One of President Obama's key talking points seeks to reassure Americans that are happy with their current coverage that there's no need for them to worry. "If you like the health insurance coverage you currently have, you can keep it," is his mantra. The strategy behind these words is obvious: people who like the status quo are resistant to change, so they need to be assured that health reform doesn't mean change for them. The problem with this approach, however, is that it makes people complacent when they really ought to be anything but.
Sure, health reform is about providing access to coverage for the over 45 million residents who are uninsured, but it is just as importantly about ensuring health security for the rest of Americans who may have coverage, but who are under-insured and/or just a step away from joining the ranks of the uninsured. Here's the kicker: That includes all of us. Does it matter? Well, in 2004, the Institute of Medicine blamed some 18,000 adult deaths a year on a lack of insurance, because of cases where needed care is foregone. I don't know about you, but I'd call that a big deal. According to an article in the New York Times, here's a breakdown of the uninsured:
"But I have insurance," you say. Fair enough, but here's the problem with that. For those of us who enjoy having health insurance through our job, costs are rising so quickly that it is becoming increasingly likely that our employers may decide offering benefits (which they do voluntarily) has become prohibitively expensive. Then we might try to procure coverage in the non-group market, only to find it even more unaffordable. So, there's nothing preventing that pink pie slice above from being flooded by millions of people just like you and I who think we've got health insurance under control.
For those of us who are unfortunate enough to lose our jobs for whatever reason (say, a prolonged economic downturn), we not only lose our coverage, but our incomes. If we're able to find any kind of work at all, I'm sure we'll be happy to learn that the big purple slice of "working poor" will be there to welcome us with open arms. Of course, the alternative is that we'll be non-working poor, and I shouldn't have to tell you that that almost never ends well.
What am I trying to say here? That even those of us who like our current coverage have absolutely no security in that. There's nothing standing between us and being uninsured other than an employer who woke up this morning feeling like they could still afford to provide you and I with insurance. The problem is, if we don't do something to reform the system, costs are going to get so high that one day the employer wakes up and thinks, "I can't run a business like this." Ta-Da! Just like that, you can say goodbye to your coverage. The message all of us need to hear is: "If you like your current coverage, then help us make the system stronger, so you can be sure it will be there for you no matter what."
Why is it so hard to get this across to people? Because we value what we have more than what we don't, and we "feel the pain of losses more than we enjoy the pleasure of gains" according to James Surowiecki who has an excellent piece in the New Yorker that explains why people love the status quo so much. It's why incumbents--even the ones who get handily criticized for the job they're doing--are typically the odds-on favorite to win re-election. The devil we know is almost always preferable to the devil we don't know.
Obama's message is halfway on-target. We do need to reassure people that health reform doesn't mean they will have to give up the coverage that they like so much. At the same time, however, it is imperative that we give people the other side of the story: Without meaningful health reform, there's a very real chance that they will lose the coverage that they have.
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