Earlier today Bloomberg View columnists Margaret Carlson and Ramesh Ponnuru met online to chat about Bill Clinton, Obamacare and their cholesterol levels. Below is a lightly edited transcript.
Margaret: Bill Clinton can be great. He can be terrible. He mostly means well, but he can't resist mischief. After he appeared at the Democratic Convention in 2012, President Barack Obama added him to his cabinet as the Secretary of Explaining Stuff. But, wow, did he hurt the case for Obamacare by telling Obama he should make good on his promise that "if you like your insurance, you can keep your insurance."
No, you can't. That goes against the essence of Obamacare. It may be true for people in group insurance, but not in the individual market. That's where the biggest problem is (along with the uninsured -- but they don't have a policy they like to keep). Letting individuals keep crummy policies (insurance companies are clever enough to make sure that you don't know it's crummy). Changing the law to make that happen takes the heart out of it. Now, Senator Dianne Feinstein is introducing legislation to Clintonize Obamacare, which is anatomically impossible to do.
Ramesh: The problem, Margaret, is that the Democrats couldn't have gotten Obamacare through without making a promise they didn't intend to keep. The bill, you'll recall, squeaked through the House with all Republicans and some Democrats opposed, and supporters kept saying that it wouldn't change people's existing policies. It does (and it makes changes to employer-based policies too). Clinton's political judgment is right: This is a big problem for the administration. You're right, too: Fixing it doesn't really make sense within the bounds of Obamacare. But Obamacare has created a situation where there's no good fix. Right now, people are losing their insurance, they can't get new insurance, and the administration refuses to back off its promise to fine them if they don't. Good luck selling that, whatever Clinton is saying.
Margaret: There's a problem that is hard to make go away as long as insurance companies are partly calling the tune. In the individual market, they are happy to cover healthy people. They go through hoops to make sure of that. And give them relatively low rates. Bring in sick people and their rates go up. That's the principle of insurance: pool and share the risk.
Ramesh, you would abolish Obamacare altogether, which means back to the bad old future where it's impossible for people with pre-existing conditions to get affordable insurance. Clinton popped off. He continues to endorse the law, he says, but he doesn't. The White House must be frantic over the latest numbers -- Obama's underwater on the question of who voters trust, a huge loss for him. Through thick and thin, he's kept that. Now according to a Quinnipiac Poll, 52 percent of voters say the president isn't trustworthy; 44 percent say he is. Meanwhile, the poll showed that just 39 percent of voters approve of his handling of his job, and 54 percent disapprove. But he can still lord it over members of Congress. Their job approval is 9 percent, meaning only blood relatives have a positive view.
Ramesh: As we've discussed many times, the president doesn't have great relations with Democratic members of Congress, let alone Republican ones. With his numbers dropping, their reasons for sticking with him are starting to vanish. Congress may be unpopular, but on this issue siding with Obama is going to make it more so. And I don't want to go back to the bad old days. We could have solved the discrete problem of people locked out of the market because of pre-existing conditions without a 2,700-page bill, regulations that forced the cancellation of existing policies or fines on the uninsured. We still should.
Margaret: The biggest headline today was about cholesterol, i.e. that more people need to take statin drugs. How's yours, Ramesh? Mine's not so bad, even though I eat a pint of Ben & Jerry's most nights (straight out of the carton; when the spoon hits the bottom, I put it back in the freezer). As I read this study, it's a big payday for the drug companies. There's a more complicated matrix of conditions to say you should take the drugs but in the end, it's justification for doctors to prescribe more and for insurance to pay. This is why we have such a health-care mess.
Ramesh: I am, um, not sure what my cholesterol level is. I suppose it has ways of making itself known to me. My internist brother told me a couple of years ago that he had done an informal survey of cardiologists he knows and that every one of them, even those with a relatively low cholesterol number, took one of those drugs. He started, too. You're right that people's desire to have access to the latest medicines increases health costs. (Well, some of them. Poor health is a cost, too.) But it doesn't strike me as terrible for the country to spend more on health care as it grows richer. The problem is that so much of our spending is opaque and inefficient.
Margaret: I'm a Christian Scientist when it comes to medicine and often get prescriptions I don't fill. I'm amazed at how people pop pills. But is your internist my internist? I can trust your brother. I'm sending him my numbers. If he's taking statins, I'll take statins even though what I need to be told is to stop with the Ben & Jerry's.