Jacob Hacker's (Public Option champion) suggestions for improving the bill

[andym]

"But the correct response to this critique is to make the requirement less necessary by providing greater assistance with the cost of premiums and by facilitating enrollment in the exchange--in other words, by making coverage more attractive and easier to obtain.

The lack of a public option also makes even more imperative tough requirements on insurers to make them live up to their stated commitment to change their business model and slow the spiraling cost of coverage. The most important way to do this is to move away from the Senate bill’s state exchanges and toward a national exchange such as that contained in the House bill. The federal government needs to be directly involved in implementing and enforcing strong national regulations of insurers and creating the new exchange. Otherwise, the effort for reform might fail at the hands of hostile governors.

The federal government is the only entity big enough and powerful enough to ensure a highly consolidated private insurance industry follows the law. It can and must demand transparency and obedience to the new rules. Insurers must open their books, and subject their rates, administrative costs, and profits to federal review. These new rules must apply to all plans, not just those within the exchange. And states should have authority not only to enforce these rules, but to innovate beyond them as well."

from http://www.tnr.com/blog/the-treatment/why-i-still-believe-bill
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About Jacob Hacker
From wikipedia
"Hacker is a media contributor and has testified before the United States Congress. He was widely recognized as a contributor to the health care plans for three of the leading Democratic candidates — Barack Obama, Hillary Rodham Clinton, and John Edwards — in the presidential election of 2008.<3> Hacker's plan, Health Care for America, is outlined in a report for the Economic Policy Institute. It proposes providing health care for uninsured or under-insured Americans by requiring employers to either provide insurance to their workers or enroll them in a new, publicly overseen insurance pool. People in this pool could choose either a public plan modeled after Medicare or from regulated private plans.

He is a Fellow at the New American Foundation, and in 2007 he co-chaired the National Academy of Social Insurance's conference, "For the Common Good." In 2007 he was given funding by the Rockefeller Foundation for a multi-year project to develop a comprehensive "Economic Security Index." He oversees a Social Science Research Council project on the "privatization of risk," and is also completing a book on inequality and American democracy, Winner-Take-All Politics: Inequality and the Transformation of American Politics (with Paul Pierson)."
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If anyone is disappointed it should be Hacker, he is the intellectual force behind the idea of a public option competing with insurers on an exchange. I think he has some important points here which should be fought for.

[mcablue]

1. Never heard of the guy before but thanks

His comments are respected.

[m448]

2. never heard

him either

[Oregone]

6. He provided the original foundations for the public option idea

His idea has transformed into such a contorted abortion that it is no longer recognizable in this reform. It was a romantic notion to inspire liberals to dive head first into the pool of reform, but slowly the water is draining before they completely land. To no fault of his own, perhaps, mind you.

[Cleita]

3. Right now my suggestion for improving the Senate bill is

a nice big paper shredder and let's start over again. First the policy needs to be done by HELP and then it should go to the Finance Committee, not vice versa. Then Harry Reid needs to go with the 51 votes he has to pass a bill that would have Medicare as a public option that everyone can get if they want it through reconciliation. I think Jacob Hacker would agree.

[andym]

4. I think they're going to try to get Medicare expansion by reconciliation

after they create this and get climate and financial regulation through.
Then they won't need Lieberman's and friends' cooperation.

BUT, they will face IMMENSE pressure from hospital and physician lobbyists against such an expansion. So we'll see what happens. it was no accident that the Medicare+5 public option did not pass the House.

[Dragonfli]

9. I second that /nt

[eridani]

10. Or just pull out some of the useful parts and pass those separately n/t

[Davis_X_Machina]

5. Another corporatist hack sellout. Tool of the insurance companies. n/t

[slipslidingaway]

7. Thanks ... Jacob Hacker speaking about his Health Care for America plan ...

Video, 3 minutes

"Jacob Hacker's "Health Care for America" plan offers a realistic path to universal coverage for all American citizens..."

http://www.youtube.com/watch?v=e-J9ZgCRiD8



Bait and switch: How the “public option” was sold

http://pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%e2%80%9cpublic-option%e2%80%9d-was-sold/

"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.


...“Public option” refers to a proposal, as Timothy Noah put it, “dreamed up” by Jacob Hacker when Hacker was still a graduate student working on a degree in political science. In two papers, one published in 2001 and the second in 2007, Hacker, now a professor of political science at Berkeley, proposed that Congress create an enormous “Medicare-like” program that would sell health insurance to the non-elderly in competition with the 1,000 to 1,500 health insurance companies that sell insurance today.

Hacker claimed the program, which he called “Medicare Plus” in 2001 and “Health Care for America Plan” in 2007, would enjoy the advantages that make Medicare so efficient – large size, low provider payment rates and low overhead..."

[andym]

8. Imagine how disappointed Hacker must really be

His idea appeared close to being implemented as THE way to achieve universal healthcare, and then the rug was pulled out from under him.

The whole basic idea was to control the insurers through competition with a massive government health care plan that would force them to not only keep their rates down, but keep the health care providers rates down as well.

Now what does he have left of his idea, just the exchanges, but only weak cost control mechanisms. Basically he's stating in the OP that given the demise of the PO, the insurers need to be heavily regulated, but I'm sure he knows how much more difficult that is to achieve.

[eridani]

11. What if the Progressive Caucus had dug in and said Single Payer or nothing?

We might have actually wound up with something like the Hacker public option.

[slipslidingaway]

12. One problem with the public option idea is that hardly any PO supporters ...

spoke up as they saw the PO being weakened.

I'm not sure what to think of Hacker, Kip Sullivan has probably read most of his papers and articles as he has commented on them from time to time.

:shrug:

Jacob Hacker’s ambiguous polls
By Kip Sullivan, JD

http://pnhp.org/blog/2009/12/11/two-thirds-support-4/

"...Unlike the Herndon Alliance, which commissioned its own polling and focus group “research,” Hacker relied on existing polling data to support his conclusion that single-payer is not feasible while the “public option” is. Hacker cites different types of polls depending on whether he is addressing the general public or health policy experts. His 2006 article for Slate cited one set of polls. A 2007 paper that he co-authored with Mark Schlesinger (“Secret weapon: The ‘new’ Medicare as a route to health security,” Journal of Health Politics, Policy and Law 2007;32:247-291) cited another set of polls. Inexplicably, neither paper discussed the Jefferson Center jury results I discussed in Part 2 nor the polls showing large majorities for single-payer that I discussed in Part 3 of this series.

In the course of examining these two papers, I will review in detail seven polls that Hacker cites. This may get tedious, but it’s important that you see for yourself how nebulous Hacker’s “evidence” is. Once you behold Hacker’s “evidence” directly, you realize that Hacker’s belief that Americans oppose single-payer is based entirely on polling results that resemble a Rorschach ink blot. You can see in them what you want to see. Where you and I might discern a public ready to support single-payer, Hacker discovers hulking impediments to single-payer...

...Hacker grudgingly acknowledged single-payer’s advantages, but then claimed single-payer advocates were “biting off too much.”

Americans like Medicare, and yes, Medicare is easy to explain. But that doesn’t mean most people are ready to say everyone should be covered by Medicare. Many of us remain stubbornly attached to employment-based health insurance, and proposing to abolish it entirely is likely to stir up fear as well as gratitude.

He hyperlinked the words “stubbornly attached” to an article in Mother Jones written by the Century Foundation. (In the fullness of time, the Century Foundation became a passionate advocate for the “public option.”) The Century Foundation article reviewed several polls on American attitudes about “universal coverage.” Amazingly, one of them was the 2003 Washington Post/ABC News poll showing 62 percent support for a Medicare-for-all system that I discussed in Part 3. Does Hacker read the documents he cites as evidence for his own claims?

...."

[andym]

13. Interesting. I didn't realize that polling data played such a big role in his work.

I always figured that besides the various health lobbies, the biggest roadblock to a full single-payer was the price tag and the new taxes needed to pay for it.

We have all read that single-payer will actually save A LOT of money, but fear mongering about the size and cost of the program was bound to be a serious impediment. With about 2.5 trillion spent on health care in America, and the assumption that single-payer would save about 50% and neglecting optional procedures, a guess might be that single-payer would cost about 1 trillion/year (which is not bad, given that Medicare/Medicaid costs around 682 billion). Note this is 12 times the cost of the current legislation (even with the small public options included) I just assumed that was his motivation for creating a less expensive public option to try to create an alternate road to fully subsidized single-payer.

[slipslidingaway]

14. The savings achieved by SP vary widely, but I do not remember ...

reading that SP would cut the HC costs by 50%, most range from 15% on the low end to 30%.

One of the most disturbing things about this recent HC debate, is that it allowed opponents the opportunity to attack a national system such as SP, even though it had been excluded.

Fear of raising taxes and a government system all play a part, even though the majority of Americans had favored a national system paid for by taxes ... until the public option idea was sold to the people.

:(

[andym]

15. You're right about the undefended attacks on SP being problematic

You mentioned you did not read the 50% estimate anywhere else.

Well, you probably would not have read the 50% savings for SP anywhere. I basically tried to estimate the best case scenario (in order to show that even this resulted in a figure that was likely to be used cynically to defeat SP). Basically it was a back of the envelope calculation:
private insurance overhead/profits + inefficiency of multipayer =-30%
replace with the cost of a government run program like Medicare =+5%
(i think this calculation is realistic)

bend cost curve by government negotiated drug rates/medical devices/hospital physician reimbursement rates= -25%
(this calculation is unrealistically optimistic because it assumes government will actually cut payments to pharma and providers to bring USA in line with other countries). The number comes from comparing cost of US care with other developed nations (even after subtracting out insurers). For example, see
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8728198&mesg_id=8728198
and especially,
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8728198&mesg_id=8728432

Total = -30% +5% -25%= -50%

However, you are correct about the estimated savings by various studies being less. For example, the California Nurses study estimated the cost for Medicare for All at about 2.1 trillion/year -- about 2X my more optimistic calculation. That's about 2/3 of the current federal budget (although I think HR676 folded Medicare and Medicaid into the new program, so it would not really add 2.1 trillion to the budget). Still I doubt our Congress would not have the political courage to create such a large program, and it would provide a major line of attack that is difficult to estimate from polls without seeing the extent of the media response.