Why Obama's Public Option Is Defective, and Why We Need Single-Payer.

[Orwellian_Ghost]

A public plan option might cut into private insurers’ profits. That’s why they hate it. But their profits — roughly $10 billion annually — are dwarfed by the money they waste in search of profit. They spend vast sums for marketing (to attract the healthy); demarketing (to avoid the sick); billing their ever-shifting roster of enrollees; fighting with providers over bills; and lobbying politicians. And doctors and hospitals spend billions more meeting insurers’ demands for documentation.

A single-payer plan would eliminate most insurance overhead, as well as these other paperwork expenses. Hospitals could be paid like a fire department, receiving a single monthly check for their entire budget. Physicians’ billing could be similarly simplified.

With a public insurance option, by contrast, hospitals and doctors would still need elaborate billing and cost-tracking systems. And overhead for even the most efficient competitive public option would be far higher than for traditional Medicare, which is efficient precisely because it doesn’t compete. It automatically enrolls seniors at 65 and deducts their premiums through the social security system, contracts with any willing provider, and does no marketing.

Health insurers compete by NOT paying for care: by seeking out the healthy and avoiding the sick; by denying payment and shifting costs onto patients; and by lobbying for unfair public subsidies (as under the Medicare HMO program). A kinder, gentler public plan that failed to emulate these behaviors would soon be saddled with the sickest, costliest patients and the highest payouts, driving premiums to uncompetitive levels. To compete successfully, a public plan would have to copy private plans.

Decades of experience teach that private insurers cannot control costs or provide families with the coverage they need. And a government-run clone of private insurers cannot fix these flaws.

Drs. Steffie Woolhandler and David Himmelstein are associate professors at Harvard Medical School. They co-founded Physicians for a National Health Program, a nonprofit research and education organization of 16,000 physicians, medical students, and health professionals who support single-payer national health insurance. For more about the group, go to www.pnhp.org.

http://www.progressive.org/mpwool072209.html



http://www.singlepayeraction.org/index.php

[natrat]

1. sadly we will end up with something worse than the present

[Dawgs]

2. It's impossible for anything to be worse.

Nice try though.

[natrat]

4. what do you mean nice try? some industry backed program goes through and bingo,worse

[snappyturtle]

5. Could this make is worse: people with pre-existing conditions getting

insurance at what cost? I think of pay day loans....no credit...no problem....extremely high interest. If insurance is mandatory I don't see the insurance companies taking on the added risk of pre-existing conditions and not profiting big time. I do not trust insurance companies and believe they should be out of the solution.

[truedelphi]

25. The executives of the major insurance companies should

be happy they are not doing jail time for all the negligent death lawsuites they are liable for.

[Kid Dynamite]

7. bad, worse, worst

you are dwelling. on the negative. We want to make it BETTER. There are many plans that fail to better the system, and the main reason is because they pander to Big Insurance, Big Pharma and god knows what other special interests.

You are asking: How can Hell be any worse? One way it can be worse is by NOT TRYING TO GET OUT OF HELL.

[natrat]

9. but we have no control, congress is corrupt beyond hope, well almost

[Kid Dynamite]

10. If that is true why do we keep talking about Congress?

An honest question

[ipaint]

8. Sure it will get worse

Not only will we end up right back where we started in 15 or so years as the crafted to fail public option dies along with any hope for cost containment, we will have a populace that is now absolutely convinced that government run insurance = epic fail.

And most importantly we will have imposed a law on everyone that forces them to buy overpriced insurance from for profit blood suckers.

Should be interesting to see what the repubs do when they are back in charge to this new large underclass of lawbreakers.

[superduperfarleft]

12. I agree 100%. Very few people on DU seem interested in hearing it, though.

[Bluenorthwest]

15. Forcing people to pay premiums they can not afford

to maintain Insurance with high co-pays and deductibles, could be much worse. Right now, my pals with no coverage save a bit to go to the doctor if they need to. If all of their money goes to premiums, they will not have money to use the benefits, which require even more money.
Right now, folks can skip the leeches and buy treatment, not Insurance. If they are forced into for profit plans, that is nothing but a shake down of the poor to serve the corporations. They will have to give up non covered treatments that many times are the only ones that work, in order to pay for premiums for benefits that they can not afford to use.
So it could easily be worse.

[maryf]

20. Paying premiums or being fined...

thats another thing to add to this post!! Shake down of the poor, good way to put it!!

[sutz12]

48. Every time I ever thought that things couldn't get worse, they did.

:shrug:

[Hannah Bell]

32. I think so too. I think it's going to be back-door defunding of Medicare & Medicaid

& mandatory private pay for most of the population, with the bogus "public option" = penurious care.

If the insurance cos are in, no savings except through denial of care & denial of claims for damages.

[bluethruandthru]

3. The country needs to change their mindset about "insurance"

and start imagining life without the worry of losing it.
Everyone needs to understand that insurance companies only goal is profit...not care. They only make money when they deny care. Still, so many are so afraid of single payer.
Would they like a for-profit fire department? The house catches fire but they tell us we only have one story coverage...not two. So they won't put any water on the second story...even though it's the second story that's burning. But the second story plan wasn't offered by our employer so, tough luck!

Ludicrous, right?

[snappyturtle]

6. Interesting analogy....if people would only think. nt

[maryf]

22. We need stop for profit insurance, and start demanding health care...nt

[superduperfarleft]

11. "A kinder, gentler public plan that failed to emulate these behaviors would soon be saddled with the

sickest, costliest patients and the highest payouts, driving premiums to uncompetitive levels."

QFE.

This public option, if it attempts to compete alongside private insurance, will fail. There's a good reason why Canada's system does not allow private insurance to compete against the government-provided plan.

And when it goes down, it'll take any chance of single-payer in this country with it.

I still amazed that people are cheering for this joke of a bill.

[natrat]

13. funny when you read between the lines in washington you always find evil,always

[TreasonousBastard]

14. Except for-- who pays for single payer? Right now...

Medicare pays HMOs around 800 bucks a month or pays fees to insurance companies to handle claims (one reason Medicare's expenses are so low) and if they paid the 800 bucks for the 40 million uninsured, it would be close to 400 billion a year. Just where is that money coming from?

Changing the mix of private and employer plans to single payer would also mean that well over half the nation would have its current health plans replaced--at what cost and confusion?

Every nation on earth with modern health plans had them evolve from existing patchworks of care. Our patchwork of care involves a mix of government and private plans, and that's really the only way to go forward.

(Besides, I've heard from Dr. Steffie before, and she's not only very happy with her Harvard employee health plan, but she doesn't seem nearly as interested in cutting her costs and billing as she is cutting insurance costs.)

But, hey, nothing wrong with demanding the impossible, or even the highly improbable.

[ipaint]

17. It's not confusing to continue to go to the same doctor you always did.

The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 45.7 million without health coverage and millions more inadequately covered.

This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.

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

[TreasonousBastard]

23. We've heard that arguent already, and it's tired...

An obstetrician charges $500 in England, $1,000 in France and $1,500 here for an uncomplicated birth. Why? And why are the other charges so high? Don't blame it just on paperwork or even malpractice premiums, although they do have some effect.

Since Medicaid, Medicare, and Tricare already have reduced their overhead by using HMOs and health insurers, how does single-payer ultimately reduce costs? How does it reduce the cost of a hospital stay? How do they now throw out the insurance companies they've been using all along?

How does single-payer deal with liver transpants, reduce the base cost of dialysis, or control end-of-life costs?

Where do you get your 31% figure from? Even if it's true, how much of that is phone bills, office rent, adjusters salaries, and other normal expenses that a government bureaucracy would still need if they took over everything from insurance companies?

[eridani]

30. By ending underwriting, recission, cherrypicking, lobbying and advertising

By forcing private insurance off of the Enron business model, essentially.

[TreasonousBastard]

35. OK, how much is that going to save? Underwriting...

is a very small cost, recission and cherrypicking are dealt with through regulation and have little to do with cost, and the lobbying and marketing costs are similarly low. But do you know what they are?

Numbers! Not platitudes or assumptions.

[eridani]

47. Regulation is expensive. Underwriting is a vast, huge expense to the public

--though a trivial one to insurers, who are useless sociopathic intermediaries. Underwriting forces the sick and poor into being cared for in the most expensive way way taxpayers. It means that kids like the one in Maryland whose mother didn't have $80 to deal with an infected tooth get $250,000 spent by taxpayers in a useless attempt to save his life.

Check out the following financing scheme proposed by WA State for single payer in one state. Let's get rid of those Enron health care shitstains!

http://www.healthcareforallwa.org/health-security-trust-summary/

Employers pay a health security assessment of 10% of payroll above a threshold of $125,000 per quarter. (In other words, the first $125,000 of payroll doesn't count.)

Residents 18 and over pay a health security premium of $75 per month, with state subsidies available for low income people. (My COBRA payment is now $450/month. Are there any idiots out there who hate taxes so much that they'd rather pay a $450/month "premium" than a $75/mo "tax"?)

Medicare enrollees pay a premium of $50 per month to add trust benefits beyond their Medicare benefits.

•State funds for health programs are transferred to the trust. Whenever the trust obtains federal waivers, funds for federal health programs will also be transferred to the trust. Until then, federal coverage remains in effect.

Patients will pay small co-payments for outpatient and emergency visits, and prescriptions.

Certain exemptions are included for low income families and employers facing financial hardship.

Employers may purchase private health coverage for their employees. However, the trust benefits package is intended to give employees better coverage than even the best current health benefit plans, which now cost employers 12-14% of payroll.

[TreasonousBastard]

49. That sounds similar to the Oregon proposal that...

Bush the Elder killed off saying it violated the Americans With Disabilities Act. Nobody at the time really believed it violated the Act, but the point is it never got a chance to see if it would work. Personally, I thought it sounded like a good idea, but we'll never know.

Be that as it may, it says it's working with 1999 data, and that is problematic. It also makes a lot of assumptions on cost savings, inflation, and avoids questions like the $45,000 per individual we spend on elder care each year.

More to the point now are questions of future costs and how to contain them. Reducing emergency room care and opening more neighborhood clinics with salaried doctors and staff would help a lot, but I haven't heard anything about that for a long time. I have heard that it's getting more difficult to get family care and primary care doctors, since they make so little compared to specialists. Nationwide, a primary care doctor averages maybe $150,000 while a dermatologist makes $450,000-- so, you got a bright intern with a half million in school loans waiting for him to get a job and which residency do you think he'll go for?

Insurance problems have nothing on the structural problems our system has managed to build into itself.

[ipaint]

31. I provided a link, use it to educate yourself.

[TreasonousBastard]

33. I read your link, and it doesn't address the practical...

problems involved. It's a nice piece of wishful thinking.

It does hint that doctors and hospitals should make less money, but nary a clue how to accomplish that.

[ipaint]

37. We do it the way every other industrialized country does

A single insurer (government) with or without a subset of non profit private plans which combined have the ability to negotiate prices for care for 300,000,000 million people at once. Taking away profit and the huge amount of wasteful overhead combined with enormous bargaining power is the only effective way to control costs.

[TreasonousBastard]

38. Not every other industrial country is single payer, and...

just how far do think anyone will get pounding medical fees down? Again, no one has an accurate number for how much is "wasted" and everyone is ignoring the negotiations going on now between government, insurance companies, and health providers.

Three trillion dollars a year of the GDP and *poof* we're just gonna tell everyone to make less money? Ain't gona happen.

We have a serious problem around here where the only three hospitals in the area claim they're going broke and need a huge fee increase from Blue Cross. Blue Cross wants a reduction, and is threatening to drop them from the network. Should there be only one payer demanding such a reduction, would these hospitals stay open with reduced services, find ways to save money without reducing services, or shut down? Blue Cross is so big here that they are facing pretty much the same question.

[blindpig]

16. k&r n/t

[madfloridian]

18. Using DU to oppose a public option?

That amazes me.

[foginthemorn]

44. Are you saying it is wrong? I disagree. It is past time Pres Obama

and Congress took a serious look at single payer rather than dismissing the notion. It deserves a chance to be debated--esp. now that all are concerned with the cost.

[maryf]

19. Big K&R!!

Of course!!! Health care for People, not for Profit!! the only option is a Single Payer Health Plan!!

[nightrain]

21. very cogent analysis. Big rec!! Thanks for posting it. nt

[ProSense]

24. But Kucinich said the bill is stronger and will help all Americans

So did Kucinich sell out?

[ProSense]

26. He actually said

"Protect" Americans.

[blindpig]

39. Wouldn't be the first time.

I had been a great supporter in '04 until he delivered that rancid speech at the '04 convention, complete capitulation. And all for that wretch Kerry. Very disappointing.

[ProSense]

41. '"supporter...until he delivered that rancid speech at the '04 convention, complete capitulation"

"Very disappointing."

I'm sure. :rofl:

[ProSense]

43. Oh and about that "wretch" Kerry

This should disappoint you further.

[blindpig]

45. Seeing as single payer is off the table that is useless

and I expect even that measure will be emasculated.

Whatever comes out of the sausage grinder is gonna make the insurance companies happy, or it won't happen. and that means the people are getting fucked again. Mandated insurance, will the public picking up the tab on the unprofitable clients is an absolute win for those vultures.(with apology to all feathered scavengers)

[ProSense]

46. Your first point says it all. LOL! n/t

[leftstreet]

27. K&R

[johnaries]

28. I would prefer single-payer, but I honestly don't think it stands

a chance of getting passed. A public option is a viable alternative.

[eridani]

29. Not if it is designed to fail n/t

[maryf]

36. The original one maybe...

The versions in different committees are too scant.

[maryf]

34. Kicking for health care! nt

[blindpig]

40. Everybody in, insurance companies out! n/t

[foginthemorn]

42. Too late to Rec--but will bump it.