October 22, 2013
OLD SPIN: Death Panels are just some crazy thing Sarah Palin made up.
UPDATE: A reader emails about classism in the ObamaCare setup:
With regard to the ACA roll out, one of the things that is striking to me is how different the new insurance enrollees who receive press coverage seem than the majority of uninsured patients with whom I deal as a physician. In general, those highlighted in the press seem well-educated, self-motivated, and well-organized rather than living the very difficult, impoverished, chaotic, and marginalized lives that many of my uninsured patients need to navigate. Perhaps this just reflects PR spin or journalistic biases toward individuals who are more like themselves, but I don’t think so.
Rather, my impression is that the healthcare.gov website (when functional) will serve the needs of people like my neighbor, who is the graduate of an elite business school and who struggled to find insurance in the 18 months he was unemployed after selling his company. However, I just can’t see a lot of my patients having the wherewithal to go online, navigate the long and confusing process, and ultimately sign up and pay for a plan that costs “only” a few hundred dollars per month. Healthier uninsured individuals in whom health issues and costs aren’t in the first tier of their daily challenges seem even less likely to do so.
In short, I suspect that the website and the ACA enrollment plan in general were designed by individuals without a good feel for the needs of the people they intended to serve. Rather it was designed for people fundamentally like themselves (educated, upper middle class) who lack health insurance but lack for much else. Even when the website is fixed, this will be a huge problem.
As I tell my Administrative Law students, poor people don’t deal well with bureaucracies, something you find out over and over again.