Health Care Reform: Single Payer Vs. Public Option is Not the Most Important Issue

[Time for change]

I believe that much of the argument over whether we should support a national health care plan that includes a public option for all Americans, but which also leaves some room for private insurance company participation (for those who choose it), vs. a pure single payer system, is misplaced.

The most important goal of a national health plan is that all Americans have access to good quality health care at an affordable cost – and also that the system be reasonably efficient, so as to keep the cost to our faltering economy within reasonable limits. A third goal, which I personally do not consider to be quite as important as the first two, but which is probably politically essential to the enactment of the plan by Congress, is that Americans maintain their choice of physicians.

A single payer system, by itself, does not guarantee any of these goals. And alternatively, it is possible for a public option plan, appropriately devised, to attain them.


The basic difference between a single payer plan and the “public option” plan

When you get down to the basics, there isn’t really that much difference between these two plans that are advocated by progressives. A single payer national health care plan is one where the government pays for all medical care for everyone. The “public option” plan is one in which all Americans would have the choice between a government sponsored health insurance plan or a private insurance plan or none at all.

Since the “public option” plan would give us all the opportunity to make our own choice, for those of us who choose the government plan the effect on us would be virtually identical to operating under a single payer system. The only difference would be that in the “public option” plan, Americans could instead choose private insurance. Therefore, private insurance companies would not be totally out of the picture – at least not initially.


The problem with private health insurance

Most of us are well aware of the problems with private health insurance, as compared to government sponsored health insurance. Private insurance companies exist to make a profit. Therefore, part of the money that could otherwise be used to provide good quality health care would instead go into profit for the insurance company. Furthermore, there are many other costs that private health insurance companies have that government sponsored health insurance does not have: they pay for screening out prospective clients whom they consider to be poor health risks, based on prior medical history or other risk factors; they pay for advertisement; and they pay of lobbying government to pass laws that are favorable to their bottom line. After they pay for all these things, what is left for providing the health care that they promise to the health care consumers who purchase their product? Not much. For all these reasons, government sponsored health insurance is much more efficient than private health insurance. And on top of all that, in their desire to make profits, private health care insurance companies often cheat their clients. I’ve had several experiences myself where they tried to cheat me and my family.


How a single payer national insurance plan could fail to provide adequate health care

Though government health insurance is far more efficient than private health insurance, for the reasons described above, that doesn’t mean that government health insurance will automatically lead to good quality, or even decent health care.

What if, due to right wing political pressure, legislation providing for single payer health care simply does not provide enough money to offer a decent health care package? If that is the case, then health care consumers under such a plan may be no better off, or even worse off than they are under private health insurance plans.


How to devise a national health care plan that provides good affordable health care to all Americans

Therefore, it seems to me that one of the first steps in devising a good national health care plan is to determine what specific health care services, and at what cost, are required in order to provide good quality health care to individual Americans. After this is determined, then do the following:

1) Offer that as the “public option” package to all Americans
All Americans would have the option of choosing that package to cover their health care needs.

2) Determine the value of the package
Determine the value of the package at today’s market prices. That would be the price that we would all be charged for the package if we chose to purchase it.

3) Help Americans to be able to afford the “public option” package
Provide Americans with the money that they need to be able to easily afford the package, either through tax credits or other means.

Those with the lowest incomes would receive the full value of the package. Essentially, that would mean that they would receive it for free – if they so chose to do so.

It does not seem feasible that the full value of the package could be provided to all Americans. That would probably make the plan too expensive, and therefore ruin our fragile economy. Therefore, those Americans making incomes above the minimum required to receive the public option plan for free would receive less tax credits (or other subsidy) than required to pay for the full plan, on a sliding scale. Persons with incomes above a certain maximum would perhaps receive no money at all to pay for it. I don’t want to specify the specifics of the sliding scale. But the purpose would be to make good quality health care affordable to all Americans without excessive cost.

A reasonable alternative to a sliding scale for subsidies would be simply to give all Americans the full value of the public option package (or simply make it available to all Americans for free), and pay for it by increasing income taxes (and the inheritance tax too) on a progressive scale.

4) Two remaining important issues
This would then leave two important structural questions: Should Americans have the option of purchasing private health insurance instead of the public option; and, should Americans have the option of not purchasing any health insurance at all, instead opting to keep the money they received from the federal government. If the answer is no to both these questions, that would leave us with a single payer system. If the answer is yes, then we would have what is commonly referred to as a “public option” plan.


What would be the effect of a “public option” plan on private insurance companies?

I’ve already discussed why private health insurance is inherently less efficient than government health insurance. Because of all the additional costs for private health insurance it would seem impossible for them to offer a comparable health care package of equivalent value to a “public option” package if the public option package really provided good quality health care.

Indeed, that is exactly why the private health insurance industry is so strenuously objecting to a “public option”. They claim that a public option would make it impossible for them to offer a competitive plan and still be able to make decent profits. And they are correct about that.

So, what would happen to the private insurance companies if a good quality public option plan was available to all Americans? They would have three choices: They could quit the health care insurance business and figure out something more productive to do with their time; they could offer a much better product than they currently do; or, they could continue to offer what they currently do and take their chances. Frankly, I don’t see how it would be possible for them to offer a comparable product to government insurance if what the government offered really ensured that the health care needs of Americans would be met. But if the private insurance companies were somehow able to offer a comparable product, then fine. I say, let them do it.

Undoubtedly, no matter how inferior the health care product offered by private insurance companies, some Americans would continue to choose that over the government “public option” – either out of ignorance or ideological opposition to “big government”. But, as time passed and as word got around regarding the relative value of the “public option” vs. private insurance companies, more and more people would switch over to the public option.

Some have objected to a “public option” plan that fails to completely remove private insurance companies from the market on the basis that our government would then to some extent be subsidizing private insurance companies. That would apply to any individuals who currently do not have health insurance, who decide to use their government subsidy (tax credit, or whatever) to purchase private health insurance rather than the government “public option”. But I feel quite certain that any advantage they received from that would be offset (probably many times over) by individuals who currently purchase private health insurance but who would switch over to the “public option” as soon as it became available.

The net result of this would be that private health insurance companies would lose a great deal of business and most or all of them would be forced out of the market because of their inability to offer a competitive product. That is as it should be. There is no reason for private health insurance in our country or anywhere else. Private health insurance companies are nothing more than middle-men that scoop up profits as health consumers try to find a way to meet their health care needs.


What would be the effect of allowing Americans to receive government subsidies but not use them for any health insurance?

Allowing Americans to receive government subsidies for health care, while not using the money to purchase health insurance, is a little more problematic. Those people would cause a drain on the public treasury whenever they had emergency health care needs that they could not afford, which would then have to be paid for by the government. That is why during the Democratic primaries, Kucinich, Edwards and Clinton all made their health care plans mandatory rather than voluntary.


Paul Krugman’s views on this issue

I realize that some DUers don’t care much for Paul Krugman, I believe mainly because of his criticisms of Obama’s economic policies. But I have a great deal of respect for him. He was one of the most scathing and early critics of the Bush economic policies; along with several other of our best and most liberal economists (James Galbraith, Joseph Stiglitz, Dean Baker), he was a harsh critic of the Geithner bailout plan. And most important, health care is at the top of his list of interests. Here is what he had to say about our need for health care reform in “The Conscience of a Liberal”:

The principal reason to reform American health care is simply that it would improve the quality of life for most Americans…

There is, however, another important reason for health care reform. It’s the same reasons movement conservatives were so anxious to kill Clinton’s plan. That plan’s success, said William Kristol, “would signal the rebirth of centralized welfare-state policy” – by which he really meant that universal health care would give new life to the New Deal idea that society should help its less fortunate members. Indeed it would – and that’s a big argument in its favor…

Getting universal care should be the key domestic priority for modern liberals. Once they succeed there, they can turn to the broader, more difficult task of reining in American inequality.

So I take what Krugman has to say on this subject very seriously. During the Democratic primaries, here is what he had to say about the Edwards plan, which was essentially a “public option” plan, meaning that it didn’t completely exclude private health insurers, though it would probably force them out of the market before too long:

Back in February John Edwards put his rivals for the Democratic nomination on the spot, by coming out with a full-fledged plan to cover all the uninsured. Suddenly, vague expressions of support for universal health care weren’t enough: candidates were under pressure to present their own specific plans. And the question was whether those plans would be as bold and comprehensive as the Edwards proposal.

My point in citing this is that Paul Krugman, for whom the provision of affordable quality health care to the American people has perhaps been his highest priority for a very long time, fully endorsed the Edwards plan as an excellent plan for delivering universal health care to the American people, even though it was not a single payer plan.


Conclusion

For all these reasons, I believe that a national health care plan with a robust universal public option for health care coverage could be nearly as good as any single payer plan. The main issue at stake is not whether private health insurance companies are immediately and completely excluded from a national health care plan, but rather the quality of the plan that is offered to all Americans. A good quality plan will force the private health care industry out of the market anyhow – which should be obvious from the vehemence with which they denounce a public option.

For those who say that any participation of private insurance companies in a national health care plan will make it inordinately expensive, I can’t see how that is possible. The added expense of such a plan will apply only to those Americans who choose private insurance over a public option. Those people will have to bear whatever added costs are attendant upon their use of private health care insurance, until they recognize the problem and switch over to the public option. (On the other hand, any plan that mandates people to use private insurance or fails to provide them with a good quality public option should be rejected out of hand.)

For all these reasons, I urge people to be supportive of a public option plan, depending upon its ability to ensure good quality health care for all Americans who choose it. If you want to advocate for single payer health care over a “public option” plan, then fine. But I urge you not to reject a public option plan if that turns out to be the only alternative left on the table. If progressives who care about the need for universal good quality health care for all Americans split up over the question of single payer vs. “public option”, that will only lessen our chances of getting any meaningful health care reform.

[denem]

1. Bookmarked.

[timeforpeace]

3. Kindled.

A phrase is born.

[Fumesucker]

2. The problem as I see it with a public option plan..

Is that you are going to have to be either homeless or well nigh homeless before you will qualify for any aid with paying the premiums and if you can't pay the premiums then you will have no coverage.

Not to mention I strongly suspect that there is going be much more "stick" than "carrot" involved in moving people to get insurance, either private or the public option. I'm pretty well convinced there will be penalties for those who do not subscribe to some insurance plan or another and it will come as no shock to me at all if those penalties are quite substantial.

[Time for change]

6. That is not the public option plan that Obama advertised during the primaries

The public option plan that he advocated during the primaries was one whereby ALL Americans would have the option of obtaining it -- no exceptions. And people would receive tax credits to pay for it. It was very similar to the one advocated by Edwards and Clinton in that respect. And that's the one that I refer to in the OP.

I agree that if it isn't open to everyone, then the whole idea is next to worthless and we should not support it.

[Fumesucker]

10. Tax credits sound nice..

If you have enough money to make the payments in the first place..

If you are hanging on by a couple of financial fingernails a tax credit isn't going to do much good when as far as making insurance payments.

[Time for change]

12. As I say in the OP, the tax credits need to be large enough to make it affordable for everyone

That means that for those who are hanging by a fingernail, they have to cover the full cost of the plan.

[Fumesucker]

31. It doesn't matter whether they cover the full cost or not..

If you don't get the money until the next year you still aren't going to have the money when you need to make the payment.

The thing that many people don't seem to get about those on the bottom rung of the economic ladder is that they don't have any options when it comes to spending money, every single dime is spoken for before it comes in and it's spoken for for absolute, day to day necessities such as food, clothing, transportation and shelter. Medical insurance falls pretty far down the list of must-haves for those who are just barely hanging on.

And I'll be utterly flabbergasted if this isn't means tested to a fare-thee-well, to the point you will have to be homeless or all but homeless in order to qualify for any aid, the Republicans and RINO Dems will make sure of that. Means testing is going to be the death knell of any "reform" to the health care system and it will be designed into the "reform" from the get-go.

[Time for change]

38. The tax credit can be made retroactive to the previous year

Then, if it covers the full cost of the program, people will have the money to pay for it.

If you're against means testing, does that mean that you think millionaires should be subsidized for the full cost of the program, just like everyone else? If we do that, the we'll have to figure out a way to pay for the additional cost. Devising a more progressive income tax code could do it. Ending our wars and cutting our military budget could do it. I'd be fine with either of those solutions.

[Fumesucker]

42. Can be and will be are two entirely different things..

And millionaires are covered under the Canadian national health and the UK national health plans and probably a lot of others as well.

I think basic health coverage should be available to everyone regardless of income, if you want more than the basics then I have no problem with you purchasing additional insurance or paying out of your own pocket for anything you please.

[Time for change]

64. That's fine, and I agree

I'm just saying that if we did it that way we'd have to find a way to pay for the additional costs.

[Fumesucker]

81. We, as a nation, already pay more than enough for the additional costs..

Our health care costs on a per capita basis are by far the highest in the world.

[Hannah Bell]

32. if you don't have income, tax credits = bupkis.

half the population pays extremely low or no income tax.

most people pay more in social security tax than in income tax.

[Time for change]

37. Do you know what a tax credit is?

People who pay no income tax at all can and do get tax credits.

[Hannah Bell]

53. do people who don't work get tax credits?

[Time for change]

54. According to the plans that were proposed by the leading Democratic candidates during the primaries

yes, they would. That was the whole idea of their plan. To provide health insurance to those who could previously not afford it. Tax credits are one way of doing it. There are also other ways, but that was the method that was proposed.

[Hannah Bell]

56. how does a tax credit to someone with no tax obligation fund an insurer?

[Time for change]

59. A tax credit does not depend on tax obligation. It has nothing to do with it.

It is like a subsidy. As I said in the OP, if the cost of a public option that provides good quality health care is $10,000, then those at the bottom of the income scale should receive a $10,000 tax credit. That means that they would receive a government check for $10,000. The overall effect would be to make their health care coverage free.

[Hannah Bell]

61. ah. so the government gives unemployed people money to give to aetna

and calls this a "tax credit". i see.

[Time for change]

63. My OP was about the need for a "public option" plan

as an ALTERNATIVE to the private insurance that most Americans carry today.

[Hannah Bell]

67. that's great, but facts on the ground are, the admin is proposing reducing funding to medicare/

medicaid because of the savings they'll supposedly achieve by giving people money to give to insurers. or to whatever "public option" still exists when its defunded.

[Time for change]

72. It is very difficult to know what the administration is proposing

I received an e-mail from the administration and it was very non-specific. Giving people money to give to insurers is no way to save money, and I never proposed anything of the sort.

[clear eye]

52. So you're saying you don't support any of the plans now being discussed in Congress?

Because nothing I've read, and I've been keeping up w/ current proposals, remotely resembles what you say you'd like. And they certainly don't deal w/ the issue of insurers cherry picking, and offering plans that just aren't adequate in the real world.

I do believe that the theoretical possibility of designing such a good public option--one that would naturally erode away the private insurers--has confused people into getting out of the struggle for single payer, without there being a snowball's chance of even getting such a program on the table.

As far as I can tell, if we're going to have to get something passed over the figurative "dead bodies" of the health insurance companies, we'd do better fighting for what most acknowledge is the best proposal--HR 676.

[Time for change]

55. My OP did not address any currently proposed specific plan

It said nothing about any specific plan.

Rather, it discussed what would constitute an acceptable plan.

I proposed what I thought should be our goal in the 2nd paragraph of the OP. Does that sound like a reasonable goal to you?

[DJ13]

4. Theres a substantial difference between single payer and a public option

No public option will have the economies of scale that a true single payer system would have.

That lack of scale drastically increases costs for a public option.

Also, if the public plan becomes watered down by the time its voted for it could easily become another boon to the insurance companies, as the temptation for the 'for profit' insurance companies will be for them to deny most already ill patients and forcing them into the public option.

Further increasing costs.

[Time for change]

7. The public option plan that I describe in this OP, and which Obama (and Edwards and Clinton)

proposed during the Democratic primaries would not have been a boon to the insurance companies. There is no way it could have been because it would have put the public option in direct competition with private insurance companies. And why do you think, if it would be a boon to insurance companies, that they are so adamently against it?

As far as economies of scale is concerned, what's the difference from the government's point of view (or those who choose their plan) whether or not we are given the option of using private insurance? Our government doesn't have to concern itself with those who opt for private insurance. Any inefficiency inherent in the private plans would thereby be born only by those who choose to use it.

[DJ13]

8. The public options offered from Congress in no way resemble Obama's or Hillary's

Were not not talking about the same thing here.

When Obama said he wanted to get out of the way and let Congress come up with health care reform the resulting plans offered so far are nothing like the plan he claimed to want.



"As far as economies of scale is concerned, what's the difference from the government's point of view (or those who choose their plan) whether or not we are given the option of using private insurance?"

From the government's point of view? Nothing. But then these are the same idiots that think small regional pools in a public option are preferable to a national pool because they understand that the higher cost of a smaller pool of beneficiaries will put the public plan at parity, or possibly an even higher cost, than the for profit insurance offered.

[Time for change]

9. My point is that the major issue is not single payer vs. public option

It is the quality of the plans that are offered.

If something similar to what Edwards, Clinton, and Obama promised during the primaries (i.e. available to everyone, and subsidized by tax credits) turns out to be the public option plan, and depending on whether it offers a plan that provides good quality health care, it could be a plan well worth supporting.

On the other hand, if it is not available for everyone (which would mean that we would be subsidizing private insurance), if the subsidies we receive for it aren't adequate to make it affordable for everyone, or if the quality of the plan doesn't meet our health care needs, then it won't be worth supporting.

I'm saying that it's more complicated than simply single payer vs. public option.

[DJ13]

11. I agree with that

But Congress seems determined (bought, bribed) to reduce the viability of a public option to the point its not going to be worth using.

When a few in Congress were talking about the "unfairness" of a government run public option last week I took that to be a big warning signal that there would be a huge push from the pro-insurance Congress people to make any public option every bit as expensive as private insurance.

[Time for change]

13. I agree -- We're fighting an uphill battle

We need to demand a plan that offers good quality affordable health care (through a public option) to all Americans. That's where we need to draw the line.

But to also demand that it be single payer (i.e., not allow anyone the choice of private insurance) is both unnecessary and unrealistic. Neither Edwards, Clinton, nor Obama put such a plan on the table even during the primaries. It's not going to happen. We need to set our sights on a realistic goal and fight for that. Good quality affordable health care for everyone should be enough. It would be a major victory for the American people.

[radiclib]

43. I strongly disagree with the strategy

of using an already compromised position as a starting point. This has been a common criticism of Obama's approach on many issues since he took office. We will NEVER get what we set as a goal from the outset-- the Republicans, DINOs and corporate whores will certainly see to that. I think our reach (single payer) should exceed our grasp. Then we at least have a shot at attaining something worthwhile.

[Time for change]

45. What is "compromised" about the program that I outline here?

I'm advocating a program that includes a public option that provides good quality health care to all Americans. Where is the "compromise"?

[radiclib]

48. I'm not criticizing public option

You may be right, it may actually be preferable to single payer. I mean "compromise" in a political sense. Single payer, being tantamount to the dreaded "socialized medicine", is probably not viable. Nothing wrong with your plan, TFC, but Congress is not going to end up where it starts on this. The Dems in Congress can appear to be "reaching across the aisle" if they settle on public option as a "compromise". But if they begin by proposing public option, we likely end up with crap.

[Time for change]

49. Perhaps

But I'm not recommending against advocating single payer health care. I'm just saying that if that turns out not to be viable we should support a plan that includes a public option that provides good quality health care for everyone.

It's just like I started the 2008 primary season with Kucinich as my favorite candidate. But I never would have said that if he turns out to be non-viable that I wouldn't support anyone else.

I'm afraid that some progressives are so tied to single payer health care that they would decline to support anything else. And I think that that lack of support could destroy our chance to acheive very meaningful health care reform.

[whoopingcrone]

82. no plan is offering "health care"

the argument is about how different medical care providers will be paid.
If we don't demand a single payer system to cover "basic" services,
thereby insuring that most providers will treat all comers, we will not have the
"Good quality affordable health care for everyone" you're seeking.

[Time for change]

83. A single payer health plan doesn't necessarily insure that all medical providers

will be required to supply basic medical services to people. It is primarily a government-sponsored health insurance program. Like Medicare.

http://www.hr676.org /

[puebloknot]

21. It's very complicated, and we can't assume that those who are hatching a plan ...

... have our best interests at heart. In great part, there's a lot of posturing that is basically politically driven.

There is already talk of cutting Medicare benefits. Whether it's Medicare or private insurance, it is certainly true that there could be a lot of trimming of the fat and much better use of our resources. But to target Medicare payments for diagnostic tests and doctor visits is unconscionable.

[Time for change]

29. I agree -- Any plan that is presented should be evaluated by us in its entirety before we support it

whether single payer or public option. There are many details that will be very important to a plan's ability ensure that all Americans have access to good quality health care.

[Kansas Wyatt]

5. Kick the Death Merchants out of the damn room!

Fuck'em! They had their chance for several years now and blew it. The greedy parasites do absolutely NOTHING for health care.

If an 'educated' person (dumb ass government representatives) cannot see that insurance companies do nothing for health care, then they are piss ignorant fools.

[emsimon33]

18. Yes!

[ejpoeta]

25. they do nothing for healthcare, but they do contribute to campaigns. and that is

what matters to these people. and as long as they make sure that the insurance companies are still making their profits enough to keep contributing.. that's what matters. not the voters.

[quidam56]

14. After seeing what is deemed, defended and suppported in TN & VA

as 'THE ACCEPTABLE STANDARDS OF HEALTH CARE' Clearly Profit Care is more important than Patient Care. How many more will die while the greedy politicians and profit machines fill their pockets ? We are the change we voted for, it's time to push harder than ever for health care reform NOW. http://www.wisecountyissues.com/?p=62

[harry_pothead]

15. It's like this (visual):

Good-----------------------------------------------------------------------------------------------Bad


Single Payer----Public Option-----------------------------------------------------------Current System

[Time for change]

57. Yes, that's just about it

Except that the specifics of the plan matter more than whether it is "single payer" or "public option". The quality of the plan is not captured by those words alone. A single payer plan could be a catastrophe if it doesn't provide enough coverage, or if it has some other fatal flaw. Same thing with a public option plan.

[Ms. Toad]

16. Good analysis, but you've missed one crucial piece

Private insurance companies must be forced to operate under the same restrictions as the public option: They must accept all applicants, provide coverage for all pre-existing conditions, and meet minimum coverage standards.

If this is not done, the public option will fail because it will be the dumping ground for everyone above the subsidy level with pre-existing conditions, and likely for quite a few in the partly subsidized range with pre-existing conditions. I've tried writing an explanation, but got lost in my own words, so I'm somewhat arbitrarily picking numbers to use as to explain it. The details will vary with more accurate numbers, but the general principles still hold.

Market value for health care (across the board): $5711/year (US per capita expenditures in 2003 for health care)
Private insurance for high risk pool: $26,298/year (average annual premium in Ohio for High Risk Pool HMO Health Ohio)
Private insurance for non-high risk pool $2711/;year (average annual premium in Ohio for the best Kaiser plan)

If the value is based on the $5711 cost for care, the public health option will be a bargain for individuals currently eligible only for the high risk pool. It will be major sticker shock for anyone in the non-high risk pool. From a purely economic standpoint, those currently paying more than $5711 will flock to the public option - i.e. all of the individuals who currently cannot purchase insurance at all, or those purchasing it from the high risk pool - the costlier patients. Those paying less will avoid it. The cost of care for the individuals in the public option will be significantly more than $5711 per person taken in (ignoring the fact that the government will not actually take in all of that amount because of the income based subsidies), and the plan will be underfunded. To support the plan, in addition to the income based subsidies proposed, you would need an across the board subsidy to make up the difference between the average per capita health care costs and the significantly higher per capita costs for those actually in the plan.

The need for an across the board subsidy could be eliminated by setting the value of the plan at the amount that would actually pay for the care for those enrolled, but that cost would be closer to $26,298 because of the population for which the public health option is attractively priced compared to what they might need to pay as part of a high risk pool. In that instance even more relatively healthy people would flock to the lower cost private plan because the difference between the cost of private insurance (for those eligible) and the public option is even greater, providing even less competition for the individuals the private insurance companies are interested in - the healthy, more profitable patients.

The bottom line is that for a public option plan to be successful, insurance companies MUST be forced to offer their plans on the same basis the public option is offered - to all applicants, with premiums which are not based on health, and provide equivalent access to care. That will force private insurance companies to raise their premiums so that the premiums cover the cost of caring for the average American (around $5711 a year), rather than the being artificially low ($2711) because they only need to cover the cherry-picked-healthier-than-average people they currently accept into their plans now.

[Time for change]

30. Yes, that is a very important point

This was a stipulation of the plans for all the Democratic candidates in 08 who offered a plan. To abandon it now would be a deal breaker.

[Ms. Toad]

35. And it is in Kennedy's bill. n/t

[hfojvt]

69. provinding coverage for pre-existing conditions is not insurance

isn't that a little bit like allowing me to get auto insurance AFTER I get in an accident and demanding that the insurance company cover that accident. Or getting homeowner's insurance after my house has burned down and demanding that the insurance company pay for a new house?

The government will sort of have the same problem.

[Ms. Toad]

84. If this is a serious comment,

you have a fundamental misunderstanding of the health care crisis that we are attempting to address. Make no mistake - this is not about saving the fundamental structure of insurance-driven health care, it is about resolving the health care crisis which has left access to health care out of reach of around a third of the population of the country.

As to the comparison you made, it is not the same. First, no one is saying the insurance company should pay for medical bills incurred for an isolated event prior to coverage (the analogy you suggested - an accident or fire before getting insurance). In addition, a car accident and a fire are finite events, with an identifiable beginning and relatively clear boundaries. This is not the case with health care.

As one example - there are many available - a person may live with diabetes for years without any symptoms before being diagnosed. That diabetes may cause or contribute to many other health conditions (heart attack, high blood pressure, vision problems, death of extremities requiring amputation). When did the diabetes start - and remember, diabetes is often silent so there are no symptoms you should have noticed to determine the date on which it was a pre-existing condition. Did it start when it was dignosed? Is that fair to the person who has been taking care of themselves and regular doctors' visits with a doctor who actually tests for blood sugar (which most don't) and will be diagnosed earlier - thus making it a pre-existing condition far longer than the person who never visits their doctor and/or whose doctor doesn't run the specific diagnostic test? Without any prior tests or symptoms, how far back do you assume it existed?

What about coverage for a heart attack, which the diabetes likely contributed significantly to? There is a very clear correlation between diabetes and heart attacks. Is the heart attack, part of the diabetes syndrome (so to speak) making it also a pre-existing condition?

What about an infant born with cystic fibrosis or cerebral palsy - those are pre-existing conditions on they day they are born. By your reasoning they should never be able to get coverage for those conditions at all.

Aside from the difficulty of distinguishing just what is a pre-existing condition, what isn't, and when it starts, there is the complication that no one retains the same insurance for life. My daughter has had a chronic illness since she was 4. We have had at least 5 insurance companies in that time. In a little over a month, if she can't maintain her status as a full time student because of her illness, she will be forced to change insurance companies again (>18, not a full time student = no longer eligible for parents' insurance). By your reasoning, she would never be able to obtain coverage for her chronic illness because it is a pre-existing condition at age 4 - and it shouldn't have been covered by the 4 companies after it was diagnosed when she was covered by the first policy because it would have been a pre-existing condition for every subsequent insurance policy. (Unless you try to track when it really began - we had symptoms at age 3, but it typically starts without symptoms...or we can discuss her second chronic illness that may also have started at age 4, or perhaps later, or perhaps earlier, that was diagnosed 2 months ago. BUT - if I had not insisted on running additional tests it would not yet be diagnosed. Is it fair that because I was pro-active that this condition be a pre-existing condition and not eligible for coverage under her new policy (when if you look at typical diagnostic patterns for this disease it would typically take 2-3 more years for it to be diagnosed).

Until about 10 years ago, you would have been right - there was no guarantee that even if you had had insurance from the day you were born that when you switched plans (because you aged out of your parents' plan, or because you switched jobs, got married, etc.) your new insurance company would cover your pre-existing conditions. HIPAA now requires that there be no more than a 12-18 month exclusion for coverage of pre-existing conditions (and full coverage if you do not have a gap of more than 63 days between companies). That helps a little - but insurance companies are permitted (under HIPAA) to charge pretty much what they want for that insurance. That means that my daughter, at age 19, even though she will be unlikely to be able to work full time (since she would be out of insurance because she can't manage school full time) will have the option of paying about $14,000/year for insurance or $60,000 for care (assuming nothing goes wrong) - even though she has not been without insurance a day in her entire life.

At least she is guaranteed access to insurance under HIPAA - even though it is well beyond the economic reach of most people who really need it. Many people are not that lucky - if they never had coverage or had a gap in coverage (perhaps because they lost a job and couldn't afford the outrageous premiums) can be denied coverage entirely - at any cost.

Insurance companies, as currently structured, have fundamental advantages over a public option - they can (and do) pick and choose who to cover and can deny coverage for anyone they think will have more than a minor sniffle; a public option, on the other hand, would be required to serve the entire population. On the rare occasions when insurance companies are required to accept individuals they would not normally choose to cover (because of HIPAA, COBRA, mandatory participation in the state high risk pool, for example), they are allowed to set the prices for those plans differently than for the rest of their plans. They can, and do, charge rates which are designed to ensure that virtually no one who might really be sick can afford coverage.

If a public health option is to succeed, insurance companies must play by the same rules as the public health option - they must accept all applicants and they must not set the premium based on the real or perceived health of the individual being covered, and they must cover all pre-existing conditions (not back-pay bills, but treat that illness from the day coverage starts).

If they are not required to play by the same rules, the public health option (which will need to be at least close to self-sustaining to win congressional approval) will have to charge rates far higher than the average cost of health care because only the sickest people who can't get private insurance will be using the public option. If that is the case, we are better off with HIPAA - since the failure of this poorly conceived public health option will be thrown in our faces the next time we demand a different solution to the public health care crisis.

[MilesColtrane]

17. Honestly, we'll be lucky to get any reform at all.

The Clinton health care plan of '93 was never single payer, and it was squashed like a bug. The fact that the Democrats controlled the White House and both houses of Congress back then, just as they do now made little difference.

[avaistheone1]

20. Wrong. The Democrats never held control of Congress during the Clinton administration.

We are lucky to get any reform at all? BS!! After the President, Congress and the Senate giving away a trillion dollars to Wall Street and the banks!! You must be kidding.

Not to mention the moral issue that we are the only industrialized country that does not have a national health plan for its people. That is absolutely disgusting.

The Democrats have everything in their favor. They have all the power. People are really hurting.
Millions can no longer afford insurance and we are in the worst economic times of the last 50 years.
The time is NOW. The Democratic leadership needs to pull its head out of the sand, take their hands out the health insurance industry's pockets and do something meaningful in terms of health care reform.

[MilesColtrane]

22. "The Democrats never held control of Congress during the Clinton administration."

Democrats ran the Senate and the House during the first two years of Bill Clinton's presidency.

http://en.wikipedia.org/wiki/103rd_United_States_Congre...

The president's plan died in Congress around August of '94.

I'm just being realistic.

Everyone's discussing the merits of which type of system Congress will legislate as if it's a given that some type of reform will emerge, as if Obama will simply persuade them with the force of his personality alone.

[ejpoeta]

26. my fear is that the only reform will be a mandate to buy into THIS system as it is.

and we'll end us royally screwed.

[MilesColtrane]

50. The forces that opposed the Clinton plan are still out there, and if anything,...

...they have MORE money to throw into lobbying, ads, and bribes than they did then.

My Magic 8 Ball™ says, mandated private insurance for the vast majority and a miniscule public component for lower income level/self employed citizens is the most likely outcome.

[puebloknot]

19. Very good article. I used to be an insurance agent, in my misspent youth ...

... when I was trying to find a way to earn a living and still keep my time free to be a divorced mother. So I've given a lot of thought to all this.

Though I think single payer is absolutely the best way to go, I don't think we'll see it right away. Putting aside the greed of the insurance companies just for a moment, even if it were possible to just get rid of them, it would put a *lot* of people out of work, and then we'd have more people "on the dole," so to speak. If we ever rid ourselves of the evils of insurance companies, as they've conducted business over the last decades, it will most likely have to be a matter of transitioning into a better situation. As you have said, just the slow realization of the public that a public option would serve them well might put the insurance companies in the position of the railroad barons who thought they were in the railroad business, but eventually had to realize they were in the *transporation* business. Just depending on the evolution of consciousness in the marketplace won't do it, though. A degree of force is going to be required.

Insurance companies have always used the "reasonable and customary" meme to pay as little as possible on claims. As Michael Moore has pointed out, you can be "insured," and still face no coverage (claims totally denied for some nefarious reason), or face huge debt for the portion of the bill that insurance companies won't pay. And the providers have jacked up their prices because they are basically having to subsidize insurance companies instead of making the best use of their resources for patient care.

Years ago, I started my own business and worked out of my home, so I had no insurance. I found a group I could join that had insurance underwritten by Blue Cross in California. I dutifully paid premiums for two years, made very little use of the insurance, but did have some problems -- hypoglycemia, for example -- and one day I got an announcement in the mail that they were cancelling the whole group because the claims ratio had risen too much, and they were offering new coverage only to those in pristine health.

So I had managed to get past the pre-existing period for that policy, and when they dumped me, I then was out on the open market again with pre-existing conditions that made it almost impossible to get anyone else to cover me. It is an outrageous scam, and it needs to stop.

When I was selling insurance, a close friend from Israel pointed out to me that health care is a right, not a privilege, and that it was absurd that the richest country in the world would not organize itself to take care of its citizens. She was branded a Jewish radical, and I was delusional because I kept pointing out that it was unfair and unethical for insurance companies to be able to discriminate on the basis of pre-existing conditions. We were simply two women who didn't understand the big picture (although a manager told me I was the most impressive agent in the office -- for a woman, that is).

Last year, I woke up one day and realized I'm not the person I used to be. In spite of all the problems I'd endured in the past, I had managed to have health insurance here in New Mexico through Presbyterian Health Services, and was able to choose a doctor and have a procedure done in the hospital. The insurance covered most of the costs. But suddenly I was no longer able to keep that coverage simply because I had turned 65. So I did the right thing and purchased an Advantage Plan, in addition to Medicare, to cover my health costs.

I went in to see my chiropractor very shortly, and although I had informed the office that I was on Medicare, this doctor, a woman, just didn't get it because I look ten years younger than I am. I put that forward as numerous third-party comments I've relished, rather than my own opinion. But it's true, and it's a family thing! So my chiropractor commented that I was very well preserved for my age, she was shocked, but she was so sorry that "the office doesn't take Medicare," so she couldn't legally treat me. So I figured I would just pay cash to her. And then I learned that I can't legally do that either.

And shortly afterward, I was in need of the services of a primary care doctor. So I called every general practitioner in the book here in Santa FE, and was told by all that "We are not taking on any more Medicare patients." The reason was that recent cuts in what they were paid for a Medicare patient made it "not feasible." One doctor who deigned to see me just once -- because my daughter was becoming his patient at the same time -- explained to me that if he had a lot of Medicare patients, he "couldn't pay the light bill." And I walked away angry and a bit disturbed because for the first time, I felt the sting of discrimination that I had not until then experienced in my middleclass white skin.

So with all the talk of health care reform, what can be done to see that *everyone* gets health care, and doctors are fairly compensated?

I operate a business in which I offer a training program over the Internet, and I charge what I wish and what the market will bear. I have some appreciation for the fact that doctors go into debt to get through medical school, and spend years paying for their loans and their equipment. My cousin is a dentist and I've seen that in his life. I would not like to be told that I have to train a certain percentage of people at a low fee, and thus have to spend my own life energy on something that was not compensating me very well -- not as well as I had done in a free enterprise system. On the other hand, in "Sicko," Moore points out that doctors in England and France are well compensated and have a "doctor's life," as opposed to, say, a mechanic's life, because they are highly skilled. And it appeared from that film that it was a win-win situation for providers and patients, alike.

The bottom line in all this, and I think this is what the basis of your thesis is, Dale, is that it is not moral or ethical for any entity to grow rich off of the suffering of our people, and we have to make the welfare (that word being used in its purest form) of all our top priority. A small part of the military budget would take care of our health needs. Talk of "Medicare for all" has me up in arms when I am suddenly faced with the glaring fact that I'm no longer a first-class citizen, no matter how responsible I've been all my life. The women on both sides of my family live to be between 90 and 100 years old, and I intend to cash in on that genetic heritage. But how I'm going to soldier on, without drastic social change, I just can't say. We should be careful that we might get what we ask for in wishing for "Medicare for all." Let's be sure we aren't buying a "pig in a poke."

I am greatly in favor of a plan which puts emphasis on all our citizens learning to take better care of our health, in terms of diet, and exercise, and stress control. We have an unhealthy population and we are in need of a general comeuppance, in my view, in terms of taking personal responsibility. But I am not in the camp with some of our fundie crazies who advise prayer for pain. Young or old, we all have our own health challenges, no matter how responsible we are, and the added stress and fear of not being able to get into a hospital or see a doctor compounds the matter.

Just as I am personally tired of the fact that we often have to vote for the "lesser of two evils" in a political candidate, I am angered at the thought that we have to accept a health plan that is also a "lesser" plan. But as you've said, better something than nothing -- as morally and ethically outrageous as that is. Those words stick in my throat.

L'Chaim. I'm not Jewish, but I savor that thought: "To life"!!!!!!!!!

[DemReadingDU]

23. I don't think we will see single payer for awhile either

Because I feel the economy is about to take a nasty downfall whereby more and more people are laid off losing their health benefits. It will snowball when more businesses go bankrupt thereby even more people lose health benefits.

Being retired, spouse and I have to pay for our own health benefits which is expensive, but if our rates are increased to help pay for all those uninsured people, then I'm not sure if we will be able to afford health insurance. If/when spouse loses his pension, there will be no money for health insurance at all, so we then would also join those uninsured.

We need single payer now, but the powers of the insurance companies, lobbyists and pharma companies will do whatever they can to prevent it from being passed.

Think of the health insurance industry as another bubble, and it will burst when no one, except the elites will be able to afford it. So where I'm going, is that it will take thousands/millions of uninsured people to protest in Washington for single payer or public option before it is passed into law.

[puebloknot]

87. A bit late, but thanks for your comments. I agree! nt

[ejpoeta]

28. I agree that single payer isn't going to happen right now. I think that

having everyone in the same pool is the best option, but if we have a true public option, not one gerrymandered to ensure that it won't work, then most people will flock to it. Those who are currently paying way too much right now as well as those that don't have access to anything. And eventually, almost everyone would end up in it by default, because they will probably be able to see it as better than what they've got for less money. The private insurers would probably develop supplemental plans so they can get some action with those who went with public option as well as those that stayed in their plans. And possibly, god willing, the private insurers would end up going strictly supplemental insurance because that's where the money will be. I hope we can get there. It won't work when we have very few in congress on our side. It is very disheartening to see the reality of how our system 'works'. My daughter went to albany for a class trip a couple weeks ago, and came back with stuff about how a bill becomes a law and a letter from mike ratzenhoffer... and they sure do give them a line of bull. It's hard to change things from where we are. We have little control over anything... not even who we vote for!! The machine makes sure the machine will keep running, and the parts that play nice stay in the mix.

[puebloknot]

88. It will be sad if we get a national plan that is so inadequate ...

... that people have to buy supplemental coverage. And that means, once again, that health care is something only the affluent -- or at least not the poor -- can buy.

[ejpoeta]

93. well, they have it in other countries, so that is what i am thinking it would be.

like for a private room and such like that. I know that when I had my almost 4 year old daughter, I had to pay the difference for the private room. I insisted.... because I didn't want to have to walk down the hall to go to the bathroom like I had to do when i had my 10 year old. Imagine a woman who just gave birth and all stitched up... it took me forever to get to the bathroom. I hate our local hospital. I'd love to go to a different one. But my doctor only goes to the local hospital. sucks.

[Hannah Bell]

34. "it would put a *lot* of people out of work" - so what? no one cared when it was

auto workers - they at least did something useful.


"I am greatly in favor of a plan which puts emphasis on all our citizens learning to take better care of our health"

that will be so beneficial for my leukemia, my kid's broken arm, my aunt's multiple sclerosis.

education isn't a substitute for health care.

"to profits!" is the watchword of our leaders.

[Time for change]

36. She didn't suggest education on how to take better care of ourselves as a substitute for health care

She suggested it as a PART of a good health care plan.

[clear eye]

46. HR 676 (single payer) WON'T PUT PEOPLE OUT OF WORK

Quite the opposite. See the IHSP economists' study of the net effect on the economy. Hint--a net addition of 2.6 million permanent, not easily outsourced jobs. I'm sure some of them can go to people formerly in the health insurance industry. Especially those below executives.

[puebloknot]

91. Great news! Thanks!

[puebloknot]

89. You have misconstrued what I said.

Of course, we need a national health plan. But more and more people are becoming more and more obese. Diabetes is on the rise. There *are* things people can do for themselves to avoid making problems worse. Losing weight by eating less, and controlling blood sugar by *not* eating sugar, in conjunction with monitoring by a doctor, don't require a huge expenditure. And then the hospital bed not occupied by someone who can take some measure of control over their own health situation can be occupied by people with lelukemia, borken arms, andmultiple sclerosis. Shared risk!!!

Eating right (steamed broccoli and a baked potato don't cost anymore than a lot of packaged junk), exercise, avoiding stress when possible -- who in their right mind could argue against that? It would be great if everyone was enlightened and motivated to do the basic things we can all do to try to take care of our health. But a lot of young people -- and some older people -- are so lost they don't know where to begin. An educational program could do a world of good.

[clear eye]

44. Jobs lost in health insurance industry will be overshadowed by gains in jobs

throughout the rest of the economy according to economists. (Summary of IHSP study) http://www.calnurses.org/assets/pdf/ads/ihsp_sp_jobs_ad...

Good news.
The best, most comprehensive solution for our healthcare crisis, a single-payer system that expands and upgrades Medicare to cover all Americans, also promotes economic recovery. A new study, the first of its kind to examine the economic ripple effect of guaranteeing healthcare to all through Medicare, finds that single-payer healthcare reform creates:


2.6 million new permanent, good-paying jobs (jobs that cannot be easily sent overseas)

$317 billion in increased business and public revenues

$100 billion in employee compensation

$44 billion in new tax revenues

At less cost than the federal bailouts for Wall Street giants such as AIG, CitiGroup, Fannie Mae and Freddie Mac, and other banks

Findings from “Single-Payer/Medicare for All: An Economic Stimulus Plan for the Nation,”
Institute for Health and Socio-Economic Policy, research arm, National Nurses Organizing Committee/California Nurses Association.

— HR 676 (Conyers)
Only improving and expanding Medicare for all will:

Produce 2.6 million new jobs

Control costs, saving taxpayers billions of dollars

Guarantee healthcare for all

Ensure complete choice of provider

HR 676, Single-Payer, Medicare for All
One nation. One health plan for all Americans.

www.calnurses.org

See full study: http://www.calnurses.org/research/pdfs/ihsp_sp_economic...

These decisions are too important to be made on the basis of guesses.

[puebloknot]

90. Thank you for this heartening information.

When I posted, it was kind of musing over what the critics would say about shutting down insurance companies. But I was whistling in the dark because I didn't have any statistics. I appreciate your weighing in on this.

[Time for change]

66. You are basically correct about my general theme for this post

I believe that health care should be a right, and everyone should have it.

Another of my major points is that we should focus on that theme (that health care is a right) and make that the defining issue of our efforts, rather than whether or not it is singler payer -- though it is fine to advocate single payer. In other words, I think that a "public option" plan can be designed so that, rather than being "the lesser of two evils" it is in fact a great step forward to the goal of making good quality health care available for all Americans.

I think that the phrase "Medicare for all" captures the idea that everyone should have access to good quality health care, and that phrase need not carry the connotation of second class citizenship.

But the devil is in the details. Medicare has declined in quality substantially since its inception, due to a host of right wing influences. We need to keep our eye on that.

[puebloknot]

92. Yes! I'm reading a book now called "Virus of the Mind" ...

"The New Science of the Meme."

We should work to infect the brains of all those opposed to universal health care (no pre-existing bullshit) with a new meme: "Health care is a right"!

[whoopingcrone]

24. the unmentioned "issue" at stake

If "the goal of a national health plan is that all Americans have access to good quality health care"
we should be talking about who will be paid as well as how it will be paid for.
Right now, even with millions un-and-under insured, primary care physicians have more "customers"
than they can serve efficiently.
Why would they treat public option-ers unless the government paid far more than private insurers?

[ejpoeta]

27. how much do they fight with the private insurers. they have so much hassle

that many are refusing to deal with some of them. If they are getting paid and don't have to fight to get paid, then I bet they wouldn't hesitate to deal with the public option. Besides, the insurance companies only pay what they want, which is rarely what the doctors charge in the first place.

[Time for change]

33. Exactly

When I refer in the OP to a public option plan that will provide good quality health care to all, that presupposes that it will pay doctors and other health care providers enough to make it worth their while. In fact, it will be able to -- and should -- pay them more than private insurers will be able to pay them, because of all the ancillary costs that private insurers have, including the money that goes into their profits.

[destes]

39. I'm tired of this straw man. We have no "choice of physicians"

"politically essential to the enactment of the plan by Congress, is that Americans maintain their choice of physicians"

Most people are insured by carriers who provide a LIST of physicians they are mandated to choose from. That is a FAR CRY from a choosing one's physician. When the insured's employer changes insurance provider the LIST changes.

Some physicians are refusing to keep clients who are insured by some carriers because those carriers do not suit the physician's business requirements. My GP refuses to treat me and my family. She told us that our insurance provider (United Health Care) allowed such a low fee for office visits that she was "working for free". She said she'd been doing it for about 2 years, hoping things would improve. They haven't so she "laid off" about 50 of her regular patients. This is a story that needs to come out and become part of the dialog. United is not the only one. My GP is not the only one either.

[clear eye]

40. I wish a mixed plan could provide good care affordably for all, and not create more economic pain.

If the first line of defense for rising costs is cuts in care and/or subsidies as in the currently proposed plan, and not insurance profits and administrative expenses, coverage and/or quality of care will inevitably suffer. That kills people. Just ask the nurses.

Virtually all of the reforms being floated by President Obama and other centrist Democrats have been tried, and have failed repeatedly. Plans that combined mandates to purchase coverage with Medicaid expansions fell apart in Massachusetts (1988), Oregon (1992), and Washington state (1993); the latest iteration (Massachusetts, 2006) is already stumbling, with uninsurance again rising and costs soaring. Tennessee’s experiment with a massive Medicaid expansion and a public plan option worked - for one year, until rising costs sank it.

and

Enacting phony “universal coverage” has not brought any state closer to a single-payer system. Since the early 1990s, Minnesota, Oregon, Maine, Florida, Utah, Washington, California, Vermont and Massachusetts have been among the states that have attempted to “patch-up” their fundamentally fl awed systems while retaining a place for insurance companies. All have failed. Upon passage, incremental reforms in each of these states were hailed by politicians and the media as a “step toward universal coverage.” Yet despite all the claims of pragmatism, incremental reformers have been unable to shepherd through meaningful change in nearly four decades of trying. And while reformers in these states continue to wait for the next “step,” residents continue to suffer.

http://www.pnhp.org/news/2009/june/hold_out_for_single_...

See also the human consequences of supporting a plan that includes the spiraling costs of the many for-profit insurers:

Because what's happening now is certainly not painless. It's costing me plenty in significantly reduced value of my IRA and pension and every essential purchase I make from food to utilities to transportation as the dollar loses value because of the U.S.'s excessive borrowing. It's costing me in additional state fees and property taxes as the state and local gov'ts have to try to make up for federal cutbacks and the inflation-fueled increase in costs for everything they use to provide essential services. Both you and Obama think you can just keep printing money, not hold anyone to account in order to reduce theft, fraud, and excessive profit-taking and there will be no consequences. There already are painful consequences, especially to Baby Boomers who paid a lifetime in taxes and Soc. Sec. and find themselves unemployed and unemployable as businesses prefer to hire young people living in their parents' homes instead of 50-somethings. This economy is crashing down around our ears if you haven't noticed, with our few remaining large industries closing, and our gov't unwilling or unable to stimulate new industry as they promised instead of using our total revenue plus borrowing power each year to donate to banks and now to health insurance cos., and to service the debt on that expenditure. Debt in service of measures that truly revitalize the economy can protect quality of life and eventually pay for itself. What is happening now is just plain punishing for most people.

By not standing firm for single payer, we will also be abandoning hope for the economic stimulus of a plan that frees businesses, large and small, from crushing costs of insuring employees, the same costs that hastened the shut down of most of Chrysler and the bankruptcy of GM.

Americans need desperately to base our support of a measure on experience, if available, as the best kind of info, rather than repeating failures in hopes that the consequences will be different.

[Time for change]

47. The plan that I'm advocating does not include

"the spiraling costs of the many for-profit insurers".

Rather, the plan I'm advocating, as Edwards, Clinton and Obama did during the primaries, competes against them and will likely drive them out of business.

[clear eye]

51. Private insurers aren't stupid.

Please explain why you believe that your proposal would be more politically feasible than HR 676.

Political insiders know that the fight for a truly viable public option is no easier than the fight for single payer because a workable public option is just as much a threat to the continued existence of the insurance industry, and they know it. They would fight just as hard, w/ just as much money, just as many promises of high-paying jobs for Congressmembers when they retire, and just as much farflung disinformation. That's why no public option like you are describing has been proposed.

I do believe that the theoretical possibility of designing such a good public option--one that would naturally erode away the private insurers--has confused people into getting out of the struggle for single payer, without there being a snowball's chance of even getting such a program on the table.

As far as I can tell, if we're going to have to get something passed over the figurative "dead bodies" of the health insurance companies, we might as well fight for what most acknowledge is the best proposal--HR 676.

[Time for change]

60. I don't know if it would be more politically viable or not

One possible reason that it might be more politically viable is that there is a certain segment of the population that is ideologically averse to having their government take away an option to purchase private insurance. The right wingers could spin that every which way, and it could make such a plan less politically viable.

But I don't know that it would be more politically viable.

I am not advocating against single payer. I am just saying that if and when single payer is completely off the table, we should support alternative plans the provide good quality health care to all Americans.

[L0oniX]

41. The core issue is about weather or not we care about our fellow human beings to do ...

something about health care. It's a human right and this country is soooo fucking hypocritical to call its self a christian nation and then let people die for lack of money. it's immoral and totally sick! You assholes who call yourselves christian should read Mathew Mark Luke and John sometime and take note of what Jesus did.

[slipslidingaway]

58. The saddest part of this debate is that there is No Debate in

Washington between these two systems.

From the beginning the policy was to exclude discussion of SPHC.

[Time for change]

62. Yes, but I don't think that should be surprising, since neither Obama nor any of the other leading

Democratic 2008 presidential candidates ever proposed it.

So, I think that if we can get a plan that provides good quality health care to all Americans, while not subsidizing the private insurance industry, we should support it. That would be a tremendous advance and provide great relief to many millions of Americans. I think it would be a terrible shame if we lost out on that because some progressives were unwilling to support anything but single payer.

[slipslidingaway]

70. Just pointing out that there is no real debate :( Obama did say

that all ideas would be considered and that has not happened.

[Time for change]

74. Yes, I see your point

I've been disappointed over several decisions he's made.

[slipslidingaway]

77. I just believe Real reform begins with a Real debate :) nt

[LongTomH]

65. Good post, THC. Can I add two points?

First, any health care reform that does not a prescription drug plan - and the ability to bargain with Big Pharma for reduced costs - will be a failure.

Second, there must be provisions for preventive health care, including education and incentives for people to seek yearly (at least yearly) checkups.

Just these two points will do more to reduce inflation in health care than any number of administrative measures - including putting patient data into computerized databases.

For the record, I'm very much for computerized databases. When I see my primary care physician, the nurse or MD refers to a bulging folder of medical records going back more than 20 years. If this stuff was on a well-designed database program, every time I go in for a checkup or for routine care, they would see flags referring back previous problems, including my diverticulitis and the fact that I had polio as a child. No, I haven't been diagnosed with post-polio syndrome yet! Yet!

I just don't think putting everything into an electronic database will do that much to reduce costs.

[Time for change]

76. Thank you -- I absolutely agree with your additional points

I didn't discuss that in the OP because I wanted to keep it very general.

The need for a prescription drug plan and preventive health care are essential IMO in order to provide good quality health care. A large percent of our population need perscription drugs, and a plan without it would leave them in a precarious situation. Similarly, preventive health care is important for retaining good health. The ability to negotiate drug prices is essential for keeping costs down, and will prevent us from throwing away our money to the pharmaceutical industry.

[kenny blankenship]

68. What if, due to right wing political pressure... single payer simply does not provide enough money..

Then the political party responsible for sabotaging the national healthcare plan would be slaughtered. Metaphorically, even, by the voters although I expect few would be patient enough to wait for the next election.


C'mon that was weak. Even Margaret Thatcher didn't threaten the National Health Service.

[Time for change]

73. Why would they be slaughtered any more for providing a poor single payer plan than

they would for providing a poor public option plan?

Medicare is a public health insurance plan, and that has been attacked and become of lesser quality over recent years.

[slipslidingaway]

78. JMO...segments of people are fragmented to fight the system

on their own, a SPHC system would have all citizens arguing for the best plan.

[Time for change]

79. Sorry, I'm not familiar with the abbreviations you're using

[slipslidingaway]

80. JMO - just my opinion, SPHC - single payer health care n/t

[shimmergal]

71. Keep in mind:

Medicare still provides private insurance cos. plenty of chance to make money--because of that 20%-patient-co-pay rule, the first $1000-dollar patient-pays for hospital stays, etc. These policies are known as Medicare Supplementals and a lot of Medicare recipients can't afford them, either. I could see this easily happening in either a public option or a single-payer plan. Unless the plan paid for ABSOLUTELY EVERYTHING that's medically necessary. And would the latter ever be politically feasible? I truly don't know.

No, you can't make tax credits the only way subsidies are given for medical care. You can't do it via cash either (like the stimulus payments that were sent to people not on the income tax grid). It needs to be done through some sort of voucher, payable only for health insurance or comparable coverage. Shouldn't be too difficult to work this out.

[Time for change]

75. I believe that it would be better to do it through a voucher, as you suggest, for reasons I stated

in the OP.

But on what basis do you say that it CAN'T be done through tax credits?

[clear eye]

85. Ya know? It doesn't come down to what you "believe".

The costs, carefully researched, calculated, and compiled by numerous specialized health economics researchers say different.

There's an enormous difference in direct and indirect costs to us as individuals between the two options.
Single-payer is hugely less expensive than any mixed private/public plan. People, especially Baby Boomers whose life savings and pensions are already accumulated in yesterday's dollars, are now feeling the hit that excess borrowing is taking on the dollar. In this dreadful economy we also can't afford the combination of increased taxes, either VAT or taxed health benefits AND decreased care for the poor and elderly that is needed to fund a mixed plan. Single payer, even if subsidized to cover the poor and self-employed and chronically ill, would cost less in taxes for almost all working people than they are already spending on insurance premiums with no danger of ever being dropped from the rolls.

The options would strongly effect the economy in opposite ways.
The expensive, partially employer-funded mixed plan would worsen the economy. In contrast, as a result of removing employer costs for health insurance, single-payer will make U.S. enterprises more competitive w/ the rest of the world, and allow more small enterprises to succeed, thus improving the whole economy.

There are great amounts of research available explaining these differences to those who care to look.
This is not simply my "belief". If you go to the PNHP and the CNA websites, you can find study after study by health economists from Harvard and elsewhere proving it. Please, don't take my word for it. Find out for yourself what the difference between the two options is to our society. And that holds true even if a miracle happens and a "public option" is passed that doesn't simply function as a hugely expensive dumping ground for those who won't be profitable for private insurers.

You present yourself as someone who speaks as a statistician--a numbers cruncher. This journal entry is terribly misleading in that light. For anyone who has studied the issue, your credibility has taken a hit. Saying that you think strategically we need to support a mixed plan is a defensible opinion. I don't believe experience in other countries and the individual states has shown that to be true, but it is something reasonable people can differ on. But saying that you, as a numbers cruncher, don't "believe" the difference between the two choices is "important" is irresponsible, especially as you don't include info on the enormous difference in costs and sorts of coverage that are likely with each.

[Name removed]

94. Deleted message

Message removed by moderator. Click here to review the message board rules.

[clear eye]

86. Krugman wrote his newspaper column supporting the Edwards plan BEFORE the bank bailouts

when a person could reasonably say that since we were able to find the money for the war, a lot more could be found for healthcare. Well we've already blown through that and way more and our economy has taken a nosedive.

But I'm stating the obvious.