Could the upcoming public option actually be worse than doing nothing?

[clear eye]

It's become a cliche for Democrats to say that while single-payer healthcare would be ideal, any public option would at least help some by covering more people. This is an unexamined assumption that could very well be wrong.

The current proposal out of the White House would combine Medicare with a public option for the uncovered. The line the Administration is taking, echoed by most Congressional Democrats, is that the new program will be paid for by "reducing overpayment to insurers, rewarding providers for positive health outcomes rather than excessive tests and procedures". Some costs could theoretically be saved by allowing the public option/Medicare to bargain with providers of services and pharmaceuticals for reduced rates, and by creating a dept. to follow up on reports of fraudulent billing by doctors for procedures not actually provided (up until now blocked by the AMA lobby). Instead of exercising these kinds of constructive cost-saving measures, what the current bill proposes is denial of services disguised as cost/benefit analyses. These decisions can't be spelled out in the bill, so the terms what we will have contracted to accept will manifest only after the fact, determined by anonymous bureaucrats pressured to save money. Paying for covering the uninsured by imposing denial of services in a new, expanded Medicare would expand the horrific inhumane problem now only inflicted by private insurers into the public sphere. A hip replacement that an otherwise healthy, active 79 year old needs to maintain a basic, decent quality of life--and could get under the current Medicare--might well be prohibited under the new system's cost/benefit calculations as an "excessive" procedure. This will be experienced by the millions of Baby Boomers as a destruction of the Medicare program they paid into all their working lives. Believe me, this won't make the Democratic Party more popular.

It's becoming increasingly clear that bought and paid for Congressmembers are only interested in curbing the demand for single-payer by destroying the example of a good government healthcare program--Medicare. As of now, Medicare recipients can at least expect essential expensive treatments for arthritis and cancer to be provided by the public hospitals. What's being proposed may well deny them that care by the fiat of a numbers-cruncher, just like the private insurers do. Examples of the degradation of people's basic quality of life abound under this system in the private sector.

This Medicare/public option combo trades giving more of the uninsured (not all, mind you) coverage for basic primary care for the coverage current Medicare recipients have of more expensive quality of life (such as staying out of a wheelchair and out of pain for 10 years) or life-extending care. What happens to the new "public option" members if the primary physician finds an expensive health problem, or a hard to diagnose condition requiring many tests and sessions with specialists is questionable. All members of the combined gov't plan w/o extensive (and expensive) additional private plans will become "underinsured", and as we know, denials of service make even expensive private plans unreliable. With the accelerating inflation expected to continue, most retired Baby Boomers on fixed incomes will find it increasingly difficult or impossible to afford such additional private insurance.

This proposed system serves the purpose of appearing to "do something" in allowing more people to see primary physicians. After seeing important care being denied under the government program over and over, will most Americans continue to favor "Medicare for All"? So it also serves the purpose of stemming demand for government single-payer. It most likely won't serve the purpose of giving Americans the right to reasonable, essential healthcare.

[Cleita]

1. I'm afraid so. They keep talking about a strong public option, yet there

is no concrete public option being offered. If they mess with Medicare, it could bring the lot of them down though. I hope they aren't so foolish to do that.

[redqueen]

2. No. (nt)

[lumberjack_jeff]

3. No, it's not.

First, your premise is flawed. Denying procedures to medicare recipients is not the primary way that the plan intends to cover the working poor.

... but even if we were to accept it as true there is a strong argument that the same pool of public dollars would be better spent on primary care for a fifty-thousand 20-somethings than on titanium hips for two-hundred, 80 year olds.

[clear eye]

5. Where in the bill do you see the money coming from?

They say that the "public option" can't enlarge the deficit (war can, & retaining bank executives' bonuses can, but not health coverage), and they have no plans to rescind Bush's prohibition against bargaining with Big Pharma. The people in the public option will be heavily loaded with people that private insurers won't cover or have found excuses to drop because they're too sick and can't afford high premiums. They have no plans to incorporate better monitoring of fraud by doctors. (You can still steal by billing for 10 permitted procedures you don't actually do.) Yet they say the expansion will be paid for by reducing overpayment and "eliminating excessive tests and procedures". Please, I'm waiting to hear where this new source of excess is to be found, if not by arbitrarily denying older people coverage under the cost/benefit analyses they have proposed.

As for the advantage of primary care--that becomes a charade if the coverage does not pay for proper follow-up if a problem is found.

I'm guessing you're a 30-something man, and this early in your life you can be persuaded that old people who worked and contributed for 45+ years should just go sit down on an ice floe and drift off for the benefit of everyone else.

[lumberjack_jeff]

12. Don't guess. I'm pushing 50.

There is no reason that the public plan will insure greater risks than any of the privately-offered plans in the exchange.

The bill gives the director of HHS has broad latitude to implement fraud reducing measures.

... but that's beside the point. The public plan will be self-supporting, and the subsidy which allows people to buy coverage will be paid for by a tax on the rich.

Besides, I don't care if the bill is *actually* revenue neutral. With the recent history of deficit-busting wars, bailouts and tax cuts, they could head-fake the numbers any way they like. I have lost whatever sense of fiscal conservatism I may have once had.

[clear eye]

14. The problem is that elements in the gov't DO care about revenue neutrality for this one item.

I'm really curious about the "tax on the rich" you're talking about. As far as I know, the only tax change planned is the resumption of a previous rate in 2011. And I haven't heard anything about the difference being sequestered for the purpose of the public option. Please enlighten me if I'm wrong.

If the subsidy offered to private insurers is enough to allow them to profit even while covering high-cost people it will quickly outstrip its funding. The only way to stay w/i budget while providing private insurers w/ guaranteed profit, is for the plans that receive the subsidies (and the public plan too, as they promise not to exceed what the private plans can afford) to operate with a Draconian set of banned procedures which Medicare covers as a matter of course now, and most people think of as part of normal health care for the very ill. I'm sure the private insurers will offer upscale customers different, unsubsidized, high cost plans that include just about everything known. Middle-class and lower-income retirees who can't afford the ultra-expensive plans will find themselves prohibited by the government from getting treated in ways that most people can now, and would expect. Inevitably the outcomes will frequently be both heartbreaking and enraging. All to maintain the private, for-profit insurance.

[lumberjack_jeff]

16. Obama has talked about capping deductions at the 28% rate for high income taxpayers.

The house has discussed directly raising the top tax rate. (or creating a new one for the top 1 or 2%)

And you're confused about the subsidy.

The rates for the public and private plans in the exchange are approved by the exchange administrators. People of up to 400% FPL can get affordability credits to purchase any of the plans within the exchange, including the public option. It is anticipated that public plan will be 10% cheaper than any of the competition.

These affordability credits come from the government, and are most likely to be paid for via a tax hike on the rich.

The public plan subscribers are not any higher risk than anyone else getting insurance from the exchange.

http://www.philly.com/inquirer/world_us/51284802.html

[clear eye]

17. So they're "considering" new taxes for the heavily subsidized ultra-wealthy.

Even if the subsidy goes to the individual, what the plans cover is decided by the "administrator" and maintaining guaranteed profitability is a mandate. Very sick people usually don't have much money as they are often not fully employed and have to pay a lot of medical deductibles, even if they don't qualify for Medicaid, so they are most likely to end up in the cheapest (governmental) option.

Every time a tax hike for the rich has been brought up since Obama was inaugurated, the media is wall-to-wall "You can't raise taxes during a recession!" so the subject is quickly dropped. If there were something solid written into this bill about this source of funding I would feel more secure about the likely coverage. As it is, all I keep hearing is how the plans will be able to cover everyone because they will "eliminate unnecessary procedures". Your unnecessary may be my whole quality of life or even years of living.

This sounds similar to the Japanese plan, but w/ less coverage, and we all know how much it has helped their economy. (not)

[kjackson227]

4. No.

[Warpy]

6. Oh, please. Nothing is what I have now because I'm uninsurable.

Trust me, nothing is worse.

[clear eye]

8. I'm uninsured as well--fall through the cracks because my life's savings

are in the form of an IRA instead of a house, and I'm given the choice of insurance now while I'm underemployed and a few years too young for Medicare along with utter destitution in my old age, or taking my chances with ignoring problematic symptoms and having a little cushion when (or if) I'm really old.

What I'm afraid of is that the Medicare/Public Option I see unfolding in the current proposals will amount to "nothing" if you're really sick because you will be "cost/benefit"-ted out of the really effective treatments for many serious ailments, and merely given palliative care as you're allowed to die.

Believe me, I didn't write this because I don't get the importance of coverage.

[babylonsister]

7. No.

Whatever they come up with, pre-existing conditions will no longer be a consideration.

Insurance companies will no longer be able to selectively refuse to renew coverage if a condition gets worse.

Those two alone are worth the price.

[clear eye]

9. Not if you've retired and can't afford a private plan.

If what you want is a few insurance regulations you should be calling for a bill to provide that, not one that wrecks Medicare in the process and causes incalculable hardship for retired people.

[BlooInBloo]

10. More DUers joining with republicans. Wonderful.

[clear eye]

11. How many Republicans do you know supporting single-payer?

The authoritarian personalities that demand that people toe the party line or be called the enemy sound like Republicans to me.

[lumberjack_jeff]

13. You're not supportins single-payer. You're supporting the status quo. n/t

[clear eye]

15. Read my diary. Where in my OP do you see something against single-payer?

What I'm saying is rather than support a government plan so onerous, with such heartbreaking results for many very sick and older people that it sours the public on anything governmental, including single-payer, it might be better to hold out for something that doesn't prioritize profits over care.