The Left/Right Beltway Campaign Against The Public Option

By Big Tent Democrat, Section Other Politics
Posted on Sun Nov 01, 2009 at 11:48:12 AM EST
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Opponents of the public option, both from the Right and from Village "progressive" wonks, have spent months trying to denigrate the potential of a public option to reform health care and insurance. Yesterday, Jeralyn linked to one of the latest of such articles. Only 2% (6 million souls)will use the public option they (and the CBO) say. Why fight for it they ask? It's the "rest of the bill" that matters. This is nonsense. Let me present 3 arguments why this is so.

The first, and to me the most telling, why is it the insurance industry and anti-reformers have drawn their line in the sand on the public option? Why are they not fighting against the "rest of the bill?" Why do they have no problem with the magic "exchange?" Or they "no denial for preexisting conditions" provision? Simply put, they know that these "regulations" are toothless and will do nothing to hurt them. They know that the public option is the threat to their profits.

Second, the Village "progressive" wonkers do not give a honest appraisal of the potential for the public option. They ignore the history of Medicaid, which began covering 4 million people and that covered, by 2004, 47 million people. The fact that eligibility for inclusion in the potential public option pool is likely to grow (indeed, the House bill contemplates such an expansion by as early as 2015) is completely ignored by Village progressive wonks, because of their belief in magic "exchanges" and "regulation." The fact that both have been proven to NOT work and that only public insurance programs have proved to be effective cost containers and providers of affordable insurance are inconvenient facts for the Village wonks. More . .

The third consideration is the need for Democratic operatives and wonks to declare any "health care reform" a "success," whether the bill is worthwhile reform or not. They have a partisan stake in the perception of this bill. In short, they have other considerations besides the merits.

At this point, there are few analysts you can trust on this issue. I strongly suggest you do your on research and thinking about health care reform, and decide on your own whether the bill finally offered up for approval is worthy of support. I have done my own research and thinking on the issue and have concluded that I can support the House proposal, can not support the Senate Finance proposal and can support an opt out public option. As for what finally emerges, we'll have see what it is. Until then, I reserve judgment.

Speaking for me only

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The Left/Right Beltway Campaign Against The Public Option | 108 comments (108 topical)

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Without a public option (5.00 / 2) (#8)
by Militarytracy on Sun Nov 01, 2009 at 12:38:08 PM EST

the healthcare delivery and payment system is going to implode. Nobody can go on the way things are. I don't even know how some people are going to afford the insurance they are going to HAVE to HAVE now, and without a pubic option to offer some sort of growing challenge this is nothing except a recipe for disaster with Obama's name and fingerprints all over it. If I was a Bot I would be fighting so hard for the public option. To not do so is almost to wish ill on Obama, and he already is up to his arse in alligators these days and these are just the start of these days. I want the public option in order to save the people, too bad Bots won't go down fighting for their man though.

With the current public option proposals (5.00 / 1) (#40)
by Makarov on Sun Nov 01, 2009 at 01:54:32 PM EST

it will likely implode anyway. Giving providers the right to opt out without affecting their Medicare reimbursement status, and requiring the public plan negotiate rates means its possible it will never insure anyone. In the end since it's limited to people who can access the Exchange, it will have no impact on premium prices or medical costs in general.

The public option debate is kabuki theater. It's a distraction from the fact that subsidies for junk health insurance will not improve access to health care for many, if not most, of the newly covered.

Here are some examples of what people will have to spend for health care, premiums and co-pays/co-insurance combined if they hit annual out of pocket maximums:

Married couple earning 4x poverty - $58K
$17K or 30% of gross income

Single parent + 2 kids 3x poverty - $55K
$14.5K or 26% of gross income

Single person earning 2x poverty - $21.6K
$3200 or 15% of gross income

All of this is excluding prescription medication, of course. Aside from the people covered under Medicaid expansion, the only winners with the current House plan are Insurance Companies, Pharma, and most providers.

At best, we'll go from 75% of medical bankruptcies being insured people to 85% or 90%. People will also have improved access to primary care, but that's not worth sending $50B a year to private insurance companies.


Where did you get your numbers? (none / 0) (#41)
by nycstray on Sun Nov 01, 2009 at 01:59:54 PM EST

And what percentage of people reach their out of pocket max?


Susie Madrak (5.00 / 2) (#102)
by Makarov on Sun Nov 01, 2009 at 05:41:18 PM EST

at FDL had a post similar to mine, and she used a summary document put together by politico as her source. I used the same document.

I have no reason to question its accuracy, since the ranges for both premium contribution and max out of pocket expenses are consistent with what I read about HR 3200:

http://crooksandliars.com/susie-madrak/heres-lowdown-are-affordability-credi

http://www.politico.com/static/PPM41_hcr_complete_summary.html

Now, one can make the argument most people won't face serious illness and therefore come close to the (absurd, in my opinion) out of pocket caps. To that, I saw you're making middle class and poor pay a premium for insurance they aren't using, and can't afford to still if they become seriously ill.

What remains to be revealed is how many people living paycheck to paycheck will obtain insurance to begin with, since all proposals I've seen to date say individuals will receive a Tax Credit for purchasing and maintaining it. It was a question that no one (Clinton, Edwards, Obama) answered even back during the Democratic primary. Here's my idea:

Let's contract with large banks to issue Insurance Credit Cards at the low rate of prime +15%. That way, Citibank and Bank of America don't get left out of this bailout, focused on insurance and pharmaceutical companies. People can buy their insurance on the card and then pay it off when they get their tax refund, less interest. Also, the IRS can simply send the refund directly to the bank issuing the card, and skip the unnecessary step of cutting a check to you.


Who will be paying enough (none / 0) (#103)
by Militarytracy on Sun Nov 01, 2009 at 05:49:56 PM EST

in taxes and receiving this "credit" to get this tax credit working for them in any meaningful way?


A Tax Credit (none / 0) (#104)
by Makarov on Sun Nov 01, 2009 at 07:09:38 PM EST

is not the same a Deduction. One example is the EITC - Earned Income Tax Credit - available mostly just to people with dependent children. It's possible with Credits to actually pay no tax and receive money.

The problem remains for people living paycheck to paycheck - who don't have the cash in their bank accounts (if they have bank accounts) to begin with. They can't wait until next Feb-April for that credit.

My suggestion to issue Credit Cards is, of course, facetious.

Now, if we had the real, strong public option Jacob Hacker proposed to begin with, subsidies would only be available to those choosing the government insurance plan. In that case, it would be easy to just charge them the premium less subsidy to begin with. That system (which you can read about if you google search for "pnhp bait and switch") could potentially lead to defacto single payer, and Obama, Reid, et al want nothing to do with that. So we're left with a weak, minimalist public option that may or may not actually up to 5-10M people, and possibly no one if it can't sign up providers and negotiate rates.

BTD used a lot of words laboring the obvious - why does the insurance industry so vehemently oppose even a weak public option? The answer is simple: There's always the off chance once the public at large figures out almost no one is eligible for it (people who aren't self employed), Congress ponies up and opens it to everyone. I don't think this is particularly likely, and maybe even AHIP doesn't either. In their shoes, why take the chance?


Whether that's true or not (none / 0) (#105)
by TeresaInSnow2 on Sun Nov 01, 2009 at 08:02:10 PM EST

depends on the credit.

For earned income credit, it's true.

However, for lifetime learning credit (the education credit) you can only credit as much as you owe in taxes.

Look at the 1040, and see that the education credit and the EIC are figured in different places.

I don't know where the insurance premium credit would lie. .


: well in the context of health insurance (5.00 / 1) (#106)
by Makarov on Sun Nov 01, 2009 at 08:06:36 PM EST

subsidies, I've only heard it discussed as being in the same category as the EITC. Your mileage may vary.
My main point is - a tax credit to someone who has no money to begin with doesn't mean they'll be able to take advantage of the subsidy.
No one throughout the recent years long debate has discussed this problem and its resolution.

Heck, where does anybody get their numbers? (none / 0) (#55)
by lambert on Sun Nov 01, 2009 at 02:52:39 PM EST

Including the poster?

We're slinging around stuff that's already out in the discourse, but it's a 3000 page bill. I know there are summaries out there from Pelosi, but at this point I'd like something more trustworthy.


The Bots are clueless idolators (none / 0) (#11)
by Spamlet on Sun Nov 01, 2009 at 12:43:12 PM EST

They fought blindly and passionately for their love object in 2008. Mission accomplished.


And now they will give aid in killing him (5.00 / 1) (#13)
by Militarytracy on Sun Nov 01, 2009 at 12:48:17 PM EST

politically in the eyes of the American people. It is nothing short of pathetic. I take no comfort in watching our first black President floundering in the quicksands of bought and paid for.


Obama has done some of this to himself though (5.00 / 3) (#16)
by cawaltz on Sun Nov 01, 2009 at 12:54:26 PM EST

He chose to take a milquetoast stand on an issue that will basically be his legacy. He made the choice not to fight for his preferred method(a robust public option) and gave the podium to Snowe every single opportunity he got.

I have a real hard time feeling sorry for someone who chooses to turn his back on his own base to court people from the other side of the aisle.


Well, the secret deal with Big Pharma... (5.00 / 5) (#53)
by lambert on Sun Nov 01, 2009 at 02:50:18 PM EST

... was done about the time Obama was lowering his right hand from taking the oath. So...


: Yup, a real solution for the people (5.00 / 2) (#76)
by Militarytracy on Sun Nov 01, 2009 at 04:03:27 PM EST

was never his goal. I will keep fighting though. What else do we have?

I fight enabling though (none / 0) (#99)
by Militarytracy on Sun Nov 01, 2009 at 05:08:22 PM EST

It is never too late for someone to grow up :)


Watch it. I read today NSA is monitoring (5.00 / 1) (#17)
by oculus on Sun Nov 01, 2009 at 12:54:50 PM EST

400,000 in U.S., including telephone calls and e mails.

Meanwhile, 2000 kids go trick-or-treating at the WH last night.

Is this consistent?


Heh (5.00 / 1) (#25)
by cawaltz on Sun Nov 01, 2009 at 01:07:18 PM EST

Little did I realize I'd have to advise people that "this is a non secure line" AFTER my time in the Navy was through.

(waving hi to the nice NSA folk tasked with monitoring)


Got a link on that? (none / 0) (#54)
by lambert on Sun Nov 01, 2009 at 02:51:05 PM EST

I can't find it.


I just looked but nada. (none / 0) (#62)
by oculus on Sun Nov 01, 2009 at 03:16:59 PM EST

Maybe I added that to Greenwald's column today?


As a hack stage magician might say... (none / 0) (#63)
by EL seattle on Sun Nov 01, 2009 at 03:25:29 PM EST

Is this your card?


: Not NSA, FBI (none / 0) (#67)
by lambert on Sun Nov 01, 2009 at 03:40:14 PM EST

No doubt NSA has a completely different program.

: Thank you very much. Although (none / 0) (#68)
by oculus on Sun Nov 01, 2009 at 03:42:15 PM EST

I hadn't read that article. Maybe NYT or LAT.

Still to early to tell what the bots will do... (none / 0) (#107)
by NealB on Sun Nov 01, 2009 at 11:09:36 PM EST

...if anything. The idea, I gather, is to deliver health [insurance/care] reform by Christmas. It's just good marketing sense and Obama Inc. has that sense, if little else. So they have a deadline: Christmas, this year. In short, time is running out for "the masses" to register what is being done to them by this. Obama, Inc. hopes it's all going to happen very quickly at the last moment and the masses won't notice. Then they can do their Rose Garden with Snowflakes signing ceremony, at the close of Obama's first year, with all the hallelujah-it's-over-thank-god glad-tidings, good-cheer bullsh!t and deliver massive profits to the health insurance companies, wash their hands, and be done with it.

They're probably going to succeed.

And the public option will be buried in there somewhere noone will find it until we're all dead.

Unless...

Unless what? Not much can go wrong any more. Baucus, at Obama's bidding, delayed past the summer window when what they were doing might have caught notice. Finally, mid-fall, the Senate Finance Committee passed out their piece-of-sh!t bill. Late-fall Reid presents an opt-out bill and one day later Joe Lieberman (with Obama's blessing) sinks it. Not much can go wrong any more for Obama, Lieberman, Snowe, the Republicans, or the medical industrial complex. None of them give a rat's ass about health care reform. They are, all of them, liars.

Health care reform is dead. The only thing Obama, Republicans, Reid, and a half dozen Democrats in the Senate ever wanted was to cut medicare by half a trillion dollars and force 30 million powerless Americans to forfeit prospects for their futures to protect the profits of the rich.

That's all that will end up happening. That's all that was ever going to end up happening with a presidential candidate that rose to power extolling the virtues of a "purple" America.


Speculation of where the Senate is (5.00 / 2) (#36)
by MO Blue on Sun Nov 01, 2009 at 01:34:48 PM EST

currently headed.

Sen. Sheldon Whitehouse (D-R.I.) predicted that healthcare reform in the upper chamber would shift from its current construction, which allows states to opt out of a public option, to a version that forces states to opt into such a plan.
"I think it's falling into an opt-in, versus opt-out," Whitehouse said during an appearance on MSNBC. "You have a public option, but it's up to a state to take an affirmative act to take advantage of it."
Whitehouse suggested the opt-in as a potential compromise on the public option to win enough Democratic votes in the Senate, where Sen. Joe Lieberman (I-Conn.) has said he will vote against a bill containing a public option, and several other centrist Democrats have been reluctant to support the current proposal. link

Before this is all over the Senate will just disperse the $900 billion to the Insurance/Pharma/Medical complex and beg them not to screw us quite so much/

: Unacceptable (5.00 / 2) (#38)
by Big Tent Democrat on Sun Nov 01, 2009 at 01:44:17 PM EST

Indeed, pointless, as Lieberman reiterated he would filibuster ANY public option. So reconciliation is the only way to do it.
Dems need to stop negotiating against themselves. They will only have 52-3 votes in the end anyway.

Medicaid's incrementalism (5.00 / 1) (#59)
by Pacific John on Sun Nov 01, 2009 at 03:09:38 PM EST

...isn't a good example because of the political times in which it was enacted.

If we were willing to trust incrementalism in the hands of the current party leadership, we'd see evidence in the way they handle Medicare, and see it expanding, say to 55, like the hated-failure-corporate-sellout Bill Clinton tried. Sorry Nancy, you're no Bill Clinton. You either, Barack, not where expansion of successful institutions is concerned. (Which btw is my theory about a lot of the current insanity, the sotto voices drive the leadership nuts that they aren't tremendously successful being the anti-Clintons).

The most relevant recent political example scares the h*ll out of me: No Child Left Behind. Like healthcare, there is a consensus among DC outsiders (voters and ed professionals) that it is c*ap, and needs to be overhauled or scrapped... in fact that liberal radical Wes Clark ran on scrapping it in '04. A major overhaul might work if the leadership were competent on the policy, but, well, you know, they aren't; the NEA blistered the Obama ed plan because it's out of the third Bush administration.

If the sales pitch on the public option is, trust the leadership because they seem to annoy the insurance lobby, I'm not buying. Recall, a lot of these CEOs, in their souls, are John Birchers, and will go to war over anything that smells to them of socialism. Just because they oppose it doesn't mean they're right.

Let's see the evidence. How do we know that the likely public option is structurally designed to succeed and expand, i.e. force the shoddier insurance companies out of business?

And the alternative is? (none / 0) (#60)
by Big Tent Democrat on Sun Nov 01, 2009 at 03:14:25 PM EST

This is the same question (5.00 / 4) (#65)
by Pacific John on Sun Nov 01, 2009 at 03:34:44 PM EST

people asked about going into Iraq. Sometimes it's better to do nothing. "Reform" under current DC logic looks a lot to me like a quagmire.

If we had it to do over again, we would have killed NCLB.


A public option (5.00 / 1) (#70)
by Big Tent Democrat on Sun Nov 01, 2009 at 03:48:00 PM EST

is the right direction.

Expanding Medicaid is the right direction.

Subsidies for the less well off is the right direction.

Iraq was the wrong direction.

Not comparable.


I notice you don't respond on NCLB (none / 0) (#72)
by lambert on Sun Nov 01, 2009 at 03:49:23 PM EST

Better precedent than Iraq, I would say, being domestic policy.


I did not see the response until now (none / 0) (#83)
by Big Tent Democrat on Sun Nov 01, 2009 at 04:15:43 PM EST

It's a fair question.

The difference I think is that in the realm of public health insurance programs, their scale and reach have expanded.

NCLB is not really a precedent to this situation imo.


: Thanks (not ironic) (none / 0) (#92)
by lambert on Sun Nov 01, 2009 at 04:39:32 PM EST

I like the point made that the political environment is different, and I'd go further and say that attitudes toward privatization are very different. Gotta go and do RL stuff now.

Why does he have to provide an alternative? (none / 0) (#71)
by lambert on Sun Nov 01, 2009 at 03:48:12 PM EST

It's a question of fact.

BTD writes:
the Village "progressive" wonkers [STILL unidentified, after a request for a link -- lambert] do not give a honest appraisal of the potential for the public option. They ignore the history of Medicaid, which began covering 4 million people and that covered, by 2004, 47 million people.

Pacific John responds:

...isn't a good example because of the political times in which it was enacted...

And instances NCLB as a more appropriate precedent than Medicaid.

The only "alternative" being posed here is whether BTD is reasoning from false premises here. Based on Pacfic John's points, I'd say that BTD's non-response is, indeed, a showing that such is the case.


The future is not known (none / 0) (#82)
by Big Tent Democrat on Sun Nov 01, 2009 at 04:14:33 PM EST

you disagree with my view of whether a public option can lead to the type of reform I think we need.

But both you and I are expressing opinions on that. Not facts.


: Fair enough (none / 0) (#87)
by lambert on Sun Nov 01, 2009 at 04:32:53 PM EST

I also think that NCLB is a more fair predictor than medicare.
Premises need to be tested, as well as conclusions, and desired policy outcomes, no?

Seemed to me that some bloggers (5.00 / 3) (#61)
by ruffian on Sun Nov 01, 2009 at 03:16:53 PM EST

and media heads, like Ezra for example, got thrown for a loop when the cues from some of the pols, like Obama, were that they were supposed to talk up the public option while simultaneously maintaining it would not threaten the insurance companies, and is not a 'nose under the tent'. I don't know how you maintain any credibility pushing the PO on those terms. The messaging on this "HCR" has been mishandled from the beginning, and it comes from having such low expectations from the start - reform without hurting the medical industrial complex. WTF?

: Clarify (5.00 / 1) (#66)
by ruffian on Sun Nov 01, 2009 at 03:39:27 PM EST

By "you maintain any credibility" I of course mean "It is possible to maintain any credibility". Not speaking to any 'you' here, unless Clair McCaskill reads this blog. And I so wish she would.

Anything, before it is actually implemented, (5.00 / 1) (#74)
by Anne on Sun Nov 01, 2009 at 03:50:31 PM EST

has potential, but I think what is being discounted is the limited effect on competition that will be brought to bear on the private market by this public option - limited, as it is, to those whose employers do not offer a private plan, and to employees of companies with less than 25 employees.

It is this potential that the private companies are fighting against.

And it isn't a question of how many "will" use it, it's a question of how many "can" use it. It's a question of how angry people will be that they are stuck with employer-provided coverage that is less-than satisfactory from both a coverage and cost perspective. And it's a question of whether there is a big enough pool to be able to exert downward pressure on costs in the private sector.

Maybe I'm missing something, but if we don't all have the option to leave the private sector for the "public option," how do lower costs within the government plan force the private companies to lower their costs?

In some ways, I feel like private insurance is like the Democratic Party: if there's "nowhere else to go" how does that effect change?

Again... (none / 0) (#80)
by lambert on Sun Nov 01, 2009 at 04:08:28 PM EST

... this is why a post that begins:

Opponents of the public option, both from the Right and from Village "progressive" wonks, have spent months trying to denigrate the potential of a public option to reform health care and insurance.

And yet resolutely refused to cite to detail on the actual bill before us is, at best, a message to bill opponents to STFU. It would be better to get the opponents of the bill to STFU with actual evidence of what the bill would do, but perhaps such is not on offer?


Again (none / 0) (#81)
by Big Tent Democrat on Sun Nov 01, 2009 at 04:12:57 PM EST

You know, as do my readers, precisely who I am talking about.

Your disingenuousness in this thread is dismaying.

This is not my first post on the subject.

What do you REALLY want to know? It's clear you are just trying to start a fight. As I said, go do with that with Bowers.

I'm bored with your act. I know your position. you know mine. I've never said for you to STFU or anyone for that matter.

I say what I think. I name names. I name provisions.

You know all this.

You had enough of fighting with Bowers? You are barking up the wrong tree. I am not worried about whether anyone thinks I'm progressive or not. you have me confused with Bowers.


New bill, 3000 pages (none / 0) (#85)
by lambert on Sun Nov 01, 2009 at 04:29:14 PM EST

Used to be 2000. What's in the new 1000? Nobody knows, including you, and including me.

Lots of assertions made about what that bill does and what will happen, no evidence at all.

You call pointing that out "picking a fight." You know what we used to call it?

"Blogging."


: Dude, I'm doing my best to fight the (5.00 / 1) (#93)
by Militarytracy on Sun Nov 01, 2009 at 04:40:23 PM EST

enemy I know. The enemy that I don't know will have to expose itself eventually if that one is there. This is so much exactly like Obama's Afghanistan strategy......nobody says anything about it because nobody can define what it is. Freaks at Orange are writing crap today how Neocons still run everything. WTF? Commander in Chief is exactly that when it comes to military decisions. Now I'm going to turn on some Opera before my head explodes in the ensuing insanity of everything that Obama touches, but we don't know for sure that he touched, he says that he is touching it and continues to touch it just right but we have NO evidence. I'm completely sick of all that crap and insanity today too.

Usual reaction: shouldn't you start (none / 0) (#84)
by oculus on Sun Nov 01, 2009 at 04:20:23 PM EST

your own blog? Oh, wait.


I imagine lots of commenters... (none / 0) (#88)
by lambert on Sun Nov 01, 2009 at 04:33:45 PM EST

... have their own blogs. Your point?


You seem to want BTD to have posted (5.00 / 1) (#89)
by oculus on Sun Nov 01, 2009 at 04:36:28 PM EST

something different than he did.


: Not perhaps as to the thesis (none / 0) (#96)
by lambert on Sun Nov 01, 2009 at 04:43:22 PM EST

Whether or not I agree with it, the thesis is fine.
But when the "wonker progressives" are STILL unidentified...
When the bill is mentioned but HR392 is not brought up....
And other examples I've been poking at on the thread...
Yeah, I'd like to see a different post. Evidence is important, and in the reality-based community, linky goodness used to be the gold standard.
I'm multitasking in RL, so I could be missing something, but I'm seeing a highly tendentious thesis with very little underpinning in detail. For obvious reasons, that sets off alarm bells with me.
RL calls, gotta go.

Medicaid (none / 0) (#1)
by cawaltz on Sun Nov 01, 2009 at 12:09:58 PM EST

is a pretty poor model from where I am sitting. Both the people I know who are on it had difficulty finding a doctor who would accept it.

47 million people covered (5.00 / 1) (#2)
by Big Tent Democrat on Sun Nov 01, 2009 at 12:12:20 PM EST

is better than 47 million people not covered.

But different strokes I guess.


"Coverage" (5.00 / 1) (#7)
by cawaltz on Sun Nov 01, 2009 at 12:32:53 PM EST

I have to wonder how familiar you are with the Medicaid program. In order for my sister to actually be able to utilize the program her visit must exceed $400(this is in Florida).

How in the world is that actually any incentive to drive costs down when you basically set the out of pocket so high for people living in poverty?

Meanwhile here in Virginia, the one doctor my disabled neighbor qualified for basically called her a deadbeat and told her that she would need to see a specialist to get the MRI she had already had put off for many years(because she made too much on disability to qualify for government medical coverage).

Frankly, considering we have a Democrat in the WH and a majority in the Senate as well as in the House just "coverage" isn't cutting it for me. I believe that the people garnering a six figure income on my dime should actually pass health coverage that improves the system, not kicks the can down the road in hopes that maybe someday millions will have better coverage.

This country and the people in it deserv e better than "mediocre"


Look (none / 0) (#9)
by Big Tent Democrat on Sun Nov 01, 2009 at 12:39:49 PM EST

I will not engage you anymore.

Do you know how private insurance works?

If you are not even going to engage what I write that what's the point.

Enjoy yourself.


I'm well aware of how private insurance works (5.00 / 2) (#12)
by cawaltz on Sun Nov 01, 2009 at 12:43:38 PM EST

My household is covered by it(a really good Blue Cross Blue Shield policy that my husband's union negotiated for thank you). My point is that you are touting Medicaid as a great success story and a reason I should be happy to see a medium strength public option. From where I am sitting Medicaid isn't a success story.


You did not read what I wrote (5.00 / 1) (#18)
by Big Tent Democrat on Sun Nov 01, 2009 at 12:56:13 PM EST

Or you did not understand it.


I read and understood (5.00 / 2) (#22)
by cawaltz on Sun Nov 01, 2009 at 01:03:37 PM EST

I was under the impression that it was okay to weigh in on where I stood with what is being offered up.

I don't think anything being proposed is good enough and will actually reform the system.

I guess we shall see.


: Then you ignored it (none / 0) (#34)
by Big Tent Democrat on Sun Nov 01, 2009 at 01:31:44 PM EST

Again, if you do not engage what I write, then I will not engage you substantively.

: With respect (none / 0) (#64)
by gyrfalcon on Sun Nov 01, 2009 at 03:28:51 PM EST

because I usually do respect what you post, you did not understand. If you did, you couldn't possibly suggest BTD is declaring Medicaid a "success story" and certainly not doing so on the basis of the very real problems you address.

Once again, no links, no evidence, no engagement (none / 0) (#49)
by lambert on Sun Nov 01, 2009 at 02:41:44 PM EST

I mean, come on.

We've got a commenter giving actual experience, and the response is STFU based on talking points without even linky goodness to an HCAN't brochure? WTF?


: I am not going to engage you (none / 0) (#58)
by Big Tent Democrat on Sun Nov 01, 2009 at 03:05:41 PM EST

You just want to fight.
Which number do you doubt BTW?

By 2019, right? (none / 0) (#48)
by lambert on Sun Nov 01, 2009 at 02:40:26 PM EST

And depending on what states do, right?

And mostly from Medicaid, and not from [a|the] [strong|robust]? public [health insurance]? [option|plan], right?

I mean, just asking. You seem to have adopted a general policy on this thread of not providing any links for the usual talking points whatever. In my experience, that's never a good sign for the strength of the point being made.


BTW (5.00 / 4) (#3)
by Big Tent Democrat on Sun Nov 01, 2009 at 12:14:46 PM EST

Yours is an argument for improving Medicaid, not against my point, that Medicaid grew by an exponential factor in number of persons covered.


And some states have decent medicaid (5.00 / 2) (#4)
by Militarytracy on Sun Nov 01, 2009 at 12:23:53 PM EST

and some states don't, but it does exist and has been altered many times over to suit situations.


Indeed (5.00 / 2) (#5)
by Big Tent Democrat on Sun Nov 01, 2009 at 12:24:55 PM EST

A public option would not be subject to state by state whims.


In terms of the program itself I mean (none / 0) (#6)
by Big Tent Democrat on Sun Nov 01, 2009 at 12:25:44 PM EST

States will have the right to opt out.


Will every single doctor... (none / 0) (#19)
by EL seattle on Sun Nov 01, 2009 at 12:56:28 PM EST

... have to take part in the public option system unless the individual state that they're working in opts out?

Otherwise, I'm concerned this might be a difficult issue that would haunt the public option the way it's haunting Medicare right now.


They can opt out (none / 0) (#32)
by Big Tent Democrat on Sun Nov 01, 2009 at 01:30:58 PM EST

just like any other insurance plan.


Link? (none / 0) (#47)
by lambert on Sun Nov 01, 2009 at 02:37:49 PM EST

This a two or three thousand page bill, and I'm looking for a decent summary.

Can you give me a link to the source of this statement, which is presumably once such? Public option advocates, even the paid ones, have been notably light on detail, so sourcing is important.


: Not really (none / 0) (#75)
by Big Tent Democrat on Sun Nov 01, 2009 at 03:50:45 PM EST

It is what has been reported, from Pelosi's mouth on this issue.
I am not your reference guide.

and many times it has been (none / 0) (#10)
by cawaltz on Sun Nov 01, 2009 at 12:40:25 PM EST

altered for the worst and has been subject to the whims of state budgetary constraints. Just ask the people in Tennessee.


: This altering for the worst is in my opinion (5.00 / 3) (#15)
by Militarytracy on Sun Nov 01, 2009 at 12:54:26 PM EST

an outgrowth of this social dynamic that the insurance companies are working so hard to nurture, the social dynamic that some people in America "deserve" to live and some people don't. Has anybody noticed that we Americans have literally purchased this social belief? When we buy something that heinous, do we dare wonder how such legislative "altering" ever was able to take place? I fight against this giant lie that the insurance companies are doing everything in their power to keep alive.

This is my thinking (none / 0) (#14)
by Left of the Left on Sun Nov 01, 2009 at 12:54:20 PM EST

Which could be way off. The best solution was single payer, but it was a long shot, so out it went, didnt even get used as a bargaining chip. We gotta save this political capital for things like tort and entitlement reform.

Yes we can, except when its too hard.

So that left a robust public option as the best situation, even an opt-in one. Except no republican would go for it and we'd have to lean on moderate dems for it. No Unity Pony, no go.

Fired up, ready to go..simply choosing not to.

I understand incremental progress, I would be fine with incremental. But if its too small to succeed, would it not be more likely to die young? I'm not as knowledgeable as others here on this stuff. But if we cant muster the will to act now, which of these gutless wonders will stick their neck out to expand a failed/failing program?

I don't see the proposed size of the (5.00 / 1) (#20)
by oculus on Sun Nov 01, 2009 at 12:57:41 PM EST

public option as too small to succeed. The envisioned population base is 10 times as large as that of CalPERS. To me the question is whether the public option will have enough of a base to leverage pharma prices, hospital costs, and MD fees, and other health care costs. I think the public option will be sufficiently populated to have such leverage.


Except... (5.00 / 2) (#56)
by lambert on Sun Nov 01, 2009 at 02:54:19 PM EST

... surely the CBO considered all that, and they concluded that there would be no cost savings at all (and also concluded that public option would be, if anything, more expensive).


Isnt that what this is about (none / 0) (#21)
by Left of the Left on Sun Nov 01, 2009 at 01:02:16 PM EST

Not who it will be "open" for, but who'd actually sign up for it.


: Self employed people would like (5.00 / 4) (#29)
by nycstray on Sun Nov 01, 2009 at 01:21:19 PM EST

an affordable option. Smallest businesses. Those eligible for subsidized PO. With the job and main street economy not recovering (imo) the eligibility pool is going to get larger even if they don't expanded it ;)
The question is, have they dropped the word "affordable" from "affordable public option" and they now think it's enough to just have a PO?

: Sounds to me like the question will be: (none / 0) (#23)
by oculus on Sun Nov 01, 2009 at 01:06:40 PM EST

who can meet the criteria to be eligible for the public option. If a person is barred whose employer offers insurance coverage or the person has "affordable" other insurance coverage options, will the person still be able to choose the public option.

This concerns me. (none / 0) (#24)
by Susie from Philly on Sun Nov 01, 2009 at 01:07:13 PM EST

And I didn't even know about it until today: Depending on the final version, states are going to be making a lot of the important decisions.

http://www.washingtonpost.com/wp-dyn/content/article/2009/10/31/AR2009103101769.html?hpid=moreheadli nes

Since it isn't going to provide uniformity (5.00 / 1) (#26)
by cawaltz on Sun Nov 01, 2009 at 01:10:11 PM EST

and is going to be piecemeal state by state from an administration standpoint what are the odds that this going to drive down costs?

I'm betting slim to none.


That is about the non public option provision (5.00 / 1) (#31)
by Big Tent Democrat on Sun Nov 01, 2009 at 01:29:38 PM EST

"Besides the opt-out choice, proposed last week by Senate leaders, health-care legislation being drafted on Capitol Hill would delegate to state officials a multitude of momentous decisions, from what benefits are offered to low-income families to what hurdles to put in front of private insurance companies before they can raise premiums."

All of that is about non public option provisions.


Moral of the story: don't reside in TX (5.00 / 1) (#33)
by oculus on Sun Nov 01, 2009 at 01:31:07 PM EST

if you require state assistance re medical care.


: Well (none / 0) (#35)
by Big Tent Democrat on Sun Nov 01, 2009 at 01:33:10 PM EST

The people of Texas elect their state reps as well as their federal reps.

Disturbing! (none / 0) (#28)
by Militarytracy on Sun Nov 01, 2009 at 01:18:27 PM EST

Except for one: single payer (none / 0) (#45)
by lambert on Sun Nov 01, 2009 at 02:31:36 PM EST

That's been outlawed, presumably since it would actually work.


It's really not fair to denigrate the non-public (none / 0) (#27)
by steviez314 on Sun Nov 01, 2009 at 01:18:13 PM EST

option aspects of health care reform. And I'm not saying this to get you behind a no-public option bill, but just to lay some facts out there.

First, for small businesses (like my wife's and mine-2 person), the ability to enter a health exchange and have a wider variety of plans available, along with the chance to combine with other small businesses in order to get a better group rate, or community rating, is a real potential money saver. That would be even truer for individuals.

Second, as my wife is undergoing treatment, we dread receiving any envelopes from the insurance company. We hope it's just a statement of benefits, not some stupid, immoral excuse to rescind the policy, let alone that we've reached out lifetime benefit limit. This legislation removes that fear--it's not nothing.

And consider, those features of the legislation will be harder to pass--if the Senate spits the bill into two, these would be subject to the filibuster.

The non-public option reforms need support too.

: I'm not sold on exchange only (5.00 / 2) (#37)
by nycstray on Sun Nov 01, 2009 at 01:34:54 PM EST

there is nothing in it to stop the rising premium rates is there? People are dropping employer insurance as rates increase, and those that continue to pay the inflated rates are having services cut and cost increases on other services. Will somewhat affordable plans have some nice little twists in them like I can't get an OB/GYN exam covered unless I've paid off my at least $2500 deductible? (WTF?!)
I guess that's why I'm still holding out for medicare for all. I can't agree to an "exchange" just because our President talks about how great they are with his pretty words . . .

: You do not understand (none / 0) (#30)
by Big Tent Democrat on Sun Nov 01, 2009 at 01:28:01 PM EST

The non-public option provisions will not help you.
You won't get a statement cancelling your policy, just one denying you specific treatments, raising your premiums or otherwise screwing you over.
The exchange you like will do none of the things you expect. Look at the data on the subject please.

There will be many stars (none / 0) (#42)
by oculus on Sun Nov 01, 2009 at 02:25:35 PM EST

in your crown.

Cautions: religious reference.

lyrics

: I like that caution (none / 0) (#52)
by lambert on Sun Nov 01, 2009 at 02:47:49 PM EST

Nice. Thanks.

There are no links to "progressive" ... (none / 0) (#43)
by lambert on Sun Nov 01, 2009 at 02:29:30 PM EST

wonkers, so I'm left in confusion about who, exactly, you're indicting, and who is making the case that you attempt to refute.

Can't be this little single payer advocate, since I wouldn't be caught dead identifying as a "progressive," the brand is so polluted.

* * *

The question of how many enrollees [a|the] [strong|robust]? public [health insurance?] [option|plan] would have has always been a vexed one, due to the shapeshifting bait and switch tactics used by its advocates [see here, which has the link to the original Sullivan post].

Tactically, my advice to you would be to actually come up with links and analysis to something authoritative. To say, essentially, "Lie back and enjoy it, because other programs got bigger in the past" really does strike me as advocating from a position of analytical strength.

TYPO (none / 0) (#44)
by lambert on Sun Nov 01, 2009 at 02:30:10 PM EST

sb "does NOT strike me as advocating"


I do not mind your comments (none / 0) (#46)
by Big Tent Democrat on Sun Nov 01, 2009 at 02:33:36 PM EST

but keep your advice to yourself.


Let me revise and extend, then (none / 0) (#51)
by lambert on Sun Nov 01, 2009 at 02:46:18 PM EST

No longer advice, then:

Please come up with links and analysis to something authoritative on the bill if you want readers -- who are, after all, only concerned with life and death matters like health care -- to take this post as anything other than "non-PO supporters STFU." Right now, all I'm seeing from you throught this post is a series of unsupported assertions about a 3000-page bill.

If lay "Lie back and enjoy it, because other programs got bigger in the past" is the best you can do analytically, my confidence in a good outcome for this program sinks even further.

Better?


My readers (none / 0) (#57)
by Big Tent Democrat on Sun Nov 01, 2009 at 03:03:55 PM EST

including you, know precisely what I am talking about.

The notion that I have not named names is ludicrous.

But hell, you seem intent on picking a fight with everyone you meet.

You caught me on thew wrong day for that.


Classic personalization (none / 0) (#69)
by lambert on Sun Nov 01, 2009 at 03:43:02 PM EST

I ask for a link for evidence of what you're saying. It's a 3000 page bill, and I'd like to know where you're getting your numbers from.

You classify this reasonable request as "picking a fight". This is not responsive.

I conclude you do not because you cannot.


Interestingly (none / 0) (#73)
by Big Tent Democrat on Sun Nov 01, 2009 at 03:49:34 PM EST

I do not reference the bill in this post. The CBO study and the history of Medicaid.

What data in my post do you doubt?

You're looking for fights.

Go fight with Bowers.

I'm not interested.


Sure you reference the bill in this post (none / 0) (#77)
by lambert on Sun Nov 01, 2009 at 04:06:04 PM EST

Here it is:

The fact that eligibility for inclusion in the potential public option pool is likely to grow (indeed, the House bill contemplates such an expansion by as early as 2015)

That's talking about the bill.

When you say:

47 million people covered is better than 47 million people not covered. But different strokes I guess.

Sorry for your lack of interest -- but other readers might be interested. Eh?


Wait up (none / 0) (#78)
by Big Tent Democrat on Sun Nov 01, 2009 at 04:07:18 PM EST

Are you doubting the statements?

Lambert, you know the statements are true.

What's your game here?


: I am ONLY refuting your point (none / 0) (#90)
by lambert on Sun Nov 01, 2009 at 04:37:31 PM EST

You say that you don't discuss the bills.
I point out where you DO discuss the bills.
That's it. Now we can cross that bad argument off the list, and go on.
* * *
HR3962 is an entirely NEW bill, with 1000 extra pages. I can't imagine those 1000 pages are like dead DNA. What do they do? I'm desperate for analysis of what they do. So if you've got linky goodness on it, I want to see it. (I want to see if, of course, for stuff we both don't know is true, too, but that's a separate issue). It's not a game. I've got friends whose lives are affected by this, and none of this is a game to them or me.

BTW the 47 million (none / 0) (#79)
by Big Tent Democrat on Sun Nov 01, 2009 at 04:08:11 PM EST

is a reference to Medicaid in 2004. the number is likely higher now.

But the question is do you doubt it? Why?


: Oh, missed that (none / 0) (#91)
by lambert on Sun Nov 01, 2009 at 04:37:58 PM EST

On the other, see above.

Is the conscience clause still in there? (none / 0) (#50)
by lambert on Sun Nov 01, 2009 at 02:42:23 PM EST

Or did "progressives" find it in their hearts not to throw women under the bus?

How will the HR3962 be administered? (none / 0) (#86)
by lambert on Sun Nov 01, 2009 at 04:31:39 PM EST

Since all the assertions about what will actually happen with "public option" depend on HR3962 (or whatever it morphs into), it's useful to look for analysis about what the bill will actually do.

Here's a detailed post from Kip Sullivan on possibilities for how the public option will actually be run.

I told ya (5.00 / 1) (#94)
by Militarytracy on Sun Nov 01, 2009 at 04:41:46 PM EST

It will be administered in the same fashion that the win in Afghanistan and the drawdown in Iraq will be :)


Kip Sullivan does not cite the relevant (5.00 / 1) (#95)
by oculus on Sun Nov 01, 2009 at 04:42:47 PM EST

portions of any of the proposed plans. Must be the lawyer in me (inactive). But Huff Po is making fun of Boehner for whining about having to read 3000 pages.


Heck, I"M whining about the 3000 pages (none / 0) (#97)
by lambert on Sun Nov 01, 2009 at 04:45:47 PM EST

and as I said above, it used to be 2000, so what's in the extra 1000?

And since the only current operational definition of "public plan" is somewhere in those 3000 pages, it would seem to behoove all of us to be figuring them out, public option advocates not least. Surely the burden of proof is on them to defend their own bill?


: lambert, I understand where you are coming (none / 0) (#101)
by Militarytracy on Sun Nov 01, 2009 at 05:20:28 PM EST

from. And we all know we can be screwed over on several fronts here and we all know that nobody but us is on our side in all of this. This post though from BTD is about addressing one sort of attack on our chances of ever having suitable health-care. You seem to be pointing out another possible attack. You can't fault BTD though for leading the charge on the attack that he addressed. It was an attack to prevent any meaningful reform from taking place.

On the relevant portions... (none / 0) (#98)
by lambert on Sun Nov 01, 2009 at 04:48:32 PM EST

Sullivan cites to previous articles, see the links:

For information on who would run these local programs, we had to consult the "option" language in the Democrats' legislation. It is there we find evidence that these programs will be run by private firms. I have reviewed the murky "option" sections of the Senate bill and House bill in previous papers.   In the remainder of this paper I will focus on why our commonsense tells us that a very small "option" has to be a balkanized program consisting of multiple local programs. I believe it is the failure of many people to comprehend this fact that leads some of them to misinterpret the language in the Democrats' bills authorizing the federal government to outsource "administrative functions" necessary to run the "option."

What I don't hear him saying directly is that the clauses in HR3962 are the same as those in HR3200 which would be nice o know.


The exclusion of the relevant (none / 0) (#100)
by Militarytracy on Sun Nov 01, 2009 at 05:13:08 PM EST

along with the ridiculing of Boehner serves what purpose? To distract and deny it seems to me. Is this happening because we are looking at a fillibuster threat or is it to pull something over on the intent watchers?


What do you think of a trigger? (none / 0) (#108)
by barryluda on Mon Nov 02, 2009 at 06:38:43 AM EST

BTD says he:

can support the House proposal, can not support the Senate Finance proposal and can support an opt out public option.

It looks to me like the only way to get something through the Senate will be to include a trigger.

Wondering if you can support that??

: BTD has said he would not support (5.00 / 1) (#109)
by jes on Mon Nov 02, 2009 at 08:30:03 AM EST

a trigger.