What a trigger might mean

[BzaDem]

If we got a bill that had a trigger instead of a public option, I would be extremely disappointed. I'm just trying to lay out what such a trigger might mean. For people who would much rather have nothing at all than a bill without a public option, you will probably be wasting your time reading this. This is mainly for people who are trying to figure out whether a non-public-option bill would still be worth having (vs. nothing at all).

There are three main ways in which countries around the world have provided universal healthcare to their citizens. They are:

1. Single payer: Government is the main or only insurer. (Ex: Britain, Canada). Some of these countries also have government providing medical care itself (Ex: Britian).

2. Heavily regulated private insurance for all. (Ex: Switzerland, The Netherlands).

3. A combination of both. (Ex: France)

If the ultimate healthcare bill included an individual mandate, subsidies for the poor to buy health insurance, and a trigger for a public option, we would resemble number 2. The trigger would provide the stict regulation of the private industry. Health insurance companies would be so afraid of the trigger from being pulled that they would do everything in their power to keep costs low enough to prevent that from happening. It would essentially act as a price control (similar to those controls in other number-2 countries).

So whether or not a triggered-public-option bill would be good would depend on how strict the trigger is. A very strong trigger would act as very strong regulation, similar to what exists (and works) in Switzerland and the Netherlands. A weak trigger would act as weak regulation that might not force insurance companies to keep costs low enough. So for those primarily interested in reigning insurance companies in, a weak trigger might mean the bill isn't worth supporting. But if the trigger is strong (and has strict conditions to keep the trigger from being pulled), it might be worth taking a look at. (Again, this is vs. nothing at all. Of course we would all much rather have a public option without a trigger.)

[sandnsea]

1. I think the subsidies will do that too

If the subsidies cost too much because premiums are so high, they will be forced to keep costs down or we will have to go to single payer. Once people get used to having health care and not worrying about whether they can take their sick child to the doctor or being bankrupted by an emergency, they won't want to give it up. Medicare is proof of that. If the medical industry wants to keep their profits, they will have to figure out how to do it while offering truly affordable care to everybody.

[dflprincess]

2. Pelosi has already indicated she would be willing to see the income

caps for subsidies lowered. The public option allows for some pretty hefty out of pocket expenses that increase with income until you reach the cap and you become responsible for all the out of pockets. And, like all insurance policies, the bill does have the caveat that any premium payments are not applied to the out of pocket (now cutely called "cost-sharing" because that sounds more benign) nor are any expenses not covered by the plan.

Currently the max out of pocket (plus premiums and anything not covered) are $5K for a single and $10K for a family. And, if you get ill near the end of the of the benefit year and that illness carries over to the next year, you will be looking at having to come up with the out of pocket twice in just a few months. There will still be people worried about how much the trip to the doctor will cost and there may not be as many, but there will still be medical bankruptcies with this bill.

And keep in mind the CBO thinks it will be 2013 before anyone is covered and by 2019 only 10 million will be on the public plan.

The only solution to the mess is extending Medicare to all, but I fear Congress will pass this faux reform and expect us to thank them for it even though we'll still be screwed.

[sandnsea]

3. Medicare has co-insurance and deductibles

Plenty of senior citizens with Medicare face bankruptcy too. Health care costs money, no way around that. There is no magic wand that will resolve every issue.

2009 MEDICARE DEDUCTIBLE, CO-INSURANCE & PREMIUM AMOUNTS

Hospital Deductible: $1,068 / benefit period

Hospital Coinsurance:

•Days 0-60: $0

•Days 61-90: $267 / day

•Days 91-150: $534 / day

Skilled Nursing Facility Coinsurance

•Days 0-20: $0

•Days 21-100: $133.50 / day

Part A Premium (for voluntary enrollees only)

•With 30-39 quarters of Social Security coverage: $244 / month

•With 29 or fewer quarters of Social Security coverage: $443 / month

Part B

•Deductible: $135 / year

•Standard Premium: $96.40 / month (for incomes under $85,000/yr)