By Jon Healey
7:41 PM EDT, September 19, 2013
The battle over healthcare reform legislation has always been as much about politics as policy. So it's not surprising that, as full implementation of the law approaches, the tactics are looking more and more like the last-ditch smears of a failing campaign.
And to think that the anti-Obamacare side is ahead in the polls.
The latest example, as reported by Yahoo News, is a pair of ads from Generation Opportunity, a libertarian-leaning advocacy group that targets young Americans. (According to Yahoo and Politico, the group is funded at least in part by the Koch brothers.) GenOpp, as it calls itself, has launched an advertising campaign on 20 campuses designed to persuade students to "opt out of Obamacare."
The ads focus on a college student (female in one, male in the other) -- who supposedly "signed up for Obamacare" -- going into a doctor's office for a checkup. The doctor positions the student for an unexpected pelvic or prostate exam and leaves the room. As ominous music plays, a "creepy" Uncle Sam rises up out of nowhere, wielding a vaginal speculum or donning a latex glove. "Don't let government play doctor," the ads warn. "Opt Out of ObamaCare."
These are dynamite ads -- if the only thing one cares about is shock value and virality. They also happen to be wildly misleading, taking the hyperbolic "government takeover of medicine" meme to an extreme.
First off, no one will "sign up for Obamacare." Those who are not covered by group plans through their employers will shop for private insurers' individual plans the same way they do today, or through new state insurance-buying exchanges created by the 2010 law.
The law will make individual coverage more affordable for many people -- particularly college students with little income -- by subsidizing the premiums sold through the exchanges. It will also require that coverage to be more comprehensive, mandating that insurers meet or exceed the new minimum coverage levels set in each state. But it will still be private insurance, and care will continue to be delivered mainly by the private sector. (The exception being the county hospitals and public university medical centers that insurers may include in their provider networks.)
In states that choose to do so, the law also expands Medicaid to more low-income individuals and families. That's a public insurance program, but as with private insurers, the care is delivered mainly by the private sector.
Second, despite widespread claims to the contrary, the 2010 law doesn't tell doctors what care to provide or how to provide it. Doctors won't hand over sensitive aspects of patient care -- or any aspect, really -- to the government. The main government role is to look for ways to reduce inefficiencies and change the incentives that are driving up costs without improving quality. That's not the stuff of nightmares; in fact, such efforts are overdue.
(Some critics argue that the cuts the law makes in projected Medicare spending will affect the availability of certain types of care, especially from specialists. But the law specifically bars a new governmental cost-control panel from rationing care or reducing benefits. Besides, Medicare is an insurance program for the elderly, not for college students.)
The law may prompt some people's insurers to trim their provider networks, forcing policyholders to choose between keeping their insurance plan and keeping their doctor. As my colleague Chad Terhune wrote this week, insurers are trying to cut costs by assembling smaller networks of doctors and hospitals for at least some of the plans they're offering through the exchanges. So in order to obtain a more affordable plan, some people may have to switch doctors.
But that process has been happening anyway because insurers are under enormous pressure from big customers to cut costs. Witness the recent fight between Blue Shield of California and the UCLA Medical Center that led the insurer to drop UCLA temporarily from its networks.
GenOpp President Evan Feinberg told Yahoo that the group was trying to persuade students not to buy health insurance. “You might have to pay a fine, but that’s going to be cheaper for you and better for you,” Feinberg is quoted as saying.
Whether it's cheaper for students to go without coverage depends on how much care they need while they're uninsured. The odds are that, if they're as healthy now as they are young, they'll get through 2014 without spending a day in the hospital. But it's a roll of the dice.
And that's the thing about these ads. GenOpp wants to gamble against the 2010 law by playing with other people's money. If younger, healthier people ignore the requirement to carry insurance next year and go without coverage, insurers will be left with a costlier pool of customers, driving up premiums. The higher premiums go, the harder it will be for the law's supporters in Congress to resist the push for repeal.
In the meantime, Americans who need individual insurance coverage will either have to pay more for it (because they were prudent enough to buy it) or will find themselves without it when disaster strikes (because they took GenOpp's advice).
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