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The Latest Public Option Bamboozle, and How to Recognize the Real Thing
Here's the latest contortion from Senate Dems trying to win over a few Republicans to a "public option:" Let nonprofits create health-care cooperatives, and call them the public option. Kent Conrad came up with this bamboozle. Finance chair Baucus is impressed, and some Republicans -- even Grassley -- seem interested. Watch your wallets.
Nonprofit health-care cooperatives won't have any real bargaining leverage to get lower prices because they'll be too small and too numerous. Pharma and Insurance know they can roll them. That's why the Conrad compromise is getting a good reception from across the aisle, just as Olympia Snowe's "trigger" (whereby no public option until some time down the pike, and only if Pharma and Insurance don't bring down and extend coverage a tad) is also gaining traction.
The truth is that there's only one "public option" that will truly bring down costs and premiums -- one that's national in scale and combines its bargaining power with Medicare, and is allowed to negotiate lower drug prices and lower doctor and hospital fees. And that's precisely what Pharma and Insurance detest, for exactly the same reason.
Whatever it's called -- public option or chopped liver -- it has to be able to squeeze Pharma, Insurance, and the rest of the medical-industrial complex. And the more likely it is to squeeze them, the more they'll fight it. And the greater the opposition from Republicans, and from Dems who either believe any bill has to have some Republican support or who have sold themselves out to the medical biggies.
As long as single payer is off the table, then we need a real public option. Don't be fooled by labels. Demand the real thing.
Nonprofit health-care cooperatives won't have any real bargaining leverage to get lower prices because they'll be too small and too numerous. Pharma and Insurance know they can roll them. That's why the Conrad compromise is getting a good reception from across the aisle, just as Olympia Snowe's "trigger" (whereby no public option until some time down the pike, and only if Pharma and Insurance don't bring down and extend coverage a tad) is also gaining traction.
The truth is that there's only one "public option" that will truly bring down costs and premiums -- one that's national in scale and combines its bargaining power with Medicare, and is allowed to negotiate lower drug prices and lower doctor and hospital fees. And that's precisely what Pharma and Insurance detest, for exactly the same reason.
Whatever it's called -- public option or chopped liver -- it has to be able to squeeze Pharma, Insurance, and the rest of the medical-industrial complex. And the more likely it is to squeeze them, the more they'll fight it. And the greater the opposition from Republicans, and from Dems who either believe any bill has to have some Republican support or who have sold themselves out to the medical biggies.
As long as single payer is off the table, then we need a real public option. Don't be fooled by labels. Demand the real thing.
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I believe we *have* been demanding the real thing, and public opinion has been strong and clear for at least the last two election cycles.
It's just that no one is listening.
June 11, 2009 12:52 PM | Reply | Permalink
The public option will be single payer health insurance, very soon after it goes into effect, if it is done correctly. That is why the drug companies and the health insurance racketeers are so adamantly opposed to it. They are in this game only to get a bill passed that forces all of us to buy their products at whatever price they chose to put on it.
Maybe that was the approach the US Automobile industry should have taken - make it mandatory for all Americans to buy a new car every 2 years, whatever the cost and whatever the quality.
Look at Senator Baucus' source of campaign funds some time. You will no longer wonder what is driving his effort to emasculate any form of universal health insurance that is proposed.
June 11, 2009 12:57 PM | Reply | Permalink
They're going to pass it with a fake public option. The big problem is that it won't be available to everyone, just to the self-employed or maybe to people who work for small businesses. They will call it a public option but they won't give people the right to choose between their current insurers and the government plan. They need to offer a public, low deductible plan that people who have corporate high deductible plans can switch from.
June 11, 2009 1:19 PM | Reply | Permalink
As Conan said on the Tonight Show last night:
June 11, 2009 1:35 PM | Reply | Permalink
LOL! I wish I'd caught that last night.
June 11, 2009 6:06 PM | Reply | Permalink
The whole health care reform debate is a bamboozlement...our politicians have been bought and paid for by the people who want the status quo to remain. All that is left to hear is the 'We need to let the free markets work this out'.
Thanks for the Conan quote ct. How come 'comedians' like Conan and John Stewart can grasp what the print and electronic media reporters can't? It should be embarrassing to our press corps one would think. But then again it is a system where the press wants access to the politicians who want to do what their benefactors will and ask that it be reported as such if there is to be access...so we get garbage in, garbage out.
And I still see on the evening news that anything passed will need to have 'bi-partisan support' and usually talk to politicians who have (R) following their names. Why?
June 11, 2009 4:41 PM | Reply | Permalink
"what the print and electronic media reporters can't?"
Media is corporate owned...........................................................................................................
June 12, 2009 12:06 AM | Reply | Permalink
Before commenting further, let me preface those comments with a statement of where my own sympathies lie. I favor a strong public option of the type envisaged by the President. I also find the single payer concept appealing, although I've expressed uncertainty elsewhere as to whether it would work well in a nation as large and heterogeneous as ours. In any case, it's off the table politically, and so I'll focus on the public option, which seems still to be on the table, although teetering precariously on the edge.
That said, let me also address the issue from a "devil's advocate" perspective, so as to inspire some thoughtful analysis from others. Imagine Senator X tells us he's unconvinced. He sees the virtues of a public option but is opposed to a system that is fully "government run" (read "single payer"). He has just been visited by insurance/pharmaceutical lobbyists who have stated the following: "we're willing to accept some cost controls and some limits on profits, but there is no way an enterprise can make any profit at all and still keep costs as low as an agency that makes none. If any form of public participation charges for services at a level that undercuts our ability to make even a small profit, we'll go out of business, and the only health care will be government-run health care."
Now never mind whether you think that's a good idea, because we can be confident Senator X will not. What type of public option can we persuade him to support?
June 11, 2009 5:34 PM | Reply | Permalink
I think we keep mixing different concepts here. Single-payer or public option isn't "government run" healthcare. HealthCARE is run by the providers. You don't get a colonoscopy from an insurance beancounter. It just feels like you do.
June 11, 2009 5:40 PM | Reply | Permalink
Single payer is politically unfeasible currently because it is perceived as "goverment run". In one sense, it would be, from the administrative perspective, while it would not be from the perspective of performing the actual services.
These nuances are irrelevant to the major obstacle facing a public option - the claim that it would force private health care out of the market, leaving only a government-managed system in place.
If a public option is to prevail, it must surmount or circumvent that concern. My question/challenge remains: how can a public option be promoted that would not face this very formidable obstacle?
June 11, 2009 7:07 PM | Reply | Permalink
Single payer is perceived as government run because Democrats surrendered the debate. As long as we fear to make arguments, the other side wins by default. We could have simply campaigned on an extension of Medicare. People understand Medicare. They understand that they or their parents or grand-parents don't go to government doctors to get their healthcare. They uhderstand that supplemental private insurance is available to cover expenses not in the basic Medicare plan. It didn't have to be exactly Medicare but the concept should have been easy to explain. Instead, Democrats have over complicated the issue so that it's almost impossible to explain. I wish someone would explain it to me because I don't understand what the party is even after.
June 11, 2009 7:18 PM | Reply | Permalink
I don't mean to be disrespectful, but neither you nor others have so far addressed the only issue relevant to today's political reality - the claim that any form of public involvement in health care would drive private health care out of the market.
However much some would welcome such a scenario, it has no chance, no matter how promoted, of succeeding with Congress or the public. On the other hand, a public option still seems viable, although perhaps on life support.
Or is it viable? If no-one can refute the claim that it will eliminate private health care, a public option is destined to fail, at least in its present incarnation, and any substitute will be left to those who actually engage in the relevant debates rather than indulging in wishful thinking.
June 11, 2009 7:26 PM | Reply | Permalink
Let me take a stab at answering my own question raised above, with the hope that others can come up with even better suggestions.
Any public participation in health care that threatens to drive private care out of the market is non-viable politically. On the other hand, the need to control costs is critical. I would suggest that a viable compromise will preserve the ability of insurers and drug companies to make a profit, while constraining them to stay within very tolerable limits. I believe that universal health care in some European societies in fact manages that balance.
This will not be possible from regulations or price controls alone, but I suggest that the non-profit cooperatives Robert Reich cites (disapprovingly) might provide a model for an expanded future non-private endeavors might play. These entities would not likely possess the bargaining power to completely eliminate profits for private competitors, but if private enterprises became too greedy, the availability of the non-private alternatives would grow more attractive, and these plans would expand.
In a sense, I'm suggesting that progress towards universal coverage that is optimally inexpensive and efficient will be gradual, and it will therefore be important to make a start with something that's achievable in the current political environment.
June 11, 2009 7:59 PM | Reply | Permalink
correction - "expanded future role" above (I left out "role").
June 11, 2009 8:02 PM | Reply | Permalink
This is how I would have explained it. I would have had a pretty motherly senior citizen on TV explaining how she loves her doctor and how easy it is because her doctor sends her bills to Medicare. Then I'd bring in her beautiful family - her middle-aged daugher and son-in-law and their photogenic darling children and I'd have grandma say that she wants her children and grandchildren to have the same choices she has and the same quality of healthcare.
June 11, 2009 8:07 PM | Reply | Permalink
It really isn't that difficult a sell if the D's wanted to pitch it.
June 11, 2009 11:00 PM | Reply | Permalink
What's so overwhelmiingly depressing is the con game. The games they are playing with "public option" are probably just the tip of the iceberg. God only knows what is actually going to be in the fine print in this bill.
The Blue Dogs have done what the Republican were never able to do: scare the hell out of me on healthcare legislation.
Who needs Harry and Louise when you've got Kent and Max and Mary and the rest of them.
June 11, 2009 5:35 PM | Reply | Permalink
More bullcrap about "bipartisanship." I just hope we can scrape up enough votes from SOMEONE to pass a decent public option. Sounds like some people just want to get a bill passed, no matter how lame. If we don't get a good bill that gets us going in the right direction, I see a collapse of the system in our future and then we will have single payer for sure. That's my most optimistic forecast. Because how can we afford more of the same, when we are all in fact paying for the most expensive kind of health care in the emergency room? If we don't change this, we are going down.
What if they require everyone to buy insurance... except poor people who can't afford insurance--and also can't afford health care? Less preventative care for the most vulnerable population. And more emergency room expenses.
Oh well. I really like Canada.
Also, why are we permitting the AMA to say that 70% of the American public is covered by private insurers? Isn't the opposite true, that counting Medicare and the VA (...and Congress and other feds), the majority is in the public system?
June 11, 2009 6:20 PM | Reply | Permalink
Mr Reich, I have read pretty much every blog you have posted on this subject, and this feels like you are changing tacks. When you and others say the single payer option is unfeasable; when you say the answer is taxing benefits, I wonder if you think we have been paying attention all along.
Because we have. Barack Obama campaigned on increasing taxes of the wealthy and NOT increasing taxes on the middle class. Taxing health insurance benefits is not consistent with the last sentence, and you yourself said he needed to do it because republicans wouldn't let him increase taxes on the wealthy. Sorry, but the WEALTHY DIDN'T BRING OBAMA INTO OFFICE.
I also acknowledge that he did not campaign on Single Payer, or mandated coverage. Obama is too smart to ignore what is obvious, however.
Read my lips:
THE ONLY WAY TO MAKE HEALTH CARE AFFORDABLE IS TO SPEND ALL HEALTH CARE DOLLARS ON HEALTH CARE!
Not on stockholder's profits; not on multimillion-dollar compensation packages for CEOS; not on myriad paper-pushers whose entire raison d'etre is to deny needed coverage to make more $$$$ for the first people in this sentence.
There is only one way, and all the other developed countries have already figured it out:
Only when you have healthy and ill; young and old; thin and fat; paying in at a reasonable rate so that the risk is shared, can you have a sustainable health care program. Yes when you are young and healthy you pay more than you use, but you will get older and sicker, and other young will come up through the ranks to offset your needs.
Is it not a no-brainer to get rid of the profit margin in otder to make health care available to all? Well, yes.
June 11, 2009 9:22 PM | Reply | Permalink
Lex Parsimoniae
June 12, 2009 12:15 AM | Reply | Permalink
Hi CVille Dem - You ask,"Is it not a no-brainer to get rid of the profit margin in order to make health care available to all?"
I'd have to say no, and I would add that some other nations that provide effective universal health care do so without eliminating the profit motive.
I state this as a political reality, and not as a wish; I would be happy with a non-profit health care system, but it's not in the cards.
Rather, as I suggest above, the realistic political options available to us for the near future entail efforts to control costs, including the costs attributable to profits, rather than eliminate profits entirely. I hope you'll read my comments above for more details underlying my reasoning, but politics is the art of the possible, and we have to play within those rules.
June 11, 2009 10:27 PM | Reply | Permalink
I disagree with you on this and many other things. I posted these compensation packages elsewhere, but I will cut & pate them here again. You tell me if this is the best way to spend health care dollars:
As much as you would like for the phrase, "This is just unfeasible" to be repeated enough that it will be considered unalterable truth; it is NOT true. The people who want to stand in the way of true health care are losers.
As I wrote to our President:
June 11, 2009 10:55 PM | Reply | Permalink
I know it sounds cynical (and I'm not a confirmed cynic), but I recommend that all here who fervently wish for a single payer system make a concerted, organized effort to denounce President Obama for his failure to promote that effort. In particular, I believe the President should be accused of compromise on this issue rather than a willingness to stand up for single payer with a non-negotiable, uncompromising attitude.
If things go well, this will attract media attention: "Obama denounced by leftists for willingness to compromise on health care".
Under such circumstances, I'm reasonably hopeful in expecting a favorable outcome for the current health care debate.
June 11, 2009 11:19 PM | Reply | Permalink
Obama has said that if he was starting from scratch he would create a single payer system. This is not feasible even with his current popularity and political judo.
The best we can expect to see is this so called public option or non-profit standardized plan that will be able to compete with private insurance. The only way this will succeed is to have health care insurance reform to allow a level playing field - no cherry picking or arm chair quaterback medical decision making.
I suspect that corporate health does not fear the public option as much as it fears mandated regulation. Medicare has been the model to date and has not destroyed the private sector
June 12, 2009 12:32 AM | Reply | Permalink
Anyone older than 60 or so should remember that this country used to have community and non-profit hospitals. Doctors made house calls and were paid directly. The whole big-business health care (a misnomer if there ever was one--very little actual health care involved) and insurance scams is fairly recent.
Universal health care CAN be done, but it won't happen here because the fix is in and only wealthy people can get health care in the US.
By the way, another part of the big lie is "we have the best health care in the world." Not true! We just have the most expensive care.
June 12, 2009 1:39 AM | Reply | Permalink