Ezra Klein: 'The Public Option Act'

[ProSense]

'The Public Option Act'

This is a good idea:

Congressman Alan Grayson, (D-Orlando), today introduced a bill (H.R. 4789) which would give the option to buy into Medicare to every citizen of the United States. The “Public Option Act,” also known as the “Medicare You Can Buy Into Act,” would open up the Medicare network to anyone who can pay for it. ...

The bill would require the Secretary of Health and Human Services to establish enrollment periods, coverage guidelines, and premiums for the program. Because premiums would be equal to cost, the program would pay for itself.

“The government spent billions of dollars creating a Medicare network of providers that is only open to one-eighth of the population. That’s like saying, ‘Only people 65 and over can use federal highways.’ It is a waste of a very valuable resource and it is not fair. This idea is simple, it makes sense, and it deserves an up-or-down vote,” Congressman Grayson said.

Comprehensive visions for reform and incremental visions for reform have been at odds throughout this process. That was proper, in many ways: When you're building a new structure where the different parts work together, you have to be relatively comprehensive about it. But once that structure is constructed, incrementalism makes a lot of sense. Want a public option? Write the bill. Want to outlaw fee-for-service in the exchanges, or give a tax break to insurers who are constructing networks where the doctors have a different payment structure? Offer it in committee. Think subsidies should be higher, or maybe lower? Amendments are a wonderful thing.

A lot of these reforms become easier to implement when there's a place to put them, and incentives you can offer to encourage their adoption. The exchanges are a big step forward in that regard. The public option is a good example. If we passed a public option now, how would you get it, exactly? Call the government? And how would you handle the adverse selection problem, where sicker people who were rejected by private insurers would use the government's offering as a last resort?

There are a lot of other good ideas that wouldn't work very well in the current system, but work a lot better when you've got a simple marketplace where a lot of different insurers are competing with transparent prices, standard descriptions, and some basic rules of the road. You need a comprehensive bill to set that up, but it can play host to a lot of incremental legislation going forward.

Everything offered in the way of a public option has to rely on comprehensive reform.

[CTyankee]

1. Why didn't Grayson or someone else in Congress do this at the outset?

I don't get it...

[Donnachaidh]

6. why didn't the WHITE HOUSE do this from the onset?

hmmmmm?

[CTyankee]

7. I think it's because Obama really believed that he could get a public option

in the hcr package that would sow the seeds of destruction of the private insurance companies hold on the market. All the Dem candidates for Pres. had a public option built into their reform proposals. That was because they were hearing from people who said they liked the insurance they had, so the PO was an add on. Well, that was in 2007. We've seen the outcome. This has GOT to have been a bruising experience for Obama and one he perhaps didn't anticipate back then. Now he's got the worst of all possible outcomes.

I don't think Obama "saw it coming."

[pundaint]

9. He freakin' took it off the table at the start - stop glossing this shill as for the People!

[CTyankee]

13. Oh, c'mon, shit happens...I will criticize Obama for lots of things as I did Clinton before him,

but this whole "Obama was a secret corporatist" stuff is just juvenile...I think that history shows that most presidents screw up when they underestimate or completely ignore the power of the entrenched power structure against them and they do not know what to do in response. LBJ is a good example of a leader on domestic policy led completely astray by the military whose cooperation and approval he so desperately wanted.

Obama wanted to be a president of the people, all of the people. His hubris was believing that HE was different and could do what nobody else had done. He believed his own legend. It was never real. We are still a racist country in so many ways. The depth of that racism was a bit of surprise to me, because I basically thought that the American people had largely outgrown that. I am sadder but wiser myself...

[ncteechur]

11. Why don't you write a letter and ask him?

[CTyankee]

14. Sure. Will you? nt

[ShortnFiery]

10. Because they KNOW it will never pass the Senate but it may DUPE enough of the House

progressives to vote for the shitty Senate Bill "just in case."

Grayson is a Pseudo-progressive. He talks a good game but, in essence, accomplishes NOTHING.

[CTLawGuy]

22. I think you're confusing him with Dennis Kucinich

NT

[IndianaGreen]

12. HR676 was the Medicare for all bill--the single payer bill that was kept off the table

by you know who.

[njlib]

15. Wasn't HR676

Kucinich's bill? Didn't he suggest exactly what Grayson's suggesting now?

[IndianaGreen]

16. It was John Conyers' bill--with 93 co-sponsors

http://thomas.loc.gov/cgi-bin/bdquery/z?d110:HR00676:@@@P

[slipslidingaway]

19. No a Medicare buy-in is quite different from an improved Medicare for All bill...

Grayson’s “Public Option Act” or “Medicare You Can Buy Into Act”

http://pnhp.org/blog/2010/03/12/graysons-public-option-act-or-medicare-you-can-buy-into-act/

Comment by Dr. McCanne


"Throughout the reform process members of Congress have been fighting over whether or not the reform legislation should include the option of purchasing a government-sponsored plan through the proposed insurance exchanges – the so-called “public option.” Since Congressman Alan Grayson introduced the “Public Option Act” or “Medicare You Can Buy Into Act” three days ago, a wave of enthusiastic support has been generated based on the perception that this is the perfect solution. Today’s comment briefly discusses this legislation, and it will sound really great at first blush, but do not draw any firm conclusions until you read through to the end.


...Although Medicare is a very popular program, it is highly flawed. It has an oppressive central bureaucracy. It fails to use more efficient financing systems such as global budgeting for hospitals and negotiation to obtain greater value in health care purchasing.

...When we advocate for an improved Medicare for all, we really aren’t advocating for Medicare with a few tweaks. We are advocating for replacing Medicare with a single payer national health program that covers everyone, which we can still call Medicare, just as the Canadians do. Adding another buy-in program to the two buy-in programs that already exist in our highly dysfunctional system will do virtually nothing to fix these flaws we now have. It does nothing to slow the growth in our national health expenditures, and the high premiums for a package of mediocre benefits will do little to reduce the numbers of uninsured.

For those who say that a Medicare buy-in is an incremental step towards health care utopia, explain precisely how that is going to work. Explain each problem that it solves. Explain how it is going to morph into a universal or near universal system in which each individual is paying the full actuarial value of the coverage. It won’t happen.

Playing with a Medicare buy-in is an unnecessary diversion at a time that we need to get serious about reform. We need to fix Medicare and expand it to cover everyone. Nothing less will do."

[andym]

2. Preiums should be some percentage above cost (5-10%?)

1) It is a good idea.

2) It should be offered at 10% above cost, the surplus money should be given to the Medicare trust fund to make it solvent over the long-term, which should be very popular politically and give a strong reason for fiscal conservatives to support it.

3) A family plan would need to be created, in order to make it affordable to families

4) Adverse selection won't happen because at $400-600/month for individuals, it is more than competitive with equivalent private plans (not including families-- see above). Since Medicare has less overhead (less than 4% compare to 15% or more for private plans), it will tend to become even less expensive with the addition of younger, healthier individuals and would help keep health care prices down.

5) If enough people opt for this (which may happen given the competitive rates), doctors/hospitals would be unable to drop Medicare, because the loss of a large pool of patients would hurt their bottom line more than serving a few people at higher rates.

6) Since Medicare provider rates are up to 50% reduced from private rates, this will help hold down cost inflation due to provider inflation
http://www.businessweek.com/news/2010-02-25/hospital-clout-spurs-higher-california-health-costs-correct-.html

7) New Medicare rules on using scientifically proven technology may help hold down costs due to medical technology inflation.
http://www.thelundreport.org/resource/new_technology_is_driving_up_healthcare_costs

[Cha]

3. Good for Grayson...he's a team player.

[HughMoran]

4. Go Grayson! THIS is how you get it done !

!

[PHIMG]

5. "Liberal" Ezra Klein drips with right-wing framing on "free markets, transparency"

Until we get away from this ridiculous fairy tale that ill people are going to shop around for care in some sort of "free market" -- we are screwed. How many people want to spend hours shopping for the best healthcare plan. It would take litteraly hours to educate your self just to know the jargon.

This is Medicare Part D writ large. It's going to be a disaster.

The exchange is like where you are going make a bet on your health...do you put your chips on the high premium low copay/deductible plan or do you gamble on the low premium/high deductible plan. And when you get sick is the insurer you bet on going to find some new loophole in this bill to deny you care and steal your money?

There is a better way, of course I'm preaching to the choir.

MEDICARE FOR ALL - one Cadillac plan for everyone paid for $400 billion in administrative savings from the move to a single payer.

WE AREN"T GOING TO GET REAL HEALTHCARE UNTIL WE FORCE THE ELITE TO GIVE IT US and that means demanind it by name - MEDICARE FOR ALL.

Join the Movement! Join the Movement! Join the Movement!

[jeanpalmer]

21. The average person will have a hard time

understanding it. The insurance companies will deliberately make it confusing. They'll simplify it for the exchange, but the complexity will be in the details. Kind of like the easy-to-read auto insurance policies. Mine has a two-page summary of coverage, and then twenty pages explaining it. You need to be an attorney to understand the details. But that's where key provisions regarding deductibles and co-pays will be.

[TheKentuckian]

8. Open up Medicaid to everyone and I bet "negotiations" with "stakeholders"

would be a LOT more productive.

Do that first and big insurance and friends will be happy to discuss "getting in line". Actual comprehensive reform seems to actually depend on pulling some bargain power out of our collective ass and until the ca$hflow is really on the table there will be too much resistance to reform an industry that buys statehouses like nothing and Washington is on retainer.

[bvar22]

17. Completely BOGUS.

"Everything offered in the way of a public option has to rely on comprehensive reform."---ProSense

There is absolutely no need to pass the 2800 page labyrinth of loopholes, trapdoors, poison pills, and intentional ambiguities to get REAL "reform".

Simply expand Medicare eligibility, and watch the Health Insurance Industry "reform" itself.
If we do THAT, the Invisible Hand of the Marketplace WILL work for US this time.

[ProSense]

18. Completely clueless.

There is a reason Congressman Grayson supports the current bill.

What is going to control prescription drug costs that are going up under Medicare?

What about the age rating and other discriminatory practices built into the system?

What about dental coverage, which Medicare doesn't cover, but is usual offered in conjuction with private plans?

Hacker...explained that Medicare was not designed “to provide health security to a younger than 65 population.” “There are a lot of holes in the Medicare program that should be fixed but which aren’t going to be fixed immediately. One of the important reasons to have a separate insurance plan is to make sure you’re providing the kind of good coverage that you know younger Americans need,” Hacker said.

link

A lot of people shoot off at the mouth and have no clue what they're talking about.

[ShortnFiery]

20. It. Won't. Happen.

Smoke and mirrors.