surprise. Rather, it was the decisiveness and speed with which the bank moved to cut short-term interest rates a quarter point, down to 0.25 percent. Analysts had assigned only perhaps a one-in-four or so chance it would make such a move, and thought it more likely the ECB would drag its feet and wait for more data to prove that Europe is falling into a Japan-style deflation trap." Neil Irwin in The Washington Post.

TARP official in line to be next CFTC chief. "The Obama administration is preparing to tap Timothy Massad, who has overseen the Treasury Department's bank-rescue program for the past three years, to head the Commodity Futures Trading Commission, according to current and former government officials familiar with the matter. If confirmed by the Senate, Mr. Massad would fill the role vacated by Gary Gensler" Andrew Ackerman in The Wall Street Journal.

Yellen hearing to stir up Fed issues. "Senators will press Janet Yellen on a number of issues next week during a confirmation hearing on her nomination to lead the Federal Reserve, but one likely topic is a matter over which she has no control: the vacancy for a Fed vice chairman for supervision. It is up to President Barack Obama to nominate a candidate for the job, a new role within the seven-member Fed board created by the Dodd-Frank financial law more than three years ago. He has yet to do so, frustrating Republican critics and some Democratic supporters of the law." Victoria McGrane in The Wall Street Journal.

Watch: The University of Chicago hosted a cool forum on the work that won Eugene Fama and Lars Hansen the Nobel Prize in economicsJohn H. Cochrane's blog.

Freddie, Fannie payments nearly match aid. "Fannie Mae and Freddie Mac will pay $39 billion to the U.S. Treasury by the end of the year, the companies said Thursday, putting the firms close to having paid as much as the government injected in the mortgage-finance giants — nearly $188 billion — to keep them afloat through the housing bust...[U]nlike other financial companies that were bailed out by taxpayers, Fannie and Freddie will continue to send the bulk of their profits to the Treasury indefinitely, as dividends. They aren't allowed to earn their way out of government control." Nick Timiraos in The Wall Street Journal.

Weekly jobless claims decline. "Initial claims for jobless benefits, a measure of layoffs, declined by 9,000 to a seasonally adjusted 336,000 in the week ended Nov. 2., the Labor Department said Thursday. Economists surveyed by Dow Jones expected 335,000 new claims. The Labor Department revised the prior week's figure upward to 345,000." Sarah Portlock in The Wall Street Journal.

And you thought you had seen it all interlude: Your TV arrangements may soon change dramatically.

3) How to help and hurt the poor

$10 minimum wage has more support from White House. "President Obama, the official continued, supports the Harkin-Miller bill, also known as the Fair Minimum Wage Act, which would raise the federal minimum wage to $10.10 an hour, from its current $7.25. The legislation is sponsored in the Senate by Tom Harkin of Iowa and in the House by George Miller of California, both Democrats. It would raise the minimum wage — in three steps of 95 cents each, taking place over two years — to $10.10, and then index it to inflation. The legislation will probably be coupled with some tax sweeteners for small businesses, traditionally the loudest opponents of increases to the minimum wage." Catherine Rampell and Steven Greenhouse in The New York Times.

Localities have taken the lead on wages. "Eighteen states and the District of Columbia already mandate wages above the federal minimum, and New Jersey and New York join the ranks next year. California, Connecticut and Rhode Island will also raise their minimum wages in 2014." Eric Morath in The Wall Street Journal.

The cut in food stamps will make life harder for those it is already a struggle. "[F]or millions of poor Americans who rely on food stamps, reductions that began this month present awful choices. One gallon of milk for the kids instead of two. No fresh broccoli for dinner or snacks to take to school. Weeks of grits and margarine for breakfast. And for many, it will mean turning to a food pantry or a soup kitchen by the middle of the month." Kim Severson and Winnie Hu in The New York Times.

Unemployment benefits for 2.1 million workers are set to expire early next year. "On Dec. 31, the federally funded Emergency Unemployment Compensation program is slated to expire. Once that happens, jobless aid programs will largely shrink to their pre-recession states, and millions of people will lose their unemployment benefits. The report (pdf), from the National Employment Law Project, estimates that 1.3 million jobless workers will lose their benefits immediately at the start of 2014. Another 850,000 workers will exhaust their regular unemployment insurance in March and won't be able to take advantage of the expanded benefits." Brad Plumer in The Washington Post.

How Social Security redistributes money from minorities to whites. "There are obvious ways in which the program was designed to be progressive, by redistributing (some) money from high earners to low earners. But it also has some regressive features: Because retirement benefits are paid out in monthly installments rather than in lump sums, wealthier people who live longer tend get bigger benefits than, say, poor people with shorter lifespans." Brad Plumer in The Washington Post.

Inspiring interlude: Helping a homeless veteran.

4) Is this the beginning or the ENDA?

Senate approves ENDA. "The Senate passed legislation Thursday banning workplace discrimination against gay, lesbian, bisexual and transgender workers, nearly two decades after a push for such protection began in Congress. Supporters hailed Thursday's bipartisan 64-32 vote as a civil-rights milestone, but opponents said the measure could generate costly litigation for employers. Resistance in the GOP-controlled House is expected to bring the bill's momentum to a halt." Kristina Peterson in The Wall Street Journal.

Mormons for gay rights. "At nearly every critical juncture, the Senate bill that passed Thursday banning workplace discrimination because of gender identity and sexual orientation has had an unconventional and powerful ally. Mormons, reflecting shifting attitudes inside their church, have stepped in to provide the political muscle, the additional momentum or the decisive vote...Their support for including civil rights protections for gay, lesbian, bisexual and transgender people is the latest example of a broader evolution by some of the most visible members of the Church of Jesus Christ of Latter-day Saints, who have come to cautiously embrace gay rights." Jeremy W. Peters in The New York Times.

Time interlude: Visualizing the eons with Wikipedia.

5) How easy is it to be green?

California may beat its renewable-energy production goal. "Public support for rooftop solar and investments by major companies will push renewable energy generation beyond California’s targets by 2020, a Los Angeles energy lawyer said. Projects by Microsoft Corp. and other companies are showing an appetite for wind and solar power that will continue even if the federal government doesn’t extend tax credits that expire at the end of the year, said Jerry Bloom, chairman of Winston & Strawn LLP’s energy, project development and finance practice group." Naureen S. Malik in Bloomberg.

How the Energy Department is trying to make solar panels cheaper. "For many people, living in a solar-powered home is a pipe dream. Local rebates, federal tax credits and plummeting hardware prices help, but in the end, panel installation will generally cost the average homeowner at least $20,000. This is largely due to so-called “soft costs,” required to fulfill permitting and inspection obligations that can account for as much as 60 percent of total panel installation, according to the U.S. Department of Energy. An Energy Department study recently found that more than 35 percent of panel installers avoid selling in certain areas because of permitting difficulties. They’re aiming to change that. On Wednesday, the Energy Department announced an investment of $12 million to make solar permitting easier for approximately 147 million people in 25 states." Emily Atkin in Think Progress.

Energy Dept. failed to report concerns as green-tech firm was heading for bankruptcy. "The Department of Energy failed to disclose concerns about a green-technology company that won $135 million in federal funding but ended up filing for bankruptcy in September, according to a watchdog report released this week.... The report said the DOE knew in May that Ecotality was not on track to meet an important milestone for a grant to install charging stations and that agency officials failed to disclose that information for an audit that the inspector general’s office released roughly two months later." Josh Hicks in The Washington Post.

Obama taps former Reid aide to run Interior energy agency. "President Obama is tapping a former aide to Senate Majority Leader Harry Reid (D-Nev.) to direct the Interior Department branch that regulates oil-and-gas drilling, green power development and conservation on huge swaths of federal land. Neil Kornze, the nominee to formally head the Bureau of Land Management (BLM), is BLM’s principal deputy director and has been leading the bureau on an acting basis for eight months." Ben German in The Hill.

Reading material interlude: The best sentences Wonkblog read today.

Wonkblog Roundup

Can Whole Foods ever be cheapLydia DePillis.

Why investors love Twitter’s low sales numbersNeil Irwin.

Why did we go to war in Iraq? An interview with Peter BakerEzra Klein.

The budget myth that just won’t die: Americans still think 28 percent of the budget goes to foreign aidEzra Klein.

Watch Obama (kinda, sorta) apologize to Americans’ losing their health plans. Sarah Kliff.

Unemployment benefits for 2.1 million workers are set to expire early next yearBrad Plumer.

Uh-oh: Techies are finding new problems with HealthCare.gov. Sarah Kliff.

The FDA wants to eliminate trans fats. You can thank Mike Bloomberg for thatSarah Kliff.

Obama’s former exchange czar defends the insurance cancellationsSarah Kliff.

How Social Security redistributes money from minorities to whitesBrad Plumer.

Super Mario to the rescue: The ECB cuts interest ratesNeil Irwin.

Here’s how the economy was doing before Congress decided to shut down the governmentNeil Irwin.

Et Cetera

CIA said to pay AT&T for call dataCharlie Savage in The New York Times.

U.S. students make slight progress on test scoresStephanie Banchero in The Wall Street Journal.

Got tips, additions, or comments? E-mail me.

Wonkbook is produced with help from Michelle Williams.

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