WASHINGTON >> It sounded so simple. Too simple, it turns out.
President Barack Obama's early efforts to boil down an intricate health care law so Americans could understand it are coming back to haunt him, leaving a trail of caveats and provisos in place of the pithy claims he once used to sell the law.
In the summer of 2009, Obama laid out his health care agenda in a 55 minute speech to the American Medical Association. It was, his former speech writer Jon Favreau recalls, "one of the longest speeches he ever gave."
Fine as an initial policy speech, Favreau thought, but not a communications strategy.
"My lesson from that was, well, he can't be giving a speech this long and complicated every time he talks about health care," Favreau said.
Indeed, a good sales pitch must be brief, compelling, accurate. But when it comes to a complex product like health insurance, brevity and persuasiveness can take a toll on precision.
For example, Obama had promised, "If you like your health care plan, you'll be able to keep your health care plan, period."
Instead of a period, the statement required an asterisk. It turned out that, yes, some plans would be taken away as an indirect result of the law's tougher standards.
The enrollment experience, Obama said, would be simple: Hop online and comparison-shop "the same way you'd shop for a plane ticket on Kayak or a TV on Amazon."
Instead, as the entire country now knows, October was a website disaster.
Then there was the cost. "Through the marketplaces," Obama said, "you can get health insurance for what may be the equivalent of your cell phone bill or your cable bill, and that's a good deal."
A good deal, indeed -- for those who qualify for federal subsidies to offset the cost. But not for all.
*** [11/20/13]
Obama at the Wall Street Journal CEO Council [excerpts]
On Healthcare.gov: I think we probably underestimated the complexities of building out a website that needed to work the way it should.
There is a larger problem that I probably could have identified earlier, and that's the way the federal government does procurement and does IT is just generally not very efficient. There's probably no bigger gap between the private sector and the public sector than in IT.
We've see that, for example, the [Department of Veterans Affairs] trying to deal with electronic medical records for our servicemen as they move into civilian life. Most of that stuff is still done on paper. We have spent billions of dollars -- I'm not saying "we" as in my administration, I mean we've now had about a decade of experimentation, spent billions of dollars -- and it's still not working the way it should.
On health care: Even though the rollout of the new health-care marketplace has been rough, to say the least, about 500,000 Americans are now poised to gain health care coverage beginning Jan. 1. That's after only a month of sign-up. We also have seen health care costs growing at the slowest rate in 50 years. Employer health costs are growing at about one-third of the rate of a decade ago, and that has an impact on your bottom line. ...
This has been a big problem for a very long time, and so it was always going to be challenging not just to pass a law, but also to implement it. There's a reason why, despite a century of talking about it, nobody had been able to successfully try to deal with some of the underlying problems in the health care system.
The good news is that many of the elements of the Affordable Care Act are already in place and working exactly the way they're supposed to. Making sure consumers who have employer-based health insurance are getting a better deal and better protected from the fine print that left them in the lurch when they actually got sick. That's in place. Making sure young people under age 26 can stay on their parents' plan. That's helped 3 million children already. That's making a difference. Helping seniors to get better prescription drug prices. Rebates for people who see insurance companies who are not spending enough on actual care, more on administrative costs or profits -- they're getting rebates. They may not know it's the Affordable Care Act that's giving them rebates, but it's happening. There were a number of things that were already in place over the last three years that got implemented effectively.
The other thing that hasn't been talked about a lot is cost. There was a lot of skepticism when we passed the Affordable Care Act that we were going to be giving a lot of people care but we weren't doing anything about the costs. And, in fact, over the last three years we have seen health-care costs grow at the slowest pace in 50 years. That affects the bottom lines of everybody here.
On optimism: I'm actually a congenital optimist. I have to be -- my name is Barack Obama, and I ran for president. And won, twice.
On politics: When you go to other countries, the political divisions are so much more starker and wider. Here in America, the difference between Democrats and Republicans -- we're fighting inside the 40-yard line. [really?]
People call me a socialist sometimes, but, you've got to meet real socialists. [Go to other countries and] you'll get a sense of what a socialist is. You know, I'm talking about lowering the corporate tax rate. My health-care reform is based on the private marketplace. The stock market is looking pretty good last time I checked. It is true that I'm concerned about growing inequality in our system, but nobody questions the efficacy of market economies in terms of producing wealth and innovation and keeping us competitive.
A lot of [Republicans] believe in basic research, just like I do. A lot of them want to reform entitlements to make sure that they're affordable for the next generation. So do I. A lot of them say they want to reform our tax system. So do I. There are going to be differences on the details. Those details matter, and I'll fight very hard for them, but we shouldn't think that somehow the reason we've got these problems is because our policy differences are so great.
*** [11/20/13]
Obama at the Wall Street Journal CEO Council [excerpts]
On Healthcare.gov: I think we probably underestimated the complexities of building out a website that needed to work the way it should.
There is a larger problem that I probably could have identified earlier, and that's the way the federal government does procurement and does IT is just generally not very efficient. There's probably no bigger gap between the private sector and the public sector than in IT.
We've see that, for example, the [Department of Veterans Affairs] trying to deal with electronic medical records for our servicemen as they move into civilian life. Most of that stuff is still done on paper. We have spent billions of dollars -- I'm not saying "we" as in my administration, I mean we've now had about a decade of experimentation, spent billions of dollars -- and it's still not working the way it should.
On health care: Even though the rollout of the new health-care marketplace has been rough, to say the least, about 500,000 Americans are now poised to gain health care coverage beginning Jan. 1. That's after only a month of sign-up. We also have seen health care costs growing at the slowest rate in 50 years. Employer health costs are growing at about one-third of the rate of a decade ago, and that has an impact on your bottom line. ...
This has been a big problem for a very long time, and so it was always going to be challenging not just to pass a law, but also to implement it. There's a reason why, despite a century of talking about it, nobody had been able to successfully try to deal with some of the underlying problems in the health care system.
The good news is that many of the elements of the Affordable Care Act are already in place and working exactly the way they're supposed to. Making sure consumers who have employer-based health insurance are getting a better deal and better protected from the fine print that left them in the lurch when they actually got sick. That's in place. Making sure young people under age 26 can stay on their parents' plan. That's helped 3 million children already. That's making a difference. Helping seniors to get better prescription drug prices. Rebates for people who see insurance companies who are not spending enough on actual care, more on administrative costs or profits -- they're getting rebates. They may not know it's the Affordable Care Act that's giving them rebates, but it's happening. There were a number of things that were already in place over the last three years that got implemented effectively.
The other thing that hasn't been talked about a lot is cost. There was a lot of skepticism when we passed the Affordable Care Act that we were going to be giving a lot of people care but we weren't doing anything about the costs. And, in fact, over the last three years we have seen health-care costs grow at the slowest pace in 50 years. That affects the bottom lines of everybody here.
On optimism: I'm actually a congenital optimist. I have to be -- my name is Barack Obama, and I ran for president. And won, twice.
On politics: When you go to other countries, the political divisions are so much more starker and wider. Here in America, the difference between Democrats and Republicans -- we're fighting inside the 40-yard line. [really?]
People call me a socialist sometimes, but, you've got to meet real socialists. [Go to other countries and] you'll get a sense of what a socialist is. You know, I'm talking about lowering the corporate tax rate. My health-care reform is based on the private marketplace. The stock market is looking pretty good last time I checked. It is true that I'm concerned about growing inequality in our system, but nobody questions the efficacy of market economies in terms of producing wealth and innovation and keeping us competitive.
A lot of [Republicans] believe in basic research, just like I do. A lot of them want to reform entitlements to make sure that they're affordable for the next generation. So do I. A lot of them say they want to reform our tax system. So do I. There are going to be differences on the details. Those details matter, and I'll fight very hard for them, but we shouldn't think that somehow the reason we've got these problems is because our policy differences are so great.
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