Monday, June 22, 2009
Health The Public Option
Posted by Eli Sanders on Mon, Jun 22, 2009 at 11:13 AM
I wrote about it in the current Stranger, Krugman wrote about it this morning, and the New York Times did some important polling on it a few days ago and found that 72 percent of Americans support a public option.
What's this public option that everyone keeps mentioning in the health care reform debate? Ezra Klein explains in detail here, but basically it's the idea that a government-run health insurance plan should be created to compete against private insurers, with the theory being that this kind of increased competition in the health care market would bring costs down for everyone. Republicans call it socialized medicine—and worse. Progressives call it progress—and a back-door route to a single-payer health care system. And you?
I have a guess of what this Slog poll is going to find, but let's get it on the record—indisputable, infallible, legal, and binding as always.
Do you support a public option for health care reform?
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1
Your posts always include this implicit bragging / claims to authority that go something like "*I* wrote about this, (then) the *Krugman* wrote about this, the *Times* wrote about this"
it makes me feel sad for your needy validating
it makes me feel sad for your needy validating
2
I support a public option, indeed a single-payer system, but the idea that this is going to create any kind of competition is fantasy. There's no competition now; there's THEORETICAL competition, but in practice it's to the doctors' benefit to jack up expenses as high as possible, and that will continue to be true. Hence all those exotic hardwoods in your doc's office, and all those incredibly expensive tests ordered for practically anything, and all those docs funneling patients to private-but-approved-for-referral private businesses. Some docs at Group Health barely get you seated before they start plying you with glossy sales brochures.
3
The outcome will most obviously reflect the manner of your questioning: "If you're right wing, you'll say 'nay!', if you're progressive, you'll say 'yes! progress!'".
Missing in your question is the alternative. "Public Option" instead of what, exactly? What would be the outcome if you had said, "Do you support a public option for health care reform, instead of a single-payer system?" A back-door route is okay, if the front-door is out of the question.
Missing in your question is the alternative. "Public Option" instead of what, exactly? What would be the outcome if you had said, "Do you support a public option for health care reform, instead of a single-payer system?" A back-door route is okay, if the front-door is out of the question.
4
Like so much of the writing around this topic, your post fails to address the economicly most important question: does the "public option" get a subsidy (i.e. money from the government in addition to the premiums it charges), or is it a financially-on-its-own insurance company that just happens to have been started by the government?
6
You had three heads of major insurance corporations testifying before Congress last week that they would refuse to stop rescissions (the practice of cancelling a policy retroactively only when expensive-appearing claims are made) of people's individual policies, usually done on the flimsiest of pretexts. Even California is only making a belated, half-assed effort to control this (because state insurance commissioners are usually in the vest pockets of the industry) and legislatures are full of pussies.
A public option is the only way to seriously control this practice, not to mention control premiums and costs of care.
A public option is the only way to seriously control this practice, not to mention control premiums and costs of care.
7
I do support a public option. I wonder if we the consumer will be part of the solution. I think we often forget that we are a huge part of the problem. Here's two examples. At present, we spend a huge amount of health care dollars on end of life care (conservative figure 10%), and I'm not refering to hospice, I'm refering to "do everything possible" to delay certain eventual death. We as a society don't discuss death, it's not a comfortable dialogue to have. Although, some of us have living will and instructions for our ends, many of us do not. Also, we need to accept responsiblity for our demand society, we as a whole do not take personal responsiblity for our own health, yet we demand that our health coverage pay for preventable diseases that we won't do our part to prevent. I hope that public option will give us a push to become part of the solution.
Anyway, that's some of the discussion that moves around our dinner table. My husband is in health insurance, he supports a public option, and thinks that there is an excellent chance that he will need to make a career change in 20 years.
Anyway, that's some of the discussion that moves around our dinner table. My husband is in health insurance, he supports a public option, and thinks that there is an excellent chance that he will need to make a career change in 20 years.
8
@4, I have come to respect your generally well articulated libertarian arguments, though I disagree with the underlying beliefs.
As I understand it, insurance companies often spend 30-50% of every premium dollar generating flurries of paperwork attempting to reduce claim amounts or deny them outright. They wear down busy medical staffs and patients at their sickest.
I think a public-option entity that doesn't cancel policies for making claims, accepts all comers, simplifies paperwork, and has the power of size to negotiate lower fees... will naturally do so well that a no-subsidies clause could be included in its founding documents. Think Medicare for younger, healthier, but poorer people who need what insurance was originally conceived to provide and now does not: prevention of financial catastrophe.
As I understand it, insurance companies often spend 30-50% of every premium dollar generating flurries of paperwork attempting to reduce claim amounts or deny them outright. They wear down busy medical staffs and patients at their sickest.
I think a public-option entity that doesn't cancel policies for making claims, accepts all comers, simplifies paperwork, and has the power of size to negotiate lower fees... will naturally do so well that a no-subsidies clause could be included in its founding documents. Think Medicare for younger, healthier, but poorer people who need what insurance was originally conceived to provide and now does not: prevention of financial catastrophe.
9
I read the Ezra Klein bit, but has anyone explained exactly why they can't just drop the age restriction on Medicare and have people pay the low Medicare premiums? Wouldn't that in itself guarantee the solvency of the program? Everyone would be covered, and doctors and hospitals are already trained to take it.
10
My thought is that if they want to keep the insurance companies (which I think is a mistake) then there should be legislation that makes all insurance companies single payer. There would be a minimum standard (which would need to be pretty good), with the ability to purchase more insurance if needed/wanted. In addition, insurance companies would not be allowed to deny coverage to anyone, nor deny claims.
Then the government would have their plan, same and similar to the above plan. That not only would create actual competitive healthcare, but every person would be able to choose what they wanted, government or private (which is the what the right always talks about). The government would have to keep costs down, and so would everyone else. Insurance companies would have to cover everyone, so they'd have to be more fiscally responsible and possibly merge to absorb the costs.
Eh, not ideal, but that is the only way I can see it working if they want to keep health insurance companies around and not have *actual* public healthcare.
Then the government would have their plan, same and similar to the above plan. That not only would create actual competitive healthcare, but every person would be able to choose what they wanted, government or private (which is the what the right always talks about). The government would have to keep costs down, and so would everyone else. Insurance companies would have to cover everyone, so they'd have to be more fiscally responsible and possibly merge to absorb the costs.
Eh, not ideal, but that is the only way I can see it working if they want to keep health insurance companies around and not have *actual* public healthcare.
12
Universal healthcare, straight up. Don't just control costs by making insurance more expensive or limiting benefits. Need to also take the profit out of most of the health care system.
15
@7
Agreed.
However, how many of you who support this plan also support a "public option" for social security? I think you'll find yourselves more among conservatives than progressives. I'll miss you.
Agreed.
However, how many of you who support this plan also support a "public option" for social security? I think you'll find yourselves more among conservatives than progressives. I'll miss you.
16
A public option = single payer health care = socialized medicine.
That's where it's heading and you all know it.
Canadians and Brits come here every day because of our superior medical delivery system and they don't want to wait months for crucial operations.
SAY NO TO SOCIALISM!!!
That's where it's heading and you all know it.
Canadians and Brits come here every day because of our superior medical delivery system and they don't want to wait months for crucial operations.
SAY NO TO SOCIALISM!!!
17
@9,
It's the same reason why immigration reform can't involve making it easier for illegal aliens to get a green card or making it easier to enter the country legally: it makes too much fucking sense.
It's the same reason why immigration reform can't involve making it easier for illegal aliens to get a green card or making it easier to enter the country legally: it makes too much fucking sense.
18
@14, did you have a particular point of debate or difference?... My sky is dark, very dark.
@15, I don't think you can compare the public insurance option with Bush's every-man-for-himself-in-the-stock-market alternative to SocSec. I too would prefer a single-payer, government health-care system, but I think the public option is the only thing we can fight for and have a chance of winning, thanks to all the cowardly Congressional Democrats out there. And a "public option" that consists of private insurance companies assigned geographically to serve up a bare-bones, mandatory-enrollment package under government mandate is NOT what I or most people who use the term have in mind: a new, nationwide, chartered entity that acts as I described in the third paragraph of @8. The stock market does not work to the specific benefit of individual investors below the $10 million range. A real public-option insurance entity modeled on Medicare, or extended from it, has a strong likelihood of both benevolent operation and financial self-reliance without screwing over its clients.
@15, I don't think you can compare the public insurance option with Bush's every-man-for-himself-in-the-stock-market alternative to SocSec. I too would prefer a single-payer, government health-care system, but I think the public option is the only thing we can fight for and have a chance of winning, thanks to all the cowardly Congressional Democrats out there. And a "public option" that consists of private insurance companies assigned geographically to serve up a bare-bones, mandatory-enrollment package under government mandate is NOT what I or most people who use the term have in mind: a new, nationwide, chartered entity that acts as I described in the third paragraph of @8. The stock market does not work to the specific benefit of individual investors below the $10 million range. A real public-option insurance entity modeled on Medicare, or extended from it, has a strong likelihood of both benevolent operation and financial self-reliance without screwing over its clients.
19
This is such a good and NORMAL thing for our government to do. When a particular part of our society is important, the government sets up a standard for the private sector to compete against to insure a minimum of quality and access. It is why we have public schools. It is why we have a post office. Mister liberty himself, J.S. Mill, considered it the proper way for the government to positively effect its people.
20
This is definitely a preferable option to the socialist extremism of the single-payer advocates. Good to know that I'm not alone at the SLOG.
21
It's a pale imitation of single-payer, which is the only sensible solution for health care. But it's the best we'll get. It's also the minimum I'll support. I'll ask my representatives to vote no on anything without a true public option at the national level. State-level coops don't count.
23
Rob @ 8: Thanks for engaging.
I must admit to being flabbergast at the numer of intelligent progressives who, like you and Ezra Klein, appear to quite sincerely believe that a public option will, without any subsidy and merely by virture to being run the government way, will be able to deliver more value than existing private insurers to the person looking to spend $X/month on medical insurance. I wonder why, if this were possible, a private insurer wouldn't adopt the same methods and pocket the savings relative to his peers as profit, or lower his premiums slightly to lure customers away from his peers? This seem all the more mind-boggling when I'm told that part of the government way is to offer coverage to the expensive people that private insurers don't want, without charging them higher premiums.
Even though I don't understand it, I'm perfectly happy to let any progresive who wants to found such an entity, as long as her guarantees that he will never ask for a red cent from the taxpayer to keep it going.
By the way, medicare may be a model for the kind of coverage you want to offer, but it is not a model of the fiscal structure you purport to support. Medicare absolutely depends on a tax of 3% of all the wages earned in the U.S., to subsidize the coverage of less than 10% of the population that is eligable, because the premuims it charges don't begin to cover its outlays.
I must admit to being flabbergast at the numer of intelligent progressives who, like you and Ezra Klein, appear to quite sincerely believe that a public option will, without any subsidy and merely by virture to being run the government way, will be able to deliver more value than existing private insurers to the person looking to spend $X/month on medical insurance. I wonder why, if this were possible, a private insurer wouldn't adopt the same methods and pocket the savings relative to his peers as profit, or lower his premiums slightly to lure customers away from his peers? This seem all the more mind-boggling when I'm told that part of the government way is to offer coverage to the expensive people that private insurers don't want, without charging them higher premiums.
Even though I don't understand it, I'm perfectly happy to let any progresive who wants to found such an entity, as long as her guarantees that he will never ask for a red cent from the taxpayer to keep it going.
By the way, medicare may be a model for the kind of coverage you want to offer, but it is not a model of the fiscal structure you purport to support. Medicare absolutely depends on a tax of 3% of all the wages earned in the U.S., to subsidize the coverage of less than 10% of the population that is eligable, because the premuims it charges don't begin to cover its outlays.
24
@23: That is why so many people are against the public option or anything that is not real universal healthcare.
The reason that many insurance companies cannot offer lower premiums, and must deny claims, is:
1) They are mostly regional
2) There are so many plans, and so much paperwork that they must rely on higher premiums and denying claims to make a profit
3) They try to make a profit, which goes against the sheer fact that once you make healthcare a for-profit industry you then make it worse for the consumer.
4) They can't negotiate rates with doctors, big pharma, etc because they don't have enough people on their rolls to do so. Much like Walmart gets better rates on products because of the amount they buy, so does Britian get better rates on drugs because of the amount they "buy".
True universal healthcare means that instead of thousands of insurance companies, with thousands of different plans, there are 300 million people on 1 plan. It is very easy. All coverage is the same, and the US government gets to collectively bargain with big pharma and with doctors to lower rates and stop doing unnecessary testing.
For example, the doctors must spend 30% of their income to deal with claims and insurance companies. Imagine that number going to 3%, which is where it should be. One of the reasons that medicare doesn't make enough to cover costs is that is must pay the same high cost of health care as insurance companies (because, again, it doesn't have high enough numbers of insureds to bargain with) AND it actually has to extend insurance to people who private companies won't. So they have all the hardship cases without the benefit of high premiums.
Brazil is a country of 191,241,714 people (the 2009 estimate). The government there was able to negotiate a 30% drop in price for HIV/AIDS drugs. They were already paying much less than us to begin with. Imagine the buying power of the USA with a population of 306,727,000 people (2009 estimate).
Having thousands of insurance companies jacks up the price for everyone, with little benefit for those in need. And it ties healthcare to employment, so it makes it hard for people to accept work where the healthcare won't adequately cover their families.
It is in the best interest of the government to have a stable healthy populace. Healthy people are more productive, less violent, more employable, etc. It also reduces the amount of bankruptcies that occur due to medical debt. Those cases tie up our court system, and drain our taxes even more.
More...
The reason that many insurance companies cannot offer lower premiums, and must deny claims, is:
1) They are mostly regional
2) There are so many plans, and so much paperwork that they must rely on higher premiums and denying claims to make a profit
3) They try to make a profit, which goes against the sheer fact that once you make healthcare a for-profit industry you then make it worse for the consumer.
4) They can't negotiate rates with doctors, big pharma, etc because they don't have enough people on their rolls to do so. Much like Walmart gets better rates on products because of the amount they buy, so does Britian get better rates on drugs because of the amount they "buy".
True universal healthcare means that instead of thousands of insurance companies, with thousands of different plans, there are 300 million people on 1 plan. It is very easy. All coverage is the same, and the US government gets to collectively bargain with big pharma and with doctors to lower rates and stop doing unnecessary testing.
For example, the doctors must spend 30% of their income to deal with claims and insurance companies. Imagine that number going to 3%, which is where it should be. One of the reasons that medicare doesn't make enough to cover costs is that is must pay the same high cost of health care as insurance companies (because, again, it doesn't have high enough numbers of insureds to bargain with) AND it actually has to extend insurance to people who private companies won't. So they have all the hardship cases without the benefit of high premiums.
Brazil is a country of 191,241,714 people (the 2009 estimate). The government there was able to negotiate a 30% drop in price for HIV/AIDS drugs. They were already paying much less than us to begin with. Imagine the buying power of the USA with a population of 306,727,000 people (2009 estimate).
Having thousands of insurance companies jacks up the price for everyone, with little benefit for those in need. And it ties healthcare to employment, so it makes it hard for people to accept work where the healthcare won't adequately cover their families.
It is in the best interest of the government to have a stable healthy populace. Healthy people are more productive, less violent, more employable, etc. It also reduces the amount of bankruptcies that occur due to medical debt. Those cases tie up our court system, and drain our taxes even more.
25
@ 16 & 20,
If "socialized" medicine is so bad and horrifying, would you like to tell me how many people over 65 would be willing to give up Medicare for a private policy?
Thought so.
If "socialized" medicine is so bad and horrifying, would you like to tell me how many people over 65 would be willing to give up Medicare for a private policy?
Thought so.
26
I fully support a public option, I don't think it's a backdoor to a single payer system and I think a single payer system is totally stupid. You know what though, what we have is not working and I'm willing to try anything, however being that we're not exactly stupid a public option would be a good start, let's take it from there.
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