I still don't know what a "public option" means

[SHRED]

In other words...what are the details of it?

The most costly patient demographics are covered by Medicaid and Medicare.
Private insurance loves the fact that they don't need to cover the elderly thus increasing their profit margins.

Will the so-called "public option" do the same and become a "dumping ground" that relives private insurance?
Who will be eligible?
Will the employee or employer decide?
Will those retired at 55 be eligible?


---

[rug]

1. It's GEICO without the lizard.

[titoresque]

31. googly eyes watching us?

:shrug:

[rug]

36. No, a competing insurance policy.

[titoresque]

53. I know, sorry.....dry humor. nt.

[lilwunder]

2. Public option i.e. think post office

The 'Public Option' would be an insurance PROVIDER that was controlled by the government. Since profit would not be a motivator, and the government has negotiating power, prices could (theoretically) be kept low. Anyone would have to option to purchase the Public Option, or choose to purchase insurance from a private company, or keep the insurance they have through their employer... if the employer keeps healthcare as a benefit for the employee.

No matter what the decision, all citizens will have to buy into one of the plans, if you choose NOT to have insurance there will be a fine / penalty / tax... currently it is listed at 2.5% of income I think. There are subsidies written in to help people afford the insurance, but the public option is not something that is just provided, even if you pick the public option, you will still have to pay for it. The purpose of the public option is to (theoretically) bring down the cost of insurance from private insurance companies.

[Le Taz Hot]

4. And when you don't have a job

to pay for this MANDATORY insurance?

[lilwunder]

5. looks like you would have 3 options...

1) Get a job so you could pay for it

2) Use your savings to pay for the mandated insurance, or the fine

3) Use the healthcare that is available to the impoverished.

[Le Taz Hot]

6. And this is different from what we have now

in what way? (Honest question, not a snark.)

[lilwunder]

7. Good Question...

I agree, but this has been in the bill (3200) the whole time, this is why it is important for people to understand what they are fighting for. This is going to come back and bite us, and put healthcare reform another 100 years!

[DireStrike]

49. Most people are not fighting for a particular bill

Pretty much all of the bills in congress are bad ones. I don't know of anyone in any political party who likes the idea of mandatory insurance purchasing. This is a surefire loser, and if the politicians want to lose their jobs they will pass something with this.

[Ms. Toad]

11. The difference is not so much in the availability of a public option

but in the new insurance restrictions (which also apply to the public option).

Any new insurance policies cannot reject anyone for pre-existing conditions, must cover pre-existing conditions, cannot charge more for issuing a policy to people with pre-existing conditions, and cannot have lifetime caps. There is some price variation for age (I believe the house bill permits a 2:1 ratio from the top of the scale to the bottom). There are subsidies (which can be used to purchase either the public or private option) for incomes up to 3 or 4 times poverty level

The rules start in 2013 in the most detailed house bill and are phased in over several years. The headline on the "compromise" bill which came out yesterday suggested it might even be longer, but I haven't read the bill.

Under most proposals, insurance (either public option or private insurance) is mandatory and enforced by meanso of fines.

The role of the public option is to provide competition to the private insurance companies. In my opinion, that will be a minor price driver compared to the mandatory uniform policy costs, and including everyone in the insurance pool. These two factors will average the cost of health care over teh entire population. That means young healthy people will pay more (either more than their non-insured choice now - or more than their super cheap policies based on age and health), and older people or those with costly health conditions will pay less (and will actually be able to get insurance, which many cannot now).

[treestar]

48. Don't you qualify for Medicaid then?

[kctim]

26. Then it's not really an "option" then, is it?

"even if you pick the public option, you will still have to pay for it"

[KoKo]

3. Explanation here with links to articles...

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6485037&mesg_id=6485037

[RKP5637]

8. Public Option

Public Option = The public option would be a government run plan as a choice for health care instead of private health insurance. HOWEVER, the public option would be competitive with private insurance from a cost basis, but would not prevent competition from the private insurance sector. In essence, the public option would work to keep private insurance cost under control. To me, the public option would define the benchmark for fair and cost effective insurance in the private sector while not excluding the private insurance sector.

[Buzz Clik]

9. That's something that you must support fully or risk the wrath of some posters at DU.

Get on board. The train is leaving the station.

[Ms. Toad]

15. Ding-ding-ding...

But most of those posters couldn't define what that means.

My biggest fear is that we will lose the insurance reforms that there seems to be wide agreement on (which will guarantee access, coverage of pre-existing conditions, and premium uniformity) because the ultimate bill doesn't include something (anything) called a public option.

I would strongly prefer single payer, but if single payer is not politically feasible right now a public option would be a nice thing -BUT - having a public option is far less crucial than requiring that insurance (which will continue to exist under any proposal with a chance of passing) be available to everyone at a uniform rate and cover pre-existing conditions.

[Buzz Clik]

24. Number 1 priority -- overriding all else -- is getting everyone insured.

Number two is reforming health insurance followed closely by reforming health care.
It would be awesome if the public option is part of that equation.

[Ms. Toad]

34. I agree. n/t

[blondeatlast]

27. I've advocated single-payer for over a decade, long before it

was fashionable. I realize we aren't going to get it anytime soon. But as a longtime insulin-dependent diabetic, I feel pretty comfortable supporting the public option as it is currently defined. Some of my fellow SP advocates are appalled--but to a one, none have a pre-existing condition.

It makes a HUGE difference.

[Echo In Light]

29. +1 ... even though you probably don't "know what it means."

ugh

[treestar]

50. The pre-exsiting condition rule

Sounds like it would make insurance available to many who don't have it.

I don't understand this drawing of a line in the sand over the Public Option, since without it there is still improvement in the current situation.

[Ms. Toad]

52. That and the guaranteed access, and pricing uniformity

Folks with pre-existing conditions get hit in three ways: (1) complete denial of insurance (access) and (2) issuance of a limited policy that denies coverage for certain pre-existing conditions adn (3) risk based pricing (for me that means that even though my particular pre-existing condition is not costly to treat and I'm otherwise healthy, IF I can find a policy on the open market the coverage costs about $42,000 a year)

The insurance reform proposals eliminate these barriers to coverage for folks who have money to pay a "reasonable" rate in the ballpark of $5000-$8000 a year. We'd still need subsidies for those who can't afford it - but even without a public option these changes alone would make insurance available to a lot of people who can't get it now even though they are willing and able to pay for it.

[TreasonousBastard]

17. That's the important part-- whatever it is, it must be good.

[BurtWorm]

10. Ask yourself the question Anthony Weiner asked Joe Scarborough:

What value do private insurance companies add to American health care? If you can answer it, please do so here.

[SHRED]

12. I want single-payer

Insurance vultures must go.

[BurtWorm]

14. Ok. I agree with you there.

Still, if we get a public option, we are much further to that goal than if we don't have one.

[berni_mccoy]

13. Have you read HR3200? That's the best legal definition for a Public Option that is being considered

[TahitiNut]

16. What the 'Public Option' is or isn't depends upon whether you're for or against it.

No. Really.

:shrug:

[lilwunder]

18. no

No, it isn't. Whether you agree or disagree, that won't change. Whether or not the Public option actually brings down insurance cost, or increases them... that doesn't change what it is. It is an OPTION for people to choose, but, they still will have to choose and pay, or be fined.

[TahitiNut]

21. Q.E.D.

:shrug:

[Ms. Toad]

22. I agree with you, but what people say or believe it is does

change based on their bias toward or against it.

A public option is merely a government run insurance plan.

If it works as its advocates predict, it will bring down costs by competing with private plans under the same restrictions imposed on all insurance options (and perhaps have better bargaining power because of its size/government backing). In order to attract customers, private insurance companies will have to cut their costs (i.e. profits). All plans (private and public) must take all applicants, all plans must cover all pre-existing conditions, all plans are prohibited from capping maximum lifetime payouts, and all plans must have relatively uniform pricing (variations currently proposed to be permitted are for age and geographical location, but not health or gender). All are eligible for subsidies for lower income individuals.

If it works as opponents fear, it will be so successful that it will drive private insurance companies out of the business.

Personally, I suspect it will do neither. I don't see the USPS either driving costs down at FedEX or UPS, nor do I see it driving either out of business.

[blondeatlast]

28. True on DU, certainly! nt

[spanone]

19. edumacate yourself

www.google.com

[TreasonousBastard]

20. Don't worry, nobody knows what it means, just...

they're for or against it. The details, as always, are irrelevant, but the concept of a public option is that whatever else bad happens with healthcare, there would be some sort of safety net for the un- and underinsured.

For those who want it, it's the next best compromise for those who want single-payer. For those who hate it, it's socialized medicine.

Lost in all of this is the simple concept that started the whole thing-- universal and affordable health care. It seems the way we get there is more important to some than whether we get there or not.

Those details, though... Yeah, it could end up being be an "assigned risk" pool for the unhealthy, and then in two years we start arguing over who pays for it.

[Ms. Toad]

23. Not if we stop demanding a public option at all costs.

There is wide agreement on changes to the insurance rules in every bill I have reviewed (aside from the single payer bill) that would abolish risk pools for the unhealthy, and put everyone (young or old, healthy or not) in the same pool. Everyone would be entitled to full coverage insurance, including pre-existing conditions, at the same cost (with variations for age and geographical location currently). There are also caps on profits (although probably not tight enough caps to prevent the premiums to be higher than they ought to be).

Subsidizing the uniform premiums for people making lower incomes is apparently why the changes don't take effect until 2013.

If the cost of a public option is the status quo, and we lose the new restrictions proposed for universal coverage, it will be a long time before we have the opportunity again. Around 1996 was the last significant move toward universal coverage - virtually no one knows about it, but if you have had insurance for 18 months (and jump through the proper hoops) you are entitled to obtain coverage (including for pre-existing conditions) once your original insurance ends under HIPAA. Unfortunately, there are no restrictions on what can be charged - but a small portion of the otherwise uninsurable population does have an absolute right to purchase insurance. We cannot afford to be stuck there because we can't make it to the single payer (or even public option) goal line.

[TreasonousBastard]

30. But, like almost every other comment, you ignore...

the basic costs underlying any form of insurance-- the enormous cost of healthcare delivery here that is higher than any other country on the planet.

I see no problem with regulating healthcare companies far more than they are now, but if we demand that they accept a cancer patient, tell them what the premium will be, and then order them to pay $50,000 and up a year for treatment, we cannot expect things to end well.

We also have had no discussion on coordinating or combining the existing healthcare benefits, programs, and coverages-- publicly owned hospitals, workers comp, seamen's Jones Act care, automobile no-fault medical coverage, SCHIP and Medicaid and other existing programs started or administered by the states, Indian Health Service, and the big dogs of employer paid insurance, Medicare, VA, and Tricare. These are only off the top of my head, and I'm sure there are more ways to get someone to pay for some care.

One of my own anecdotes is the time I got rearended while on company time. I went to my HMO doctor at the time and while payment was being shifted to workers comp everyone was up in the air how to treat my injured arm. Finally, Comp paid for an orthopedic specialist and physical therapy. I sued the guy who hit me, and his auto policy eventually reimbursed the medical bills. Then, they refused to settle with me over the injury, so we went for and additional $15,000 in comp medical expenses, including the very nervous doctor the lawyer sent me to who wrote a report saying I was pretty much on my deathbed. Over $20,000 in medical bills, over $15,000 of which were to prove I had an injury worth the $3500 settlement I asked for but they refused.

The more one digs into the subject, the more complex, and insane, it becomes.

[Ms. Toad]

35. I am absolutely not ignoring the underlying costs.

The average cost for health care is around $5000-$8000 a year for everyone - including those $50,000 a year individuals and the $50 a year individuals.

Currently, those costing $50,000 a year either cannot get coverage (and they either pay out of pocket or the provider passes a portion of the loss on that treatment to everyone else it serves), or are being charged $14,000-$50,000 a year for insurance.

Those costing $50 a year are currently being charged $1000 a year (or so - I haven't checked those premiums recently).

In order to cover the underlying costs, everyone will be paying an average premium - enough to cover the $5000-$8000 a year plus profits and administrative fees, with some age variation. No one tells the insurance company what it is permitted to charge, but the legislative proposals do limit the profit (what is charged beyond what it takes, on average, to cover the care provided.

That is the structure set out in the house bill - and every other bill that includes private insurance companies I have read.

As to all of the other sources of payment - generally, they are mutually exclusive as long as private insurance is in the mix. For the most part, if you are eligible for one, the others will deny payment. To fix that mess, we need single payer and we're not getting there this round.

[TreasonousBastard]

41. Still talking about "coverage" not why...

it costs $50,000 a year for some cancer treatments. A lot more for others. Does it cost that much to deliver the same treatment in France? Japan?

European dialysis patients can book "dialysis cruises." I'm curious how much it costs to get your treatment on a ship off the Riviera vs. in a hospital or center here. Insurance or not, it generally costs a lot less to get patched up
over there than here. I doubt it's cheap enough to cover the cruise, but you never know...

$2.4 trillion is the generally accepted number for the amount health care contributes to the GDP, but nobody bothered to figure out how much of that is boob jobs, tattoo removal, litigation evidence, general waste or other amounts that aren't actually health care.

No matter, it still comes out to around $7,500 per person. That's $30,000 for a family of four. Look closely and you see it's mostly spent at the beginning and end of life, so comparing the 30 grand to the median income isn't as scary as it looks. Well, except maybe for parents-- how much is spent on the total care from the time a woman finds out she's pregnant to the child is grown enough to be over the usual childhood problems? How much more for fertility treatments, extraordinary childhood problems...

Oh, and that $7,500 is taking 2.4 trillion and dividing it by the total population-- including the 40 million or so who are not currently insured. If they WERE insured, the total would likely go up. Way up.

Anyway, right now we have to figure out a way to come up with over 7 grand for every person in the country, realizing that a lot of them, at least half, don't have 7 grand lying around. And let's just say we have to come up with another 7 grand each for the 40 million uninsured-- that's close to 300 billion more.

So, the wisdom goes that we'll save a few hundred billion in insurance company waste to pay for all of this, but nobody's bothered to even run the basic numbers properly-- nobody knows what it SHOULD cost to treat a simple fracture or do a bypass. Or what a doctor's visit for chest pains resulting in a simple URI diagnosis should cost.

Just what IS in that 2.4 trillion everyone talks about?

[Ms. Toad]

42. Sorry, but at this stage coverage - or access to health care

if you prefer - is the critical thing that must be addressed. Far too many people right now do not have access to health care, and that is my top priority. Shaving the waste is far down the line in my priorities.

Once people are no longer dying for lack of access to health care, then I'll be willing to talk to you about making the system more efficient. A tourniquet is a rough tool, and admittedly does some damage in the process of stopping the hemorrhaging - but ultimately it saves lives. That's where we are right now. Once the bleeding is under control, I'm willing to discuss how a tourniquet might be refined in the future so that that might do less damage in the process of saving lives - but not while people are literally and figuratively bleeding to death.

For what it's worth, you're talking apples and oranges with your numbers. About $7500 per person is in the middle of the range I noted; nice to know it is consistent with 2.4 trillion divided by the population. But the 2.4 trillion includes money already in the system. You don't have to come up with $7500 more for each person - many of those are already covered by insurance that puts, in that ballpark, that much money into the system already. Adding a public option and imposing insurance equity doesn't remove the money already in the system from the system. We will need to come up with the money to provide access to health care for the currently uninsured individuals - some of which will come out of individual pockets and some of which will need to come out of our collective pocket in the form of subsidies.

I am sure there is waste in that $7500/person that can be trimmed - but as I said, I'm not willing to dicker over systemic inefficiencies until the bodies stop hitting the floor. If we can come up with money to bail out wall street and the auto industries almost immediately, we can come up with the money to save people as well. I am far more willing to go into long term debt to provide access to health care for individuals than I was to bail out either wall street or the auto mile.

[goclark]

25. Thank you ~ I still don't get it either

I have begged at DU for a 123/ABC explanation of single payer and public option.

Now I am more confused because everyone is reading the little print now (that is a good thing)but the little print keeps changing according to the politician/expert that is explaining it.)

We need to DO something about Health Care in America and the public needs to understand quick!

Tonight, President Obama needs to have charts and 123 language or we are back to square one.

The Republican message is easy to remember on Health Care -- " JUST SAY NO" to whatever the Democrats try to say.

Come on Democrats ~ keep it simple please.

[Romulox]

32. It's the sugar coating on mandatory, for profit insurance.

The first rule of any Public Option is that you and I are not likely to qualify for it.

[Junkdrawer]

37. That's what it is now...Didn't start as that...But that's what it is now...

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.

...

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

[peacetalksforall]

33. Debate debate. In the end - it's affordability, affordability right now means non-profit for x per

cent of citizens, private option means profit from x per cent of citizens who can afford it.

I think the label for this should have been 'private option'.

The problem is that the range of people in this country and what they can afford runs from zero to plenty.

The problem presently, is that we can't afford any more uninsured people - everyone needs help unexpectedly and few practice illness prevention.

[madfloridian]

38. It's the government competing with private insurance to bring down costs.

It's a good thing. Like Medicare. Single payer would mean only the government option with the insurance companies left out. Since they control our country now...good luck on that.

[lumberjack_jeff]

39. You should

the explanation has been posted many times in the last several months.

You can't miss it, if your motivations are anything other than obfuscating the truth.

As envisioned by HR3200, anyone who is eligible to purchase insurance from the exchange is eligible to select the public plan.

[Ms. Toad]

40. Thank you for reposting the link to one of the better summaries

of HR 3200, but with all due respect, I know what a public option is and the explanation provided at the link is not a clear one:

"One of the many choices of health insurance within the health insurance Exchange is a public health insurance option. It will be a new choice in many areas of our country dominated by just one or two private insurers today. The public option will operate on a level playing field. It will be subject to the same market reforms and consumer protections as other private plans in the Exchange and it will be self‐sustaining – financed only by its premiums."

No real explanation provided there at all. Here is a clearer explanation: a public (health insurance) option is health insurance plan run by the government, rather than by a private insurance company.

The link you provided is one of the better summaries of the bill, but it still intertwines the explanation of the insurance reforms aspects of the bill and the definition of a public option.

How the public option operates is also part of HR3200, but is not an essential part of defining what a public option is. If a different bill is passed, how the public option plan operates (and its chances of being an effective option) may well be quite different.

I would love for everyone to understand both what a public option is, and what the bill says - but the reality is that far too many of us don't - and because we don't, we can't counter the death panel allegations, for example. If we don't know (and can't point out) that the relevant section of the bill merely adds one more thing (end of life counseling) to a list of things permitted to be paid for by Medicare, we are stuck with the not terribly effective response that death panels already exist. The consequence is that payment for a vital end of life planning tool is now left out (and only available to those who can afford to pay out of pocket) because we could not effectively counter the ranting and raving of idiots because we were not that much beyond idiocy in our own understanding of what was proposed.

I am grateful the question was asked - and I am pleasantly surprised that there are as many responses grounded in reality as there have been.

[lumberjack_jeff]

43. There are a number of misconceptions here about public option that are like kudzu.

One of the main ones is embodied in the OP. "Won't the public option simply become the insurer of last resort? Those rejected by private insurers?"

Misconceptions like this should not be so common here.

[Ms. Toad]

45. It could well be the insurer of last resort.

If only a public option is implemented, and not the rest of the insurance reforms in the bill. In that case the public option will be the insurer of last resort (and will fail because it will be so expensive no one can afford it). As long as the insurance companies are permitted to play by special rules, they will continue to reject people, who will have no option for insurance but the public option. That will drive up the price of the public option (which is mandated to accept everyone and to charge enough to cover its costs) so that no one other than folks who cannot find insurance elsewhere will opt for the public option.

That is why it is so crucial to flesh out what is meant by a public option. Without further definition, a public option doesn't mean anything more than an insurance plan run by the government. What makes it not a dumping ground in HB 3200 are the reforms that govern not specifically how the public option operates, but how all competing insurance companies will be required to operate (including the public option).

[lumberjack_jeff]

46. Has anyone suggested dropping the other reforms?

Every bill, every rumor I've seen;
a) ends recission
b) establishes an exchange
c) prohibits insurance companies from dropping people for any reason other than nonpayment
d) ends preexisting condition exclusions
e) eliminates all actuarial criteria other than age and gender (Baucus' plan also apparently includes marital status and tobacco use)

I don't think there's any doubt that these things will be part of any bill, if for no other reason than you can't have compulsory coverage when the insurance companies reserve the option to refuse you.

[Ms. Toad]

47. Those features are in the bills I have seen

Compulsory coverage is also in the bills I have seen - but just because things are currently in the bill does not mean they will end up there. If compulsory insurance is dropped because of substantial public resistance (and it is growing), there will be responsive pressure from the insurance industry to drop the rest of insurance reforms. That would leave us with a public option without insurance reform - and in that case the public option would be the dumping ground for those who can't get insurance elsewhere since the insurance companies could continue to thumb their noses as the currently uninsurable individuals.

The problem is, all we have been demanding is a public option (or the meaningless phrase "strong" public option). A public option doesn't inherently include the other things that are currently in the bills - which are then subject to being bargained away if what is of overriding importance is the mere existence of a public option.

To make sure reform is not meaningless, we need to demand not only a public option - but also insurance reform; a public option without accompanying insurance reform WILL fail, since it WILL be the costly dumping ground for everyone who cannot obtain insurance elsewhere.

[TransitJohn]

44. Private = for profit (always)

Privatization of Social Security = bad.

[Kurt_and_Hunter]

51. I don't know how a unicorn tastes, so we are in the same boat.

A joke, meaning we will probably never need to know in real world practice because it will never come up.