ObamaCare’s Hidden Trigger Paves The Way For Single Payer

[Burgman]

audio at link.
http://www.politicususa.com/en/obamacare-single-payer

When ObamaCare was passed conservatives slammed it as a government takeover of the health insurance industry and progressives complained the law didn’t offer at the least a public option, but it seems as though that the law had a hidden trigger that may very well pave the road to single payer health insurance system or Medicare for all. That trigger is the medical loss ratio. This is the part of the law that makes the health insurance industry use at least 85% of your premiums to cover medical expenses. This is something the for profit health insurance industry detests, because it limits the amount of dollars you pay into the system to go toward CEO pay, bonuses, lobbying and advertisements.

[Kennah]

1. Queen to Queen's level 3. Check.

[tridim]

3. +1^3

[Gregorian]

7. Eggsackly.

I do feel the chess metaphor is belittling. Yet also accurate.

Time will tell...

[Kennah]

10. Belittling to whom?

Politics is in many ways a game, but the stakes are much higher.

[TheWraith]

12. Exactly. There's a reason the science of strategy is called "game theory."

It means a lot more than just "silly fun and games."

[Gregorian]

14. The chess metaphor has been used both as admiration and as disbelief in Obama.

I personally have great faith in him. I haven't admitted that in public before. I may be proven foolish. Somehow I don't think so. Sometimes you can tell when someone is bright and honest.

[Kennah]

16. I too have great faith in Obama

I think some were using the chess metaphor derisively, but I believe the tide may now have turned.

As for the GOP hopefuls, the games they play range from checkers to Three Card Monte to Bullshit.

[izquierdista]

30. It's a great metaphor

Considering that the point of chess is to sacrifice all the pawns to protect the king, I'm sure Goldman Sachs would approve.

[gateley]

11. I recall reading a CIA novel in which it was stated that Russia played chess, able to plan ahead,

wait for us to make our move.

If this is indeed how Obama's playing, it's great. And so unlike us.

[Motown_Johnny]

18. rook to king's knight 4

[Scootaloo]

2. Anything that slaps the "Insurance Industry" in the face makes me smile

It's the only industry in the world that makes money by refusing to provide its advertised service. Fuck them.

[tabatha]

4. It was not so hidden.

I remember this being discussed quite a lot.

I am sure Rachel discussed it.

[Gregorian]

9. Similar threads were posted on DU2 a few weeks ago. It just feels new each time I read it.

Reassuring in a way.

[loudsue]

5. Which is why the corporations put so much money behind the tea party candidates in 2010, and why

the corporations are going to put even MORE money to any republican they can find in 2012. That provision, if not the whole thing, will be changed before it hurts too many 1%-ers. Mark my words.

[limpyhobbler]

6. cool

It sounds like the 85% rule is awesome.

I don't think it's part of a secret plan to put private insurers out of business.

But they will need to find a away to live with smaller profits, smaller executive pay, lower legal fees, etc.

My guess is they will find a way to adjust to the new rules, and not go out of business.

Democrats should run for office with a platform of proudly Socializing health care. That would win elections.

Too bad there's nobody pouring millions of dollars into the campaign coffers behind that goal.
All the industry money is on the other side.

[Quantess]

13. great!

[dkf]

15. Why does this pave the way for single payer?

[bhikkhu]

17. Perhaps its indirect, but the massive profits must be squeezed out of the equation

before there is any chance the health insurance industry will give up their share.

As an aside, this brings us closer to Germany's health care arrangement, which is universal multi-payer, and gets pretty high ratings. http://en.wikipedia.org/wiki/Universal_health_care . I think single-payer is probably the simplest and fairest, but there are plenty of other ways to do it that are much better than our own.

Its a rare step in the right direction, definitely.

[joshcryer]

25. This is why the public option was oh so important, however, it's only a matter of time...

...before states adopt their own public options, as the for-profit insurers won't be able to make as much money.

[Motown_Johnny]

19. The problem with this is that there is no way to limit medical costs

or premiums.


All this will do is force them to charge more and to throw more money at more expensive treatments even if the patients don't need them.



My one last hope for a path toward single payer is that the mandate is overturned as a stand alone clause.

If this happens the insurance companies are going to throw a fit. The clause which forces them to provide coverage for people with pre-existing conditions will still be in place so people could wait until they are sick to buy insurance. THIS is what will eat into their profits and will force some type of a deal to be struck

I don't see the medical loss ratio doing this, they are already working on having things classified as treatment related which are not. I think they will find their way around this fairly easily.

[mmonk]

20. PNHP response:

“Limiting overhead to 15%-20% is far from the stringent regulation that Ungar implies. Private insurers’ overhead currently averages about 14% nationwide, and they will probably be able to reclassify some items currently classified as overhead into the patient care expense category (despite regulations that attempt to stop this). Moreover, some current sales expenses will be offloaded to the insurance exchanges, which are likely to have overhead of 3-4%, and the exchanges’ expenses will not count as part of insurers’ overhead. Finally, ACOs will take over many of insurers’ administrative tasks and expenses, but these ACO overhead expenditures will not count toward the 15%-20% overhead limit. In sum, total insurance overhead (and profit) is likely to grow, not fall in the years ahead.”


http://pnhp.org/blog/2011/12/12/pnhp-response-to-rick-ungars-obamacare-bomb/

[joshcryer]

24. Ungar doesn't address the fact that the MLR will kill smaller insurers who have much higher MLR...

...and forcing the insured in those companies to go to larger group pools which have a low MLR. If the insurers try to offload sales expenses into the exchange expenses, then HHS will get involved, because they already said sales expenses must be accounted for, you can't just shuffle things around if an administration is watching closely.

Meanwhile the exchanges will dwindle as the smaller insurers move to group pools and the overall expenses for those exchanges will go lower still.

[eridani]

21. Only when it melts down completely

There are no meaningful cost controls.

[joshcryer]

22. MLR and mandates = single payer.

The mandates shouldn't be overlooked, because single payer requires mandates.

[TheKentuckian]

28. A common feature cannot be conflated with being the same.

A mandate is not a mandate and the structure of the mandate will dictate many of its results.

This is not a tax but a requirement that most Americans purchase a for profit product, sold on the market at the discretion and through their employers. The mandate is not for a tax with equal benefits, nor is it a requirement to pay into a seperate system. It isn't a requirement to even pay into the same pool.

This plan from its inception is to strengthen and insure the profit stream of the insurance cartel, nothing more. This has been hatching for decaded knowing the trouble the industry faced with so many boomers headed for Medicare, the young being less able and motivated to participate, and the industry suicidally pricing the population out of its service.

The "reform" has less potential to evolve into single payer than what we had before because the cartel has a captive base and a key to the treasury, their profits are assured. At least before their greed could collapse upon its self, now Uncle Sam has removed a couple of the industry's biggest wea spot, now to cut away the healthiest portion of seniors from Medicare and they will be in shape as far as the mind's eye can project and essentially protected by the government as gatekeeper.

[Quantess]

23. sounds promising.

[TheKentuckian]

26. There is no reason to believe any such things. The MLR is set where the industry is and

it is likely, not just possible but actually likely that the scheme will cause higher systemic costs over time. The easiest path to uncontestable, legal, while being 100% compliant is to just increase allowables.

The industry wrote the bill, there is nothing in it that is dangerous to them, not without it being balanced elsewhere and anything they didn't get Baucus to include off the bat is probably hidden in the over a hundred amendments the the TeaPubliKlans got included (without any voted, by the way).

If you think the TeaPubliKlans have a hundred good ideas, you are probably in the wrong spot.

[Vinca]

27. Sadly, the only way this bill might have turned into single payer was if there was a public option.

People would have gravitated to it because it was more affordable until it overtook the insurance criminals. The 85% sounds wonderful on paper, but big insurance probably has teams of people working to figure out how they can call the CEO's gold toilet fixtures a medical expense. At this point, I'm thinking if the Supremes toss the health care bill (not a surprise given the makeup of the court), Obama will make a hard left turn in the campaign and go full tilt for bona fide single payer. That's what the people want.

[Saving Hawaii]

29. The economics of a public option were all wrong and it would've failed badly.

Set up an altruistic player that suffers from 95% of the same flaws that the rest of the system does and its gonna get murdered by its competition. Doesn't matter if it's not collecting a profit or trying to be rude. It attracts the wrong clientele (i.e. the people with health problems who say "this won't screw me over&quot , ends up with prices that are above market average (compared to a lot of insurance companies that strategically advertise to healthy clients), and eventually ends up in a vicious cycle as the healthy clients ditch it for cheaper alternatives. I'm a big fan of single payer but the public option would've just given the for-profit crowd ammo... it would've imploded and left a big "public option failed miserably and you want to give them the whole insurance system" stick to wave around.