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Wed Oct 16, 2019, 11:03 PM

 

The 'Public Option' on Health Care Is a Poison Pill

Last edited Wed Oct 16, 2019, 11:58 PM - Edit history (1)

Some Democratic candidates are pushing it as a free-choice version of Medicare for All. That’s good rhetoric but bad policy.
By David U. Himmelstein and Steffie Woolhandler
October 7, 2019

Health care reform has been the most hotly contested issue in the Democratic presidential debates. Bernie Sanders and Elizabeth Warren have been pushing a single-payer Medicare for All plan, under which a public insurer would cover everyone. They would ban private insurance, except for items not covered by the public plan, such as cosmetic surgery or private rooms in hospitals. The other Democratic contenders favor a “public option” reform that would introduce a Medicare-like public insurer but would allow private insurers to operate as well. They tout this approach as a less traumatic route to universal coverage that would preserve a free choice of insurers for people happy with their plans. And some public option backers go further, claiming that the system would painlessly transition to single payer as the public plan outperforms the private insurers.


That’s comforting rhetoric. But the case for a public option rests on faulty economic logic and naive assumptions about how private insurance actually works. Private insurers have proved endlessly creative at gaming the system to avoid fair competition, and they have used their immense lobbying clout to undermine regulators’ efforts to rein in their abuses. That’s enabled them to siphon hundreds of billions of dollars out of the health care system each year for their own profits and overhead costs while forcing doctors and hospitals to waste billions more on billing-related paperwork.

Those dollars have to come from somewhere. If private insurers required their customers to pay the full costs of private plans, they wouldn’t be able to compete with a public plan like the traditional Medicare program, whose overhead costs are far lower. But this is not the case: In fact, taxpayers—including those not enrolled in a private plan—pick up the tab for much of private insurers’ profligacy. And the high cost of keeping private insurance alive would make it prohibitively expensive to cover the 30 million uninsured in the United States and to upgrade coverage for the tens of millions with inadequate plans.

Public option proposals come in three main varieties:

§ A simple buy-in. Some proposals, including those by Joe Biden and Pete Buttigieg, would offer a Medicare-like public plan for sale alongside private plans on the insurance exchanges now available under the Affordable Care Act. These buy-in reforms would minimize the need for new taxes, since most enrollees would be charged premiums. But tens of millions would remain uninsured or with coverage so skimpy, they still couldn’t afford care.

https://www.thenation.com/article/insurance-health-care-medicare/
If I were to vote in a presidential
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Arrow 38 replies Author Time Post
Reply The 'Public Option' on Health Care Is a Poison Pill (Original post)
BeckyDem Oct 2019 OP
HerbChestnut Oct 2019 #1
BeckyDem Oct 2019 #2
wasupaloopa Oct 2019 #3
SterlingPound Oct 2019 #4
BeckyDem Oct 2019 #7
SterlingPound Oct 2019 #8
Thekaspervote Oct 2019 #24
emmaverybo Oct 2019 #22
HerbChestnut Oct 2019 #13
PatrickforO Oct 2019 #34
pnwmom Oct 2019 #5
crazytown Oct 2019 #9
NYMinute Oct 2019 #10
BeckyDem Oct 2019 #11
Celerity Oct 2019 #15
Thekaspervote Oct 2019 #25
AncientGeezer Oct 2019 #27
PatrickforO Oct 2019 #29
Yo_Mama_Been_Loggin Oct 2019 #20
PatrickforO Oct 2019 #30
pnwmom Oct 2019 #33
BeckyDem Oct 2019 #6
Thekaspervote Oct 2019 #26
mr_lebowski Oct 2019 #35
BlueMississippi Oct 2019 #12
BeckyDem Oct 2019 #14
pnwmom Oct 2019 #19
crazytown Oct 2019 #16
Celerity Oct 2019 #18
BeckyDem Oct 2019 #21
Celerity Oct 2019 #23
Celerity Oct 2019 #17
blm Oct 2019 #31
AncientGeezer Oct 2019 #32
kcr Oct 2019 #37
PatrickforO Oct 2019 #28
Fiendish Thingy Oct 2019 #36
PDittie Oct 2019 #38

Response to BeckyDem (Original post)

Wed Oct 16, 2019, 11:05 PM

1. Yup.

 

It leaves the core of our current broken healthcare system intact. There is a reason most other industrialized countries have figured out some form of national health insurance.
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Response to HerbChestnut (Reply #1)

Wed Oct 16, 2019, 11:07 PM

2. Totally.

 

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Response to HerbChestnut (Reply #1)

Wed Oct 16, 2019, 11:16 PM

3. M4A $34 trillion over 10 years. Yes your taxes will go up.

 

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Response to wasupaloopa (Reply #3)

Wed Oct 16, 2019, 11:23 PM

4. But so will the amount of care avalible for you.

 

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Response to SterlingPound (Reply #4)

Wed Oct 16, 2019, 11:35 PM

7. That fact is lost on some.

 

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Response to BeckyDem (Reply #7)

Wed Oct 16, 2019, 11:37 PM

8. YUP

 

How I will never know, but it sure is.
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Response to BeckyDem (Reply #7)

Thu Oct 17, 2019, 12:55 AM

24. The fact that is lost is voters, therefore congress is never going to pass a 32 trillion $ bill!

 

CBO out today... these are the figures
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Response to SterlingPound (Reply #4)

Thu Oct 17, 2019, 12:00 AM

22. You mean quality? Not necessarily for those with good plans ---some are affordable or paid for by

 

employers or retirement benefits. So the “you” needs to be qualified.
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Response to wasupaloopa (Reply #3)

Wed Oct 16, 2019, 11:40 PM

13. That's fine. It will likely be cheaper than paying for private insurance.

 

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Response to wasupaloopa (Reply #3)

Thu Oct 17, 2019, 01:30 AM

34. Indeed. And I'm willing to pay a lot more taxes in order to get rid of the giant

 

premiums I have to pay, and the financially crippling copays. Thus, I will have lower total costs for healthcare.

Do you know, this year is open enrollment time at my employer, and my premiums are up over 17%? And, if I end up in the hospital my yearly out of pocket max is 3 large. For each member of the family. And, they've put in a nice little loophole, too. Now, they say the 'max' out of pocket isn't necessarily the max - they can just say no, you have to pay more if they have even a little, tiny, weak justification for that.

Aren't you tired of hoping you don't get seriously sick and have to count on one of these companies to care for you? Because they don't care about you. They care about profits (or retained earnings, in the case of the not-for-profits).

What everyone needs to understand is that there is a direct conflict of interest for an insurance company to pay out on the treatments you need. They use complex actuarial tables to determine what your premiums ought to be, and that calculation is based on the statistical probability that you will ultimately pay in more than you cost. So, just with THAT, the insurance company has incentive to deny or skimp on treatment, and when we add in the concept of shareholder primacy, providing you the treatment you actually need is in direct conflict with profits.

This is why our system sucks so bad.

Now, look at what's happening. The corporate owned media are dutifully posing the question, 'won't M4A take away the private insurance plans of millions of Americans?'

And, during the debate, Warren got hammered when she answered the question of whether middle class taxes would go up with 'your costs will be less.' That is a true statement but I wish she would admit that taxes would go up, and then add 'and you won't have to pay premiums any more, or copays, or coinsurance. So your costs WILL actually go down.'

What is happening here is unconscionable, but then there are MILLIONS of dollars lined up against our politicians doing the right thing. For profit healthcare and big pharma are going to fight, and fight, and fight tooth and nail, 24/7/365 against even a public option, which as the Nation article points out, wouldn't necessarily work too well.

We're trying out a public option in Colorado, but I'm not sure how, or if, it will work. And, honestly, I'd rather have M4A because then not only would I and my family have enough, but everyone else would, too. And people who wanted could still purchase supplemental policies as they do in other, more civilized, countries than ours.
If I were to vote in a presidential
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Response to BeckyDem (Original post)

Wed Oct 16, 2019, 11:25 PM

5. The DU rules specify a 4 paragraph limit, to avoid violating copyright limit.

 

And the Nation, which attacked Hillary frequently in 2016, isn't one that deserves an exemption from the rules, IMHO.
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Response to pnwmom (Reply #5)

Wed Oct 16, 2019, 11:38 PM

9. +1

 

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primary today, I would vote for:
Undecided

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Response to pnwmom (Reply #5)

Wed Oct 16, 2019, 11:38 PM

10. "The Nation" is a RW source nt

 

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Response to NYMinute (Reply #10)

Wed Oct 16, 2019, 11:39 PM

11. lol

 

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Response to NYMinute (Reply #10)

Wed Oct 16, 2019, 11:45 PM

15. that is simply a false assertion, regardless of whether you agree with the OP or not

 



https://mediabiasfactcheck.com/the-nation/

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Response to NYMinute (Reply #10)

Thu Oct 17, 2019, 12:56 AM

25. It certainly has some pretty far out there ideas. Stopped reading anything they print

 

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Response to NYMinute (Reply #10)

Thu Oct 17, 2019, 01:10 AM

27. That's flat out false...it endosed Sen. Sanders in '16

 

From the Nation's website...."About The Nation

Principled. Progressive. The Nation speaks truth to power to build a more just society."
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Response to NYMinute (Reply #10)

Thu Oct 17, 2019, 01:13 AM

29. No it's not. What kind of talk is that?

 

You know very well the Nation is a left-leaning publication.
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Response to pnwmom (Reply #5)

Wed Oct 16, 2019, 11:55 PM

20. +10000

 

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primary today, I would vote for:
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Response to pnwmom (Reply #5)

Thu Oct 17, 2019, 01:15 AM

30. Ah, that explains it. The Nation attacked Hillary.

 

One person below is calling it a right wing source, which is not true. The poster should probably edit and cut to four paragraphs, but just because the Nation was critical of Clinton in 2016 does not necessarily put it in opposition to the Democratic party.
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Response to PatrickforO (Reply #30)

Thu Oct 17, 2019, 01:27 AM

33. And The Nation has promoted Edward Snowden. n/t

 

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Response to BeckyDem (Original post)

Wed Oct 16, 2019, 11:34 PM

6. From 2017

 

Single-Payer Reform Purported to Save Estimated $504 Billion

The latest repeal and replace plan from GOP leaders contains various references to limiting Medicaid spending through set state budgets. But Steffie Woolhandler, MD, MPH, and David U. Himmelstein, MD, do not support the GOP plan, citing significant economic and social impacts whether the ACA is kept or repealed. The pair claims that a single payer healthcare can improve patient outcomes with affordable and fiscally sustainable alternatives.

“The ACA has helped millions. However, our healthcare system remains deeply flawed,” write Woolhandler and Himmelstein.

“Reforms that move forward from the ACA are urgently needed and widely supported,” they continue. “Even two fifths of Republicans (and 53% of those favoring repeal of the ACA) would opt for single-payer reform (10). Yet, the current Washington regime seems intent on moving backward, threatening to replace the ACA with something far worse. Polls show that most Americans – including most people who want the ACA repealed, and even a strong minority of Republicans – want single-payer reform. And doctors are crying out for such reform.”

According to their findings, streamlining a single payer system could produce an estimated savings of $220 billion on insurance overhead. Over $150 billion in hospital administration costs can potentially be saved and $75 billion in paperwork costs could be reduced under a single payer program.

https://healthpayerintelligence.com/news/single-payer-reform-purported-to-save-estimated-504-billion
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Response to BeckyDem (Reply #6)

Thu Oct 17, 2019, 12:58 AM

26. Oh please! Of course repubs favor repeal.. and replace with nothing

 

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Response to Thekaspervote (Reply #26)

Thu Oct 17, 2019, 01:53 AM

35. I think you're missing the point here ... compare and contrast the OP with this 2017 article

 

And you should find that there's been a significant change in these 2 author's rhetoric re: a single-payer plan.
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Response to BeckyDem (Original post)

Wed Oct 16, 2019, 11:39 PM

12. Please self-delete .. The Nation is a RW source nt

 

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Response to BlueMississippi (Reply #12)

Wed Oct 16, 2019, 11:41 PM

14. No, it is no such thing. The authors are also not right wing, not in any shape or form.

 

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Response to BeckyDem (Reply #14)

Wed Oct 16, 2019, 11:51 PM

19. DU was sued for copyright infringement and one reason it won the suit

 

is because of the 4 paragraph limit.

So why won't you just follow the rule? It's in the Terms of Service

Respect copyrights
Excerpts from copyrighted sources must be no more than four paragraphs and include a link to the source. See our DMCA Copyright Policy for more information.
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Response to BlueMississippi (Reply #12)

Wed Oct 16, 2019, 11:48 PM

16. You've got to be kidding.

 

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Response to crazytown (Reply #16)

Wed Oct 16, 2019, 11:50 PM

18. +10000

 

If I were to vote in a presidential
primary today, I would vote for:
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Response to Celerity (Reply #18)

Thu Oct 17, 2019, 12:00 AM

21. Thank you.

 

If I were to vote in a presidential
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Response to BeckyDem (Reply #21)

Thu Oct 17, 2019, 12:01 AM

23. yw

 

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Response to BlueMississippi (Reply #12)

Wed Oct 16, 2019, 11:48 PM

17. lol, the same bollocks as the other poster making the exact same erroneous claim

 

Regardless of whether you agree or not with the OP, it serves no legit purpose to posit falsehoods

https://mediabiasfactcheck.com/the-nation/

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Response to BlueMississippi (Reply #12)

Thu Oct 17, 2019, 01:21 AM

31. Who told you that?

 

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Response to BlueMississippi (Reply #12)

Thu Oct 17, 2019, 01:21 AM

32. Horse pucky as we geezers say.

 

They endorsed Sen Sanders in '16.....from the "About" pg...
"About The Nation Principled. Progressive. The Nation speaks truth to power to build a more just society."
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Response to BlueMississippi (Reply #12)

Thu Oct 17, 2019, 03:52 AM

37. Wrong

 

Don't know who told you that, but you were misinformed.
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Response to BeckyDem (Original post)

Thu Oct 17, 2019, 01:11 AM

28. Interesting logic, and compelling.

 

I saw another post on here that used the analogy of us getting nickel and dimed by the airlines after they were deregulated to show that the public would not buy the argument that overall cost would go down.

But, you know, that post made me think maybe we ought to re-regulate the airlines.

Your post, I agree with. Medicare for all would be the right thing to do, but it will take major political courage on the part of the whole Democratic party to roll over the billion dollar healthcare provider and big pharma lobbies.
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Response to BeckyDem (Original post)

Thu Oct 17, 2019, 01:57 AM

36. Essential reading for all, but especially those who oppose M4A

 

Just as Warren refuses to utter a word about taxes regarding her M4A plan, those candidates who oppose M4A refuse to acknowledge the shortcomings of their proposals, especially the millions who will remain without coverage, or will still go bankrupt from medical debt.
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Response to Fiendish Thingy (Reply #36)

Thu Oct 17, 2019, 07:48 AM

38. Or will die

 

because they cannot afford their meds, or to go see the doctor because they shudder at the thought of the bills they'll get. EVEN THOSE WITH GOOD INSURANCE.

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