Mandates without a public option must be defeated.

“Without it, we’re just subsidizing the current wasteful system.”; if such was good enough for Wall Street, why not the insurance companies? Hell, AIG already provides the example.
Yes,snark.

IIRC, even with what passes in the house bill for “public option” will wind up covering only 9 million additional people — in other words, the windfall to the for-profit insurance sector will still be massive, because the mandate will wind up “forcing” 23 million new “subscribers” into private insurance…

that’s why what passes for the “public option” is such a terrible joke — and why blind support of a “public option” rather than single payer/medicare for all is playing into the hands of the health care parasites.

No PO? It’s a bailout!

champion post! copied and bookmarked for future citation!

The one piece of the puzzle you seem to be missing is that it appears many major corporations are looking toward dumping – in whole or in part – their provision of health insurance come this fall.

So, in other words, we get mandates, a new requirement that we pay for health insurance, and the corpoations plump their bottom lines by not paying for it and, of course, not giving anyone a raise.

Thanks for this masaccio. It looks like the insurance industry has learned lessons from both the banksters and tobacco companies.

Have to feed the bottomline first and foremost.

You might take a closer look at the CBO estimate, linked in the post As I read the chart on the second to last page, the number of people buying through the exchange increases each year, beginning with 11 million in 2013 then 20, 27, 28, 29, 29, 30. One of the options in the exchange is the public option. I assume people will buy it if it is the cheapest.

I would love a link if you have one to some other information.

Wow, off topic, but I just read this, and… well, still scratching my head over the Republican Party and just how fucking insensitive they are.

U.S. Rep. Lynn Jenkins (R) told a recent gathering in northeast Kansas that the Republican Party is looking for a “great white hope” to help stop President Barack Obama’s political agenda.

scribe, this may be true. I am working off the CBO estimates, which don’t account for that.

why do you think the po will be the cheapest?

p.s. fabulously awesome post. will take me some quality time to digest. but i will thank you now!

Mandates without a public option = certain defeat for Dems. After getting rolled by the financial industry on the bailouts, the public is in no mood to get rolled by the insurance industry through a universal mandate to buy a worthless product. Only mad independents votes in the midterms. The GOP base always shows up. A dispirited Dem based doesn’t turn out. Result. Repeat of 1994. What so hard for the Dem leadership to figure out about this?The GOP is counting on it.

I have been worried that I would no longer be among the most consevative and cautious(economically at least), here at FDL. Well, I just fixed that -I am one of the goofy 6% who answered ‘yes, take it to a vote, regardless of public option’ to the poll in previous post.

I would prefer to present the insurance lackies with a choice:
Public option,
or
Very stringent federal regulation of insurance companies, similar to Swiss, with a kind of rate regulation and public federal audits of not just their books, but everything (data, records, statistical analysis, models).

Make that an option in public, and see what happens when the insurance companies’ Senators and Congresspeople are made to explain why ‘neither’ is a good option.

On other hand, it is very encouraging to see that over 70% of public still wants a public option. The duped teabaggers, insane, dishonest and thuggish, and very well monied have done their best over the first three weeks of August, and support for public option went up, if anything.

So we need to make a full court press on this, in terms of civic action and communication to Congresscritters, and money. And citizen confrontration of media hacks and their extremely lousy job of communicating facts and information.

I do not like games of chicken in politics. The awful cycle of a big helath reform push followed by a decade of doing nothing is not an option now, the US health care system is too close to falling apart.

We need to plan constant hard relentless pressure that works over the long haul, that can continue regardless of short term set-backs, and one that will allow us to continue with an effective and publicly persuasive campaign regardless of the outcome this fall. IMHO.

It was not easy in other countries that have adopted workable health care systems. Sometimes it took decades in other countries too, often by making incremental but irreversable changes to elminate the worset aspects of the under-regulated and dysfunctional private system.

Without a public option, I think the healthcare situation will be considered outrageous by most sane citizens over next few years. People will get soaked, the only question is, if we cannot get the public option, which situation is better for next stage of the push: partial reform, or no reform at all (which is the industry and GOP/Corporate Democrats’ plan)?

I asked this in the poll thread, but I’m gonna ask again (Mods if that’s a no-no, please delete, and sorry).

But didn’t Obama campaign against mandates in the primary against Hillary Clinton??? I’m having a hard time recalling if it was him hammering her for mandates or if it was her hammering him for them. I only seem to remember the hammering.

In 2019, the individual plans will cost $9,197, and the family plans will be at $ 24,575. Just wow. That doesn’t include deductibles and co-pays.

Behold the magic of compound interest: 6.2% over eleven years more or less doubles the premiums.

And God knows the deductibles and co-pays aren’t going to go down or even remain stable over that time period.

WOW.

Also, thanks for the very interesting analysis.

Great reporting. I’ve already sent a link to a few people I know who are of the Wingnut Persuasion. Whether they will read it or not remains to be seen. I’m not holding my breath.

selise, please take a look at this post: link. It is a starting point for an analysis of savings from a public option, and explains the changes I made. synoia did a similar study of Wellpoint, linked in the comments to that post, and while I don’t agree with all the changes, it too indicates the size of the admin and other costs which a public option would not face.

If we can use the public option to pressure providers into lower prices, using rates at Medicare +10%, for example, and use the government to drive down drug costs, we can produce excellent results at a much lower cost.

ShotoJamf thanks for the kind words. I hope we pick up some readers not used to the kind of work being done by all the posters at FDL.

I’ve already sent a link to a few people I know who are of the Wingnut Persuasion Perversion.

Lol, I read your comment like this as a first take.

Huff, huff.

Congress has fucked us.

May be a stupid question, but can the gov’t force you to buy something that you cannot afford? If car makers were in trouble would be forced to buy new ones? This just does not make sense to me.

comment below about talking points, more than massacio’s post:
Talking about Medicare-for all and Medicare rates is problematic. That will scare the whiskers off some well meaning Congresspeople, and allow some of the weasels a place to hide.

I think that it is true that in some regions Medicare fees are seriously underpriced and there is significant cross subsidy from private insurance to Medicare. Simply adopting Medicare for all with current structure would cause huge turmoil in some regional markets. I have been reviewing some new cost-to-charge data and the distortions in pricing is amazing. CA stats now claims a 0.25 cost-to-charge ratio, that is the ratio of listed cahrges of acute care hospital services to historical costs is now 4 to 1. I will have to check to see whether that is a mistake. But is shows how messed up pricing is in the industry, making consumer bargain shopping almost meaningless.

It was a interesting PR gimmick Obama used to emphasize insurance reform, but distortions and dysfunction in financial markets has caused significant problems in real markets as well (just as it did in the housing boom). And there is also what I consider corrupt self-dealing in physician owned labs and hospitals, fragmented, incoherent, and closed professional association and budget driven government control of supply of docs and nurses. There is much more than the health insurance market to fix.

that’s where the subsidy column comes in – people with incomes below some threshold get a subsidy (usually structured as a tax credit) to pay premiums. The threshold proposed is 300% or 400% of federal poverty level, and the subsidy is on a sliding scale, lower income means higher subsidy.

Increased training for nurse practitioners (and utilization of same) is going to be needed.

We also need to get doctors to get over themselves ego wise and use things like ICU checklists, plus fund serious research to find other cost and life saving efficiencies.

Thanks. This has gotten to be such a mess I can’t keep up with it. I suspect that was the plan all along – that people would be overwhelmed with figures and “facts” that didn’t make any sense.

You’re most welcome. Good work you are doing…all the FDL people are doing. Fighting the Good Fight.

Perversion, Persuasion. Close enough for jazz…

the subsidy is something that wingnuts hate. it is ironic because current costs subsidize ER care There’s good reason to believe that more preventative care and early application of therapeutic care would save a lot.

EG: A borderline hypertension patient on blood pressure reducing medications from age 35 doesn’t end up in ER with a coronary at age 42. The annual cost of screening his BP and buying his medications is a lot lower than paying for stabilizing him after emergency open heart surgery.

The wingnut response seems to be, be that as it may I don’t want that 35 year old to have his check up and meds paid by out of MY MONEY. “but but but, he’s getting something for nothing – communism!!” so we all get to pay more for all health care when the 42 shows up needing open heart surgery and the hospital raises other rates to pay for the 42 year olds treatment.

I worry a bit about that, but I like the idea of a setting medicare rates through a commission for a short period, say six months to 1 year, with instructions to fix problems like these, and to re-examine the entire system. The important part of this is adequate funding, lots of it, and plenty of non-professionals on the panel who can be trusted not to suck up to the industry.

Ooops, forgot to credit Jason Rosenbaum for his help.

I agree, though clinical trial data on alternative community practice regimes are just coming in on that (though if you have some articles, please post them). The lack of good treatment for chronic disease is a feature (or perhaps better, bug) in the US system.

You do not hear much about our bugs, only jingoistic prancing around about the very best US acute care for catastrophic illness for those with reliable oney and access. Many patent drugs cost 30% to 50% more in the US, and that does spur RandD, but we have 20% less drug utilization than in comparable high income countries.

Diabetes care has been found to be more efficiently provided with better outcome in the UK, because it is easier to provide cooredinated team care. But you don’t hear anything about that from the media, only goofy soundbites about breast and prostate cancer (followed by advice that will produce UK-style survival rates in the US!)

You are brave to tackle the Medicare prising problem, or even bring it up. So, my comment was not mainly aimed at including it in your analysis. It is a tough problem. One of the most important factors in the formula for Medicare payments (the ‘Conversion Factor’) preserves historical costs and they must change very slowly, whithin a narrow window, each year in order to avoid disruption. So it is true that historical costs from years ago influence relative prices now.

Adding to the problem is that advanced specialty groups have a very large influence in setting relative prices for different services, and the private market tends to adopt the Medicare relative price system (Medicare provides a coherent, if distorted reference point for pricing, which the private sector has found very useful to adopt). Many in the physician commmunity have asked for a fairer process that takes into account the importance of primary care, and the effect on overall health system needs, but the AMA committee that does the pricing has been very slow to respond (well, actually, it hasn’t responded yet at all, as far as I know).

Then the whole cost structure is shifted up and down arbitrarilty each year as Congress fights over whether to impose the draconian cuts often dictated by statute law.

So, the distortions in pricing caused by the combo of Medicare and AMA professional association influence, and short run government budget driven shifts has created a mess.

Bottom line is that a ‘market based’ solution to health care crisis will be impossible as long as structure of supply is determined this way.

i remember that post because i had some questions about your analysis (see for example my comments @9 and @14). have you by any chance reconciled your take on cost savings with woolhandler & himmelstein?

I am intrigued by the regulatory model. I have had experience as a securities regulator, and I know that a) it can be done well if you are willing to pay enough to manage it; b) there is a lot of pressure on regulators from politicians to help their friends.

The big issue is that regulators are looking not at a career in regulation, where they have reputations to protect, but at changing sides. They do that because the money paid to regulators totally sucks. That makes them amenable to pressure from politicians.

From the CBO estimate of the “House Tri-Committee bill”

Taking into account both the access to providers in the public plan and the relative premiums its enrollees would pay, CBO estimates that roughly one-third of the people obtaining subsidized coverage through the insurance exchanges would be enrolled in the public plan—so enrollment in that plan would be about 9 million or 10 million once the proposal was fully implemented.4

note that these estimates are probably high, because they are based on a public option that is using medicare reimbursement rates…

Another significant feature of the insurance exchanges is that they would include a public plan that largely pays Medicare-based rates for medical goods and services.

since there seems to be considerable resistance to allowing a public plan to pay “Medicare” rates, the premiums for the public plan would probably be higher than those used for this estimate, and consequently even fewer people would enroll in the public option (providing even more of a windfall for the health care parasites)

The 2007 New Yorker article I linked to @25 doesn’t event address coordination of care, just getting doctors to use a checklist like pilots. Atul does a fine job of writing just as he did this year with the El Paso/McAllen cost comparison.

There’s just so many perverse incentives in the current structure of how we buy health care.

Woolhandler offers an interesting criticism of the public option, but it is a projection of how companies will operate in the future. I am working on something stronger on the cost savings from a public option, and if my memory works, I’ll address this point then.

Sorry, I missed the link. Eyes getting bad, I guess. thanks. There are a number of orphan cheap quality of care fixed floating around. There are few incentives to implement them in fragmented private sectort, it seems.

Probably a powerful constitutional question, and for certain to go to the supreme court if 3200 passes

I am probably naive about the problems of regulation. From what I know of it, the Swiss system seems best to me where private insurers are retained. As mentioned above, it is pretty strong. It would involve federal audits, with public input and at least partial disclosure of not only financial statments and supporting documents, but all company records and data. The internal records and data and analysis of the company must be transparent to the federal regulators for audits. This audit process would be triggered whenever a company requests a rate that is above announced guidelines.

That seems stronger than US style regulation to me, but I admit I don’t know much about the realities of regulation in the US.

Thanks for the help. This stuff is really complicated. I agree it is ludicrous to restrict access to the public option.

I think if the price is low enough, people will revolt over that limitation.

thanks so much!

btw, iirc, there is press contact info for woolhandler & himmelstein (from when their latest medical bankruptcy study with elizabeth warren was published). i’d be surprised as hell if she wouldn’t be willing to talk with such a well informed blogger. if you are interested, i’ll go look up the info (unless you have it already).

even if you and she end up coming to different conclusions, it would be very helpful to understand clearly where the differences are.

I also believe risk adjustment should be a part of reform, to prevent any adverse selection that remains after adopting laws that require uniform basic plan, some form of community rating, and no exclusions for frivolous rescissions (if you did something that merits your policy being cancelled, that means you plainly broke a law, and will get your healthcare in jail).

The risk adjustment would also have public input and oversight, and would require company disclosure of their utilization patterns and enrollee risk profiles.

I think private insurance for basic comprehensive policies should be very srongly regulated public utility, with very strong disclosure requirement of company info, aided by an open risk adjustment process. Otherwise the private market for basic policies will be unlikely to work in a a stable way over time.

I would be a mistake for Congress to direct a public plan to set provider rates at some artificial level higher than necessary to retain sufficient quality providers. But of course, that’s the same consideration that Medicare administrators use to set provider payments. If the Public Plan is allowed to set it’s own rates, then it seems reasonable to expect it would (a) cover its costs and (b) have a strong incentive to push its costs- and hence rates — to be sufficient to attract the necessary providers. For these reasons, the concern about not automatically pegging to Medicare rates seems to be a red herring.

And the CBO assumes the number of those eligible for the exchange — about 30 million, doesn’t change after the initial years. That would mean that the Sec. of HHS refused to use her discretion (in the House Bill) to raise eligibility to employees of larger businesses, even though that discretion is designed to allow this increase. So it’s not clear that the public option would remain limited or that it’s market share would not grow. But the point is, the public option would, under the conservative CBO assumption, place enough competitive pressure on the private insurers that it would capture about a third of the market — so that suggests that without the public option, and no such pressure, private insurer rates would tend to rise higher than they would without the option creating that pressure and threatening that loss of market share.

Again, I like the idea. With a high degree of transparency, maybe there are enough people who would be looking over the shoulders of the regulators to make a difference.

Is there an analysis of what would happen if public option was open to all, including all employers? That is the best way to implement it, I think. I think many employers would join, as would many individuals who would be younger and healthier than middle aged with chronic disease. My main fear about the public plan with limited eligibility is that would become an expensive chump plan suffering from adverse selection.

No worries.

I’ve been promoting that article in comments now and then. It deserves reading to help people get at some understanding of where savings (both $$ and lives!) can be found. h/t to an article in the Atlantic… the Atlantic article is a bit heavy on free market ideology for me, but still a good read. I agree with his conclusion that medical price discovery should be more transparent.

His proposal to change medical payment from third party payer to mandated Health Spending Accounts for routine care, and universal catastrophic insurance doesn’t fly for me – even with HSAs given to indigents at a $3k/year as he suggests. It is not feasible politically, and I’m very dubious that we’d see cost contained even if it could be enacted.

The problem is that no one can set provider rates rationally without reference to the Medicare rates. We need to rationalize them, but we can’t do without them.

I was told by a guy that might know that hospitals generate about 70% of their revenues from Medicare, so if we make it a rule that if you want to participate in Medicare you have to participate in the public plan will make it impossible for them to say no.

Doesn’t your table imply that in 2019 there will be 18-20 million Americans who will still be uninsured?

And as another question, will any of this decrease the rate of medically related bankruptcies?

Is there an analysis of what would happen if public option was open to all, including all employers?

have you read kip sullivan’s post looking at hacker’s original proposal? just skip over the single payer bits, the rest i think may give you some of the info you are looking for.

That is the best way to implement it, I think. I think many employers would join, as would many individuals who would be younger and healthier than middle aged with chronic disease. My main fear about the public plan with limited eligibility is that would become an expensive chump plan suffering from adverse selection.

amen. amen. amen.

also very much appreciate your comments re risk adjustment regulation.

Public option or veto. Does Obama have the gumption? He’s beginning to seem like a powder puff to me.

Let it be known forever more: No public option and Obama fails.

Here that Rahm.

Well, recall that UnitedHealth’s subsidiary did make a projection of how many people would opt for the public plan if there were total open access — that’s the study the Republicans always cite — and their number was over, I think, 110 million. IIRC, that projection just arbitrarily assumed that public plan provider payments would be fixed at Medicare rates — 20 percent below private insures — and that private insurers couldn’t match that, and/or the PO was kept at some percentage level below private insurer rates. So then you insert those select payment assumptions into a competitive model and voila! — a certain percentage of people will move from private plans A, B, and C to Public Plan!, because the model says that a certain percentage will decide on price. The assumptions about differential rates [and sensitivity to price] drove the outcomes.

wrt to adverse selection — one of the arguments for the pay or play provision is that it discourages employers from dumping their employer-based plans, because they still have to pay the penalty — i.e., contribute to the pool fund for subsidies. I would expect that as insurance premiums continue to rise at 6-7%/year, more and more employers would be tempted to drop coverage, with the smaller employers changing first. Discouraging this change would require a strong penalty — the “pay” of play or pay.

Another thing to keep in mind is that eligibility for the exchange, and through it, to the Public option, may be limited at first to those who are uninsured (or self-insured), but if larger employers can’t or don’t want to keep paying higher premiums in future years, then their employees would become eligible for the exchange => public option.

So I don’t think CBO is correct to assume that the number of eligible people remains at 30 million. There’s a reasonable argument that the number is likely to rise, even if the Sec. of HHS doesn’t formally raise the eligibility criteria.

There are some interesting dynamics that will come into play as long as rates continue to rise so dramatically, in which the PO could start to eat into the market for those who currently are insured by their employers, but might not be in the future. It’s just a guess, but I think the private insurance industry is far more worried about that dynamic — losing their current customer base — than the prospect that they might lose 1/3 of the people who are currently uninsured but who, CBO assumes, would purchase under the Mandates plus Exchange.

In both House bill and Senate HELP bill, all providers who currently take Medicare patients are automatically eligible to serve public plan patients, but the providers can opt out. This is why I believe the public plan will need to make whatever adjustments in rates it deems necessary to retain sufficient providers.

Who do you do you prefer to make a decision for a needed medical procedure for your child, a non-fire-able, arrogant, overpaid government employee that sole objective is to make it through the 6 hour day without signing anything and with a politician mandating what he can do, (deal with them every week) or, a for profit insurance agent that has to answer to about a thousand competitive healthcare providers? Each knows to make a better profit and life for themselves is to provide a product that is 1. Quality, 2. Fast, 3. Cheap. Pick any two. A competitive market would never allow any one company to provide all three due to every company striving for that three point goal. Introduce the one payer government controlled health care. Simply, when there are no profit incentives, there can be no quality, speed or price reduction. Tank all three and exterminate innovation. Quote Obama “ competition from a government plan — without high executive salaries and the need to post profits could keep big insurance companies honest.” Great, who keeps the Billions in government payroll honest. Absolutely no one. Proof of what I’m saying is in the history books. Socialized health care in every country across the globe has caused hundreds of millions to suffer and die an early death. No exceptions. Will it work here, of course, our DNA is superior to the rest of the planet. Right. The so called not for profit government will not allow the government media propaganda to acknowledge that the government cut of the cash flow is far in excess to the insurance companies. The red stared fur caped progressives have been brainwashed into thinking that a for profit insurance company is a cuss word. Unless they are bleeding heart idiots that have no clue to planet history or they are arrogant self serving F… our children, freedom and the country, no rational person could support Obama care. Forcing Americans to purchase Government health care at the point of a gun IS un-constitutional. Freedom and capitalism built this country so that even the poorest have better health care then the other socialized countries. No government program on the planet has ever been successful. The progressive communist can call me all the names they want, I don’t give a s—- they are the enemy of my country and children and must be defeated. Vote to keep government out of health care!

Yes, but you should also read Hacker’s latest, in which he praises the House bill and addresses the adverse selection (and other) points. So even though the House bill is deliberately scaled down/limited from his original proposal, he still supports it.

Site with pdf file link:

http://healthcare.change.org/b…..lic_option

I appreciate your effort to put a price tag on the size of the insurance industry bailout that Health Care for America Now and other “public option” advocates are promoting. HCAN doesn’t come right out and say they are promoting a trillion-dollar bailout for the insurance industry. But that’s in effect exactly what they’re doing when they urge us to support the Senate HELP Committee bill and HR 3200 (the House “tri-committee” bill) because the “public options” in these bills are “strong.” In fact the POs in these bills are tiny little things that will be unable to set their premiums below those of the insurance industry in all or most the country, and may not even survive.

But I have three disagreements with the way you presented your argument.

First, you are very unclear about what “public option” you are talking about. I feel like I’ve been saying this to PO advocates now for months. Why can’t we have a discussion about a real PO with real specifications? Why must we continue to read and write about POs that are never defined? Now that we actually have legislation in front of us (draft bills were published more than two months ago), why don’t we discuss the actual POs described (however vaguely) in that legislation?

The title of your article and the first few paragraphs suggest that you think any old generic “public option” would minimize or eliminate the $1.39 trillion you estimate will go to the insurance industry over the eight years from 2012 through 2019. But then you refer to a July 1 comment you posted alleging that “a public option” would be much cheaper if your guesses about the administrative costs and other costs of the “public option” were true. Your reference to this comment leads me to believe you really don’t believe that any old PO will do the trick. In any case, I don’t know what PO you’re talking about.

(I know of no research that supports the statements you make in your July comment. Could you post, for example, research documenting your claim that the selling costs of the “public option” will have to be lower than those of the typical insurance company. I’ve seen that allegation made often by PO advocates. I have no idea why PO advocates think “competition” between a PO and the insurance industry will be vigorous if the PO doesn’t advertise, doesn’t hire a sales force, doesn’t open offices, etc. Can you give me some evidence for that claim in your July 1 post?)

It obviously isn’t true that a public program that never gets very big and has no negotiating clout with providers and drug companies will undersell insurance companies, enroll tens of millions of people, and thereby siphon away to itself a substantial portion of that trillion dollars per decade that will go to insurers of some ilk over the period you analyzed. If Congress enacts an individual mandate with a scrawny public option, all, or nearly all, of the subsidies will go to the insurance industry. It is,in short, entirely possible for all of the trillion tax dollars per decade that will be spent on subsidies (so Americans can afford to obey the proposed mandate to buy health insurance) to go to the insurance industry, and none of it will go to the PO, EVEN THOUGH a dysfunctional, token PO is open for business.

I think the more accurate title for your article would have been, “Scrawny public option in Democrats’ bills should not serve as excuse for Democrats to give $1.39 billion to insurance industry in first 8 years.”

Second,you appear to base your estimate of how much money the insurance industry will make solely on the subsidies they will receive. I could be wrong about this, but that’s what I gather from your table. If I’m correct, that means you left out the new premiums the insurance industry will receive from people who make more than four times the poverty level who are forced to buy insurance from the insurance industry who were previously uninsured. People making more than 400 percent of the poverty level won’t get subsidies under HR 3200. But they constitute a substantial minority of the uninsured.

Figuring all this out is really complicated. I’m probably nitpicking with this second point. It may not amount to a lot more money for the insurance industry.

Third (and this is really minor), it isn’t true that the figures you show in your second column are “newly covered.” Those are CBO’s estimates of how many americans will be able to shop for insurance within the exchange. Some of those people will be uninsured at the moment the law takes effect, and some will have insurance.

Kip Sullivan

Hugh, the CBO says that there will be about 17mn uninsured people, which includes illegal immigrants and people eligible for Medicaid but who aren’t enrolled.

As to bankruptcies, I think the answer depends on the co-pays and the deductibles. Let’s hope they will be lower on balance.

You simply don’t know what you are talking about. Almost all other industrialized countries have some version of a single payer, and essentially all do so at substantially lower cost all the while better health outcomes. About half do so with wait times that are comparable to or better than ours. Now if you are a shill for the insurance, medical, or drug companies I can see why you say what you do. But if you are an ordinary American like the rest of us, you are being had. You are being sold a bill of goods by people who don’t have your or our best interests at heart and you are buying it hook, line, and sinker.

scarecrow: thanks for the links.

airmaster2: I don’t know who you think you are adrressing here, but I do not think it is me. I do not care a fig whether we have single payer, public option, or private insurance companies financing care, as long as the financial system is properly regulated.

You say: “Socialized health care in every country across the globe has caused hundreds of millions to suffer and die an early death. No exceptions.” And what is socialized medicine: Australia, New Zealand, Switzerland? Please provide links to, or citations of, some evidence and sources and answer my question. I won’t reply to anything else you say until you do. Data talks and BS walks.

That would be using a base number of 49 million. The problem with this is that the economy has lost 6.7 million jobs since the beginning of the recession in December 2007 and I am thinking a substantial fraction of these are without or have lost insurance coverage. So unless I see something a lot more specific and/or updated from CBO, I’m thinking their estimate is too low.

that link doesn’t address wesgpc’s question re an analysis of a po that is open to all. (aside: although i’d seen hacker’s lastest, i’ve only skimmed it. so, can’t comment on it yet… not until i’ve had a chance to really read it and think about it — which i plan/hope to do soon. iow, you’re right, i should read it.).

1. The only point of this post is to estimate the amount of money flowing to the insurance companies if there is a mandate and no public option. I have an idea of what the public option would look like if it is going to succeed, and will flesh that out in another post. Of course whatever I say is talk, not attached to any specific legislation. I stated my rationale, agree or disagree.

2. You misunderstand the chart. The column Increased Net Income gives an estimate of the increase in net income to for-profit companies from the increase in premiums. The right-hand column is the part of profits that flow to the for-profits from the subsidy.

3. As I explain, the number of newly covered is the sum of the CBO estimate for increase in employer plans and increase in people insured through the exchange. See the chart on the second to last page of the CBO link in the post.

If I understand this argument, it is that if Congress enacts a system in which the only alternative to private insurance in the Exchange was a “scrawny” ineffective, non-cheap option that could never grow, never improve, and had no incentive to survive, then . . . it would fail. I don’t know anyone who disagrees with that; it’s a tautology.

Suppose the public option was essentially based on Medicare, used its providers and piggy-backed on its pricing mechanisms, linked to MedPAC and other methods of gaining expertise and cutting costs. Suppose the structure allowed eligible consumers to opt in what we might then call “Medicare for under 65 people”

Would you then argue that there is no value in having such an option, compared to the same system without such an option? Or would you conclude that this question is not worth considering, because a single payer system is far preferable and therefor any consideration of this possibility is a waste of time?

You have a point. I worked with the CBO numbers because they are the lingua fraca of this discussion.

selise — I just used that link because it has the pdf link to the hacker study. Here’s a better source:

http://www.ourfuture.org/repor…..ublic-plan

I think what Masaccio has done is a useful exercise. It establishes parameters that we can monitor, but as I was writing on a different economic subject today projections beyond 1-2 years enter into the realm of fiction. This is especially true now when we are in a time of great economic uncertainty. I am concerned that we will be facing depression in 2011. So I am thinking at a minimum the economic assumptions are going to prove wrong, and that the current process, even if a bill is passed, will be made irrelevant by events.

Well, the good news is that if there is a depression, no one will be able to pay the insurance companies another $1.3 trillion.

As I said, I appreciate your intention and understand your goal. I do believe, though, that in the future you should not write articles with titles that imply that any PO is better than no PO, that all POs are of equal potency. Thanks to the relentless know-nothing campaign for any old PO, no matter how nondescript and dysfunctional, that has been waged by PO advocates over the last year, we now stand a serious risk of seeing progressives in Congress vote for an insurance industry bailout as long as they can go home and say they also voted for some generic little PO.

I am having some trouble understanding your methodology. But your estimate of $1.4 trillion is definitely in the ball park. Please keep it up.

Kip

OTOH meaningful healthcare reform could become a reality simply to head off social unrest.

it’s probably my fault for focusing on the po cost. i just don’t understand how it (in any of the current bills) is going be able to save so much $$. and since the whole concept (and viability) rests on that assumption/calculation, i keep coming back to it because i just don’t see it (and so am at best still fence sitting on support for current legislation)

p.s. i’m way psych’ed that kip is here to discuss this with you.

Yea, I don’t know history at all, France 2003, the Health ministry could not afford to by a $98 Wall Mart air conditioner so 15,000. Grandmas died in just one month over and above the natural death rate. Not to mention the thousands that died in the other progressive communist countries around France. You idiots want that, need read history 101. http://www.usatoday.com/weathe…..heat_x.htm
A government health care system with years of experience that we should copy, right.
Obama now predicts that it will need to confiscate 100% of the income of one Million Millionaires and multiply that times 9 to cover the deficits now projected, That’s only if you believe everything the Government tells you. None of that 9 Trillion will pay for the trillions required for Obama Care. Once evoked never revoked, an entitlement beyond anything Karl Marx ever dreamed.
The Obama administration is beyond bizarre, killing 45 Americans soldiers a month and bankrupting the country at a super-sonic rate.

I think it’s more likely the dollars will go to the military — when regimes feel threatened, they usually worry about security for themselves, not health care for everyone else.

i’ve got it thanks, it’s in the “to read” pile folder on my other computer.

hope other folks will take advantage of your link to give it a read too….

masaccio – i found the press contact info for woolhandler & himmelstein. email me at gmail dot com if you want it.

I’m not sure why my argument wasn’t clear. My argument was that it is confusing and misleading to talk about “reform without a public option” without informing readers which version of the PO the author is talking about. A PO that meets Jacob Hacker’s original criteria would almost certainly destroy the insurance industry, in which case the trillion dollars in subsidies would go to the public program. A PO like the one in the Senate HELP Committee bill and HR 3200 will probably allow all of the subidies to go to the insurance industry. Surely you don’t think this is a trival issue.

I appreciate your proposing a PO I can actually visualize. Yes, if you proposed Medicare as the “option” that people could turn to, I’d be very interested. There are numerous issues we’d have to discuss, including whether there would be subidies to help people buy into Medicare, whether Medicare would be expected to adjust the premiums to reflect the health status of the applicants, and if Medicare doesn’t do that how we would prevent employers and insurers from dumping the sickest Americans on Medicare.

If there were no subsidies, many unemployed people and people in small firms couldn’t afford to pay the cost of coverage, even assuming Medicare charged premiums 20% below the industry premiums. But many employers that do buy insurance now would probably want to switch from the insurance industry to Medicare even without subsidies.

I’d be even more interested in adding slices of the American population to Medicare one slice at a time, perhaps starting with people age 55-64. Adding entire cohorts like that eliminates the adverse selection problem. But it also means we have to drop the pretense that we are offering an alternative to the insurance industry. We would no longer be offering an “option.” We would simply be expanding Medicare’s eligibility. I personally see that as a promising strategy for reaching single-payer in stages. I hope that’s where our discussion turns once the current slow-mo train wreck in Washington comes to its final resting place, the debris is cleaned up, and we can start plotting a truly effective strategy — on that unifies the PO and the single-payer advocates and which weakens, not enriches, the insurance industry.

Kip

You slept through Bush/Cheney, I see, but you believe everything their supporters tell you about Obama.

This whole thing has been pretty thoroughly covered here and elsewhere over the last few weeks. What you’re saying is misleading at best, and outright lies at worst.

What happened in France that summer was indeed a tragedy but when such disasters strike it is really the responsibility of the whole government to react. I would point out that over 500 died in Chicago one summer for similar reasons. Is that an indictment of our private insurance healthcare industry? There are no communist countries left in Europe, except for perhaps Belorus, so your knowledge of history remains deficient. I am not a supporter of Obama but I would point out that Bush got a lot more Americans killed on 9/11 through his negligence than Obama has, and it was Bush who started these stupid wars which Obama to his discredit is continuing. I am signing off from this conversation with you. I find no value in discussing much of anything with someone who knows so little and believes so much.

I’m one that knows little and believes much, don’t give a S— if you reply.
I have a 15 year old son (straight A’s) looking at choosing a career. His mother has 33 years experience as an RN. A medical Doctor was a logical choice, I have discouraged him from this field due to an extra 8 years of schooling with 400K in dept all for government controlled wages. Additionally the tort risk are unbearable. We will need to outsource massive numbers of doctors from Pakistan, India, Nigeria just as the socialized European countries do now. Must remove government from all health care CONTROL, Insurance companies are heroes not villains. Personal medical savings accounts would control the incentive to waste and could be administered by insurance companies. Save 100’s of millions of our grandchildren from suffering and early death. Keep capitalism, not communism! Hasn’t worked anywhere on the planet and caused massive suffering. Many Democrats sincerely believe that our DNA is better then all of the other countries that have Communist health Care. Some how, Communist-Progressives hope our government will be successful when no government program in any country has ever been successful.
Don’t expect credibly from me by calling me a name, tell us real solutions that aren’t based on CHANGE blindness. Some solutions that cost no Tax $s:

• We need to deal with the 100 of millions in Medicare /Medicaid fraud that only the government can afford to continue. Insurance Companies could not afford such fraud and would stop most if they could control Medicare. Get the complacent Government employees out of health control
• We desperately need tort reform to reduce doctor’s unimaginable insurance premiums and stop the expensive defensive medicine most need to practice.
• Allow smaller business to band together to bargain for better premiums as the large companies do.
• Allow 100% individual tax deductions for health care expenses and medical savings accounts for those that don’t get sick.
• Allow insurance companies to compete across state lines. Any form of Government health care is monopolistic and deadly.

Obama will be history’s biggest mass (unintentional) killer if this bill passes. So sad that they will be our American children and grandchildren. We have the best medical system because of capitalism. Saves lives, support it at all cost. Small Aviation business owner, not in the insurance business.
(Copy and Past)
I find it interesting that one of our greatest founding fathers, Thomas Paine, called it correctly in his time when he said “But to expend millions for the sake of getting a few vile acts repealed, and routing the present ministry only, is unworthy the charge, and is using posterity (that’s our children’s and grandchildren’s future) with the utmost cruelty; because it is leaving them the great work to do, and a debt upon their backs, from which they derive no advantage. Such a thought is unworthy of a man of honor, and is the true characteristic of a narrow heart and peddling politician.”

Yes, a lowering of the Medicare eligibility age would be worthwhile way to phase it in.

But putting that aside, I understand your answer above that to be that there is, at least in theory, some construct of a Medicare-based public option, and being able to choose that public option in lieu of private alternatives, that you would find “interesting.” That suggests to me that there might be some “advocates of a public option” who have a similar idea that is worth considering, especially if they made a political judgment that the Medicare/single-payer phase in was not feasible now.

That’s an important statement by you, since people’s judgments can reasonably vary about what is or is not politically possible in these times in which the very legitimacy of government is being challenged.

Given that, I’ll just note that it’s probably not helpful to state that everyone who has been considering this public option by choice approach was therefore engaged in a “bait and switch.” The fact that Hacker’s original proposal is different from what’s in the current bills doesn’t make everyone who still wants to pursue the concept dishonest. Nor do I think it’s helpful for the alliance you seek to imply that all those who shared that view were, apparently without exception, engaged in a “relentless know-nothing campaign for any old PO, no matter how nondescript and dysfunctional.”

You are raving and abusive, so I this will be my last reply whatever you offer, on this post or any other. Good that you do not give a doodoo about whether I ever respond to you again because I will not unless you can be civil.

Deaths due to excessive heat in rest homes is a common occurance all over the world, including the US. Rest homes both public and private are able to avoid thorough investigations here, so we don’t know how many occur, but deaths from neglect in rest homes happen all the time in the US. Egregious cases with obvious attribution do end up in the press. Here is a link to a recent example in the US.

http://archives.cnn.com/2000/US/06/16/heat.deaths

Some people I know investigate these incidents, so I know what I am talking about.

Also, by data and statistics, I mean population based statistics reporting what can be expected to happen to the typical person at the mercy of a particular country’s system. Not reports of exceptional and one time cases that happen in any system. Why not point to the US’s failure to respond to the AIDS epidemic (for political reasons) count the many thousands of resulting deaths, and use that to damn the US healthcare system as murderous? That would not be fair or reasonable either. If you take a better approach to understanding the issue, you would see that life-expectancy of the elderly is higher and growing faster in many (actually most) of these countries you damn as socialist than in the US.

You refused to answer my question about whether you considered the three contries I mentioned were socialist. You apparently think they all are. If that is the case, you are truly ignorant.

You should not quote Paine in your cause, You have obviously not read much of his work, but rather have picked a quote you like. Please go to the Project Gutenberg site and read the man. He is not on your side, and if you read all the way through his works you would see why. Please do that, I am trying to help you, even though you have acted in an abusive and offensive way.

Good-bye and good luck.

I read the hatred on this Firedog site daily and it is infested with vulgarity and revolting anti Christian civility. Would love to be more civil except conservatisms reads as the enemy with most posters. Went to Project Gutenberg and could not find information, They wanted a donation. My 35 years of personal experience with overpaid arrogant Government employs has taught me that Government MUST be restrained. I, yes I can control arrogant private employees simply by changing companies. Cannot happen, even in theory with Government.
What Pain said was He and the rest of the founders were terrified of a central (POWER) government. (Washington). The concept of the Bill of rights was to protected the minority from the majority. How does that fit into forcing all Americans to pay tribute to Washington at the point of a gun. Right, don’t pay Washington taxes and the sheriff shows up at your door with a side arm. Tell him NO and a squad of men dressed in black with machine guns knock your door down. Taxes are not voluntary, they just seem so because few will say no with all of the guns pointed at them.

Ya know, if you’d like people to hear what you say, you should do it a) in fewer words b) without every mindless conservative talking point ever uttered, and most important c) you should make some sense. You think the government will be worse than the system the way it is?

I just go out of the hospital. This will be my third hospitalization in the last 25 years. I’ve been insured for all of them, jumped through all the insurance company’s hoops. The surgeries were pre-approved and still, after they were performed, my insurance refused to pay, saying the surgery was unnecessary, against all my doctors’ evidence. It cost me thousands extra in attorney fees to get them to pay.

Who was standing between me and my doctor? Not the government, dear. I’ve been a government employee and I know how good the health care the government provides is. I would dearly love to go back to such a system.

And Thomas is not Pain, you illiterate fool, he’s Paine.

Are you saying that I have made the following statements:

* “everyone who has been considering this public option by choice approach was … engaged in a ‘bait and switch.’”

* “The fact that Hacker’s original proposal is different from what’s in the current bills … makes everyone who still wants to pursue the concept dishonest.”

If so, could you tell me where I could find myself saying those things?

What I have said is that it was unethical for the leadership of the PO movement, including Jacob Hacker and various representatives of HCAN, to announce that they supported a version of the PO first proposed by Hacker that would enroll over 100 million Americans, and then fail to apprise the public that the POs actually written up in the Senate HELP Committee and House tri-committee bills did not meet Hacker’s original specifications and in fact may not enroll a soul. Yes, I consider such behavior to be dishonest and worthy of a label like “bait and switch.”

My guess is Hacker and HCAN didn’t deliberately set out to pull a bait and switch. My guess is that they adopted the dumb policy of rarely explaining what the PO was and just decided to stick to that policy even when they became aware of what was in the Democrats’ bills and how very different the POs in those bills were from Hacker’s original proposal.

I strongly disagree with lots of people over many issues, but I don’t accuse them of duplicity and lack of integrity. I just argue that they are wrong or inaccurate in as civil a tone as I can muster. But when you say you’re for one thing and then promote another without warning me you’ve pulled a switcheroo, I believe it is not only fair to accuse you of duplicity but necessary. Democracy thrives on accurate information and credible leaders, and suffocates on false information and snake oil salesmen. People who deliberately or recklessly mislead others need to be exposed, especially when they have a lot of access to the media, and especially when they’re misleading the public about an issue as important as the health care crisis.

Kip

I suspect a lot of folks on this site depend on the Government in one way or another. Woops, left an “e” off, congratulations for such a sophisticated reply. Betcha that great government care was not in a County or VA hospital.

I don’t think you are an illiterate fool just because you left Paine’s e off. You are just a fool, plain and simple. Your arguements are specious and you clearly have a lot of hatred in you, too, in spite of being a good “christian”.

Not very sophisticated but true.

I am attempting to protect my children and country from a group of totally insane voters that don’t have a clue about an irreversible tragedy that lingers. Call me a fool, fine, you are an enemy within. I know I am right, your defense is indefensible.

This is what I’m talking about. Why is it you believe that someone who thinks differently than you is an enemy? I don’t call you anything but a fool for your beliefs, yet you call me an enemy trying to destroy our country for mine.

I see absolutely no way that what you think will happen, will happen if health care is reformed. You are living in some dark world I don’t wish to look at too closely.

You should read this article, airhead2. It’s by a former health insurance executive who finally couldn’t look himself in the mirror anymore and quit. Then tell us if you still think our current system is fair or workable and should continue.

scarecrow, you haven’t done it and absolutely aren’t responsible for other people doing it (and i don’t think kip has said “everyone”). but imo there HAS been a massive amount of dishonest, misleading, or related statements from some (*) public option advocates. and to be clear, i don’t mean stuff where people make honest mistakes and concede the point when challenged and i certainly don’t mean honest differences of opinion (no matter how large).

i do though wish the dishonest, misleading, etc statements were getting called out by other public option advocates (instead of single payer advocates who are dismissed as biased or having an axe to grind, etc). sometimes the silence, if widespread, can appear to be, even if it’s not, complicity or agreement.

* note: i hate the use of “some” without naming names, so here are a couple of likely candidates i was just thinking about (there are a lot more). 1) darcy burner sent out a fund raising letter on july 27 that included the line, “The current House bill includes the robust public option demanded by the Congressional Progressive Caucus…” and 2) another one from jason rosenbaum: “Health care has to pass this year, and what’s moving is a public option. As Howard Dean says, it’ll allow you to choose a single payer system if you want one.”

Please read your own comments, as well as your original post in which you accused advocates of a public option of a “bait and switch.” You didn’t qualify it then.

In that post and in your comments here, you have criticized advocates of a public option without qualifying who you meant, other than “advocates,” which left the impression, which you still haven’t corrected, that anyone who advocates a public option deserves the same criticism. In your comment at 84, you continue that.

Further, you say “I strongly disagree with lots of people over many issues, but I don’t accuse them of duplicity and lack of integrity. I just argue that they are wrong or inaccurate in as civil a tone as I can muster.” All unqualified statements. But that is immediately followed by a personal attack on Professor Hacker for duplicity and being unethical, and you repeat the bait and switch terms, even though you acknowledge that perhaps Hacker “didn’t deliberately set out” to perform a bait and switch.

You can’t have it both ways.

Jacob Hacker is not here to defend himself. There are lots of ideas that are proposed in concept for legislation, backed by papers explaining them in detail. Hacker wrote a paper doing just that. Then the ideas enter the legislative process and when they come out, they often look very different from the original idea. That doesn’t make anyone, including Jacob Hacker, dishonest or unethical. It just means you can’t control what happens in Congress.

Moreover, Hacker may well believe that retaining the concept, even in a limited, scaled back version in the current bills, is better than not having the concept at all, not because he believes the scaled down version would succeed by itself, but because he can envision a scenario in which the concept is improved, grows and becomes the viable approach he originally envisioned. But he could easily conclude that complaining about what happened to his paper is not necessarily the best strategy for keeping the concept alive in Congress. That’s not being dishonest.

What exactly is your complaint about Dean? He prefers single payer; he regards Medicare as a version of single payer, and generally a good thing (he concedes it has flaws that need attention). And when he describes a public option, he describes it as “like Medicare.” How that qualifies as part of a “massive amount of dishonest, misleading, or related statements” escapes me.

I don’t think there’s any doubt Dean understands the concepts, the terms and the politics. He’s trying to sell a concept he believes is worthwhile and that could become something like Medicare. He also believes it would lay the ground work for single payer. At NN09, he also made clear that he would prefer to see Medicare gradually opened up, by lowering the age eligibility. So you have someone who believes in single payer, supports opening Medicare, and in the meantime, if the latter aren’t possible, wants a public option that people can choose that would be like Medicare. And now he’s dishonest?

I repeat my request: Please post the statements you think illustrate your complaint that I have accused all PO advocates of unethical behavior.

It seems to me we can boil our issues down to two statements. I’ll set them out below, and you tell me if you agree with them.

(1) There is a difference between urging PO advocates not to support the POs in tne Senate HELP Comm bill and HR 3200 and accusing PO advocates of deception.

(2) People who deceive others sometimes, perhaps often, do not start out with the intention to deceive.

Can we agree these statements are true? If you can’t agree to them, then I don’t know what to suggest. Perhaps you should ask ten friends what they think and let us know what you find out. If you disagree with these statements, then I think we should agree we have wrung as much meaning out of this conversation as we’re going to get and close it up. Thanks.

Kip

the example i gave @90 is wrt jason’s statement (i quoted him not dean) about the public option(s?) moving in congress. that statement, that “it’ll allow you to choose a single payer system if you want one” is just not true. would love to be wrong on that one, but don’t think i am.

it is an especially aggravating statement because there have been other reports of hcan reps conflating single payer with public option. for example, here is a youtube from just about a week before the quote i linked to @90.

p.s. fwiw, i do not read kip’s post or comments as you do (for example w/ my bold, as you wrote, “… everyone who has been considering this public option by choice approach was therefore engaged in a “bait and switch”). maybe it’s a misunderstanding? i have a vague memory of you and i having a similar misunderstanding. actually iirc it was my misunderstanding — you had i think written something along the lines of “the somebodies-but-i’ve-forgotten-who” and i misunderstood the “the” to indicate you meant “all” and not “some.” anyway, i think it’s an easy thing to misunderstand.

Both (1) and (2) can be logically true statements, but neither has anything to do with the point I’m raising. That is a distraction from the essential point I am making, that it is not helpful to make statements that can be interpreted to lump all advocates of a public plan together and then use words like “bait and switch” to describe them or impugn their honesty. You seem not to be willing to acknowledge that you’ve done that. You admit you don’t really know what was in Hacker’s mind, but you still seem to accuse him of dishonesty.

If you did not intend that interpretation, it’s simple enough to say so.

I also agree there is nothing further to be gained from this conversation, since we seem to interpret language differently.

I can no longer figure out what you’re saying. According to you, someone is guilty of a “massive amount of dishonest . . . statements,” but who is it? Is it Jason for relating what he thinks Dean had said? Or is it Dean for expressing his assumption of what he thinks a good public option should be like? This seems a rather thin basis for calling either or both dishonest.

Dean has been fighting for aspects of universal care for over a decade; he tried to get a phase in of something like Medicare in his own state. Jason is working hard for a coalition that is trying to extract as much reform as they think they can out of this session of Congress. Maybe their political judgement was right; maybe wrong.

Right now, it’s looking a little ambitious, given where the debate is going. But I’m having to spend time defending decent people from charges they’re dishonest, while the political discourse in America is focused on whether it’s legitimate under the 10th Amendment for the US government to do much of anything on health care, even the existing Medicare program, let alone an expansion, and if it’s not Constitutional, whether it’s okay to shoot the President.

Somehow I don’t think the problem with the health care debate is about Howard Dean and Jason. I don’t work for either of them (or anyone else here), but if you attack decent people, I’ll defend them.