Grassley Knoll
So the good Senator Grassley, who was not so long ago recommending the moonbat Glenn Beck's book, is up in arms at the prospect of a public option:
"Government is not a competitor, it's a predator," he said of the public option that has been embraced by key congressional Democrats. "We'd have 120 million people opt out [of private insurance], then pretty soon everyone is in health care under the government and there's no competitor."
Let's see: And why might hordes of people opt out of private insurance if they had the choice? (Informed estimates are far lower than Grassley's 120 million, but that's not the point.) Could it be that they would rationally judge that a public option would do better for them than private insurance companies that rip people off, dump them when they can, sometimes impose lifetime ceilings (aka rationing), virtually monopolize many markets, charge a gross overhead, require a vast expenditure of bookkeeping hours filling out the many different forms that each company in its distinct wisdom requires, and above all seek to maximize profit?
My excellent general practitioner left his profession a few years ago because he was so sick of the paperwork (more than 90 different forms!) and overall hassle.
In the current debate, I've been waiting for somebody to explain why, for the public good, private insurance companies are sacrosanct. Granted that many people want to hold on to the insurance we have. (I have to say that my own has been pretty damn good.) But then there's the doctor who recently wrote to TPM:
Doctors, as a group, hate no one more than insurance companies....Remember our daily lives: every insurance company requires that we are certified with them, every company has a different form to use, every company says no to our initial request. Hospitals rarely collect more than 40 cents on the dollar billed.
This doctor recommends that the reform include, at the minimum, these elementary measures:
a universal billing form, available for electronic submission to cut down on paper work and administration costs; a penalty for a claim incorrectly rejected (say a 20% penalty paid by the company when their mistake causes the office or hospital to go back and forth); formation of a public-option malpractice insurance company to lower insurance premiums (participation may require use of electronic records or other public good); standardization of electronic medical record keeping so that all systems can read the others data...etc.He thinks that doctors haven't been sufficiently mobilized in their own professional behalf, and that a strong reason is that the bills in play aren't specifically responsive to their ideas about how medicine ought to be practiced. I've seen this myself.
Similarly, small business owners who could benefit from the bill by getting some help with their own health care costs haven't been mobilized either to pound on the Blue Dogs.
But the essential point here is that the folklore of private insurance has achieved such an exalted position that conventional political discourse takes its wonders for granted. The public option is then cast as the bogeyman. Whether this has anything to do with the upsurge in insurance company contributions to our august legislators is--well, coincidental, right?
It's past time for advocates of reform to stop being cowed by the High Church of Insurance.
The common GOP complaint that a public plan would be an unfair competitor is on its face paradoxical, when they worry it would out-compete private business. But there is an unspoken assumption, that any government activity is actually less efficient and hides its costs, making up the difference in more taxes.
This ignores self-contained and relatively successful enterprises like the USPS, and also ignores that fact that government activity is in principle (read, law) open to inspection at every stage. Not so in business, where non-disclosure agreements dominate every interaction with the outside world. Who is more opaque than your own health provider?
But the real meaning of worrying about public plans killing business is that the assumed inefficiencies of public health will be paid for by the better-off, who have no interest in helping their fellow citizens. As usual, conservatives are just mean and stingy people who imagine they need nobody else, that their wealth is a fundamental of physics, and that they got where they are without help.
August 26, 2009 9:35 AM | Reply | Permalink
My excellent general practitioner . . . (I have to say that my own [health insurance] has been pretty damn good.) Todd Gitlin
Says about all that has to be said, eh wot?
August 26, 2009 11:39 AM | Reply | Permalink
Cheap shot, Ellen. I'm not for the health care reform for self-serving reasons. (Is that the only reason to do politics? Adam Smith didn't think so.) My doctor's flight from the field is only a small measure of what's not so great about the current situation. Start scaring people about losing their insurance and they back off universality. Don't you believe in competition anyway? If the public option stinks, why fear it?
August 26, 2009 12:29 PM | Reply | Permalink
Don't take it personal, boyo; it wasn't directed at you -- in other than your representative capacity.
See, David Leonhardt, today.
. . . people may not like their insurer, but they don’t hate it, either. If anything, they are more anxious about losing their insurance than they are eager to be given more choice.
August 26, 2009 1:23 PM | Reply | Permalink
Ellen,
the problem with people who like the health insurance they now have is that they have no insurance against losing that insurance.
Go back 8 months to the thousands of people around the country that worked for GMC auto dealerships who were probably quite happy with the health insurance they had and who may have been ambivalent or downright against any kind of "reform." Now, fast forward 8 months and GMC closes down many dealerships putting thousands out of work and out of health insurance.
Now, everything they own, their house, car, life savings, 401Ks, all are at risk of an illness hitting themselves or their family.
Its OK to "be happy with the health care I have".....but what if its lost, then what?
August 27, 2009 11:34 AM | Reply | Permalink
"Don't take it personal, boyo; it wasn't directed at you -- in other than your representative capacity."
Sounds like she was not directing it at you. Only at you and people who think like you! A fine distinction!
August 27, 2009 1:54 PM | Reply | Permalink
Small business isn't "mobilized" for health reform because it (along with all healthy citizens) would bear the brunt of the changes. Why would I vote for a bill that forces me to provide insurance for employees whose value isn't high enough to warrant health insurance benefits?
The "Universal Mandate" (which is not, in fact, universal anyway, given that people can opt out for a fee) is the most wrongheaded idea ever to grace our health care debate. Obama was right to oppose it during the campaign, and wong to embrace it as a sitting President. It amounts to an $815 Billion tax increase on the middle class (the amount of money -AFTER subsidies- that the CBO estimates people without insurance now will be forced to spend to get insurance).
As if it is any better to force people to buy a product they don't want from a private company rather than taxing them and providing it as a government program.
$815 Billion is 5.7% of GDP that the current House bill would force people to spend on health insurance. Not only would that reduce disposable income, savings, and consumption (of things other than health insurance), it would represent a massive transfer of wealth to the insurers.
Which is, of course, what Obama's donors are looking for from their President.
August 26, 2009 12:11 PM | Reply | Permalink
"...As if it is any better to force people to buy a product they don't want from a private company rather than taxing them and providing it as a government program."
THAT seems to me to be the crux of the matter! Besides the fact that I think it is immoral to FORCE anyone to contribute to someone elses profits!
August 26, 2009 2:44 PM | Reply | Permalink
The idea of insurance against something you are assured will occur is actually a little silly. Insurance companies operate on the idea something won't happen and have all the statistics to let them know the extent to which it will happen and to who. Then they stack the deck by insuring persons who have a lower likelihood of getting sick and denying claims to those who do get sick.
This is really no more than a numbers racket. Its like a reverse lottery in a way. You buy tickets (premiums) and hope you don't win. The bookmakers in this are the insurance companies. The difference is these bookmakers don't pay off the winner when somebody hits it big. The entire thing has the feel of organized crime.
August 26, 2009 12:11 PM | Reply | Permalink
Businesses large and small, who stand to be relieved of considerable financial burden by a public option, haven't jumped on board for the rather obvious reason that making affordable health insurance available to the general public, rather than having the only affordable insurance available through employment, is bad for the labor market.
It will set people free and remove the fear of losing health insurance if you lose your job. Health insurance is one way many companies retain employees who would not otherwise put up with the crappy working conditions and low pay. I know a guy who died working a second job just for the dental insurance so he could afford a new set of teeth.
A public option won't just force insurance companies to compete, it will force all companies to come up with creative new ways to frighten/retain employees. This, I think, is the single greatest fear of conservatives and their corporate constituency. And this is one argument that would change the minds of a lot of fence sitters, if someone in the media would only hammer it.
"Corporate America is opposed to the public option because they're afraid of the power it gives you, the lowly employee, to tell them to 'take this job and shove it.'"
August 26, 2009 1:07 PM | Reply | Permalink
I agree that employer provided health insurance is a poor system and that it retards employee mobility (which is a bad thing).
Of course, that isn't itself an argument for the public option. It's an argument for getting rid of counterfactual "risk pools" and more importantly, the tax immunity of health benefits.
If everyone brought health insurance individually, the individual market would be less dysfunctional.
The public option, as currently conceived, wouldn't change anything in this picture.
August 26, 2009 4:30 PM | Reply | Permalink
Actually, it would. It would provide a single risk pool from which everyone could purchase health insurance individually.
August 26, 2009 5:37 PM | Reply | Permalink
Sure it would. Taxpayer money will be subsidizing all the folks who currently can't afford policies.
Why should those subsidies be any more expensive than necessary? The market has proven it can't create a product that can serve the needs of millions of Americans, the government can and should.
August 26, 2009 9:25 PM | Reply | Permalink
Mr. Conspiracy: A single risk pool doesn't change the cost, it just spreads it out. Even leaving aside the moral hazard issue, and the unfairness of making healthy people pay for sick people as a matter of law, there's no reason to believe that overall costs would be reduced. Just spread out.
Tirebiter: According to CBO estimates based on the most recent Congressional plans, subsidies would pay for about 10-12% of the cost of the uninsured. Taking 2015 as an example, people uninsured now who are mandated to buy insurance buy insurance at a cost of about $925 billion (incidentally, this is 6% of the economy that is mandated to shift from productive use to the government or health insurers). Subsidies are about $110 Billion.
August 27, 2009 11:35 AM | Reply | Permalink
Even leaving aside the moral hazard issue, and the unfairness of making healthy people pay for sick people as a matter of law
Indeed. Which is why the healthy people of Germany, France, Spain, the UK, Japan, Canada, Switzerland, Costa Rica, the Netherlands, Austria, Denmark, Norway and Sweden are all demonstrating against their governments as we speak demanding to be released from this horrible unfairness.
Oh, wait...
And it's also why all those countries spend so much more than we do on health care.... with worse outcomes... oh, wait again.... well, you know how this one ends.
August 27, 2009 9:41 PM | Reply | Permalink
I was actually making a different point. I think taxes are basically morally wrong too (that doesn't mean I'm opposed to them; I think locking people up is morally wrong but I'm not against jails).
But the planned system is actually -worse- than expropriating the money through a progressive tax system. It makes people pay a flat rate regardless of income, which amounts to a massively regressive tax.
Which the planned subsidies are entirely insufficient to deal with.
August 28, 2009 11:38 AM | Reply | Permalink
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