Do Americans Want Choice, or Do They Just Want Health Care?

Do Americans Want Choice, or Do They Just Want Health Care?

25 mins read

Ad will collapse in

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The ad is slick; the actors, suitably concerned. “We can’t afford one-size-fits-all plans,” a woman protests. Her complaint, written for her by the Partnership for America’s Healthcare Future — a front group for private insurers, hospitals, and pharmaceutical companies — is a simple one to grasp. She doesn’t want Medicare for All. She wants choice: the choice to keep her private -insurance plans, to tell the government to butt out. It is not a novel presentation. The woman in the ad revives fears once given life by opponents of the Affordable Care Act. Though the ACA, even in its most liberal version, introduced a public option while keeping the private insurance industry intact, critics in both parties warned that it would sacrifice choice on the altar of big scary government. Then and now, the implication is consistent: Americans are hardy and independent creatures, and they value free will above all else.

Pete Buttigieg expressed those exact sentiments at a campaign event this week:

But Buttigieg and his fellow travelers might be wrong, according to a new report from Axios, based in part on research by the Kaiser Family Foundation. When people have choice in health care, they don’t often exercise it. People “rarely switch” health insurance plans “even if they could have gotten a better deal,” Axios reports — and the tendency is widespread. Workers who get insurance through their employers usually keep whichever option they initially picked, no matter what alternatives are available to them. “You’re more likely to stick with the choice you’ve already made if you’re not sure you’re going to benefit from switching,” economist Benjamin Handel told the New York Times back in 2014. Handel’s research, as cited by the Times, found that workers lost “as much as $2,000 a year by staying in their insurance plans.” Though the ACA’s marketplaces were designed to protect choice and to encourage competitive pricing from insurers, they also aren’t working as intended. Most people don’t shop around for better coverage, according to data provided by the Centers for Medicare and Medicaid Services; the Trump administration’s decision to cut funding for insurance navigators, who help consumers choose the best plan for their needs, is at least partially responsible for the trend.

But another reason for all this inertia, a Kaiser Family Foundation expert told Axios, is that the process of shopping for insurance is complicated. Plans themselves are expensive and confusing, which encourages a sense of fatalism. “It’s just too hard,” a Kaiser Family Foundation expert explained to the news outlet last year. With all the uncertainty caused by potentially catastrophic costs, and the innate difficulty of predicting medical needs a full year in advance, many consumers decided to stick with what they know. Despite the ACA’s subsidies or an employer’s contribution to a benefits package, insurance, as Axios points out, is one of the most expensive purchases an average household makes.

The data highlighted by Axios offers a strong counterargument to Medicare for All skeptics like Buttigieg, who seem to think that Americans treasure the notion of consumer choice. In fact, they might value it far less than they claim, or certainly less than Buttigieg, the Partnership for America’s Healthcare Future, and the insurance industry itself all claim. Choice isn’t everything. Applied to health care, it creates work: work that we have to do in order to get basic care, work that we pay for the privilege of doing. It doesn’t look much like freedom at all.

Opponents of Medicare for All often cite polling data that suggests most people have a preference for private insurance. But the polls aren’t really that straightforward. Scrutinize them a little further, and a dilemma reveals itself: A preference for choice is only one element in a bigger, and more complicated, set of public opinions. One Gallup poll, published in 2018, does show that 69 percent of the American population says they’re pleased with their current coverage, while 80 percent said they also like the quality of the care they receive. But they’re less cheerful about the overall state of the nation’s care: In the same poll, only 34 percent rated the nation’s health-care coverage as excellent or good. As of this August, only 38 percent told Gallup that they have a very or somewhat positive view of the American health-care industry. Meanwhile, 57 percent said they believed the government had some responsibility to make sure all Americans had insurance — not exactly an enthusiastic public endorsement of choice at all costs.

In another poll, conducted by CBS News in October, about 60 percent said they wanted a national health insurance plan to compete with the private market. Moderates like Buttigieg take this and polls like it as proof that voters do not want Medicare for All, which would eliminate private insurance. While it’s certainly true that Medicare for All’s supporters have yet to completely sell the public on such a radical transformation of the American health-care system, organizations like the Partnership for America’s Healthcare Future — the group behind that sleek ad against Medicare for All — should still be worried. Americans might say they like their coverage when they have it. But if they aren’t shopping around, or comparing prices, and they’re deeply unhappy with the health-care system overall, then they are open to alternatives. The polls offer no reason to think that Americans are so committed to private insurance that choice matters more to them more than affordability, or a guarantee of care.

The gap between what Americans say they want, and what they actually do, sets up a series of important questions for opponents and skeptics of Medicare for All. If it’s too difficult and too expensive for most people to exercise the choices they technically have, why is the private market so preferable to a government-run alternative? How much can the government really do to make private insurance less complicated and more affordable to use? And why should the government prioritize that project over one that guarantees an equal level of health-care coverage to everyone?

Opponents of Medicare for All should answer these questions. They haven’t, perhaps because no one with any power has asked them to try. In primary debate after primary debate, health care has topped the agenda. But moderators have reserved most of their scrutiny for Bernie Sanders and Elizabeth Warren, the two candidates most publicly associated with Medicare for All. Advocates of a system based around consumer choice — a quality that Buttigieg and Biden both play up in their plans — are well overdue for a similar level of scrutiny. So is the concept of choice itself. It ought to imply freedom, or at least flexibility. But applied to health care, the concept of choice for most Americans is so vague as to be meaningless. That kind of choice is an abstract notion. It’s not reality.

In Health Care, Choice Isn’t Everything

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Will Trump trade paid parental leave for his Space Force?

Congressional lawmakers and the White House are on the verge of reaching a sweeping agreement that would extend 12 weeks of paid parental leave to federal workers in exchange for making “Space Force” the sixth branch of the U.S. military, according to four people with knowledge of the tentative deal.

The deal is part of a defense authorization bill that is slated to pass this month. If consummated, the agreement could mark one of the biggest deals President Trump has cut with Congress. It would secure a massive expansion of benefits for federal workers, something Democrats have long sought, in exchange for a realignment of the U.S. military that Trump has sought to secure as part of his legacy.

Multiple people close to the negotiations stressed any final package must still be approved, and Trump has been known to change his mind even when negotiations reach a final stage. The president could also be more eager to cement the deal than fiscal-hawk conservative Republicans in Congress, who might complain about the cost.

They clearly know the power of the Dark Side

Disagreements about the politics of “Last Jedi” have grown so ugly that Russian trolls have identified Star Wars debates on social media as places to sow discord, akin to online discussions about Hillary Clinton or Black Lives Matter, according to a report published by Morten Bay, a research fellow at the University of Southern California.

He cited instances in which Russian troll farms planted incendiary comments about Star Wars into online forums, simply to rile people up. It “helps spread the perception that America is divided and in chaos,” he wrote.

The disinformation campaign has made it hard for Lucasfilm executives and members of a story group charged with plotting the franchise’s trajectory to understand fans’ true concerns, one former story-group member said. Did racism spurred by online trolls drive their rejection of Ms. Tran’s character, or was it a broader issue of how her character’s arc was developed in the film? “What’s the note behind the note?” the person said. Often, the person added, fan responses boil down to “Don’t change a thing I love.”

A brief respite from standoff

Iran and the U.S. conducted a prisoner exchange Saturday that saw a detained Princeton scholar released for an Iranian scientist held by America, marking a rare diplomatic breakthrough between Tehran and Washington after months of tensions.

In a trade conducted in Zurich, Switzerland, Iranian officials handed over Chinese-American graduate student Xiyue Wang, detained in Tehran since 2016, for scientist Massoud Soleimani, who had faced a federal trial in Georgia.

While the exchange represents a rare win for both countries, it comes as Iran still faces crushing American sanctions and the aftermath of nationwide protests that reportedly saw over 200 people killed. Meanwhile, Western detainees from the U.S. and elsewhere remain held by Tehran. They are likely to be used as bargaining chips for future negotiations amid Iran’s unraveling nuclear deal with world powers.

A letter that sounds like Trump wrote it

 The White House signaled on Friday that it does not intend to mount a defense of President Trump or otherwise participate in the House impeachment proceedings, in a sharply worded letter to Democrats calling the process “completely baseless” and urging lawmakers to get it over with quickly.

“You should end this inquiry now and not waste even more time with additional hearings,” the White House counsel, Pat A. Cipollone, wrote in a letter to the House Judiciary Committee chairman, Representative Jerrold Nadler of New York.

“Adopting articles of impeachment would be a reckless abuse of power by House Democrats and would constitute the most unjust, highly partisan and unconstitutional attempt at impeachment in our nation’s history,” he added.

You could have kept this one to yourself, Mr. President

Trump expresses frustration about water efficiency, says sinks don’t have enough pressure and people have to flush toilets multiple times. He says he has directed the EPA to look at opening up water standards. It’s called rain, he says, referring to states with lots of water.


Still going with “thoughts and prayers” after all these years

Just received a full briefing on the tragic shooting at NAS Pensacola in Florida, and spoke to @GovRonDeSantis. My thoughts and prayers are with the victims and their families during this difficult time. We are continuing to monitor the situation as the investigation is ongoing.


Three confirmed dead in Pensacola mass shooting

Three people were killed in a shooting at Naval Air Station Pensacola on Friday, according to the Escambia County, Florida, Sheriff’s Office.

The shooter was also killed, Sheriff David Morgan told reporters in a news conference, after two deputies engaged the shooter in a classroom building on the base.

Both deputies were shot – one in the arm and one in the knee. Both are expected to survive.

Eight people are receiving treatment at Baptist Health Care, Chief Deputy Chip Simmons said.

Yet another one

BREAKING: An active shooter at the Naval Air Station in Pensacola has the base on lockdown, with 10 people reportedly being taken to area hospitals. A sheriff has confirmed that the shooter is dead.


The usual caveat on the jobs numbers

Wage growth continues to remain puzzlingly weak. Over the past year, hourly earnings are up only 3.1%. That’s the sort of number that’s unlikely to worry the Fed much (even as it continues to be puzzled by such low wage and price growth at such a low inflation rate).


A jobs report number that markedly exceeds expectations

+266k payrolls, unempllyment rate down to 3.5%.

Merry Christmas, everybody.


There’s a good chance the Russians have been listening in on Trump’s chats with Giuliani

President Trump has routinely communicated with his personal lawyer, Rudolph W. Giuliani, and other individuals speaking on cellphones vulnerable to monitoring by Russian and other foreign intelligence services, current and former U.S. officials said.

Phone records released this week by the House Intelligence Committee revealed extensive communications between Giuliani, unidentified people at the White House and others involved in the campaign to pressure Ukraine, with no indication that those calls were encrypted or otherwise shielded from foreign surveillance.

The revelations raise the possibility that Moscow was able to learn about aspects of Trump’s attempt to get Ukraine to investigate a political rival months before that effort was exposed by a whistleblower report and the impeachment inquiry, officials said.

Trump is not identified by name in the House phone records, but investigators said they suspect he may be a person with a blocked number listed as “-1” in the files. And administration officials said separately that Trump has communicated regularly with Giuliani on unsecured lines.

“It happened all the time,” said one former senior aide, who noted that Giuliani had a range of foreign clients.

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