What about a harsh, automatic, certain to be met trigger? (0.00 / 0)

Something like full coverage for $100/mo, or a PO automatically comes into existence if premiums are above (total Canadian health care expenditures/Canada's population)?  

There's probably no chance that something like that could quell the Olympia Snowes of the world, but perhaps something like that would give some political cover to friendly moderates who can then say 'well, the insurance companies couldn't bring costs down, so the government's going to have to.'

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by: Valatan @ Thu Sep 03, 2009 at 11:26:09 AM CDT

my thought is that the Republicans were masterful with (4.00 / 2)

conceding meaningless 'compromises' in their efforts to pass legislation during the Bush and Clinton administration.  Perhaps it might be worthwhile to do the same to them.

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by: Valatan @ Thu Sep 03, 2009 at 11:35:18 AM CDT

[ Parent ]

I do not understand this. Could you explain this. (0.00 / 0)

Public options funded only through premiums are the only type of public options passed through committee.  So, we really don't have much choice right now.

Is there some amendment rule I am unaware of?

For example (I know its a silly example)
The red train must be funded by the individual riders.

cannot be amended to read:

The red train must be funded by the individual riders, and a 1 cent levy on snow cones.

Really? The 1 cent levy on snow cones must be added in committee?

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

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by: HousesofProgress @ Thu Sep 03, 2009 at 11:33:57 AM CDT

I think what he's saying is that (0.00 / 0)

the bill that gets passed, THIS TIME, has to be passed as a revenue-neutral bill.  Consequently, it will probably have to be funded through premiums, and premiums only, at least for the time being.

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by: Valatan @ Thu Sep 03, 2009 at 11:36:31 AM CDT

[ Parent ]

Thanks but thats not what the sentence says (0.00 / 0)

And adding a levy on snow cones helping make the option 'revenue neutral" ie it doesn't add to the deficit.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

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by: HousesofProgress @ Thu Sep 03, 2009 at 11:41:09 AM CDT

[ Parent ]

Reconciliation (0.00 / 0)

The budget authority under reconciliation would expire on September 30th, 2014(the end of fiscal year 2014), if the public option is losing money and isn't revenue neutral. At least that is what Martin Paone said in the article I linked above.

Valatan has it right.

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by: Chris Bowers @ Thu Sep 03, 2009 at 11:40:51 AM CDT

[ Parent ]

And would need to be passd again, if it was losing money. (0.00 / 0)

But that doesnt answer the question about adding a tax on snow cones.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

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by: HousesofProgress @ Thu Sep 03, 2009 at 11:42:48 AM CDT

[ Parent ]

Huh? (0.00 / 0)

Not sure what you mean.

1. Yes, it would have to be passed again if it was losing money.

2. Not sure what you mean with the snow cone thing. I'll try to answer though.

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by: Chris Bowers @ Thu Sep 03, 2009 at 11:45:15 AM CDT

[ Parent ]

LOL (0.00 / 0)

Is it not possible to make it more likely to be revenue neutral, if the final included, and is it not possible, to add an extra revenue stream, on the floor or in reconciliation, such as a cigarette tax.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

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by: HousesofProgress @ Thu Sep 03, 2009 at 12:02:04 PM CDT

[ Parent ]

the Kucinich amendment (0.00 / 0)

allowing states to create their own single payer plans is the best we can hope for at this point. The fight for single payer has already moved to the states and there is a very real chance of it passing in Pennsylvania.

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by: AliceDem @ Thu Sep 03, 2009 at 11:54:17 AM CDT

And whilke I have not read the bills, it passed twice in California, only to be vetoed by Californias worst governor. (4.00 / 1)

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

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by: HousesofProgress @ Thu Sep 03, 2009 at 12:03:35 PM CDT

[ Parent ]

What was the point... (4.00 / 2)

Of not having it come into existence until just after the 2012 elections?  I realize these things take time to set up, but that couldn't be a coincidence... Do the Democrats really want to have to defend this for the next 3 years in both congressional and presidential elections without actually having some kind of number to point to as a "win"? (Ie, X million people signed up and report Y% satisfaction with it).  So even with a public option Obama would be basically arguing "Hey, look... you'll be able to buy the public option next year because of me" while the GOP will probably be spewing all the lies we've come to know about it and promising to kill it as soon as they're in office.

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by: leshrac55 @ Thu Sep 03, 2009 at 12:11:23 PM CDT

There were calculations for the spending portion that went on the OMB ten year estimate (0.00 / 0)

And to keep the $ inside their deficit projections the cash rich part is delayed. Its a pain in the keister.

It has happened before...

Tommy Douglas, the CCF/NDP leader who introduced single payer, was shocked to find the books of his province destroyed whehn he took office, went on TV and said "I can't do it yet, the conservatives have given us a massive debt, I will fix it, and run again, and then I'll put health for all into law." (OWTTE)

That's how it started in Canada.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

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by: HousesofProgress @ Thu Sep 03, 2009 at 12:51:25 PM CDT

[ Parent ]

Several slippery slopes (4.00 / 1)

For financial viability, any slippery slope must deal with or eliminate the 30% paperwork, profit and bureaucracy overhead of the private health insurance industry. Otherwise mandates and subsidies just feed the bad part of the machine. We can imagine several ways to slowly take out the insurance companies.  

Creeping Single Payer Mechanisms

(1) Add all children and pregnant women to medicare.
(2) Extend medicare to 55 year olds.

Age-band mechanisms take a whole slice of the population of private insurance.

(3) All unemployed get medicare
(4) All university students get medicare
(5) Self-employed permitted to buy-in to medicare

These have the value of providing economic stimulus, taking the burden off the states, or deal with non-workplace situations.

No's 1 - 4 deal with the 20% insurance company profits and staffing, but don't eliminate the 10% Doctor's have to pay to deal with all the insurance forms.

Segmentation by service type

(6) Make all primary care (Doctors offices) medicare.

This is easy to do based on treatment codes that are already used for insurance reimbursements. This removes a whole class of medical professional from dealing with insurance, which saves you both the Doctor's 10% and Insurance company 20%. Also, it puts public health into long-term planning, something Insurance companies have little incentive to do because churn rates are so high.

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by: MetaData @ Thu Sep 03, 2009 at 14:55:32 PM CDT

The plan that dare not speak its name (0.00 / 0)

Then again, I don't really know why we are supposed to be afraid of talking about a slope toward single-payer.

Well, for one thing, that goes against the official talking points: such talk would allow Republicans raise the "specter" of such an evolution.

So, we have either a restricted, weak public option (as in HR 3200) that cannot compete and cannot evolve toward the scary single payer or we have a robust public option that in the best case scenario is open to all and snowballs into the single payer system other countries enjoy.

Of course, a proposal for such robust public option would encounter similar resistance as a single payer system yet be harder to sell and be prone to causing fractionation of health care reform advocates (because there could be all sorts of variations on the theme) so it isn't exactly a panacea.

It's sort of what happens when you have stated policy goals (e.g., "keeping the insurance companies honest," "competition")  ones (e.g., a public option can't be truly competitive or else it will "dominate" the private insurers).

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by: jeffweinberg @ Thu Sep 03, 2009 at 17:51:56 PM CDT

last sentence (0.00 / 0)

"It's sort of what happens when you have stated policy goals (e.g., "keeping the insurance companies honest," "competition") masking and conflicting with covert ones (e.g., a public option can't be truly competitive or else it will "dominate" the private insurers)."

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by: jeffweinberg @ Thu Sep 03, 2009 at 17:53:47 PM CDT

You're being far too complicated - just expand Medicare (0.00 / 0)

To get to single-payer, you have to make it a big program with open access, and the easiest way is to simply expand an already existing government program.  This is really not complicated:

(1) Consolidate the many federal heath care programs.

Shift all SCHIP and Medicaid patients to Medicare, which will be wildly popular in all 50 states who are currently required to match the federal dollars.  It would immediately free up over $100 billion in state revenue (~$20 billion in California alone).

(2) THE KENNEDY PLAN: Shift all federal employees to Medicare, and make it truly public by opening it to any local or state agency, person or business.

Shift all federal workers to Medicare (including Congress), and allow any local or state agency, person or business to buy into Medicare.  Call it "The Kennedy Plan," a program that actually befits the man (not this weak ineffective versions of the public option floating around).

No more deductibles, and make the premium cost simple: split it equally between employee-employer (3.5% of wages each, is the number I've seen floated around before).  Provide subsidies for those who can't afford the premiums, and require any services previously guaranteed through private insurance plans/labor agreements that is not delivered through Medicare to be provided by a supplemental insurance.  (Let the parasitic immoral death-panel bastards we call the health insurance have that).

(3) Mandate health insurance and auto-enroll those who don't buy it into the Kennedy Plan.

Require every person to have health insurance and automatically enroll those who have yet to purchase it 100 days after the requirement goes into effect into the Kennedy Plan.

#1-3 is actually not very far from what is actually possible in the House of Reps today - if only the Progressive Caucus would come out for it.  It in itself is likely enough to lead to a Kennedy Plan that covers 80-90% of the nation if not more.  But if we really want to ram a stake in the heart of for-profit insurance, we'd include #4-5:

(4) Require doctors to take Medicare

Require every doctor to accept Medicare and prohibit them from providing preferential treatment to any patient on private insurance.

(5) Negotiate prices for all prescription drugs

Self explanatory.

The private insurance industry as we know it would be dead within a year.  And here's the best part, and the most frustrating as well: what I propose above is very likely cost-neutral and might actually reduce the deficit, because the Medicare rolls would now be populated with people who are much younger and healthier, instead of simply the disabled and the elderly.  We very likely would have enough left over to increase Medicare payments to doctors and eliminate any share of cost beyond small copayments.

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by: DWCG @ Fri Sep 04, 2009 at 01:55:54 AM CDT

[ Parent ]

You're being far too complicated - just expand Medicare (4.00 / 1)

To get to single-payer, you have to make it a big program with open access, and the easiest way is to simply expand an already existing government program.  This is really not complicated:

(1) Consolidate the many federal heath care programs.

Shift all SCHIP and Medicaid patients to Medicare, which will be wildly popular in all 50 states who are currently required to match the federal dollars.  It would immediately free up over $100 billion in state revenue (~$20 billion in California alone).

(2) THE KENNEDY PLAN: Shift all federal employees to Medicare, and make it truly public by opening it to any local or state agency, person or business.

Shift all federal workers to Medicare (including Congress), and allow any local or state agency, person or business to buy into Medicare.  Call it "The Kennedy Plan," a program that actually befits the man (not this weak ineffective versions of the public option floating around).

No more deductibles, and make the premium cost simple: split it equally between employee-employer (3.5% of wages each, is the number I've seen floated around before).  Provide subsidies for those who can't afford the premiums, and require any services previously guaranteed through private insurance plans/labor agreements that is not delivered through Medicare to be provided by a supplemental insurance.  (Let the parasitic immoral death-panel bastards we call the health insurance have that).

(3) Mandate health insurance and auto-enroll those who don't buy it into the Kennedy Plan.

Require every person to have health insurance and automatically enroll those who have yet to purchase it 100 days after the requirement goes into effect into the Kennedy Plan.

#1-3 is actually not very far from what is actually possible in the House of Reps today - if only the Progressive Caucus would come out for it.  It in itself is likely enough to lead to a Kennedy Plan that covers 80-90% of the nation if not more.  But if we really want to ram a stake in the heart of for-profit insurance, we'd include #4-5:

(4) Require doctors to take Medicare

Require every doctor to accept Medicare and prohibit them from providing preferential treatment to any patient on private insurance.

(5) Negotiate prices for all prescription drugs

Self explanatory.

The private insurance industry as we know it would be dead within a year.  And here's the best part, and the most frustrating as well: what I propose above is very likely cost-neutral and might actually reduce the deficit, because the Medicare rolls would now be populated with people who are much younger and healthier, instead of simply the disabled and the elderly.  We very likely would have enough left over to increase Medicare payments to doctors and eliminate any share of cost beyond small copayments.

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by: DWCG @ Fri Sep 04, 2009 at 01:56:48 AM CDT