Clearing the Obamacare cobwebs

The fight we've been having for the last week over the president's broken "If you like your health plan, you can keep it" promise has not been very informative.

To hear liberals tell it, this is mostly a story of people losing their grip on "junk insurance." If people are paying more, it's because their new insurance plans will be better, and very often subsidies will offset the higher premiums anyway. That's not the whole truth.

To hear conservatives tell it, health care reform is disrupting an individual market that was working pretty well before government interference. That's not true either — the existing individual market is so dysfunctional that more than 3/4 of people who lack group coverage go uninsured. The existing market mostly works well for people who are healthy and have moderate to high incomes; the goal of the ACA is to make it work for everyone.

And the ACA will do that, making insurance accessible and affordable to tens of millions of people who lack it now. Some people who are already insured through the individual market will be better off, too: Their premiums will go down and/or their plans will get more comprehensive.

But at the same time, the law will make several million people worse off, by driving their premiums up, pushing them into plans that are less comprehensive, or causing insurers to switch them to plans with narrower provider networks that don't include their preferred doctors or hospitals.

ACA supporters need to argue not that these people don't exist or that their circumstances only changed because of greedy insurance companies; they need to argue that their losses are more than offset by the gains of the sick and uninsured who will get better and more affordable coverage under the law.