Ezra Klein: If You Give Away the Public Option, What Do You Get?

[flpoljunkie]

(Perhaps something to consider, with the public option getting weaker by the day and not providing the competition necessary to drive down the cost for us all. Emphasis mine.)

If you give away the public option, what do you get?

Most of the energy in the Senate right now is being directed into a mad rush for compromise proposals on the public option. This reflects the sense that the right compromise on the public option is a compromised public option. That's true to an extent, but you can define the public option so far downward -- a state-based, opt-in, trigger-dependent, nonprofit option, for instance, is seriously under consideration right now -- that you'd be better off trading it away for something that's more meaningful.

Candidates on that score would be a few hundred billion more in subsidies, a national exchange that's open to larger businesses, and tighter rating rules governing how much insurers can discriminate against people of different ages and demographic characteristics. The first would do more than a really weak public option to increase affordability, the second would do more to increase choice, and the third would just be a good idea. Having something called a public option is not, in the end analysis, as important as achieving the goals of the public option, and at this point, the policy itself is getting so watered down that it might be worth attempting to achieve its goals in a more straightforward fashion.

So far, I've not heard anyone discuss a deal along these lines. The horse-trading over the public option is taking place entirely in terms of the public option, and not in terms of the broader health-care bill. That strategy made sense for trying to keep the public option alive, but if the votes aren't there, that may not be the right strategy for letting it die.

By Ezra Klein | December 2, 2009; 1:40 PM ET

[madfloridian]

1. Is that the same post where he condemns Dean for criticizing ...

the way the public option has been watered down?

Do you have a link?

Never mind I found the post where he blasts Dean for criticizing the bill.

Note that he fails to mention something very important that Dean says....that the bill is a giveaway to insurance companies. Nor does he mention that unless a person with pre-existing condition is rich, they can't afford to buy insurance. The insurance companies will be allowed to charge 2 or 3 times as much as a regular person is charged.
That defeats the purpose right there.

http://voices.washingtonpost.com/ezra-klein/2009/12/howard_dean_health-care_reform.html

"Organizer friends have patiently explained to me that the public option only has a chance if its supporters take a hard line on its inclusion. That may be right, but the problem is that that strategy relies on people such as Dean actually convincing their base that the public option is central to health-care reform's success and desirability.

That's not true. Indeed, it's not even clear how it could be true. The strongest public option on the table -- the House's version -- would serve a couple million folks and cost a bit more than private insurance. It's worth having, for reasons I've argued over and over again. But a lot of things are worth having. It isn't decisive, or even obviously relevant, to the bill's success or failure. If the bill is "worthless," then it's worthless in the presence of the public option. And if it's not worthless, it's not worthless in the absence of the public option.

Which leaves us arguing over the meaning of the word "worthless," I guess. This is a bill that cuts premiums costs. That extends insurance coverage to more than 30 million Americans. That cuts the deficit. That establishes an expectation for near-universal health-care coverage. That really digs into delivery-system reforms. That takes the first, halting steps away from the fee-for-service system. That makes better insurance cheaper for the poorest Americans. If passed, it will be, without doubt or competition, the largest piece of progressive social policy since Lyndon Johnson established Medicare and Medicaid. If this isn't worthwhile, then progressives should pack up and go home, because nothing Congress passes in the foreseeable future will even come close."

[flpoljunkie]

6. Sorry! Link below. No, he does not mention Howard Dean.

http://voices.washingtonpost.com/ezra-klein/2009/12/if_you_give_away_the_public_op.html

[madfloridian]

8. Maybe if we get a good majority someday we could get a decent bill

that included competition for insurance companies.

I keep forgetting we already have one of those majorities.

The bill is a giveaway to insurance, and we keep defending it.

Hey, if we got a big enough majority we might stand up for women's reproductive rights.

[Guy Whitey Corngood]

2. This lousy t-shirt? nt

[karynnj]

3. Interesting ideas

I agree with him that these three things would accomplish some of the goals of a public option better than a weak public option.

Of them, I assume the few hundred billion for subsidies is a nonstarter. The cost of the bill would lead many to vote against it and it would likely not meet Obama's cost constraint.

Making the exchange national was, I think, the original idea. I think making it state level was done to pacify the more conservative Democrats and to facilitate state level opt out. It also lets each state design their public option. Opening it to larger companies seems a great idea. There are likely companies too big to use the exchange, but small enough that their pool size gives them higher rates than either the exchange or bigger companies. This one is nice as it should cost nothing. The third one as he said is just a good idea.

[Armstead]

4. If they give away the public option THEY SHOULD ELIMINATE MANDATES TOO

Thats's what really frosts me about this whole Democratic health Care debacle.

We going to get saddled with the worst aspects of "socialized medicine" by forcing people tom buy health insurance, but will get none of the benefits of a true public-health plan.

If the Democrats are so spineless that they won't actually provide public healthcare, they should at least keep out of our goddamn wallets instead of forcing us to become customers of the corporations that caused the problem.

[flpoljunkie]

7. Mandates necessary without single payer. Fines are much reduced in Senate bill.

[madfloridian]

9. Do you realize how much pre-existing will pay for that required insurance?

2 or 3 times more than the regular person.

What if they can't afford it?

[flpoljunkie]

10. Do you have a link?

[madfloridian]

11. Yes.

http://tpmlivewire.talkingpointsmemo.com/2009/11/dean-theres-no-real-insurance-reform-in-health-care-bills.php

Actually if I get time to search videos....he told one interviewer the amount for pre-existing could be up to 3 times more...that he was just learning that was in the House bill.

[flpoljunkie]

12. Thanks, mad. Below is from the Kaiser foundation on the House bill re pre-existing conditions.

Establish a temporary national high-risk pool to provide health coverage to individuals (and spouses and dependents) with pre-existing medical conditions. Individuals who have been denied coverage, offered unaffordable coverage, have an eligible medical condition or who have been uninsured for at least six months will be eligible to enroll in the national high-risk pool. Premiums for the high-risk pool will be set at not higher than 125% of the prevailing rate for comparable coverage in the state and could vary by no more than 2:1 due to age; annual deductibles will be limited to $1,500 for an individual; and maximum cost-sharing will be limited to $5,000 for individuals. (Effective January 1, 2010 and until the Health Insurance Exchange is established)

http://www.kff.org/healthreform/sidebyside.cfm

[Armstead]

13. No option -- No mandate.....It's a matter of principle and pragmatism

We should have a public option. We should have the choice of a basic Medicare for Every Who Chooses it.

Without that, then mandates are nothing but enforced consumerism. They should at least not force people to buy a product from monopolistic corporations.

Social Security is a mandate, but it is a portion of one's income and it is a public plan. Suppose the government were to require everyone to buy a private retirement plan -- but plans without any real oversight except for "the market." And one that was goung to force you to pay even if you couldn;t afford the "market rates."

That is what they want to do to us in healthcare.

It is an unfair combination of the worst of the Nanny State (without public backing) and the worst of Darwinian Free Market Capitalism.

[bvar22]

5. K&R ...back UP to +4

The the Health Insurance Cartels are at work here.