Why the Critics of a Public Option for Health Care Are Wrong
Which is precisely why the public option has become such a lightening rod. The American Medical Association is dead-set against it, Big Pharma rejects it out of hand, and the biggest insurance companies won't consider it. No other issue in the current health-care debate is as fiercely opposed by the medical establishment and their lobbies now swarming over Capitol Hill. Of course, they don't want it. A public option would squeeze their profits and force them to undertake major reforms. That's the whole point.
Critics say the public option is really a Trojan horse for a government takeover of all of health insurance. But nothing could be further from the truth. It's an option. No one has to choose it. Individuals and families will merely be invited to compare costs and outcomes. Presumably they will choose the public plan only if it offers them and their families the best deal -- more and better health care for less.
Private insurers say a public option would have an unfair advantage in achieving this goal. Being the one public plan, it will have large economies of scale that will enable it to negotiate more favorable terms with pharmaceutical companies and other providers. But why, exactly, is this unfair? Isn't the whole point of cost containment to provide the public with health care on more favorable terms? If the public plan negotiates better terms -- thereby demonstrating that drug companies and other providers can meet them -- private plans could seek similar deals.
But, say the critics, the public plan starts off with an unfair advantage because it's likely to have lower administrative costs. That may be true -- Medicare's administrative costs per enrollee are a small fraction of typical private insurance costs -- but here again, why exactly is this unfair? Isn't one of the goals of health-care cost containment to lower administrative costs? If the public option pushes private plans to trim their bureaucracies and become more efficient, that's fine.
Critics complain that a public plan has an inherent advantage over private plans because the public won't have to show profits. But plenty of private plans are already not-for-profit. And if nonprofit plans can offer high-quality health care more cheaply than for-profit plans, why should for-profit plans be coddled? The public plan would merely force profit-making private plans to take whatever steps were necessary to become more competitive. Once again, that's a plus.
Critics charge that the public plan will be subsidized by the government. Here they have their facts wrong. Under every plan that's being discussed on Capitol Hill, subsidies go to individuals and families who need them in order to afford health care, not to a public plan. Individuals and families use the subsidies to shop for the best care they can find. They're free to choose the public plan, but that's only one option. They could take their subsidy and buy a private plan just as easily. Legislation should also make crystal clear that the public plan, for its part, may not dip into general revenues to cover its costs. It must pay for itself. And any government entity that oversees the health-insurance pool or acts as referee in setting ground rules for all plans must not favor the public plan.
Finally, critics say that because of its breadth and national reach, the public plan will be able to collect and analyze patient information on a large scale to discover the best ways to improve care. The public plan might even allow clinicians who form accountable-care organizations to keep a portion of the savings they generate. Those opposed to a public option ask how private plans can ever compete with all this. The answer is they can and should. It's the only way we have a prayer of taming health-care costs. But here's some good news for the private plans. The information gleaned by the public plan about best practices will be made available to the private plans as they try to achieve the same or better outputs.
As a practical matter, the choice people make between private plans and a public one is likely to function as a check on both. Such competition will encourage private plans to do better -- offering more value at less cost. At the same time, it will encourage the public plan to be as flexible as possible. In this way, private and public plans will offer one other benchmarks of what's possible and desirable.
Mr. Obama says he wants a public plan. But the strength of the opposition to it, along with his own commitment to making the emerging bill "bipartisan," is leading toward some oddball compromises. One would substitute nonprofit health insurance cooperatives for a public plan. But such cooperatives would lack the scale and authority to negotiate lower rates with drug companies and other providers, collect wide data on outcomes, or effect major change in the system.
Another emerging compromise is to hold off on a public option altogether unless or until private insurers fail to meet some targets for expanding coverage and lowering health-care costs years from now. But without a public option from the start, private insurers won't have the incentives or system-wide model they need to reach these targets. And in politics, years from now usually means never.
To get health care moving again in Congress, the president will have to be clear about how to deal with its costs and whether and how a public plan is to be included as an option. The two are intimately related. Enough talk. He should come out swinging for the public option.
All good points Prof. Reich and hopefully they will be taken to heart by those who are in a position to make a difference.
The real problem here is that what is being proposed in 2009 is what would have served as a progressive and useful approach 20 years ago. But as time has passed, the health care crisis has metastasized to the point where these sorts of go slow measures are inadequate to say the least. Sure, a strong and economical public option is better than nothing. However, if it is a public option in name only and is incapable of offering the clear benefits that are desired of a public option, then it isn't better than nothing.
What the nation needs is a single payer system. The half measures under discussion are not going to solve anything. All they do is keep this rotten and far too expensive current situation going. Why would we want to extend the life of our current health care system? It stinks. The system we have is irretrievably broken, corrupt, rotten to the core. We need to summarily dump this rotten system and let the insurance and drug company predators sink or swim. It matters not to the common folk out here in flyover country if the insurance parasites live or die. We not so secretly hope they will die after the way they've raped the US workforce and economy for decades.
June 24, 2009 3:27 AM | Reply | Permalink
"Without a public option, the other parties that comprise America's non-system of health care -- private insurers, doctors, hospitals, drug companies, and medical suppliers -- have little or no incentive to supply high-quality care at a lower cost than they do now."
Why does extant competition fail here (fail to drive unnecessary costs down)? Isn't the problem of cost simply that too many people want too many expensive services and won't make the effort to "diet" effectively because they have developed a case of "entitlementosis"?
"A public option would squeeze their profits and force them to undertake major reforms."
Would it really? Since the public option is not socialized medicine, how would it drive doctor, hospital, and pharma billings down? But frankly I don't even know WHICH public option Reich is talking about in his biased antagonism. One I've heard of simply replaces "insurance companies" with government run funding agencies. Now, that might run with less overhead, but it has no direct effect on doctors, pharma, and hospitals etc. And it shouldn't. For the government to dictate such things is simply a matter of effective wage controls on doctors etc. If the idea is Socialized Medicine, stop lying about it.
And if the public option is ONLY an option, and it WON'T take over the whole field, how is it going to have the leverage it's proponents tout as a big advantage?
"But plenty of private plans are already not-for-profit."
So, why aren't those driving down costs compared to for-profit ventures, driving the for-profits out of business already?
"Medicare"
Medicare's insurance costs are low because it's tax money not risk pools. Speaking of which, when public money goes into a public option, no matter how it gets there, that is called government s-u-b-s-i-d-y even if some money also goes into private options. So it's just dishonest to say "no subsidy" and then admit "subsidy".
And on and on and on...
Can we have an honest post sometime on this topic?
June 24, 2009 3:29 AM | Reply | Permalink
Eds, a few thoughts on why today's health care market fails and why "extant competition" is ineffective at controlling costs.
First, the purchase of health care is a complex transaction that involves three (at least) parties rather than the usual two: the buyer (patient), the provider (doctor, hospital, etc.), and the payer (insurance company/employer). If we look at each party's interests, we see why the current private system fails.
First the buyer. Several things are unusual about the purchase of care:
Now let's look at the provider:
Finally, let's look at the payer:
So when you look at all these factors, you see a huge market failure. It's possible maybe to fix the market, but it's also possible that health care is one of those services that simply can't be successfully provided through a market system. I think the latter may be true, but I'd be interested in hearing alternative viewpoints.
June 24, 2009 7:27 AM | Reply | Permalink
Sorry, but that just doesn't add up for me. Basically you are saying that patients are clueless cattle being led to slaughter, that doctors don't care about costs, and that big companies who self-insure have no reason to keep their internal costs down. That's just a total denial of the role of individual responsibility across the board. I say, if patients won't negotiate, tough for them. My limited experiences with doctors from the patient point of view is that most are quite willing to consider cheaper options. Extreme cases don't represent the norm.
I'm sure I missed some points, and it's not that I dispute every point you made, it's that your thoughts aren't compelling when I sit back and reflect.
June 24, 2009 3:39 PM | Reply | Permalink
Oh, please. So I've had a heart attack, I'm in the emergency room, the doctor is ready to administer the paddles and you want me to COMPARISON SHOP? Most of the big expenses in health care come at a time when people are in very poor positions to negotiate. And it's not just because it's someone else's money. People routinely spend large amounts of their own money on worthless treatments, supplements and the like. They travel to foreign countries to get treatments or surreptitiously import drugs that are not approved in the US, all on their own dime. When you're sick you'll pay anything to get well.
June 24, 2009 5:10 PM | Reply | Permalink
"Extreme cases don't represent the norm."
The heart attack scenario in the EMERGENCY room is hardly the norm. Please try to follow the point. Besides if you are not competent to make a decision, no court should uphold outrageous billing against you.
June 24, 2009 9:44 PM | Reply | Permalink
Eds, please stop bloviating. Extreme cases are very much the norm in health care. According to the American Heart Association there are nearly 1 million heart attacks each year in the US, or about one heart attack every 34 seconds. A significant percentage of these events result in emergency room visits and often in emergency surgery immediately afterward. Survival requires prompt treatment--there is neither time nor capacity to choose a provider or negotiate fees. When your heart stops, you're either in an ambulance to the nearest hospital for emergency treatment or you're dead. Cost is not an issue.
And in the minute or so it took you to read this, two more heart attacks are likely to have occurred and at least one of the two victims is at this very moment in an ambulance headed to the nearest emergency room.
June 24, 2009 11:19 PM | Reply | Permalink
It's not bloviating, so please stop lying.
Anyone likely to have a heart attack is being irresponsible not to know his or her coverage in advance, or to fail to shop around for better coverage or better price before the fact. But we should indeed question whether as a society we should bankrupt ourselves saving lives.
The problem with focusing on extreme cases - they like any caricature distort the true picture. Even at $10,000 for an emergency room admission for a heart attack, that's only $10B/yr. Anything done after the emergency room admission and initial stabilization is a separate story, including surgery. And how many heart attacks are in principle preventable by inexpensive means such as exercise and diet modifications? It's morally criminal to demand that I pay a steep price for the negative consequences of your wanton self-abuse.
So really, stop bloviating yourself.
The essential issue is that some people claim health care as a right of human existence. The problem is that the only way this can be so is if health care providers are forced to provide health care.
June 25, 2009 4:26 PM | Reply | Permalink
Eds, you might want to consider the possibility that sometimes when people present evidence you haven't heard before it's not because they're dishonest or lying, it's because they're better informed? Until you demonstrate just a bit better command of the facts, I suggest you stop calling other people (me, Robert Reich, cuchulain, mans_best_friend) dishonest. Your lack of knowledge about a subject doesn't make those who know more than you liars.
June 25, 2009 10:08 PM | Reply | Permalink
Well sit back and reflect some more. Get back to us when you have something to say.
June 24, 2009 8:20 PM | Reply | Permalink
Considering as how your long ramble didn't really touch my points, and I showed I read it, I need say no more. If you prefer delusion, that's your sorry business.
June 24, 2009 9:42 PM | Reply | Permalink
It is virtually impossible to collect and present a set of factual data that would refute that the public option is not a necessity.
People lie like hell.
Numbers don't lie.
June 24, 2009 5:32 AM | Reply | Permalink
With so many negatives in that sentence, I don't know what you actually meant. It's early, so maybe it's me, but could you restate it?
June 24, 2009 8:13 AM | Reply | Permalink
Public option is necessary. Only a dumbass would argue this.
June 24, 2009 10:56 AM | Reply | Permalink
You mean expanding the public option is necessary? Many people think of Medicare as a public option we already have.
But are the public options being discussed the same as Medicare? I don't believe so.
June 24, 2009 3:27 PM | Reply | Permalink
EDS,
It seems you are in favor of putting all of the onus on the patient. That's typical, whenever I read conservative thought. Their mantra of "personal responsibility" never seems to go beyond individuals on the lower end of the scale. It never seems to include corporations, corporate execs, etc. What about their responsibility?
The "public option" is too little and too late. But it's better than nothing. Single Payer would solve our health care problems, lower costs dramatically, and even help businesses, large and small down the road.
But, because our government seems to think it is in the business of protecting business and profits over people, we won't get there.
We need Single Payer. It looks like the lobbyists for Big Insurance and Big Pharma will crush even a public option.
Funny, I thought the "free market" was so wonderful and that competition was good. What are they afraid of? Letting people discover that the government can finance health care more efficiently, at a far lower price? Are they afraid that the government will offer them a better deal?
In a word, yes.
June 24, 2009 7:04 PM | Reply | Permalink
"It seems you are in favor of putting all of the onus on the patient."
"It seems" is your imagination at work, or your reading comprehension problem. The burdens are distributed but the focus clearly is on the patient if it's not on some, what is that Repo talking point, "rationing by Government bureaucrats". Get real. Individuals don't personally control macro costs, duh. But each individual can play a role in keeping costs down if it matters to the individual. Until you show significant cartels driving up prices, you've got nothing else but distortions.
I repeat from my first comment in this thread: Can we have an honest post sometime on this topic?
June 24, 2009 9:48 PM | Reply | Permalink
Here's honesty for you.
Patients aren't responsible for allocating eight figure salaries to the heads of the major private insurers. That's their call, not the patient's.
Patients are trapped. They have no other option. They have to pay the middleman to cover their health care, when it would be far more economical, far more logical, far cheaper, if the government did the financing.
Medicare currently runs at 3% overhead. Most private insurers can barely manage 30%. Right off the bat, patients are paying a HUGE surcharge to private insurance companies who take HUGE profits and increase costs.
Take FOR profit insurance companies out of the mix, and you INSTANTLY lower prices. That's just straight math. No way around that.
We don't need private insurers mixing with health care. They're parasites. They add no value to the transaction. They just get in the way, increase costs, take their cut like drug dealers, and add an unnecessary layer of private sector bureaucrats between the patient and the doctor.
And with their despicable practice of RECISSION, they are fast approaching the status of disgusting pigs.
You want to defend them? Be my guest. But realize something. You have ZERO rational, logical or empirical support for doing so. They should NOT be involved. Period. Our government can do financing more efficiently, cheaper, and with the patient's actual needs in mind, instead of profits.
Single Payer is the way to go. All other options are cosmetics.
June 25, 2009 1:22 AM | Reply | Permalink
That may well have been sincere but it didn't meet the honesty criterion.
Those paying for health insurance are not trapped, generally.
Given not-for-profits, how do the for-profits manage to waste so much and stay in business?
All insurance is parasitic to some extent, even Whole Life.
"You have ZERO rational, logical or empirical support for doing so."
No, that's you describing your fevered state. Settle down. And ... I don't have to defend them to criticize Reich's post or others who cannot be honest.
June 25, 2009 4:15 PM | Reply | Permalink
Actually, there is another option.
That would be to actually regulate the health care system. In every way. Devise systems and enforce uniformity in every instance of recording data, billing etc. Move to industrywide standards for everything.
Fat chance.
It would take to the end of the century for the idiots in health care to agree to even one thing out of millions. Not to mention all the suppliers of all the same but different products would go batshit. If ever there was an industry that could stand some standardization health care is it.
June 24, 2009 7:30 PM | Reply | Permalink
What would it take in principle, which is apparently now missing, to do that regulation without micromanaging each step along the way of ordinary or extra-ordinary health care?
The few horror stories I know of directly (from friend or relative) have one thing in common -- they all chose not to negotiate before or after. In one case an outrageous bill for $22K (3 hr outpatient procedure with doctor getting $700) with $3000 co-pay - the $3000 was paid, the person was happy enough with the outcome and left any disputes to the insurance company and the care providers. In another case a steep bill was not contested (about $2K possible excess).
If we, as Americans, won't take responsibility for our pocket books, that's one factor in rising overall costs. Pardon the traditional conservative quip about eternal vigilance and liberty. If we behave like sheep, expect us to get sheared if not reamed.
June 24, 2009 10:27 PM | Reply | Permalink
"He should come out swinging for the public option."
I like the way he is handling it better, where yesterday he is quoted as saying for right now that's part of the plan. If I were one of the lobbies fighting reform tooth and nail I would be much more worried with that approach.
It forces the lobbies opposed to argue against it, publicly. That is good. It is useful and maybe essential to have much more of the public understand why it is such an important feature of a reform plan that can work.
Taking this stance reinforces that the President is the one who is trying to be flexible on means while insisting that anything done be effective in meeting the essential ends of health care reform.
If in fact there are good, or even reasonable, arguments, against a public plan, well, then let that come out in discussion. That strikes me as most unlikely. But then that is the point of there being a discussion where those with differing views are forced to justify their views publicly.
Lack of sufficient public engagement and understanding are the biggest enemy of effective reform in this context, because the organized interests are so powerful as against the diffuse groups favoring reform, no single one of them dominant and disagreeing as they do among themselves.
June 24, 2009 7:21 AM | Reply | Permalink
Actually, we should come out of the gate swinging for Private Option.
The truth is, we are already paying for Universal Single payer health care. We just aren't getting it.
This OECD study shows (see top graph on page 13) that the U.S. government already pays out more money, per capita, in health care expenditures than any other country, except Norway.
What that means is, we are already paying for universal public health care, we just aren't getting it.
If we changed to, say, the French system (argued as the best in the world) the amount of money the government spends on health care would actually go down. In other words, universal single payer means we'd all be in for a TAX CUT!
Since the rule of thumb in insurance is, the bigger the pool, the lower the cost, and since we're 6 times larger than France, we might expect even more and bigger savings.
The point is we are already paying for universal health care, we just aren't getting it. The government could make a policy change tomorrow and the cost to government, and thus the tax payer would go down.
In essence, then, universal public insurance would be free - because it's already paid for.
Public Option, then, shouldn't be the compromise position.
Private Option should be the compromise position.
Obama should say that, we're flipping the switch on a certain date, and from that point on everybody is covered. However, if you have a private plan you think is great, and you want to keep, you can. It's your option. It will be redundant though, because you are already covered.
Everyone else, can then go into work on Monday, tell their HR department that they want the insurance benefit monetized and rolled into their paycheck.
The resulting increase in purchasing power, will lift up demand and we will be able to walk out of our current Great Recession that we are in.
So for the price of a tax cut, we would get free health insurance for life and get out of the Great Recession we are in.
The current plan is not only killing our economy, killing our industries, and killing all our jobs, it's also killing people. 50 million are without health insurance. 18,000 people will needlessly lose their lives this year because they didn't have enough or any insurance coverage -- EVEN THOUGH THEY ARE ALREADY PAYING FOR IT!. That's six times more people dying than Al Qaida killed on 9/11 or that died when Pearl Harbor was bombed.
The current plan benefits, at most, maybe 3,000 billioinaires and near billionaires. For their sake we sacrifice our economy, industries, jobs, and tens of thousands of lives. The imposition of the current system says that United States is not a democracy. It is a plantation. To paraphrase John McCain from the election last summer: "We're all n!gg@rs now."
June 24, 2009 9:22 PM | Reply | Permalink
Reform and revolution aren't generally the same.
Impractical idealism is fine for some things but not for the US Congress.
June 24, 2009 10:30 PM | Reply | Permalink
I am disappointed that, at this date we hear (for the moment) the public option is on the table. I agree with Oleeb that single-payer is the only sensible and productive way to solve this problem, but I don't think it will happen. But from a negotiating point of view, if for no other reason, it should have been on the table from day one. At Max Baucus's hearings, single-payer advocates were not even allowed AT the table!
By bringing up the public option as a starting point, months after the discussion began, where is the room for compromise? What room is there? I think the concept of bipartisan agreement on this is a lost cause, and I don't know why the President (who is a whole lot smarter than I am) doesn't realize it.
How many bills has he passed with zero republican votes? Does he really think they will help him in any way to give our citizens comprehensive health care reform? If Obama succeeds and all Americans suddenly have portable, accessible, affordable health care, the republicans are screwed and they know it. If they were actual grown-ups, they would participate in this, and get the best possible program going, and they could take part of the credit as well, but they only want the president to fail.
----that, AND they don't want to lose the big $$$$$ they get from insurance, pharma, AMA, and other Santas.
That is why having the public option as a starting point seems naive to me. This is really going to be tough, and if you start out at a point from which you can't budge, where do you go?
June 24, 2009 8:28 AM | Reply | Permalink
I hear what you're saying, Jan--a very reasonable concern.
However, I don't think he needs to budge on this aspect of the issue. If he doesn't hear a persuasive public interest reason why the public option should be removed he can simply say he sees no reason to accept its removal. In fact, he could assert his belief that it is essential for comprehensive reform to work. But by not at this point holding it as sacrosanct he certainly should get the benefit of public doubt as to whether he is flexible and listening to all sides to try to find a consensus that will actually work, as opposed to just getting something passed.
I've written to Josh suggesting that he go back to the playbook he used so successfully to fight the Bush 2005 Social Security privatization attempt.
What he did then, on the mother ship, was ask denizens to contact their members of Congress to ask their stance on this issue and report back to him on what they said. He then shared the responses. Basic name and shame/embarrass.
This time, he could ask denizens to contact their House and Senate reps and ask them to state their position on whether they support or oppose a public option as part of the health care proposal (or, perhaps alternatively, whether they will insist on a public option as a condition for a yes vote--not sure what the best precise question is here).
He could link to a part of the site that makes it easy for site users to find out where their House and Senate members are on this issue.
As important, perhaps, he could report on the justification House and Senate members opposed to a public option (or who will not insist on it) provide, and compile this information for easy access.
This is one of those issues where, with fairly minimal editorial add-on, just listening to the "explanations" given by opposing members of Congress helps surface the self-serving and ridiculous nature of those arguments.
This thought occurred to me when I read the "reason" given by one of the opposing lobbies for opposing a public option--it would be "unfair" to the insurance companies because the government would have certain advantages.
Well, if by "unfair" his organization means that socially we give our citizens an option of not paying for admin overhead, marketing costs, profit requirements, etc., then, doh, that is part of how we are going to ensure a much higher percentage of the health care dollar goes for actual health care.
Why should the health of our fellow citizens be sacrificed on the alter of protecting profits for insurance and drug companies and others, along with the admin and marketing and R&D to segment the health insurance consumer market that entails, for starters? All the points Reich makes ably in his post I think need to get much more play in the media.
The only way the forces of justice have a chance of prevailing on this fight is if enough of the informed public gets engaged and active. There just isn't a single health-care reform organization which has enough clout to compete with the monied interests. Social Security benefited from at least having a single large lobby in AARP. No such good fortune here.
On health care, it's Obama and (mainly--I don't mean to suggest the groups that are out there have no effect--of course they can help a lot) the informed and right-thinking members of the public, versus the organized defenders of the status quo.
This is an ultimate challenge for the netroots--whether there can be enough effective self-organizing, done quickly and creatively enough, to counter the opposing big lobbies. To dust off and amend Gore 2000's awkward phrase, it is "the people [plus the President] versus the powerful". In those situations the powerful usually win. Will it be different this time?
Josh's work in 2005 on Social Security was a prime example of what the netroots are capable of doing. Here it is even more important, given the diffuse nature of support for reform--and not even just one version of it, to further complicate matters.
June 24, 2009 10:33 AM | Reply | Permalink
But they already have tremendous incentives to lower costs. With prices effectively capped by the market (try selling health insurance at twice the price of the other insurers) a reduction in cost translates to increased margin and increased profit. A cost advantage on the competition allows for price undercutting for even greater profit.
On a related note, a government option would almost certainly lack the profit incentive to lower costs. There is every reasonable expectation that the HQ for a government option would be located in West Virginia, not because of anything to do with cost but everything to do with Senator Byrd.
June 24, 2009 9:19 AM | Reply | Permalink
"With prices effectively capped by the market (try selling health insurance at twice the price of the other insurers)"
Wrong for economic reasons.
Almost all health insurance companies are operating in local monopoly or cartel situations.
Even when they aren't, they offer baffling and secretive "insurance" contracts, and behave confusingly. So for an individual, the incentive to switch is made mainly on the basis of "Will this company be more or less likely to cheat me when I need benefits?", not on costs.
For a small company, most decide between offering health insurance or *not* offering it -- the trouble of switching is not worth a minor premium savings. For a self-insured company, there are no premiums -- and there's a principal/agent problem, in that the company with the incentive to save money is not the administrator of the plan.
Finally and most importantly, the "incentive to lower costs" is most easily satisfied for privateer insurance companies by (a) cheating people who have insurance by denying and delaying benefits, (b) denying insurance to anyone who looks potentially expensive.
The advantage of a government plan is that it would not be allowed to do either, so it will lower costs in ways which don't hurt people instead!
As practical proof, the continual premium increases ranging from 15% to 40% per year show that prices are not, in any sense, capped by the market.
June 24, 2009 7:44 PM | Reply | Permalink
Hopefully, the House and the White House will bring the public option to the negotiating table. I fear the Senate is so tied to the lobbyists and removed from the needs of most Americans that they'll fail on this issue.
I hope we can keep the pressure on Senate Dems, but I'm pessimistic right now.
June 24, 2009 10:00 AM | Reply | Permalink
If you support the public health care option like 76% of Americans, let your voice be heard. Sign here and your name might show up on TV in an ad that will run on CNN, MSNBC and the Daily Show! www.WeWantThePublicOption.com
June 24, 2009 12:35 PM | Reply | Permalink
All well-argued points, but I'm not certain to what purpose. Those who oppose a public option do not do so for logical reasons based upon the public good. They oppose the public option for logical reasons based upon their own good, which is diametrically opposed to the public good. Arguing with them is pointless, as they are not in a position to be convinced otherwise.
The only effective strategy at this point is to crush them, see them driven before you, and hear the lamentations of their accountants.
June 24, 2009 3:48 PM | Reply | Permalink
why try to sugar coat it with arguments at all?
the truth is simple.
we have corrupt people in congress bought and owned by corporations.
they are payed to make those companies money and pass laws that screw the average person.
so naturally they would be against anything that might help people.
shheesh.
June 24, 2009 5:06 PM | Reply | Permalink
How right you are!
June 24, 2009 7:27 PM | Reply | Permalink
Single payer and the public option are just that: options.
There are a number of models which could be followed. In particular, the Swiss system is another option which could be considered without either single payer or the "public option."
Under this system, mandatory insurance is offered by 87 non-profit insurance companies who may not discriminate based on age or pre-existing conditions. Prices are negotiated between the insurers and the medical providers, subject to governmental approval.
There is no "public option" just a heavily regulated system of competition between non-profit insurers. The insurers cannot complain about "unfairness" because they all are competing on a level playing field where they all are subjected to the same rules.
However, our insurance industry wants to make insurance mandatory while retaining the right to continue to engage in adverse selection and charge whatever premiums they can get away with. Such a system is unacceptable.
June 24, 2009 5:28 PM | Reply | Permalink
"Under Swiss law, insurers may not make a profit on the basic plan" (http://www.npr.org/templates/story/story.php?storyId=92106731). So, would our private insurers sign up for the whole Swiss program?
June 24, 2009 5:50 PM | Reply | Permalink
[So, would our private insurers sign up for the whole Swiss program?]
Our insurers will not like any change from the current system. They like things the way they are. The real danger is that if they get their way, they will make the situation worse.
The underlying problem is that you have a lot of people making a lot of money doing a lot of nothing. 31 cents of every health car dollar is spent paying bureaucrats to shuffle papers from one pile to another and dreaming up ways of denying coverage. This 31 percent is pretty much the difference in cost between our system and most of the European system.
We realize savings simply by cutting the fat out of the current system. ("Cutting the fat" is a favorite buzzword of right wingers everywhere.) Of course the people who are living off this fat are not going to be happy.
June 24, 2009 6:11 PM | Reply | Permalink
I thought the private-only guys were supposed to be making the argument against the public option. So um... how come all their "objections" sound like arguments in favor?
June 24, 2009 5:43 PM | Reply | Permalink
The only reason the insurance companies are even discussing this, instead of just advertising extremely heavily and dishonestly against this, is to get a law to force every single one of us to buy their product, by law. My money is on the insurance companies winning what they desire. I have no confidence at all that Obama will stand in their way. If he were willing to do so he would be speaking out much more forcefully.
If each of us posting here were to fill a petition with about a dozen signatures, asking that their senator vote for and ensure that we get a public option in the health care bill, we might have some chance to get it. Otherwise, it is just one more lost opportunity.
June 24, 2009 5:49 PM | Reply | Permalink
What a great bunch of responses! Definitely elevating the debate! Thanks!
June 24, 2009 6:00 PM | Reply | Permalink
How can you get anyone to listen to you though? Most of the congress has been dead set against the public option and they don't care about anything to the contrary.
June 24, 2009 6:03 PM | Reply | Permalink
I have no expertise or background in health care. Perhaps someone has already proposed a system like this...
But what if the government system offered to pay (for people enrolled in the public plan, or a single payer system) a fixed amount per non-emergency procedure. If someone is having their hip replaced the government offers to pay a fixed amount for that operation any certified hospital is eligable to recieve this payment. A certain percentage of the fee is payable upon completion and a second fee is payed after a specified duration based on how successful the surgery was. If there are zero complications and the patient is highly satisfied then the hospital recieves the maximum payment. This performance based payment could even be the bulk of the fee.
A hospital that is renowned for their hip replacements could charge additional money above and beyond that which the government agrees to reimburse, and the patient would have to pay that out of pocket. But they would know that going in. Patients would select the hospital for their hip replacement based on prior performance and cost. This would introduce some degree of capitalism into the system, at least for non-emergency procedures. It would incentivise cost reduction and quality improvement since both would result in increased profits for the hospital. Obviously only certain procedures would lend themselves to this specific structure, but perhaps there would be a way to apply similar incentives to all types of medical procedures.
June 24, 2009 6:32 PM | Reply | Permalink
If insurance companies are ag'n it, it must be a good idea.
June 24, 2009 6:57 PM | Reply | Permalink
Once again I'm scratching my head at Obama's reluctance to to call a spade a spade. He's got a 65% approval rating; he's got a big majority in both houses of Congress; the American people favor a public option. So what is this mouse he's so afraid of that he can't just smack it with a broom? Obviously there are a handful of Democratic senators who are doing the bidding of the insurance companies and the medical lobby - why not simply out them? Why not say to Kent Conrad, "You cross me on this one, buddy, and you and the insurance companies are on your own in the primary." Why not tell Diane Feinstein that if she can't see her way to supporting a public option Obama's gonna have a hard time finding the funds to bail out her bankrupt state? Why, when it comes to something that's so obviously in the public interest is he so dainty in his advocacy - yet when trillions are requested for Wall Street banks, he's willing to bite the bullet? Can somebody please explain this reluctance to play hardball politics from Mr. Chicago Politics?
June 24, 2009 11:50 PM | Reply | Permalink
It may yet come to that. I believe he would probably do all this privately.
June 25, 2009 12:21 PM | Reply | Permalink
Any bill that does not include a public option will be counter-productive. Better to drop the whole idea than to pass an ineffective bill.
June 25, 2009 6:41 AM | Reply | Permalink
Fact: Any real cost containment and increased access is going to require taking some of the profit out of the system. It will mean requiring health insurers to charge the same rates and not exclude for pre-existsing conditions. The insurers now making the best profits will be hardest hit, as cherry picking goes out the window.
Fact: The health insurance industry won't cave easily. They are a huge source of campaign contributions. Right now, their commercials and PR are still "soft". The more a public option of any kind moves forward, the sooner they will draw their daggers with massive attacks and threats of a government takeover. We can all imagine what these spots will look like.
Fact: Fear works. Many Americans are confused and subject to a scare campaign. It will take a major effort--money, message and mobilzation to counter this kind of a campaign. It didn't happen in 1993 and I am not confident it will happen now. Are you?
Fact: Obama is offering the insurance industry the best deal they have a right to hope for--the ability to continue in the market, but with much greater restrictions on how they can do business. Yet, if they compete effectively, they still have the opportunity to make pretty decent profits on the tremendously increase pool of potential customers that will be available. Should those who can't function under this situation really even be providing health care coverage at all?
Final thought:
Somebody needs to find Harry and Louise. Make a spot with them today. Harry's job has been outsourced. Louise has insurance for both of them through work, but she is now working as a greeter/customer service rep, etc. at (fill in blank ) and now has some health problems. Her contrbution to her premium is approaching 50% and her plan no longer pays for a whole host of procedures. Even so, her employer may soon have to drop coverage, and maybe even lay her off. They are sitting around that same kitchen table, regretting how they got bamboozed back in 1993 and telling themsevels, and us, that we can't let it happen again!
June 25, 2009 11:56 AM | Reply | Permalink
I will reiterate here what I also suggested in the comments in response to Theda Skocpol's column on public option.
June 25, 2009 12:08 PM | Reply | Permalink
what happened to the edit function?
June 25, 2009 12:10 PM | Reply | Permalink
I like this idea. A lot, actually. I am willing to pitch in financially. I hope that if there is such an effort Josh and others will give it plenty of play.
June 25, 2009 12:25 PM | Reply | Permalink
Strange, but Congressional committees continue to receive empirical proof for why we should get rid of private health insurance, period. They're getting the info, but won't act on it.
Their hearings continue to demonstrate that we can't trust private health insurance companies. And they show that its apologists are full of shit. I've read several commentators in health care threads here try to say that insurance companies make their money on investments, not on the difference between incoming premiums, copays and out of pocket expenses, and payment for health care.
Wrrrrrrrong.
If that were true, they wouldn't spend so much time and effort trying to avoid making health care payments. They would also be in some OTHER business. Why set up a source for investment capital that doesn't make a profit for you, in and of itself? They exist. Those models are everywhere. Why pick a net loser, if it's supposed to be one?
It's not. Health insurance companies make HUGE profits SOLELY on the difference between incoming and outgoing payments. Investment gains are gravy.
Great link about that here:
http://digbysblog.blogspot.com/2009/06/stop-me-if-youve-heard-this-one-before.html
June 25, 2009 2:59 PM | Reply | Permalink
I am all for a public option, but I have a question. Suppose there are a series of options of policies, some public and some private, some less expensive with more limited coverage and some more expensive with greater coverage. What is to stop young healthy people from picking the less expensive policy with limited coverage, and then years later when they get some serious medical condition, switching to a more expensive policy with greater coverage? This would make the less expensive policy even less expensive because all the people on it are well, and the more expensive policy even more expensive because all the people on it are sick.
As an example, my present (expensive) policy has a Cancer-Care program that pays 100% of all expenses for cancer with no copay and no deductible. What is to prevent someone from switching to my policy if they should ever get cancer? If this were allowed, the company issuing my policy would no longer provide that program because it would be too expensive for them.
June 25, 2009 8:36 PM | Reply | Permalink
...substitute nonprofit health insurance cooperatives for a public plan.
I like this idea. And I hope someone will tell me why it's wrongheaded.
Secretary Reich says, it's because "...such cooperatives would lack the scale and authority to negotiate lower rates with drug companies and other providers, collect wide data on outcomes, or effect major change in the system."
But earlier, the former Secretary says that, "subsidies go to individuals and families who need them in order to afford health care, not to a public plan."
So why would the cooperatives lack "the scale and authority?" I mean, I'm assuming that the nonprofit cooperatives would form one large government endorsed company. If that organization couldn't compete with the private companies on the market, why should we assume that a government run company would?
June 25, 2009 9:15 PM | Reply | Permalink
This is so going to backfire if it passes.
It reminds me a bit of the school voucher argument. Public sector advocates claim that if you subsidize private providers (private schools) there will not only be a mass exodus from pubic providers (public schools) but that the private provider will be able to charge even more than before because the govt. is offering a subsidy for its product by increasing the competition for it.
What is likely to happen is that people will take the subsidy and use it on private insurers leaving the small percentage that even with a subsidy can't afford private stuck with the "public option" which will become a bureaucratic boondoggle that will cost far more per patient than private insurance.
Also reminds me a bit of the Beta vs. VHS scenario. Govt. is going into the insurance business at such a huge scale the it will kill off the better product.
June 26, 2009 2:32 AM | Reply | Permalink
There is one way that's historically shown to bring the economy back - a big war. Iran specifically, and made to last long enough to provide the necessary "stimulus," funds to bring back full employment and get money circulating again.
Unfortunately, it'll kill a lot of people. But as if anyone really cares, despite lip service to the contrary.
July 10, 2009 10:32 PM | Reply | Permalink