An Exemplar: The Substance And Politics Of Obamacare Evidence In One Citizen

"Obamacare: Where's The Train Wreck?"

http://paxonbothhouses.blogspot.com/2014/01/wheres-train-wreck.html

The substance and politics of Obamacare, in one citizen

Paul Waldman, Washington Post

There’s a journalistic trope that has become so common over the past couple of decades that you probably don’t notice it anymore, or just assume that it’s how news stories have always been written. It’s what media scholars call the “exemplar” — an individual person whose story is used as a vehicle to explain the effects of a policy or an event. There’s always a danger that this narrative technique can oversimplify things. On the other hand, the use of an exemplar is a good way to connect large issues to the lives of the people affected by them.

And every once in a while, a good reporter can find an exemplar whose story so perfectly captures an issue that it does more than just spice up an article, but actually leads us to a deeper understanding.

So it is with this story in today’s New York Times by Abby Goodnough, who reports on the successes and hurdles of the Affordable Care Act in Kentucky, which accepted the expansion of Medicaid and set up its own exchange. Here’s the beginning of the story of one of the exemplars Goodnough found, which tells us a tremendous amount about where the ACA has come, substantively and politically, and what its future holds:

Amanda Mayhew is one of the beneficiaries. She earns little enough to qualify for Medicaid under the new guidelines, and she enrolled in August. She has been to the dentist five times to begin salvaging her neglected teeth, has had a dermatologist remove a mole and has gotten medication for her depression, all free.

“I am very, very thankful that Medicaid does cover what I need done right now,” said Ms. Mayhew, 38. “They ended up having to pull three teeth in the last three weeks, and I would have been in a lot of pain without it.”

Then a bit later in the article, we learn more:

A nurse practitioner at Family Health Centers had prescribed anti-depressants after Ms. Mayhew had her last baby in 2013 — at the time, she had temporary Medicaid for her pregnancy — but she stopped taking them when the coverage ended. Now she is back on them, and feeling good.

“That’s been a big thing for me,” she said.

And yet.

“I don’t love Obamacare,” she said. “There are things in it that scare me and that I don’t agree with.”

For example, she said, she heard from news programs that the Affordable Care Act prohibited lifesaving care for elderly people with cancer.

There is no such provision, although a proposal to pay doctors to engage patients in end-of-life planning — such as whether they would want life-sustaining treatment if they were terminally ill — was removed from the law after it sparked a political firestorm over “death panels.” The misperception remains widespread: A poll this month by the Kaiser Family Foundation found that 41 percent of Americans still believe the law created “a government panel to make decisions about end-of-life care for people on Medicare.” An equal number found the law did not.

“If we have Obamacare and the insurance is available to me, I will use it and be thankful for it,” Ms. Mayhew said. “But would I gladly give up my insurance today if it meant that some of the things that are in the law were not in place? Yes, I would.”

Ms. Mayhew is obviously a good-hearted person. In fact, she’s so considerate of others that she’d give up the insurance that has been life-changing for her, if it meant she could save others from the horrifying things that she has heard Obamacare does, like denying cancer treatments to the elderly. It’s not her fault that what she has heard are outright lies — how is she supposed to know that? She got it from “news programs,” supposedly authoritative sources, which might mean a talk radio show or maybe a certain television network.

Now let’s consider how the two parties look at Amanda Mayhew and people like her. Start with what Democrats would say to her:

We believed that it was a terrible thing that you were uninsured. We fought, at considerable political risk, to get you insurance. And now we’re very pleased that you have it. But we really wish you understood the truth about what the Affordable Care Act does and doesn’t do. Please vote for us.

And here’s what Republicans would say to her (if they were being honest):

We didn’t care all that much that you were uninsured. We fought with all our might against the law that gave you the insurance you have now. If we could, we’d repeal it tomorrow and take that insurance away. But we’re overjoyed that you believe the false things you do about the ACA — indeed, we encouraged you to believe things like that, even though we knew they were lies. Please vote for us.

Not every Republican thinks that — there were many Republicans in Kentucky who went along with Democratic governor Steve Beshear’s acceptance of the Medicaid expansion, which made the change in Mayhew’s life possible. But every important congressional Republican does say that, as does every Republican who wants to be president (with the exception of Ohio’s John Kasich, another governor who accepted the expansion).

You can read those two paragraphs and say that they’re caricatures, warped by my liberal bias. But look back and see if you can find one of those sentences that is demonstrably untrue. Did Republicans care about the fact that before the ACA, there were more than 50 million Americans without health coverage? They certainly never tried to do anything about it. Are they actually disappointed that so many people believe falsehoods about the ACA? Give me a break — they couldn’t be happier, because it makes their political task that much easier.

Every voter who thinks there are death panels, or that Obamacare means elderly people aren’t allowed to get cancer treatments, or that Obamacare made their insurer use a more limited provider network (a business decision made by a private company to cut costs, which I’ve had people tell me they thought was required by the law) is someone who’ll nod their head at the next Republican candidate who tells them that Obamacare is a horror show.

At the same time, Republicans know that if they actually took Amanda Mayhew’s insurance from her, she probably would turn against them, as would others who heard her story. There’s a level of obvious cruelty and real-world consequence that no amount of propagandizing could overcome. In a way, both parties are satisfied with the status quo. Democrats are happy that she has insurance, and Republicans are happy that the lies she’s been told keep her from being too supportive of the ACA. So neither of those things is likely to change.

Paul Waldman is a contributor to The Plum Line blog, and a senior writer at The American Prospect.