There is no point in posting this in GD because people still refuse to learn why mandates are essential to any reform, so any type of nuanced discussion drops like a stone. I am not optimistic but there is a way that this bill, that I think is counterproductive in its current form, could be transformed into a great bill, even without the public option.
There is set of changes that have been talked about that if combined would bring all the benefits, even more, than a public option.
Condition One: The Medical Loss Ratio is set at 90% The CBO states that this would in effect create a government run health care. This would be rather revolutionary and dramatic but it wouldn't have any price control and in fact insurance companies would make more money through price escalation. Health care companies would now approve every request for every procedure in order to justify higher costs, bringing us to condition number two.
Condition Two: OPM would authorize plans along the lines of the FEHB. OPM is the Office of Personnel Management and is the basic Human Resource clearing house for all federal (including postal) employees. For federal employees the create a health interchange called FEHB where federal employees can, once a year during open season, pick any of the health plans. Currently Blue Cross, Concordia, Aetna, Kaiser are the providers. Their plans differ somewhat and each provider offers both single and family plans with low, medium and high options.
If the plan offered both of these conditions together it would be supperior to anything discussed to date including public option. The CBO said this:
http://wonkroom.thinkprogress.org/2009/12/14/cbo-90-mlr/A proposal to require health insurers to provide rebates to their enrollees to the extent that their medical loss ratios are less than 90 percent would effectively force insurers to achieve a high medical loss ratio. Combining this requirement with the other provisions of the PPACA would greatly restrict flexibility related to the sale and purchase of health insurance.
In CBO’s view, this further expansion of the federal government’s role in the health insurance market would make such insurance an essentially governmental program, so that all payments related to health insurance policies should be recorded as cash flows in the federal budget. The reason that I am not particularly hopeful is that no one seems to be talking about it. On the other hand it is possible that it has been agreed to let the traitor have is day in the sun and then make these revolutionary changes in the conference report.
I am wonder why great progressives in the Senate and the House that were so committed to the Public Option are not making a stronger objection to what now exists. Could it be that they have already read the script for the final act?
more detail here:
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x7259615
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