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June 24, 2009

Comments

FWIW, I think there would be something to a claim of "unfairness" if the public plan wasn't designed to be self-sufficient -- but, as is, Hacker, Reich, and Publius are right in that those claims are pure fantasy.

Minor thought: if private insurance companies are allowed to continue the process of adverse selection, won't the government plan be an example of subsidies toward the insurance companies? Arguably, this is already the case.

This is only mildly related, but I have what may be a dumb question--why doesn't Obama start out by making Medicaid's means testing less ridiculous? Make the cutoff point for Medicaid eligibility be the poverty line and that would go a long way to solving the problem of a lot of uninsured folks.

Unfairness is having your health insurance, for which you've regularly paid the premiums, cancelled because, oddly enough, you got sick in a more-than-average-expensive way.

If you want to be in the maximize profits business, start a bank. Or rob a bank, whatever floats your boat.

If you want to be in the health insurance business, insure people's health. Or get out of the way of folks who actually do want to do so.

Fairness is as fairness does.

Just because the initial draft legislation says it won't be subsidized does not mean that it won't, in fact, be subsidized.

Coverage for the poor and people with pre-existing conditions should be subsidized. But Democratic Senators are within their rights not to believe in magic.

It isn't about unfairness it is about transparency. If the government 'competes' with enormous subsidies then it will drive companies out of business *without creating overall savings*.

'k Seb. And if the government doesn't artificially compete through subsidies (as the President and now publius have both assured you)?

We rationally do not trust such assurances. The government doesn't, as a matter of normal practice, refrain from giving itself artificial advantages, when it gets involved in things that are already done in the private sector. It issues orders, where private entities negotiate. It exempts itself from generally applicable laws. It sets itself up as an "opt out" rather than opt in choice.

I don't even see what advantage this government option could HAVE over private sector plans, if the government didn't make the playing field uneven.

"Last week, at a hearing before the House Subcommittee on Oversight and Investigation, Rep. Bart Stupak, the committee chairman, asked three insurance industry executives if they would commit to ending rescission except in cases of intentional fraud. "No," they each said."

From the Ezra Klein article cited in the "Reason for the Season" post.

I really don't care if health insurance is provided by the government, or by the private sector. I just don't. What I care about is that people who need to go to the doctor are able to do so without bankrupting themselves.

Most people are generally healthy. Some folks have issues, and some of those issues cost a lot of money to address. To make sure that the folks who draw the short straw can get the help they need, we have health insurance. It's a way to spread the risk. Everyone pays in a (relatively) small amount, so money is available when bad things happen to some of us.

That is the health insurance deal.

If health insurance companies, as a deliberate policy, aggressively seek to disqualify people making legitimate claims in order to make more money, as far as I'm concerned they've reneged on their side of the bargain.

They're not getting it done.

So if government stepping in is what it will take to get it done, I'm fine with that.

I understand all the arguments about government inefficiency, and the distorting effect of public sector intrusion in the market, etc etc etc.

I just don't care that much about it, because the private sector greedheads are living under the delusion that all that nice money that we all pay to them to insure that we can go to the doctor when we need to is *their money*.

It's not their money.

I can understand that it might go to their heads when they see all those zeros and commas roll by on the financials, but *IT IS NOT THEIR MONEY*.

I'm happy to live with the normal level of bureaucratic government nonsense and inefficiency if it means that *PEOPLE CAN GO TO THE DAMNED DOCTOR WHEN THEY GET SICK*. Small price to pay, sez I.

The insurance guys are greedy freaking SOBs. Period. Screw them.

A public option is "unfair" to private industry? Maybe they'd prefer hanging or jail.

Next question.

That's my two cents.

If the problem is really for-profit companies, then why not set up a non-profit co-op? If one or more of those can outcompete the insurance companies, I can't see who could object. But if they couldn't, then Brett must be right and the whole point of the public option is the subsidies.

I don't even see what advantage this government option could HAVE over private sector plans

1. Not having to worry that your health insurance will be arbitrarily withdrawn because you have become ill and need it - or having endless arguments for weeks or months about will they/won't they pay up for something that's explicitly covered in the plan.

2. Not losing your health insurance when you change jobs.

3. Not having to pay sudden and unexpectedly high premiums because you are now self-employed and your previous plan assumed you to be an employee of a large corporation.

4. Not worrying about having coverage denied for skin cancer because you forgot to mention an acne appointment you had 10 years ago when they asked "any pre-existing conditions?"

However, your and Sebastian's passionate conviction that it's not the government's business to invest in the health of American citizens is... noted. By the way, aren't you both self-identified as "pro-life"? Yet you both sturdily feel that women who can't afford pre-natal care should be denied it...

But wait a minute, aren't these the same people - Seb, Brett, et al - who also rail against the USPS?

Has the Post Office 'outcompeted' UPS? In particular, has it 'outcompeted' UPS via the use of subsidies?

If that's not the case, then all they are left with, as usual, is the 'what if' scenario. Guys, really, 'what if' is not a valid logical argument unless you can attach some figures to it. And no, pulling a random figure out of the air, like 10% or 1% or whatever is not an example of generating legitimate figures.

I'm perfectly willing to believe that insurance companies are run by nasty people, who would do things like that if they can get away with them; Favoring a free market doesn't mean you have to like businessmen. But I find it somewhat difficult to believe that they said, "No.", rather than, "No, blah blah blah...". Unless maybe they were immediately silenced after the "No." emerged from their lips.

And the Blah blah blah might actually be informative.

Jes, that's not a list of advantages the government has over the private sector in providing/paying for health care. That's a list of the advantages you expect we'd get out of having the government pay for it, with no explaination as to why the government would be better able to supply them than somebody in the private sector.

Jes, that's not a list of advantages the government has over the private sector in providing/paying for health care. That's a list of the advantages you expect we'd get out of having the government pay for it,

It's actually a list of of advantages you'd get from having an insurance market that deals intelligently with needs over a lifetime, rather than a year, and whose focus is saving money by improving efficiency in the entire system, rather than by getting rid of expensive customers.

Brett, I asked "if".

"I don't even see what advantage this government option could HAVE over private sector plans, if the government didn't make the playing field uneven."

Which, I guess, is the heart of the disagreement here. You (and Seb, Pithlord, etc) don't think it *can* compete with the free market, so there must be something else planned. I don't think that's the case..

Pithlord - who do you want to set up your non-profit co-op? If the govt, how is it different from this public plan idea?

"And the Blah blah blah might actually be informative."

I got $100 that says the "blah blah blah" is some form of "it'll be less money for us and our shareholders".

It's not their freaking money.

"Jes, that's not a list of advantages the government has over the private sector in providing/paying for health care. "

No, it's a list of several of the ways in which the private sector fails to provide insurance coverage where and when it's actually needed.

If you want to take the money, you have to provide the service. Otherwise the rest of us owe you nothing, and if we're sane we'll find a way to get it done without you.

They made their bed, and they can lie in it.

It strikes me that these are all boilerplate objections, that is, these same people would make the same objections to public schools, mail delivery, electrical and water utilities, etc should they become the subject for a discussion that is brought up in a certain way.

Is there an objection to public health coverage that can not be immediately categorized has the standard libertarian cant?

"It's actually a list of of advantages you'd get from having an insurance market that deals intelligently with needs over a lifetime, rather than a year, and whose focus is saving money by improving efficiency in the entire system, rather than by getting rid of expensive customers."

I agree with this 100%.

As stated above, I have precisely zero objection to providing insurance through private companies. Zero.

However, companies that sign up to provide health insurance *are responsible to do so*. It should be absolutely unacceptable for them to refuse to pay for legitimate and necessary claims, or even to make it more than reasonably difficult to pay those claims, in order to increase their own profitability.

If they can't make money at the game, get the f**k out. Seriously. Go do something else.

The question of unfairness to the private providers is, IMO, borderline insane.

If they want to make more money, they need to put in the hard work of figuring out how to reduce costs *without denying needed care to their insureds*. That is called *providing value*, which is the one and only thing that anyone should be rewarded for in a market economy.

If you want to operate in a free market, you have to respect the responsibilities and obligations of participating in one. If you can't do that, we'll kick your sorry behinds out and do it for ourselves through public means.

"And if the government doesn't artificially compete through subsidies (as the President and now publius have both assured you)?"

I don't believe it. It doesn't actually happen that way. See for example the recent Chrysler bailout where the government tried to change all the normal rules of bankruptcy. And I still don't understand what is going to happen to Ford (the healthiest company) now that it is competing with the bottomless cash of the government in GM and Chrysler.

See also cap and trade. We were assured that it was better than a tax because it harnessed market forces. Which may have been true in theory. But that was an ideal cap and trade vs. a poorly implemented tax. Now that we see the actual plan, we are exempting a majority of the worst polluters for purely poltical reasons.

When the government plays in any big game, the poltics of the matter takes over the other considerations.

It isn't crazy for me to think that the normal thing will happen here.

I would much rather have the government just expand Medicaid to everyone without insurance. It would provide the baseline level of care and insurance could insure everyone who wanted more (which would be lots of people, because Medicaid isn't anyone's favorite program). Then we could try to improve Medicaid without trying to screw up everyone else's care.

I am not concerned about being fair to the insurance companies. I'm concerned that, if the insurance companies have no effective way to conceal a substantial portion of the cost of their product, (And I'm glad they don't.) and the government does, (And it's got lots of ways to do that.) then we can potentially get a circumstance where the government product "out-competes" the private sector product, even though it's less cost-effective.

That's the reason for wanting a level playing field. If it's not a level playing field, a government program can prevail in the 'marketplace' even though it is, using honest accounting, worse.

The non-profit co-op is different because it increases the transparency of subsidies from the general fund. The non-profit can be subject to the same rules. It is usually impossible for the government to be subject to the same rules.

If non-profits can compete better than for-profits (and in some industries they can), that's cool.

How is this diffrent than the many public entities that have been created to compete with private insurers in other lines of insurance? The State Insurance Fuind of New York and the SCIF in California (for example) are state-owned carriers that write workers comp and compete directly with private WC carriers.

Likewise, several states have wind or flood insurance carriers that compete with private homeowners insurance carriers.

To moan about the "public option" is to say that all of these other public interventions in the insurance marketplace ought not exist either.

[Obama takes a long drag on a cigarette, coughs a couple times and says]:

D'd'dave, I know you're completely healthy, you've exercised and eaten a healthy vegetarian diet...

[takes another drag, coughs]

for your entire life, you don't smoke or drink, and your...

[cough]

excuse me

[cough, cough]

recent ancestors have all lived well into their 90's. But you need to subsidize the payment of healthcare for median income smokers and drinkers...

[voice in the background]

Yes, yes, I know. You've already been subsidizing those guys because you and your family have healthier habits and have therefore demanded less healthcare....

[voice in the background]

Yes, yes, I know. It's not even the healthcare you've used up to now that you've subsidized. Your healthier life habits have decreased and deferred the various late life health issues we all have...

[voice in background]

Look, it's because your income is high. That's why i'm asking you to add to the subsidy you already have been giving. Don't be selfish D'd'd'dave! We all are sacrificing for the common good.

[voice in background]

Uh..no...I won't be giving up smoking. Why do you ask?

[voice in background]

...uh huh, I see. Well frankly, it's none of your business whether I or anyone else smokes and drinks. Those are matters of personal choice and freedom that are protected in our great country. Isn't that the beauty of our great country. We protect rights and freedoms....Now, D'd'd'dave, please make out those checks to Internal Revenue Service....

Hey Dave, two words: Cayman Islands.

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