The change was subtle, but significant.
In his speech to Congress on Wednesday night, President Barack Obama gave a more accurate — and less reassuring — account of the impact of his proposed health care overall than he has done in the past.
It went by in a blink.
He told Americans, in excerpts released by the White House, that nothing he is proposing will force businesses or consumers to change their existing insurance coverage. That much is true.
It’s also true that nothing in his plan guarantees that policies people have now will continue to be available in the same form. In earlier accounts, he spoke with unmerited certainty in saying people who are happy with their current insurance can simply keep it.
Other parts of his speech repeated some of the oversimplified claims that have marked his salesmanship. A look at some of his assertions Wednesday night:
OBAMA: “Nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: Nothing in our plan requires you to change what you have.”
THE FACTS: That’s correct, as far as it goes. But neither can the plan guarantee that people can keep their current coverage. Employers sponsor coverage for most families, and they’d be free to change their health plans in ways that workers may not like, or drop insurance altogether. The Congressional Budget Office analyzed the health care bill written by House Democrats and said that by 2016 some 3 million people who now have employer-based care would lose it because their employers would decide to stop offering it.
In the past Obama made repeated statements such as, “If you like your health care plan, you’ll be able to keep your health care plan, period.” Now he’s stopping short of that unconditional guarantee by saying nothing in the plan “requires” any change.
He’s dropped the “period.”
OBAMA: Requiring insurance companies to cover preventive care like mammograms and colonoscopies “makes sense, it saves money, and it saves lives.”
The facts: Studies have shown that much preventive care — particularly tests like the ones Obama mentions — actually costs money instead of saving it. That’s because detecting acute diseases like breast cancer in their early stages involves testing many people who would never end up developing the disease. The costs of a large number of tests, even if they’re relatively cheap, will outweigh the costs of caring for the minority of people who would have ended up getting sick without the testing.
The Congressional Budget Office wrote in August: “The evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.”
That doesn’t mean preventive care doesn’t make sense or save lives. It just doesn’t save money.
OBAMA: “Now, if you’re one of the tens of millions of Americans who don’t currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage.”
THE FACTS: Left unsaid is that the Democratic proposals in Congress could, in fact, require all individuals and families to buy insurance, including many who want it but can’t now afford it and many who choose not to get it. Waivers or discounts would be available to lower-income Americans.
That requirement, called the individual mandate, is designed to increase the size of the insurance pool and, by including younger and healthier Americans, reduce overall costs.
To be sure, Obama has not yet endorsed the push by some fellow Democrats for a mandate. Obama opposed the individual mandate as a presidential candidate, but announced in the spring that he’d support it as long as there are hardship waivers.
If a mandate becomes law, the claim that “you will be able” to get coverage will be misleading. People will have to get it.