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The Town Halls the Media Didn't Cover

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One of the questions a lot of people asked amid the hysterics of August was why, if these town halls were astroturfed shout-fests, were members holding them at all? The answer appears to be simple: They largely weren't astroturfed shout-fests. But the ones the media covered were.

E.J. Dionne Jr.interviewed a range of House Democrats about their town halls. Virginia representative Tom Perriello divided his into three groups: conservatives, who were worried about "big government, socialism and all that"; the left, who wanted "corporate accountability"; and the middle, who focused on "health-care costs" and problems with their coverage. Ohio Rep. Mary Jo Kilroy said, "I think the media coverage has done a disservice by falling for a trick that you'd think experienced media hands wouldn't fall for: allowing loud voices to distort the debate." But the scariest comment came from Rep. David Price of North Carolina, who chatted with a stringer for one of the television networks at a town hall he held in Durham.

The stringer said he was one of 10 people around the country assigned to watch such encounters. Price said he was told flatly: "Your meeting doesn't get covered unless it blows up." As it happens, the Durham audience was broadly sympathetic to reform efforts. No "news" there.

In his concluding sentence, Dionne mocks impressions that the media is "liberal." But this doesn't prove anything about ideology. It proves something about sensationalism, and what gets ratings. As Matt Yglesias points out, "this dynamic wasn’t helped by the rise of a left-wing mass media (blogs, Rachel Maddow, etc.) that was more interested in poking fun at the nuttiest voices on the right than in trying to amplify the concerns of pro-reform voters."

The sober, serious coverage came from non-competitive media — NPR and PBS and even the major papers. They covered the town halls, but by and large they didn't hype them in the way that cable news and blogs or talk radio did. That's not an attack on other mediums: They're audience-driven, and so they cover shiny things. For O'Reilly, that meant hyping the authenticity of the town halls. For Olbermann, that meant talking about the gun-toting nuts who attended them. But for both of them, an entertaining hour of politics meant covering them, and largely ignoring the conversation in the center.

Photo credit: By Gerald Herbert — Associated Press

By Ezra Klein  |  September 3, 2009; 3:07 PM ET
Categories:  Journalism  
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Comments

***** As Matt Yglesias points out, "this dynamic wasn’t helped by the rise of a left-wing mass media (blogs, Rachel Maddow, etc.) that was more interested in poking fun at the nuttiest voices on the right than in trying to amplify the concerns of pro-reform voters." *****

When the nuttiest voices on the right include the likes of Rush Limbaugh, Glenn Beck, and Sean Hannity, it's necessary to counter their slander.

I also think that Matt is making the usual invalid comparison between the right nuking the discourse and the left being sarcastic. The two sides are clearly not engaging in the same kind of behavior.

Posted by: starfleet_dude | September 3, 2009 3:19 PM | Report abuse

Perriello seemed to make the correct divisions (or groupings) and it's the conversations in the middle that are the 'important' ones.

As I look back on your lunch chat, it's sort of refreshing to hear people asking deeper questions, such as the first concerning constitutionality of health care mandates. Your answer ("A number of people have looked into this and concluded that it passes legal muster.") is true provided that certain other parameters are present in a bill. In US v. Ballard (322 US 78 (1944)), the Court declared that "freedom of religious belief... embraces the right to maintain theories of life and of death and of the hereafter which are rank heresy to followers of the orthodox faiths." One pending bill, S.391, attempts to address the issue through its section 102(a)(1)(B) and 102(a)(3). Other bills also try to address the issue, but it's more of an open item than many people would like to acknowledge.

As discussion begins to turn to details, the whole health care reform issue is going to be even tougher going.

Posted by: rmgregory | September 3, 2009 3:35 PM | Report abuse

"The sober, serious coverage came from non-competitive media — NPR and PBS and even the major papers"

Ezra, I challenge you to find me some links from Post articles that gave non-sensationalist coverage of the health care town halls. I can't recall a single one. Prove me wrong!

Posted by: dkinmd | September 3, 2009 3:49 PM | Report abuse

Suppose you as a private insurer were out to kill, not healthcare "reform," but any major challenge to your unnecessary overheads and profits. You hire one of the big Washington public relations firms to help you devise strategy. They report:

"Objective: whip-up enough emotions among uneducated voters in Blue Dog districts to make the floor votes difficult.

"Here's how you do it: Get out 50,000 insurance employees on the phone to scare seniors about Medicare, get those employees out to the recess "townhalls" to help vocalize, get a couple of cadres together to keep hitting memes in the comments to blogs.

"The memes? Don't mention that there are different bills and nothing is finalized. Stay away from substantive discussions of issues and basics. Get out the old Frank Luntz emotional playbook: "government control of your life, socialism, deficits, special interests, liberal media, etc." and hit them hard. Likely result? You will get a 10-15% soft bounce up in the polls right away. Use that fact that the polls have moved, too. You must direct people away from the longer and steady polls that see 70-80% support for a public insurance choice option."

----So, just have a read through some of the comments under Dionne's column today. It's about 3 or 4 to 1, IN FAVOR OF healthcare reform. Those opposed, are hitting those memes. And adding, "Dionne you're just another slanted journalist." You can always find a new meme for the occasion.

Senator Schumer is exactly right on this one. The President should aim to change those polls back, before the floor strategies are laid.

One thing he really might do is spend about half his speech on illuminating the entire Washington lobbyist and p.r. astroturf game and how the mechanism has worked in this case, in his comprehensive and entertaining way.

This would really be great! It is certainly not out of bounds, nor should it be. Yet it is something we haven't heard from any politician ever, much less a President! It would instantly change the debate; the media would have something new to report; indeed the news reporters could chase down executives and ex-employees of Burson-Marsteller or whomever is behind this new crookedness, and they will find weeks of entertaining scandal for their readers.

Posted by: Lee_A_Arnold | September 3, 2009 3:54 PM | Report abuse

Ezra, what you say may be true and all well and good, but the reality is that the biggest audiences are for those faux-news entertainment centers at Fox "News" and MBNBC.

But they aren't limited to those places. As a daily watcher of the NBC Evening News, I can you that even the broadcast network news shows reported on the shoutfests as though those were the only townhall moments worth reporting on. They did it daily. Those shows have far larger audiences that the cable know-nothing, talking heads.

The reality is that the even the network evening news shows are more invested in doing a 2-minute story on Arlen Specter getting brow-beat than on highlighting even the broader points of the actual bills before Congress.

Posted by: scorbett1976@hotmail.com | September 3, 2009 4:01 PM | Report abuse

Still clinging to the "astroturf" myth, eh Ezra?

Posted by: wd11 | September 3, 2009 4:02 PM | Report abuse

wd11: "Still clinging to the "astroturf" myth, eh Ezra?"

As is the Wall Street Journal:

"AHIP [America's Health Insurance Plans, the industry's chief lobby] spokesman Robert Zirkelbach says about 50,000 employees have been engaged in writing letters and making phone calls to politicians or attending town-hall meetings." WSJ August 24, 2009

Posted by: Lee_A_Arnold | September 3, 2009 4:34 PM | Report abuse

"The sober, serious coverage came from non-competitive media — NPR and PBS and even the major papers"

except, said outlets were not above running with the noisemakers. At Netroots Nation, the Post-Gazette and Tribune both ran the photo of the dude yelling at Arlen on A1 full page ATF. I'll bet you a beer if we go back and look at the front pages from early- and mid-August of the pillars of journalism such as, oh, say, the Washington Post, we'd find them similarly covered in glory.

Posted by: NicholasBeaudrot | September 3, 2009 4:38 PM | Report abuse

EzK: "The answer appears to be simple: They largely weren't astroturfed shout-fests. But the ones the media covered were."

I and a others said the same repeatedly on these boards throughout the month of August. I guess it only became credible when E.J. and other true-blue believers lent the idea credence.

Ezra has been among those in the media working overtime to write off opponents of the Dem. bills as corporate shills and worse. Day after day he was publicizing the most extreme views of a few protestors while ignoring the reasonable critiques which were much more commonplace at these affairs.

The townhall h/c protesters grew out of the tea protests of the Spring and early summer. Many of attendees are as disillusioned with the Republicans as they are with the Democrats - it's just that the Dems happen to wield power at the moment and their agenda would result in higher taxes and indebtedness - both anathema to "tea-baggers".

Posted by: tbass1 | September 3, 2009 4:59 PM | Report abuse

Teabaggers, inflamed by agent provocateurs promulgating falsehoods, then reported by media in search of eyeballs, to attract advertisers seeking customers.

Posted by: Lee_A_Arnold | September 3, 2009 5:25 PM | Report abuse

I'm curious then what you make of complete lies in the media about townhall meetings? The Washington Examiner had a front page story called "Fists Fly at Town Hall" about the one Rep Jim Moran held with Howard Dean at Fair Lakes High School in NoVA. No other report mentioned any fists flying, except maybe fist-bumps.

Posted by: GrandArch | September 3, 2009 6:06 PM | Report abuse

Having attended a Town Hall meeting in Atlanta last month, I can say that it was tense, fractious, and -- by the standards of national discourse anyway -- quite reasonable. However, it was not a "conversation in the center," because the only ones not present were the extreme right wingers who want to disrupt things. Leftist of all sorts were there, centrists were there, and right wingers who hate the government were there, but the shouters weren't. It wasn't a conversation at the center, it was a conversation that included everybody -- except for the rightmost 10%.

Posted by: Ulium | September 3, 2009 9:04 PM | Report abuse

Ah, the corporate media never fail to not disappoint. Should anyone be surprised by this? They are sportscasters, not journalists? They might as well be ringside at a cage fight. They want blood on the floor, they don't want to inform the public. That's too boring.

Posted by: cmpnwtr | September 3, 2009 11:19 PM | Report abuse

Lee_A_Arnold,

you're being more than a little bit disingenious when you call health insurers employees as astroturf. We're merely trying to get out what we know as facts. And to prove that point one of the chief architects of the bill is Frank Pallone. I went to his town hall a week or so ago. he stated that if you're a family in NJ in the individual market you could pay say $13,000 but if you have a pre-existing condition it could cost $20,000 per year.

NO IT CAN'T. NJ is a guaranteed issue state with modified community rating. There can be no change in rates. The rate is set and posted on the NJ Dept of Banking and Insurance website. The fact that one of the architects doesn't even know the current law in his own state where he's been serving for 30+ years is a big problem and many of us feel we need to educate those like him that have no clue.

Don't believe me? Here's a youtube clip i found of the town hall meeting. Its in the very beginning, within the first minute.

http://www.youtube.com/watch?v=luGZiEEpchA&NR=1

Here's the page from the NJ DOBI website that shows how individual health insurance works in NJ SINCE AUGUST 1993:

http://www.state.nj.us/dobi/division_insurance/ihcseh/index.html

I'm going to then say that either Pallone was lying to sell his healthplan, or he's just plain stupid. Either way he doesn't deserve to be in Congress.

Posted by: visionbrkr | September 4, 2009 12:14 AM | Report abuse

and on top of that everything that I have ever read from insurers has been in an attempt to "inform" the public that insurance reforms like an end to pre-ex and an individual mandate need to be put in place. The reason being is that costs have skyrocketed not because of profits or salaries its because not everyone is covered. People several years ago started realizing the rules of EMTALA and dropping out of coverage when they were healthy and saw no benefit of having insurance. Then they get sick and use an ER instead of a doctor's office. Sure many can't afford it which is why costs need to be addressed as well as subsidies for those who truly are indigent. But studies show that many of the uninsured make $50-$75000 a year who could easily afford a catastrophic plan, especially when costs come down with the benefits of an individual mandate and removal of subsidies from insurers and strict loss ratio requirements.

Posted by: visionbrkr | September 4, 2009 12:18 AM | Report abuse

visionbrker, you are being more than a little illogical when you state that an error by Pallone proves that the health insurers didn't send out employees as astroturf.

And disingenous? Pallone appears to be talking about taking out new policies. From all the sources I have found, the N.J. insurers are free to deny coverage to new buyers with existing conditions. Is this untrue?

Of course they want an individual mandate. They get 43 million new buyers -- and the ones who can't afford it, at the taxpayer's expense.

Posted by: Lee_A_Arnold | September 4, 2009 1:50 AM | Report abuse

to wit the Howard Dean whoop moment that played incessantly on the media for days on end. That more or less ended the Howard Dean presidential bid.

Posted by: mickster1 | September 4, 2009 3:19 AM | Report abuse

Lee,

of course it wasn't the reason but Pallone is a glaring example of why it was necessary. Again it wasn't to stop reform, we've all admitted reform is necessary. It was to inform the public. And don't take this the wrong way but the way you point out:

"From all the sources I have found, the N.J. insurers are free to deny coverage to new buyers with existing conditions. Is this untrue?

They cannot deny coverage at all. If you have had more than a 62 day lapse in coverage (HIPAA law) from group coverage or a 30 day lapse in individual coverage then you can be subject to pre-ex for up to a year and that's it.

If they didn't at least do that without an individual mandate than what would stop anyone with say cancer from being covered when they need treatment and then stopping it when they were done. Its all about personal responsibility. I understand some can't afford it which is why we need subsidies. Insurers 85% loss ratios will ensure profits are to a minimum.

Posted by: visionbrkr | September 4, 2009 6:47 AM | Report abuse

and one of the other positive issues of reform is the fact that all benefits will be standardized. Those that are saying people will "lose coverage" are wrong and are just fear mongering from the right. The fact that every state in the union has different laws, rules, mandates etc makes it impossible for anyone to help people in our positions. I can't tell you how many clients I've had to tell that moved out of state that I would love to help them but i'd be doing them more of a dis-service because I'm not familiar with the laws and rules of Texas for example. I have to direct them to www.nahu.org to have them find a local agent by them that can help them. On top of that they should allow the purchase of policies across state lines. In NJ here we opened up BCBS from PA and NY to sell across state lines several years back and it helped keep rates in line for a bit. Anytime you bring in more competition it helps. Part of the problem though honestly is if you open up so much of it (1300 insurers) it gets to be so confusing to many so i can see why that argument would be a problem too.

Posted by: visionbrkr | September 4, 2009 7:56 AM | Report abuse

So New Jersey insurers must sell you a policy?

Posted by: Lee_A_Arnold | September 4, 2009 10:24 AM | Report abuse

Lee,

yes. you cannot be denied coverage. you can be subject to pre-ex for a period of time but you can't be denied coverage. If you're coming from existing coverage or had no more than a 62 day lapse in coverage for group plans (HIPAA) or 30 days for individual you also can't be denied coverage for that pre-existing condition. Also the only benefit NJ covered individuals would receive from reform is lower costs because everyone would be insured. Already our mandates (and Rep Pallone has attested to this) are higher than anything in HR 3200. Our only problem is that not everyone is insured because of cost, not because of denial of coverage.

Again every state's not like that and I need to be cognizant of that when I'm on here but that's how it works in NJ.

Posted by: visionbrkr | September 4, 2009 10:57 AM | Report abuse

So New Jersey insurers must sell you a policy?

Posted by: Lee_A_Arnold | September 4, 2009 10:24 AM | Report abuse


not only must they sell you a policy they can't raise the rates unlike what Mr Pallone says.

Posted by: visionbrkr | September 4, 2009 11:30 AM | Report abuse

Spector along with other representatives said that they didn't think that those people at the town halls were representative of their constituents. My question is this, if these are the people he never hears from except possibly at election time how would he know if they were representative or not? If the silent majority is silent most of the time these senators haven't a clue as to what they are thinking. In fact I would bet that the majority of both parties don't really have a clue as to what this silent electorate thinks, believes, does or doesn't do.
As for the media, they don't know these people either so of course instead of trying to report on a phenomena and really trying to give a clear picture of a burgeoning movement they have to paint them with their stereotypical brush. They are left, they are right, they are fringe, they are fake, a lot easier than getting to the truth and trying to really understand the silent majority and the direction in which this country might be heading.

Posted by: no_USSA | September 4, 2009 12:44 PM | Report abuse

Sorry misspelled Specter but my point being that the continued laziness of the media and politicians is leading to their downfall. The disconnect continues and it is detrimental to our country.

Posted by: no_USSA | September 4, 2009 12:52 PM | Report abuse

visionbrkr:

"...and one of the other positive issues of reform is the fact that all benefits will be standardized."

Sorry but I wouldn't view that as a possitive. Reminds of Henry Ford saying his customers could buy his Model T's in any color so long as it was black. Then, General Motors came along and ate his lunch by designing all manner of cars to fit different tastes and budgets. Let diversity reign, I say.

Posted by: tbass1 | September 4, 2009 12:58 PM | Report abuse

no_USSA:

"My question is this, if these are the people he never hears from except possibly at election time how would he know if they were representative or not?"

Public opinion polls, I'd guess. The people showing up at the townhall meetings are not representative of the electorate but they are a measure of intensity of feeling. Its just such motivated types that fund and volunteer for political campaigns.

Posted by: tbass1 | September 4, 2009 1:02 PM | Report abuse

Any town hall meeting that was not explosive was Democrat astroturfing.

I live in Austin. Lloyd Doggett had a townhall at the downtown First Methodist Church. The first thing I found interesting was the sign-in sheet, which allowed you to check one of two boxes - that you support healthcare, or that you support healthcare and would like to donate your time to informing others about health care reform.

The announce time was 3:00pm, but when I got there at 1:00pm with my camera, there was already a line around the corner. I was then told many of the people on the grass on across the street that many of the ObamaCare supporters had been bussed in from Dallas and surrounding areas.

Not wearing anything or carrying anything that would identify me with one side or the other, I decided to try a little trick, which worked on about 10 people until someone overheard me and told everyone to quit talking to me.

I would start by stating I was on their side and the public option is a must. I would then tell them I intended on taking my kids to the Austin International Zoo and Aquarium. I told them it was the second time in six months I had been there and asked them what they thought of it. They had ALL been there and loved it.

One problem - there is no Austin International Zoo and Aquarium.

Those who got inside who were anti-ObamaCare were treated to a lengthy tirade against teabaggers and were called liars by Doggett himself.

This from a man who on KVUE Austin stated he would debate anyone on health care. When the Austin Tea Party Patriots offered to host the debate, all we saw of Doggett was his backside running panicked in the other direction.

Go figure.

Of course, the town hall was not newsworthy as any media person with an ounce of sense knew the entire event was staged and that nothing interesting would happen.

So there goes your theory. Real people = interesting town halls. Astroturfing = boring town halls. And independents polled indicate they did not believe the concerned citizens at the town halls were astroturfers, but that they were legitimate and passionate citizens.

Next time, invite someone from MoveOn.org and have them bite someone's finger off.

Oh, and follow the polls. America is not as dumb as many in the media think, and I believe they are catching on to this fact. Polls against ObamaCare indicate plummeting numbers. Angry people at town hall meetings coupled with plummeting poll numbers = real grassroots people at town hall meetings.

Simple math.

Posted by: geraldmerits | September 4, 2009 3:57 PM | Report abuse

tbass1,

don't go nuts. The standardized benefits are a floor of mandates. Everyone's able to adjust from there as long as they maintain the minimum standards. The real lobbying starts when you decide what makes up the floor. Look for reproductive endocrinologists for example to push their wares as a necessary benefit. You NEED cost mavens there to ensure its not abused. My state of NJ has mandatory infertility coverage for many size groups and I'm sorry I'm not happy I'm paying for it because its not medically necessary and it still is very expensive and results in multiple births and complications whose costs can run into the millions.

Posted by: visionbrkr | September 4, 2009 4:16 PM | Report abuse

Visionbrkr, just to be clear, if you had no prior policy, but you have a pre-existing condition, NJ insurers must sell you a policy at the same rates as those with no pre-existing condition?

Posted by: Lee_A_Arnold | September 4, 2009 4:27 PM | Report abuse

Lee,

yes. You could be a cancer patient in a hospital and they would have to cover you at the same rate that's online here:

http://www.state.nj.us/dobi/division_insurance/ihcseh/ihcrates.htm

The Dept of Banking and Insurance in NJ wouldn't, couldn't post the rates if they were not locked in. Pre-reform, in the early 90's it was phased in and NJ had guaranteed issue but once health questions were answered rates could be increased by up to 300% based upon health answers. Again if people were sick, it was denied. Then in 93 reforms were put in and rates spiked but then held steady throughout the 90's and early 2000's. Since then utilization and people realizing they can opt out and get ER care whenever they want is killing the rates. We need an individual mandate badly.


Posted by: visionbrkr | September 4, 2009 8:06 PM | Report abuse

lee,

again the only issue with that hypothetical cancer patient is if they haven't had coverage in the past 62 days if they were on group coverage or 30 days if individual is that they will not be covered for that pre-existing condition for a year. So yes its not perfect but its darn close.

Also what many people honestly on here don't realize is the laws are different in every state. and there are varying degrees of guaranteed issue, community rating, modified community rating etc. so people make accusations at one or another not realizing what the rules or laws in my state differs from yours. If you go to your state's DOBI then you can see how the rules are there. Once again once we get to a guaranteed set-up for all nationwide all will benefit but all need to be covered. The taxes need to be strict enough to keep everyone covered and not opt out.

Posted by: visionbrkr | September 4, 2009 8:35 PM | Report abuse

So what if someone wants to include the pre-existing condition from the beginning of coverage? Does the rate differ by as much as Pallone said?

Posted by: Lee_A_Arnold | September 4, 2009 9:57 PM | Report abuse

Lee,

they can't. Again you're not getting the idea of insurance and risk management but I understand its not what you do. First off they shouldn't have let their coverage lapse. Again there are issues sometimes where it can't be helped I understand that so even NJ laws have flaws but NJ also has NJ Family Care. Family care (which many states have) and it covers children from 0-350% of the poverty level and full families from 0-200% of the poverty level.)
Also you can purchase a catastrophic coverage plan in NJ for as little as $128.45 for a single person per month.

But asking an insurer to pay a claim for a KNOWN condition when someone already wasn't covered isn't risk management, its just payment and its dollar for dollar cost to premium. Its like a client of mine who couldn't get pregnant and then asked to add infertility coverage. Sorry you can't do that. The cost is dollar for dollar. If say a year ago you asked for it then possibly it could be added but if it was a known condition it shouldn't be able to be added even though many times you can "game" the system and cover it.

To that end we need a total end to pre-ex but that can only come with an individual mandate because otherwise who will buy the coverage unless they're sick? Unless the cost of their expected claims outweighs what they'd pay in premium.

Also i've seen a lot of hatred around here in regards to insurers profits. NJ has one of the strongest "loss ratios" of any state in the country. that is dollars paid vs claims paid. By law insurers must have an 80% loss ratio now (it was 75% a year ago and had been 75% since 1994 reform).

Below is the info from 2005 showing an 81.7% loss ratio when 75% was the requirement:

http://www.state.nj.us/dobi/lifehealthactuarial/2005comhealth_attach3.pdf

Wellchoice and Genworth both had over 100%. Guess what, no longer in business.

Guardian and Trustmark were under the 75% so they refunded monies back to policyholders.

PART 2 TO FOLLOW:

Posted by: visionbrkr | September 4, 2009 11:20 PM | Report abuse

PART 2:


Here is 2004 where the average was 82.5%
Again remember that this loss ratio is only premium vs claims. It doesn't factor in employees salaries, capitalized costs, buildings, rents, premium taxes, marketing and advertising. This talk of 20-30% profit that some on the left just doesn't exist, at least not in NJ.

http://www.newjersey.gov/dobi/lifehealthactuarial/2004comhealth_attach3.pdf

Here is 2006 which shows an 81.5% loss ratio.

http://www.newjersey.gov/dobi/lifehealthactuarial/2006comhealth_loss.pdf


And in 2007 (not available on the site yet) in a meeting with Rep Pallone it was announced that the data showed NJ had an 85% loss ratio with the largest insurer, Horizon BCBS showing an 88.2% loss ratio.

So again in NJ costs aren't high because of insurers profits. That's a talking point of the left that just false, at least around here its false. They're high because of high utilization and the fact that not everyone is covered. If we find ways to adjust utilization downward without affecting care and get everyone covered (via a mandate as well as subsidies to those who truly need it) then costs will come down.

Posted by: visionbrkr | September 4, 2009 11:20 PM | Report abuse

Show me an "Unbiased" broadsheet!
NPR? HA! - 53 articles on Kennedy and only 1 reference to his young victim Mary Jo.

FYI, most conservatives I know are "Pro Reform"! They just want "All" options to be considered and a good starting point is the founding principles of our nation. (It's given us 200 yrs of success)

As an 'independent' I just want someone to show me a successful (large scale) government endeavor. Then I'll have a credible reason to listen.

What you can't deny (as hard as the main stream media tries) is the mountain of evidence against a public/ single payer option. (But ABC et-al is adamant the world of Obamacare is flat!)

Posted by: netrto4149 | September 5, 2009 12:12 AM | Report abuse

Utilization will never be directed downward; in fact demand for healthcare is a predictable constant and has stabilized in the postwar period at an income elasticity of demand of around 1.6.

But what you are saying is that N.J. insurers are forbidden to sell insurance at a higher price to consumers who are willing to pay to have their pre-existing condition covered from the beginning of the policy? Where does it say that?

Posted by: Lee_A_Arnold | September 5, 2009 1:57 AM | Report abuse

Lee,

first off I appreciate your interest in getting to the truth and what's right and for not blatantly calling me a shill as some others do.

Below is the link to the Dept of banking and insurance website in NJ that specifically details pre-existing conditions and how they are affected in NJ.

http://www.state.nj.us/dobi/division_insurance/ihcseh/sehguide/features.html

Here's a big chunk of it as it relates to group coverage:

Prohibits the application of pre-existing condition limitation periods to any members of a small group with 6 to 50 eligible employees, except in the case of late enrollees;
Prohibits the application of a pre-existing condition limitation period to groups of 2 to 5 eligible employees for more than 6 months following the enrollment date in the health benefits plan;
Prohibits the application of a pre-existing condition limitation period to late enrollees for more than 6 months following the effective date of the late enrollee’s coverage;
Prohibits the application of a pre-existing condition limitation period to late enrollees altogether when 10 or more late enrollees ask to enroll in a small employer’s plan within the same 30-day period;
Prohibits the application of a pre-existing condition limitation period to children who, within 30 days following birth or adoption, were covered under creditable coverage; and
Requires carriers to reduce a pre-existing condition limitation period applied against a person by the amount of time that the person had prior creditable coverage, not including periods of time occurring prior to any lapse in coverage of more than 90 days.


ALSO AND VERY IMPORTANT there is a lookback period. That is the period of time an insurer can LOOK BACK and see if someone was treated for something. it'll be detailed in part 2.

Posted by: visionbrkr | September 5, 2009 8:25 AM | Report abuse

When I hear people saying that insurance companies are trying to derail obamacare, I have to laugh. I am an insurance agent and recently we just had a huge meeting with United Health Care (they now own AARP, Health Net, Oxford, and several other companies). One agent asked how we respond to peoples’ concern about obamacare and the representatives said …” tell them it is ok. We have already met with government officials and we are in solid. When obamacare passes we will be in the driver’s seat.”
Most of us were ticked off because all these reps cared about was that United Health Care already had their inside connection. We, however, parents, children of older parents and ourselves were not happy and we let them know it. They promptly ended the meeting.
It is so naïve of Americans to think that this administration is trying to save us from the big bad corporations. Why do you think Wall Street, Warren Buffet, Soros, big corporations keep voting Democrat? Everyone by now must have read about obama’s meeting with Big Pharm. The sad thing is that true to community organizers dream, they have kept us pitted at each other. By the way, I live in CT and I love my insurance plan. We still have the right to choose a plan that is scaled down to our needs and pay less. I no longer need pregnancy coverage, infertility coverage, drug or alcohol coverage so at 63 years old I only pay $359 for my policy. I also am in good health, but if I need care, the money I have saved over the 40 years that I have paid for my own insurance more than makes up for my measly $5000 deduction.
One other thing, I can attest to the fact that our town hall meetings were attended by truly concerned citizens. No one ever tried to solicit our voice. However, several of our comrades who are with the local unions told us they had been called by the union reps to “go support Joe Courtney and disrupt and interrupt any anti-obamcare citizens”. Our local paper called us “right-wing radicals disguised as concerned citizens”. What a joke. It didn’t matter because no matter how thought provoking our questions were, Courtney always took the moral high ground stating that no matter what we said he was going to make sure every person had health care “because it is the right thing to do”. He was our moral police and that was his mantra.
We have decided to call upon the people running against our incumbents and get a meeting with someone who will listen to us and see what they would be committed to.

Posted by: charlenestrong | September 5, 2009 8:27 AM | Report abuse

PART 2,

text below directly from the NJ DOBI website:

Specifically, the SEH Program Act does not allow carriers to look back more than 6 months at a person’s medical or treatment history for purposes of limiting coverage, and does not allow a carrier to consider any condition as pre-existing unless the condition was actually diagnosed or treated, or treatment was recommended or prescribed medications were taken for the condition. And under no circumstance may a carrier consider a pregnancy to be a pre-existing condition

------------------------------

this basically says pregnancy can NEVER be a pre-exisitng condition under any circumstance and insurance companies can only look back 6 months to see if someone was treated for something.

I had a specific client whose daughter we didn't cover but he asked us to help out and we did. She had a heart condition when she was younger (around 22) and that was covered but now she's 34. She had a gap in coverage and then unfortunately she was hospitalized and had about $40,000 in bills that we argued was not related to her heart condition. Originally her insurer had subjected her to pre-existing conditions. We appealed to the carrier and to the Dept of Insurance and the Dept ruled that it had to be covered and its being paid now.

Unfortunately many people don't understand the rules and that there are people out there to help them. I guess that's why I get ticked off when people call me the "devil" and a "shill" becuase without me there to help her she would have been another medical bankruptcy statistic. Yes it would be better if we can get to no pre-ex at all but we can't get there without a mandate that everyone be covered.

Posted by: visionbrkr | September 5, 2009 8:34 AM | Report abuse

so in essence the only people who can be subject in even limited circumstances for a limited time frame is groups from 2-5 and single individiual policies and if they've had consistent coverage they cannot be subject to pre-ex and under no circumstances can pregnancy ever be a pre-existing condition.

Posted by: visionbrkr | September 5, 2009 8:39 AM | Report abuse

But what you are saying is that N.J. insurers are forbidden to sell insurance at a higher price to consumers who are willing to pay to have their pre-existing condition covered from the beginning of the policy? Where does it say that?

Posted by: Lee_A_Arnold | September 5, 2009 1:57 AM | Report abuse


Lee,

the point is they cannot "pay extra" to have that covered but if they've had consistent coverage they wouldn't need to it would be covered. If they have had too long of a lapse under the law the pre-exisitng condition would not be covered (if they were a single individual or in an employer group from 2-5 employees) for a year if you're a single individual or 6 months if you're in the 2-5 market segment.

Posted by: visionbrkr | September 5, 2009 8:42 AM | Report abuse

You know what? When Ezra's right, he's right. There were lots of Town Halls that went off without a hitch. All the ones at the UNION HALLS, the ones that were 'By Invitation Only', the ones in the Childrens' Wards of Hospitals, and the ones where ACORN and SEIU were BUSED IN, and snuck in through the back doors, were hunkey dorey. What an idiot.

Posted by: GoomyGommy | September 5, 2009 9:45 AM | Report abuse

Visionbrker, it seems to me that you are splitting a lot of hairs to avoid my question and that Pallone wasn't telling the whole story (he was after all speaking to New Jerseyans who already know the whole story) but was technically correct. Is that a fair assumption?

Posted by: Lee_A_Arnold | September 5, 2009 11:09 AM | Report abuse

lee,

no splitting hairs, just different market segments.

Individuals and small employers with 2-5 employees-- no rate change ever and no pre-ex if they've had less than a 62 day lapse in coverage for small employers and 30 days for individuals.

employers 6-50 no pre-ex, no rate change.

IN NO WAY CAN A RATE CHANGE IF SOMEONE HAS A PRE-EXISITING CONDITION IN NJ.

Posted by: visionbrkr | September 5, 2009 1:24 PM | Report abuse

But Pallone is only speaking about one market segment at the beginning: He says, "And so we recognized the fact that we had to do something primarily for this group."

And you haven't provided evidence that disproves his description of it.

You are slipping on the astroturf.

Posted by: Lee_A_Arnold | September 5, 2009 2:34 PM | Report abuse

Lee,

you can use all the astroturf arguments you want but the fact is he said the rate in NJ can change and it cannot.

end of story.

I have given proof. The rates are on the NJ DOBI website. How could a state governemntal entity put rates online if those rates were subject to change. Don't you think they'd SAY "SUBJECT TO CHANGE??"

Or is the state of NJ in "cahoots" with insurers???

Posted by: visionbrkr | September 5, 2009 3:01 PM | Report abuse

This is the end of the your story?

You directed me to the video. You wrote, "Its in the very beginning, within the first minute." And you misinterpreted what the man said there.

Posted by: Lee_A_Arnold | September 5, 2009 3:41 PM | Report abuse

lee,

we were being civil and had a nice diaglogue going and I'd like to remain that way.

You're right. i slightly misinterpreted what he said and just went back and re-listened to it. He said that if you had no pre-existing conditions you could pay in the individual market say $12 or $13,000 a year. If you had a pre-existing condition you could pay $20,000 or even $25,000.

That's 100% FALSE.

Posted by: visionbrkr | September 5, 2009 4:13 PM | Report abuse

But pre-existing conditions have a waiting period. Are you saying that an insurance company is forbidden from waiving the waiting period in return for a higher premium?

Posted by: Lee_A_Arnold | September 5, 2009 9:04 PM | Report abuse

Lee,


honestly I don't know if they're "forbidden" to bypass the waiting period. In my 15 years I haven't heard of one example of them waiving it. What do you think is a fair "price" for them to waive that waiting period for say, "lymphoma"? What about for lung cancer? How about liver cancer?

Remember now that the insurer knows that the patient will need and receive hundreds of thousands of dollars of treament before you make your answer.

Posted by: visionbrkr | September 6, 2009 12:12 AM | Report abuse

Well exactly, these things should simply be covered by a single payer, to remove the immorality of denying help to people with lymphoma or lung cancer.

On the other hand, you imply that the insurance industry will consent to cover everybody for everything, if only we get all 43 million missing customers into the system (by the "mandate.")

But that's a one-time windfall, and partly paid for by the taxpayer. It doesn't fundamentally change the cost structure of the healthcare industry, and so the good effects won't last. Because every one of the insured is eventually going to need healthcare, probably extensive and costly healthcare.

So we'll be back to the same fight over the private medical loss ratio. Without a public option, this guarantees an endless political fight over capture of the system by the private insurers, who are no less corrupt than anyone else. (Indeed possibly a little more than most.)

Basically your strategy is to get the young and healthy to pay for the old. Well if you're going to run a transfer program like Social Security, you might as well keep it to Social Security's overhead and transparency. Even Medicare's real overhead is probably around only 6-7%.

And if we eliminate the amount of time that hospitals spend administratively on dealing with private insurers, we will save costs there, too.

The real question is what value-added do private insurers give for disappearing 15-20% of every healthcare dollar, and the answer appears to be subjective and incomplete. Because the insurance industry aren't the ones who are going to cure cancer.

Posted by: Lee_A_Arnold | September 6, 2009 1:29 AM | Report abuse

and again you don't call Rep. Pallone on the carpet for being wrong about something so crucial. Were you as forgiving to the Republicans on WMD's? You shouldn't have been but I suspect you weren't and if you weren't then you're doing nothing but showing how partisan you can be.

As i've said before I don't believe single payer works in the US for 3 reasons.

1-fraud and abuse of the Medicare system isn't included in your slightly more realstic cost figures. That's 50-60 billion a year by most estimates.

2-the current single payer system of medicare is going bankrupt quick. Why would we put everyone there and risk the entire country's healthcare to a group that hasn't managed costs well since inception even when they are the ones making the deals.

3-without economic changes to the salary structure of the entire country it couldn't work. If we bring down doctors salaries to the levels for it to work we would have to bring down all other salaries for all other professions or people won't want to become doctors. They'd rather be engineers, financial planners, anything other than doctors that make as little as doctors in other countries make. We already have a doctor shortage in this country and single payer would make that worse.

Oh and as for what private insurers bring. They bring the only time (the 1990's) when healthcare costs were in line and sustainable.

To me that's pretty impressive.

Posted by: visionbrkr | September 6, 2009 9:23 AM | Report abuse

So cancer is like WMD's? Stop blabbering and answer if it is immoral to deny immediate treatment. If there is a waiting period, how was Pallone wrong? I would prefer a two-tier system with a public option, but your three reasons why single-payer won't work are hardly decisive there, either. Costs are going up with private insurance.

Posted by: Lee_A_Arnold | September 6, 2009 2:29 PM | Report abuse

Lee,

I was pointing out your being partisan in your comments. Could you ever admit when a Democrat is wrong?

Yes it is immoral. I've said for a long time that we need an end to pre-ex as long as everyone is required to be covered. It is not only a fair trade off but it makes 100% economic sense. Anyone who has ever managed risk of any kind knows this.

If there is a waiting period it is NOT the insurer charging more in premium. THAT IS WHAT HE SAID. It is if the individual is being treated for that condition during the waiting period the insurance not covering them and the hospital and doctors charging them. How people don't get that insurers don't charge anything I still don't understand. people should have at least a working knowledge of how things work before they decide to talk on the subject. Its the same reason you'll never see me in a quantum physics chat room.

Yes costs are going up with private insurance but the only time costs were EVER in line with either a private or public insurance was the 90's and the era of Managed Care.

And don't try to tell me about Medicare and Tricare or the VA managing costs becuase they're funded by the taxpayers and those costs are extremely high which is the reason that they are unsustainable.

Posted by: visionbrkr | September 6, 2009 8:53 PM | Report abuse

Pallone didn't say anything about a waiting period policy. You haven't proven your case yet.

You also need to prove that the public option won't save money for the consumer. It looks to everybody like the price will be 10-15% cheaper in the long run.

Fraud? According to a new study by the George Washington University Medical Center, there is no less fraud in private insurance.

Don't forget to add the Wall Street bailout to the real costs of private insurance. The private insurers were up to their necks in mortgage derivatives. The real medical loss ratio is probably 50% or worse.

Posted by: Lee_A_Arnold | September 6, 2009 10:03 PM | Report abuse

so basically if pallone said the world was flat you'd believe him right? you need to get off of your Democrats do all right and Republicans do all wrong that you've been brainwashed into. Myself for example knows the first part of the stimulus worked and saved us from financial ruin. I disagree now with how the balances are being done and think it was too much but the end result is good so i'm in favor of it. I'm fine with praising Obama for that.

"Pallone didn't say anything about a waiting period policy. You haven't proven your case yet."

You're right and you've proven my case. He didnt' say anything about a waiting period just that insurers can change rates which they can't! HE SAID IF SOMEONE HAD A PRE-EXISTING CONDITION THE RATE COULD GO UP AND IT CAN'T. DON'T BELIEVE ME. CALL THE NJ DEPT OF BANKING AND INSURANCE YOURSELF. 609-292-7272.

Yes fraud does happen in private insurance but private insurers have been investigating fraud for years and they've been "firing" doctors from their networks that are fraudulent. Medicare just started investgating fraud and its only a drop in the bucket to what's being done there. The inspector general of HHS and the FBI has reports on it.


"Don't forget to add the Wall Street bailout to the real costs of private insurance. The private insurers were up to their necks in mortgage derivatives. The real medical loss ratio is probably 50% or worse."

Are you seroius? mortgage derivatives? I'd love to see your proof of this? I highly doubt that health insurance (which is the most highly regulated industry and about to become moreso) would be even allowed to invest in such things or be allowed to submit losses in such things in their MEDICAL LOSS RATIO.

You'd need to actually KNOW what a medical loss ratio is. Its premium paid vs claims. THAT'S IT END OF STORY. YOu see no mention of deriviatives. Next thing you'll have space aliens as CEO's or something. Please step away from the cliff and join reality again.

I've really tried to be polite this weekend in explaining things to you. But when you go off on things you honestly don't know anything about I really should rein you in.

Posted by: visionbrkr | September 7, 2009 7:51 AM | Report abuse

You've already admitted that you don't know: You wrote, "honestly I don't know if they're 'forbidden' to bypass the waiting period." Well, if they ARE allowed to, then Pallone would be technically correct.

On the financial health of the insurance industry: If the insurers invest in any financial securities (and or course they do, it is their investment function,) then their value is maintained by the taxpayer bailout. It's all connected. They don't even have to be directly in mortgage derivatives, although places like AIG appear to have been central. So for a proper reckoning of the medical loss ratio, the health "premiums" ought to include the amount that each taxpayer is losing on the fiasco.

It's hard to credit any part of the financial industry with intelligence or due diligence.

Indeed two of the largest single frauds in U.S. history until the recent fiasco are Columbia/HCA and NCFE. It's ridiculous to suppose that private insurers are going to investigate themselves.

Posted by: Lee_A_Arnold | September 7, 2009 11:47 AM | Report abuse

You've already admitted that you don't know: You wrote, "honestly I don't know if they're 'forbidden' to bypass the waiting period." Well, if they ARE allowed to, then Pallone would be technically correct.

its amazing to me how you're falling all over yourself trying to prove a politican correct. I don't know if they're forbidden BECAUSE ITS NEVER HAPPENED. Why would an insurer take on a risk that is a known expense when the law states that they don't have to. As i tried to explain before what do you charge as an "extra" premium for that risk? $200,000 more?? Does any individual have that sitting around nowadays?

now back to reality. So by your definition of the insurance industry's involvement in the financial markets then I guess your corner grocer is tainted with that too. My God we're all complicit.

Posted by: visionbrkr | September 7, 2009 12:10 PM | Report abuse

so if you've ever deposited money in a bank. accepted a paycheck that was drawn on by a bank then you're invovled in the plot too. I'd suggest you turn yourself in now before it gets too ugly for you. You'd better get back to the caveman barter system where its safe.


oh and AIG is really not a health insurer. Sure they do that to a small degree but its a small fraction of what they do so to call them a health insurer like it sounds like you're trying to do is really wrong.

Posted by: visionbrkr | September 7, 2009 1:03 PM | Report abuse

So if someone had paid to bypass the waiting period, you yourself would know? How do you know this, exactly? Or is based only upon your questionable logic that they would have to charge somebody $200,000 -- for something that might not happen? Since you, who understand insurance so well, have decided that there is no way to calculate the new risk?

In other news: depositing money in a bank is blameless, and the grocer's business is not choosing investments. Insurers do that -- and they are moving around enough money in the capital markets that they ought to know: AIG was managing risk there as a house of cards.

You appear to willfully misinterpret. I am not trying to prove Pallone is correct; I simply do not know. What I do see is that you haven't proved your point at all. But you used it to go on a long and misleading tangent about how the private health insurers are necessary to the system. They are not necessary. They are sucking out extra healthcare dollars. We should have a public option, so you can do without them if you want.

Posted by: Lee_A_Arnold | September 7, 2009 4:51 PM | Report abuse

lee,

the point is when its a known condition like cancer but you don't know the actual cost you have to as an insurer err on the side of caution which means you don't cover it unless the law says you have to.

The $200,000 figure was a random number by me. If the law said you had to cover it at an additional cost (WHICH IT DOESN"T) then the insurer would figure out the maximum possible cost and charge that number.

Insurers are necessary. Not in the way that doctors, hospitals, pharma is necessary but still very necessary. As Ezra correctly points out they are the only ones ever to manage costs responsibly (in the 90's). Government can't do that and ration care because the people would never stand for it and if care isn't rationed healthcare would continue to grow to unsustainable levels. Insurers need to play the "bad guy". And instead of pre-ex they'll do it by telling you that you can't have 3 MRI's in a year or that you need to take a generic and can't have a brand named drug. That will be the new rationing for all of us. If you want the 3rd MRI, pay for it yourself. If you want the Lipitor, pay for it yourself becuase the system cannot continue at its current pace with such limited resources. California is letting prisoners out of prison because of its healthcare bills bloating its budgets. Other states are closing state offices one day a week. A school district in Georgia is going to 4 day school a week to save costs. This is what we've come to. I hope a $10 copay was worth it.

Posted by: visionbrkr | September 7, 2009 9:02 PM | Report abuse

People will never stand for it? Quite the opposite, I imagine. Let individuals decide for themselves what they will put up with. The private insurance motto appears to be "Let us charge you 15% more for rationing and denial of coverage." If people were able to put that 15% into their economic demand for other non-medical goods and services, the non-medical economy would grow at a better compound rate and we'd be better able to afford the healthcare.

Posted by: Lee_A_Arnold | September 7, 2009 11:03 PM | Report abuse

lee,

you really still don't believe that 15% profit do you? Again you all have been told what a medical loss ratio is and you still don't understand it. You can throw all this mumbo-jumbo about derivatives you want but you need to stick to the DEFINITION of it. Premium in vs claims out. 15% is overhead, taxes, operating expenses, marketing and advertisement. It is better than what Medicare does when medicare' ACTUAL expenses are factored in. The problem is that medicare is a captive market so no marketing is done. THye don't pay premium taxes so that's another 5% on average. They also don't factor in costs of ownership of buildings, rents etc because that goes into the general treasury. There is so much that people don't know yet assume medicare is more efficent because the pundits pushing their agenda say so. Look at the facts.

Posted by: visionbrkr | September 8, 2009 9:26 AM | Report abuse

I didn't say 15% "profit."

It is entirely legitimate to state that the private insurance system is costing us more than our premiums. At this point, just about everybody knows it.

In fact we should also add the time and energy costs of chopping down all this ridiculous astroturf.

If Medicare saves money by not having to pay certain useless private expenses, that's a feature, not a bug.

Posted by: Lee_A_Arnold | September 8, 2009 10:02 PM | Report abuse

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