A Better Conversation Needed About Paternalism and Health Insurance

Americans have reacted angrily the past couple of days after many have found out that their health insurance plans have been cancelled due to Obamacare. These are plans in the non-group market which comprises about 5% of Americans and do not live up to the minimum standard of coverage that the Affordable Care Act requires. Any plan that existed before 2010 was grandfathered in, but insurers could not continue selling these plans after the law passed. Thus, while Obamacare did not force insurers to change their plans, it offered a strong incentive for them to do so. Millions of Americans around the country are now receiving notices that their plan has been cancelled.

This is contrast to President Obama’s often repeated line that if you like your health plan, you can keep it. This was a complete lie and Americans are rightly furious at him for it. Many liberals have responded to this by arguing that the new plans will offer more comprehensive coverage that will be less expensive for many people, especially when the subsidies are factored in. It will only be a select few that truly have to pay more – and Obama never denied that there would be some losers from health reform.

This argument is exactly correct, but it hides a larger disagreement that lurks beneath the surface and which conservatives have jumped on. By increasing the standards that health insurers must live up to, Obama has decided what constitutes adequate insurance for Americans. He limited their choices by outlawing plans that do not meet those standards. Worse, the president lied about it. He told Americans if they liked their insurance, they could keep it, but in reality, Americans can keep their insurance only if Obama deems it satisfactory. In 2009 and 2010, Americans would never have supported such an open case of paternalism and limitations on consumer choice. This lie was critical in the passage of the Affordable Care Act.

The revelation of this lie has created a lot of anger and finger-pointing from the right. This is entirely justifiable, but that anger will fade as time passes. Americans will finally log on to the federal exchange, see their options are not that bad and be even happier when they factor in the subsidies. Obama knows this anger will pass. The more important question is whether this paternalism is appropriate for the health care sector.

A fundamental problem with health insurance is that people have a difficulty predicting their expected future costs when the risk of catastrophe is low. They choose plans with high deductibles, high out-of-pocket limits and low monthly premiums. These plans may cover limited services and have no lifetime cap. It leaves people open to huge financial risk, but it’s tough for people to take that risk into account when the odds of it are so low, particularly for people who haven’t had to deal with many medical issues.

Think about it this way: the whole point of health insurance is to provide a safety net if something goes wrong. After all, it’s insurance. That means that if nothing goes wrong (i.e. you’re healthy), health insurance won’t save you money. However, if something does go wrong, the opposite is true. That’s why people value health insurance so much. However, having insurance that provides minimum benefits and does not prevent financial catastrophe doesn’t do that. It still leaves you open to financial ruin. That’s not the point of insurance. Many Americans have plans like that though. These are the plans that Obama is looking to effectively eliminate with the new regulations in Obamacare.

The law forces insurers to cover 10 essential health benefits, limits out-of-pocket expenses and bans lifetime caps. All of these rules are there to ensure that a severe injury or illness will not lead to a financial catastrophe as well. These requirements raise the price of coverage, but this is partially offset by the subsidies.

Conservatives may not approve of these regulations, but they have not addressed them in their arguments the past couple of days. Here is the Daily Caller’s Matt Lewis:

The proles were happy with inferior plans. They were too stupid to know what’s good for them. Obama’s lie was necessary in order to bring about the greater good for the most people. The ends justify the means.

For those looking to draw grander conclusions, this is a teachable moment. The hubris necessary for this kind of vast undertaking — impacting nearly 20 percent of the economy! — is  patently unconservative. And I don’t need to trot out some fire-breathing or controversial conservative to demonstrate why this sort of chutzpah is a fundamental affront to basic conservative philosophy.

It’s fine to consider paternalism in general as an “affront to basic conservative philosophy.” The problem is that this sweeping generalization prevents Lewis from evaluating whether this instance of paternalism is justified.

Now, some on the right adhere strictly to a philosophy that freedom of choice is important to a person’s welfare than the welfare-improving effects of any paternalistic policy. Motorcycle helmets may save lives, but the welfare lost by requiring them – and thus the restriction on freedom – is more important. I respect this view, but I don’t subscribe to it. If that is your opinion, then nothing I can say after “Obamacare is a paternalistic law” will convince you that it’s justified.

But if you are open to the idea that paternalism has it’s place in the government, then simply declaring that the law represents a unique form of hubris due to its paternalistic features is not enough. You must explain why it is beyond the level of paternalism that you deem acceptable. This is the stage that conservatives have not tackled yet. They have crucified the president for setting minimum health insurance standards for Americans, but have yet to demonstrate why this is bad.

Why should insurers be able to impose lifetime caps or set exceedingly high limits on out-of-pocket expenses? Why shouldn’t they have to cover hospitalization? Should Americans be able to purchase insurance that leaves them open to financial ruin?

Smart conservatives differ on these questions and have ideas to address them, but the arguments so far have centered on the fact that any paternalism in the law is unacceptable. That generalization does nothing to answer those questions. It’s time to break out of that limited mindset and address the actual issues.

FOMC Expectations Show The Non-Taper Worked

The FOMC will release its October statement at 2PM today and the widely held expectation is that the Fed will stand pat and continue its $85 billion in bond purchases. Despite the overwhelming belief that the Fed would taper in its September meeting (it didn’t), the exact opposite belief is now conventional wisdom this time around. Why did everyone’s expectations about Fed policy take such a dramatic turn?

Not because the economy suddenly crashed. Equities are still rising and interest rates have fallen in the past month as the market has pushed back the timeline for the taper. The jobs report was underwhelming, but not catastrophic. Consumer confidence fell, though this wasn’t surprising. The government shutdown hurt the economy, but much of it will be made back in the upcoming quarters and we also avoided a default. The shutdown has also delayed the release of some economic data.

All in all, it has been a mediocre, slightly below average last month of economic news. But based on market expectations last time, slightly below average data would still lead the market to expect the Fed to taper. Since that’s not the case, then it’s not the data alone that has caused Fed watchers to adamantly believe that the Fed won’t taper this time. It’s because the Fed regained its credibility and realigned the market’s expectations with future Fed policy.

The Fed cannot commit to any action it will take in the future since it does not know the future state of the economy. But it can give the market a baseline of how it will react if certain economic conditions come to pass. That’s what Bernanke set out to do in June when he said that the Fed would begin tapering in the fall if the market continued to improve at a moderate pace. Over the summer, that improvement slowed, but the market didn’t adjust its expectations to take into account this slowdown. It assumed that the baseline that Bernanke laid out was a set path of action, despite his repeated admonitions not to take it that way.

In fact, this blind belief that the Fed would taper caused interest rates to rise which weakened the economy and gave further incentives to the committee to continue its bond buying. By pricing in the taper, the market helped create the economic conditions for the Fed to do just the opposite.

Through all of that, the FOMC sent a message in September: Don’t assume that the Fed won’t adjust its policy based on the underlying economic data. Finally, Fed watchers and the market are catching on. The 180-degree turn in expectations is a direct result of the Fed convincing the market that it’s data-dependent and for them to use the Fed’s forward guidance as just that, a guide not a set path. The unanimous belief that the Fed will not taper today is evidence of that policy’s success.

Why Obama’s Lie About Keeping Your Health Insurance Infuriates People

Over the last day, liberals have been on the defensive explaining why so many Americans are finding out their insurance plans have been discontinued. These explanations have been fundamentally correct, but they have failed to grasp why Americans are so infuriated by this. The Washington Examiner’s Phillip Klein gets closest to it in a piece yesterday:

When Obama took office and made health care his top priority, he understood that one of his main tasks was to convince Americans that he had a plan that could improve the health care system for those who it wasn’t currently working well for (such as those with pre-existing conditions) while leaving it untouched for those who were satisfied.

This is exactly right. Obama sold the law on the idea that for all those who liked their coverage, nothing would change. For those that didn’t or didn’t have coverage, it would be an improvement. Sure, there would be losers, but Obama assured Americans that they could keep the insurance they had.

If he was being honest, this is what he would’ve said:

For the vast majority of Americans, the Affordable Care Act won’t disrupt your health coverage. You’ll get to keep your plan and your doctor. But there are some people for whom I can’t make that guarantee, because your current health insurance is too weak to provide adequate protection. In creating this law, we set out not just to ensure Americans have access to the most basic coverage that leaves them on the hook for huge out-of-pocket costs. We sought to make health care coverage more comprehensive and that required creating a minimum benchmark that insurers must meet.

This will only affect the individual market where around 5% of Americans purchase health insurance. Plans that existed before 2010 will be grandfathered in, but we know insurers change these plans frequently and will likely do so again. That means they will have to comply with these new standards and that will require discontinuing some plans that they currently offer. I can’t guarantee that everyone will keep their plan, but I can guarantee that your new plan will be more comprehensive and provide a greater safety net in case catastrophe strikes.

Does that sound like a speech that would garner huge support? Of course not. You know what sounds a lot better? This:

[N]o matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.

That’s what President Obama told the American Medical Association in 2009. It’s straightforward, comforting and a lie.

That’s why many Americans are furious at the administration right now. They were promised they could keep their plan and they can’t. They don’t care about “the big picture,” the more comprehensive coverage or the subsidies that may reduce their premiums. They don’t like change and they don’t like navigating the confusing health care market. Now they are forced to do both. Most importantly, they didn’t expect this to happen. They are shocked and angry.

Liberals have done a good job explaining why this change is necessary and beneficial for Americans, but they have not done a good job understanding why this lie is so infuriating. It convinced Americans to support the law and allow its passage. It gave Americans comfort that if they had coverage, nothing would change. Finding out that such a critical component of Obamacare was a lie is a startling realization, especially for a law that has gone through such a turbulent few years. Supporters need to step back and let that sink in for a second. Instead of cramming an explanation down Americans’ throats and declaring that conservatives simply aren’t engaging with the policy arguments, liberals need to understand that anger over these cancellations does not stem from partisan bickering. It comes from a promise Obama broke. The blame lays squarely at his feet.