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Health Care Reform for Beginners: The Many Flavors of the Public Plan

For most of you, this is the big one. The inclusion of a strong public insurance option has become, for most observers I know, the single most recognizable marker for victory. If the public plan exists, liberals have won. If it's eliminated, or neutered, then conservatives have triumphed.

The public plan has a very particular political lineage: The lesson liberals took from the 1994 health reform fight was that you couldn't threaten the insurance coverage individuals already had. For many policy wonks, the central problem in health care was the existence of private insurance coverage. For most Americans, however, the central problem was that they could lose their private insurance coverage, and be left with something they didn't like, or nothing at all. This effectively ruled out something like single-payer, or even Bill Clinton's managed-care-within-managed-competition model. It ruled out anything that began by changing the health care coverage of those who wanted to keep their current policies.

But that political insight didn't cancel out the policy insight: The private insurance market is a mess. It's supposed to cover the sick and instead competes to insure the well. It employs platoons of adjusters whose sole job is to get out of paying for needed health care services that members thought were covered.

Moreover, public insurance is simply more efficient. Medicare holds costs down better than private health insurance. The substantially public systems employed by every other industrialized nation cost less and cover more than the American model. So the question became how to marry the policy need for public insurance with the political need to preserve the status quo.

Enter the public insurance option. It doesn't replace the insurance individuals already rely on. But it provides an alternative. It lets them make the decision. It's the health care equivalent of being pro-choice. And it thus serves two purposes. The first is to act as a public insurer. To use market share to bargain down the prices of services, much as Medicare does. To lower administrative costs. To operate outside the need for profit, and quarterly results. The Commonwealth Fund estimated that this would result in savings of 20%-30% over traditional private insurance:

publicplanpremiums.jpg

The second is to apply competitive pressure to the rest of the insurance industry. If the public plan is ruthlessly lowering its administrative costs and garnering a reputation for decent, good-faith service, it will take market share from the private insurers. The private insurers will have to respond in kind to retain their customers. If they fail to adapt, the system could become something resembling a single-payer structure.

But that's not the most likely outcome. Rather, the theory here is simple: If you can't replace them, convert them. If the public plan works, then private insurance will work better as well. In this telling, the simple existence of the public plan forces a more honest insurance market: Private insurers need to offer premiums closer to their marginal cost, and they have to cut administrative costs, and they have to work on their reputation for cruelty and capriciousness. The existence of another option changes the market. Individuals will have access to private insurers, but they'll no longer be stuck with them.

Private insurers, of course, don't want to face that kind of competition. And they have enlisted many members of Congress to help protect them from the public insurer. In recent weeks, however, the Obama administration has put some muscle into the preservation of the public option. Most observers now think that some form of public plan will survive in the final bill. The question is what form of private plan? There are three options:

• The "Trigger" Plan: Olympia Snowe is pushing this compromise, as are some conservative Democrats. The basic idea is that the public plan would act as an invisible threat: It would be "triggered" into existence if the private insurance market was unable to offer, say, enough options in a particular region, or enough cost control. In addition, the public plan would only come into existence in this or that region, or this or that state. It would be effectively useless as an insurer. It could potentially have some competitive effect in that private insurers would still work to avoid its existence. Some have argued, however, that the conditions being mentioned in the "trigger" proposals have already been met.

The Weak Public Plan: This is what people are talking about when they refer to a "level-playing field." This incarnation of the public plan -- first proposed by Len Nichols at the New America Foundation and later echoed by Peter Harbage and Karen Davenport at the Center for American Progress -- would have no special advantages over private insurers. It couldn't use the low rates that Medicare sets or access taxpayer subsidies. It couldn't force its way into networks. It would simply be another insurer, albeit with different incentives than traditional insurers.

The Strong Public Plan: This would be like Medicare for the rest of us. It could throw the federal government's weight around. It could negotiate deep discounts with providers. It could muscle its way into networks. Outside groups like the Commonwealth Fund estimate that it would save the average consumer 20 percent to 30 percent. That would give it a massive competitive advantage over private insurers, and would probably result in tens of millions of Americans dropping their current coverage and entering the public plan to save money. A variant of this was in the draft of Ted Kennedy's bill that was leaked last week.

As someone who thinks cost control and efficiency are important in health reform, I'm most interested in the strong public plan. Folks who are more interested in preserving something that looks like the current private insurance market tend to fall behind the trigger public plan, largely under the theory that it would be pretty much the same as no public plan at all.

Further reading: "A Modest Proposal for a Competing Public Health Plan" by Len Nichols.

• "The Case for Public Plan Choice" by Jacob Hacker.

• "Competitive Health Care: A Public Plan that Delivers Market Discipline" by Peter Harbage and Karen Davenport.

Have the conditions for a "trigger" already been met? By Health Care for America Now.

By Ezra Klein  |  June 8, 2009; 1:06 PM ET
Categories:  Health Coverage , Health Reform For Beginners  
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Comments

Could you comment on the complaint that the public plan is unfairly advantaged because the government "subsidizes" it and not the private plan? I've seen this talking point floated around a lot. It would seem that this is a misunderstanding of how public plans work. My simplistic understanding of the funding mechanism is something like: a family either spends $X per year on private premiums, or $X per year on payment for the public plan coverage - call it a tax, premium, whatever.) Are there other government subsidies besides this tax that give the public plan an unfair advantage? If not, then this tax is not a subsidy, but just the cost of doing business. My understanding is that the extra cost people talk about in terms of health reform is that of getting the uninsured covered, not in subsidizing the average person above what the real cost is. In other words, is the public plan expected to be cheaper strictly due to efficiencies and controls, or are there other government subsidies acting like a hidden thumb on the scale making the public plan look better than it really is?

Posted by: jeirvine | June 8, 2009 1:40 PM | Report abuse

"The first is to act as a public insurer. To use market share to bargain down the prices of services, much as Medicare does. To lower administrative costs."

In lowering administrative costs, I read, won't spend money bending over to deny coverage. If this is where much of the savings in administration will result, what will stop private insurers from cherry picking healthy individuals? Would this cause the public insurer to become a high risk pool?

Posted by: Dan_B | June 8, 2009 1:41 PM | Report abuse

To me, having a mandate without a public option is a non-starter.

If something is so essential to thep public good that everyone must buy it, how can you justify only offering it from private companies?

Posted by: SteveCA1 | June 8, 2009 1:55 PM | Report abuse

"If this is where much of the savings in administration will result, what will stop private insurers from cherry picking healthy individuals? Would this cause the public insurer to become a high risk pool?"

It would be illegal and more importantly there won't be a need to. Insurance companies that serve riskier patients will receive reimbursements from the other insurance companies on the exchange. There will be no incentive to serve only healthy patients since you're going to pay for sick people being covered by someone else anyway.

Posted by: SteveCA1 | June 8, 2009 2:01 PM | Report abuse

"Insurance companies that serve riskier patients will receive reimbursements from the other insurance companies on the exchange."

Steve, can you expand more on the exchange. I don't think I'm familiar with that.

Posted by: Dan_B | June 8, 2009 2:07 PM | Report abuse

Dan_B,
Cherry picking is thwarted in two ways.

First, insurers are explicitly prohibited from denying coverage or charging higher premiums based on health status, claims history, genetic info, etc. Without the ability to discriminate, they have to compete more in terms of quality and efficiency.

Second, is risk adjustment. Plans that cover people with more expensive health problems get paid more and those that cover more healthy people get paid less. It's not perfect but it's done in Germany and elsewhere.

Ideally, premiums / credits are paid into an exchange and distributed to insurers--including the public option--based on a formula. The formula can be adjusted over time if necessary.

Posted by: jefft1225 | June 8, 2009 2:10 PM | Report abuse

I'd like you to dive in more on what "access taxpayer subsidies" means. It seems to me the most important aspect of the strong plan is the ability to use Medicare's power in negotiating deals. Even if the public plan is Medicare, it wouldn't access taxpayer subsidies if the price is set correctly; that seems easy enough.

Posted by: ImMark | June 8, 2009 2:10 PM | Report abuse

The arguments of the insurance industry don't have to be true or make sense, they only must resonate with enough voters that the Congress (Senate) does what their insurance-industry campaign contributions were designed to do. Check out who Max Baucus's top 10 contributors are: like 8 of the 10 are in the health biz. They want to get the best law for the health biz that their contributions have paid for - and that is a non-existant or weak public option.

You've got it right that progressives will judge winning from losing on whether there is a strong public plan. Full stop. I suspect the insurance lobby views it the same way, except they don't intend to lose and end up with a strong public option.

This is Obama's test. He will lose much of his left of center support if the weak plans are the final result, but he may not care. That's why it is a test. If he can't twist arms like LBJ and produce a real reform of the industry, then Mitt Romney (or some other weather-vane in the GOP) will benefit and deserve a chance.

I'll bet Obama gets rolled by the Senate and folds his hand: he may value harmony over substance that counts. He's propping up the bankers and automakers,so giving the health insurance corps a license to steal and kill will not be a surprise, although it will be a HUGE disappointment. Instead of Yes, We Can, we'll get No, I couldn't.

Posted by: JimPortlandOR | June 8, 2009 2:25 PM | Report abuse

I wish you would refer to a strong public option this way: "This would be like Medicare for the rest of us. "

This is not what we want. A few reasons...

1. Medicare is an individual plan with costs based on individuals. It is not a family plan. We want a public plan that can cover families in an affordable way. If you're trying to cover a family of 4 with Medicare as it is now you're talking about an estimated cost between $1200-1600 per month. It's not feasible.

2. Medicare does not cover vision, dental, or prescription coverage. It does not cover the vast majority of vaccines. It does not cover birth control. It only covers abortion in cases where the health of the mother is at risk. A strong public option would include more coverage than Medicare provides.

I believe it is dangerous to try and make comparisons between a strong public option and "Medicare for all". It confuses the issue for many people. We should strive to be more specific.

Posted by: queenofbabble | June 8, 2009 2:38 PM | Report abuse

About cherry picking: (a) There is no way risk adjustment will be anywhere near complete. In Medicare only something like 10% of the variation in cost is explained by risk adjusters.

(b) To regulate away cherry picking one has to regulate *a lot*. It isn't enough to say the plan must take all comers. Plans can tweak benefits to make the package unattractive to "bad risks." The regulation will have to include standardization of plans or something close to it.

Will we get that?

Posted by: TheIncidentalEconomist | June 8, 2009 2:39 PM | Report abuse

TIE,
You're right. The devil will be in the details. But that's usually the case, isn't it?

You may know more about this than me but regarding risk adjustment, I'm not sure the approach used by Medicare is comparable in terms of method and function.

Posted by: jefft1225 | June 8, 2009 2:55 PM | Report abuse

I WANT TO BUY INTO THE SAME HEALTHCARE PLAN THAT CONGRESS GETS

...AND NOTHING LESS!

The healthcare industry, and their scum lobbiests win if we aren't allowed to buy into congress' health plan.

The reason is competition - currently there is none because insurance companies are legally allowed to collude on pricing.

Actually having a fair health care policy on the market to compete against drives these white-collar criminals CRAZY!

GIVE US THE CONGRESSIONAL HEALTH PLAN NOW!

Posted by: onestring | June 8, 2009 3:12 PM | Report abuse

What onestring said: open up the federal plan, and see how Dick Shelby sucks on that.

Posted by: pseudonymousinnc | June 8, 2009 3:27 PM | Report abuse

"Ideally, premiums / credits are paid into an exchange and distributed to insurers--including the public option--based on a formula. The formula can be adjusted over time if necessary."

How can you possibly ensure that "the right" premium is paid into the exchange? Deficit hawks and the low risk insurer cry waste and the higher risk insurer cries underfunded. The devil is in the details, perhaps using MedPAC for this would be a nice solution.

Posted by: Dan_B | June 8, 2009 3:34 PM | Report abuse

Private health insurance is completely immoral, and inefficient on top of that.

Trash it, now.

Case in point:
My parents can't afford health insurance, my mom needs to get a mama-gram. Mama-grapher told her the cost is $400, but she would need a referral from a primary care... she was then told by the primary care doctor that the visit was $1000...TO BE ALLOWED to pay for her own mama-gram!! She pleaded with the primary care doctor for a referral, crying. Finally the primary care doctor begrudgingly obliged.

Republicans against public health insurance can ROT IN HELL.

Posted by: stevek_ffx | June 8, 2009 3:36 PM | Report abuse

We either need a strong public option that covers anyone who wants coverage or we need to require the insurance companies to stop cherry picking customers. I am tired of hearing the health insurance providers saying that they don't want to cover people.

Posted by: B114 | June 8, 2009 3:41 PM | Report abuse

The Congressional Plan is the Federal Employees Health Plan, and is basically a cafeteria approach -- employees get to pick from a variety of private insurers and HMOs by comparing benefits and premiums and select the one that meets their budget and family needs the best. Premiums are lower than those paid by many private sector employees primarily because of two factors. One is economies of scale -- the government employs hundreds of thousands of people so is negotiating with insurers from a position of strength. Second, as a percentage of the overall costs of the plan the government often contributes more towards the premiums than private employers are willing or able to do.

And, yes, I agree with the other commenters who think the average citizen should be able to buy into it. It's not as good as a lot of people seem to think it is (there are still co-pays, and the premiums employees pay aren't insignificant)but it would be a huge improvement over what many people are forced to get by with now.

Posted by: historian_nan | June 8, 2009 3:45 PM | Report abuse

Ezra - If you want to support a Strong public plan that's fine. But please also discuss the implications of this decision. Also let's be clear - the government hardly "negotiates" with providers in Medicare. It sets prices.

1. If a strong public plan pays Medicare rates that means a 20-30% cut in reimbursement for hospitals and doctors vs. private insurance rates. Will access to doctors suffer? Will more doctors opt out of Medicare and move their practices to a concierge model?

2. It means the public plan will become like Fannie Mae and Freddie Mac, with an implicit (or even explicit) government guarantee. Will this public plan draw on tax dollars to fund reserves? Will it be able to issue debt at the Treasury rate? Will it be allowed to fail?

Posted by: MBP2 | June 8, 2009 3:48 PM | Report abuse

I don't think you can stop companies from "cherry picking". They will play the "catch me if you can" game with the government. They should just work on a National Health plan and remove the burden of health care from private companies, even though they probably will incur some cost of the plan.

I always felt that the President, Congress, and government employees should have to use the VA hospitals and doctors. That would of kept the quality up for our service men.

Posted by: imaginaryfriend2 | June 8, 2009 3:53 PM | Report abuse

The big question that bothers me is.
How are they going to keep Health care professionals in the plan? doctors are dropping out of Medicare in droves. Those of you who are 65 know what I am talking about. The government keeps cutting back on payments to doctors, and the administrative costs of dealing with the government are not worth the time. So what good is having a plan, if you cannot find a doctor that accepts it. And in rural areas the problem is worse. After all, the government cannot nationalize a profession as easily as GM.

Posted by: scholls3 | June 8, 2009 4:00 PM | Report abuse

The choice between a public health care plan and not having one - is NOT an option !!!

The Dems were elected for the much needed change in America today - SO DELIVER !

This is our best and maybe only chance to stop the corp greed in health care and providing health care for ALL Americans... so don't squander the opportunity and allow lobbyists to talk this down.

So many Americans need dental care and can't afford it so their teeth fall out do to gum disease etc.

Posted by: danglingwrangler | June 8, 2009 4:21 PM | Report abuse

A few important points:

1.) The administrative costs for providers dealing with Medicare are a lot LESS than the costs of dealing with private insurers. Cost of dealing with private insurers averages about 11%; cost of dealing with Medicare averages about 3%.

2.) Medicare payments are lower than private insurance payments in most places (but not all.) But the difference is less than you think, and well under the difference cited above. On a national basis, hospitals collect about 97% of costs from Medicare, and about 115% from private payers. The difference is mostly due to high costs for a minority of patients who are cost outliers not being payed by Medicare. Some hospitals actually make money on Medicare. However, some providers with strong market positions -- the poster child for this is Partners Health Care in Boston -- are able to use their market position to extract much higher payments from private payers, a game Medicare won't play.

On average doctors get about 90% as much from Medicare as private payers, and the difference in costs of billing erases a big piece of that. However, the difference is greater for primary care. It is mostly in primary care that people are running into doctors refusing Medicare.

3.) Obama has indicated several ideas to improve on the Medicare vs. private issue. The first is that one of the announced first orders of business for his new "MedPAC on steroids" proposal is to fix the problem of payments to primary care. Second, Obama has telegraphed the idea of his federal insurance plan paying 110% of the Medicare rate. That would solve a lot of the payment issues, including bringing an overwhelming majority of hospitals into the black on the program and bridging the gap between the program and private payers for doctors.

Posted by: PatS2 | June 8, 2009 4:22 PM | Report abuse

Administrative costs of public vs. private, myth vs. reality:

http://voicefortheuninsured.org/pdf/admincosts.pdf

Posted by: cvelocity | June 8, 2009 4:34 PM | Report abuse

Here's a concern of hospitals. A new public plan offers low-premium plans. Private insurers respond by offering their own lower plans, not by trimming administrative costs as you suggest, but by reducing reimbursements to hospitals. Medicaid pays hospitals about 70 cents on the dollar for the cost of caring for that population. Medicare payments are better, but the regular marketbasket updates from Medicare don't match medical inflation -- that is, the cost to hospitals of paying for labor, equipment etc. Public plans don't pay well, and all we have to look forward to if one is introduced into the market is private plans lowering their payments to match the lousy public reimbursements. Therefore, I favor the "trigger" concept. Comments?

Posted by: johneel | June 8, 2009 4:36 PM | Report abuse

Excellent summary by Ezra Klein. I too favor the strong public plan option just as many, many Americans do. The question is not just access to healthcare but access to affordable health care. Today's private insurers are inefficient and driven by huge profits. If people want to use private insurers, that's fine but give the rest of us a public plan option that is not driven by profit motive.

Companies of a certain size should still be required to contribute towards health care whether it's a public or private plan option. We shouldn't let companies off the hook either. They've already been let off the hook by eliminating defined benefit plans for retirement and eliminating company 401K matches.

Posted by: russell2 | June 8, 2009 4:53 PM | Report abuse

Ezra,

Unfortunately for me this is not "the big one", and is more of the same for the American people. This is no where near a solution for the nearly 60 million Americans who are not able to afford insurance today. 20-30% off will not make much of a difference at all.

Medicare and Medicaid are not the solution. Their administrative costs may be lower due to reasonable employee salaries and no monies spent on advertising, campaign finance and entertainment. But the federal government does not throw its weight around to negotiate deep discounts. In fact, the government only contracts with private health insurance companies that regulate and control agreements with health care providers. And, health care providers merely inflate costs for the privately insured.

It is the same for the US government Office of Personnel Management. It contracts with private health insurance plans throughout the country. Although the US government pays up to 75% of US government employee and retiree premiums, the private health insurance industry ultimately negotiates the traditional insurance plans or locally available HMOs while administering costs and income.

Check out the following URL if you want the real story on the monopoly the private health insurance industry has on the US health care industry.

http://healthcareforamericanow.org/site/content/new_report_private_insurers_consolidate_and_control_prices

Posted by: ranxerox1 | June 8, 2009 5:11 PM | Report abuse

The Republicans are showing once again how well campaign contributions from private insurance industry and big pharma work to delay and /or destroy any chance the American public has of getting the same kind of medical coverage that the ordinary citizen gets in every other civilized nation on the globe. Americans are regarded as the intellectually challenged of the Western hemisphere because we haven't got medical coverage that Canadians, English, French and Germans do, or even Cubans for that matter. Republicans and "conservative" democrats, the best legislators money can buy. How about any Rethuglican or Dino (Democrat in Name Only) who lobbies against this plan or votes against this plan, be required as a matter of law and/or ethics to give up the plan they and their families have on the tax payers dime and be forced to go into the private market at their own expense. I need to see a dr. now, I can't wait for a so-called trigger which is just a device to delaying health coverage for all until a Rethuglican administration can be elected and we never get public health care. Everybody, call your Senator or Representative and tell them you want the adoption of Rep. Conyers bill for single payer health care HR 676. Let's cut the crap NOW!!!

Posted by: jokr8790 | June 8, 2009 5:13 PM | Report abuse

jeirvine: "Are there other government subsidies besides this tax that give the public plan an unfair advantage?"

75% of Medicare is funded by payroll taxes and general federal revenue; only 25% comes from premiums. If the same is to be true for a public plan like Ezra is describing, those would be other subsidies not available to private plans.

EK: "Private insurers need to offer premiums closer to their marginal cost, and they have to cut administrative costs, and they have to work on their reputation for cruelty and capriciousness."

This is internally contradictory. The first clause says that private insurers need to push their insureds not to consume so much health care, while the third clause says that private insurers need to *stop* pushing their insureds not to consume so much health care.

Posted by: tomtildrum | June 8, 2009 5:19 PM | Report abuse

I don't really see the advantage to the government running an "insurance" plan, you almost certainly end up with a high risk pool, which means it will end up being a drain on the taxpayer. If it pushes rates down too far, it will end up not being accepted at many providers.

The proposals for forcing people to accept money losing customers and the risk exchange fund, which looks like something designed by a failed AIG quant, do not seem like the kind of thing that would "lower administrative costs". If you want to lower administrative costs, develop a standard claim submission form and coding for $5M and regulate that into billions in IT savings- not additional IT expenditures as many are proposing.

When I look at a plan, I look at which providers accept it and the catastrophic benefits it provides. A lot of idiots out there look at co-pays as the key indicator of plan quality. Those are basically meaningless. You need catastrophic coverage. Too many people equate paying for health insurance with paying for health care.

I wish we would stop conflating healthcare savings with covering additional people. Covering the additional people is going to mean me paying for other people's health care more than I do today. There's no reason for this this to be mashed into the efficiencies discussion.

Posted by: staticvars | June 8, 2009 5:26 PM | Report abuse

Wow, it's amazing to me that so many people think the government can provide a better, cheaper and more efficent (ie lower administrative and fraud) plan than the private insurance industry. HELLLOOO, Social Security? Medicare/Medicade? Perscription Part D? or how about the most recent fiasco "REFORMED Part C"?

Believe me, I've been an agent for many years and BY FAR the biggest, most wasteful, most fraudulant and absolutely the worst adminstrative plans I have ever marketed were via the government (Medicare/Medicade Part D and Part C) It's a huge, HUGE mistake to think the government will be any better than their track record. (And in case any of you are thinking I'm worried about my income, forget it... I made TONS of commissions on marketing the Part D and Part C plans. It was easy money because all I had to do was sign them up.) It made me sick, SICK to see how stupid, wasteful and useless theses "government" plans were.

A prime example of what I am talking about it is the recent Obama Administration COBRA subsidy... where our government in it's infinite wisdom decided to "help" people out by paying 80% of their COBRA for up to 9 months if they had benn laid off. So here I was easily writting Catastophic plans with EXTRA benefits for a family of 4 for $500/month TOTAL! BUT because of the Obama plan the clients decided to keep their $1,200 dollar a month COBRA??? So my clients saved because they only had to pay $240 or so but our government paid $960!! For a plan that was less protection!! Just one example of the "leveraged marketing, more efficent and lower priced plans the government can offer."

CRAZY!! This money has got to come from somewhere!! Me, my children or in the 10 trillion spend-a-thon washington is onto my childrens, childrens, children... until it goes bankrupt like SS.

Furthermore. I'm a professional and I do care about my clients. I'm all for "standardized pricing." An MRI should cost the same in the same area. I am all for "guarenteed issue" laws (see Massacusettes). But if you think health care is costly now, just wait until the government gives it to us for "free". OR even tries to run it at all. It's a huge tax increase, if not income then some back door tax increase on fuel or vices or luxury items etc etc etc.

This is AMERICA! We are a free market, capitolistic society. And for all of those wonderful reporters who like to quote "other industrialzed nations all have a government health plan" well, just talk to 10 people from each of those countries and you will find a MAJORITY do not like them one bit... because of service, the government dictating lifestyles AND cost... nothing is FREE!

Posted by: MikeOFW | June 8, 2009 5:27 PM | Report abuse

The problem with the Obama Administration's numbers is that they are not credible!! Their estimates -- based on all we have seen thus far -- are not even close!! To wit: Obama initially estimated in all of his budget projections that the highest unemployment rates would be slightly over 8%. For Pete's sake, they are well above (% already, and most economists estimate it will exceed 10%!! He also estimated that there would be millions of jobs created by his herculean federal spending -- WELL, where are they? The Administration is trying to sell another pig in a poke, and urge the erstwhile politicians in Congress to be REAL CAREFUL, for 2010 is coming, and for the HOUSE, A DAY OF RECKONING!!

Posted by: wheeljc | June 8, 2009 5:30 PM | Report abuse

cvelocity - I don't think the AMA, who is responsible for the article you cited, is a disinterested observer. Several of the studies they reference have been discredited.

For example, they talk about one that compares Canadian wait times to the US wait times. But these figures are not comparable since everyone in Cnanda that needs treatment gets it while thousands in the US _never_ get needed treatment. Their wait time is infinity. How do you average in infinity?

Posted by: lensch | June 8, 2009 5:33 PM | Report abuse

Ezra - Are you going to print my first comment?

Posted by: lensch | June 8, 2009 5:36 PM | Report abuse

MikeOFW. You do not know what you are talking about when it comes to other industrialized nations's universal health plans. They are fantastic, and provide far better care more expeditiously than any I have received in the states. Private health insurance is causes way too much overhead and waste. Medicare is just as riddled with fraud and waste. They are both broken and need to be replace.

Canada has an amazing health care system.

Tommy Douglas is considered "The Greatest Canadian" for his part in reforming health care in Canada.

http://en.wikipedia.org/wiki/

It is time to tear down the broken US health care system, Medicare, private insurance and all.

Just check out the following URL if you really want the story on the monopoly the private health insurance industry has on the US health care industry.

http://healthcareforamericanow.org/site/content/new_report_private_insurers_consolidate_and_control_prices

Posted by: ranxerox1 | June 8, 2009 5:39 PM | Report abuse

In July 2008, the Globe-Mail and the Canadian Broadcasting System ran a poll which simply asks which do you prefer the Canadian health care system or the US health care system.

91% preferred the Canadian one.

Posted by: lensch | June 8, 2009 5:54 PM | Report abuse

Public vs. private = apples vs. oranges. Public looks cheaper because cost estimates don't include:

• Tax collection to fund Medicare—this is analogous to premium collection by private insurers, but whereas premium collection expenses of private insurers are rightly
counted as administrative costs, tax collection expenses incurred by employers and the IRS do not appear in the official Medicare or NHE accounting systems, and so are usually overlooked

• Medicare program marketing, outreach and education

• Medicare program customer service

• Medicare program auditing by the OIG

• Medicare program contract negotiation

• Building costs of the Centers for Medicare & Medicaid Services (CMS) dedicated to the Medicare program

• Staff salaries for CMS personnel with Medicare program responsibilities

• Congressional resources exhausted each year on setting Medicare payment rates for services

Posted by: cvelocity | June 8, 2009 6:03 PM | Report abuse

O.K. Let's try it in pieces.

Part One

Ezra says,"It ruled out anything that began by changing the health care coverage of those who wanted to keep their current policies."

Here is a question from a Washington Post - ABC poll:
"Which would you prefer: the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance, OR, a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers?"

62% favored Medicare for All; 33% were opposed. That's pretty decisive. And this is with the facts suppressed. Other questions in the poll show that the 62% supporting the universal program mostly believe it will cost more when it will cost less. They believe they won't be able to pick their doctor when Medicare allows much more freedom than most private plans. They believe there will be long waiting times when this is a myth. And still they support a universal plan like Medicare for All by 2 to 1.

Posted by: lensch | June 8, 2009 6:04 PM | Report abuse

Part Two

Ezra Says, "So the question became how to marry the policy need for public insurance with the political need to preserve the status quo."

No, the question is how to get the facts out to the public in the face of the best propaganda campaign since Goebbels.

The President says we have to take incremental steps. Medicare for All IS an incremental step. Step one was Medicare for the highest risk pool, old fogies like me. Step 2 is Medicare for everybody else which is actually easier because it does not cost any more (see below). Step 3 would be more efficient medical practice.

The main reason that it is far better to extend Medicare to everyone is cost. Private insurance companies waste about $400 Billion each year in high overhead and unnecessary requirements on physicians. There is another $100 Billion wasted on high drug prices to companies that spend 3 times as much on "marketing" as on R & D. This $500 Billion each year can be used to pay for the extension of Medicare to everyone.If you simply add a public plan, you are leaving the $500 Billion on the table. You are simply adding cost. This is just stupid.

In addition, there are technical reasons just adding a public plan is foolish. If it has to take everyone while private companies can pick and choose , it will wind up with another high risk pool--the sick and the poor. While the idea of creating another pool is bad enough, if it is a high risk pool, it will be very expensive. The Republicans will seize on this and progress will halt. Also if it covers preexisting conditions, then it will greatly expand the pool of the self insured which is terrible from an efficiency point of view. After all, why pay premiums when you are well?

Finally as to the attitudes of the public, Representative Anthony Weiner recently held a telephonic town meeting with 4,700 members of the public. He asked who preferred the public plan option and who preferred Medicare for All. Two thirds preferred Medicare for All. Then the Representative said the private insurance industry would never permit that option.

Who is running this country?

Posted by: lensch | June 8, 2009 6:05 PM | Report abuse

Government healthcare cannot possibly be any worse than the b&stards running the private insurance industry.

Posted by: orange3 | June 8, 2009 6:11 PM | Report abuse

I simply do not see any of these plans as being the best way to go.

We need a national health plan that will enable you to survive a trauma circumstance and then continue working. I do see something along the lines of .. fall out for sick call.. with the people going to a clinic, being examined and prescribed as needed, or refered on where that is called for. An emergency room/clinic is exactly what is called for at the entry level to care.

As part of the plan, the deep care will cure your cancer or make that attempt. Fix your broken bones, do what can be done to restore your eyesight.. remove your gallbladder. But what ever is require to move you back to work after treatment, or move you to disablement, limited working ability, or retirement. I think to protect us all we need to include a polygraph where the doctor says nothing is wrong with the person, and the person says yes they are in pain/sick.

So simple insurance through the end of your life.

So in a sense, it would be Medicare that anyone could subscribe to.. or reject. One low cost monthly payment and a co-payment. That unless your income is to low to make you pay the fees.

I would also suggest to any and all that we must keep it simple, or it will fail.

And also...give me a nose job or I will commit suicide? Ask them to commit suicide near a trash dump please.

Posted by: joelwisch | June 8, 2009 6:43 PM | Report abuse

Put the private scum out of business. Move their claims processors over to Medicare and fire the rest of the b...tards. They provide NO VALUE ADDED...ONLY GRIEF!

Posted by: tamalemolly | June 8, 2009 7:08 PM | Report abuse

National Healthcare Reform is inevitable but the extent of the reform is another issue. The public plan as stated in the article poses the major stumbling block. No one wants to compromise quality of care and the Public Plan threatens quality. The idea that The Public Plan can deliver medical care at a 20% to 30% savings is delusional. Today Medicare and Medicaid is subsidized by the private insures according to a resent Kaiser Foundation Study to the tune of 30%. That means it cost the private insurance companies $1.30 for every $1.00 of services they provide. By shifting more costs to the private insurance companies it is only a matter of time until private insurance will only be affordable to the very rich. Add to that the removal of tax benefits for insurance from employers and you have a recipe for disaster. The Public Plan will be the only plan affordable to the average citizen. The cost of this program of $1.5 Trillion is a great Legacy for our children and our grandchildren.

Posted by: samuel9722 | June 8, 2009 7:11 PM | Report abuse

We need a strong public plan. Otherwise we'll get what the GOP gave us in the Medicare Drug Plan--a large donut hole, skyrocketing drug prices and drug insurance premiums. To the people like Richard Shelby, I'd just say, Let us buy the same coverage privileged people like you already have. If you don't, you are a hypocrite.

Posted by: tinyjab40 | June 8, 2009 7:12 PM | Report abuse

You, like the rest of the MSM and Congress are obviously bought off by the insurance industry. How can you write an article about health care reform in 1009 and not even mention single payer except to say its not politically feasible. Poll after poll show that upwards of 2/3 of the American public want single payer. Only the politicians who have been bought off by the insurance industry - Baucus $1,000,000, Obama ? - or the pharmaceutical industry - Baucus $500,00, Obama ? - say it is unfeasible. They simply thumb their noses at the will of the people. As long as columnists like this continue to buy into and propagate this crap we will have no real health care reform

Posted by: jklfairwin | June 8, 2009 7:24 PM | Report abuse

Ezra, you stated "For most Americans, however, the central problem was that they could lose their private insurance coverage, and be left with something they didn't like, or nothing at all. This effectively ruled out something like single-payer..."

Why would it effectively rule out single-payer, if single payer covers everyone? Part of the point of single payer is to get insurance off the backs of business so they can control costs (and adjust their pricing to compete with the rest of the planet). Single-payer should be financed by taxes as a trade-off for premiums.

Also, you state that Medicare "saves money". No, providers simply shift costs, if they accept Medicare at all.

However, among the 3 choices you outline, the "strong public" is the only logical one. The others are stupid and don't change diddly until some futue date, if ever.

Posted by: michael4 | June 8, 2009 7:37 PM | Report abuse

To those who oppose a government plan, you should attempt to purchase insurance, once you lose your group coverage. My wife just lost her Cobra coverage, and the plan she got from Humana,which was the lease expansive, will cost over $11,000 per year with a $5,000 deductible. The insurance companies will not provide decent coverage at a reasonable cost for the unemployed. Individuals that are against a government sponsored plan, should think of the consequences if they were to lost their employer group coverage. The insurance industry is making outrageous profits on people who do not have group coverage. The uninsured should be abel to purchase health insurance from the government at a reasonable cost. I am glad to express my feeling on this matter. The Republican Senators who are against the Obama government plan are living in a fantasy world . If they had to provide for there own cost the opponents to the government plan will cease.

Posted by: escob4 | June 8, 2009 7:38 PM | Report abuse

BTW, cherry picking already occurs, and is part of the problem (of many) with insurance today. They got away from pooling risks to making executive salaries/bonuses, dividends, and oh yeah, profits.

Posted by: michael4 | June 8, 2009 7:41 PM | Report abuse

Gather around kiddie's and listen to the story of Bill McGuire. Bill was the CEO of United HealthCare and in 2006 was caught with his hand in the till and forced to retire. In that year his compensation was $148,000,000. Ye know, you can live on that if you don't serve Chateau Petreus on a week day. But wait. Even tho good ol' Bill left on a sorta sour note, he got a pension. His pension plan was costed out at $1,500,000,000 (yeah, $1,5 Billion). End of story.

I brought up the story of Bill McGuire to show that the opposition to single payer has such prospect of gain, of wealth that would embarrass an oriental potentate, that they will misrepresent, lie and spin to keep the system in place until they get their's. Furthermore, since even middle level executives are wealthy by normal standards, they have plenty of money to buy politicians and influence media. Therefore, Ezra, the rare people such as yourself who get exposure on this subject, I believe, have an obligation to speak out with the facts.

Posted by: lensch | June 8, 2009 7:53 PM | Report abuse

I am highly troubled by this debate. Profit margins in the insurance industry are typically only 2 to 5%. A public plan could never squeeze more than that from admin savings or competition. The real bugga-boo in healthcare is the cost of end-of-life care. Make euthanasia legal, and the system will make giant improvements in the cost of care and the insurance to cover it.

Posted by: CarolGBOS | June 8, 2009 8:11 PM | Report abuse

Check out this clip of Uber-Christian, Pat Robertson slipping and saying that private health care systems couldn't compete with a government run system. Does he even realize what he said?

http://progressnotcongress.org/blog/?p=1666

Posted by: Atticus1104 | June 8, 2009 8:22 PM | Report abuse

I really agree with your post on about 99% but just to be clear, Medicare doesn't bargain down costs. Medicare has set reimbursement rates and it's a "take it or leave it" proposition. I suppose you could call that bargaining but it sounds like you're trying to say there's some negotiation-- there's not.

Posted by: lredman | June 8, 2009 8:42 PM | Report abuse

As is typical with many discussions of "health care reform" everyone argues about benefits and no one cares about costs. Any plan by any other country is always superior to anything we have here. Little is said about physicians who refuse to accept Medicare or Medicaid patients because reimbursements are too low in those programs. Somehow, everyone is going to preserve the choice of doctors, receive the best care in the world, and pay much less for it that we pay now.

This is pretty much the same bunch of baloney that got Obama elected, as he made 503 promises that covered every niche group's expectations from their new Messiah. Congress struggles to find a source of funds for all this wishful thinking and Obama says "tax the rich."

I know how popular and easy that sounds, but the data (e.g., "facts") shows that the government never realizes the revenue from tax the rich schemes. Check google for what happened in Maryland when they decided to soak the rich.

People with private insurance will rue the day they invited the government in to control their access to medical care. If Congress can't help meddling with the banks, the auto companies, insurance companies, do you think they'll be hands off when they control your health care?

Posted by: Curmudgeon10 | June 8, 2009 8:49 PM | Report abuse

CarolGBOS - Here's something you can do in the privacy of your own home. Look up the financial statement of United Health Care or Wellpoint or Aetna or any big health insurer. Look at inflow (premiums) and outflow (benefits). Overhead is (inflow - outflow)/ inflow. It will be something like .15 to .20 (15% to 20%). Overhead for other countries is under 2% as is the Federal part of Medicare, e.g. Canada's is 1.3%. This is big money.

Also ask your physicians how much time they spend dealing with private insurance companies, filling out forms and fighting for coverage for patients. Now France which has fee for treatment has a one page form for practically all treatments. If a US company can save a buck having a physician fill out a 40 Page form (actual example), they will do so. Again we are talking big money.

Google Alan Sager. He studies Big Pharma. He found they spend about 11% on R & D, 19% on profit (average of all induatries about 10%) and about 34% on "marketing" the porpose of which is to get us to use drugs we do not need or to get doctors to prescribe new expensive drugs when old cheaper drugs would do as well or better. We could easily cut drug prices by a third and not touch R & D. Again, big money.

Altogether it's about $500 Billion a year which would easily pay for Super Medicare for everyone without spending anymore than we are now paying. Now sure they are other even larger savings to be had, but this would give us time to work on the really difficult problems of delivery and how much is a life worth.

Posted by: lensch | June 8, 2009 8:51 PM | Report abuse

Does anyone understand how many people will come out of the woodwork demanding (DEMANDING!) top-notch healthcare? That homeless panhandler who drank himself into poor health? He will be in the queue ahead of you for his very expensive health care.

Adding 45 million to the rolls (or whatever the number, it is large) means providing healthcare for 45 million more. No matter who is paying. It simply doesn't exist in our country. There are not the doctors and hospitals to handle the crushing influx.

If the gov't runs healthcare, you will end up with the NHS of the UK. Where a prominent medical ethicist said old demented people had a duty to die. And natural childbirth was being encouraged because anaesthesia was too expensive.

The UK and Canada are very polite cultures, but I don't think American citizens will stand for the long waits and denial of care that is the norm in these other countries. Not with all the lawyers we have.

The problem with socialism is the number of high maintenance non-contributors that have no end to their appetite for handouts and resources. Never paid into any health insurance, high risk activities (including deliberate infection with HIV), and expecting medical science to make them better and whole.

Glad everyone has a simplistic plan for solving this problem. Pointing to other eurotrash socialist countries as shining examples isn't exactly reassuring.

Posted by: oracle2world | June 8, 2009 9:06 PM | Report abuse

Why don't we just go for a single payer system and spend whatever necessary to have the best doctors and medical technology possible? Why do we always have to talk about cutting costs? Isn't human health and life worth it? Health care should be the most expensive item in both personal and national budgets. Let's wind down the empire, stop maintaining this insanely expensive imperial military constantly engaged around the world and spend the money on ourselves.

BTW, CarolGBOS, when you get old and sick, you can always kill yourself and save the rest of us the cost of caring for you. Why do you need the doctor's assistance?

Posted by: alientech | June 8, 2009 9:21 PM | Report abuse

I'm getting a bit tired of the talk about long wait times im Canada. I have aleady remaked that you can't compare them to ours since the wait time for many Americans is infinity. But if you want to see the actual numbers

http://canadaonline.about.com/od/healthcarewaittimes/Wait_Times_for_Health_Care_in_Canada.htm

gives wait times for every treatment of every disease at every hospital in Canada. And remember they spend half as much per person as we do. Try and imagine our system if we cut health expenditures by 50%.

Posted by: lensch | June 8, 2009 9:23 PM | Report abuse

The strong public option would be a real step in the direction of reform. I figure that between paying for my own premiums and having an employer pay for my premium I've paid something like $18,000 into the private insurance system from 1999 to 2006. During that time I took out a total of perhaps $3,000 in total services. When I switched jobs I lost coverage and I lost the benefit of the $15,000 or so that I and said employer paid into the insurance pool. If there's no strong public option, I think it's almost better if no reform is enacted at the present time. A mandated plan along the Massachusetts model would just be a boondoogle for private insurance. And the God lord knows that those b-stards don't deserve any more money. People should have then option to buy into a the for-profit, or a non-profit system. If people are happy with their private coverage -- and I know some who are -- they should be able to keep it. For those of us, who have no interest in paying for high administrative costs, executive compensation, shareholder dividends, and for lobbyists who actively campaign against the interests of health care consumers and ordinary citizens, there needs to be a real option.

I don't have a great deal of confidence in the current bunch of clowns in the Senate, but I've been letting my Reps in both Houses know where I stand, and I've been encouraging like-minded friends and family to do the same. I hope others do the same. Our private insurance system is a moral disgrace and a major drag on economic growth. We can do better.

Posted by: JPRS | June 8, 2009 9:33 PM | Report abuse

I forgot that on every page of the report on Canadian wait times you will see the sentence

"Emergency cases are treated without delay."

Posted by: lensch | June 8, 2009 9:35 PM | Report abuse

I don't feel any obligation to protect the private health insurance industry from competition. I have had health insurance for 41 years and the cost has gone up, up, and up without any meaningful improvements. We always hear that the private sector is so much more effective and efficient than the government so they should have no problem competing with a public plan. A public plan seems to be our best hope for controlling cost and providing coverage for all. What are we waiting for?

Posted by: cdierd1944 | June 8, 2009 9:42 PM | Report abuse

Bigger Govt. = Job Security for Politicians and Bureaucrats !!!

Smaller Govt. = Job Responsibility for Politicians and Bureaucrats !!!

The math is NOT that complicated !!!

Scariest and most expensive words you will ever hear.........."I'm from the Govt. and I'm here to help you !!!"

BTW: Botox Stretched Stonewall faced San Fran Nan is STILL a "LIAR" !!!

Posted by: thgirbla | June 8, 2009 9:44 PM | Report abuse

This seems more like a way for the government to strong arm the public to a sub par health care system for everyone. I may be in the minority, but I don't feel that the proposed system is better for most people. Instead, it appears to drag down many at the benefit of a few.

I hope my employer is able to offer me my PPO still after Obama starts to tax my benefits. Maybe we can take people who smoke and drink excessively. Afterall, if they are going to be on our system, and they technically add to the risk/cost, make them pay.

Posted by: joe_average | June 8, 2009 9:44 PM | Report abuse

Bigger Govt. = Job Security for Politicians and Bureaucrats !!!

Smaller Govt. = Job Responsibility for Politicians and Bureaucrats !!!

The math is NOT that complicated !!!

Scariest and most expensive words you will ever hear.........."I'm from the Govt. and I'm here to help you !!!"

BTW: Botox Stretched Stonewall faced San Fran Nan is STILL a "LIAR" !!!

Posted by: thgirbla | June 8, 2009 9:45 PM | Report abuse

"For most Americans, however, the central problem was that they could lose their private insurance coverage, and be left with something they didn't like, or nothing at all."
On the contrary, for many if not most Americans whose health coverage is through their employers, the forced annual 'choice' of less coverage for higher premiums is among the many burdens of the multi-payer health system we now have.
A public plan? I'd jump on it!

Posted by: elmvwm | June 8, 2009 9:53 PM | Report abuse

My additional suggestion would be Kaiser for all: an integrated system with doctors on salary and all services provided in house. It's a highly efficient nonprofit system with tremendous muscle in the markets. For example, drug company representatives aren't allowed on Kaiser property to promote their wares. A committee decides on the formulary. Combine this with subsidies for medical school and suddenly doctors aren't paid on a piecework system, one of the major inefficiencies/bad incentives in the current system

I would be fine with additional coverage for, say, psychotherapy and other mental health services that are difficult to integrate.

Posted by: LisaHirsch1 | June 9, 2009 11:36 AM | Report abuse

We currently have at least FOUR publicly managed and funded plans (1), and at least three federal programs to manage private insurance(2).

(1)MEDICAID, MEDICARE, the VA, and S-CHIP
(2)Health plans for Federal employees; active duty military and their families; and MediCare private options.

I'd like to see a plan that opens all of these options up to all interested Americans, and all interested employers. Private companies can compete as well if they think they can provide a better value, but I think most will work harder to get accepted as providers under the plans listed in (2).

One other inequity I'd like to see addressed is "Family Plans" should be abolished. Rates should be based purely for individuals. This will likely mean higher premiums for families with a large number of children, but that is not a cost that should be paid by the taxpayers. Parents need to accept the consequences of expanding their families. The one exception I'd make is for adopted children who should be subsidized to some extent until they reach age 18 - as a I realize a lot of current adoptions would not be happening now were it not for the parents knowing that they already have "family" coverage that won't be increased when the size of their family size increases.

Posted by: cbury | June 9, 2009 11:54 AM | Report abuse

Ezra, the fact that the point of contention is the *existence* of a public *option* shows that the conservatives have already won.

Had single-payer not been shut out by Baucus n Co., this would be a very different conversation.

Posted by: DemosthenesofPaeania | June 9, 2009 12:03 PM | Report abuse

i dont want a kaiser plan for myself.
i pay a fortune for my medical plan, but i choose it over kaiser.
......with my medical decisions, i want a lot more autonomy than what kaiser gives.
i want to hold on to the plan that i have., and i am trying my darndest to do that.
i am very thankful and happy with my medical plan, i just wish that it wouldnt cost me so much.

Posted by: jkaren | June 9, 2009 12:40 PM | Report abuse

A "trigger" option is no option at all. Currently Medicaid could be considered a trigger plan, since it's implimented state-by-state. I have a family member on Medicaid, and when she travels she has virtually no health coverage at all. A hospital will take her in an emergency, but she can't get in to see a doctor or get prescriptions filled outside of her home state. She ended up in the hospital a second time, I think, because she could not get the medication needed to recover from a previous stay.

We need single-payer health care in this country, but if that's too much of a challenge for some then we MUST have a strong public option. One that is portable, for when people want to travel.

Posted by: BAC104 | June 9, 2009 1:30 PM | Report abuse

There are two major, often overlooked, cost-saving components with Single Payer:

1. Providers do not require large staff, and the office space and equipment entailed, to deal with insurance companies, allowing huge savings. Two examples:

a. My wife sprained her ankle in Canada, on a weekend, so we went to the ER. No forms to fill out, no insurance card required, as we were not Canadians. The sole receptionist said cost was $110, and gave us a receipt to submit to our insurance company. Service, after a short wait, included xrays, exam by MD, treatment & crutches.

A year later she sprained the same ankle. This time, again on a weekend, we went to the ER in Renton, WA. Filled out several pages of forms, submitted insurance card, waited far longer than in Canada, received same treatment. Reception area was staffed with many people, presumably to deal with all the paperwork/insurance issues. When bill arrived, it had many lines of codes for services, totaling $540. Our 20% co-pay was about equal to the entire bill in Canada.

b. My wife went to a doctor in Paris, France for possible flu, again on a weekend. His office had no receptionist, no bookkeeper, no nurse - just the doctor. The patients themselves kept track of who was to be seen next. After exam and writing prescriptions, doctor filled out simple bill and asked for 40 Euros (~$60).

2. Employers in countries with Single Payer do not need to have a large employee-benefits department to deal with healthcare. Small businesses do not need to worry about the expense of providing health insurance to attract good employees.

These two issues account for a significant reduction in overall medical costs, yet are seldom mentioned in the debate.

Posted by: wapowa | June 9, 2009 1:46 PM | Report abuse

Congress is debating on whether to add taxes our employer-based health benefits, as well as place mandates on individuals & small businesses to purchase insurance coverage with the new health care bill. Some saboteurs in Congress also want to delay implementing reform. First of all, Single-payer HR 676 should be included in hearings to debate the merits of this plan particularly since majority of Americans want it. No other developed country has left investor-owned, for-profit companies at the core of their basic health care systems and made it work. The only way to achieve cost containment, guarantee access for all & regain true doctor-patient autonomy is by implementing a Single-payer Universal health care system such as HR 676. Historically, insurance companies have not played well with consumers so why we'd think they will now escapes me! Definition of insanity is to keep doing the same things over again & again and expect a different result. Why would we want to create new markets instead of actually solving the problems? This is not change. If anyone is not familiar with the different health care deployment models, google the PBS Frontline documentary: "Sick Around the World". This documentary explains alot!

Posted by: WahsUpDoc | June 9, 2009 1:47 PM | Report abuse

Our daughter was just diagnosed with cervical cancer. She's a hair stylist for a salon that provides limited health insurance. Just because she has insurance does not mean it's affordable.

Her premiums are $182/month, with a $1500 deductible, just for herself. After the deductible is met, she still pays 30-50% of medical charges for in/out of network, with a maximum out-of-pocket of $8500.

So, even with insurance, she faces medical expenses of over $10k on an annual gross income of $24k. How many people could afford that? $24k is far too high an income to even qualify for Medicaid, which itself is being rationed in our state.

Our daughter had hopes of moving to a salon where she could lease a station and be her own boss. That dream is now impossible, as no company would ever sell her medical insurance at any price.

If we had National Single Payer, our daughter would not have to worry about the crushing expenses she faces, and could fulfill her dream of earning a good living in a profession she loves.

Posted by: wapowa | June 9, 2009 2:08 PM | Report abuse

60% of our health care dollars are subsidized by our gov't now including the employer-based benefits. Americans pay roughly $3 per person and not all of its citizens are covered (America has approximately 46 million uninsured; another large sector of its population lands in bankruptcy & financial ruin because they're underinsured!) France pays $2 per person and EVERYBODY covered!! If you remove the for-profit middle-men from the bureacracy, that's 31 cents on every dollar that can actually be applied toward health care; enough to cover all Americans currently without coverage.

Posted by: WahsUpDoc | June 9, 2009 2:15 PM | Report abuse

Kaiser Family Foundation. One of the most prestigious liberal inside the beltway think tanks on health reform policy. Saul Friedman is a reporter for Newsday. In February, Friedman wrote an article for Newsday arguing that single payer is suffering from a conspiracy of silence. And he says Kaiser is the most culpable of the co-conpsirators. Kaiser, funded initially by insurance industry money, regularly keeps single payer off the table, Friedman says. When single payer advocates released a study in January asserting that Congressman John Conyers' single payer bill (HR 676) could create 2.6 million new jobs and would cost far less than the private insurance currently paid for by individuals and employers, "the Kaiser Family Foundation's daily online report on health care developments at kff.org didn't mention it," Friedman reported. "Nor has Kaiser, the most comprehensive online source of health care information, made any mention of single-payer or the Conyers bill since it was introduced in 2003, despite widespread support for such a plan according to Kaiser's own polls." After a number of insistent inquiries, Kaiser told Friedman that they would publish charts in March comparing the Stark and Conyers bills. They never did.

Posted by: WahsUpDoc | June 9, 2009 2:20 PM | Report abuse

I can see why Canadians like their health care system. It's actually several systems, as each province has its own plan.

My mother, who lived in Montréal, had Parkinson's disease. The public plan kept her in her home, with a live-in aide, and weekly nurse visits. When she deteriorated to where that was no longer feasible, she was moved to a private room in a very nice nursing home where she eventually succumbed. She was treated with the respect that all human beings deserve.

For this first class treatment, she only had to give up her pension, less a small allowance. She was not forced to sell the family home, where my brother still lives with his family.

By contrast, my adopted mother had Alzheimer's. My father took care of her at home until that became impossible. We moved her to an Adult Family Home which provided 24 hour care. My parents' HMO provided nurse visits as necessary.

The expense for this was $5500/month which is near the lower end. After using mom's $2500 Social Security, dad still had to pay $3k out of his own pocket for two years until her death. She could have lasted much longer if she had not contracted an infection.

The AFH owner rarely took Medicaid customers, as they only paid $2500/month total. She only took them if they were fairly self-sufficient, not requiring staff for mobility, personal care, feeding, etc.

Canadians only pay 10.6% of GDP for health care, yet none of my numerous Canadian relatives ever complain about their medical care. My ob/gyn uncle raised his family in a very comfortable lifestyle - they certainly weren't suffering.

Meanwhile, as we Americans spend 17% of our GDP, I see horror stories like my daughter's, or worse. Why do the insurance companies run our country? That's the only reason I can see for Single Payer not being 'On the table'.

Posted by: wapowa | June 9, 2009 2:41 PM | Report abuse

Why are politicians always on the receiving end?

This is not a pretty sight. In 2008 members of congress received $46 million from the insurance industry and $400 million from the complete health care complex. You might ask, Why would this money be given if it didn’t buy or block policy? Aren’t these patient dollars to begin with?

The last thing in the world the insurers want is a good public system competing with a good private system. Neither do the politicians. The private system cannot come close on price because of excessive costs not seen in the public plan. Like broker commissions, high CEO salaries, high shareholder profits, marketing and actuarial costs, and even their lobbying and campaign contributions that must be passed on to the patient.

The privates want to do away with the public option and so do the politicians. Not just because of the $46 million in bribes that they’ve already received from the industry, but because going forward private entities can continue loading up their campaign coffers, and public entities like Medicare cannot give political cash.

Politicians will always prefer private over public for this reason. And this is why they prefer mandates to buy “private” insurance, even if some is taxpayer subsidized. But "mandates" are just more of the same waste we've been trying to get rid of.

Why else would they block more efficient health care? In this case the politicians get a share of the private system but zero from the public system. They even get a piece of the taxpayer-subsidized dollars, and they get some patient dollars as a sweetener.

Aren’t politicians great?

And of course even if we win this the insurers will continue bribing the politicians to weaken whatever efficiencies we achieve, just as they are doing in Canada to destroy their system. A weak system gives both parties another shot at the prize, and that’s also why they seek to preserve the right to make campaign bribes.

As long as we keep playing with the words we give them wiggle room. Public option or not, single payer or not, mandated insurance or not… they can keep dancing around the real issue. Money. They are getting paid campaign bribes to cannibalize the system to the benefit of the insurers and to the detriment of the public.

We MUST start calling this what it is… political corruption. It may be an “issue,” but its one that generates loads of campaign cash.

Until we achieve full public funding of campaigns, it is what it is. Live with it, or change it.

Jack Lohman
http://MoneyedPoliticians.net

Posted by: jlohman | June 10, 2009 8:16 AM | Report abuse

THANKS FOR THE LAUGHS, COMMIE-CRATS

The Commonwealth Fund as a data-source?

Their whole purpose is the COMMIE-CRAT raise-taxes health care plan.

To use them as a data source is as ridiculous as using Madonna as a moral compass for abstinence.

Posted by: russpoter | June 10, 2009 5:11 PM | Report abuse

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