Health Care Reform 3: What We’ll Get
Despite their efforts to kill it — discussed in previous blogs — the Republicans won’t be able to stop some version of health-care reform from becoming law. Tuesday, the Finance Committee will vote on an amended version of Montana senator Max Baucus’s bill. Last week the Congressional Budget Office importantly assessed that his bill, which proposes new taxes on high cost health insurance plans and cuts in Medicare, will pay for subsidies for low and middle income people to buy insurance. The CBO estimated that the bill won’t add to the deficit and might even reduce it modestly. That quieted the criticisms about cost and maintained important industries’ glee with the bill:
–Private insurers are resisting a bit now but have been delighted. If the government offered everyone subsidies to buy shmattas, wouldn’t the shmatta industry be happy?
–Pharma is happy, for the same reason: More people will be able to buy pills.
And it looks like the Democrats are winning the public-relations war: A new a Quinnipiac University poll found that two-thirds of voters disapprove of how Republicans are acting on health reform and only 25 percent rate the party favorably.
Yet a “public option” is missing from the bill, which is surprising for three reasons:
1. Voters want it . The Quinnipiac poll found that 61 percent of voters support a government-run plan to compete with private insurers.
2. Americans who already have a public option like it, including military personnel and veterans, everyone over 65 and the disabled younger than 65 (Medicare), and the poor (Medicaid and State-CHIP)
3. A public option actually offers the best hope to reduce health care costs and opposition from conservative House Democrats — Blue Dogs — is fading. Pharma and insurers know that a pubic option would successfully compete with their business models.
The big question is whether health-care reform without the public option is better than nothing. The answer is yes. The bill will cap lifetime payments, prevent denial of coverage for pre-existing conditions, and cover virtually everyone — but I wince at saying yes, because we really need a public option. Not just “we, the people,” but specifically employers. They need a public option that holds down costs and fiercely attends to quality.
Entities that pay for the bulk of health insurance — private universities, steel companies, etc. — should be able to choose among the privates like Blue Cross, Aetna, etc. and Medicare, the Veterans Administration, and the Federal Employees health-insurance system when selecting policies for their workers.
7 Responses to Health Care Without a Public Option?
lindamcphee - October 13, 2009 at 7:40 am
The 61% would probably be even higher if we were all more precise in what we’re saying… not ‘healthcare system reform’ but ‘healthcare payment reform’. The insurance companies are uncontrolled leaches. They control some risks for some people. They don’t train healthcare personnel or build hospitals, they build skyscrapers (look at Hartford and Boston). They’re out of control in the USA. Meanwhile, controls over insurance companies in other countries hasn’t driven their insurers out. I support the alternative of Medicaid for all who want it.
joeerwin - October 13, 2009 at 10:14 am
What insurance companies are doing is selling fear, or, more precisely, protection against fear. We are currently all victims of something resembling the “protection” schemes that were once a common means of extortion used by neighborhood bullies and “The Mob.” Of course, greed by healthcare providers also plays a roll. Everyone should have access to emergency services and fundamental health care through nonprofit publicly funded clinics–which should be allied with each other in ways that promote preventive medicine rather than waiting for emergencies. Elective and cosmetic procedures should be outside the public health system. Diagnostic labs could probably best be small businesses that might have access to government loans or grants to acquire state-of-the-art technology, or even be open to cooperative use of government-owned technology. And don’t get me started on pharmaceutical issues. We are now being over-prescribed to the point that grave damage is being done to our health by the interactive consequences of ingesting multiple compounds whose safety IN COMBINATION have never been adequately evaluated. My sister has 15 prescriptions. I think they are killing her and ruining her quality of life–but her insurance pays for them (everyones’ insurance, of course) and will continue to do so as long as she lasts. At some point we have to say “NO MORE!” We must substitute diet and exercise for costly pharmaceuticals and preventive medicine for most “emergency” treatment.
11172680 - October 13, 2009 at 10:30 am
Not only is the public option important to control costs, it’s morally necessary. Jacob Hacker’s original model on which Hillary Clinton and Barack Obama based their campaign proposals would provide taxpayer-funded subsidies only to pay premiums for the public plan. The Senate Finance Committee plan is completely unaffordable for ordinary Americans, according to figures in today’s Washington Post on total out-of-pocket expenses (premiums, deductibles, and copays) by income group, since the Committee’s prime means to save money is to cut subsidies necessary to make premiums affordable. The insurance companies complain that the law won’t require everyone to buy their products — which has been their sole aim all along — so they will increase premiums. It seems too obvious that their concern for their stockholders trumps their concern for the health of the American people or for the federal budget. Why does our intelligent President think he can do business with these people?
zizzer - October 13, 2009 at 10:43 am
The problem with the “public option” is that the government will not have to turn a profit. They can throw as much money into insuring people as they want, so the private sector will not be able to compete. One by one insurance companies will be forced to close. It will not matter if the legislation says you can keep your current insurance if the company that insures you does not exist anymore. There are PLENTY of insurers out there to provide competition without the public option. The problem is that they don’t really compete because FEDERAL REGULATIONS HAVE PREVENTED COMPETITION across state lines. If Congress just lifted those regulations then insurance companies would be forced to compete in a truly open market and prices would go down and quality of service would go up. the competition would automatically provide restraint. Republicans have proposed this in the alternative legislation they provided (that the Democrats and the MSM say don’t exist) and it has been ignored and rejected by Democrats. WHY?One might argue that FedEx and UPS manage to compete against the USPS, and that insurance companies could do the same, but there are stark differences. For one thing, letter and package delivery ARE the primary services the customer is getting from FedEx, UPS, and the USPS. Consider that FedEx and UPS compete in the areas of speed, efficiency, and international service, and that is where they found their niche of the market. Folks will pay a premium for those services when they need them, and the USPS cannot compete in those areas, just like FedEx and UPS don’t really compete in delivery of non-time-sensitive letters. With health insurance, the HEALTH CARE is the primary service, and the insurer is just a means to manage the costs and the risks associated with health care. The insurance company does not provide the health care, they just help you pay for it, so there is much less opportunity to be innovative and find a niche in the market in which to compete. The package delivery analogy would only hold up if there were intermediary companies providing mailing cost management services, which, to my knowledge, don’t exist.Once the private insurers are gone, we will have a single payer system. And I don’t care what some politician says, there WILL BE RATIONING OF HEALTH CARE. It’s simple supply and demand. There are only so many doctors, nurses, clinics and hospitals to go around. Right now the free market is rationing health care. Those who cannot afford it, are not getting it, or are delaying seeking service. If health care becomes universally accessible, the system will be overwhelmed and SOMEONE will have to decide who gets service and who does not. And if legislators cap how much doctors can earn, particularly specialists, the number of doctors will shrink significantly.I went without insurance for years and I paid as I went along, with some mercy from my health care providers. Employer provided health insurance was a major motivator for me to better myself and get a good education and a better job.
usaret - October 13, 2009 at 3:59 pm
This “compete across state lines” is a bit of a canard. Yes, insurance companies are regulated by each state, which mandates different levels of coverage for different conditions in different states. And yes, insurance companies create subsidiaries sometimes to offer coverage ina state if that state’s insurance commissioners require a company be in the state in which it operates. But by and large, the big companies–Aetna, Anthem, Humana, etc., already operate nationwide and simply offer policies tailored to a particular state’s requirements. Something like 60% of the health insurance written in the US is provided by four companies. If the issue is state level regulatory burdens on companies, then that is a separate issue–it came up early on in the current health insurance debate, but has largely been subsumed by the national discussion.
zizzer - October 13, 2009 at 5:01 pm
usaret, The “public option” is the real canard: http://bit.ly/1viJCW
mbelvadi - October 15, 2009 at 7:08 am
#3, it isn’t the “intelligent President” “doing business” with the insurance industry. The industry has pretty much bought the Congress, so the President is forced to “do business” with its minions. zizzer, the easy answer to the argument that govt can oversubsidize and drive out private insurance is to just make the program self-funding after a couple of years – it can only pay out what it takes in via premiums. If the private industry is more efficient than govt (as so many Repubs claim), then they should have no problem competing AND squeezing out a margin for profit. But they know that their costs and profits are unreasonably bloated so they would lose that competition, hence they fight dirty, by buying votes instead of engaging in real market competition.