"Public plan is doomed by design". Explaine why this isn'/t true.

[napi21]

Just heard a Dr. on KPOJ that the public HC plan is doomed by design. The working people WITH ins. today are not eligible for the public plan. Working people are the healthiest people. The people who aren't working are the sickest, so the sickest people will sign onto the public plan, making it much more expensive than those the ins companies cover. In 2-3 years it will become obvious that the public plan is way to expensive to afford to continue it and it will be a major failure.


This was all said by a Dr. who was just on the Oregon radion station KPOJ. I have to admit, it sounded to me like what he said made sense. What do you think? I honestly hope he's wrong!

[FormerDittoHead]

1. Yes. The fix is in. See who was THERE. PLEASE look at this:

http://www.npr.org/news/specials/2009/hearing-pano/

We WILL get a public option but it won't result in any meaningful competition:

http://news.yahoo.com/s/nm/20090727/hl_nm/us_usa_healthcare_4

"...The CBO report estimated only about 10 million to 11 million people would sign up for the public option by 2019..."

WHAT THE HELL GOOD IS *THAT* GOING TO DO?




.

[Eric J in MN]

2. Companies with 25+ employees will be banned from using the public option...

...unless they get special permission.

[cloudbase]

3. That's true.

Adverse selection of participants.

[SammyWinstonJack]

4. "Working people are the healthiest people." Except for those who are overworked and stressed out.

Except for those who can't afford their health insurance premiums or don't have health insurance offered by their employer and can't afford to seek treatment.


The people who aren't working are the sickest, so the sickest people will sign onto the public plan, making it much more expensive than t hose t he ins companies cover.

Damn those lazy people! They're the reason we can't afford a public plan. :eyes:

Do these a$$hole$ ever listen to the absolute bullshit they spew?

[RDANGELO]

5. He is ignoring the most obvious.

The private insurance companies operate for profit. The public option can operate at cost.

[harun]

9. Exactly, the public option isn't going to try and increase its share price

by 15% every year by reducing coverage.

[SammyWinstonJack]

11. Well that doesn't fit into his blame the 'non-working' sickest people BS. How convenient for him.

[lumberjack_jeff]

6. In the first two or three years, there will be some adverse selection.

The uninsured who are most desperate for help are probably those who are the sickest. Costs will be higher in early years, and the Repukes will use these higher costs to argue for abandoning it.

However, the public option will use Medicare +5% as a reimbursement rate. The costs are pretty well-defined and will be much lower than the competing private plans in the exchange.

Because of the way the subsidy is set up there's no incentive for the public to choose the cheapest among otherwise equal plans. The public option will therefore have fewer customers initially. The fix for the problem is simple. In Y3 when the trends are obvious, cut funding by changing the subsidy so that the government will pay affordability credits based on the cost of the cheapest option. This will provide incentive for people to choose the public option.

As the insurance plans for large companies expire, those companies will migrate to the health insurance exchange. It will normalize over the following years.

The problem is real but temporary, and the CBO has accounted for it.

[superduperfarleft]

10. "However, the public option will use Medicare +5% as a reimbursement rate"

Has there been any allowances made for the fact that many doctors won't want to accept patients on the public plan because of the lower reimbursement rate? I seem to remember them specifically not requiring participating among providers, but I could be wrong.

[lumberjack_jeff]

15. It is assumed that anyone who takes Medicare/Medicaid will take public option patients.

After the plan has some track record, they plan to negotiate new rates with providers.

Personally, I think that's the wrong idea. They should stick with medicare reimbursement rates and squeeze the other insurers out by encouraging people to choose the public option. Doctors and hospitals will then have to take the lower reimbursement rate.

[superduperfarleft]

16. But if the public option is "competing" alongside private insurers

Why would doctors agree to see public option patients when they can make twice that seeing the people on private insurance plans?

I don't think it's right, I just think that's reality.

[lumberjack_jeff]

19. Doctors will feel economic pressure to take the insurance their patients have.

If most of 'em have the public option, that's good.

Besides, in a competitive environment, profit insurers can't leave their reimbursements (and premiums) in the stratosphere.

[superduperfarleft]

21. This is partly why Canada doesn't allow private insurers for primary services.

There are already issues where Medicare and Medicaid patients can't access care from many doctors, and one of the competitive advantages private insurers will have is that they reimburse at a much higher rate. I guess my concern is just how competitive the public option will be.

[Progressive_In_NC]

7. All this does is remove the risk pool from the insurance companies

Thus making them more profitable.

Sounds like corporate lobbies win again.

Steven

[harun]

8. Answer: Where do you think the money to provide care from these

sick people with no insurance is coming from now?

Which is of course a question. One that leads to the real answer. That is insurance and the gov't are subsidizing care for these people already.

[superduperfarleft]

12. I agree with him.

It has nothing to do with whether or not working people are healthier than non-working people, it has to do with the fact that the people who are desperate right now are the ones that are sick and can't get insurance elsewhere (otherwise, they'd have it). These people will immediately gravitate towards the public option, leaving the private insurance companies with nothing but the moneymaking machines that are young, healthy people.

Nevermind the fact that not requiring providers to accept patients on the public option will create the exact same tiered system of care we have today.

When the public option starts bleeding money, the right will use it as an example of the "failure" of government-run health insurance, and single-payer (which should be our eventual goal) will be doomed for generations.

I hope I'm wrong, but that's how I see it playing out.

[TreasonousBastard]

13. He's working on a few faulty assumptions...

the first being that the healthiest people are working people with insurance and everyone else is pretty much on their deathbeds.

There is a major problem with smart people talking about things out of their area of expertise. And there's that old wisdom about a little knowledge being a dangerous thing...

The good doctor may be an excellent physician, but he's reinvented "adverse selection" which is a problem with statistical anomalies and has been basic to such things as insurance underwriting, banking, and even retailing. and it's behind Gresham's Law in economics. Essentially, if you price something to an average market price, savvier people will find it cheaper and your customers will be the dumb ones, or the ones not fast enough to get the cheap price before it disappears.

This may be OK if you're selling shoes, but if you're selling insurance at a group rate, the rate will reflect the bad risks as well as the good, so the best risks will manage to find a policy a little cheaper somewhere else. Eventually, you will be stuck with nothing but bad risks who are paying at a rate far below what they should be. So far, the doctor understands this.

But, underwriters get around this in a number of ways, one of which is simply refusing to do business with the plans most at risk to devolve this way. Some other ways are flexible rating, deeper analysis of the groups, and mutual associations with dividends and premium calls.

All that, however, doesn't really count for much since we already have vast experience with Medicare and Medicaid which are exactly the sort of public plan he claims is doomed to failure. This, the doctor has deliberately ignored in order to make his point.

[napi21]

18. I disagree with you on the analysis of medicare/medicaid.

Medicare has been successful BECAUSE everyone over 65 MUST sign up for it. In that case, you have the healthy as well as the sick in the pool. In this public option there doesn't seem to be an incentive for the healthy to sign on, thus leaving mostly the sick (or currently uninsurable) to enroll.

I'd like to see some mandatory basic coverage where EVERYBODY had to enroll. Insurance companies could then be free to offer supplemental ins. for broader coverage. IMO, both the public & the ins. cos. could do well.

[TreasonousBastard]

20. Everyone? SS recipients are automatically signed up, but...

I didn't know there was a requirement for everyone to sign up. Besides, I believe it's Part B that has the premium deducted from SS payments, so you have the option to sign up or not.

Be that as it may, however, everyone on a payroll pays medicare payroll premiums (again-- that's not everyone) but the senior population is the demographic that gets the most, and the most expensive, care.

The mandatory coverage thing is a bit of a problem, with a lot in Congress dead set against it. Personally, I don't have much of a problem with it, but it's something that will need a very hard sell.

Perhaps a compromise is where EVERYONE pays a premium, whether enrolled or not, but you pay a little more if you sign up. The other way 'round would be more fun, but has even less of a chance of ever seeing light.

[OneBlueSky]

14. a partial fix like the "public option" has never been a realistic approach . . .

as long as insurance companies are allowed to skim 30% or more off the top, our healthcare system will remain broken . . . the ONLY real fix is universal single payer insurance for all that removes the profit motive from the healthcare equation . . .

no corporation should be allowed to profit from the misery of others, which is exactly what they are doing every day . . . and building a "new" system which maintains insurance companies as its central, controlling feature neglects the single most crucial aspect of healthcare reform -- removing the profit-motivated "middle men" that now control the entire system . . .

[ipaint]

17. Obama's Doctor: President's Vision For Health Care Bound To Fail

The man Barack Obama consulted on medical matters for over two decades said on Tuesday that the president's vision for health care reform is bound for failure.

Dr. David Scheiner, a 70-year Chicago-based physician who treated Obama for more than 20 years, said he was disheartened by the health care legislation his former patient is championing, calling it piecemeal and ineffectual.

"I look at his program and I can't see how it's going to work," Scheiner told the Huffington Post. "He has no cost control. There would be no effective cost control in his program. The said it's going be incredibly expensive ... and the thing that I really am worried about is, if it is the failure that I think it would be, then health reform will be set back a long, long time."

Scheiner was hesitant about trying to divine the president's motives, although he said he believed that "in his heart of hearts" Obama "may well like a single-payer program. But his pragmatism is what is overwhelming him." Scheiner added: "I think he's afraid that he can't get anything through if he doesn't go through this incredibly compromised program."

http://www.huffingtonpost.com/2009/07/29/obamas-doctor-presidents_n_246870.html

There are a lot of people who understand this is a guaranteed failure from the start. The something better than nothing strategy is a losing one given the insurance companies are writing the plan. It will take a mass movement of folks middle class and below speaking with one voice demanding a canadian style/medicare for all plan for any chance at real reform.