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Public attitude on Obamacare: Mend it, don’t end it

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Despite the sudden rash of nervousness among Democratic lawmakers over the problems plaguing the rollout of Obamacare, the death of the Affordable Care Act is not on the horizon.

Alexander Burns and Katie Glueck assess the situation HERE:

A White House under siege. A signature policy initiative turning into an embarrassing public spectacle. Dissent within the president’s own party that threatens to turn into a full-blown revolt.

For Republicans, such a moment came in 2005, as the party faced a daunting midterm election under the shadow of the disastrous Iraq War and a presidency in the dumps. For Democrats, the fear now is that the Affordable Care Act’s clumsy rollout — complete with a botched enrollment website and a debunked presidential pledge that Americans could keep their existing insurance plans — could produce a similar rout at the ballot box, with candidates dragged down by President Barack Obama’s dropping job approval and dimming public perceptions of the law known as Obamacare.

On Wednesday, the administration announced that only 106,185 people had selected new health insurance policies through the Obamacare exchanges as of Nov. 2, falling below early White House hopes. And only a quarter of that figure stemmed from the HealthCare.gov website.

It’s utterly premature, Democrats insist, to assume that the ACA will be a millstone around the party’s neck in 2014. But going by the behavior of Democratic lawmakers, it’s plainly not too soon for the party to tackle this dilemma: how to create distance between a set of candidates and a president of the same party whose agenda is on the rocks.

The paradox for any party is this: Standing in lock step with an unpopular leader can only taint candidates in competitive races by association. But if too many candidates flee the president, it serves to amplify his unpopularity, with potentially deeper ramifications for the whole party.

So far, the Democratic approach to all the ACA bungling is to let a thousand Obamacare critics bloom. It’s not that Democratic candidates and officials are openly breaking ranks and calling for the law’s repeal — there’s still solid Democratic consensus that the ACA is mostly a good thing — but politicians across the party have claimed wide maneuvering room for themselves to wander away from the White House line and even directly rebuke the administration.

The political calculus is straightforward, Democrats say. Voters are uncomfortable with the ACA, but private polling shows they are receptive to a “mend it, don’t end it” message. If Democratic House, Senate and gubernatorial candidates can show they want to fix the law proactively, the party believes voters will forgive some bungling by the administration. And if some Democrats are inching away from the president in an awfully public fashion, lawmakers say they have felt little pressure from the White House and other party leaders to make the existing text of the ACA a political hill to fight and die on.

“This is not about loyalty to the White House. It’s about getting the health care law right for the American people,” said Vermont Rep. Peter Welch. “This is a situation where good implementation is good politics.”

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10 Comments

  1. Just because you repeat the company line, does not make it true.

    Why won’t the administration come clean, and admit they want the instability they have created, so people will only have one way out – the single payer/government healthcare system Obama and the Dem leaddership advocate.

    The big lie is not “you can keep your plan”, or “you can keep your doctor”, or “it will cost 2500 less per family”, or….

    The big lie is that this is not about government takeover of healthcare – 1/6th of the economy, and putting us on a path to being a socialist state.

    • Double J, that’s really out there. They want the instability? Come on, you’re really going off the deep end on that perspective.

      What are you afraid of? Do you know what a socialist state looks like? Do you know that public schools are a socialist based program? Same goes for Social Security, Medicare, Medicaid.

      I’m not a rich person. I like that there’s a social safety net for people. Do you know what it was like before the social programs were enacted? Old people died on the streets. I’m grateful we have programs that will be there for the elderly and those unable to care for themselves. Are there people who abuse these programs, hell yes. And they eventually get caught. I’d rather pay taxes for services I benefit from than to give subsidy’s to very profitable corporations.

  2. Question –
    If Obamacare is “settled law of the land”…
    Why is it that only the President can change the law?
    Isn’t the role of the Congress, as granted by the constitution to do that?

    Seems to me the congress has become a patsy, and our president is acting more in the role of a monarch.

  3. Steverino

    The ACA is really our only hope to improve a healthcare system that ranks behind 36 other countries.

  4. thehereandnow1

    Really Steve-o? “really our only hope”? If that’s the case then we are screwed. Pathetic sign-up numbers, increased costs, lower standard coverage? People getting kicked off of insurance they were perfectly happy with because the govt. didn’t like it? You got a weird definition of hope pal.

    • Steverino

      thehereandnow – Watch Fox News much?

      • thehereandnow1

        Nah Stevie, I’m busy doing this thing called living in the real world. I’d invite you to give it a try, but with beliefs like Obamacare is just the thing Americans need, you’re pretty much off in la-la-land.

  5. Steverino,

    While I certainly agree that healthcare reform is necessary, don’t confuse health care system rankings with quality of health care provided. They are 2 very different things.

    http://online.wsj.com/news/articles/SB125608054324397621

    Among all the numbers bandied about in the health-care debate, this ranking stands out as particularly misleading. It is based on a report released nearly a decade ago by the World Health Organization and relies on statistics that are even older and incomplete.

    “It’s a very notorious ranking,” says Mark Pearson, head of health for the Organization for Economic Cooperation and Development, the 30-member, Paris-based organization of the world’s largest economies. “Health analysts don’t like to talk about it in polite company. It’s one of those things that we wish would go away.”

    The study is both flawed and dated, but that does not necessarily mean that we are doing better on health care than the study indicates.

    More recent efforts to rank national health systems have been inconclusive. On measures such as child mortality and life expectancy, the U.S. has slipped since the 2000 rankings. But some researchers say that factors beyond the control of the health-care system are to blame, such as dietary habits. Studies that have attempted to exclude these factors from the equation don’t agree on whether the U.S. system looks better or worse.

    The WHO ranking was ambitious in its scope, grading each nation’s health care on five factors. Two of these were relatively uncontroversial: health level, which is roughly the average healthy lifespan of a nation’s residents; and responsiveness, which is a sort of customer-service rating encompassing factors such as the system’s speed, choice and quality of amenities. The other three measure inequality in health-care outcomes; responsiveness; and individual spending.

    These last three measures struck some analysts as problematic, because a country with unhealthy people could rank above a healthier one where there was a bigger gap between healthy and unhealthy people. It is certainly possible that spreading health care as evenly as possible makes a society healthier, but the rankings struck some health-care researchers as assuming that, rather than demonstrating it.

    An even bigger problem was shared by all five of these factors: The underlying data about each nation generally weren’t available. So WHO researchers calculated the relationship between those factors and other, available numbers, such as literacy rates and income inequality. Such measures, they argued, were linked closely to health in those countries where fuller health data were available. Even though there was no way to be sure that link held in other countries, they used these literacy and income data to estimate health performance.

    Philip Musgrove, the editor-in-chief of the WHO report that accompanied the rankings, calls the figures that resulted from this step “so many made-up numbers,” and the result a “nonsense ranking.” Dr. Musgrove, an economist who is now deputy editor of the journal Health Affairs, says he was hired to edit the report’s text but didn’t fully understand the methodology until after the report was released. After he left the WHO, he wrote an article in 2003 for the medical journal Lancet criticizing the rankings as “meaningless.”

    The objects of his criticism, including Christopher Murray, who oversaw the ranking for the WHO, responded in a letter to the Lancet arguing that WHO “has an obligation to provide the best available evidence in a timely manner to Member States and the scientific community.” It also credited the report with achieving its “original intent” of stimulating debate and focus on health systems.

    Prof. Murray, now director of the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, says that “the biggest problem was just data” — or the lack thereof, in many cases. He says the rankings are now “very old,” and acknowledges they contained a lot of uncertainty. His institute is seeking to produce its own rankings in the next three years. The data limitations hampering earlier work “are why groups like ours are so focused on trying to get rankings better.”

    • “Prof. Murray, now director of the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, says that “the biggest problem was just data” — or the lack thereof, in many cases.”

      Suspect data is always the rallying call when its something the right doesn’t want to lend their support to. But, if it supports their perspective, its as firm and credible as concrete.

  6. I agree with you Robert, it is often the case that the data is called into question whenever it is used to engender change. And sometimes the data is the best available and all we have to use. However, sometimes the data IS old, lacking or otherwise inadequate.

    It is too simple of a generalization to use the old WHO rankings to say that the US health care system is of poor quality. In fact, that isn’t what the rankings were even measuring. They are measuring the quality of the health of the population. If we want to improve that ranking (and we certainly do) we need to focus on much more than the healthcare delivery system.

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