Why HCR Without A Robust Public Option Will Not Work In The US

By Big Tent Democrat, Section Other Politics
Posted on Wed Sep 23, 2009 at 09:59:12 AM EST
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From a surprising source, Ezra Klein, riffing off of Sen. Kent Conrad:

[SEN CONRAD:] [T.R. Reid] found [that] many countries they have universal coverage. They contain costs effectively. They have high-quality outcomes, in fact higher than ours. They're not government-run systems in Germany, in Japan, in Switzerland, in France, in Belgium -- all of them contain costs, have universal coverage, have very high quality care and yet are not government-run systems.

Germany, Japan, Switzerland, France and Belgium have a level of government intrusion in their systems that would make the average tea partier retch. In France, for instance, the government provides all basic insurance coverage directly. In Germany, insurers aren't permitted to make a profit. In Japan, health insurance is publicly provided, and private insurance is available only to ease co-payments or cover services that the government leaves out. This stuff makes the shackled public plan look downright objectivist.

(Emphasis supplied.) PRECISELY SO, Ezra. To imagine that the United States will enact a regulatory regime remotely like those is to be delusional. The only "health care reform" that has proven effective in the United States has been the creation of public insurance options (Medicare) or government provided health care (TriCare.) To believe the US will enact and enforce a regulatory regime that would do what is done in France, Germany or Japan is to either be a liar (Conrad) or delusional (Klein.)

Speaking for me only

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Why HCR Without A Robust Public Option Will Not Work In The US | 28 comments (28 topical)

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Public or no public (5.00 / 2) (#1)
by Stellaaa on Wed Sep 23, 2009 at 10:11:35 AM EST

This is where we just get confused when it comes to public policy. In the countries without public plans they opted for regulating insurance companies and price controls. Instead, we come up with the Baucus plan, which will require an army of people to implement the contrived machinations that are proposed. In the end, the public good will be buried in the contrived delivery system.

The entire Baucus plan is part of the trajectory of public policy that coddles the private sector and provides minimal public good. In a fit of madness I read the entire Baucus proposal. Instead of just taxing people and buying or creating bulk health insurance, we continue with the pretense of people having a choice to buy insurance.

Precisely, the Swiss limit the insurance company profits, the Germans made health insurers non profit and are regulated beyond anything we have proposed.

The Swiss require an insurance company to process a claim in five days, if they do not, you dont have to pay your premium for 3 months or could be 2. Imagine that here?

Stellaaa, who, in a fit of madness, read the (none / 0) (#7)
by oculus on Wed Sep 23, 2009 at 11:33:59 AM EST

entire Baucus plan, is now ready to rival Ezra Klein as a blogger. You go girl.


Ezra missed another wopper (none / 0) (#10)
by Stellaaa on Wed Sep 23, 2009 at 12:15:57 PM EST

the income parameters for the subsidy are based on National Poverty Levels. Typically, such programs are based on regional numbers. Why? Easy, 70,000 annual income for a family of four say in Louisiana, buys a whole lot more housing and other basics than in California or New York. So, another hand out to our "southern friends" who despise handouts, bailouts and welfare.

Oculus....I was waiting for the C-Span public meetings with the the butcher paper and all I got is a proposal that was crafted with the aid of the Insurance lobby. So much for secrecy.


Pretty disappointing. Although (none / 0) (#16)
by oculus on Wed Sep 23, 2009 at 12:49:14 PM EST

Huff Post says some people attending town halls are starting to embarrass their elected representatives by asking questions the latter can't answer.


Hey its pretty hard to answer (5.00 / 1) (#25)
by Socraticsilence on Wed Sep 23, 2009 at 03:04:02 PM EST

Non-syllabic grunts of rage at being stripped of ones rights to:

Not have a Democratic President
Not have a black President (its not all racial, but good god- why has every single rally I've been to had at least 20% of signs referring to Muslims, Africa, or Black Culture?).

I'm glad someone else is concerned about the (none / 0) (#27)
by cawaltz on Wed Sep 23, 2009 at 03:20:24 PM EST

income disparities and how that will affect a portion of the population. Basically the states who enacted living wages(and went around minimum wage law) are now about to be collectively screwed for doing so. The irony being these are BLUE states, who will end up penalized.


Gee (5.00 / 4) (#3)
by MO Blue on Wed Sep 23, 2009 at 10:29:58 AM EST

Does that mean that those countries are more interested in the health and well being of their citizens than in protecting the profits of an insurance industry? I heard tell that they even negotiate the price of prescription drugs so that all their citizens can afford the medicine they need. What a novel idea.

Good for Ezra for shooting down the false claims by Conrad and others. I, personally, am sick of these deceptions.

Slightly off topic (5.00 / 2) (#6)
by Stellaaa on Wed Sep 23, 2009 at 10:52:32 AM EST

Regarding the employer mandates as I read it, Wilson and the "anti illegal gang" shot themselves in the foot. By excluding illegals, there is a higher incentive to hiring illegals. Employers do not have to pay the "fees" to the Feds if their underpaid and under insured employees use the subsidies. Since the fees are proportional to the subsidy received, the poorer the employ, the greater the "penalty".
So, why hire people from the "welfare to work" programs? Why hire people with families? Why hire people who are mandated to have insurance? Much easier to hire undocumented workers.

Again, contrived public policy.

I think what has me so depressed (5.00 / 2) (#8)
by Anne on Wed Sep 23, 2009 at 11:42:50 AM EST

about the reform effort is how those directly involved in it seem to have less information available to them than ordinary folks like us with internet access, and when they do "discover" something, act as if they've done something remarkable.

It's demoralizing to still be saying the same things months after Obama took office, and have to watch as these legislators bounce off the walls and dead-ends of a maze they don't have to be trapped in. If they would just stand up and stop groveling, they would realize the maze is only three feet high and - gasp! - they can see their way out!

And the media? Holy moly. They are useless. Maybe less than useless because much of what they do just makes things worse. Does Ezra get points for finally revealing why it is that the European countries have been successful at making sure their residents have health care? Well, maybe he shaves off a few of the thousands of minus points he's accumulated, but he has a long way to go to move into positive territory.

Seriously, I don't know how much longer I can tolerate these people plucking on my last nerve. And what worries me is that the longer this insanity goes on, the more people will detach from it, and that opens the door to exactly the wrong kind of legislation that will spell doom for reform and be no help to the millions of people who need it.

Let's just say for the sake of argument (5.00 / 1) (#15)
by inclusiveheart on Wed Sep 23, 2009 at 12:38:18 PM EST

that this Congress (yes, I know that's laughable, but go with me here anyway...) enacted tough and comprehensive regulations for the private insurers. The GOP would strip everything out as soon as they possibly could. That's a big reason why single payer or at least a widely available public option are the only two possible answers here. It would be much harder to take something away from the public - evidenced by Medicare and Social Security's survival - than it would be to chip away a regulation that the public is removed from and doesn't really understand. Meaningful reform has to come in a direct delivery system, not some convoluted and arcane set of regulations that most people wouldn't even know to invoke were they being abused by an insurer.

But isn't that the point? (none / 0) (#2)
by masslib on Wed Sep 23, 2009 at 10:14:22 AM EST

A "robust" public option would drive the insurers out of business. That's why they don't want to offer it.

Finally, some truth about how it is done in other countries who don't have a total single payer. This is far more honest than Krugman's recent work. Again, folks, we do not have the political capacity to regulate like the other industrialized nations.

OT, but did you see Paul Craig Roberts endorsement of Medicare for All, placing him to the left of Ezra.

I'm the eternal pessimist (none / 0) (#4)
by TeresaInSnow2 on Wed Sep 23, 2009 at 10:45:41 AM EST

Right now I'm making a list of countries I want to move to when the Baucus/Obama junk bill becomes law....

I refuse to be forced to feed the coffers of big insurance. Refuse. They can throw me in jail.

Civil disobedience... (5.00 / 1) (#5)
by kdog on Wed Sep 23, 2009 at 10:50:25 AM EST

will be most called for if we get an unaffordable to the 8 bucks an hour crowd mandate.

But will we answer the call? Our collective track record is the pits lately...we've proven much more adept at lubing up and taking it over and over and over.


Your right, but, in the short term, (5.00 / 1) (#19)
by KeysDan on Wed Sep 23, 2009 at 01:10:08 PM EST

it is difficult to mobilize against needlessly complicated proposals continually, and probably, deliberately confused and in flux--yes, we will have a public option, no it will something else, just like it, no/yes mandates, will not add a dime to the deficits, on and on. Your criticisms will be dealt with in amendments, conference etc. Moreover, politicians depend upon the fact that so many Americans are busy making ends meet and look forward to their leisure time enjoying sports or other entertainment. Meanwhile, President Obama works hard on building his popular base, with banter on shows like David Letterman and minimizing criticism with another brilliant speech. And, perhaps the biggest factor going for the Democrats is that most of the bill that does pass will be phased in over time, not even kicking in, for the most part, until 2013.


I suspect (none / 0) (#11)
by TeresaInSnow2 on Wed Sep 23, 2009 at 12:16:01 PM EST

the 8 bucks an hour crowd won't have a choice but to go to jail. Who could afford to pay $900/person tax on 8 bucks an hour? The 8 bucks an hour crowd isn't even taxed (except FICA).

I think people will answer the call, because this is unprecedented. What other choice do they have?

Maybe the Democrats want an end to their own party, because that's what we'll have if the [F]aucus tax passes.


: I meant to say (none / 0) (#13)
by TeresaInSnow2 on Wed Sep 23, 2009 at 12:17:07 PM EST

the 8 bucks an hour crowd isn't currently taxed (except FICA).

In the 60s (none / 0) (#9)
by Natal on Wed Sep 23, 2009 at 12:04:49 PM EST

Canada welcomed draft-dodgers so we'll gladly welcome insurance-dodgers. Single payer health care is right next door. Living in Toronto or Vancouver really isn't that bad.


I love Vancouver (none / 0) (#12)
by TeresaInSnow2 on Wed Sep 23, 2009 at 12:16:22 PM EST

I live in the Seattle suburbs.


Does Canada cover undocumeneted (none / 0) (#17)
by oculus on Wed Sep 23, 2009 at 12:50:23 PM EST

immigrants?


: No (none / 0) (#20)
by Natal on Wed Sep 23, 2009 at 01:13:38 PM EST

in BC, for example, you must be a citizen of Canada or be lawfully admitted to Canada for permanent residence. Basically, the same as Medicaid in the US, citizen or have a green card.
However, with Medicare in the US as I understand it from my case, non-citizen and non-green card holders, can qualify for Medicare if they have the required number of credits from their employment in the US. These would be people who had J1s and HB1s. But they can only receive the benefit if they have the medical service in the US.

I visited Toronto years ago (none / 0) (#18)
by MO Blue on Wed Sep 23, 2009 at 01:05:25 PM EST

and really liked it. Of course, my visit was in the summer. My now old bones don't like the cold weather.

I once told another Canadian that the illegal migration patterns were going to change soon. It would be Americans sneaking across the border into Canada so that could actually get health care.


: Well (none / 0) (#23)
by jbindc on Wed Sep 23, 2009 at 01:41:04 PM EST

Where I'm originally from (Detroit), senior citizens are going over by the busload to get cheaper prescriptions already. If you're gonna sneak over for full health care, you just need to learn about milk in a bag and what a touque is.

Well it does have some good things (none / 0) (#26)
by Socraticsilence on Wed Sep 23, 2009 at 03:05:19 PM EST

its just mostly a crap giveaway to Big Insurance- I mean the expansion in SCHIP eligibility is great for instance.


Draft-dodgers (none / 0) (#14)
by DancingOpossum on Wed Sep 23, 2009 at 12:19:05 PM EST

...still going to Canada:

To avoid serving in Iraq, 300 American soldiers have left their homes and families and fled to Canada, 75 of them to Toronto. Many assumed they'd get a visa, settle down and live a normal life. But the federal government has rejected their refugee claims and ordered them deported. Some go into hiding; others wait for appeals and judicial reviews of their cases.

http://www.torontolife.com/features/we-wont-go-back/

Not draft dodging (none / 0) (#24)
by Raskolnikov on Wed Sep 23, 2009 at 02:43:25 PM EST

You can't call voluntarily enlisted people "draft dodgers", they're just going AWOL. Both my brothers are in the military, and both knew, as does everyone, exactly what could very likely happen when you sign up, which is that you'll serve one or several tours of duty in Iraq or Afghanistan.


: Well (none / 0) (#28)
by cawaltz on Wed Sep 23, 2009 at 03:25:19 PM EST

I'd argue that some of the youngsters may not have been more than aware that this was going to be significantly different than the paintball games where the recruiter met them. Recruiters aren't always upfront when convincing folk to sign that bottom line.

"Contain Costs" (none / 0) (#21)
by Slado on Wed Sep 23, 2009 at 01:18:19 PM EST

Is subjective.

These countries pay lots of money for medical care through taxes. Simple as that. Like anything run by the government it's short of money. I don't care what system we come up with if it's run by the gov't it will run a deficit. Anyone care to argue with that?

It is specifically impossible to contain costs on something (healthcare) that naturally gets more expensive every year because the amount of services it can provide grows as does the amount of people who need those services. Especially now with the aging of baby boomers.

The question is do we let the state ration care or supply and demand.

I favor capitalist forces, most on this site favor the state.

What Conrad states is simply not true.

: The chart on the link is most telling (none / 0) (#22)
by Slado on Wed Sep 23, 2009 at 01:24:12 PM EST

All systems costs are rising. Japan, France, US, UK etc...
Fhe question is should it be the repsonsibility of our government to pay the tab and what are we going to give up to help pay for it?
In Europe it was their military. In the US it could be that, it could be other services but to pretend that a government system is going to contain costs is a fantasy.