The thing I don't understand about healthcare reform

[BattyDem]

You will be able to choose between private insurance plans and the public option. If you don't have insurance and/or can't afford to buy it, the government will subsidize the cost.

Well ... if they subsidize the cost of a private insurance plan, that means tax-payer dollars are going to go directly to the health insurance companies, which does nothing to increase the quality of care. Why give money to a third-party, private company when the government already has its own insurance plan: Medicare. Doesn't it make more sense to expand Medicare and let that be the public option? Those who buy in to the system can choose between private companies and Medicare (public option). Those who are subsidized can automatically be placed on Medicare, which would save the government money, because it's not a "for profit" system, and prevent tax-payer dollars from going directly to insurance companies.

On the plus side, they already know that Medicare works (though it's not perfect), they wouldn't have to spend money setting up a new insurance plan or bureaucracy and thousands of providers already accept Medicare. Why is this simple (and obvious) solution being ignored? What would be the downside to doing this?

[bobbolink]

1. Why? Because single-payer wasn't allowed at the table.

Call Max Baucus and thank him.

Need I add..... :sarcasm:

[BattyDem]

7. Infuriating, isn't it?

I want single-payer, but I wasn't even addressing that issue. I just don't understand why the government would waste time and money creating a government-run insurance plan when they already have one. It doesn't make sense.

[bobbolink]

9. And there are many deserving targets for your fury!

1. The damned bought and paid for politicians, first and foremost. BUT, that comes back around to WE, THE PEOPLE for not getting the $$$$ out of the polical system!

2. PNHP and other organizations who talked among themselves for years, rather than developing a strategery for educating the populace and overcoming the corporate bullshit.

3.. US! Our apathy and lack of action, and wanting to complain to each other instead of getting INFURIATED and DEMANDING single-payer!

Yes, we are to blame, also. Even now, look at the threads here... story after story of health-care heartbreak. Yet, where are the action threads!

And, lastly, I cannot forget ANDY, PLEADING for us to work for health care.

...

......

.......

crickets.....

....


fizzle.....

[BattyDem]

11. Andy ...

HE would have been the one posting the action threads. :-(

I agree with every point you made. I don't get it. Why isn't the entire country furious and demanding action? :shrug:

[bobbolink]

13. why aren't WE????? Why didn't we do more, years ago?

It's time for us to take a good look at our own collusion.

:(

yes, Andy would have been raising Cane here about this..... would we have listened more to him now, than we did then?

There was lots of talk about a memorial, and some of us suggested naming a strong push for single-payer for him.

You can see how seriously that was taken.

:cry: :nuke: :cry:

Sometimes we have to look at ourselves.

[BattyDem]

16. I honestly don't know.

You're right - we sit here on our asses and complain, but we do nothing. Maybe it's because the task at hand seems so massive and we don't know where to start. :shrug:

DUers are doers ... when there's a strong leader to get behind. I think that's the problem. There's no well-known, well respected leader rallying the troops for single payer. We need someone who would be what Al Gore is to climate change. Someone who could make people listen, stand up and fight!

:-(

[bobbolink]

17. If I may.... I'm going to give you my best guess, because I worked hard as a volunteer

years ago for a single-payer organization, and I also see the dynamics at DU.

First, DU.... you and others see this as a "doer" site.... yet, many of us really don't see that. It's another version of the society at large.... wanting to be diverted by the DU version of American Idol. It gives the illusion of participation, but in reality it's so much empty calories.

And why would that be? Our Rugged Individualism is such a strong component of our sense of who we are, and we don't stand back and take an objective look at that. We are the products of our society, and share many of the same traits that we so despise among the RW..... we just dress those traits differently.

To take ACTION, we would have to drop some of that rugged individualism, come together and not only LISTEN to each other, but care and support each other for the long haul effort it would take. We're not yet hurting enough to make that commitment. It would be scary to come from behind our masks.

Too complex? Too massive? No, I don't think so. We're smart, we're creative.

Don't know where to begin? By coming together, and seeing each other, ALL of us, as people of value, rather than trying to out-power each other.

And that is more than we can risk right now. We'll have to hurt a hell of a lot more to get to that point.

[BattyDem]

19. Thank you for your insight

:hi:

I never really thought about it that way, but I see your point. We have to realize that we're all in this together or nothing will get done. You say that we're not hurting enough to make that commitment ... and that's very scary. How bad is it going to have to get before we come together? How many more people will die in the meantime? :-(

[bobbolink]

22. Thank you for being willing to listen.....most aren't, and that is precisely the point.

You know, back in my dirtyhippiecommiepinkobum days, we had a saying... actually, a song: "Let there be peace, and let it begin with me". We used to look at the big picture, yes, and there was plenty to be fought against.

BUT, and I can't emphasize this too much, we also looked at ourselves. We saw ourselves as part of the whole picture, and we would meet before an action, and share ourselves, and try to get to the real crux of what we wanted, and how we wanted to achieve it. Then after the action, we would come together again and share with each other what we saw happening, how it felt to us, and what was right with it and what was wrong with it.

We saw OURSELVES as part of the whole gestalt.

How did we lose that?

Why can't we even reclaim some of that right here on DU?

If the larger group is too fractured, why can't we come together in a smalll group that really desires peace and community, and make that happen through supporting and caring for each other?

Peace groups in other countries do that, what is our problem.

More importantly, why don't we CHALLENGE ourselves to do this, if we think "Change" is so bloody important?

[eridani]

49. The OP is not proposing single payer--just that Medicare be one of the options

As a single payer advocate, that is a compromise I could live with.

[endless october]

2. the insurance companies are still a formidable lobbying force.

that's my take on it.

[RufusTFirefly]

3. You're actually thinking and asking smart questions. Sorry, but that's not allowed.

Didn't you get the memo? It's "off the table."

Now please return to your TV before we are forced to arrest you for disorderly conduct.

Thank you and have a nice day.

[Rosa Luxemburg]

4. I hear you

[OHdem10]

5. In reality, we have Health INSURANCE Reform. They are reforming

policies --Inurance. There is no Health Care System in US.

They are doing things like: Persons cannot be denied coverage
because of pre-existing conditions.

From the beginning, they are more or less expanding the Insurance System
we have--just trying to provide for everyone to be able to get Health
Insurance.

[BattyDem]

8. That's true.

:-(

[BattyDem]

6. Someone unrecommended a question?!?

:wtf:

I ask why the government is creating a new insurance plan when they already have one that works (which is a legitimate question)and some people feel the need to unrecommend the post. :eyes:

[inna]

12. i know, it's absolutely astounding.

well, i just rec'd it, and that seemed to offset it, at least now it's at zero.

sometimes i semi-believe the "conspiracy theory" about unreccers being employed by unsurance "industry"...

[BattyDem]

14. Thanks for the rec

:hi:

I'm with you on the "conspiracy theory" :tinfoilhat:

[bobbolink]

15. HUSH. Skinner assures us it's being used "responsibly"

Don't look at how many poverty threads have been unrec'd into oblivion.

:grr:

I'm going to edit this to add... those of us who point out the obvious are just WHINERS.

It has nothing whatsoever to do with JUSTICE.

[nightrain]

10. Why? It would undercut the private health insurance extortion corporations.

Baucus and other Congresspeople have been the recipients of millions of donations to prevent the private sector from being too adversely impacted by reform. Just like, why importation of less expensive drugs from Canada, and negotiating drug prices, and longer delay in getting generics are part of these "public options" or have already passed (generic delay was passed).

Others have recommended that Medicare be opened up to others under 65 on a gradual basis, but Congress won't look at these options.

My experience is--The game was rigged from the beginning. It never has been open and transparent, nor inclusive. Congress is attempting to pull the wool over our eyes. Some of us are attempting to pull the wool back and take a look at the actual reality. It hurts to see the ruse. We have a hard time believing that we're being betrayed.

[bobbolink]

18. Yes, that's right. BUT... it doesn't answer the REAL question... why are WE allowing it?

[ipaint]

20. Because up until the last half dozen years

it was the lower classes suffering. The rot finally made it up to an increasingly uncomfortable middle class and the screaming started. 10, 20, 30 years ago when the numbers where 10-25 million uninsured, nobody cared enough to do anything.

And if the current puny public option plan passes we will be waiting on another 20 year cycle for the suffering to reach those who can afford slightly lower payments and are pacified by no open cherry picking by the insurance companies.

[bobbolink]

21. So, why weren't those of us on the bottom rungs screaming?

the students of Iran made a big fuss, at great peril, because of an election.

What the fuck is our excuse???

[ipaint]

23. Most have been beaten down over the long haul.

Working full time at two minimum wage jobs so you can put food on the table, sick and no doctor, no money for electricity, welfare reform (that was a douzy), some people just don't understand and internalize all the negative shit the upper classes dump on them continuously, no unions, shredded safety net. Most importantly no leaders.
People get punished when they make waves. The last person I remember to bring the plight of the lower classes to the fore front and inspire people to protest was Martin Luther King. And look what happened to him.

For something this big it will take both the middle class and the lower classes together to pull it off and right now the middle class is hell bent on settling for less.

[bobbolink]

24. Oh, that's right.... the slaves weren't beaten down.

The Indians weren't beaten down.

The victims of Jim Crow laws weren't beaten down.

Women without the right to vote, the right to own anything in their own names weren't beaten down.

Yes, none of those people came together and changed things.

[ipaint]

25. What do you suggest?

[bobbolink]

27. In the first place, I don't have to have a solution to be able to name the problem.

However, I will say that our largest problem in this society is our damned Rugged Individualism, which is a barrier to us coming together and actually solving things.

Our rugged individualism is worse now that it was in the past, and is just as much a part of "progressives" as it is the conservatives.

When we decide to learn to listen to each other and care about each other, and that includes progressives, rather than turning everyy damned thing into a debate we must win, then we will BEGIN to get to the point where we can actually change things.

[ipaint]

28. I agree

But I believe the only way things change is when the pain reaches critical mass which includes the majority of the middle class. In order for people to pull together they have to be able to understand what it's like to be in another's shoes. I know what it's like to be homeless, I know what it is like to not have health insurance, I know what it's like to not have food.

Most of the middle class has no clue. Settling for less is fine for the upper classes. It won't be them that falls through the cracks.

I don't know how you change that. But if a leader ever comes along that truly represents the lower classes, I'll be there.

[bobbolink]

30. While I have no doubt your heart is in the right place, that is such an easy copout.

I don't know what it's like to have my home bombed and my child killed in front of my eyes but that doesn't meann I can't fully empathize with Iraqi women who have lived that.

If we don't have empathy or compassion, it's because we chose not to.

[ipaint]

31. I agree again.

What I'm saying is if you don't have it the quickest way to get it is to experience things first hand.

[bobbolink]

41. Thank you. It's all just so sad that so many people in this culture lack empathy

Actually, I think a big part of the problem is we, as a society, are so emotion-phobic.

The word "compassion" means "to feel with". If you stiffle your own emotions, it's highly unlikely that you will be able to empathize with others.

[nightrain]

35. I dunno... are we allowing it? We're speaking out, taking action,

confronting inaccuracies, writing to Congress, protesting in the streets and in front of Congressional offices, making good connections with each other. I see it as a great opportunity to build community and to strive for what we want

[bobbolink]

42. A few are speaking out, taking action. The rest......complain.

I speak from experience.

I spent many, many hours a number of years ago, making phone calls for the local medical group working for single payer. Their agenda at the time was to pull together hearings for the community and also for the congresscritters to attend.

I called literally HUNDREDS of organizations, churches, etc., and they ALL thought it was a great idea, but all they wanted to do was to tell me their sad stories. In the end, a handfull actually signed on as sponsors, and participated. (No, money was required, and I know that I never brought it up... we wanted people and organizations to PUT THEIR NAMES OUT THERE, so we could have the cache to bring in the politicians!)

There were so few sponsors that we had NO politicians who came.... they would have come had we had a LIST of sponsors, so they knew they were being watched.

That was my first clue that people want to complain, but they don't want to actually DO something useful.

I've also brought up action ideas here on DU, asked others for ideas....

..................

......................

................

crickets.

We're great at complaining.

Taking action....

.......not so much.

[nightrain]

44. I spose it's difficult to rouse people out of a comfort zone which

is to withdraw rather than to risk being visible. Does that match your experience?

I'm finding that some of the house meetings have really gathered new folks together who are willing to take action. At least that's what's been happening very locally here.

I've been a single payer supporter since the late 70s.

[bobbolink]

45. I'm glad you're experiencing something somewhat different. I'm afraid people aren't hurting enough

yet.

Since most people really don't say what is really going on with them (probably because they don't make the effort to really KNOW), we tend to attribute causes to what we see.

All I know is tremendous effort on my part resulted in hardly any CHANGE.

:(

And I decided I couldn't keep throwing my energy down a rat hole like that.

[nightrain]

46. yes, it's hard to sustain the momentum alone. Gosh, not hurting enough yet? Doesn't bode well...

and I can certainly appreciate your sentiments, hard to accept that it might be accurate. Take care of yourself! I enjoy your posts.

[bobbolink]

47. Thank you. And I agree completely that looking at the facts is very depressing.

I understand totally why it's so much easier to live by bromides and keep ones head in the sand, and sweep things under the rug. (Did I leave out any cliches? hehehhe)

It HURTS to look at things as they are.

Which is precisely why realists tend to be more depressed.

Reality bites.

[JayMusgrove]

26. In short, the answer to your original question is this......

We cannot put that many angry rich insurance execs out of business by outlawing profit in health care insurance.

It will take 4-8 more years to kill those dragons.......deader than dead.

[Juche]

29. I don't know if that would work

Medicare covers the elderly and I think people with severe chronic diseases like kidney disease. As a result it is going to cost more per enrolle than an employer healthcare plan, which tends to cover fairly healthy people in their 30s, 40s and 50s. As a result I think that would make the public option unpalatable since you'd have a public option consisting of sick people vs. private plans consisting of employed people in their 40s.

Medicare should be expanded to everyone. But if you make it a system where 50% of its enrolles are elderly and the other 50% are young and fairly healthy it will not be cost competitive with a private system that is made up mostly of fairly young, healthy people.

[BattyDem]

33. I never thought of that.

That's a good point. It would make it very difficult to stay competitive. :-(

[eridani]

50. True, but it is likely that a good fraction of young and healthy would also chose this

And don't forget--in EVERY age demographic, 5% of that demographic accounts for 50% or all health care costs.

[Juche]

54. I use that stat all the time

Whenever I am debating healthcare on other boards, because it is extremely important. The sickest 5% use up about 50% of healthcare costs, the sickest 20% use 80% of all healthcare costs while the healthiest 50% of the public use up 3% of all our healthcare costs. So the sickest 15 million people are using 1.2 trillion in healthcare, and the healthiest 150 million people are using 75 billion in healthcare, about $500 a person.

Anyway, in 2002 the elderly used up 36% of all healthcare expenses, despite only being 12% of the public.

http://www.ahrq.gov/research/ria19/expendria.htm#diff2


So any public plan that is a mix of the healthiest 50% combined with the elderly, will not be cost competitive with a private health plan that is made up mostly of healthy people. And those age 65+ make up at least 43% of the individuals in the sickest 5% of the public based on statistics from that site, despite only being 12% of the public.

Policy wonkery is hot.

[bvar22]

32. Very few Americans are going to be "allowed" to "choose" the Public Plan.

According to the CBO which scored HR 3200, the current Bill in the House.


*ONLY 10 Million Americans will be covered by the Public Plan by 2019.
Big Insurance should be very happy.
With the MANDATE that ALL Americans MUST purchase Health Insurance, and only 10 Million in the Public Plan after 10 years, they will be raking in the money.
Billions of it will be YOUR Tax Money buying Resorts and Yachts for the Big Insurance CEOs.

If the Public Plan only enrolls 3% of Americans, will they have any negotiating power to drive down Health Care Costs?

"Most importantly, the CBO coverage tables undermine the conservative claim that a public option would eliminate private insurance and erode employer-sponsored coverage. The House bill actually increases the number of people who receive coverage through their employer by 2 million (in 2019) and shifts most of the uninsured into private coverage. By 2019, 30 million individuals would also purchase coverage from the Exchange, but only 9-10 million Americans would enroll in the public option, the rest would enroll in private coverage."

http://wonkroom.thinkprogress.org/2009/07/14/house-bill-comes-in-at-1-trillion-undermines-gop-talking-points/

*Health Insurance will be mandated for all Americans, but Providers will be able to refuse Public Plan Participants.

Provider participation is voluntary – Medicare providers are presumed to be participating unless they opt out."

*The Public Option "should" be about 10% cheaper than Private Insurance.
I guess that is something, but a Publicly Owned Government Administered Plan that is open to ALL Americans could cut costs by at least 25%. (Difference between Medicare and Private Insurance administration).



*Many that are receiving Employer Based Insurance will be locked out of the "Exchange" and forced to keep their more expensive insurance.

"Under the main health bills being debated in Congress, many people with job-based insurance could find it difficult to impossible to switch to health plans on a new insurance exchange, even if the plans there were cheaper or offered better coverage. The restrictions extend to any government-run plan, which would be offered on the exchange.

<snip>

But critics argue that the rules run counter to suggestions from health care reform advocates that an overhaul could provide people with a broader choice of insurance options. The rules, they say, could be especially unfair to some lower-income workers who are enrolled in costly job-based insurance. Also, they argue, the restrictions would hurt the proposed public plan by limiting enrollment."

http://www.newjerseynewsroom.com/healthquest/for-many-workers-insurance-choices-may-be-limited-after-health-care-overhaul

There are many other details that need to be examined, but the one MOST glaring is the prediction that ONLY 10 Million will be enrolled in the Public Option by 2019. That is minuscule compared to what America is demanding.

Do you believe that the 72% of Americans who are calling for a "Public Option" will be satisfied with this?

[BattyDem]

34. That's what my doctor said yesterday.

He basically said the public option is bullsh*t. :-(

[leftstreet]

39. Good post

:thumbsup:

[kenny blankenship]

40. So many here remain clueless about that.

[Wednesdays]

36. K&R

:kick:

[Ms. Toad]

37. For one thing - much of Medicare is through private insurance plans

There are 72 options in my area - one is traditional Medicare. The other 71 pay an insurance company to administer the plan (and often provide better coverage than traditional Medicare.) What is being proposed in the House and Senate - with a private insurance plans and a public option is really not that different than Medicare.

Not saying that is what I want - I would prefer single payer - but the call to "just expand Medicare" is basically what the House bill expressly calls for and the Senate bill has basic organizational structure for.

[BattyDem]

38. That's true, but it's optional.

If you don't want (or can't afford) to pay for the better coverage, you still get Medicare. The private companies aren't really competing with the government, they are running a Medicare-approved plan and adding some additional coverage that is not offered under traditional Medicare.

From what I understand, the public option will be one choice on a list of insurance plans. All other plans on that list will be offered by private insurance companies. Those companies will not be working with the government to administer a government-approved plan, they will be directly competing with the government's plan, which is exactly why they don't want the public option. They'll have to keep their rates under control if they're going to stay competitive.

It's so hard to cut through all the "legalese" in the bills and determine what they're planning. I was hoping President Obama would get more specific about the details during his press conference, but without a final bill, there was no way for him to do that. :-(

[Ms. Toad]

51. I was responding to the OP which (paraphrased) said don't pay money

to private insurance companies - just expand Medicare.

All I was pointing out was that the House is, essentially, the current Medicare structure, in that Medicare offers both a public option and private insurance plans. Traditional Medicare (the public option) is one of many choices, Medicare Health Plans (privately run insurance plans being the other options. Many of these plans do not charge any additional premiums - so you do not have to be able to afford (or choose to pay) in order to choose to have the government buy private insurance for you rather than choosing traditional Medicare.

What makes it look different is that Medicare is 100% subsidized. Health care under the House bill is not, so you see a premium that you pay, in full or in part, whether you take the public option or private insurance.

Here's how it works:

Medicare - the government pays the "premium" - a step which is invisible to you since it is 100% subsidized by the government.

If you choose traditional Medicare, the government moves the money set aside for your care into the portion of its own pocket designated to cover costs incurred for everyone on traditional Medicare, and pays for bills as they are incurred for covered services. This portion of Medicare looks like what we typically think of as single payer since we don't see the premium - all we see is the government paying the bills.

If you choose Medicare Advantage, the government pays that same money (or recently a bit more, I believe) to the private insurance company. The private insurance company then pays for bills as they are incurred for covered services. The private insurance company keeps the difference (its profit) (There are options which also charge an additional premium - but there are many private insurance plans that require no premium payment from the individual.)

House plan - public private option.

If you choose the public option (equivalent of traditional Medicare), the government moves it's share (if any) of the money set aside for your care into its own pocket designated to cover costs incurred for everyone choosing the private option. You pay your share of the premium to the government (or some government agency designated to collect the public option premiums). The government pays the bills as they are incurred for covered services.

If you choose private insurance, the government pays its share (if any) of the money set aside for your care to a private insurance company. You pay your share of the premium to the private insurance company. The private insurance company then pays the bills as they are incurred for covered services. The private insurance company keeps the difference (its profit).



(Private insurance) Medicare Advantage is currently in direct competition with the government (traditional Medicare) for the guaranteed senior health care dollars - just as private insurance plans would be in direct competition with the public option under the House plan. If it offers an attractive enough package, seniors will choose their plan, with the government footing the bill. The plans these insurance companies provide under are traditional insurance packages - not administration of a government plan. No one is twisting the arms of these private insurance companies to participate - they are doing it because it is profitable for them. If it weren't, they wouldn't be in the business.

If you go here: http://tinyurl.com/msn5h6 you will notice that the search includes traditional medicare (the equivalent of a public option) and Medicare Health Plans (private insurance plans). If you click on "Find and Compare Health Plans." it will give you a list of plans you can choose from. To quote you, "the public option will be one choice on a list of insurance plans." With Medicare, the public option is Traditional Medicare, and the insurance plans are the Medicare Health Plans (Medicare Advantage - or Medicare Part C).

Around 20% of people on Medicare choose the private insurance (Medicare Advantage) option. It can provide better benefits, but limits choices of physicians in the same way as a traditional insurance plan - because it is a traditional insurance plan.

Again, I would prefer single payer (essentially traditional Medicare with the payment of the premium entirely invisible to those of us who use the plan). The public health option, as currently proposed - with a subsidy for lower income individuals and the restrictions on health insurance companies that they must play by the same rules as the government (public option) is acceptable to me - it is essentially the current Medicare structure with a premium structure superimposed (i.e. the fee to buy into the plan comes out of our pockets instead of the government's pocket).

What is not currently acceptable to me is the proposed delay until 2013 of the implementation of the access and parity rules for insurance companies. There is no governmental cost to requiring immediately that private insurance be open to all (and cover pre-existing conditions), and offer plans on a level cost basis to everyone (with no more than minor age based variations).

[nightrain]

43. are those 71 plans the Medicare Advantage Plans?

[Ms. Toad]

48. Yes. n/t

[nightrain]

52. ah... good money-makers I spose.

[Ms. Toad]

53. I would guess so.

Guaranteed payment. Higher than average cost per patient - but if it wasn't profitable, they'd drop out.