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The Snowe Job, and Why a "Trigger" for a Public Option is Nonsense
I was just on the phone talking with a reporter for a national media outlet who referred to Senator Olympia Snowe's idea for a public option "trigger" as the "centrist position." Whoa. When the mainstream media start naming something as "centrist" the game is almost over because just about everyone with any authority in our nation's capital wants to be at the "center."
Let me back up a step. The public insurance option has become a lightening rod for Republicans, hate radio jocks, Fox News, the Wall Street Journal's editorial page, and lobbyists for the health-industrial complex who accuse the White House and Democrats of planning a "government takeover" of health care. Anything that has the word "public" in it is always an automatic target for their rants. But most Democrats understand that a public insurance option is essential to control healthcare costs and expand coverage -- both because private for-profit insurers now face so little competition in most markets that only the prod of a public option will force them to lower costs and extend coverage, and also because a nationwide public option would have the scale and authority to negotiate lower rates with drug companies and healthcare providers, thereby pushing private insurers to do the same.
The White House is looking for a way to be in favor of a public option but also get enough Blue Dog Democrats -- many of whom hail from swing districts and states, and therefore need some cover -- to vote for it. One such cover is a Republican Senator from Maine, named Olympia Snowe. If she votes for the bill, Blue Dogs can calm their constituents -- who have been worked up into a lather by the right -- by saying "you see? Even a prominent Republican senator is voting for this."
So will Snowe play ball? It depends. Her idea (evidently encouraged by Rahm Emanuel, the President's chief of staff) is to hold off on any public option. Give the private insurance companies a period of time -- say, five years -- within which to make changes that extend coverage to more people and also drive down long-term costs. If those goals for coverage and cost aren't met by end of the five-year grace period, kaboom: the public option is triggered -- which will force such changes on the insurance companies.
The beauty of Snowe's proposal is that it seems to offer Blue Dogs a way out and liberal Democrats a way in. Nobody has to vote for or against a public option. The public option just happens automatically if its purposes -- wider coverage and lower costs -- aren't achieved. And the trigger idea seems so, well, centrist.
The problem is twofold. First, it's impossible to design airtight goals for coverage and cost reductions that won't be picked over by five thousand lobbyists and as many lawyers and litigators even if, at the end of the grace period, it's apparent to everyone else that the goals aren't met. Washington is a vast cesspool of well-paid specialists who know how to stop anything resembling a "trigger." Believe me, they will.
Second, any controversial proposal with some powerful support behind it that gets delayed -- for five years or three years or whenever -- is politically dead. Supporters lose interest. Public attention wanders. The media are on to other issues. Right now the public option is very much alive because so many Democrats care deeply about it, with good reason. But put it off for years, and assign it to the lawyers and lobbyists I just mentioned, and you can kiss it goodbye for ever.
If the idea is to have a public option waiting in the wings in case private insurers blow it, why wait for it at all? If it gets lower costs and wider coverage, it should be included right from the start.
What worries me isn't just that the mainstream media are calling Snowe's trigger "centrist," but that the White House might see it as an easy out. "I continue to believe that a public option within that basket of insurance choices would help improve quality and bring down costs," the President said Monday. Fine. But he hasn't yet said the public option is essential. He hasn't threatened to veto a bill lacking it. There's even reason to believe the White House has quietly encouraged Olympia Snowe to pursue her "trigger."
The best way to give Blue Dogs cover is for the President to explain clearly and boldly why the public option is essential to health care reform, and why he's ready to veto any bill that doesn't include it. That's also the only way to give the nation a good chance of getting true health care reform. Hopefully, that's what he'll do Wednesday evening.
Otherwise, we get a trigger to nowhere.
Let me back up a step. The public insurance option has become a lightening rod for Republicans, hate radio jocks, Fox News, the Wall Street Journal's editorial page, and lobbyists for the health-industrial complex who accuse the White House and Democrats of planning a "government takeover" of health care. Anything that has the word "public" in it is always an automatic target for their rants. But most Democrats understand that a public insurance option is essential to control healthcare costs and expand coverage -- both because private for-profit insurers now face so little competition in most markets that only the prod of a public option will force them to lower costs and extend coverage, and also because a nationwide public option would have the scale and authority to negotiate lower rates with drug companies and healthcare providers, thereby pushing private insurers to do the same.
The White House is looking for a way to be in favor of a public option but also get enough Blue Dog Democrats -- many of whom hail from swing districts and states, and therefore need some cover -- to vote for it. One such cover is a Republican Senator from Maine, named Olympia Snowe. If she votes for the bill, Blue Dogs can calm their constituents -- who have been worked up into a lather by the right -- by saying "you see? Even a prominent Republican senator is voting for this."
So will Snowe play ball? It depends. Her idea (evidently encouraged by Rahm Emanuel, the President's chief of staff) is to hold off on any public option. Give the private insurance companies a period of time -- say, five years -- within which to make changes that extend coverage to more people and also drive down long-term costs. If those goals for coverage and cost aren't met by end of the five-year grace period, kaboom: the public option is triggered -- which will force such changes on the insurance companies.
The beauty of Snowe's proposal is that it seems to offer Blue Dogs a way out and liberal Democrats a way in. Nobody has to vote for or against a public option. The public option just happens automatically if its purposes -- wider coverage and lower costs -- aren't achieved. And the trigger idea seems so, well, centrist.
The problem is twofold. First, it's impossible to design airtight goals for coverage and cost reductions that won't be picked over by five thousand lobbyists and as many lawyers and litigators even if, at the end of the grace period, it's apparent to everyone else that the goals aren't met. Washington is a vast cesspool of well-paid specialists who know how to stop anything resembling a "trigger." Believe me, they will.
Second, any controversial proposal with some powerful support behind it that gets delayed -- for five years or three years or whenever -- is politically dead. Supporters lose interest. Public attention wanders. The media are on to other issues. Right now the public option is very much alive because so many Democrats care deeply about it, with good reason. But put it off for years, and assign it to the lawyers and lobbyists I just mentioned, and you can kiss it goodbye for ever.
If the idea is to have a public option waiting in the wings in case private insurers blow it, why wait for it at all? If it gets lower costs and wider coverage, it should be included right from the start.
What worries me isn't just that the mainstream media are calling Snowe's trigger "centrist," but that the White House might see it as an easy out. "I continue to believe that a public option within that basket of insurance choices would help improve quality and bring down costs," the President said Monday. Fine. But he hasn't yet said the public option is essential. He hasn't threatened to veto a bill lacking it. There's even reason to believe the White House has quietly encouraged Olympia Snowe to pursue her "trigger."
The best way to give Blue Dogs cover is for the President to explain clearly and boldly why the public option is essential to health care reform, and why he's ready to veto any bill that doesn't include it. That's also the only way to give the nation a good chance of getting true health care reform. Hopefully, that's what he'll do Wednesday evening.
Otherwise, we get a trigger to nowhere.
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Great post Robert!!!
The 'trigger proposal' represents the worst case scenario.
First off it will give opponents of reform something more to scream about in terms of government 'socialism'. The proponents of reform won't be happy because there is no public option, never mind single payer, and probably won't be. And the American people who want reform but aren't sure about what to support will view this as what it is...just another example of politicians not doing what needs to be done and 'kicking the can down the road'.
We are expected to wait for the industry which has got us to this fubar place to reform itself? We'll have to wait until hell freezes over. This is like letting the banks regulate themselves...and we all know how that turned out, $1T+ later. We need the public option put in place now or it'll never happen...
I say if the final proposal is a 5 year in the future trigger that'll will almost assuredly never get pulled, even though it would be warranted, the progressives should kill the bill.
September 8, 2009 7:59 PM | Reply | Permalink
Since Obama has made it clear he will sign anything and the "progressives" have made it clear they will cave in on everything (Lawrence O'Donnell doesn't even think Nancy can hold them for one token, pretend we're trying, vote), I expect Chuck Grassley will be writing the bill with the assistance of UnitedHealth and Wellpoint. We are so toast.
September 8, 2009 9:10 PM | Reply | Permalink
And that's why the whole thing should be killed. No bill is not worse than the crap they're settling for.
September 8, 2009 10:22 PM | Reply | Permalink
Yep...the biggest democratic majority in a generation and all we are gonna get is a republican health care industry giveaway.
Doesn't it make feel better. The pigs have won tonight. And they can all sleep soundly...everything is alright. (Off the appropriately named album "The Downward Spiral"
September 8, 2009 10:27 PM | Reply | Permalink
All the triggers have been pulled already! How many more nightmare stories of dropped coverage, non-coverage, under-coverage need to be told to be 'enough'?
A trigger is an insult and not worthy of the name reform.
September 9, 2009 2:17 AM | Reply | Permalink
Great Point! Progressives have been working on Public Heath Care for 70 years! The private insurance companies have had plenty of time to do right by the American people and they chose their own wallets instead.
Too late! No Triggers!
September 9, 2009 2:44 PM | Reply | Permalink
Right, and there were no bullets in the gun.
September 9, 2009 4:02 PM | Reply | Permalink
I am the unknown poet, a long-time candidate for president, roasting in the sun.
Once upon a time our Fourth Estate was independent, standing watch, reporting true. Today’s corporate approach to politics locks out the unknowns who seek public office, a primary reason there aren’t any candidates. You announce, “I’m a candidate.” The editor’s don’t ask, “What are your ideas?” But, “Show us twenty million dollars.” And without access to buckets of ducats, the access to broadcast speech, to present their platforms is also blocked. Blog in the bog, dog.
We need to renew our politics, starting with the reestablishment of our First Amendment Right to televised political speech. Upon this essay, I am requesting e quill time of our television networks, to give my response to president Obama’s health care speech to the congress, which the networks intend on playing live.
Here is my Health care solution. My innovative approach deserves your attention.
Health Care For The Rest of Us
Health care, a major element of our economic heartbeat is stressed! My Loose Penny Program, a capital injection, will start to repair our muscle, but mission critical diplomacy is required.
The president needs to bring our fast foods, supermarkets; Target and Wal-Mart CEO’s to the Rose Garden, to ink the deal. Barack Obama went to Cairo. He can meet with KFC. Our pocket change can make the critical health care diff rinse.
Every chain must participate in our Loose Pennies Program, regardless the size of their enterprise. Our purpose: an additional two-cents in their cash registers. For every item registered we want two pennies extra, tacked as patriotic gratuity.
This is not a government mandate. A patron can refuse to pay the voluntary two cents. Burger, fries and a drink total six extra cents, pennies off the pavement. Regardless what we purchase at the market; we are only pitching in some loose change out of pocket. 40 items at the supermarket could easily add up to $150. Does 80 cents inhibit your generosity?
A worker chosen by the workers to represent them can meet with the managers to approve the total pennies for everything out the door the week before, dividing that total by everyone’s hours worked.
Then we include up to $2 dollars extra for every hour in the worker’s paychecks. We could deduct 5 % for a medical mal-practice pool, but employers are exempted from matching, so sticker prices won’t be raised to cover any additional cost of doing business. Fast food chains and supermarkets won’t be harnessed by charges from our two-pennies program!
The worker’s pay raise doesn’t come out of management’s pocket, but work place production will increase. When someone quits, the crew might ask the boss leave them to pick up the slack, so they earn more money!
The overage, beyond $2 dollars hourly extra in every pay, goes to interest bearing medical savings accounts, with the worker's name on his or her portion. President Obama can ask everyone on the low end of the economic chain to divide their bounty, or he can order the take home half in cash, with the balance going to grow their medical savings accounts.
The medical savings account, as a health care solution beats health insurance! Insurance companies are dedicated to making money, not protecting the sick from financial disaster. When an insurance company cancels your policy because you have an expensive disease, they don’t refund your premium. But with a Health Assurance Savings Account, when you quit or get fired from the job, your medical savings account goes with you!
After a year behind the fast food counter, a 40-hour per week worker could have more than two grand in their Health Assurance account. Ten million uninsured people at the bottom of our economic food chain might not have health care insurance but all would carry Health Assurance. In the event they don’t feel right they have access to medical care, and a second opinion, because the money to pay is there! When it’s your money, wasteful procedures evaporate.
This works for the medical professional. You agree to the fee, the doctor swipes your card and the money is deducted from your Health Assurance account. The insurance company is out of the mix.
This proposed over-the-counter voluntary two-cent gratuity, $344 dollars monthly is transferred to the working not so rich by management, without bureaucracy. Government bureaus are out of the mix.
In all the dry cleaners add a nickel to every shirt pressed, a dime for every dry cleaned piece. In all the family operated dry cleaners, medical savings accounts will replace the worker’s share of their family’s health insurance.
This 2 cents extra covers 90% of all the minimum and lower wage jobs in USA, juicing the recovery by pumping the bottom of our economic chain, enriching the people most likely to purchase consumable goods with their money! Those in a low echelon hourly job, working 40 hours a week will have $80 extra weekly in his or her pay envelope, the diff rinse between a life scraping by and getting ahead; the advantage of $76 after a 5% set aside for a medical mal-practice pool, or $40 in their pay with minimum $36 earmarked for Health Assurance savings.
Millions of uninsured not so rich people building Medical Assurance Accounts will directly benefit from this voluntary deal. We gain from tipping our pennies to working folks, as these millions of uninsured won’t be crowding emergency clinics for care, which we all pay for.
Emergency health care is infected by the actuarial projections of how many uninsured people might use an emergency room walk-in for care during the course of any year.
Working people in min-wage jobs with Health Assurance accounts cover their access on a need-to-be seen basis. In addition to medical savings accounts, the two cents gratis could save a million mortgages, a contribution to neighborhood health as deserted house disease devalues the whole street.
For the rest of our uncovered citizenry, doctors and dentists must be given the volunteer opportunity to do tax deductible charity work, treating them. A charity patient is anyone without insurance. The plan: doctors do $50,000 in charitable medical services and deduct the 50 large off the top of their federal tax. Then, after all the deductions, the doctors take an additional half off their bottom line; twenty-five thousand or half, whichever is greater.
The hallmark of Obama’s campaign for president was “change” beyond a changing of the guard.
Medical professionals could perform $100,000 in charity and deduct $50,000 off their tax and because they only owed $49,000 in taxes, earn a one thousand dollar income tax credit.
This health care approach cost effectively makes sense.
Doctors won’t be at the mercy of an insurance companies,’ take it or leave it payment. Those who cannot afford the premiums, with pre-assurance from their family physician, will cancel their outrageous insurance policies.
Every doctor will have a waiting list of patients waiting to be classified as charity. Doctors will have more patients, their work incentive, freedom of income tax.
Isn’t this one-line change in our tax code easier to digest than a thousand page med-reform vaccination, a stick-it-to-us hatched by a scam congress? Would the insurance company’s shills show up at town hall meetings screaming, “It’s a communist plot! Down with their two cents extra for medical savings accounts?”
Every doctor and dentist will have a sign on the door: “No insurance? I’m here.”
These ideas will enrich our economy from the bottom up, possibly save a million mortgages, and insure access to health care services for many, if not all the millions of uninsured people, whilst leaving the greedy insurance companies out.
But your on-the-take congress, salted with insurance money, won’t allow it.
The long-term solution to our health care prob limb is free medical education for doctors, dentists, and all related personal, our goal one hundred thousand doctors graduated every year until we have one family doctor for every thousand people. A national marijuana tax could fund this program. Politishinz are good at identifying issues, but those who finance their campaigns govern the solutions.
In that light, the above proposed change in our tax code, encouraging doctors and dentists to treat the uninsured as a deductible charity, could not pass either House of the current congress in a million years without a public outcry first.
The following web address will create a download from my web site of a word file devoted to the fact that Barack Obama is wearing eye shadow. It has 8 still shots and youtube links.
http://michaleslevinson.com/Eyeshadow2.0.docx
for more on the author: http://youtube.com/poetprophet
September 9, 2009 10:43 AM | Reply | Permalink
Okay, I don't mind a good joke mr.l (horrifically enough, I'm not sure you intend one).
All the same, could you manage a diary instead of hijacking a thread? It took me about 4 years to scroll past this unfortunate comment.
September 9, 2009 3:37 PM | Reply | Permalink
Oh shut the fuck up, you narcissistic dickhead.
September 9, 2009 5:47 PM | Reply | Permalink
It would be astonishing if the WH allows this goofball trigger play. Anything that doesn't have PO (Teddy's compromise) better wear somebody else's name and be deep-sixed.
September 9, 2009 3:32 PM | Reply | Permalink
It looks to me like health care reform has been esentially defeated. It was defeated because there are just too many people out there who have coverage and have been convinced that any change will not benifit them personally.
The irony is that many of those who are against health care will one day lose their plan. They will lose a job. Someone in their family will get sick and not have adequate coverage. Bad things will happen to thousands of them. The theiving insurance companies will drop them and they will go bankrupt.
Good. It serves them right.
September 8, 2009 8:36 PM | Reply | Permalink
Totally off topic, but thanks for the great video. It wasn't partisan and it sure boiled down to an easy sound bite. The WH Communications Office should consult with you next time around!
September 8, 2009 8:49 PM | Reply | Permalink
The "trigger", heh heh heh.
I wonder what will happen when circumstances require the trigger to be pulled. Will the Insurance companies be asleep? Will the Republicans stand by and watch it go off? Will the Blue Dogs?
September 8, 2009 9:22 PM | Reply | Permalink
With respect to the first part, it is not true that only a public option will force insurers to extend coverage. All versions of health care reform on the table involve regulatory changes that forbid denying coverage based on pre-existing conditions and dropping coverage when someone gets sick, among other regulatory changes. These changes are highly significant. Combined with subsidies, these changes will extend coverage.
The public option will make a difference in the cost side of the equation. As Prof. Reich points out, in many parts of the country, there is only one insurer available. A public insurance plan would provide competition for the first time in many places and likely lower costs.
I realize that selling the public option requires emphasizing the coverage part of the issue, not the cost part. But that is where the public option matters the least.
One other point worth noting: If private insurers are forbidden by law from denying coverage, won't they be forced to lower their costs? I can't believe they would have total price freedom. If they can't raise prices, and are forced to pay claims they previously denied, their margins would be under a lot of pressure. This will require a more aggressive cost reduction strategy. Isn't this also part of the goal?
That's a key part of this debate that gets no discussion at all. What will the new insurance regulatory regime say about pricing freedom? I would really be interested in understanding that.
September 8, 2009 9:31 PM | Reply | Permalink
It isn't in some places that the insurance companies have monopoly control it is virtually every market in the nation. The mere existence of other health plans means nothing when one insurance company completely dominates the market as they do almost everywhere.
September 8, 2009 10:36 PM | Reply | Permalink
So make the exchanges national or at the very least regional where the country is divided into maybe 5 or 6 regions at most. The public option is only available as a choice on the exchange, anyway.
If we only expect 1 insurer to participate in the exchange then what is the point? If there are many who choose to participate then what is the basis for their competition?
September 9, 2009 2:39 PM | Reply | Permalink
Monopoly market share doesn't mean they are the only one there. Others do business in the maket but the controlling company sets prices. The others follow. You get this market, I get that one. One hand washes the other. Introducing a government health insurance plan for anyone who wants it would instantly put real competition into every marketplace.
September 9, 2009 5:01 PM | Reply | Permalink
1. Of course that kind of collusion is often illegal, and could easily through regulation be made illegal.
2. Why is the current competitive structure relevant when considering what happens under an exchange? I mean there may be a version of the exchange that simply mimics the current local market, but what on earth is the point of that. If the exchange had a large regional base or better yet a national scope then most asuredly there would be many more entrants into the market.
3. When insurers are forbidden from cherry picking healthy clients but instead need to attract as large risk pools as possible to lower average payouts, then why isn't there an incentive to lower prices to gain the biggest market share? Isn't that what is happening in Part D?
4. You'd be surprised at how often it is the doctors and hospital who set the prices. Medicare and private insurance are getting more expensive becuase the underlying care is becoming more expensive. When you acknowledge that then we can talk about what the public option can and cannot accomplish.
A public option would be a competitor. Telling people it is the only way to create competition is a form of being untruthful.
September 9, 2009 7:19 PM | Reply | Permalink
One other point worth noting: If private insurers are forbidden by law from denying coverage, won't they be forced to lower their costs? I can't believe they would have total price freedom.
I don't think so. I don't see anything in the Baucus Plan about price controls. The reason the insurers don't offer affordable coverage to people with pre-existing conditions is that those folks require more pay-outs for treatment, and are thus expensive to cover. If insurers are required by law to cover them at the same rates, and if all private insurers are in the same boat, then they are going to pass the added pay-out costs onto the rest of us. So unless some other parts of the plan are working to drive aggregate costs down, many of us will pay more.
September 9, 2009 1:33 AM | Reply | Permalink
Yup -- they will have total price freedom and a small portion of their captive customers will get subsidies from the rest of us.
A bill without public option is a giveaway to an unregulated insurance company industry.
If all the other benefits of the bill are so important, let the Blue Dogs and the recalcitrant Senators be the ones to decide if they can vote against a bill containing a robust public option.
September 9, 2009 8:19 AM | Reply | Permalink
Hmmmm . . . H.R. 3200
And the related Sec. 161:
~OGD~
September 9, 2009 10:30 AM | Reply | Permalink
This regulates the medical loss ratio but does not regulate insurance costs for the consumer and provides the perverse insentive for the insurance company to pad costs since their profits are regulatorily limited as a ratio of their medical costs. Without vigorous competition they will be in cahoots with healthcare providers to order as much health care as possible. After all with mandates, limited competition and limits to their medical loss ratio, higher medical costs means more profits not less profits. This provides an insentive to the insurer to upsell insurance and provide the best deals on the gold plated coverage that provide the largest profits. What is more it provides the insurance companies cover for their profits. Their profits will now be under regulatory control so if in the future you want to complain about outrageous insurance profits they'll tell you to go complain to the democratic congress that set the allowed profit margin.
September 9, 2009 3:25 PM | Reply | Permalink
Will insurers costs go up or down?
Insures are forced to give insurance to everyone, can't drop them and must charge everyone the same rates with some exceptions (smoking behavior and age is what I heard about). Everyone is mandated to get coverage.
So presumably insurers will get more enrollees with high costs (those who were previously denied) but also those with lower costs (younger folks who were happy to forego.
They will not be able to comb through your record to find any evidence of pre-existing condition to justify denying a claim, but then they will not be engaging in all the administrative practices that do not go towards care and deservedly engender the outrage of fair-minded people.
Not allowed to compete based on how good they are at denying coverage, on what basis will they compete? By trying to attract as many new customers as possible to create the largest risk pools, thereby lowering their average payout? If so, would they then have incentives to pressure providers to lower their costs. Would they provide incentives to their customers to improve their health (in the same way car insurance companies give discounts if you have a car alarm or more extensive safety features in your car.)?
Will the exchange provide competition in the markets where there are currently no or few competitors?
If insurers simply jack up rates with no economic basis, why wouldn't lower cost competitors enter the market. If Walmart can sell $4 prescriptions, and cash pay checks for less than the competitors, how far behind is their health insurance plan
My take on this is that it is ambiguous. There are some very large changes being proposed, and the competitive landscape willbe different.
That said, I have full confidence that Congress can write legislation that befuddles everyone.
September 9, 2009 3:21 PM | Reply | Permalink
Medicare would have to play by the same rules as private insurers for the reforms to work.
Totally agree that the system is not only unsustainable in its current form but actually causes havoc in the rest of the system for the reasons you state. You can't negotiate bargain-basement rates and then only pay 80%.
That delta will always be fed back into the system in some fashion, even with "supplemental" plans.
September 9, 2009 4:13 PM | Reply | Permalink
Not sure how this ended up here, but it was in response to another comment. Agree with all of the above.
September 9, 2009 4:41 PM | Reply | Permalink
By the time anyone pulls a trigger we'll be dealing with a health care mushroom cloud.
September 8, 2009 9:38 PM | Reply | Permalink
The entire situation has become ridiculous and insulting. The trigger is a scam. And mandates without an active public option choice is the republicans and corporations dreams come true. It will most likely mean the end of the democrat majority in at least one house of congress if not both. And I for one will looking for a new way ahead politically because it doesn't look like the democrats in congress can get it done and the republicans in congress can't do anything helpful but tend instead to be highly destructive and ignorant. I am still hoping I am wrong and the democrats and the president manage to pull a public option out of this health reform hat.
September 8, 2009 9:43 PM | Reply | Permalink
If you think the insurers will simply game the trigger and render it useless, then what makes you think they won't do the same thing to the public option.
Are the new regulations on insurers worth nothing to you? Is there any value in not being able to be turned down or dropped because of apre-existing condition? Do you have a pre-existing condition. Do you have coverage? Do you have a lifetime job?
September 9, 2009 3:27 PM | Reply | Permalink
How do you game the public option?
September 9, 2009 5:54 PM | Reply | Permalink
You game the rule makers. You buy congresspeople and set the rules to your favor, just like they do in Medicare. Have you not been paying attention?
For example, there is a Medicare rule that is supposed to cut physician payments by about 10% each year. And every year, Congress acts to override it. Medicare, you must know, cannot negotiate over drug prices.
I'd be more impressed with your arguments if you were jumping up and down advocating for giving MedPAC rule-making authority unless explicitly over-riden by Congress instead of pretending the public option is any more immune to the cravenness of our corrupt political process than are any other regulations.
September 9, 2009 7:25 PM | Reply | Permalink
The lack of leadership, political backbone or even common sense on the part of the Democratic Party starting with the President is just breathtaking. If they shouted from the rooftops that they are pussies and that they like to be submissive to bullies and those who detest them they could not be humiliating themselves any more than they are doing presently. It is embarassing to be a Democrat under such circumstances. It's bad enough to have to put up with all the spineless appeasing and bootlicking the Democrats do with the Republicans and the powerful but it is just downright sickening to have to face the fact that there is literally no issue where they will stand up and fight for what they believe.
This brings to mind once again a quote I keep close from Helen Keller:
"We the people are not free.
Ourdemocracy is but a name. We vote? What does that mean? It means we choose between Tweedledum and Tweedledee.
We elect expensive master to do our work for us, and then blame them because they work for themselves and for their class."
From this quote it becomes clear that the situation we face now on healthcare is not really new at all. It has been going on a long, long time. But I remain hopeful that one day, the people will rise up and reject this bogus arrangement and demand once again, a new deal. But should we choose to wait for "a leader" as many thought Obama was, then that day will never come to pass.
September 8, 2009 10:33 PM | Reply | Permalink
It is just about high time for a new party. I am tired of the corporate right and the corporate left...even though referring to any of these clowns as being on 'the left' is an idea that I find highly insulting.
Corporate whores and c*cksuckers all...even though I think they give prostitutes a bad name, prostitutes actually work for their money.
September 8, 2009 10:42 PM | Reply | Permalink
Libertine said;
c*cksuckers.
Yeah, I think that's their technical name.
September 9, 2009 2:30 PM | Reply | Permalink
Hehehe...sorry about getting all technocrat on this one John.
September 9, 2009 3:35 PM | Reply | Permalink
I thought craniumupananus was the technical term?
September 10, 2009 8:08 AM | Reply | Permalink
head up ass? :)
September 10, 2009 8:50 AM | Reply | Permalink
I didn't read Bill Clintons "Don't worry about Republicans"
But I would suggest to the Democrats; you'd better worry about your supporters, who’ll see through the cowardice.
If Healthcare dies and the economy were to worsen, and many more become uninsured; then maybe all heck will breakout, and it just won't be healthcare on the table.
Maybe we can finally bury the idea that Capitalism works for the benefit of all.
When all is said about history, it was the arrogance of the aristocracy that brought down the King of France. Let it be so for the arrogance of the Capitalists, unwilling to give crumbs to the people.
Blind fools, couldn’t they see Universal Healthcare benefited them also.
The next big battle if Healthcare fails should be our trade policies, bring back the good paying jobs, and the people could buy their own Blue cross/Blue shield policy. Immigration will also be a big item to address if HealthCare Fails.
Go after the cherries of the well healed, the well insured. Come join us in our misery, then maybe your perception will be enlightened.
September 8, 2009 10:48 PM | Reply | Permalink
Excellent comment, Resistance.
September 9, 2009 11:48 AM | Reply | Permalink
Close the borders! Close the borders!
September 9, 2009 3:29 PM | Reply | Permalink
It's not a matter of closing the border. Visitor’s welcome
There’s an old biblical saying about taking care of your own family members first.
AMERICA FIRST
Are we as a Nation, to be our brother’s keeper? Our American brothers, OUR Family
Don't allow manufactured goods back into the country without a tariff collected.
A tariff collected to pay for the needs of American workers; a tariff that would pay for Universal healthcare for all Americans.
Jobs for naturalized Americans; you know the ones I'm speaking of; the ones that get drafted and go to war.
Good paying jobs for American workers, who pay the taxes, not those who work for pay under the table thereby avoiding paying taxes. Taxes that pay for Government services. Earning money that stays within the US, creating the multiplier effect.
If US countries that moved overseas, in order to find cheap labor; discovered the Tariff collected, penalized their importation, they might discover it would have been better to stay at home.
A win for American workers, maybe a win for manufacturers, when considering a tariff could be detrimental to the bottom line of these traitors.
If Universal healthcare fails, I hope we address the REAL CULPRITS of the dismal Healthcare in America.
I hope the shamed Companies that undermined the middle class, will find we gave them enough rope to hang themselves.
September 9, 2009 7:12 PM | Reply | Permalink
Let's send all the foreign doctors and nurses home first!
September 9, 2009 7:30 PM | Reply | Permalink
Are they illegal?
September 9, 2009 10:32 PM | Reply | Permalink
Who cares, they are not Amurikuns. They must be taking someone's job.
September 9, 2009 10:54 PM | Reply | Permalink
Good point, maybe they can spell American?
I was going to ask, Maybe your a doctor or a nurse, But rereading your reply it becomes evident your not really concerned at all about American Doctors or Nurses are you?
I guess if many were like you, I'd be afraid, if our Doctors and Nurses who couldn't even spell the place of their origin.
Hmmmm maybe your one of those trouble makers who've slipped into the country yourself? Do you even pay your taxes or are you a drain, on the system?
Maybe if you went to their country you too could recieve an education. I don't know if you could get it for free though.
You probably couldn't afford it on the wages they pay.
Then again if cheap foreign workers keep taking the jobs, undermining decent wages.
I suppose my children won't be able to afford it either.
September 9, 2009 11:24 PM | Reply | Permalink
I wish Mr. Reich would say how he would get the public option passed. Lawrence O'Donnell (former Chief of Staff in the Senate Finance Committee) tells us that reconciliation can be filibustered "countless" times. That gets you back to needing 60 votes. With only 45 senators supporting the public option, at least 5 Democratic caucusing senators saying no the public option, and two of those senators coming from Arkansas, where 60% of the people oppose the public option, and at least one of the Democratic senators there would have to sacrifice her seat to vote for the public option, where do you get the 60 votes?
September 8, 2009 11:54 PM | Reply | Permalink
By making a better argument...like how removing the cost of health care from the backs of companies will actually create jobs and removing the burden from individuals will spur consumer spending and lift the economy. Like the public option/single payer has done for all the economies of the industrialized world.
All the opponents wring their hands and bemoan 'how much it is going to cost' when in reality it will be stimulative.
September 9, 2009 12:02 AM | Reply | Permalink
I don't see how the President re-iterating the benefits of a public option is going to flip a state with a 60% opposition to the public option into a state where it's at least evenly split between opposing and supporting. You look at a state like Arkansas and half of the people don't even know if Obama was born in the US. They just don't want to do it.
Then let's take Connecticut (Lieberman's state). I think that's a pretty liberal state that favors a public option, yet Lieberman opposes it. The man seems to be able to defy public opinion and he alone can block the breaking of a filibuster.
Look at Nebraska. Some liberal groups tried to campaign in there to pressure Nelson to change his position and he didn't.
I think that pressuring Senators to vote for the public option is like shooting 10 straight shots from the foul line without missing one. Sure it's possible, but highly unlikely and if you miss one, then you lose the game.
September 9, 2009 1:19 PM | Reply | Permalink
Uh, public option and single payer aren't the same thing (unless your are buying into the arguments of the Republicans). And tell me what countries in Europe that have single payer or public option plans that are doing significantly better economically than the US? Fact is that all the countries of Europe are where we are - struggling to get out of this recession. Universal health care is a great idea but it hasn't made the countries that have it economically superior to us. I'm all in favor of a public option but the idea that it (or single payer) is a panacea to our economic problems or will be a great stimulus to recovery is fantasy. I think Reich makes a lot of sense in his argument why the trigger is likely to be useless but the plain fact is that there are not 60 votes in the Senate for a public option and the reconciliation process is a real long shot given the archaic rules of the Senate.
September 9, 2009 2:50 PM | Reply | Permalink
I am aware they are different richard. I am for single payer but would settle for a public option, against my better judgement. I used single payer/public option in an either/or sense.
I also didn't say it would be a panacea either. I did say I thought it would be stimulative, as opposed to the end of the worlders who say that kind of spending would doom us. But it could be an integral part of a long term plan to stimulate our economy. Part of the reason that the economic downturn is being felt less in Europe is partly because of their nationalized health care. But as long as we remain a country that imports far more goods than we export it'll be a long hard slog no matter what we do.
September 9, 2009 3:34 PM | Reply | Permalink
Are we maybe making too much of the public option? My understanding is that insurance companies are making a profit margin of 5% or so. It'd be nice to have a public option that would compress this margin, but in the scheme of things a couple percent isn't that big a deal.
September 9, 2009 12:02 AM | Reply | Permalink
in 2006 profits for the ten largest health insurance corporations ranged from 2% to 10%.
but focusing on profit alone misses the point. you have to also consider what insurers spend on marketing, administration (including executive compensation packages), and profit.
it is about how much we spend for what we get and who gets it.
but when we talk about a robust public option we aren't talking about 'compressing profit margins' for health insurers. i'm not sure where you get that from.
the benefit of a robust public plan is it's ability (depending on its robustness) to control the costs of the medical services, not just contain the marketing, administration, and profit costs.
September 9, 2009 7:54 AM | Reply | Permalink
What share of our total health care costs are taken up unjustly by insurance companies? (hint: Federal and State governments pay for close to 50% of all care today) What share of the total excess costs of the system do they represent?
Won't the new regulations change the administrative activities on the insurers? That is they won't be able to waste your money trying to figure out who to deny coverage to.
And why are private insures not capable of negotiating lower costs from providers also? Do you think it takes longer for Congress to change the public reimbursement policies or for a private insurer to do the same?
What are the disadvantages of cutting costs by reducing reimbursement rates? (as opposed to say rewarding more efficient care?)
September 9, 2009 3:37 PM | Reply | Permalink
they already do.
September 9, 2009 8:46 PM | Reply | Permalink
I agree that we are being to short-sighted with regards to the public option. Like social security and medicare, we can come back to this well again and again and keep expanding it. If progressives want to play hard at the bargaining table so be it, but if it's clear that the Blue Dogs in the Senate will not blink in Committee, then the House Progressives need to blink. The Blue Dogs can actually lose their seats for voting for the public option. Progressives will not lose their seats for pressing hard for a public option and getting a public option trigger. That seems to be where we can all meet, survive and prosper: public option trigger.
We then come back in 2012 or later and turn the sucker into a real public option. Even the CBO estimated that less than 10% of the population would be on the public option. This is not some moment in history we will miss if we don't get the public option by 2009. Take the long view. We can keep moving things like this forward, but conservatives can never move this back, just as they could not move back social security and will never be able to move back Medicare.
September 9, 2009 1:26 PM | Reply | Permalink
Hey, I've got my Medicare, have you got yours? You could have had it, except Obama will pull the trigger tomorrow. Don't blame me, I didn't vote for him.
Anyhow, as OhioGuy says, you're probably making too much of the public option. Trust the health-scam corporations, he says.
Not when you're dead for lack of health care, for sure.
September 9, 2009 1:08 AM | Reply | Permalink
Here's the trigger I like. We do a robust public option for five years. Then, without a vote of reauthorization, it sunsets. Would love to see them try and take away that benefit after Americans have enjoyed it for five years.
September 9, 2009 1:33 AM | Reply | Permalink
krcook- this is the best proposal I have seen for the triggers.
September 9, 2009 2:16 AM | Reply | Permalink
You are absolutely right. 'Triggers' are just another way of providing political cover for a do-nothing Senate and a spineless White House.
I had hoped for better from President Obama.
The only kind of "change" this is is small change.
September 9, 2009 2:17 AM | Reply | Permalink
Sweeney Todd Is getting real: This is the real future of "heathcare reform"
http://www.nytimes.com/2009/09/06/business/06insurance.html?hp
September 9, 2009 4:34 AM | Reply | Permalink
I have to ask again: What happened to the guy who wrote Reason?
This blog seems short on that precious commodity while being long on hyperbole and angst. Odd coming from someone who has actually been involved with the process. I know you rarely respond to what us little people have to offer, but I am going to attempt to explain this one last time.
Failing to get something, anything, done right now that will move the ball in the right direction will derail health insurance reform for another generation. This blog shows a startling lack of tactical acumen when it comes to navigating a country that is roughly divided between competing ideals. The "public option" as outlined in the current bill is a waste of time and money, whether it is on a trigger or not.
I suspect it is being used as a lightning rod on purpose, so it can "sacrificed" at the right time as a way to get this initial round of legislation passed with true bipartisan support, thus isolating the GOP fringe even further. If the Obama team is smart, which they certainly seem to be, I would think the next step is to begin the long, hard conversion of Medicare into a true public option at significantly less cost as what is currently being proposed and as the only possible way to save it.
The whole Super Bill concept is lame. It causes way more problems than should happened given the public's - that includes most businesses - overwhelming support of substantive health care reform. Sacrificing the public option today will lead to a much stronger and more unassailable version tomorrow by way of comprehensive Medicare reform. Why build a new car if you can simply fix the flat tire?
A vast majority of Americans on the left and right love Medicare, yet not a single democratic representative put forth a bill that would use Medicare reform as a way to build a more rubst public option. It was Medicare-for-All or Nothing. Now the cry is Brand New Public Option Right Fucking Now or Nothing.
I suspect nothing is exactly what democrats will get if they follow this advice.
September 9, 2009 8:47 AM | Reply | Permalink
Waaaaaaaaaaaaa . . .
All fired up ... Ready to GO!
Mister Bluster needs to find a party or start one.
Oh wait ... That's basically been his one trick pony all along.
Divide and conquer ... dood!
~OGD~
ps: I hear the coming refrains of The Looking Glass Left and The Rapture Right . . .
September 9, 2009 10:41 AM | Reply | Permalink
Might as well throw in an ad hominem or two as well! And don't forget WORD!
September 9, 2009 10:52 AM | Reply | Permalink
It was all ad hominem. The entire comment. You guys really have a sever lack of self-awareness.
September 9, 2009 10:58 AM | Reply | Permalink
Yet another predictable response that has zero to do with what I actually wrote. Comments of this nature are designed to provoke an emotional response rather than motivate a reasonable discussion of the issues at hand.
Sorry to disappoint.
"You're either with us or you're against us!" would become the rallying cry for the democratic party if your advice was followed. Seems a little bit off from the liberal message as I understood it, but perhaps you use a different dictionary.
In fact, I think I heard that sort of rhetoric before.
September 9, 2009 11:11 AM | Reply | Permalink
Jason,
you've become quite the whiner. No, make that a predictable whiner.
September 9, 2009 2:32 PM | Reply | Permalink
While you continue to be the predictable far left partisan, picking up where the neocons left off in trying to destroy the country. You hang with good company.
September 9, 2009 3:04 PM | Reply | Permalink
Olden,
that's MISTER Phinius T Bluster to you, Bub.
September 9, 2009 6:09 PM | Reply | Permalink
Paul Krugman:
But what is one to make of the practical, political argument from the likes of Ezra Klein, who argue that any public plan actually included in legislation probably wouldn’t make that much difference, and that reform is worth having even without such a plan?
There are three reasons to be suspicious of that argument.
The first is that I suspect that Ezra and others understate the extent to which even a public plan with limited bargaining power will help hold down overall costs. Private insurers do pay providers more than Medicare does — but that’s only part of the reason Medicare has lower costs. There’s also the huge overhead of the private insurers, much of which involves marketing and attempts to cherry-pick clients — and even with community rating, some of that will still go on. A public plan would probably be able to attract clients with much less of that.
Second, a public plan would probably provide the only real competition in many markets.
Third — and this is where I am getting a very bad feeling about the idea of throwing in the towel on the public option — is the politics. Remember, to make reform work we have to have an individual mandate. And everything I see says that there will be a major backlash against the idea of forcing people to buy insurance from the existing companies. That backlash was part of what got Obama the nomination! Having the public option offers a defense against that backlash.
What worries me is not so much that the backlash would stop reform from passing, as that it would store up trouble for the not-too-distant future. Imagine that reform passes, but that premiums shoot up (or even keep rising at the rates of the past decade.) Then you could all too easily have many people blaming Obama et al for forcing them into this increasingly unaffordable system. A trigger might fix this — but the funny thing about such triggers is that they almost never get pulled.
Let me add a sort of larger point: aside from the essentially circular political arguments — centrist Democrats insisting that the public option must be dropped to get the votes of centrist Democrats — the argument against the public option boils down to the fact that it’s bad because it is, horrors, a government program. And sooner or later Democrats have to take a stand against Reaganism — against the presumption that if the government does it, it’s bad.
September 9, 2009 2:40 PM | Reply | Permalink
Still doesn't address the fact that we already have a public plan and can barely afford that one. It makes little sense to create an entirely new plan without first fixing the one we have by way of creating the robust public plan we need.
September 9, 2009 3:10 PM | Reply | Permalink
Jason, it would appear, from what I know, or think I know, that fixing Medicare would also be a hornets nest--especially if part of the solution were to be raising taxes to solve the insolvency. Or cutting benefits. Or using means testing. Or any of the hard political choices that always get kaboshed.
So, bottom line, you'll end up in a wrangle and all the folks who don't have coverage, or who have inferior coverage, or whose coverage is going to get whacked when they make a claim, or whose premiums are going to go through the roof, will go begging while we "fix Medicare."
September 9, 2009 3:43 PM | Reply | Permalink
The solution to most of Medicare's woes, as well as the stress it puts on the system as a whole, would be to open it up to every American based on a percentage of their income. A true public option that everyone is asking for an already exists.
Like the health care system at large, Medicare must be reformed because doing nothing is not a solution either. Most Americans seem realistic enough to understand that basic assumption that the program will go broke absent huge changes.
We bring all those people into Medicare as a way of fixing it. Two birds with one stone and no "going begging" required.
September 9, 2009 3:58 PM | Reply | Permalink
The problem with medicare financing is (1) they pay for quantity not quality of care. Their payment policies are screwed up and lead to escalating costs and worse care.(2) the system is a large subsidy to retirees from workers. the share of workers relative to retirees is falling rapidly because of the baby boom followed by baby bust, and our increasing longevity.
Expanding coverage may have some effect on cost in and of itself although the effect is ambiguous. We won't have to pay for other people uncompensated care, but people who have insurance also tend to spend more than those who do not.
You reduce the cost of insuring people by reducing the cost of providing care to people. By providing organized care. By using fewer resources. By reducing errors. By applying evidence to medical decisions and application of new technologies. By empowering people to make decision about desired care in concert with their doctors. BY designing payment systems that encourage efficiency and quality rather than over utilization.
September 9, 2009 4:14 PM | Reply | Permalink
The only way to truly lower costs is to lower demand. The only way to lower demand is to have healthier citizens. The rest of these solutions are stop-gap measures at best.
I agree with the point about Medicare as I indicated elsewhere. It would need to be made to perform by the same set of rules that we set up for private insurers to be both effective and sustainable.
Still, the first point remains. Unless we detoxify the American diet, nothing we do today will last.
September 9, 2009 4:38 PM | Reply | Permalink
No actually you are wrong. You can lower costs by lowering the supply of care, because much of that supply is unnecessary, and some of it is counterproductive. Go look up work by John Wennberg, Jon Skinner, and Elliot Fisher.
You can walk into a doctor's office perfectly healthy and still get several thousands of dollars of tests just to prove it, and maybe even a referral to a gastroenterologist to see about that stomach ache you had last Wednesday.
September 9, 2009 4:59 PM | Reply | Permalink
But what is one to make of the practical, political argument from the likes of Ezra Klein, who argue that any public plan actually included in legislation probably wouldn’t make that much difference, and that reform is worth having even without such a plan?
that's funny, Paul Krugman seems to think it addresses whether we need a new public plan
September 9, 2009 3:43 PM | Reply | Permalink
Krugman's "arguments" are tissue thin. He didn't address the idea that Medicare is the most logical place to have a public option.
September 9, 2009 4:11 PM | Reply | Permalink
and yet I find his arguments more compelling than yours.
If I remember correctly, during the election, you said it was impossible for the Dems to gain so many seats, especially in the Senate. I thought you were rather foolish to claim such then. My impression of you has improved since then.
September 9, 2009 5:09 PM | Reply | Permalink
There are a few problems with the comparison.
1.Medicare pays lowers rates for physician and hospital services than do most private insurers, but what is the relationship between the two. Is there cost shifting going on. The head of the Mayo Clinic, one of the most efficient providers of care in he country (they save Medicare a lot of money because they waste so little) said this about Medicare reimbursement: “The system pays more money for worse care. If it doesn’t start paying for value instead of volume, it will destroy the culture of the organizations with the best care. We might have to start doing more procedures just to stay in business.”
2. What will insurers do under a new regulatory scheme? How will exchanges change who they are forced to compete with? It seems much of their latitude to discriminate/deny coverage will be gone. Krugman admits this will lower their costs, but then does not quantify it. What will be the effect of insurers having motivation to create the biggest risk pools possible (if they are only allowed to community rate)? How big will the exchanges be? Open to whom? How many firms will compete in the exchange? Seems impossible to evaluate the competitive pressure if we don;t knwo the answer to this.
3. How will the administrative costs of a public plan that competes on an open exchange differ form Medicare that has automatic payroll tax collection, automatic premium deductions from Social Security checks and automatic enrollment (at least for part A, in practice pretty much for part B too).
4. Negotiating lower rates from providers is a blunt and often stupid way to cut costs, but it is also likely to be a one time effect. then it is back to the inexorable escalation of costs. Krugman was right to point out that Medicare costs may be increasing more slowly than private insurance, but they are still going up much faster than the resources we have to pay for it. So we save 20% tomorrow and then three years of 7% increases has you right back where you started.
September 9, 2009 4:04 PM | Reply | Permalink
If the Dems had 60 votes for a robust public option the bill would already be signed.
September 9, 2009 2:46 PM | Reply | Permalink
Robert Reich nails it right on the head. A trigger would be like a Maginot Line that corporate lobbyists and lawyers could easily circumvent and kill. The Democratic base won't fall for it.
As Paul Krugman wrote yesterday, "the funny thing about such triggers is that they almost never get pulled."
September 9, 2009 2:53 PM | Reply | Permalink
Somehow the link got screwed up:
http://krugman.blogs.nytimes.com/2009/09/08/why-the-public-option-matters/
September 9, 2009 2:55 PM | Reply | Permalink
Why wouldn't the corporate lobbyists be able to play havoc with the public plan. If it is run by the government or more precisely subject to law and regulation then it is vulnerable to lobbyists.
If you are going to be that cynical then you have to be cynical across the board.
Federal and State government's pay for almost 50% of total health spending in the US. The Medicare Payment Advisory Commission has tons of excellent recommendations to improve Medicare, so why don't they have a bigger impact. Is it not the same political influence you say will undermine the trigger?
September 9, 2009 4:35 PM | Reply | Permalink
they absolutely can. What's your point? That's why liberals and progressives talk about robust and strong pubic options.
But if there is none, it's much easier for them to win in that fight.
September 9, 2009 5:12 PM | Reply | Permalink
People are here arguing that a Public Option that is implemented only if specific market conditions are not met will just get carved up by all-powerful lobbyists and rendered meaningless. If that is true then it is equally true that a public option implemented tomorrow has the same vulnerability.
In fact your desire for a "robust" option merely proves the point. I desire a robust trigger. So there.
The point is to implement the smartest policy, or the one that actually has the best chance of solving the problem. It's a given the political system will try to fuck it up.
Flogging the public option to the exclusion of all the evidence about how to lower costs of health care would be a nice start.
September 9, 2009 7:41 PM | Reply | Permalink
Ok the trigger is single Payer and make the perid 2 months. and also demand that health care costs be cut in half.
Thats the only trigger I want.
September 9, 2009 2:53 PM | Reply | Permalink
Why don't we let Roy Rogers have Trigger, and we'll give Rahm Emanuel 5 years off, at which point we'll re-evaluate if he should be let back into Obama's administration.
September 9, 2009 2:57 PM | Reply | Permalink
when i made these points weeks ago about the white house i got booed.
glad to see most people finally come around after it is to late.
but i knew that already too.
September 9, 2009 3:02 PM | Reply | Permalink
What's the point here? I heard the current legislation for the public option makes it impossible for it to compete. First, the public option cannot negotiate drug prices for anything other than the name brands, i.e. generics are excluded. Then as Mr. Reich has said the public option even without a trigger will not be in place for years. Additionally, the public option will not allow anyone/everyone to enroll. Then the final nail is if an employer offers insurance, no matter how crappy it is that person cannot apply for any other insurance. Thus, in short the bills in both the House and Senate are a sham and no one, not even Mr. Reich are telling us these little facts.
September 9, 2009 3:14 PM | Reply | Permalink
Long past time to abandon Obama and the Democrats. They are continuing the Bush/Cheney wars (and ramping up the one in Afghanistan), they are supporting the torturers, they are continuing illegal imprisonments, and they are scamming us on health care. Further support for them has a name: collusion.
September 9, 2009 3:32 PM | Reply | Permalink
What am I missing here?
-- There aren't enough votes for the public option. If there were, we'd already have it. Millions of people are saying they want it and it's good but I haven't heard anyone make a realistic argument that it's *possible.* So ...
-- Congress passes a reform bill without the public option.
-- Under Mr. Reich's scenario, Obama then vetoes the bill, preventing *any* reform from happening.
And what happens then? The Blue Dogs and Republicans come to their senses and realize that they are up against a man of fortitude and that since reform is necessary for the good of the country, they'll have to do it his way?
-- or ---
Does everyone on the right do a victory dance, point to a "feeble" Obama who can't get what he wants even with double majorities, start blaming every health care horror story on Obama because "you could have had a lot of health care except he vetoed it" ..... and they just wait ... letting things get worse, and worse, because they just don't CARE what happens to this country so long as they can win. Keeping things at the status quo and making Obama look weak and ineffectual is a win-win for them.
Tom Brokow, I think it was, pointed out on Morning Joe this morning that Obama simply doesn't have the kind of Republicans that FDR had in enacting the New Deal, or LBJ had in enacting the Civil Rights Act. He simply doesn't have the core of true statesmen who cared about their party and ideology but cared about their country and making things work more. He's got Olympia Snowe, God bless her, but I don't know that *all* of the Blue Dogs will come over even if she does and provides them some (dubious) cover.
So please someone explain how Obama vetoing any bill that doesn't contain a public option gets us TO a public option. I just don't see how you get there from here.
September 9, 2009 3:46 PM | Reply | Permalink
I am 50 year old diabetic and wife is 49 year with health issues. We got laid off and we lost our health insurance. We are uninsurable with only option being a state High Risk policy for $2100 a month with no pre-exisiting conditions covered (unless I avoid treatment for 6 months prior in other words stop taking meds and let my Diabetes get out of control)
Everybody here is saying that we need health reform and that your hearts are breaking for all those that don't have insurance and are going bankrupt. We have bills in Congress that if passed would insure millions that are not insurable or can't afford it.
Yet for the sake of the public option you are willing to sacrifice passing anything or at least telling Obama that if there is no public option he is toast and will lose your support.
Think about it. You are telling me and my wife that YOU are willing to have no bill passed unless there is a public option even with a trigger. You are telling us to get ready to go bankrupt or even to die (if we cant get a treatment to help us) on the altar of the public option.
If this bill dies because of the public option think about how many people that will go bankrupt, will suffer disease, how many will actually die due to lack of necessary health care because they cant afford it, don't have employer provided care.
And for what. I have read every major blog on this issue, (KOS, TAPPED, Klien, etc) plus the actual bills and analysis from think tanks.
All the current bills with even the most robust public option will be just a bandaid on a severed limb. Our health system is broken and the current bills will at most delay its collapse.
From the comments I see that many people have no real idea of what the public option really is or what it will do. Saying it is the lynch pin for reform or that it will save it or that its lack is sufficient reason to kill a bill, shows a deep lack of knowledge of what it is and what is does.
Here is what the robust public option will do. 1) it will be only available in the health exchanged for people not covered by employee or gov health care. That means that at best we are looking at ~30-40 million people who will have access to it.
2) it will pay medicare rates which means that many doctors will refuse to join it.
3)expect that some people will not want it for whatever reason
4) while it may put cost pressures on insurance companies it will only be on those in the health exchanges. It will have no effect on employer plans because employers will be penalized heavily if they dump their employees on the Health Exchange. Insurance companies will really not care if employers don't like their prices since the employer has not real option to go anywhere else. Keep that in mind, 90% of people will have no access to any public option robust of otherwise period.
basically a robust public option will allow some people, about 3% of the population by 2019 to participate in it
(CBO calculates that ~10 million people will join it in 2019.). It probably will reduce some costs for people on the in Health Exchanges but have very little or no impact for the vast majority of others. And it will do little to bend the cost curve. While insurance companies are a part of the health problem, they are not the main or even a major contributor. If we went to a single payer system tomorrow we would still have a broken dying system. Medicare is single payer and its dying and unsustainable. You can only reduce costs by cutting care or cutting the cost of care. HMOs in the 90s were able to get costs down significantly by cutting care, people including the Left, cried bloody murder. Medicare mandates cuts to the cost of care by paying providers less. Well that has worked pretty well, right? Congress has stepped in and made sure those cuts were not allowed to go in after providers made their weight known, and as it is more and more doctors are refusing to take Medicare period.
There is something in the bills that should be a line in the sand if there is one yet few people mention or even know it. in the House bill section H.R. 3200. It will have an impact on health care costs. Basically it states that medical loss ratios will be set up (basically how much of every premium dollar has to go for medical care) by the government for insurance companies and if they don't meet it they will have to issue rebates (see Angry Bear a great econ blog http://angrybear.blogspot.com/2009/07/hr3200-sec-116-golden-bullet-or-smoking.html). basically it will mandate how much profit they can make since some insurance companies has ratios are low as 70%. expect ion is that gov will put it in the high 80s or low 90s.
September 9, 2009 3:56 PM | Reply | Permalink
That's not what I am saying - what I am saying is the legislation for the Public Option now is a sham. It won't do anyting for you and your wife. We need it to be an option for everyone from day 1 and allow it to negotiate prices for all types of medications, not just name brands.
September 9, 2009 4:14 PM | Reply | Permalink
In others words Medicare for All. Great idea from a coverage perspective and will reduce costs due to no insurance companies. However it just postpones the collapse. And it will not happen. 25-30% of the population will literally rebel before that happens. when the situation gets desperate enough maybe just like with Social Security and Medicare.
September 9, 2009 5:33 PM | Reply | Permalink
But the other reforms that would *also* be in the bill, that included the less-optimal trigger, would make a difference for the poster and thousands or millions of others. Sorry -- when folks start saying, in effect, let's let people suffer if we have to because the most important thing is to regain our ideological purity, I want to walk out and check to see what door I came in. Did it say Democrat or did it say Republican (or even al-Quaeda, come to think of it)?
I repeat my question above: what as a matter of actual fact, what is the probable sequence of events, what is foreseeable if Obama adheres to ideological purity and vetos the only bill that is going to come out of Congress? That's what you have to look at also before you make a decision -- or at least that's what a good President would consider.
September 9, 2009 5:33 PM | Reply | Permalink
Thanks, that is an excellent comment.
Anyone with a pre-existing condition who has no insurance, recently lost it, fears losing it, or is afraid to change jobs will benefit tremendously from the provision that forbids denial of coverage for pre-existing conditions and forbids price discrimination based on the same.
It's true healthy people will pay more. Sick people or those with chronic condition who account for the vast majority of all spending (10% of Americans account for 62% of spending in a given year, the healthiest 50% account for 3% of all spending). Stand to gain tremendously.
You are correct that simply reimbursing at lower rates is not a viable cost cutting strategy.
Organized care rather than managed care (the distinction being that the locus of decision-making in one case is the budget examiner's office and in the other is the clinician's team) is the long term way to get higher quality , lower cost care.
September 9, 2009 4:24 PM | Reply | Permalink
what about these people:
But the Colorado Center on Law and Policy examined the household budgets of 903 low- and moderate-income families and concluded that those who spend more than 5 percent of earnings on health care end up making sacrifices in child care, transportation, housing or other areas. Some of these families, faced with significant debt and insufficient income to meet their expenses, could not afford much more than token premium costs, the survey determined.
Lower earners "have very little capacity to absorb significant health care costs," says Peter Cunningham, a senior fellow at the Center for Studying Health System Change, a Washington, D.C. research nonprofit. "We've found financial burdens and medical debt have increased the most for low-income or middle-income people who have private insurance."
The overhaul plan would offer little benefit for some of those families who say they are struggling right now to afford insurance.
To cover her husband, herself and their three children, Liz Stevens, a business manager at a small design firm who lives in Waterbury, Vt., says she currently pays $8,687 in premiums for insurance, and her employer chips in $2,213. In addition, she contributes $2,600 to a health savings account while her employer pays $1,500; the money goes toward her plan's $4,000 annual deductible. All told, the family's share adds up to about 12 percent of the Stevens' income of roughly $91,000 a year.
Those costs are so high, Stevens says, that she and her husband stopped saving for college or retirement, and are discussing dropping out of her employer's plan and enrolling their three children in the state insurance Vermont offers to minors. Stevens and her husband would then go without coverage, as they did during the family's leaner financial years. As it is, she says she already shuns regular check-ups for herself to save money.
"It's the equivalent of what happens with people without health insurance: you avoid going to the doctor," she says. "It definitely changes your mental approach."
Under the House bill, Stevens would have to pay more than $10,000 a year on premiums before the government subsidized the remainder. Even then she would still be on the hook for deductibles and face as much as another $10,000 in out-of-pocket costs should family members fall very ill. “The least expensive option for her would be to keep her current employer coverage,” says Ken Jacobs, chairman of the University of California, Berkeley's Center for Labor Research and Education, who reviewed the case for KHN.
much more here:
http://www.kaiserhealthnews.org/Stories/2009/September/04/health-insurance-affordability-rau.aspx
September 9, 2009 5:24 PM | Reply | Permalink
Nice vision, think. I'll be looking for more comments or blogs in the future.
September 9, 2009 4:49 PM | Reply | Permalink
Thank you.
I am originally from Costa Rica and was just there for a few months. It is a 3rd world country poor with limited resources. Yet everyone has universal health care from birth to death with no copays for care or drugs. My 70 year dad gets treated for diabetes and other issues and for visits and drugs his costs were zero. His 20 year step granddaughter got eye surgery for no cost either. Sure waiting lists are very long for non emergency cases (4-5 months to get a joint replacement, a physical can take 18 months in advance) and the latest and greatest stuff is not available, but if you are sick you will get seen right away or within days. Pregnant women, babies, nursing mothers and elderly get in from of the line for regular stuff.
Employers and employees pay for it and self employed pay directly. Care for a poor family is ~5% of income raises a bit more for others.
there is also a government provided insurance policy for ~$600 a year at special government owned hospitals without waiting lists.
And there are private hospitals that rival what we have here.
My point is how can a little tiny country with limited money insure all its people and do it in a reasonable manner.
its because in the 1950s the country came to the realization that health care was a right and made the decision to make it a reality. Yearly costs are ~$250 per person, yet CR has a longer life span, lower infant mortality, and its was ranked ahead of the USA in United Nations survery on Health Care in 2000.
September 9, 2009 5:22 PM | Reply | Permalink
Two points on terminology.
First, it should not be "health-industrial complex" but instead "insurance-industrial complex" since health and medicine have nothing to do with its core interests and mission.
Second, I propose taking control of the language used here (which so far the progressives and MSM have ceded entirely to the wacko-right). Let us term the advocates of a "private only" health care "privateers", as in "pirates".
September 9, 2009 4:03 PM | Reply | Permalink
The health-industrial complex pulls the trigger on tens of thousands of Americans every single day. Cheating them out of the health care they contracted and paid for, ruining them financially, and crippling or killing them through health care denial.
Lets stop the slaughter-for-profit.
September 9, 2009 4:13 PM | Reply | Permalink
Those practices are largely outlawed in this plan, no?
September 9, 2009 10:52 PM | Reply | Permalink
It's "lightning rod", not "lightening rod".
And I agree with you completely, the so-called trigger is just a Trojan Horse. Olympia Snowe can propose something else serious as an alternative, or get steamrolled.
May I remind everyone talking about "free market competition" that along with Major League Baseball, the insurance industry is the only major industry specifically exempted from the anti-trust laws by an act of Congress.
So no more BS about fair "competition" amongst them, please. It's just not part of our reality-based world.
September 9, 2009 4:32 PM | Reply | Permalink
Pass it On:
http://www.youtube.com/watch?v=dBi8A_HutII
Robert Reich brilliantly lays out the Public Option in just over two minutes.
September 9, 2009 5:20 PM | Reply | Permalink
What's the beef about triggers? They're like benchmarks, right? Remember how benchmarks were set for Iraq, and then we got out of there?
September 9, 2009 6:14 PM | Reply | Permalink
It's a trigger option alright... to shoot down real health care reform and shoot ourselves in the foot for the 2010 midterm elections.
September 9, 2009 6:36 PM | Reply | Permalink