It’s simply not true that President Obama wants to to give people cheap healthcare. He wants to subsidize their consumption of expensive healthcare. A better sales pitch might not be on how free it is but how expensive it would be without the subsidies. It might be true that people like free stuff but it’s also true that American consumers are pretty sophisticated and just might think that you get what you pay for.
One of the underlying points that needs to be emphasized: enrollment for insurance programs hasn’t been as slow as it has and awareness as weak as it is because of a lack of trying. Quite literally billions of dollars have been spent on outreach over the last couple of years. It’s just barely possible that those billions have been squandered.
My own view is that those doing the outreach were naive amateurs who didn’t really understand how to reach people. Or the nature of a marketing universe and that there are some people who just can’t be reached.
I suspect Obama does want us to have cheap health care. To be fair, every other politician probably wants that also. However, what Obama actually did is work to expand health care to those who don’t have it. Cost cutting measures are in the ACA, but they were secondary for the most part. So far, it is not possible to tell if the major efforts at cost cutting, like placing health care in actual markets via the exchanges so that people can buy based upon price comparisons have had much effect. The Cadillac tax has not started yet, and is already under assault.
Steve
The way one can determine what others want as opposed to what they might wish for is by their priorities.
Since you usually can’t have everything you want, you do have to prioritize. As I think I have said pretty consistently, the priority was expanding coverage. That does not imply they did not want to cut costs. They chose the coverage leg of the iron triangle to emphasize, then added what they could to cut costs and improve quality.
Steve
There was an idea, once upon a time, that Obamacare was going to be available to most low and medium-low people in just about all the states. And a whole bunch of Republican governors and legislators decided “Not in MY state, damn it!” Which came as a great surprise to people in the White House.
I don’t it’s possible to say much about the success of “marketing” Obamacare until more time has passed, perhaps another decade. If it’s still the case in say 2025 that federally-subsidized health care is available only for bottom rung poverty dwellers in 30 states, then we can probably say Obamacare has failed.
What’s your confidence that Republicans will keep govenorships and legistative majorities in all those states for another ten years?
I think there’s a lot of things to said. Just as you can analyze how effective the marketing of a brand of oatmeal is. If the number of people buying the brand of oatmeal increases, the marketing plan may be working. If the number of people buying the brand of oatmeal decreases, it’s reasonable to have questions about it.
In the specific case of the PPACA, there were problems with its construction from the start. Lots of weak assumptions. An assumption of overwhelming popularity. An assumption that everyone eligible would enroll.
A reasonable expectation was that encouraging the eligible to participate would become more difficult over time. That has been the experience in every developed country. Some percentage is quite difficult to bring into the fold.
Spending on outreach was front-loaded—most was spent in the first year, less in the second. Now in the third the federal funds available are much smaller and the states, strapped for cash, aren’t tossing in funds of their own (another weak assumption).