« The Limits of Twitter | Main | Pictures »

June 15, 2009

Comments

I think that last distinction made about having a choice is misleading. True, no one for now will be forced to accept the government's plan, but the very fact that the government is offering a plan will drive out private competition.

http://www.reason.com/news/show/134016.html

In the end, there won't be any other choices.

but the very fact that the government is offering a plan will drive out private competition.

A) This reasoning tends towards the knee-jerkish.

B) This is not a bad thing, given the other plans in the world.

I agree with dane.

The draft I saw floated last week had provisions for subsidizing policies in the gov't plan on a sliding scale every family up to those earning 500% of the poverty line. That is something like 75% of all families.

How is a private insurance market going to compete with that?

So your 'pants-on-fire' characterization seems harsh to me. Further, saying that a line of attack is 'familiar' as politico does, is not the same as saying it is an untrue.

In the end, there won't be any other choices.

This is not an unreasonable point but I guess it would concern me more if the private market weren't so ridiculously horrible. My feeling is that if there is a way to drive down costs and improve the overall quality of health care without the public option, I am all for it. What I have very little interest in as a voter or as a consumer is some lame, watered down plan that basically amounts to a tax cut to buy into the same craptastic system I am in now. It would be nice if my premiums cost less but it is far from my only complaint about my insurer or indeed, any insurer that I have ever had.

If a combination of regulation and markets can somehow create a significantly better outcome than what we have now, than more power to it. But I haven't seen any very persuasive proposals in that regard.

Another thing, I don't know if the administration argued this, but many argued here in favor of squeezing the profits out of the health insurance business as a means of decreasing overall healthcare costs.

How can private insurers survive if they earn no profits? If they earn no profits they will withdraw from the market. If they do so, then how can one say 'no one is going to be forced to take government-run insurance. People may choose it, but it's not required.' Particularly when part of the plan IS to require everyone to carry insurance.

"True, no one for now will be forced to accept the government's plan, but the very fact that the government is offering a plan will drive out private competition."

So if people freely choose a plan because they think it's better, that'll be a bad thing, simply because it's a "government" plan?

Ronald Baily: "The best result of creating a parallel public insurance scheme is that the United States would end up with an explicit two-tier medical system in which privately insured Americans have better access to better medical care."

Whoa, that'd be totally unlike today, where people without private insurance don't actually have better access to health care than the privately insured! Why, some -- I'm told -- don't have any insurance at all!

The idea of having governmental health insurance sure must scare such people, or those in danger of being such people, I bet.

"The worst case scenario is that the public option plan would eventually absorb what remains of the private health care system. This could happen as the political constituency for private health care and insurance shrinks while more and more Americans become covered by government insurance."

This would be bad for anyone besides insurance companies, why, exactly?

"How is a private insurance market going to compete with that?"

And I should care because...?

As one of the fortunate with medical insurance paid for by my employer: I'd be absolutely okay with trading my current insurance for the care that my French coworkers get in their home country.

i like how AP puts it : "GOP using buzz words to taunt Democrats"

I don't have a fundamental problem with a single payer healthcare system or even a VA-type system from the standpoint of quality of care.

My issues are twofold. First, I don't believe that the government can decrease costs by adding efficiency. I believe that instead they will decrease costs by decreasing reimbursements which, over time, will merely starve the industry. Second, I don't believe that whatever plan comes into being will decrease costs for me personally. The gov't will subsidize 75% of the people but not me. I'll be asked to pay more in order to cover the subsidies.

The postal system is more or less fair. It is not subsidized and everyone pays 44 cents for a stamp. If they make a system like that then i'll jump on the bandwagon.

I'm not worried about the government driving competition out on a level playing field. I'm just relatively certain that there is no way in the world that the government will be willing to not give itself regulatory exceptions and advantages. We already know that Medicare charges below cost for many things. That is possible because it isn't the whole market.

"My feeling is that if there is a way to drive down costs and improve the overall quality of health care without the public option, I am all for it."

Why do you believe having a public plan will drive down costs? The US government already spends what it would take to have a universal plan in the UK and with the margin of error of the Canadian universal plan.

I'm all for figuring out a way to getting to a universal system. But saving money has pretty much nothing to do with it.

Why would any of you make the assumption that the US federal government will do a more efficient job at providing complicated health care services, than the self-interested private market would?

This is the same gov. that couldn't get the switch to digital TV right.

I'm not suggesting our current health care situation is good. I'm suggesting that a government plan is not better, simply by default.

I think the issue needs to be handed over to state governments, and people can vote with their feet on what health care system they prefer.

The US government already spends what it would take to have a universal plan in the UK and with the margin of error of the Canadian universal plan.

we're doing it wrong.

"And I should care because...?"

You shouldn't care. You'll get subsidized healthcare. Yippee!

I'm not precisely sure why healthcare should be a profit center for investors in the first place.

"Profit" and "healthcare" do not mix, for the very simple reason that curing the sick isn't nearly as profitable as maintaining them at an acceptably functional level. And, oddly enough, all of the major pharma breakthroughs over the last decade or so have been precisely that: palliatives, not cures.

"And, oddly enough, all of the major pharma breakthroughs over the last decade or so have been precisely that: palliatives, not cures."

Maybe treating symptoms is easier than curing diseases. It isn't as if the public health care systems of France, the UK, Germany and Canada are such a hotbed of pharma disease curing that it puts the US to shame.

Dave, where the heck is healthcare subsidized? Coverage may be, but not healthcare.

For all those who say private insurance will be forced out of business, that is pure BS. Many companies make a lot of money by selling supplemental insurance to Medicare recipients to cover those expenses Medicare doesn't, and ther is a lot Medicare doen't cover, plus there are deductibles and co-pays with Medicare.

I would hope that the public option does pay more than Medicare for one basic reason. If it doesn't many providers and hospitals will chose not to participate in it. Basically, paying about 10% more to physicians and 5% more to hospitals should make it extremely acceptable.

As for the ridiculous statement that the public won't stand for rationing, that disregards the fact that we have, for the most part, been accepting that for the last 20 years at least.

I won't even get into the fact that, if we were fortunate enough to get single payor, most people would spend less than now, even if taxes were raised.

So yes, the accusations are pure lies, unless you are willing to concede that the critics are just plain ignorant people.

the public won't stand for rationing

this is such utter bullshit. anyone who says that with a straight face is either flat-out lying or has absolutely no idea how the majority of American health insurance plans work.

I think the issue needs to be handed over to state governments, and people can vote with their feet on what health care system they prefer.

People who can't afford healthcare right now are probably not in much of a position to move to another state just to get it.

This is the same gov. that couldn't get the switch to digital TV right.

Well, first of all, "the government" didn't perform the switch to digital TV; broadcasters did. All "the government" did was mandate the switch. Do you really think the FCC was out there installing new equipment at your local stations?

Second of all, things actually went just fine on that end; it was unprepared consumers and an insufficient number of coupons for converter boxes that caused delays.

"I don't have a fundamental problem with a single payer healthcare system"

Regrettably, from the POV of many, the president does.

[...] What are not legitimate concerns are those being put forward claiming a public option is somehow a Trojan horse for a single-payer system. I’ll be honest. There are countries where a single-payer system may be working. But I believe — and I’ve even taken some flak from members of my own party for this belief — that it is important for us to build on our traditions here in the United States. So, when you hear the naysayers claim that I’m trying to bring about government-run health care, know this – they are not telling the truth.
"The gov't will subsidize 75% of the people but not me. I'll be asked to pay more in order to cover the subsidies."

Do you need subsidizing? Do you deny that some people do need subsidizing if they're to afford health care? If your answer to either question is "yes," do please elaborate. If your answer to both is "no," then why are such subsidies bad things? Why should folks be upset that poor people who need help are being helped just because you, for some reason, think that it's "unfair" that poor people who need help get help that you don't need?

Is there something I'm missing here?

"Why would any of you make the assumption that the US federal government will do a more efficient job at providing complicated health care services, than the self-interested private market would?"

Because the government doesn't have to take out a huge portion of the money to pay "profits"? Why shouldn't the money that goes to private profit instead go towards savings in the system?

"Dave, where the heck is healthcare subsidized? Coverage may be, but not healthcare."

The draft I saw floated last week had provisions for subsidizing policies in the gov't plan on a sliding scale every family up to those earning 500% of the poverty line. That is something like 75% of all families. This is subsidized coverage.

Subsidized healthcare exists in cases where medicare and medicaid reimbursements are less than the cost of the care.

"Do you need subsidizing?"

Yes. Just as much as you.

"Why shouldn't the money that goes to private profit instead go towards savings in the system?"

The money that goes to private profit is a return on the capital private parties expended to provide the service. The federal government will substitute it's 'own' capital for that provided by private parties. The capital of the federal gov't is not without cost. To some extent it borrows to provide this capital and pays bond yields. To some extent it levies taxes to obtain capital. Even these have a cost; private money is withdrawn from other useful pursuits to pay taxes. So one cannot say that 'profit'/cost of capital is removed once the venture is moved into federal hands.

"The money that goes to private profit is a return on the capital private parties expended to provide the service. The federal government will substitute it's 'own' capital for that provided by private parties."

The private parties are overcharging for providing *the service*, such as it is. The federal government's substituted capital would still go out into the economy via a single-payer system, and can be put to all sorts of 'useful pursuits' by those who receive remuneration from it. I don't see any value currently being added by health insurance companies.

Of course research into drugs and devices would still need to be funded, but 1) the government already funds a large portion of the research anyway and 2) a prize system could be instituted by the monopsonist (gov.) so there is a financial incentive for private research, but producers would have to compete on the price of production, marketing, transportation etc., rather than getting fat on an inefficient monopoly.

"Do you need subsidizing?"

Yes. Just as much as you.

Hilarious. You are a land developer who, by his own admission, is in the top tax bracket. (Or close to it.) Gary lives as close to poverty as anybody I know. Yes, I can see how your needs are absolutely the same.

Seb: "I'm just relatively certain that there is no way in the world that the government will be willing to not give itself regulatory exceptions and advantages."

Plainly, we have different views on the influence of the insurance industry over members of Congress ...

"Yes. Just as much as you."

Really? Can you afford a a really crappy studio apartment of your own without some kind of subsidy? Do you, in fact, have a roof over your head only because of charity? Can you afford health care other than the ER, or a barebones community clinic? Do you have income of over $8k a year? How much of that income is charity? Do you qualify for a credit card?

My answers to the quesions are no, yes, no, no, mostly, and no.

I'm going out on a limb and guessing your answers are not the same.

"Do you need subsidizing?" [of your health care]

D'd'd'dave: "Yes. Just as much as you."

Let's try again: if you have a medical bill that's higher than $20, or a total of medical bills that comes to more than $200 in a year, can you personally afford to pay those bills out of pocket, or do you have to end up not paying those bills, or do you have some form of insurance that pays such bills in whole or part?

Are you in the same position as someone whose answers are no, yes, and no?

d'd'd'dave: First, I don't believe that the government can decrease costs by adding efficiency.

This reminds of an exhortation to design engineers I once saw in Japan:
"Simplificate and add lightness".
But I digress:)

Sebastian: I'm all for figuring out a way to getting to a universal system. But saving money has pretty much nothing to do with it.

A "universal system" of what, exactly? A universal system of health insurance means exactly and precisely this: everybody pays into the insurance system. Taxpayers will need to subsidize some people's premiums for "universal coverage" to happen. Got a problem with that?

--TP

Gary

There are things I don't have but you do.. There are things you don't have but i do.
You believe that the government should take from my plenty and give to you. Do you believe it should take from your plenty and give to me?

You will be pleased to accept healthcare subsidized by me. What will you give me?

Or are you more 'equal' than me in the eyes of the govt?

"Do you believe it should take from your plenty and give to me?"

What plenty do you believe I have that I should give to you?

I'd be happy to give some of any over-$20,000 a year to others, should I ever earn that much. If I have more plenty than that, I'd be willing to give more of it. I've done various volunteer work at times; I'm happy to give more of that when I'm healthy enough to, and not overcome with survival worries.

Since you didn't answer my questions, I'm going to assume that you if you have a medical bill that's higher than $20, or a total of medical bills that comes to more than $200 in a year, that you can personally afford to pay those bills out of pocket, or you do have some form of insurance that pays such bills in whole or part, and thus, no, you don't need those costs subsidized, contrary to your previous claim.

I'm going to also assume that you can afford at least a really crappy studio apartment of your own without some kind of subsidy, that you don't have have to rely on charity to put roof over your head, and that you can afford health care other than the ER, or a barebones community clinic and that you have income of over $8k a year, and none of it is charitable donations to you because of your need.

If I've gotten any of this wrong, please do correct me.

In which case, if I've gotten it right, I'm glad for you, but wonder why you regard helping those less fortunate than you in such things as "unfair" to you. Why would it be a priority in your life to campaign in conversations such as this against such rampant "unfairness"?

"Or are you more 'equal' than me in the eyes of the govt?"

I rather doubt that, since I get from the government, let's see, a visit to a psychiatrist every three months, with some price breaks on the prescribed drugs, now that I've moved to North Carolina, unlike previous states I've lived in. And I'm finally getting to see a Physician's Assistant for fifteen minutes about every 3-4 months, for a $20 co-payment, and no drugs price-break.

These are both via private charities, by the way, but they do get government money as some significant chunk of their operating budgets, I gather; I don't know the percentages or workings.

And beyond that, I get, um, let's see, uh, hmm, um, er, oh, yes, that's right, nothing.

Except the same use as everyone else of public roads, pollution limited in my air and water, the incredibly awful Raleigh public transit system (oh, I so miss that of Boulder or Seattle or Boston or NYC), and so on.

So I do wonder what the heck you're talking about: what great help am I getting from "the government" that you are lacking?

Gary

So, you lack money. Then don't give me money. Can you sing? Can you write? Can you tell a story? Can you cook?

Tony P, I have no idea where you think we are disagreeing in that comment.

Gary: "Because the government doesn't have to take out a huge portion of the money to pay "profits"? Why shouldn't the money that goes to private profit instead go towards savings in the system?"

This is nice in theory but doesn't seem to actually happen regularly in practice. And it also ignores that profits in many/most companies without regular and high dividends tend to be reinvested in the business. Your appearances in my previous post on the topic didn't do much to address the problem which you seem to be assuming out of existence here: that the US government already spends as much as most other countries and yet covers less than a third as many of its people. Whatever its relative advantage compared to US private systems (which I would argue is mostly illusory as it scales up) on an absolute basis it appears to suck. There appears to be underlying issues with the American health care system which are independent of whether they are run by the government or are in private hands.

Right now I have health insurance because it is subsidized by the state of Washington. Without the subsidized insurance I would have no insurance. My situation is not uncommon.

I have job. I just don't make enough money from my job to afford private insurance. If Obama's public plan goes through I and all the other people who work in my field would be able to switch to the public plan which would save the state of Washington a whole bunch of money.

I do in home health care for disabled people. Without care providers like me people like my clients would have to move to nursing homes and their care would be paid for by Medicaid or Medicare, programs which are already overburdened.

I think of health care as being like ecology: every thing is connected to everything else. Public insurance has all kinds of ripple effect benefits. Another benefit is to businesses: more and more busineses cannot afford to provide insurance to their employees. Freeing businesses from the burden of insurance will make businesses more viable with all of the benefits that flow from that. If all this has the effect of forcing private insurers to provide better services, well that's a benefit, too.

Right now, for those families that have to pay for private insurance, the cost is a big hunk of their disposable income. The option of of going on a public plan would be the equivalent of a significant pay raise, thus freeing those families to buy goods and services they can't afford now. That would have the ripple effect of supporting those producers of good and services, thus helping the over all economy.

What's not to love? A public plan helps everyone.

As Obama pointed out, we are going to have to do it sooner or later. the current system is not sustainable.

BTW, if public insurance would drive the private insurers out of business, why haven't the private insurers been driven out of business in Britain?

As it is I can only expect to have insurance for the next two years. When my union contract comes up for negotiation things could change for the worse.

Can you sing? Can you write? Can you tell a story? Can you cook?

Dance, monkey! Dance!

"Can you sing? Can you write? Can you tell a story? Can you cook?"

He can vote. True, you can, too, but taxes on you can subsidize several Garys, and they out-vote you. That's all he really needs to provide, in a democracy.

"So if people freely choose a plan because they think it's better, that'll be a bad thing, simply because it's a "government" plan?"

Yes. Because the private plans have to make ends meet, the government plans don't. So the government plan can out-compete the private plan even if it's less cost-effective.

Anyway, I've never understood why monopolies with armies are supposed to be better than monopolies with advertising firms.

Actually, ddddave probably would like the respect that Gary has of the commentariat, but unfortunately, ddddave can't buy that from Gary, it has to be earned.

Anyway, I've never understood why monopolies with armies are supposed to be better than monopolies with advertising firms.

if you hate it that much, you can always move to Somalia.

Yeah, and if I hate getting my toenails pulled out, I can always volunteer to be drawn and quartered. Like that suggestion made a lot of sense...

I think that the main problem for national health care advocates is that they keep reacting to Republican offensives, instead of re framing the debate? Its not a question of whether a rich guy should subsidize the less fortunate for health insurance-its whether we would be a better country if we had national health care.
Our founding fathers (PBUT) decided that we would be a better country if we had national main service and so wrote the US Post office into the Constitution. Today we take it for granted that the resident of the (mythical) Buzzard Point, Alaska (pop.75) has just as much right to have his mail delivered as Bill gates does and we don't have conservative senators bloviating about "gumint" mail service ruining us all.
That noted comsymp pinko, Dwight Eisenhower decreed that there will be a national highway system, and so I, who lives in a big city, subsidize access roads both for some farmer and some one richer than I who owns an exurban Mc-Mansion somewhere. On the whole, I think its a good deal because I agree with Ike that a national highway system is good for the country. I also think its a good thing that everyone learns to read and write, so I , who have no children, am OK with a taxpayer-funded "public option" for elementary and secondary schools-even though its not in my immediate self interest.

It seems to me that national health insurance advocates should be framing the debates in those terms instead of reacting to Republican scare tactics about the "gumint" rationing health care or taking away "your" doctor.National health insurance makes as much sense as national mail delivery, a national highway system , or a "public option" for education-and most Americans think that those "public options" make us a better country.

Yeah, and if I hate getting my toenails pulled out, I can always volunteer to be drawn and quartered

if i thought living here was on-par with getting my toenails pulled out, i'd want to GTFO, ASAP.

maybe Somalia's not right for you. but i'm sure there are other places where the government has been drowned in the local equivalent of Norquist's Bathtub that will suit you better. Liberia ?

That's not at all what the plan does. It adds various regulations to private insurers (such monstrosities as eliminating exclusions for pre-existing conditions), but no one is going to be forced to take government-run insurance. People may choose it, but it's not required.

As step one, sure. They realize that they can’t initially go for broke ala HillaryCare. They realize that a backdoor is necessary. Some Democrats make no secret of the long term goal.

Obama: “I happen to be a proponent of a single-payer, universal healthcare plan [applause]…but as all of you know, we may not get there immediately. Because first we have to take back the White House, and we got to take back the Senate, and we got to take back the House."

(I do realize at this point that anything he said on the campaign trail is no longer relevant.)


Rep. Schakowsky (D-IL): “I know many of you here today are single payer advocates and so am I … and those of us who are pushing for a public health insurance don’t disagree with this goal. This is not a principled fight. This is a fight about strategy for getting there and I believe we will.”


Secretary of Health and Human Services Kathleen Sebelius (2007): I’m all for a single payer system, ah, eventually. I think what we have to do though is work with what we’ve got to close the gap.”


Sen. Russ Feingold (D-WI): Question: Do you support single-payer healthcare? FEINGOLD: I do. I always have. I don’t think there’s any possibility that that will come out of this Congress. And so, for people to simply say, “That’s—it’s this way or nothing,” are looking at something that can’t happen now. But I would love to see it. And I believe the goal here is to create whatever legislation we have in a way that could be developed into something like a single-payer system.


And what incentive will any employer have to provide private insurance when there is a public option available? Are they going to pay employees more when they no longer have to pay insurance premiums? Doubtful. Rather, employees will have to pay into the public plan out-of-pocket. Small group insurers will be forced out of business almost immediately. Larger insurers may survive longer by focusing on supplemental plans. But by definition, if the eventual goal is single-payer it means eliminating private insurance. The only market left will be supplemental insurance for those who can afford more than the government is willing to pay for.


I would hope that the public option does pay more than Medicare for one basic reason. If it doesn't many providers and hospitals will chose not to participate in it. Basically, paying about 10% more to physicians and 5% more to hospitals should make it extremely acceptable.

Medicare initially paid providers based on costs and on what other providers charged for the same services. Now, not so much. Many Doctors are just opting out, making it more difficult for patients to find a doctor at all. No matter what a public plan promises to reimburse initially, they’ll cut back eventually. Doctors will opt out. Then what? I guess new regulations to force every healthcare provider to accept the plan. At that point many doctors and even hospitals will just throw in the towel, leading to a shortage of available care. Rationing by any other name…

I’m for universal insurance. But it has to be structured in such a way as to work with private insurance, not eliminate it. And I’m not going to support a plan when the intent is to backdoor single payer.

He can vote. True, you can, too, but taxes on you can subsidize several Garys, and they out-vote you. That's all he really needs to provide, in a democracy.

Indeed, this is what we have come to. If only we could return to the era when the Constitution was drafted, and elected bodies had no power to impose taxes.

Because the private plans have to make ends meet, the government plans don't.

The two definitions of "make ends meet" here are interesting. Private plans borrow, invest, and charge premiums in order to raise enough revenue to cover their current operating expenses plus a healthy profit. Government plans borrow and collect taxes in order to raise enough revenue to cover current operating expenses with no profit motive. Yet for-profit plans are the ones trying to "make ends meet"? Whoa, I hope their CEOs can afford to buy bread.

But by definition, if the eventual goal is single-payer it means eliminating private insurance.

Here in Japan, there are add on policies that one can buy, especially for cancer (a big fear among Japanese) and it seems that there is that option in most other countries. So I'm not seeing how this synchs with your claim.

I’m for universal insurance. But it has to be structured in such a way as to work with private insurance, not eliminate it. And I’m not going to support a plan when the intent is to backdoor single payer.

Why? Is private insurance such a generator of sound medical practices that we have to keep it?

Every other OECD country has some type of nationalized health care. I realize that is not a particularly powerful argument, but it does point to a particular type of convergence that is hard to avoid.

To back up to your previous point, I agree the doctor payment is a key sticking point, but what doctors earn in the US seems way out of line with the rest of the world. Here's a link for GPs (link at http://www.worldsalaries.org/generalphysician.shtml

, which is double that of the next country, and in the US, we have a shortage of GPs because it doesn't pay enough. I'm not sure that we can continue to pay US doctors twice as much (or more) as other countries pay their doctors. Having been poked and prodded by doctors all over the world, I don't see that US doctors are really worth twice as much.

OC Steve,

I don't understand why you think that

"No matter what a public plan promises to reimburse initially, they’ll cut back eventually."

If there was a single-payer, it seems to me the health care industry in this country would become like the arms/defense industry - a single, domestic purchaser with several large vendors. When's the last time you heard about 'cutting back' on tanks, radar systems, stealth fighters etc?

Now there is the argument, valid perhaps, that we would then develop a health care industrial complex with runaway costs analogous to the one we have in defense.

My response to this is twofold. First, it would at least continue our position at the forefront of medical technology worldwide, and if we're going to (possibly over-)spend so much on healthcare, at least we would guarantee that the availability of medical technology is more widespread among our population than it now is. Second, a lot of our defense contractors export the additional production for which they have capacity. Assuming the same held for medical technology, at least we could look forward to leading the world in the production and export of things that save people's lives and improve their quality, rather than things that blow them up, maim them and burn them.

Just my opinion, FWIW.

I like stonetools' framing of the debate, but I view the public plan as addressing a market failure. It's not as spectacular as the financial market's failure, but every denial of coverage, every denied claim, and every bankruptcy due to health care expenses is a symptom of it.

Has there been any real accounting of where all the money in the US health care system goes? I'd like to see the health insurance companies have to open up their books. I'm confident we'd find a lot of it there, but how much? Where are the other inefficiencies?

@OC STEVE


I’m for universal insurance. But it has to be structured in such a way as to work with private insurance, not eliminate it. And I’m not going to support a plan when the intent is to backdoor single payer.

Well, that's where you and i differ. For me, I don't give a $%^# about protecting the private health insurance industry. What I care about universal coverage, and if the private health insurance industry has to shrink in order for me to achieve that goal, so be it. Heck, its the failure of the PHII to provide broad based coverage that has led us to this mess.
The issue is really, do we want universal coverage or do we just want to fool around. We all know from empirical analysis that single payer is the best solution. Its single payer in Europe, Australia, New Zealand, Canada, Australia, Singapore . AFAIK every country that has universal coverage has single payer, and they have chosen that route after looking at other options and finding those other options don't work as well.
Why isn't it single payer here? Two reasons-the power of the PHII lobby and the myopia of those who just can't understand that, ideology aside, single payer IS the best and most efficient way to have universal coverage. The result? We have to settle for a second best "public option" plan and hope that the myopics finally come to their senses down the road.

stonetools: AFAIK every country that has universal coverage has single payer

No, the UK has socialized health care with private health insurance for those that want it: the NHS isn't a single payer system. (And the UK is best in the world at universal coverage.)

The distinction is explained here.

The US has a socialized highway system; a socialized education system; a socialized post office; a socialized military. As stonetools points out upthread, all of these things are clearly in the public interest to provide. It's up to conservatives to show it's not in the public interest to provide healthcare to all.

LJ: Why? Is private insurance such a generator of sound medical practices that we have to keep it?

Not for that reason no. Certainly there are problems with private insurance, even rationing of care. It’s certainly not perfect. But it’s a hell of a lot better than I fear government single-payer would be. And we simply can’t afford it. Director, CBO on Obama’s plan:

According to our preliminary assessment, enacting the proposal would result in a net increase in federal budget deficits of about $1.0 trillion over the 2010-2019 period. When fully implemented, about 39 million individuals would obtain coverage through the new insurance exchanges. At the same time, the number of people who had coverage through an employer would decline by about 15 million (or roughly 10 percent), and coverage from other sources would fall by about 8 million, so the net decrease in the number of people uninsured would be about 16 million or 17 million.

A cool trillion to get a net of fewer than 20 million more people insured. That’s not even considering expansion of other programs like Medicaid. How many trillions to insure 330 million people? Because once the private insurers go out of business that is what we have left… We simply can not afford it. The only option I can see having any chance at all is keeping private plans intact and publically insuring those who have no access to a private plan. I would think folks would support that unless the goal is single-payer for single-payer’s sake.

The only option I can see having any chance at all is keeping private plans intact and publically insuring those who have no access to a private plan.

This seems like an awesome way to ensure that private plans get to cherry pick the healthiest people while leaving the sickest to the government. That's great for insurer profits but perhaps not so good for the rest of us.

What we can't seem to afford is the transition. Other countries seem to be able to afford it. Why can't we?

Private insurers can move to lucrative niches in the market. They don't have to go out of business. I'm not seeing why they have to, given that it doesn't seem to have happened in other countries that have single payer.

Other countries introduced their systems long ago before the cost explosions (starting with Germany in 1883). Most other nations (with functioning systems) also lack the paranoid anti-regulation government-is-the-problem mindset so influential in the US.
Germany btw is not single-payer either and the insurance industry is not actually starving despite being heavily regulated. I don't say it's working perfectly but well enough to disprove the Apage-Satana cries of the US HI Moguls.

OCSteve: But it’s a hell of a lot better than I fear government single-payer would be.

Yeah, but you're ignorant. So your fears are the fears born of ignorance. Become educated. Be less fearful.

How many trillions to insure 330 million people? Because once the private insurers go out of business that is what we have left… We simply can not afford it.

Because the US is a poverty-stricken, Third World country, more miserably without resources and incapable, than any other developed nation in the world. Yeah, yeah.

It's always amazing to me how far conservative Americans are willing to go to make sure we all know they think the US is poor and incapable and just can't afford to do what other countries do.

"Crying poormouth" they used to call it when I grew up...

Thanks for the correction, jes

@OC Steve

Hey, the USA has the largest economy in the world and is the richest country , by some measures. If freakin' SINGAPORE can afford universal coverage, so can the USA. Its a matter of willpower.

Singapore has a universal health care system where government ensures affordability, largely through compulsory savings and price controls, while the private sector provides most care. Overall spending on health care amounts to only 3% of annual GDP. Of that, 66% comes from private sources.[1] Singapore currently has the lowest infant mortality rate in the world (equaled only by Iceland) and among the highest life expectancies from birth, according to the World Health Organization.[2] Singapore has "one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes," according to an analysis by global consulting firm Watson Wyatt.[3] Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized catastrophic health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of healthcare services in the country" to keep costs in check; the specific features have been described as potentially a "very difficult system to replicate in many other countries." Many Singaporeans also have supplemental private health insurance (often provided by employers) for services not covered by the government's programs.[3]


http://en.wikipedia.org/wiki/Health_care_in_Singapore


Now the Singapore system is probably not exactly how we would do it, but it shows that it CAN be done.
Maybe Ted Kennedy's plan isn't the way to go- but let's get rid of the idea that somehow, for reasons uniquely American, that it's IMPOSSIBLE to have universal coverage. It ain't.

Hmm..I remember an old Democrat adage, "Republicans don't think government can do anything right and when voted in to power PROVE it".

Perhaps this is why so many of the more conservative posters are against government involvement with healthcare?

The market has failed to provide universal healthcare and indeed is incapable of doing it. If universal healthcare is in the national best interest (and I think it is) then private industry needs to step aside and let the government do the best job it can. The market can then step back in and provide additional and specialized health coverage.

"This seems like an awesome way to ensure that private plans get to cherry pick the healthiest people while leaving the sickest to the government. That's great for insurer profits but perhaps not so good for the rest of us."

I agree. The bigger the risk pool the better, and "all Americans" is the biggest risk pool of all.

"Its a matter of willpower."

Yeah, I think I've heard that called the "Green Lantern" theory, in another context.

Yeah, I think I've heard that called the "Green Lantern" theory, in another context.

"Let all who fear AMA's might,
Beware my power -Obama's light!"

http://en.wikipedia.org/wiki/Green_Lantern

Yeah, I think I've heard that called the "Green Lantern" theory, in another context.

Why, yes, because seeking to remake the Middle East, and indeed the world, to neoconservative specifications is virtually identical to the implementation of domestic universal health insurance coverage. Why, just look at all the other nations with universal coverage, and how they failed so completely to offer it.

Hint: sometimes "another context" is actually another context.

Although, if this spurious analogy were true, we might have been able to use that Nathan Fillion trailer to push the public insurance option. Oh, well.

OCSteve: The only option I can see having any chance at all is keeping private plans intact and publically insuring those who have no access to a private plan.

Turbulence: This seems like an awesome way to ensure that private plans get to cherry pick the healthiest people while leaving the sickest to the government. That's great for insurer profits but perhaps not so good for the rest of us.

It was a done deal, from the beginning of the presidential primaries onward, that the only "health care reform" on offer would be some rearrangement of insurance provision.

For political reasons having to do both with the outsized political power of the insurers and the much greater voting rate of the 60% of the U.S. public who have health insurance and are reasonably satisfied with it than the tens of millions of us who don't have any insurance or are about to lose it), the only thing "on the table" has been something like what OCSteve describes.

Now, given that, the politics of how to get the best deal for the public, particularly the currently uninsured public, still seemed to me to call for a strong single-payer push -- so that the crappy incremental "choice" plan could be sold as a necessary compromise rather than put the public option out there as the leftward edge to be ground off during Congressional negotiating.

But the Obama-wired groups in the Health Care for America Now coalition didn't see it that way, choosing to see single-payer activism as a drain/distraction/threat rather than a useful political pole, so they've sat on their hands as the administration has frozen out single-payer from its staged hearings and "town halls".

Result: These are the real choices that are going to be before in Congress:

Option A: A public health insurance plan operated by the Federal government with a payment schedule that is set in statute and is based on Medicare.

Option B: A federal health insurance plan that is operated under contract from HHS but would play by the same rules as commercial health insurance carriers. The federal government would contract with an entity to administer the plan as well as provide start-up costs (e.g., 6 month reserve). The plan would be required: (1) to be a non-profit or cooperative entity (2) charge premiums at a level to cover costs of paying claims, making quality improvements, and administering the plan and (3) re-pay initial start-up costs. Every state gateway must offer the federal public plan. In addition, States would be permitted to operate their own public plan if the plan meets requirements established by the Secretary.

Option C: Drop public plan option.

It's pretty clear that the overwhelmingly likely outcome is B, with C as the next most likely. The "level playing field" is a b.s. term into which is built the assumption that that private profit rather than actual provision of health care is the fundamental principle on which the system should be based. Option A (the purported goal of HCAN, though its more wired elements are happy to settle for B) is actually going to be treated as some radical achievement.

The markup of the bill being considered in Kennedy's committee was to have happened today, despite there being no public text of the bill (what's quoted above is literally the closest thing that's been made public, though I'm sure lobbyist-approved text is circulating in the offices of committee members). This failure to publish flouts the Senate's new rule requiring legislative text subject to markup to be made public seven days before markup.

So I guess it's good news of a sort that the markup has been postponed (indefinitely and with no explanation). But only of a sort.

An administration that really wanted to deliver for its voters would be making its choices public and rallying its grassroots supporters behind them to put pressure on the legislators. This one wants to be seen to be trying to deliver while keeping its donor supporters happy.

OCSteve claims "we can't afford it".

Jes and others rightly scoff.

Sebastian has not weighed in on this precise point, but I suspect he would say yet again that we already spend more money than other nations do.

WE WOULD HAVE TO CUT BACK SPENDING TO ACHIEVE UNIVERSAL COVERAGE.

And that's a major reason why this debate is so fraught. The 14.7% of GDP that we spend on "health care" is INCOME to various people. It's income to hospital janitors, to health-insurance CEOs, even to actors in boner-pill commercials.

You can't spend money, not even on "health care", without buying things or hiring people. To "reduce costs" you have to buy fewer things and hire fewer people. In our corporation-based economy, where things are sold and people are hired at a profit, cost reduction means lower profits.

There's something about profits that inspires passions which mere wages cannot match. Hospital janitors trade time and effort for their wages. It's roughly an even trade. This is not true for investors in health insurance companies, pharmaceutical companies, or even the owners of janitorial-service companies. Their profits come in even while they spend their time and effort doing other things. Annoying as it may be to lose wages you have to work for, losing profits you don't have to work for feels infinitely more like a privation.

So, forget about "ideological" objections to reforming the system. The real objections come from people who have profits at risk. The ones who object most forcefully are the ones who have the biggest profits at risk. Those who raise "ideological" objections are merely (and probably unwittingly) carrying water for them.

--TP

Senator John Kyl: “The American people will not stand for rationed health care".

I would settle for rationed care, because I don't have any, like some forty some million other people. Renew my bee-sting kit? Maybe later. Get my trick ankle checked out? Someday.

Unoriginal, I know, but I'm convinced the only way real reform has a chance of passing is to strip all health insurance benefits from current, and future House and Senate members (and their families, if they are covered under the plans). Let them find out what it's like to experience the wonders of the free market.

"Actually, ddddave probably would like the respect that Gary has of the commentariat, but unfortunately, ddddave can't buy that from Gary, it has to be earned."

Hmm. Gary's Blogging Services today announces its expansion into the growing world of Blog Endorsements! For a modest fee which will rapidly pay back your investment many times over, Gary Farber will prostitute himself by endorsing you, the blog endorsee, and explaining why all and sundry should respect and admire you, the blog endorsee.

Farber's Blogger Endorsements will start out at Silver, Gold, and Platinum levels. See our rate sheets for detailed explanations of options in charges, terms of service, and services provided.

Remember, this service is currently on offer for a limited time only, so act now, while the Endorser's Word is still worth something! Send your money today!

(Offer void where prohibited, or the blogger is just too disgusted by the idea.)

I have a pen-and-paper journal kept in a tatty notebook. Can Farber's Blogger Endorsements do anything for me?

Every once in a while you run into an astroturf comment combating Obama's health plan; it provides good insight into what the likely tactics will be. Uniformly, the comments are something like, "Obama's plan completely eliminates private insurance and takes away your choice."

I suspect that this will work well for about a week before Obama utilizes his best quality and drops some knowledge on America. This is a guy who sold a tax increase (for the rich) to America for the first time in the post-Reagan era. Bush I and Clinton raised taxes to an extent, but ran on the premise of not doing it. Proposing to raise taxes for anyone was anathema in DLC/New Dem campaigns. If Obama managed that, I'm totally confident he'll cut through the bullshit and speak directly to America on this. And I don't think most people will be happy with being lied to by his opponents.

The comments to this entry are closed.

Blog powered by Typepad