If you like it you can keep it

Lost in the furor over President Obama's deliberate, pervasive, and apparently gleeful FALSEHOOD!!! (four Pinocchiosin today's Washington Post) is the question of whom he was lying to, an answer to which is succinctly suggested by Sarah Kliff (sort of by chance, since the passage is meant for a somewhat different job), also in the Post, as it happens:

Image by Hyokka at DeviantArt.

While the federal exchange has gotten much attention in recent weeks, only a small fraction of Americans are expected to use the new marketplace to buy health insurance. The Congressional Budget Office estimates that, by 2023, 24 million people will buy insurance through the state and federal exchanges; that’s about 7 percent of [jump]

the population. It’s telling that many of the large insurance companies, such as Cigna and UnitedHealthcare, have decided to participate in only a handful of the states’ marketplaces. So far, they don’t see this segment of the market as key to their growth. 

The vast majority of Americans will still get their health insurance the way they did before the Affordable Care Act: through their employers or through a public program, mainly Medicare and Medicaid.

That gives you a rough initial finding that for around 93% of us (including, full disclosure, your correspondent here), if we like it we can certainly keep it, and if we hate it we're probably still pretty much stuck.

The only people in danger of liking their plans but not getting to keep them is some subset of the number of those with individual plans; in 2012, according to Insurance Journal, some 15.8 million Americans; that's clearly fewer than 15.8 million plans, since it includes couple and family policies, so let's just round it off to 10 million plans total.

How many of those plans do the policy-holders actually like?  A ballpark notion is provided by Secretary Sebelius in a commentary from today that Dr. Google has found for me in, of all places, the Elko Daily Free Press:

Before the Affordable Care Act, coverage in the individual market often was unaffordable, had high co-pays or deductibles, or lacked basic benefits like maternity care, mental health services, and prescription drug coverage. These plans also had high turnover rates, and often were not renewed at the end of a plan year. One study showed that more than half of enrollees in the individual market left their plan within a year. 

On the basis of that turnover rate, you could say slightly less than half of the enrollees were satisfied enough with their plans at any given point in time to stick with them, say 4.5 million.

But were they truly satisfied? Since 5.5 million succeeded in ditching their plans in the course of the year, there must have been some significant number who wanted to ditch them but failed, including those who couldn't switch (until 2014) because of preexisting conditions, whose numbers are unknown, though they were a huge reason for the ACA in the first place. Maybe two million total. Then there were those who couldn't switch because they lived in an area with no competition. That's half the counties in the area served by the federal exchange now, according to the Times; mostly living in underpopulated rural areas, to be sure, but that's also where the people who need individual plans are concentrated, since relatively few of them have corporate or government jobs. Another two million?

From Hyper Death Babies by Charles.

Let's say, then that there were about 500,000 that really didn't want to change their healthcare plans in 2012. That seems pretty likely; if as CBS claims there are about two million total who face cancelation on their plans, it would be a quarter of them that would regret that.

Of those, how many actually liked their plans? How many would have switched in a minute if there was a cheaper, better-quality alternative, as there now is for most? Have you ever met anybody who said, "I like my health insurance plan?" Other than a very healthy motorcyclist? (All the motorcyclists I've known were middle-class biker wannabes on normal group plans.) Ladies and gentleman, I submit that the number of people to whom President Obama lied is very close to zero.

Pure speculation, of course but no more so than the 93 million Forbes magazine pulls out of its broad and majestic ass in a remarkable feat of reasoning using logic much like mine but rather less actual evidence.

Incidentally, it's worth noting that Obama was saying "if you like it you can keep it" from long before any bills had been written, during the 2008 campaign. He wasn't alluding to any partcular bill, he was talking about his general concept, and its whole tendency, not its exotic details.

Back in August 2009, when the first drafts of the ACA (featuring a big old public option) were first made available to the public, Politifact took a look at a claim that if you liked it you could keep it and gave it a Half True rating, mainly on the grounds that the public option was going to be so attractive to employers that they'd start hauling their employees off the private plans (they got the idea from a policy analyst at the Heritage Foundation). I guess you probably know where that particular fear went.

Most interesting in that old Politifact piece is a quotation from Barack Obama, in an answer given to Jake Tapper on the if you like it you can keep it question:

"When I say if you have your plan and you like it, or you have a doctor and you like your doctor, that you don't have to change plans, what I'm saying is the government is not going to make you change plans under health reform. ... Let's say that we take the advice of some folks who are out there and say, 'Oh, this is not the time to do health care. We can't afford it. It's too complicated. Let's take our time,' et cetera. So let's assume that nothing happened. I can guarantee you that there's the possibility for a whole lot of Americans out there that they're not going to end up having the same health care they have. Because what's going to happen is, as costs keep on going up, employers are going to start making decisions: 'We've got to raise premiums on our employees. In some cases, we can't provide health insurance at all.' And so there are going to be a whole set of changes out there. That's exactly why health reform is so important."

Oh. Um, I see. So it looks like in a sense he didn't lie to anybody, though he can certainly be accused of spinning in the sound-bite versions of his claim. Because it isn't the government that's making anybody change plans, it's the insurance companies, as you might have expected, and the president evidently did expect it. They're doing it with a great big boost from old Senator Baucus, who made sure in the markup of the bill that his friends in the insurance and health care industries wouldn't be subjected to a lot of harassment and wounded feelings.

Image via PiggyBankBlog.