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Can Obama Sell the Nation on Health Care Reform?

The views expressed are those of the author and are not necessarily those of Scientific American.

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As a journalist and a health advocate, I have a professional interest in health care reform. But as the Supreme Court upheld the Affordable Care Act this week, I had a personal interest as well. Last fall, after three decades as a salaried employee with health benefits, I became a self-employed consultant with none. And this spring, after 56 years of perfect health, I learned that cancer had invaded my colon and my liver. Fortunately, my wife has an employer-sponsored plan that covers my treatment, but without health care reform, my treatment would hinge on her job status. Any change in her employment could have landed me in front of a death panel—not a fictional one manned by bureaucrats who ration our health care, but a real one made up of insurance companies that couldn’t or wouldn’t cover people with known health problems.

Many Americans live closer to the edge than I do, and each of them has a stake in this this week’s ruling. As the Institute of Medicine declared in a 2009 report, the continuing decline in access to health care is causing “illness, suffering, and even death” among children and adults in this country. Yet polls consistently show that more Americans oppose the Affordable Care Act than support it—not because they’ve evaluated and rejected it but because they don’t understand it. There are plenty of reasons for that confusion; the law is complicated, opponents have misrepresented it, and the news media have focused on the politics rather than the substance. But as the bill’s chief architect and advocate, President Barack Obama bears equal blame for the tepid public response. Contrary to his persistent illusion, bold reforms don’t survive on merit alone. They have to be sold—and this one has scarcely been marketed.

As signed into law two years ago, the Affordable Care Act holds tangible advantages for most Americans. By 2014, it will create new health care options for 30 million people who now lack coverage, while improving quality and lowering costs for those who are insured. The act has already secured coverage for 3 million young adults by enabling them to stay on their parents’ plans through age 25. Millions more children and adults will have new gateways to health care in 2014, thanks to new tax credits and an overdue revision of Medicaid’s eligibility rules. The new law also bars insurers from discriminating against people with “pre-existing conditions”—a group that includes roughly half of the non-elderly population—and freed 105 million policyholders from the lifetime caps on essential benefits. Before that rule took effect, some 20,000 patients were being dropped by their insurers every year, often while receiving critical care. The expansion of access may sound costly, and it is. But by bringing healthy people into the insurance pool, and improving the quality of care, it will save the average American household nearly $1,600 a year by 2019, according to an analysis by Families USA. And the nonpartisan Congressional Budget Office estimates that the act will shave $130 billion off the federal deficit by 2020.

When asked, people tend to favor specific reforms such as barring discrimination against those with pre-existing conditions. Yet surprisingly few associate these reforms with the Affordable Care Act. In January 2010, just before Obama signed the act into law, the Pew Research Center quizzed a national sample of adults on its basic provisions. Only 39 percent knew it would protect people with pre-existing health conditions. Only 33 percent knew it would help them switch jobs without losing their insurance. And just one in five (21 percent) realized it could reduce their out-of-pocket health care costs. Obama acknowledged his own failure to communicate at the time, saying, “I take my share of the blame for not explaining [the act] more clearly to the American people.” But two years and countless news cycles later, the public has yet to be rallied to its own defense. In recent polls conducted by the Pew Research Center, the Kaiser Family Foundation and AP-GfK, opponents of the act still outnumber supporters by 5 to 14 percentage points. And with House Speaker John Boehner (not to mention presidential hopeful Mitt Romney) still promising to repeal health care reform, public opinion still matters.

How could a leader with Obamas rhetorical talents fall so flat on such a critical issue? The failure stems partly from his misplaced faith in the decency of his adversaries. As the Affordable Care Act was taking shape in 2009, Obama’s progressive base clamored for a single-payer system that would cover all Americans. The President ditched that idea, along with a more modest “public option” that would give people an alternative to the private insurance market. Instead he adopted a longstanding Republican idea: the so-called individual mandate. To expand the health system’s financial base without swelling the public sector, the mandate simply requires everyone to get some form of insurance. “Many [states] require anybody driving a car to have liability insurance,” the conservative Heritage Foundation argued in a seminal 1989 pitch for the idea. “But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement.”

As passed by Congress and enacted two years ago, the Affordable Care Act included that requirement. But instead of lining up behind their own idea, Republican lawmakers set about demonizing it as a government attack on consumer freedom. Meanwhile, attorneys in conservative states filed a barrage of lawsuits challenging its constitutionality. It was the President’s moment to rally the country with a story about basic human needs and his determination to see them fulfilled. But the man who won the presidency by winning our hearts held back, assuming that reason would prevail, and his opponents gladly supplied a new story line. Instead of a narrative about the desperate struggles of ordinary Americans, the public got one about Barack Obama as a radical ideologue scheming to force his views on a freedom-loving country.

The White House has learned from the experience and is speaking out belatedly on the benefits of the health care reform. Now that the court has upheld the health care reform law, the President and his allies have a new chance to forge a national consensus—not through government pronouncements but through the kind of mass mobilization that swept him into office four years ago. No one did more to defeat the Clinton administration’s 1993 health care proposal than “Harry and Louise,” the fictional suburban couple victimized by government bureaucrats in television skits produced by the insurance industry. By 2008, the actors in those ads had seen enough to switch sides and produce a new set of spots urging the next president, Democrat or Republican, to place health care reform at the top of his agenda. (“Lisa’s husband just found out he has cancer,” Louise confides to Harry this time. “He just joined a startup and he can’t afford a plan.”)

Obama heeded the call during his first year in office, but his allies have been outspent three-to-one by opponents since the Affordable Care Act took effect in 2009. This spring, his Health and Human Services department selected a PR firm to produce educational materials about the act, as the law itself requires. But the face of health care reform is still that of a demonized politician—Barack Obama himself—not that of a family bankrupted by medical bills or a child denied asthma treatment because the condition predates her insurance policy. Finally this spring, Obama’s election web site has started profiling people whose stories show in raw, personal terms what’s at stake for the country. If the president can use this week’s court ruling to reassert his own gifts as a storyteller—and his supporters can spark the kind of social-media uprising that helped elect him—health care reform may yet have a chance. His success, and our well-being, now depend on it.

Geoffrey Cowley has worked as a senior editor at Newsweek, an associate commissioner at the New York City Health Department and a media director at the Planned Parenthood Federation of America. He is now an independent journalist and public health consultant.

Supreme Court of the United States Photo Credit: Wikimedia Commons/UpstateNYer

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  1. 1. RDH 1:39 pm 06/28/2012

    So now as a self-employed person you can forgo buying health insurance and instead pay the tax that Obama swore up and down is not a tax and when you find you have cancer, you can walk into any insurance company and take out a plan and get treatment. Sweet. Comparing insurance to the tax I can see that people will save a lot of money doing just that. May be time to rebalance any portfolio to remove insurance companies as this could mean they will lose a lot of money. But I’m sure Obama knows that and is counting on it.

    By the way author, if you wife did not work (or you had no wife) would you not have taken out health care apriori? And if you could not afford it, isn’t there medicaid?

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  2. 2. Soccerdad 1:39 pm 06/28/2012

    I take offense to your statement that those who oppose the Affordable Care Act do so because they don’t understand it. I understand it very well. For me the issue with it is not so much the mandate, as offensive to freedom as that is, but the unsustainable burden it will place on Federal spending, where already $0.40 of every dollar spent is borrowed. This law will give subsidies to people with incomes up to $80,000 per year! Who will be left to actually pay a net positive income tax with subsidies like that? The capacity to extract taxes is limited, and what remains needs to be used to bring the budget into balance.

    The other big issue is the perverse incentives. Companies will have incentive to dump health insurance, saving money and paying employees more in the process. The only loser is the taxpayer, as they will be left to pick up the tab. The penalty for not buying insurance is only a few hundred dollars. Therefore there is a strong incentive to go without, and buy insurance only when you need expensive care. The loser: the taxpayer and those responsible enough (or dumb enough) to actually carry insurance all the time.

    This monstrosity is seriously flawed and will collapse the health insurance market and the federal budget. Of course, that’s exactly what many of the law’s supporters want. At that point the government will need to step in and take over the entire system and everyone will be on the public dole for health care. Of course, then everyone will also be under a crushing tax burden because of it.

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  3. 3. hanmeng 2:35 pm 06/28/2012

    Soccerdad is correct. Cowley’s commentary shows the trouble with liberals. They think they know everything and that anyone who disagrees with them is either ignorant or has some evil agenda. Many articles in Scientific American show a touching belief that government will be able to solve any problem. Perhaps it shouldn’t be surprising, since most scientists themselves are statists who get their money from the government. But it shows scientists are not necessarily as rational as they’d like to think.

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  4. 4. Bionate 3:45 pm 06/28/2012

    here is my question to everyone who opposes the affordable care act. What would you do that is so much better? Healthcare in America is the most expensive of any other advanced economy and by any numerical metric that anyone can think of we fall way behind. So we’re paying the most and getting the least clearly there is a problem.

    on a moral issue we are the only advanced economy that doesn’t provide health care for all of its citizens and we justify it by saying that people are either lazy or just young and don’t really need healthcare. Plenty of young people need health care they just manage without and if they lived in any other Western country they wouldn’t have to. And just as a side note what do young people become? Elderly people and eventually they will need healthcare so it’s kind of like a down payment on your future needs.

    And anyone who has been amongst the working poor knows they are not lazy it’s simply hard to get ahead when you’re working 80 hours a week for minimum wage.

    I fully admit that I’m a liberal and I do support a larger role for government within the healthcare industry. I am also a person with a major medical disability so I have received insurance through the government most of my life and I have always gotten excellent care.

    I’m not saying people who disagree with me are ignorant or don’t understand I’m simply asking what is the replace part of repeal and replace. We have serious issues what would you do to correct them?

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  5. 5. singing flea 11:56 pm 06/28/2012

    “Perhaps it shouldn’t be surprising, since most scientists themselves are statists who get their money from the government.”

    Most scientists? Let’s at least get real here. Most scientists work for private industry.

    Let’s not just throw up arguments for the sake of pointing fingers. There is a big difference between ‘most’ and ‘some’.

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  6. 6. Cara Schulz 12:15 am 06/29/2012

    “Yet polls consistently show that more Americans oppose the Affordable Care Act than support it—not because they’ve evaluated and rejected it but because they don’t understand it.” And with that quote, you lose me. What an assumption to make. I oppose it because I’ve lived overseas and have seen and experience what true socialized medicine is – and Obamacare isn’t it. It’s a mockery of socialized medicine. It’s the worst of both worlds – privatized profits and socialized losses. Yet we’re supposed to cheer for it and if we don’t it’s because we are ignorant.

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  7. 7. arynix 2:45 am 06/29/2012

    Moving away from payment-for-procedure, tort reform, and opening health insurance to interstate commerce are precisely the kinds of reforms we need and which will improve our very broken health care delivery system. And, surprise, these don’t cost anything. And, surprise again, they are not in the ACA.

    Something else seems to be lost on supporters: insurance companies are businesses. Hospitals are businesses. Medical providers are businesses. The notion that these businesses are forced to provide certain services at certain prices is akin to passing a law that all restaurants have to feed people regardless of what and whether they can pay, that everyone must buy a “dining coverage” plan or pay a tax as punishment, and that restaurants are not allowed to plan their own menu. Let’s use some logic, please.

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  8. 8. geojellyroll 9:31 am 06/29/2012

    ‘Scientific’ American?

    Despite the name, this is an international science site. Why not discuss Chinese farm subsidies or Russian alcohol controls?

    Back to science, please.

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  9. 9. MARCHER 6:39 pm 06/29/2012


    If we use logic, do you promise to give it a try yourself?

    Because your comment was devoid of any.

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  10. 10. slayerwulfe 4:10 pm 07/1/2012

    the one thing you didn’t mention are you paying for it(and so responsible for your care)or are other ppl paying it for you. it is not mine or anyone else’s job to provide you with life and if you think it is then you have my permission to die.

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  11. 11. jimmy boy 8:57 pm 07/1/2012

    Why is this RAG only showing one side of this story? What do they have to gain by doing so. Also the writer was bias, by him having to depend his wife insurance.

    How big was this bill anyway how can anyone understand it, even congress did read it before passing it.

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  12. 12. singing flea 3:12 am 07/2/2012

    The title of the article is a joke. Obama already did sell the nation healthcare reform. The real question is, “Can the GOP un-sell it?”

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  13. 13. Bob32 12:24 am 07/3/2012

    The GOP has alledgely spent $250 million doing it’s best
    to debunk the law with nonsense like “Death Panels” and other assorted misrepresentations – and it worked. We have the most expensive health system in the world and its costs fall upon all of us. Our so called non- governmental health insurance paid for by employers is not taxed, any costs are passed on to the rest of us as we purchase goods and services. What we have ain’t exactly free and it’s costs are growing at rates around 10% a year. Having people without healthcare going into bankrupcy or even dying is not a good thing for a great nation. Healthcare can be provided for all and should not depend upon how much an individual can afford. Healthcare must be payed for but there is also a moral imperative and a need for for some compassion. It’s OK to be skeptical and cynical and the ACA is certainly not perfect and shortcomings and we can make it better. Inaction is not a reasonable alternative.

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  14. 14. Quek807 1:33 am 07/3/2012

    So right off the bat, the AHA increases the amount I pay in taxes by raising the deductible for medical. Currently it is everything above 7.5% of adjusted income to everything above 10%. In easy terms, if adjusted income is some huge figure like 40,000 a year you can deduct that amount greater than 3000 dollars. At 10% it is every dollar above 4000 dollars. So if i had 5000 in bills, currently i can deduct 2000. After the law I can only deduct 1000. Exactly how did that make the cost go down for me? It appears to go up.

    As far as the false number of saving me 1600 dollars a year, that is patently false. If my current premium is 500 a month, it would have to drop to 366 a month. How can you add 30 million forced individuals into the insurance arena and have a lower cost?

    Currently health care in Canada is about 6500 per person per year. We have 310 million people. That equates to 1.7 trillion a year. Our current budget which is a deficiet is 3.4 trillion. That is 50% of our budget. That simply can’t work.

    And none of the numbers really means anything compared to the real loser. Our personal freedom. It might be okay for a socialist, but if you believe that you are not property of the state this is an appalling violation of individual rights.

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