Bait and Switch, How the Public Option was sold,

[maryf]

http://www.pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%e2%80%9cpublic-option%e2%80%9d-was-sold/

Bait and switch: How the “public option” was sold
by Kip Sullivan

The people who brought us the “public option” began their campaign promising one thing but now promote something entirely different. To make matters worse, they have not told the public they have backpedalled. The campaign for the “public option” resembles the classic bait-and-switch scam: tell your customers you’ve got one thing for sale when in fact you’re selling something very different.

When the “public option” campaign began, its leaders promoted a huge “Medicare-like” program that would enroll about 130 million people. Such a program would dwarf even Medicare, which, with its 45 million enrollees, is the nation’s largest health insurer, public or private. But today “public option” advocates sing the praises of tiny “public options” contained in congressional legislation sponsored by leading Democrats that bear no resemblance to the original model.

According to the Congressional Budget Office, the “public options” described in the Democrats’ legislation might enroll 10 million people and will have virtually no effect on health care costs, which means the “public options” cannot, by themselves, have any effect on the number of uninsured. But the leaders of the “public option” movement haven’t told the public they have abandoned their original vision. It’s high time they did.

The bait

“Public option” refers to a proposal, as Timothy Noah put it, “dreamed up” by Jacob Hacker when Hacker was still a graduate student working on a degree in political science. In two papers, one published in 2001 and the second in 2007, Hacker, now a professor of political science at Berkeley, proposed that Congress create an enormous “Medicare-like” program that would sell health insurance to the non-elderly in competition with the 1,000 to 1,500 health insurance companies that sell insurance today.

Hacker claimed the program, which he called “Medicare Plus” in 2001 and “Health Care for America Plan” in 2007, would enjoy the advantages that make Medicare so efficient – large size, low provider payment rates and low overhead. (Medicare is the nation’s largest health insurance program, public or private. It pays doctors and hospitals about 20 percent less than the insurance industry does, and its administrative costs account for only 2 percent of its expenditures compared with 20 percent for the insurance industry.)

Hacker predicted that his proposed public program would so closely resemble Medicare that it would be able to set its premiums far below those of other insurance companies and enroll at least half the non-elderly population. These predictions were confirmed by the Lewin Group, a very mainstream consulting firm. In its report on Hacker’s 2001 paper, Lewin concluded Hacker’s “Medicare Plus” program would enroll 113 million people (46 percent of the non-elderly) and cut the number of uninsured to 5 million. In its report on Hacker’s 2007 paper, Lewin concluded Hacker’s “Health Care for America Plan” would enroll 129 million people (50 percent of the nonelderly population) and cut the uninsured to 2 million.

Until last year, Hacker and his allies were not the least bit shy about highlighting the enormous size of Hacker’s proposed public program. For example, in his 2001 paper Hacker stated:


Quote
pproximately 50 to 70 percent of the non-elderly population would be enrolled in Medicare Plus…. Put more simply, the plan would be very large…. ritics will resurface whatever the size of the public plan. But this is an area where an intuitive and widely held notion – that displacement of employment-based coverage should be avoided at all costs – is fundamentally at odds with good public policy. A large public plan should be embraced, not avoided. It is, in fact, key to fulfilling the goals of this proposal. (page 17)

In his 2007 paper, Hacker stated:


Quote
For millions of Americans who are now uninsured or lack … affordable work place coverage, the Health Care for America Plan would be an extremely attractive option. Through it, roughly half of non-elderly Americans would have access to a good public insurance plan…. A single national insurance pool covering nearly half the population would create huge administrative efficiencies. (page 5)

Hacker’s papers and the Lewin Group’s analyses of them have been cited by numerous “public option” advocates. For example, when Hacker released his 2007 paper, Campaign for America’s Future (CAF) published a press release praising it and drawing attention to the large size of Hacker’s proposed public program. The release, entitled “Activists and experts hail Health Care for America plan,” stated:


Quote
Detailed micro-simulation estimates suggest that roughly half of non-elderly Americans would remain in workplace health insurance, with the other half enrolled in Health Care for America…. A single national insurance pool covering nearly half the population would create huge administrative efficiencies…. Because Medicare and Health Care for America would bargain jointly for lower prices …, they would have enormous combined leverage to hold down costs.

When the Lewin Group released its 2008 analysis of Hacker’s 2007 paper, CAF’s Roger Hickey wrote in the Huffington Post, “efficiencies achievable … through Hacker’s public health insurance program” would save so much money that the US could “cover everyone” for no more than we spend now.

The switch

Now let’s compare the “single national health insurance pool covering nearly half the population” that Hacker and other “public option” advocates enthusiastically championed with the “public option” proposed by Democrats in Congress, and then let’s inquire what Hacker and company said about it.

As readers of this blog no doubt know, the Senate Health, Education, Labor, and Pensions (HELP) Committee, and three House committee chairman working jointly, published draft health care “reform” bills in June. (The third committee with bill-writing authority, the Senate Finance Committee, has yet to produce a bill.) According to the Congressional Budget Office, the “public option” proposed in the House “tri-committee” bill might insure 10 million people and would leave 16 to 17 million people uninsured. The “public option” proposed by the Senate HELP committee, again according to the Congressional Budget Office, is unlikely to insure anyone and would hence leave 33 to 34 million uninsured. The CBO said its estimate of 10 million for the House bill was highly uncertain, which is not surprising given how vaguely the House legislation describes the “public option.”

Here is what the CBO had to say about the HELP committee bill:


Quote
The new draft also includes provisions regarding a “public plan,” but those provisions did not have a substantial effect on the cost or enrollment projections, largely because the public plan would pay providers of health care at rates comparable to privately negotiated rates – and thus was not projected to have premiums lower than those charged by private insurance plans. (page 3)

Obviously the “public option” in the Senate HELP committee bill (zero enrollees; 17 million people left uninsured) and the “public option” in the House bill (10 million enrollees (maybe!); 34 million people left uninsured) are a far cry from the “public option” originally proposed by Professor Hacker (129 million enrollees; 2 million people left uninsured). Have we heard the Democrats in Congress who drafted these provisions utter a word about how different their “public options” are from the large Medicare-like program that Hacker proposed and his allies publicized? What have Professor Hacker and his allies had to say?

In public comments about the Democrats’ “public option” provisions, the leading lights of the “public option” movement imply that Hacker’s model is what Congress is debating. Sometimes they come right out and praise the Democrats’ version as “robust” and “strong.” But I cannot find a single example of a a statement by a “public option” advocate warning the public of the vast difference between Hacker’s original elephantine, “Medicare-like” program and the Democrats’ mouse version.

For example, on June 23, Hacker testified before the House Education and Labor Committee that “the draft legislation prepared by special tri-committee promises enormous progress.” He went on to enumerate all the benefits of a “public option.” Yet the House tri-committee proposal bore no resemblance to the public plan he described in his papers and that the Lewin Group analyzed. Later, when Kaiser Health News asked Hacker in a July 6 interview why “your signature idea – a public plan – has become central to the health care reform debate,” Hacker again praised his “public plan” proposal and offered no hint that the “public option” so “central to the debate” was very different from the one he originally proposed.

Ditto for Hacker’s allies. Representatives of Health Care for America Now (HCAN), the organization most responsible for popularizing the “public option,” repeatedly describe the House and Senate HELP committee bills as “strong” or “robust,” always without any justification for this claim, and have repeatedly failed to warn the public that the “public options” they promote today are mere shadows of the “public options” they endorsed in the past. On July 15, the day the HELP committee passed its bill, Jason Rosenbaum blogged for HCAN:


Quote
The Senate HELP Committee has just referred a bill to the floor of the Senate with a strong public option.

Searching the websites of the organizations that serve on HCAN’s steering committee – AFSCME, Democracy for America, Moveon.org and SEIU, for example – one will find not a shred of information that would help the reader comprehend how small and ineffective the “public options” proposed in the Democrats’ bills are, nor how different these are from the one Hacker originally proposed. Yet these groups continue to urge their members and the public to “tell Congress to support a public option.”

Hacker’s original model compared with the Democrats’ mouse model

It has become fashionable among advocates of a “public option” to trash the expertise and the motives of the Congressional Budget Office. But the CBO’s characterization of the “public option” proposed in the Democrats’ legislation is entirely reasonable. This becomes apparent the moment we compare Hacker’s blueprint for his original “Medicare Plus” and “Health Care for America” programs with the “blueprints” (if tabula rasas can be called “blueprints”) contained in the Senate HELP Committee and House bills.

Hacker’s papers laid out these five criteria that he and the Lewin Group said were critical to the success of the “public option”:

• The PO had to be pre-populated with tens of millions of people, that is, it had to begin like Medicare did representing a large pool of people the day it commenced operations (Hacker proposed shifting all or most uninsured people as well as Medicaid and SCHIP enrollees into his public program);
• Subsidies to individuals to buy insurance would be substantial, and only PO enrollees could get subsidies (people who chose to buy insurance from insurance companies could not get subsidies);
• The PO and its subsidies had to be available to all nonelderly Americans (not just the uninsured and employees of small employers);
• The PO had to be given authority to use Medicare’s provider reimbursement rates; and
• The insurance industry had to be required to offer the same minimum level of benefits the PO had to offer.

Hacker predicted, and both of the Lewin Group reports concluded, that if these specifications were met Hacker’s plan would enjoy all three of Medicare’s advantages – it would be huge, it would have low overhead costs, and it would pay providers less than the insurance industry did. As a result, the “public option” would be able to set its premiums below those of the insurance industry and seize nearly half the non-elderly market from the insurance industry. According to the Lewin Group’s 2008 report, Hacker’s version of the “public option” would, as of 2007:

• Enroll 129 million enrollees (or 50 percent of the non-elderly);
• Have overhead costs equal to 3 percent of expenditures;
• Pay hospitals 26 percent less and doctors 17 percent less than the insurance industry (but these discounts would be offset to some degree by increases in payments to providers treating former Medicaid enrollees); and,
• Set its premiums 23 below those of the average insurance company.

I question some of Hacker’s and the Lewin Group’s assumptions, including their assumption that any public program that has to sell health insurance in competition with insurance companies could keep its overhead costs anywhere near those of Medicare (Medicare is a single-payer program that has no competition), especially during the early years when the public program will be scrambling to sign up enrollees. A public program will have to hire a sales force and advertise. It will have to open offices. It will have to negotiate rates, and perhaps contracts, with thousands of hospitals and hundreds of thousands of clinics, chemical treatment facilities, rehab units, home health agencies, etc. Or it will have to contract with someone to do all that. But I have little doubt that if a public program were to open with a large enough customer base, and it had the advantage of a law requiring that only its customers receive substantial subsidies, it could do what the Lewin Group said it could do.

Now let us compare Hacker’s original model with the mousey “public options” proposed by the Senate HELP Committee and the House. Of Hacker’s five criteria, only one is met by these bills! Both proposals require the insurance industry to cover the same benefits the “public option” must cover. None of the other four criteria are met. The “public option” is not pre-populated, the subsidies to employers and to individuals go to the “public option” and the insurance industry, employees of large employers cannot buy insurance from the “public option” in the first few years after the plan opens for business and maybe never (that decision will be made by whoever is President around 2015), and the “public option” is not authorized to use Medicare’s provider payment rates. (The House bill comes the closest to authorizing use of Medicare’s rates; it authorizes Medicare’s rates plus 5 percent).

Is it any wonder the CBO concluded the Democrats’ “public option” will be a tiny little creature incapable of doing much of anything? More curious is that CBO gave the House “public option” any credit at all (you will recall CBO said it would enroll maybe 10 million people). The CBO should have asked, Can the “public option” - as presented in either bill - survive?

Put yourself in the “public option” director’s shoes

To see why the “public option” proposed by congressional Democrats remains at great risk of stillbirth, let’s engage in a frustrating thought experiment. Let’s imagine Congress has enacted the House version (it is not quite as weak as the HELP Committee model and thus gives us the greatest opportunity in our thought experiment to imagine a scenario in which the “public option” actually survives its start-up phase). Let us imagine furthermore that you have been foolish enough to apply for the job of executive director of the new “public option,” and the Secretary of the Department of Health and Human Services (the federal agency within which the program will be housed) decided to hire you. It’s your first day on the job.

You know the House bill did not create a ready-made pool of enrollees for you to work with the way the 1965 Medicare law created a ready-made pool of seniors prior to the day Medicare commenced operations. You realize, in other words, that you represent not a single soul, much less tens of millions of enrollees. You will have to build a pool of enrollees from scratch. You also know the House bill authorized some start-up money for you, so you’ll be able to hire some staff, including sales people if you choose. You can also open offices around the country, and advertise if you think it necessary. But you know you can’t pay out too much money getting the “public option” started because the House bill requires that you pay back whatever start-up costs you incur within ten years. In other words, you may hire enough people and open enough offices and buy enough advertising to create a critical mass of enrollees nationwide, but you must do it quickly so that your start-up costs don’t sink the “public option” during its first decade.

The only other feature in the House bill that appears to give you any advantage over the insurance industry is the provision requiring you to use Medicare’s rates plus 5 percent, which essentially means you are authorized to pay providers 15 percent less than the insurance industry pays on average. But the House bill also says providers are free to refuse to participate in the plan you run.

So what do you do? Let’s say you open offices in dozens or hundreds of cities, you hire a sales force to fan out across the country to sign up customers, you advertise on radio and TV to get potential customers (employers and individuals) to call your new sales force to inquire about the new “public option” insurance policy. What happens when potential customers ask your salespeople two obvious questions: what will the premium be and which doctors they can see? What do your employees say? They can’t say anything. They haven’t talked to any clinics or hospitals about participating at the 15-percent-below-industry-average payment rate, so they have no idea which providers if any will agree to participate. They also have no idea what the “public option” premium will be because they don’t know whether providers will accept the low rates the plan is authorized to pay. And they have no idea about several other factors that will affect the premiums, including how much overhead the “public option” will rack up before it reaches a state of viability, or who the “public option” will be insuring – healthy people, sick people, or people of average health status.

So, let’s say you redeploy your sales force. Now instead of talking to potential customers, you direct them to focus on providers first. But when your salespeople call on doctors and hospital administrators and ask them if they’ll agree to take enrollees at below-average payment rates, providers ask how many people the “public option” will enroll in their area. Providers explain to your salespeople that they are already giving huge discounts, some as high as 30 to 40 percent off their customary charge, to the largest insurers in their area and they are not eager to do that for the “public option” unless the plan will have such a large share of the market in their area that it will deliver many patients to them. If the “public option” cannot do that, providers tell your salespeople, they will not agree to accept below-average payment rates.

In other words, you find that the “public option” is at the mercy of the private insurance market, not the other way around.

This thought experiment illustrates for you the mind-numbing chicken-and-egg problem created by any “public option” project that does not meet Hacker’s criteria, most notably, the criterion requiring pre-population of the “public option.” If the pre-population criterion isn’t met, the poor chump who has to create the “public option” is essentially being asked to solve a problem that is as difficult as describing the sound of one hand clapping. You need both hands to clap.

How did the mouse replace the elephant?

How did the “Medicare Plus” proposal of 2001 (when Hacker first proposed it) get transformed into the tiny “public options” contained in the Democrats’ 2009 legislation? The answer is that somewhere along the line it became obvious that the Hacker model was too difficult to enact and had to be stripped down to something more mouse-like in order to pass. Did the leading “public option” advocates realize this early in the campaign? Or midway through the campaign when the insurance industry began to attack the “public option”? Or late in the campaign when they found it difficult to persuade members of Congress to support Hacker’s original model? Whatever the answer, will they find it in their hearts to tell their followers their original strategy was wrong?

I suspect the answer is different for different actors within the “public option” movement. Hacker surely knew what was in his original proposal and surely knows now that the Democrats’ bills don’t reflect his original proposal. Hacker and others familiar with his original proposal were probably betrayed by the process. As the “public option” concept became famous and edged its way toward the centers of power, they couldn’t find the courage to resist the transformation of the original proposal into the mouse model.

For other actors within the “public option” movement, ignorance of Hacker’s original proposal and of health policy in general may have led them to rely on more knowledgeable leaders in the movement. Their error, in other words, was to trust the wrong people and, as the “public option” came under attack, to cave in to group think. This error was facilitated by the “public option” movement’s decision to avoid mentioning any details of the “public option” whenever possible.

What next?

Those of us in the American single-payer movement must continue to educate Congress and the public on the need for a single-payer system. We must also convince advocates of the “public option” that they have made two serious mistakes and, if they learn quickly from these mistakes, that real reform is still possible.

The first mistake was to think that a “public option” that merely took over a large chunk of the non-elderly market (as opposed to one that took over the entire market) could substantially reduce health care costs and thereby make universal coverage politically feasible. Any proposal that leaves in place a multiple-payer system — even a multiple-payer system with a large government-run program in the middle of it — is going to save very little money. Even if Hacker’s original Health Care for America Plan had taken over half the non-elderly market and then reached homeostasis (something Hacker swore up and down it would do), the savings would have been relatively small. The reason for that is twofold. First, any insurance program, public or private, that has to compete with other insurers is going to have overhead costs substantially higher than Medicare’s. (It is precisely because Medicare is a single-payer program that its overhead costs are low.) Second, the multiple-payer system Hacker would leave in place would continue to impose unnecessarily large overhead costs on providers.

The second mistake the “public option” movement made was to think the insurance industry and the right wing would treat a “public option” more gently than a single-payer. Conservatives have a long history of treating small incremental proposals such as “comparative effectiveness research” as the equivalent of “a government takeover of the health care system.” It should have been no surprise to anyone that conservatives would shriek “socialism!” at the sight of the “public option,” even the mouse model proposed by the Democrats.

The bait-and-switch strategy adopted by the “public option” movement has put the Democrats in a terrible quandary. Seduced by the false advertising about the potency of the “public option” to lower costs, Democrats have raised public expectations for reform to unprecedented levels. Failing to meet those expectations during the 2009 session of Congress, which is inevitable if the Democrats continue to promote legislation like the bills released in June, is going to have unpleasant consequences. Is there no way out of this quandary?

Conventional wisdom holds that if the Democrats don’t pass a health care reform bill by December, they will have to wait till 2013 to try again. But if the “public option” movement were to join forces with the single-payer movement, the two movements could prove the conventional wisdom wrong. This won’t happen, obviously, if the “public option” movement fails to perceive the reasons it failed.

It is conceivable the “public option” movement could decide the bait-and-switch strategy was wrong and that their only error was not to stick with Hacker’s original model. It should be obvious now that that would also be a tactical blunder. We have plenty of evidence now that conservatives will react to the mousey version of the “public option” as if it were “a stalking horse for single-payer.” We can predict with complete certainty they will treat Hacker’s original version as something even closer to single-payer. If a proposal is going to be abused as if it were single-payer, why not actually propose a single-payer? At least then, when a particular session of Congress comes and goes and we haven’t enacted a single-payer system, we will have educated the public about the benefits of a single-payer and have further strengthened the single-payer movement.

To sum up, “public option” advocates must choose between continuing to promote the “public option” and seeing their hopes for cost containment and universal coverage go up in smoke for another four years, and throwing their considerable influence behind single-payer legislation. At this late date in the 2009 session, it is unlikely that a single-payer bill could be passed even if unity within the universal coverage movement could be achieved. But if the “public option” wing and the single-payer wing join together to demand that Congress enact a single-payer system, December 2009 need not constitute a deadline.

Kip Sullivan belongs to the steering committee of the Minnesota chapter of Physicians for a National Health Program.

[Hydra]

1. K&R for later reading

But from what I've read so far, it's the rat I thought I smelled.

[maryf]

4. Thanks!

sadly, I think you thought right!

[bjobotts]

156. Should have condensed this lengthy but extremely important article

[bjobotts]

157. It's what I feared most.They couldn't get rid of the 'public option' so they corrupted it and

[bjobotts]

158. doomed it to failure trying to make sure it would never work...no reform at all.

[bjobotts]

159. All they had to do was expand Medicare for all and we'd end up paying 10% of what we now pay

[bjobotts]

160. What is taking so long in the congress is figuring a way to make sure a pulbic option won't work

[bjobotts]

161. Fighting in all directions Obama is battling an army of millionaire lobbyists and their pet senators

[maryf]

185. Thanks for all the excerpts! nt

[dolphindance]

2. Too long and obviously bashing the President. Unrec. (n/t)

[maryf]

3. Not fair...

You obviously did not read...

[Hydra]

5. Remember, when it's not what they want to see

It's "Bashing the President"

[maryf]

6. Another sad but true point you've made!!

Thanks again!

[dgibby]

29. Giving the unrec option to some folks is like giving your car keys to a toddler.

Excellent article. Thanks for posting. K&R!

[maryf]

85. Good reason for "unrec" insurance!

Thanks!

[Amos Moses]

130. We don't need all those details.

It makes our little heads hurt! :silly:

[Regret My New Name]

7. ...

[maryf]

13. Obama isn't mentioned once!! read more carefully! or at all! nt

[Kid Dynamite]

14. I highly recommend that you read the thread

and give it due consideration

I believe that reckless use of Unrecommendations is frowned upon, and here you state explicitly that you have frivolously done so. The focus of the article is not the President.

[maryf]

16. Thank you KD!

and welcome to DU!!:hi:

[Skittles]

21. you are kidding, right?

I truly fucking hope so

[TBF]

25. Your criticism is "too long"? I bet you make it through pages of sports scores

and all your investment pages.

Head in the sand.

[SammyWinstonJack]

27. REC.

:-)

[blindpig]

37. I imagine you'd prefer a 'twitter'

Maybe more suited to your attention span?

[harun]

39. Someone post a summary.

[glinda]

133. No kidding!

[Political Heretic]

53. The Dumb in strong in this one.

:eyes:

[TheWatcher]

116. "I'm clinging to my false paradigm like an infant clings to it's favorite toy, and you've posted

stuff that threatens it, so I am going to kick and scream and say it doesn't exist, because it doesn't make me feel good."

[ProudDad]

117. Too long????

:eyes: :eyes: :eyes:

[WilliamPitt]

122. (facepalm)

[LWolf]

126. "too long" = reading and thinking is "hard work."

"obviously critical of the president" from someone who thinks it's too long to read...:dunce:

Of course, deciding that anything critical of the president, substantive or not, is worth an "unrec" puts DU in the position of fan club, and the president in the position of saint.

[Donnachaidh]

132. perhaps if someone read it TO you, you'd see there was no bashing.

when does Mom do the laundry tomorrow? :sarcasm:

[waiting for hope]

144. Snort ...

The basement will have to be vacated while the laundry is being done ... then where will s/he go?

[glitch]

134. Well, I got it, and I thought it was funny. But your really should include a :sarcasm: tag

it makes jokes much clearer. Welcome to DU!

[bjobotts]

162. You're either an idiot or a troll.What bashing the president?That's what U got out of it?

[bjobotts]

164. Obvilusly didn't understand the article.He's showing you how they are changing the public option

[slipslidingaway]

8. Excellent....everyone should read and think about some of the

questions in this article.

snip>>

"...Put yourself in the “public option” director’s shoes

To see why the “public option” proposed by congressional Democrats remains at great risk of stillbirth, let’s engage in a frustrating thought experiment. Let’s imagine Congress has enacted the House version (it is not quite as weak as the HELP Committee model and thus gives us the greatest opportunity in our thought experiment to imagine a scenario in which the “public option” actually survives its start-up phase). Let us imagine furthermore that you have been foolish enough to apply for the job of executive director of the new “public option,” and the Secretary of the Department of Health and Human Services (the federal agency within which the program will be housed) decided to hire you. It’s your first day on the job.

You know the House bill did not create a ready-made pool of enrollees for you to work with the way the 1965 Medicare law created a ready-made pool of seniors prior to the day Medicare commenced operations. You realize, in other words, that you represent not a single soul, much less tens of millions of enrollees. You will have to build a pool of enrollees from scratch. You also know the House bill authorized some start-up money for you, so you’ll be able to hire some staff, including sales people if you choose. You can also open offices around the country, and advertise if you think it necessary. But you know you can’t pay out too much money getting the “public option” started because the House bill requires that you pay back whatever start-up costs you incur within ten years. In other words, you may hire enough people and open enough offices and buy enough advertising to create a critical mass of enrollees nationwide, but you must do it quickly so that your start-up costs don’t sink the “public option” during its first decade.

The only other feature in the House bill that appears to give you any advantage over the insurance industry is the provision requiring you to use Medicare’s rates plus 5 percent, which essentially means you are authorized to pay providers 15 percent less than the insurance industry pays on average. But the House bill also says providers are free to refuse to participate in the plan you run.

So what do you do? Let’s say you open offices in dozens or hundreds of cities, you hire a sales force to fan out across the country to sign up customers, you advertise on radio and TV to get potential customers (employers and individuals) to call your new sales force to inquire about the new “public option” insurance policy. What happens when potential customers ask your salespeople two obvious questions: what will the premium be and which doctors they can see? What do your employees say? They can’t say anything. They haven’t talked to any clinics or hospitals about participating at the 15-percent-below-industry-average payment rate, so they have no idea which providers if any will agree to participate. They also have no idea what the “public option” premium will be because they don’t know whether providers will accept the low rates the plan is authorized to pay. And they have no idea about several other factors that will affect the premiums, including how much overhead the “public option” will rack up before it reaches a state of viability, or who the “public option” will be insuring – healthy people, sick people, or people of average health status.

So, let’s say you redeploy your sales force. Now instead of talking to potential customers, you direct them to focus on providers first. But when your salespeople call on doctors and hospital administrators and ask them if they’ll agree to take enrollees at below-average payment rates, providers ask how many people the “public option” will enroll in their area. Providers explain to your salespeople that they are already giving huge discounts, some as high as 30 to 40 percent off their customary charge, to the largest insurers in their area and they are not eager to do that for the “public option” unless the plan will have such a large share of the market in their area that it will deliver many patients to them. If the “public option” cannot do that, providers tell your salespeople, they will not agree to accept below-average payment rates.

In other words, you find that the “public option” is at the mercy of the private insurance market, not the other way around.

This thought experiment illustrates for you the mind-numbing chicken-and-egg problem created by any “public option” project that does not meet Hacker’s criteria, most notably, the criterion requiring pre-population of the “public option.” If the pre-population criterion isn’t met, the poor chump who has to create the “public option” is essentially being asked to solve a problem that is as difficult as describing the sound of one hand clapping. You need both hands to clap..."

[maryf]

10. Thank you!! Maybe some will catch something they missed with your post!

Perhaps I should have broken this down into easier bites!

[slipslidingaway]

12. Probably not, but i do hope some take the time to read it instead

of saying it is too long.

You're welcome...my pleasure.

:hi:

[maryf]

15. Or at least a little bit before they unrec!

:yourock:

[slipslidingaway]

19. Another snip>>>>>>>>>

"...When the “public option” campaign began, its leaders promoted a huge “Medicare-like” program that would enroll about 130 million people. Such a program would dwarf even Medicare, which, with its 45 million enrollees, is the nation’s largest health insurer, public or private. But today “public option” advocates sing the praises of tiny “public options” contained in congressional legislation sponsored by leading Democrats that bear no resemblance to the original model.

According to the Congressional Budget Office, the “public options” described in the Democrats’ legislation might enroll 10 million people and will have virtually no effect on health care costs, which means the “public options” cannot, by themselves, have any effect on the number of uninsured. But the leaders of the “public option” movement haven’t told the public they have abandoned their original vision. It’s high time they did..."


And a little more :)

[maryf]

38. One of the best sections to snip!!

Thanks again! :)

[lumberjack_jeff]

80. It's a thought experiment which misses some crucial points

a) At a minimum, the doctors who currently take medicaid and medicare will almost certainly take public option patients. Why wouldn't they? It's a 5% pay raise from what they're used to getting.
b) there is a 3 year lag between starting operations and taking customers. The premiums are a pretty straightforward calculation, and there is no reason to believe that those who choose the public plan from the exchange's menu are demographically any different than those who choose a private plan. In year 1, set the premiums at 90% of regional average and adjust in following years.
c) Given that the plan only has to demonstrate self-sustenance within a decade, the big worry is how the plan sets premiums in the first year? Really?
d) Providers don't discount customary prices to insurers, they mark up services to the uninsured. The customary price is the one they usually get. The ludicrously outrageously high price to the uninsured is simply a mechanism to negotiate down to outrageous for the insurance companies.

I love how this guy talks out of both sides of his mouth. "This dinky public option plan sucks because it doesn't force providers to take 20% less, but... providers won't take this plan even though it pays 5% more than medicare."

By trying to get the public to hold out for alchemy and the magic wand solution, I think he's simply trying to torpedo any reform at all.

[John Q. Citizen]

123. You apparently missed the part where the original plan makes some assumptions

When those assumptions are abandoned then you can't expect the plan to work like the analysis said that it would.

Medicare gets 25 percent off because they are the largest insurer in the country.

I'm not sure of your background in health insurance systems, lumberjack_jeff, but i met Kip back in 1992 in MN when I was working on health care reform. He's been at this for a very long time and he was a trained expert in the field back then.

Do you have any expertise in health insurance? What do you base your statement that "the the premiums are a straight forward calculation?" How do you know that? Are you guessing? Or do you work in the insurance business?

Why did Medicare start with a massive client base instead of from scratch do you suppose?

[slipslidingaway]

9. Think I was rec #2 - before the unrecs :( n/t

[maryf]

11. Thanks anyway! they keep appearing and disappearing!nt.

[slipslidingaway]

17. Back to positive +1 :) n/t

[maryf]

40. up to +23 this morning

and it wouldn't have happened without your support! :yourock:

[slipslidingaway]

48. +29...

glad this made it past five.

:blush:

[upi402]

18. I figured as much, I never had lots of hope for change from this gang either

The lunatics are not driving the bus now, so that's good. But corporate dems are still corporatists, and not going to help the working fools stupid enough to buy what they're selling.

Kucinich was the hope. But he wasn't allowed into the debates for nomination... for some reason. hmmm

[Kid Dynamite]

28. We weren't even invited to the debate

let alone allowed in

[maryf]

30. and arrested when we came!

[GreenPartyVoter]

63. Yep :^(

[leftstreet]

20. K&R

Thanks for posting this

[smoochpooch]

22. Real health care reform = Dems control Congress for the next 50 yrs.....

But, if reform ends up being the b.s. currently being considered, Dems will lose seats in 2010, no doubt about it. What exactly will candidates be running on? "Thanks to the health care reform we passed, all of you who have shitty insurance through your employer have been forced to keep it. Costs and premiums have not been decreased by a single cent. Reelect me!"

My grandparents voted Democratic for over 60 years because Dems gave them Social Security and Medicare. That's why Rethugs will do anything to derail reform, not because of deficits or cost, but because they know they'll lose scores of voters. If there's not real change, voters will say, "Well, the Dems didn't fix anything so might as well try the Rethugs, see if they can do something."

We will not gain more seats in 2010 unless we have dramatic change now. No reasonable person can think that we will ever have more seats in Congress than we have right now. I can't help but think that although we have super majorities, this Congress isn't really going to change anything and even though the Rethugs are supposedly dead, we are gonna hand things back to them on a silver fucking platter. This is what will happen.

[FormerDittoHead]

35. They sure as hell won't be getting any more MONEY from me, THAT'S for sure.

That would be good money after BAD.

Any plan which does not reduce health insurers' PROFITS is of no value.

Either they hurt the insurance companies or WE LOSE.

This is NOT some bullshit "win-win" game. It's US VERSUS THEM, and THEY ARE WINNING.

[kath]

84. +100!

[nightrain]

23. Excellent. I'm delighted you posted this because I couldn't remember

where I had seen it and wanted to get back to it.

You're brave to post it. Lately, my experience is that controversial posts have attracted flamers and incredible misperceptions.

[maryf]

31. So glad it got to you!

Regarding the flamers, anger comes when you are woken up and you want to go back to sleep, somethings won't ever let you do that!!!

[nightrain]

34. thanks

I feel hurt when unknown people make horrid inaccurate scathing remarks and then don't have the courage to apologize. And it won't stop me from posting controversial items. But wary of some indeed.

[maryf]

36. Some people will say anything

if they are anonymous, things they wouldn't say to their worst enemy if they'd be known! Glad its not stopping you!

[blindpig]

24. This lays it all out

'public' option' is a bill of goods, the pig is out of the poke for all to see.

k&r

[TBF]

26. Very informative. K&R nt

[mmonk]

32. Thanks.

Maybe when people figure it out, we can unite again. The "uniquely American" moniker reminds me what it is that makes our system "uniquely American" and why it is the problem.

[maryf]

33. Terminal Uniqueness perhaps

Good point, mmonk!

[Catchawave]

41. Happily K&R'ing :)

Especially for finding single payer resources at your link:

http://www.pnhp.org/facts/single_payer_resources.php

So simple! Insurance companies will not make profits on single payer. Therefore, cannot donate to politicians!

I didn't know that a third of all medical costs for health care providers are spent on dealing with insurance companies too.

Amazing stuff :hi:

[maryf]

42. Happy to be of service!!

Here's another good resource http://healthcare-now.org

[Catchawave]

104. Even Obama's personal physician endorses single payer :)

Thanks for the info !

[lumberjack_jeff]

43. Why would a provider accept insurance which pays 20%+ less than another?

Unless it was the only game in town. If it's the only game in town, doesn't that mean that "you can't keep your existing insurance, even if you're happy with it"?

Also, I want to know why it is assumed that literally no one in america will sign up for the public plan as envisioned by the Senate HELP bill.

The original idea was discarded because it is politically impossible to strip people of their current insurance, and force them into a brand new plan. Incremental is the only way this will happen.

The public option, being freed from the need to pay bonuses, profit, dividends and huge marketing expenses, will have a competitive advantage within the exchange. I will be very surprised if the public plan doesn't take 60% market share of all insurance delivered through the exchange.

[Kid Dynamite]

45. paying 20% less = 60% market share

no wonder I flunked Statistics 101

[lumberjack_jeff]

49. How did you do in reading?

The op was pimping a 2001 plan of a huge "public option" (which really isn't optional), that pays providers 20% less. This would only work if it's the only game in town.

The article (which was well-written but wrong) suggests that a main problem with the currently-envisioned public option is that it doesn't retain this 20% discount for services, so it wouldn't be cheaper than the competition.

I say that, as currently written, it will still be somewhat cheaper than the competition because the insurance pool can be run cheaper, so it will take a large share of those who come to the exchange for coverage.

[Kid Dynamite]

51. Ah, you are trying to walk the tightrope

you are saying that it HAS to be priced "competitively". But you ignore the direct corollary that "competitive" means it will not be used to undersell private insurance either. That is what "competitive" means right?

A very convenient catch-22 for private insurance

[lumberjack_jeff]

55. What does "competition" mean to you?

All the insurers in the exchange are playing the same game. The one who can sell the service cheapest will gain market share. The one who doesn't need to add profit margin has a competitive advantage.

The beauty of the exchange is precisely what I hear the most bitching about; the level playing field. The private plans will be held to the same standards of conduct and range of offerings as the public plan so they must abandon their old playbook. Private plans have gotten rich by denying procedures and kicking high risk customers out. If the bill passes, they can't do that any more.

[maryf]

96. But why have a private plan at all??

I can see choosing a doctor, but the coverage of health care could be paid for by one payer, which would eliminate the overhead costs of billing and administration, from 25 to 33 cents on the dollar right now...HR 676 answers this...

Private insurance is based on profit for something everyone needs, like water (another story there)..it just ain't right...

[lumberjack_jeff]

110. Political realities are still realities.

We *could* implement single payer, from whole cloth... if we didn't live in this society.

[John Q. Citizen]

125. You must have missed this in the article

These are the criteria that the person who thought up the idea of the public option said had to be met for it to work. Now of course, lumberjack_jeff, if you don't care if it works or not then these aren't important.

Hacker’s papers laid out these five criteria that he and the Lewin Group said were critical to the success of the “public option”:

• The PO had to be pre-populated with tens of millions of people, that is, it had to begin like Medicare did representing a large pool of people the day it commenced operations (Hacker proposed shifting all or most uninsured people as well as Medicaid and SCHIP enrollees into his public program);
• Subsidies to individuals to buy insurance would be substantial, and only PO enrollees could get subsidies (people who chose to buy insurance from insurance companies could not get subsidies);
• The PO and its subsidies had to be available to all nonelderly Americans (not just the uninsured and employees of small employers);
• The PO had to be given authority to use Medicare’s provider reimbursement rates; and
• The insurance industry had to be required to offer the same minimum level of benefits the PO had to offer.

Hacker predicted, and both of the Lewin Group reports concluded, that if these specifications were met Hacker’s plan would enjoy all three of Medicare’s advantages – it would be huge, it would have low overhead costs, and it would pay providers less than the insurance industry did. As a result, the “public option” would be able to set its premiums below those of the insurance industry and seize nearly half the non-elderly market from the insurance industry. According to the Lewin Group’s 2008 report, Hacker’s version of the “public option” would, as of 2007:

• Enroll 129 million enrollees (or 50 percent of the non-elderly);
• Have overhead costs equal to 3 percent of expenditures;
• Pay hospitals 26 percent less and doctors 17 percent less than the insurance industry (but these discounts would be offset to some degree by increases in payments to providers treating former Medicaid enrollees); and,
• Set its premiums 23 below those of the average insurance company.

if you aren't in favor of the Public Option, Lumberjack_Jeff, than that's OK, i don't care. But if you are in favor of it, why don't you want it to work?

[lumberjack_jeff]

129. I am in favor of it. But you know that.

Why should I trust you, or the guy who wrote this, instead of Obama?

The guy who wrote this is also the guy who called Dean a liar. Strike one.

[John Q. Citizen]

137. #1 Obama isn't introducing legislation. As you pointed out repeatedly. So it's not his concern,

Right?

#2 Kip Sullivan, the author of the piece and a nationally known expert on health insurance systems, isn't Dr. David Himmelstein, who is the person that another poster seems to have had a nervous breakdown over because that poster has an unhealthy obsession about Dr Dean. If you click the link it will take you to the thread where a poster posts about what Dr Himmelstein (not Kip Sullivan) said about Dr. Dean

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6122494

#3 If you're interested in healthcare, I thought you would be interested in discussing the origins of the Public option, what the guy who invented the Public Option says about it (Professor Hacker) and what the congress has done with the public option. Instead you sound hostile and as if anything that might put what some congress people passed out of commiitte in an unfavorable light is somehow threatening to your sense of self. Take it easy, OK?

Ball four

[Kid Dynamite]

52. Ah, you are trying to walk the tightrope

you are saying that it HAS to be priced "competitively". But you ignore the direct corollary that "competitive" means it will not be used to undersell private insurance either. That is what "competitive" means right?

A very convenient catch-22 for private insurance

[John Q. Citizen]

113. Providers accept insurance which can deliver volumre patients for less. If you read the

whole article it spells it out clearly:

"So, let’s say you redeploy your sales force. Now instead of talking to potential customers, you direct them to focus on providers first. But when your salespeople call on doctors and hospital administrators and ask them if they’ll agree to take enrollees at below-average payment rates, providers ask how many people the “public option” will enroll in their area. Providers explain to your salespeople that they are already giving huge discounts, some as high as 30 to 40 percent off their customary charge, to the largest insurers in their area and they are not eager to do that for the “public option” unless the plan will have such a large share of the market in their area that it will deliver many patients to them. If the “public option” cannot do that, providers tell your salespeople, they will not agree to accept below-average payment rates."


So you see, the largest insurers with big market shares get better deals than smaller iunsurers with smaller market shares. Makes sense, right!

That's why Medicare can get better deals because it's the largest insurer there is and they have lots of patients for the doctors and hospitals that contract with. Make sense?

As to why no one will sign up for the HELP pool, it's in the article as well, but you would have to read it. Yopu would then have to call up or write the CBO and verify why they scored it that way, but Kip Sullivan, who wrote the article points out that in his opinion, the house pool may not get even the 10 million the CBO said it may.

Hope that helps your understanding.

[Uncle Joe]

44. Excellent analysis.

To disregard the key fundamentals required to make a public option work just so some greedy *%#@)!; having nothing to do with health care can profit from the American Peoples' illness and injury, what a bunch of scum.

I hate it when they do that bait and switch shit!:grr:

Thanks for the thread, maryf

[maryf]

74. Thanks for reading it!

:)

[AzDar]

46. K & R

[madfloridian]

47. This is the group whose founder calls Howard Dean a liar.

I think the post is up today at Single Payer Action, quoting the founder of this physicians group.

I find that insulting, and it is going to hurt us in getting any kind of public plan through to be calling each other liars.

[madfloridian]

50. Here's the post. Your group's founder says Dean and others are lying.

http://www.singlepayeraction.org/blog/?p=1204


Do you agree?

[Political Heretic]

54. Somehow, everything, always comes back to Dean.

I think the word "lying" is too strong. However, I agree with Himmelstien because it is accurately portraying the facts. What Dean is describing in quotes is not at all what the House draft currently looks like, and is certainly not what Senate ideas are shaping up to look like.

Obama doesn't have a health plan - he has ideas about the fact that we need health reform. But rather than proposing draft legislation to congress and shepherding it through, he decided to let congress build the legislation and then see what they come up with. I understand why. One of the reasons health care failed in the 90s (one of many) is that Congress felt shut out in many ways. Obama is trying to avoid that and keep support. I get it. But the result is, anyone talking about what the "Obama plan" does is being presumptuous. There currently is no plan, only a bunch of unreconciled ideas and a bunch of democrats suggesting that everything is on the table.

Now that would have been the more "accurate" thing for Dr. Dean to say.

I'll go ahead and slap Himmelstien on the wrist for using the word "liar" and thus insulting the great Dr. Dean. But his concerns about the mischaracterization (accidental notwithstanding) of health care by Dean are pretty fair.

[madfloridian]

58. I have stood with both options. Dean is NOT part of congress.

I doubt they confide in him the changes going on.

I am just plain tired of seeing this group attack him because he is doing what he thought to be right.

I am sick of it.

[Political Heretic]

60. You're making it personal and emotional.

I really don't care about your personal emotional infatuation with a politician. Himmelstein is right, Dean is wrong. Is Dean lying? I would have chosen a less inflammatory word, but in my book that's a "minor" sin, since Himmelstein continues to be basically right in the fact that Dean either misunderstands or is mischaracterizing where health care reform currently stands and he's doing that before the American people - only adding to the confusion, not helping.

See, I can make critical comments when I disagree and positive comments when I agree with Dr. Dean. That's called being healthy and well adjusted. Personally, I think Howard Dean is one of the better Democrats around, and I think he's trying to help on health care. But he's misstating where things stand and that doesn't help.

[madfloridian]

66. Oh, stop it. I hate that argument. It is childish.

Calling him a liar is inexcusable.

Disagreeing is one thing, but calling him a liar is another.

[Political Heretic]

68. Stop it? I'm not the one obsessing about a politician. See the definition of "Fetish"

here let me save you time: b: an object of irrational reverence or obsessive devotion

[madfloridian]

75. We are screwed now. PNHP is calling a fellow physician a liar.

And you are trying to discredit me using the same old tired crap from 2003.

At least be creative.

[Name removed]

78. Deleted message

Message removed by moderator. Click here to review the message board rules.

[redqueen]

57. Wow... he has a lot of nerve.

Also this:

"The private health insurance companies would cherry pick the young healthy patients, while the sick older patients would opt into the public plan – making the public plan unsustainable."

ignores the fact that the insurance companies don't get to tell young healthy people which plan to use.

[madfloridian]

62. So you think he is a liar. Discrediting one of our most honest politicians.

Well, God Bless, we have reached the bottom at DU.

Have your single payer and keep us from getting anything else. Dean also has stood for the same principles as Himmelstein or whatever.

That is just trashing a good Democrat and doctor.

[redqueen]

97. What in the everlovin hell are you talking about?

:wtf:

[Political Heretic]

64. Among the proposals in congress, includes a public option only a certain means-tested percentage

of the population. Not everyone.

Also among "public options" being debated in congress, weak public options that would provide inferior compensation to doctors and inferior care to patients, hence making his statement true. His worry is 100% valid.

Until there's an actually fracking bill, BOTH Dean and anyone else making it sound as though there is ONE "plan" being discussed are doing a disservice to clarity on this issue.

[redqueen]

98. Dean is not the one calling other people liars. (nt)

[Political Heretic]

99. Waaaaaaaa!

:cry:

My god, children....

[Political Heretic]

100. .

[redqueen]

103. You might want to think about taking a break. (nt)

[redqueen]

102. What the hell was that for?

You said yourself that the various bills are still up for debate, so anyone blah blah blah...

What you seem to fail to grasp is that there's only one side trying to act as if the details are decided, and using that information to call others liars.

[ProudDad]

124. People who don't lie are allowed to call those who prevaricate

purposely or not liars...

Dean told untruths. I heard him live on DN when he did (I yelled at the screen too, "You're LYING!"

He told untruths.

[redqueen]

189. What untruths are those again?

Are those based on the details which haven't been worked out yet?

[ProudDad]

120. You've got the quote in your sigline WRONG

"The original quote in French is "Le mieux est l'ennemi du bien.", from Voltaire's Dictionnaire Philosophique (1764) Literally translated as "The best is the enemy of good.", but is more commonly cited as "The perfect is the enemy of the good."

In other words, pursuing the "best" solution may end up doing less actual good than accepting a solution that, while not perfect, is effective. One could also infer that the best makes that which is good seem to be worth less than it is."

The operative word is "effective".

Neither of the Dem plans would be EFFECTIVE and therefore must be opposed.

HR676, on the other hand, would not only be effective but "BEST" when compared with the other feeble attempts to tinker with the existing evil system of "for profit corporate sick care"...

----------------------------

And anyway, you do realize that Voltaire was a satirist and free trader, right?

He was also a Monarchist..."Voltaire distrusted democracy, which he saw as propagating the idiocy of the masses. To Voltaire, only an enlightened monarch or an enlightened absolutist, advised by philosophers like himself, could bring about change as it was in the king's rational interest to improve the power and wealth of his subjects and kingdom. Voltaire essentially believed enlightened despotism to be the key to progress and change."

Consider the source...

[redqueen]

191. Whatever the source, what's true is true.

Imagine if FDR had been forced to get a perfect Social Security bill or let it die.

[John Q. Citizen]

152. There are two bills that have been reported out of committe. That is why Kip wrote the article. He's

talking specifically about the two bill that have been reported out of committee.


"The switch

Now let’s compare the “single national health insurance pool covering nearly half the population” that Hacker and other “public option” advocates enthusiastically championed with the “public option” proposed by Democrats in Congress, and then let’s inquire what Hacker and company said about it.

As readers of this blog no doubt know, the Senate Health, Education, Labor, and Pensions (HELP) Committee, and three House committee chairman working jointly, published draft health care “reform” bills in June. (The third committee with bill-writing authority, the Senate Finance Committee, has yet to produce a bill.) According to the Congressional Budget Office, the “public option” proposed in the House “tri-committee” bill might insure 10 million people and would leave 16 to 17 million people uninsured. The “public option” proposed by the Senate HELP committee, again according to the Congressional Budget Office, is unlikely to insure anyone and would hence leave 33 to 34 million uninsured. The CBO said its estimate of 10 million for the House bill was highly uncertain, which is not surprising given how vaguely the House legislation describes the “public option.”

Here is what the CBO had to say about the HELP committee bill:

The new draft also includes provisions regarding a “public plan,” but those provisions did not have a substantial effect on the cost or enrollment projections, largely because the public plan would pay providers of health care at rates comparable to privately negotiated rates – and thus was not projected to have premiums lower than those charged by private insurance plans. (page 3)

Obviously the “public option” in the Senate HELP committee bill (zero enrollees; 17 million people left uninsured) and the “public option” in the House bill (10 million enrollees (maybe!); 34 million people left uninsured) are a far cry from the “public option” originally proposed by Professor Hacker (129 million enrollees; 2 million people left uninsured). Have we heard the Democrats in Congress who drafted these provisions utter a word about how different their “public options” are from the large Medicare-like program that Hacker proposed and his allies publicized? What have Professor Hacker and his allies had to say?
"

So there you have it. The house bill, according to the Congressional budget Office (CBO) who does the math and estimates the effects of bills, says that there may be up to 10 million enrollees by 2019, that's ten years from now.

Yes, that's way way less than everyone indeed. That's only ten million maybe in the public option out of 350 million people in the country.

[ProudDad]

119. Young healthy people don't get a choice

If they're lucky they get the policy their employer chooses...

If they're not lucky they get the ER when they get sick or...

They'll pay through the nose for private insurance...

It is true that the private plans will find a way to exclude the sicker folk.

The only way to get Universal Care is to have Everyone In, Nodoby Out...the same advantage every civilized country has -- Single-payer - one financing mechanism for everyone's basic health care.

HR676 - the only plan that would do that...

[redqueen]

190. Which version of the bill are you basing those claims on? (nt)

[blindpig]

77. If that's what Dean is saying then yes.

Himmelstein is correct.

There is no comparing the putrid gift to the insurance companies that's being hawked now with the single payer that all industrial society except us enjoys.

[slipslidingaway]

59. Dean has said that the public option is just like single-payer, he has

been confusing the terminology on various occasions, I guess Dr. Himmelstein finally had enough.

:shrug:

Those who have advocated for a SP system since the 1980's are for a single-payer, not for profit system...everybody in, nobody out. Private insurance companies cannot compete with the national insurance plan, that is not what is being proposed.


http://www.singlepayeraction.org/blog/?p=1204

“Look, you decide for yourself,” Dean said. “We’re going to allow people under sixty-five to sign up for what people over sixty-five have. And you make the choice.”

Dean said that the Obama plan will give Americans the choice “between whether they would like a single payer for themselves and their families or whether they would not.”

One problem: Obama’s plan is not single payer.

Another problem: It’s not like Medicare.

“He’s a liar,” Himmelstein says.

“He knows that the public option plan is not single payer and he says it is to try and confuse people,” Himmelstein said. “He goes on Democracy Now and other shows and says that people can buy into Medicare when he knows that what is in the plan is not that.”

“Medicare doesn’t have to compete,” Himmelstein said. “That’s why it’s so efficient.”

...Himmelstein says that the Obama plan would mandate that people buy insurance from competing private plans – and one denuded public plan..."


Howard Dean: Single-Payer is Not Off the Table
http://www.youtube.com/watch?v=DitCTKPL-xI

[Political Heretic]

65. Again, Himmelstein's use of "liar" is too harsh, but he has a legitimate gripe with Dean

Who has, as you correctly pointed out, been confusing terminology and been less than accurate in his understanding of the state of the health care debate in congress.

[slipslidingaway]

73. I agree that it is harsh, but Dr. Himmelstein has been advocating

for a SP system since at least the mid 1980's, at some point patience runs thin IMO.

[slipslidingaway]

67. “Medicare doesn’t have to compete,” Himmelstein said. “That’s why it’s so efficient.”

http://www.democracynow.org/2009/7/17/gov_howard_dean_on_his_prescription


"AMY GOODMAN: Explain what is the public option, as it’s been presented.

HOWARD DEAN: For the average American, they should best think of it as Medicare..."

[madfloridian]

70. Dean has advocated Medicare for all.

He says we will not likely get it.

Boy, you guys are the winners now.

Must feel good.

[slipslidingaway]

82. He is not advocating for that now, instead he told AHIP at their convention

that a public option would not be that bad for the insurance industry as they might imagine.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=5792680&mesg_id=5792680

"But Dean considers public health insurance a necessity. "I think it is absolutely essential. And I don't think health reform is worth doing without a public option."

"What the president is proposing to do is say, if you like what you have, you can keep it. If you're comfortable with the private insurance market, you can keep it. Not only that, but we'll help you buy it. There will be a government subsidy based on your income, particularly helpful to small businesses, that you will receive to buy healthcare in the private market," Dean said. "But you will also have a choice of buying into a public plans such as Medicare or some other public plan. And I'm one of the few defenders of that in this room."

"Now I know people in this room, in this industry, are very, very fearful," he said. "This is the center of opposition."

He looked at the rows of representatives of Aetna, Blue Cross, and dozens of other companies assembled and said, "Your living is at stake here. But I don't think it's going to be as tough as you think it is."

The reason, he said, is that most of the nation's CEOs, despite "incredible inflation," prefer to have employer based health insurance. He emphasized that there is still a role for private health insurance, but one that would be shared by public plans..."

[madfloridian]

86. That is what he has said all along.

That there should be a Medicare type option alongside private ones.

Whether I fully agree or not, that has always been his position. He does not want insurance controlling the congress, but he doesn't want them shut out either in this economy.

[slipslidingaway]

89. Read this sentence again...

“Medicare doesn’t have to compete,” Himmelstein said. “That’s why it’s so efficient.”

Insurance companies have been included in the discusions, not for profit advocates have been silenced. And then Dean tells the insurance industry that the public option will not be as bad as they think.

:shrug:

And then this portion of the article...

"...Put yourself in the “public option” director’s shoes

To see why the “public option” proposed by congressional Democrats remains at great risk of stillbirth, let’s engage in a frustrating thought experiment. Let’s imagine Congress has enacted the House version (it is not quite as weak as the HELP Committee model and thus gives us the greatest opportunity in our thought experiment to imagine a scenario in which the “public option” actually survives its start-up phase). Let us imagine furthermore that you have been foolish enough to apply for the job of executive director of the new “public option,” and the Secretary of the Department of Health and Human Services (the federal agency within which the program will be housed) decided to hire you. It’s your first day on the job.

You know the House bill did not create a ready-made pool of enrollees for you to work with the way the 1965 Medicare law created a ready-made pool of seniors prior to the day Medicare commenced operations. You realize, in other words, that you represent not a single soul, much less tens of millions of enrollees. You will have to build a pool of enrollees from scratch. You also know the House bill authorized some start-up money for you, so you’ll be able to hire some staff, including sales people if you choose. You can also open offices around the country, and advertise if you think it necessary. But you know you can’t pay out too much money getting the “public option” started because the House bill requires that you pay back whatever start-up costs you incur within ten years. In other words, you may hire enough people and open enough offices and buy enough advertising to create a critical mass of enrollees nationwide, but you must do it quickly so that your start-up costs don’t sink the “public option” during its first decade.

The only other feature in the House bill that appears to give you any advantage over the insurance industry is the provision requiring you to use Medicare’s rates plus 5 percent, which essentially means you are authorized to pay providers 15 percent less than the insurance industry pays on average. But the House bill also says providers are free to refuse to participate in the plan you run.

So what do you do? Let’s say you open offices in dozens or hundreds of cities, you hire a sales force to fan out across the country to sign up customers, you advertise on radio and TV to get potential customers (employers and individuals) to call your new sales force to inquire about the new “public option” insurance policy. What happens when potential customers ask your salespeople two obvious questions: what will the premium be and which doctors they can see? What do your employees say? They can’t say anything. They haven’t talked to any clinics or hospitals about participating at the 15-percent-below-industry-average payment rate, so they have no idea which providers if any will agree to participate. They also have no idea what the “public option” premium will be because they don’t know whether providers will accept the low rates the plan is authorized to pay. And they have no idea about several other factors that will affect the premiums, including how much overhead the “public option” will rack up before it reaches a state of viability, or who the “public option” will be insuring – healthy people, sick people, or people of average health status.

So, let’s say you redeploy your sales force. Now instead of talking to potential customers, you direct them to focus on providers first. But when your salespeople call on doctors and hospital administrators and ask them if they’ll agree to take enrollees at below-average payment rates, providers ask how many people the “public option” will enroll in their area. Providers explain to your salespeople that they are already giving huge discounts, some as high as 30 to 40 percent off their customary charge, to the largest insurers in their area and they are not eager to do that for the “public option” unless the plan will have such a large share of the market in their area that it will deliver many patients to them. If the “public option” cannot do that, providers tell your salespeople, they will not agree to accept below-average payment rates.

In other words, you find that the “public option” is at the mercy of the private insurance market, not the other way around.

This thought experiment illustrates for you the mind-numbing chicken-and-egg problem created by any “public option” project that does not meet Hacker’s criteria, most notably, the criterion requiring pre-population of the “public option.” If the pre-population criterion isn’t met, the poor chump who has to create the “public option” is essentially being asked to solve a problem that is as difficult as describing the sound of one hand clapping. You need both hands to clap..."

[madfloridian]

94. Dean stood for the public option to do just that....provide competition

to private insurance. He has been honest from day one about that.

But it's too late...the word is out that he is a liar.

Too late now.

[slipslidingaway]

107. Read it again, you are not understanding what is being said. n/t

[maryf]

155. Gosh you could teach a course on this!

Have you joined http://pnhp.org ? Your ken is very keen.

[ProudDad]

169. Unless the for profit is removed from Health Care

it won't work.

The civilized world has already figured that out and has either replaced or severely limited their private "insurance" carriers.

THEY MUST BE SHUT OUT OR WE'LL NEVER HAVE REAL HEALTH CARE IN THIS COUNTRY!

[ipaint]

72. People look to Dean as an honest broker and

someone who they can trust. What he said was a lie.

[slipslidingaway]

108. When I heard Dean on the Ed Schultz show saying that people

could pick the public option aka single-payer I was very disappointed.

Not everyone understands the difference between the two systems, having Dean confuse the issue was not helpful, especially because as you said "People look to Dean as an honest broker..."

:(

[slipslidingaway]

83. "Public option is like single payer....

http://www.blueoregon.com/2009/06/dean-wyden-the-public-option-single-payer-and-the-rest-of-the-kitchen-sink.html

"Public option is like single payer. It gives consumers the choice. There's no such thing as a pure single-payer plan anywhere."

[ProudDad]

170. Bingo -- another Dean lie (n/t)

[John Q. Citizen]

115. If Dean said that the House bill or the Senate HELP bill public option would be like

single payer or Medicare he's wrong. He hasn't read the bills and is just talking off the cuff.

The CBO has already rated these bill and says plainly that the HELP public plan won't get off the ground and that the Congress plan will only cover maybe 10 million people 14 years from now.

Have you read this piece MF? I know Kip Sullivan a little bit from back in the early 1990s when I canvassed on health care out in Minnesota with Minnesota Citizen Action. He's brilliant and has been an expert on health care and single payer for years. It's his life work, health policy.

if you haven't reads this piece, you should. It's extremely important.

Here the link http://www.pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%E2%80%9Cpublic-option%E2%80%9D-was-sold/

[madfloridian]

56. This paragraph:

"To sum up, “public option” advocates must choose between continuing to promote the “public option” and seeing their hopes for cost containment and universal coverage go up in smoke for another four years, and throwing their considerable influence behind single-payer legislation. At this late date in the 2009 session, it is unlikely that a single-payer bill could be passed even if unity within the universal coverage movement could be achieved. But if the “public option” wing and the single-payer wing join together to demand that Congress enact a single-payer system, December 2009 need not constitute a deadline.

Kip Sullivan belongs to the steering committee of the Minnesota chapter of Physicians for a National Health Program."

Let's see, the founder of that group calls one of the most vocal advocates for public option a liar. That person is NOT against single payer, just practical about public option.

They call him a liar then actually say we can't get either unless we join? The same group that has called only for single payer and gone after the rest of us who stood with public option? They want to combine forces now?

How do you UNcall someone a liar.

[ProudDad]

171. When they stop lying one can quit calling them a liar... (n/t)

[johnaries]

61. The people who "sold us" on the Public Option aren't the ones

who wrote the bills under consideration.

Why do folks keep blaming the wrong people?

[madfloridian]

76. Because if PNHP can't get just what they want.....there will be nothing.

Nothing at all.

It is coming to fruition now.

[slipslidingaway]

87. Maybe you should take a look at those who wish to continue

paying profits to insurance companies instead of blaming physicians who are fighting to provide coverage to all, at the best possible price.

Insurance companies do not provide health care.

[madfloridian]

88. I don't care.

It does not matter. We will not get it.

Lobbying works from left and right. It usually stops us from getting anything.

And the winners are? No one but the PNHP who got to call a fellow doctor a liar

[slipslidingaway]

91. After you attempt to blame PNHP, now you say it doesn't matter

but they are not the group trying to protect insurance company profits.

[madfloridian]

92. It doesn't matter. When a doctor group calls a doctor a liar

especially one who is known for his honesty....the deed is done.

I don't care because it doesn't matter. We won't get anything.

[slipslidingaway]

109. But when a doctor misrepresents the position of a group of doctors

who have been advocating for a national plan for 25 years that is OK.

[madfloridian]

114. Did you know that 8 doctors' group support Obama's plans?

The one Dean supports.

Are they all wrong, too?

[ProudDad]

172. Give it a freakin' rest!

We know you're hopelessly under the power of this man Dean for some strange reason.

He lied. He should know better...

He had his own nefarious (political) purposes but he lied...

I'd say he thought he had to dangle the words "single payer" in front of a presumably REAL Progressive audience on DN in order to be considered "hip" and "with it" and fit in with "Progressives". He is after all a pretty conservative, blue-doggy kind of guy as I remember...

PNHP tells the truth.

PNHP are Physicians and Health Care PROFESSIONALS who know what's best for their patients and the snake oil the Dems are currently peddling, including Mr. Dean, ain't it!

[Justitia]

176. Why don't YOU give the Dean bashing a rest. Damn, you do it on every thread.

Get a new hobby.

BTW, GREAT SIG LINE :sarcasm:

[Maru Kitteh]

93. Because the pick-nits for perfection pretend to care about people before companies but they really

don't. They're quite content to watch people die without any access to healthcare at all if it means they can score political points against the only person (with an ice cube's chance in hell) up for POTUS on Nov. 4, 2008 that gave a flying shit about helping more people get healthcare. All other considerations are secondary.

[Amos Moses]

135. Don't confuse health insurance with health care.

Just because you have the former doesn't mean you will get, or will be able to afford, the latter.

BTW, I think it's safe to say nobody on this forum is content to watch people die. Why make such an outlandish claim like that?

[Maru Kitteh]

143. I understand the difference, and I have heard DU'ers say that the deaths of the uninsured

are exactly what will bring the pure and perfect world they will stand for nothing less than.

[Amos Moses]

146. Doesn't sound to me like they're content to let people die.

It sounds like they want meaningful reform instead of insurance. The insurance companies are the ones that have been costing people their lives and driving people into bankruptcy, not single payer advocates. It's the insurance companies that are content with watching people die.

[Maru Kitteh]

163. ellohay ocksuppetpay!

[Amos Moses]

167. Next time

I'll know not to bother.

[Maru Kitteh]

168. brilliant.

[maryf]

180. He is, isn't he?nt

[maryf]

153. Wow,

If someone really said that I can see why you would be upset. As Amos Moses says, I'm sure that's not what they meant...It is the fact that people are dying that we all are concerned. If I really thought HR3200 would save more lives more quickly than HR 676, I would support it whole heartedly. Sadly, from what I've read, and this is my main focus these days, HR 676 would be the best and most easily implemented...and HR 3200 allows the insurance companies to profit on what should be a human right.

[Maru Kitteh]

165. ellohay uppetmasterpay!

[maryf]

181. I am so sorry you are beyond recognizing sincerety...

I'll pray for you

[maryf]

186. And don't bother to thank me...

I'll be giving out fliers about something I really believe in...

[ProudDad]

173. Bullshit!

You have links to that bullshit LIE!?

[maryf]

150. Maru Kitteh

somewhere here or in another thread is the document for HR 676, it is 30 pages long and can be found at http://pnhp.org HR 3200 on the other hand is 600 plus pages long, I've been told, and had a great deal of feedback from the insurance companies, who, I think we would both agree don't care about people's lives as much as they should (I myself was sent home from surgery far too early to save money). Which document will waste more time? which gives legislators more to nit pick about? HR 676 is planned to be implemented much more quickly, meaning it will save lives more quickly. Something we both really want. Obama himself tonight chastised the insurance companies for their profit and premiums going up...don't you think that profit based on people's health is wrong?

[ipaint]

69. Private insurance companies push for 'individual mandate'

Thanks so much for the article. Combine that article with the fact insurance corporations are facing a bleak future without this weak public option/strong mandate reform and it's clear reform is a scam.



"Insurers do not embrace all of the healthcare restructuring proposals. But they are fighting hard for a purchase requirement, sweetened with taxpayer-funded subsidies for customers who can't afford to buy it on their own, and enforced with fines.

...Private health insurers lost an estimated 9 million customers between 2000 and 2007. In many cases, people lost coverage because they or their employers could no longer afford it as premium increases outpaced wage growth and inflation.

...The industry's real trouble begins in 2011, when 79 million baby boomers begin turning 65. Health insurers stand to lose a huge slice of their commercially insured enrollment (estimated at 162 million to 172 million people) over the next two decades to Medicare, the government-funded health insurance program for seniors.

...So the best way for the industry to preserve the private insurance market -- and derail the campaign for a single-payer system -- may be to go along with more palatable proposals on the table now, said Jeffrey Miles, a healthcare analyst and president of the Miles Organization, a Los Angeles insurance brokerage firm.

"If healthcare goes down this year, you are going to end up with single-payer care much sooner than anyone expected," he said."

http://articles.latimes.com/2009/jun/07/business/fi-healthcare7

[maryf]

149. Thanks, I paint!

This should be an OP! (and I love to paint!)

[conscious evolution]

71. Kicking to expose

the conmen we call goverment.

[Echo In Light]

79. "promising one thing but now promote something entirely different"

That sums up the core of everything to do w/this country.

[SOS]

81. The American worker is shafted again by a venal, corrupt Congress

No interest rate cap.
No card check.
No public option.

It's time to put away childish notions and come to understand that the Congress is a gang of bribed, corporate lackeys.
We live in an oligarchy and nothing will ever change.
No matter how good Obama's intentions.

[inna]

90. rec#42. also, see this quick and stark analysis here:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6109425&mesg_id=6109879

[maryf]

95. Thanks! this part is really critical...

Hope he does post this on its own, or reposts it in case it got lost! from your link:

"*ONLY 10 Million Americans will be covered by the Public Plan by 2019.
Big Insurance should be very happy.
With the MANDATE for ALL Americans to purchase Health Insurance, and only 10 Million in the Public Plan after 10 years, they will be raking in the money."

Sounds like more deaths to me...

[Political Heretic]

101. If you can ignore the stupid dean derailment, this is a good thread K&R

[madfloridian]

105. It's the same group that has attacked, protested and called him a liar.

Yes, it is stupid to do that.

But the deed is done, and when you discredit the spokesperson you hurt everyone.

[redqueen]

106. I think it's a good thread too.

I was unaware that this organization was acting as if all the details were known, and casting aspersions on people based on the assumtions they're making.

Very eye-opening.

:kick:

[John Q. Citizen]

127. Yes, it's a great article and good thread minus the attention seeking tantrum

:)

[bvar22]

111. The SAME people who brought us the Wall Street Bailout....

...are now going to bring us Health Care "Reform".
They are going to cram Health Insurance Industry Profit Protection in to a bag,
slap a label on it that says "Public Option",
and SELL it to the low information voters.

"Is it any wonder the CBO concluded the Democrats’ “public option” will be a tiny little creature incapable of doing much of anything? More curious is that CBO gave the House “public option” any credit at all (you will recall CBO said it would enroll maybe 10 million people). The CBO should have asked, Can the “public option” - as presented in either bill - survive?"

I can NOT believe that there is a parade of DUers selling this CRAP.
This will NOT "open the door for Single Payer".

K&R for w-i-d-e-r distribution.
People NEED to know what is being SOLD.

[smokey nj]

112. Kick!

[John Q. Citizen]

118. Excellent read and a fascinating very illuminating read. Thanks for posting it!

[maryf]

121. Thanks for reading! please share! nt

[John Q. Citizen]

177. Back in 1992 i was canvassing for Oregon Fair Share on Health Care Reform. We

would knock on doors 5 hours a night five nights a week and raise money and sign up supporters that our office would then organize to push for health care reform.

i was pretty good at training people how to canvass effectively so I got to travel to other offices in other states and help them build staff for their offices. I would go work at an out of state office for a month or 6 weeks at a time.

During this period i has the opportunity to work at Minnasota Citizens Action, on Hennipen Ave in Minneapolis. We would get speakers in to the office sometimes to talk about different lefty issues, to speak about local issues, to give workshops on organizing, and to do educational and issue development.

While reading your OP I realized that the guy who wrote it, Kip Sullivan, was one of the people who came into our canvass office and did a whole hour and a half on single payer. He was probably the best speaker i ever heard on single payer because he knew everything about the issue, had facts and figures at his finger tips and could answer any questiopn any one had, from what was the difference between the systems in Alberta and Nova Scotia, to how would a single payer system be implemented in a city, to what kind of start up costs might a state face if they wanted to set up a single payer system, to what was the history of health care in Denmark.

He really inspired me because he knew so much about health care system financing, insurance systems, almost any thing we asked he could provide us an answer for. I've never forgot how entertaining and informative he was on the subject.

So it's really something for me to see he's still in the trenches doing awesome, concise, and excellent analysis on the issue of health care and health care reform.

it's like my roots are still my present day reality and we are still fighting the power to get what we want. And one day we will, because we aren't giving up until we get a single payer system right here in the USA.

[slipslidingaway]

128. kick n/t

[maryf]

140. thanks, friend!!

your posts here have been great! :hi:

[slipslidingaway]

151. YW, it is a good read, hope more people take the time to read....

thanks for posting.

:hi:

[Orwellian_Ghost]

131. Top Notch

Everyone here needs to read this.

K&R

[maryf]

141. Thanks!

These doctors pushing for single payer really work overtime! I hope all do read it! :hi:

[Amos Moses]

136. an epic post full of win, mary

K&R :applause:

[maryf]

139. Thank you!

Welcome to DU! :hi:

[progressoid]

138. marking for a latenight read

[maryf]

142. Its a worthwhile read! nt

[waiting for hope]

145. Excellent article -

Thank you for posting and K&R.

[maryf]

154. Thank you waiting for hope!

:hi:

[Eyerish]

147. K&R

[Beartracks]

148. Even in majority, Dems think incrementally. n/t

[pam4water]

166. Place hold so I can read later.

[Justitia]

174. More of the same from the "all or nothing" group that DU is getting spammed with.

I know you guys are intent on killing the idea of getting ANYTHING besides exactly what YOU want.

Keep it up and we'll be looking at that "nothing" part of "all or nothing" - again.

Thanks for nothing.

[maryf]

183. From another thread...

quote from Bruce Dixon of BAR:

"The Obama plan seems calculated to buy time for private insurers, to end the health care discussion for a decade or more without solving the health care problem, do so in a way that discredits the very idea of everybody in-nobody out health care. It will leave tens of millions uninsured, a hundred million or more underinsured, and the same parasitic private interests in charge of the American health care system that run it now." . . .

[foginthemorn]

215. yes, I fear that if this passes as is--it will the one and only time

Dems will even try again--and will NOT even be workable for 3 and half years!!

[maryf]

184. and from this article...

"...When the “public option” campaign began, its leaders promoted a huge “Medicare-like” program that would enroll about 130 million people. Such a program would dwarf even Medicare, which, with its 45 million enrollees, is the nation’s largest health insurer, public or private. But today “public option” advocates sing the praises of tiny “public options” contained in congressional legislation sponsored by leading Democrats that bear no resemblance to the original model.

According to the Congressional Budget Office, the “public options” described in the Democrats’ legislation might enroll 10 million people and will have virtually no effect on health care costs, which means the “public options” cannot, by themselves, have any effect on the number of uninsured. But the leaders of the “public option” movement haven’t told the public they have abandoned their original vision. It’s high time they did..."

[John Q. Citizen]

192. We forgive you, because you know not what you do. What's it like to fight for what you don't want?

[Justitia]

196. Stuff it. I'm fighting for coverage to save my son's life. You don't have the first clue.

I work for this EVERY FUCKING DAY, so take your bloviating and shove it.

[maryf]

201. Hi Justitia

I truly hope we get something together for your son, quickly. There are others who work for this everyday, and if I may repeat something I said to another poster "If I really thought HR3200 would save more lives more quickly than HR 676, I would support it whole heartedly. Sadly, from what I've read, and this is my main focus these days, HR 676 would be the best and most easily implemented...and HR 3200 allows the insurance companies to profit on what should be a human right."

One thing about the single payer advocates is that they are keeping the insurance companies and those whose pockets are being lined by them from totally writing this bill. If I can help you find anything to help your son, I'd be happy to do so...

[ProudDad]

175. Another Kick

This thread must be kicked until this issue is settled!

The "public option" is your enemy, Single Payer is your friend...

Call your Congress-critters tomorrow and DEMAND that they vote for the Weiner Amendment...

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6121388#6128346

Keep this one kicked...

[maryf]

182. Proud Dad!! your kids must be so proud of you!!

:yourock:

[Orwellian_Ghost]

178. Kick

[ipaint]

179. People need to know what settling for less really means.

kick

[4dsc]

187. Single payer...

Single payer is all I'm going to support.. Anything less, which is what the democratic and republican parties are selling won't do..

[jody]

188. Outstanding article showing how an original "good-idea" can be corrupted by the political process

dominated by special interest groups.

The article poses one interesting question related to physicians' concerns that a PO would pay "doctors 17 percent less than the insurance industry".

According to the Lewin Group’s 2008 report, Hacker’s version of the “public option” would, as of 2007:
• Enroll 129 million enrollees (or 50 percent of the non-elderly);
• Have overhead costs equal to 3 percent of expenditures; {versus 20% for private}
• Pay hospitals 26 percent less and doctors 17 percent less than the insurance industry (but these discounts would be offset to some degree by increases in payments to providers treating former Medicaid enrollees); and,
• Set its premiums 23 below those of the average insurance company.

Apparently if a PO has "overhead costs equal to 3 percent of expenditures" then for the same coverage and same doctor payment between PO and private, a PO should cost perhaps 20 to 30% less than private insurance.

[redqueen]

193. It is so interesting that you're in agreement with the OP. (nt)

[uponit7771]

194. ***THE BILLS IN ARTICLE AREN'T EVEN PAST COMMITTEE!!****

http://crooksandliars.com/susie-madrak/bait-and-switch-public-option-no-sky

This is another knee jerk ass'd article with much speculation, I'm waiting to see what really comes out before I bash

[ipaint]

195. Why do folks assume those heavily relied upon future incremental changes

will be positive ones? We have watched the steady incremental dismantling of the new deal for 40 years. Where was everybody then? Unless the public option is drastically strengthened it will fail before those incremental changes ever happen.
The folks who will be the main victims of cutbacks and too high policy premiums will be the lower classes and historically the middle class isn't exactly a dependable advocate of their plight.

The only reason health care is front and center is because the rot worked it's way too far up the economic ladder. Keep the uninsured in the 15-20 million range and most of the middle class doesn't know they exist.

People are ready to throw the half of the 17 million uninsured who are legal citizens after "reform" under the bus. In fact the president told us last night that those folks will be the selfish risk takers. Despite the fact the results of this plan in Mass. has shown nothing could be further from the truth.

From the c and l article-

"The fact is, it will be a lot more politically difficult for members of Congress to vote against those future incremental improvements than to vote against the entire plan now. Once it's in place, and constituents start calling their elected officials with complaints about flaws in the bill, they're going to have to fix those problems - or at the very least, not get in the way of the solution."


How about the problem of heavily subsidizing overpriced mandated by law insurance from a unnecessary middleman who keeps increasing rates because the public option, which is supposed to keep rates down, needs 130,000,000 members to work properly and it has all of 10,000,000 in 2019.

Who do you think will be raising holy hell with their republican representatives? What kind of incremental change do you think we will see after 2019 when the majority of americans equate government insurance with epic fail ?

[Justitia]

197. Because that is how Medicare has ALWAYS worked. Read up on it's history (1972).

Richard Nixon signed into law the largest expansion of Medicare ever in 1972.

As you know, we have had Medicare since 1965.

In 1972 Nixon expanded Medicare to cover End Stage Renal Disease (kidney failure). This was a MASSIVE expansion of the benefit.

It was also expanded to cover ALS (Lou Gerig disease).

It was expanded at different times to cover hospice, then mammograms, later pap smears, etc., etc.

Then, of course, it was later expanded by Bush for Medicare part D.

Social Security has the same history....

The program was started and then expanded many times to include different groups (surviving spouses, the disabled, etc.)

So, this is how these programs work. You always start with the barest of programs and then expand them via statute.

People should really be more familiar with the history of these social programs and how Congress & various administrations have changed them over decades.

This is how it is ALWAYS done.

I've edited to add this timeline link for you. Check out all the expansions of coverage since inception:
http://seniorjournal.com/NEWS/2000%20Files/Aug%2000/FTR-08-04-00MedCarHistry.htm

[ipaint]

198. And which one of those government programs was forced

to directly compete for business at market prices with a gigantic, infinitely well funded corporate giant that is dedicated to it's demise?

[Justitia]

199. I answered your question and you completely ignored the information.

I guess the historical facts didn't fit your throw-away lines.

[ipaint]

200. I already know the history.

And if the for profit insurance industry was involved as they are today we wouldn't have either social security or medicare.

It's simple, they are the reason, after 60 odd years of trying, we don't have any type of universal health care. Including the proposed reform.

[ipaint]

202. The strength of both social security and medicare

comes in the fact they don't have to compete with for profit private business. They never have.

That is also the strength of a single payer approach to health care.

Forcing a weak public option with too few people enrolled to negotiate for anything in meaningful cost cuts to compete with an industry that controls the market place is a losing proposition.

The success of social security and medicare prove that.

[ProudDad]

203. You miss the point

Medicare IS SINGLE PAYER...that's why it works as well as it does in spite of the degradation of the program ESPECIALLY that obscene part d bullshit.

That's why we want single payer NOW!

Those of us on Medicare want it fixed -- HR676 would FIX IT!

The entire civilized world already has it, spend less, have better medical outcomes and piece of mind! That's why WE WANT HR676...

The bills currently being "considered" in Congress are more like Part D (a giveaway to the insurance and drug companies) than it is to basic Medicare -- a good start with Single Payer!

That's why we're concerned.

It's about time that universal single-payer is finally adopted -- 76 years too late but DO IT!

[John Q. Citizen]

204. Actually, that Susie person at Crooks and Liars drops the ball on this one bad.

This is the person who wrote the Bait and Switch article. If you or Susie think you are as qualified to write on health care legislation then lets see what you got. You go ahead and wait and see. Let me know when you have it figured out, OK

About the Author

Kip Sullivan has been teaching and writing about the American health-care crisis since 1986. His articles on this subject, which now number over 100, have appeared in the New York Times, the Los Angeles Times, The Nation, the Washington Monthly, the New England Journal of Medicine, and Health Affairs.Mr. Sullivan is a graduate of Pomona College and Harvard Law School. With the exception of a three-year stint with the New York Legal Aid Society, he has spent his entire adult life working for citizen organizations. From 1980 to 2000, he was an organizer, researcher and lobbyist for Minnesota Citizen Organizations Acting Together (COACT), an organization that teaches citizens how to work together for social justice. In 1986, COACT endorsed universal health insurance and appointed Mr. Sullivan as the campaign director for that issue. This assignment required Mr. Sullivan to develop a thorough understanding of the health-care crisis - not just its obvious symptoms, but its origins and the various proposals to solve it - and to explain the crisis to the average person. Since 1986, Mr. Sullivan has explained the health-care crisis and the debate about it to thousands of people, including members of religious organizations, unions, farm groups, political organizations, and legislators.Mr. Sullivan's background makes him unique among those who write about health policy. Unlike most health-policy experts, he has had to explain health policy to everyday people as opposed to other health-policy experts or students interested in becoming health-policy experts. Unlike most health-policy experts, Mr. Sullivan has no financial connection to the health-care industry. He has been completely free to seek a solution to the health-care crisis that will benefit the average person as opposed to health insurance companies, pharmaceutical manufacturers, and other powerful interest groups that dominate the debate about how to solve the health-care mess.~~

[maryf]

207. Thank you for this!!

Sorry it took me so long to catch it! :yourock:

[Orwellian_Ghost]

205. Bumping

[maryf]

206. Thanks

Keeping this alive is really important! :hi:

[Orwellian_Ghost]

208. Kicking this

[maryf]

209. Maybe the excerpt that could be its own OP is this:

Put yourself in the “public option” director’s shoes

To see why the “public option” proposed by congressional Democrats remains at great risk of stillbirth, let’s engage in a frustrating thought experiment. Let’s imagine Congress has enacted the House version (it is not quite as weak as the HELP Committee model and thus gives us the greatest opportunity in our thought experiment to imagine a scenario in which the “public option” actually survives its start-up phase). Let us imagine furthermore that you have been foolish enough to apply for the job of executive director of the new “public option,” and the Secretary of the Department of Health and Human Services (the federal agency within which the program will be housed) decided to hire you. It’s your first day on the job.

You know the House bill did not create a ready-made pool of enrollees for you to work with the way the 1965 Medicare law created a ready-made pool of seniors prior to the day Medicare commenced operations. You realize, in other words, that you represent not a single soul, much less tens of millions of enrollees. You will have to build a pool of enrollees from scratch. You also know the House bill authorized some start-up money for you, so you’ll be able to hire some staff, including sales people if you choose. You can also open offices around the country, and advertise if you think it necessary. But you know you can’t pay out too much money getting the “public option” started because the House bill requires that you pay back whatever start-up costs you incur within ten years. In other words, you may hire enough people and open enough offices and buy enough advertising to create a critical mass of enrollees nationwide, but you must do it quickly so that your start-up costs don’t sink the “public option” during its first decade.

The only other feature in the House bill that appears to give you any advantage over the insurance industry is the provision requiring you to use Medicare’s rates plus 5 percent, which essentially means you are authorized to pay providers 15 percent less than the insurance industry pays on average. But the House bill also says providers are free to refuse to participate in the plan you run.

So what do you do? Let’s say you open offices in dozens or hundreds of cities, you hire a sales force to fan out across the country to sign up customers, you advertise on radio and TV to get potential customers (employers and individuals) to call your new sales force to inquire about the new “public option” insurance policy. What happens when potential customers ask your salespeople two obvious questions: what will the premium be and which doctors they can see? What do your employees say? They can’t say anything. They haven’t talked to any clinics or hospitals about participating at the 15-percent-below-industry-average payment rate, so they have no idea which providers if any will agree to participate. They also have no idea what the “public option” premium will be because they don’t know whether providers will accept the low rates the plan is authorized to pay. And they have no idea about several other factors that will affect the premiums, including how much overhead the “public option” will rack up before it reaches a state of viability, or who the “public option” will be insuring – healthy people, sick people, or people of average health status.

So, let’s say you redeploy your sales force. Now instead of talking to potential customers, you direct them to focus on providers first. But when your salespeople call on doctors and hospital administrators and ask them if they’ll agree to take enrollees at below-average payment rates, providers ask how many people the “public option” will enroll in their area. Providers explain to your salespeople that they are already giving huge discounts, some as high as 30 to 40 percent off their customary charge, to the largest insurers in their area and they are not eager to do that for the “public option” unless the plan will have such a large share of the market in their area that it will deliver many patients to them. If the “public option” cannot do that, providers tell your salespeople, they will not agree to accept below-average payment rates.

In other words, you find that the “public option” is at the mercy of the private insurance market, not the other way around.

This thought experiment illustrates for you the mind-numbing chicken-and-egg problem created by any “public option” project that does not meet Hacker’s criteria, most notably, the criterion requiring pre-population of the “public option.” If the pre-population criterion isn’t met, the poor chump who has to create the “public option” is essentially being asked to solve a problem that is as difficult as describing the sound of one hand clapping. You need both hands to clap.

I don't know how that would work if I were to quote a part of one OP to make another, of course credit must be given! but maybe dancingdolphin would like this shorter version! I'm going to a workshop in NYC today http://www.healthcare-now.org or I would do it myself! I have no ownership its Kip Sullivan's piece!

[blindpig]

210. Single Payer, we ain't going away. n/t

[maryf]

214. Nope, and we're coming to the Capital in two days!!

ready or not...

[blindpig]

211. ain't done yet...

n/t

[Orwellian_Ghost]

212. Bumping

[maryf]

213. Aw what the heck!

why not...

[slipslidingaway]

216. kick - and a new article ....

http://www.pnhp.org/blog/2009/07/28/does-the-congressional-progressive-caucus-care-about-its-public-option-principles/

Does the Congressional Progressive Caucus care about its “public option” principles?

"It has become obvious that the Democratic leadership in Congress will not fight for a large “Medicare-like” program or “public option,” to use the lingo adopted early in 2009 by advocates of this idea. As I reported in an article posted on this blog on July 20, “public option” advocates originally claimed they stood for a “Medicare-like” program that would enroll 130 million non-elderly Americans, but somewhere along the line they got comfortable selling the “public options” proposed in legislation introduced by Senate and House Democrats a few weeks ago that will, at best, enroll 10 million people.

A “public option” that small will have no effect on the cost of health care in the U.S., which means it cannot bring us closer to universal health insurance. I noted in my July 20 article that neither the original proponents of the “public option,” nor Democrats in Congress, have warned the public that the “public options” contained in the Democrats’ legislation are tiny and powerless compared with the original model.

It is difficult to understand why “public option” advocates outside Congress would conceal this from the public. It is even more difficult to comprehend why members of Congress – people who actually have something tangible to lose (namely, power and a livelihood) if the “public option” turns out to be a joke - have remained silent about the degradation of the “public option.”

If you were asked to think of one group of Congress members who should be leading the campaign to warn America that the “public option” in the Democrats’ legislation is not what it’s been cracked up to be, you would think of the Congressional Progressive Caucus (CPC)..."