So is it fair to say (4.00 / 5)

that your congressman doesn't support the public option when  the staffer who answers the phone says, "well, you know, there are a lot of proposals out there, and we're waiting to see what emerges from committee/what the final bill looks like"?

Because I can almost guarantee that this is what I'll hear from my congressman until five minutes before the floor vote on the conference report. And then, at the five minute mark, the phones will automatically go to voicemail.

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by: NC 11 CD @ Wed Jun 10, 2009 at 01:15:00 AM UTC

If your congressman is Heath Shuler (4.00 / 3)

probably.


John McCain: Beacuse lobbyists should have more power

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by: Populista @ Wed Jun 10, 2009 at 01:34:57 AM UTC

[ Parent ]

just keep asking (4.00 / 6)

I had to ask Leonard Boswell's spokesman more than once before I got a clear answer about his stance on a trigger.

Then get a friend to call the office and insist on a straight answer.

Join the Iowa progressive community at Bleeding Heartland.

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by: desmoinesdem @ Wed Jun 10, 2009 at 02:07:05 AM UTC

[ Parent ]

Some will disagree with me (4.00 / 3)

but I don't see the public plan being unsubsidized as a bad thing. Even progressive advocates like Jacob Hacker who essentially put the public plan on the agenda agree with that. So I don't see what the big deal is. The biggest question to me is if has bargaining power like Medicare. At the minimum it has to be non-private, non-triggered and open to everyone. It looks like the House fulfills all of those goals. Tax treatment, subsidization, reserves and requiring Medicare providers to accept the public plan are all things that their will be disagreement on within the progressive community and that at least personally I view as non-essential. bargaining power is much more important to me then any of those other things, hopefully we'll get a CBO report on the different ways of modeling a public plan and their effects on cost so we can show more conservative Democrats that if they care about cost control they need to be for a public option with bargaining power.


John McCain: Beacuse lobbyists should have more power

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by: Populista @ Wed Jun 10, 2009 at 01:25:51 AM UTC

the most logical solution (4.00 / 4)

would be to open up Medicare, because we already have a functioning Medicare bureaucracy. Making a new bureaucracy to deal with the public option would likely be more costly.

I agree with those who say that reimbursements for doctors will have to go up if we get a Medicare-like public option.

Join the Iowa progressive community at Bleeding Heartland.

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by: desmoinesdem @ Wed Jun 10, 2009 at 02:08:25 AM UTC

[ Parent ]

They are going to push them onto Medicaid, welfare. (4.00 / 1)

Now we have a whole new group of welfare queens to harass and demonize for medical coverage that isn't even excepted by Walgreen and many doctors.

This is a sham.   The country supports single payer, it is the politicians fighting them to keep their corporate donations at the country's expense.   I am sick of being asked to fight "this", "this" and "that" or to call, email, him, her, it.   This strategy is nothing more than chasing our tails.   We need to figure out a way to get to the core, and I think it is time for slash and burn.   Until they have something to fear, they will do as they please because they have nothing to fear.    

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by: dkmich @ Wed Jun 10, 2009 at 09:39:08 AM UTC

[ Parent ]

except they're cutting hundreds of billions from Medicare to pay for this "reform" (4.00 / 2)

there'll be no real expansion of Medicare -- they're killing it.

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by: amberglow @ Wed Jun 10, 2009 at 16:44:18 PM UTC

[ Parent ]

May they all rot in hell. :-) (4.00 / 1)

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by: dkmich @ Wed Jun 10, 2009 at 22:05:59 PM UTC

[ Parent ]

it's us who will die from this -- not them. (4.00 / 1)

it's the millions and millions (and growing) who don't have health insurance and need to rely on public hospitals (being cut) and medicare/medicaid (being cut) ...

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by: amberglow @ Thu Jun 11, 2009 at 12:08:00 PM UTC

[ Parent ]

I was gonna ask about that; (4.00 / 1)

isn't one of the major points of the public option having a public, not-for-profit plan that completes with the for-profit companies on a completely level playing ground? (And will that be a level playing ground, does everyone have to accept all customers, pre-existing conditions or not?)

And what does the right 'bargaining power' look like?

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by: Joel @ Wed Jun 10, 2009 at 02:45:39 AM UTC

[ Parent ]

A subsidized public plan would bring down costs ffurther (4.00 / 1)

Competing with a public option helps bring down costs. Competiting with a public option that has low costs due to subsidies would bring down costs even further.

The lower the costs in the public option, the lower the costs in the private options. The main goal here is to bring down costs, and I don't think this plan goes far enough.

Helping people pay their private insurers won't force the private insurers to bring down costs much as will giving people the option of buying into a subsidized plan. We need such a drastic meaasure, because, compared to other large, wealthy countries, 4% of our entire GDP is being drained away. by how expensive our health care plan is.

Your suggestions are mainly nibbling around the dges of an enormous problem.

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by: Chris Bowers @ Wed Jun 10, 2009 at 03:09:42 AM UTC

[ Parent ]

But isn't this sort of a backdoor into (4.00 / 1)

a subsidized plan? I'm uncertain about this stuff, but looks to me that if you offer to help people pay for either the public or a private plan, and the public plan is lower-cost, then the majority of those people will spend that money on the public plan.  

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by: Joel @ Wed Jun 10, 2009 at 03:21:30 AM UTC

[ Parent ]

Of course they will (0.00 / 0)

The goal here is to reduce the cost of heatlh care.

I don't see how that happens unless someone starts  offering a lower priced heatlh care option.

I don't see why the private companies will ever start offering one voluntarily.

So, either price controls need to be instituted, or the government needs to just start offering a lower priced plan.

Otherwise, health care costs aren't going down.

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by: Chris Bowers @ Wed Jun 10, 2009 at 05:43:20 AM UTC

[ Parent ]

Oh wait (0.00 / 0)

It occurred to me that maybe you are being ironic.

Man, I can be pretty dense at 1:45 a.m. Sorry.

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by: Chris Bowers @ Wed Jun 10, 2009 at 05:49:35 AM UTC

[ Parent ]

No, I wasn't being ironic! (0.00 / 0)

So I guess the density happened on my end.

I haven't really studied healthcare policy, but this is what I meant:

1) The public option charges less than the for-profit options, if only because the public option hasn't the built-in cost of ... well, making a profit.
2) People spend their cash (or whatever) subsidies on the public option. Because it costs less than the private ones for the same or better care.
3) So by helping people pay for insurance, in fact we're kinda subsidizing the public option--just through middlemen.

So am I wrong to assume that 1) will happen? That the public option will offer lower costs without direct subsidies?

(None of this strikes me as nearly as good as single-payer, and if there's one lesson I wish that our elected officials learned it's that you've gotta fight for your principles even when you know you're gonna lose. That's what makes them principles. So they--and we--should've gone to bat for single-payer, lost if necessary, and then moved to the strongest possible public option. Instead, we go to bad for public option and try figuring how to water it down. Ah, negotiation ...)

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by: Joel @ Wed Jun 10, 2009 at 13:33:25 PM UTC

[ Parent ]

Well (4.00 / 1)

we will disagree on this then as I suspected.

If you have a universal, non-profit public plan and ideally one with bargaining power it will clearly cost less then private insurance. If you subsidize healthcare for people and give them a choice most of them will choose the public option as it will deliver cheaper, better care.

However if you directly subsidize the public plan you simply create a unfair advantage for the public plan. A governmental healthcare plan modeled off Medicare can deliver quality healthcare for much less cost then a private provider ever could. It doesn't need direct subsides to be a much cheaper option and arguing that it does in my opinion undermines the argument that government can deliver healthcare for less cost then private insurers.

This is a huge problem clearly as you and others have shown. Any of these things will be nibbling around the edges to some extent until we make it to Medicare for All. We barley have half of the Senate Democratic caucus even endorsing any public option so M4A is clearly not happening. The question is will this healthcare reform bill include a public option that will lower costs for everybody by providing a cheaper healthcare option for everybody. We won't win on every detail of the public option and we have to decide what's worth fighting for.

Having a public plan at all will be the biggest issue of contention in healthcare reform. Making sure that it's included, not run by a private company and open to everyone is the most important battle. Trying to wage a battle for a direct subsidized option that even leading public option proponents reject is extremely bad strategy, policy and politics that will get us no where.

That's make take at least :)

John McCain: Beacuse lobbyists should have more power

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by: Populista @ Wed Jun 10, 2009 at 04:10:37 AM UTC

[ Parent ]

I guess we don't really disagree (0.00 / 0)

"Any of these things will be nibbling around the edges to some extent until we make it to Medicare for All."

Well, I guess we don't actually disagree that much then. sorry if my tone came off as harsh and dismissive.

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by: Chris Bowers @ Wed Jun 10, 2009 at 05:44:38 AM UTC

[ Parent ]

I guess we just disagree (0.00 / 0)

on how to get there.

And no worries on tone. Compared to some people in politics I've dealt with even today you sound like a angel :)

John McCain: Beacuse lobbyists should have more power

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by: Populista @ Wed Jun 10, 2009 at 06:50:10 AM UTC

[ Parent ]

"not run by a private company" -- that's what it is (0.00 / 0)

it's not a public option or plan at all.

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by: amberglow @ Wed Jun 10, 2009 at 16:46:13 PM UTC

[ Parent ]

A subsidized plan (4.00 / 1)

is a back door path to single payer, and I think everyone knows it. There are three potential cost advantages that a public plan will have:

1.  No need to show a profit
2.  Economies of scale and the power of monopsony
3.  Subsidized costs.

Over time the first two advantages will, I think, mean that the public plan will be cheaper.  The moment 3 becomes an issue, though, the private insurance plans will not be able to compete and they will likely try to skim the cost pool in order to survive.  

You can't have public/private competition and subsidize one of the players.

But I am far from a health care expert and may be completely full of it...

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by: fladem @ Wed Jun 10, 2009 at 15:30:03 PM UTC

[ Parent ]

Not to mention (4.00 / 3)

"hopefully we'll get a CBO report on the different ways of modeling a public plan and their effects on cost so we can show more conservative Democrats that if they care about cost control they need to be for a public option with bargaining power. "

That assumes conservative democrats are opposed to a public plan because they think it will cost too much. Really, it assumes that they actually care about health care costs at all.

You have that wrong. Their opposition is largely based on opposing anything viewed as progressive for the sake of it, and with mollifying the lobbyists they talk with regularly.

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by: Chris Bowers @ Wed Jun 10, 2009 at 03:21:53 AM UTC

[ Parent ]

I don't suffer (0.00 / 0)

illusions about their motives. I know that they have made "cost containment" for overall healthcare spending (not government healthcare spending) a key talking point. If it's proven that their opposition to a strong public option is in opposition to bending the curve on costs it will put more pressure on them to do the right thing.

It's pretty clear to me, you and any other rational observer that the most cost efficient solution is a Medicare for All system or potentially even straight up socialized medicine (VA for all), in terms of sticking with the public-private mix we have today the best way to control costs is clearly again some kind of strong public option based on Medicare or the VA. But the more proof that we have to argue for that the more pressure we can put on these people. And for Congress the CBO is proof.

I haven't seen any official studies about the effects of different models of a public plan but I suspect if we get such a study it will find that having universal, non-profit public option is the most important step to controlling costs and giving it bargaining power is more important then giving it a unfair advantage (which is in my opinion what subsidizing is).  

John McCain: Beacuse lobbyists should have more power

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by: Populista @ Wed Jun 10, 2009 at 03:57:41 AM UTC

[ Parent ]

Exactly (4.00 / 3)

I actually prefer direct subsidies that can be used for either the public or private plans.  The public plan will implement all the cost savings measures we know/expect to work and be run without making a profit.  The private plans have to compete against that.  If they can compete then more power to them.  To do so will require some real innovation -- or at least some damn good commercials.

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by: Mark Matson @ Wed Jun 10, 2009 at 05:07:54 AM UTC

[ Parent ]

That is so exactly (4.00 / 1)

what I was trying to say, that I hate you.

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by: Joel @ Wed Jun 10, 2009 at 13:34:52 PM UTC

[ Parent ]

The idea of (4.00 / 2)

the government subsidizing private insurance companies is maddening, though.  Taxpayer money directly to Blue Cross or Cigna?  The government paying for their ads?  That is frittering away patient care dollars.

National Nurses United (AFL-CIO) is America's RN union, representing 150,000+ nurses from all 50 states.

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by: National Nurses Movement @ Wed Jun 10, 2009 at 19:37:44 PM UTC

[ Parent ]

Remember (4.00 / 1)

that only happens if the patient chooses Blue Gross or Cigna. Given that they almost all won't it's not much of a problem. And what's wrong with giving the patient some choice after years of being bossed around by the big HMO's?

John McCain: Beacuse lobbyists should have more power

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by: Populista @ Thu Jun 11, 2009 at 04:59:11 AM UTC

[ Parent ]

FYI (4.00 / 1)

Here's Hacker

The idea is of course to compete on a level playing field, which means that there should be no specific subsidies from general revenues. The public health insurance plan should not be able to draw on general revenues to cover its expenses in the same way that Medicare Part B does: Any subsidies for coverage are available for any plan within the national pool at the same level, however they are financed (general revenues, payroll contributions, etc.).

John McCain: Beacuse lobbyists should have more power

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by: Populista @ Wed Jun 10, 2009 at 01:35:41 AM UTC

A lot better than I expected (0.00 / 0)

If something this good can actually pass the Senate, I'll die from disbelief.

Conduct your own interview of Sarah Palin!

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by: fwiffo @ Wed Jun 10, 2009 at 14:18:54 PM UTC

it's Schumer's "compromise" -- & garbage -- PNHP : " Sen. Schumer kills reform" (4.00 / 1)

Sen. Schumer kills reform -- http://www.pnhp.org/news/2009/...

... To prevent gridlock, Sen. Charles Schumer offers the simple solution of "public option light" so that it would not be a deal breaker for either side. The progressives would have a government-sponsored plan in the mix of private plans, and the Republicans would have government-sponsored plan that is indistinguishable from private plans, creating a level playing field. Thus each side could move forward with reform without having to implement their deal-breaking rhetoric.

This is not simply Sen. Schumer's personal effort defuse this bomb. His public option compromise was prepared at the request of Sen. Max Baucus who has been working closely with Sen. Charles Grassley to craft truly bipartisan reform legislation. In fact, at yesterday's Senate Finance Committee hearing on expanding health care coverage, in addition to the fifteen scheduled witnesses, Sen. Baucus called on committee member Schumer to present the public option compromise.

Look at the history of what has happened here. The progressives were told by the moderates that the votes for single payer were not there. So negotiations began from a position that single payer was off the table. The progressive community then decided to concede that the Republicans and the insurance industry could have their market of private plans, and that the compromise position that all could accept would be the addition of a public insurance option.

In the compromise process, the Republicans and the insurance industry finally made their move. That was, "drop dead." The Progressive Caucus responded with, "we've already come more than half way, so now you drop dead." So now we have the Schumer compromise of public option light, which now has been blessed as the current, official Democratic position, even though it moves even closer to the Republican position.

What have the Republicans conceded so far? Nothing. What is the insurance industry's position on a competing public plan that looks just like their private plans? Karen Ignagni of AHIP says that she still sees "no need for a public plan." No concession.

The Democrats have already conceded on an effective public plan option. They have conceded that universal coverage is not possible so we should merely "aim for universal." They have admitted that they have not figured out a way to pay for plans with adequate benefits for working families. They have abandoned support of policies that would improve value while controlling costs.

The Democrats have already given away all major policies for reform, and the Republicans haven't had to budge the least. Why should they when the Democrats are rushing in their direction? ...

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by: amberglow @ Wed Jun 10, 2009 at 16:53:00 PM UTC

and the industry is still against even this wholly-compromised bs -- "no need for a public plan." (0.00 / 0)

from there, and many many other articles on their position.

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by: amberglow @ Wed Jun 10, 2009 at 16:54:58 PM UTC

[ Parent ]

"how similar the major health insurers are to our failed Wall Street firms" (4.00 / 1)

PNHP -- The Facts About the Health Insurance Industry --http://www.pnhp.org/news/2009/june/the_facts_about_the_.php

Most people are unaware how similar the major health insurers are to our failed Wall Street firms.They are corporate cash cows and have virtually no fiduciary responsibility and few activities for protecting or improving health or the health care system.They will devote their vast resources to prevent any meaningful health reform. They have controlled Congress and the mainstream media. The only cure is vigorous popular support for a single payer, Medicare for All reform. ...

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by: amberglow @ Wed Jun 10, 2009 at 16:58:02 PM UTC