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The Case for the Public Option -- Again

A friend wrote recently taking issue with my Oct. 1 column, which argued that centrists should support the public option. “I would have more respect for your telling [us] centrists that we are being irrational if you would engage our argument, instead of taking an inflammatory Grassley quote and pretending that represents the sum of rational opposition,” this friend wrote. “Medicare is not predatory because it has no one to compete with, but it does underpay, forcing the rest of us to make up the difference. If a state-owned insurance company behaves in the same way, it is easy to imagine private firms being driven out of the market. And if it does not underprice (as the House bill requires it to do), then what will be its advantage?”

Fair enough. Just to refresh readers’ memories, here’s the quotation from Sen. Chuck Grassley that offended me. "The government is not a fair competitor," Grassley said. "It's a predator." Of course, I do not think that the “inflammatory Grassley quote” represents “the sum of rational opposition.” (It’s why I put the word “argument” in quotation marks when I referred to Grassley’s comment in my original column.) I cited it because I think that too many sweeping and inflammatory anti-government arguments are going uncontested and wanted to devote a modest portion of that column to saying so. Part of the opposition to the public option (if not my friend’s) does arise from Grassley’s sort of thinking, and I think it is important for progressives to remind everyone that government has often expanded human freedom -- particularly, as the case of Medicare itself shows, in the area of health care.

My claim is not that health reform would be worthless without the public option. We can make progress without it. But the longer this debate has gone on, the more I have come to believe the public option would make a health bill significantly better. Do other countries provide universal coverage without a public option? Yes, the Netherlands being a good example. But Jonathan Cohn, The New Republic’s indispensable health writer -- The Post's Ezra Klein is indispensable, too -- made the essential point in a post on Sept. 29:

[T]here’s a catch. A big catch. Private insurance in the Netherlands works because it operates more or less like a public utility. The Dutch government regulates industry practices tightly--more tightly than the reforms now moving through Congress propose to do in the United States. The public insurance option was supposed to make up for that deficiency, at least in part, by setting a standard for service and affordability that the private industry would have to meet -- and by offering a fail-safe option in case the private plans simply couldn’t keep up. If Congress ends up gutting the public plan, in part or in whole, then it needs to work even harder on making private insurance work. And it’s an open question whether that will happen.

Indeed, not only are the regulations proposed in the congressional bills weaker than those in Holland; they will also be very hard to enforce, as David Hilzenrath reported in an important story in Sunday’s Post. The public option is a useful safety net for people who may run into trouble in the private market.

My critical friend also wrote: “Maybe you are just persuaded that the government can run an insurance company more efficiently than Aetna.” As a matter of fact, when it comes to insuring the now hard-to-insure, I do trust the government more than I trust Aetna. And I do not think insurance company bureaucracies are any model of efficiency -- unless one believes that they slow up and complicate reimbursements on purpose. (Several doctors on my health plan -- until recently a good one -- have had a difficult time getting routine reimbursements of late, a not atypical story.) There are costs to running a private insurance company that do not apply to the government.

Opponents of a public plan who see an effective insurance exchange as sufficient might also consult an op-ed in today’s New York Times by Cappy McGarr, who served as chairman of the Texas Insurance Purchasing Alliance. After discussing the failure of the Texas exchange, McGarr concluded:

It would be smarter for Congress to revisit the idea of creating a public plan that could provide an attractive choice for consumers and real competition for private insurers, to give them the incentive to offer good coverage at affordable prices.
But without a public plan, tough rules and restrictions on insurance companies will be essential. Otherwise, Americans will never be able to count on good, affordable health care.

On public-sector savings: My friend is right that the public option produces more savings with Medicare rates. Even though I think a plan with such rates is worth trying, I acknowledge they raise some problems -- and, in any event, if we get a public option, it will be more like New York Democrat Sen. Charles Schumer’s compromise version than like West Virginia Democrat Sen. Jay Rockefeller’s proposal with tougher cost controls. Nonetheless, the public option is likely to hold down costs to consumers by providing another form of competition, especially in states that lack it. And even a constrained public option could use its bargaining power to put at least some downward pressure on government costs. In cooperation with Medicare, it could be innovative in how it structures reimbursement. Those who say a public option is unnecessary argue that the Medicare prescription drug experience, involving competition among private plans, turned out reasonably well. But the market for health insurance is much more complicated than the market for drug coverage. I am not as confident as some are that the Medicare drug experience is dispositive evidence for how competition will work in the larger health insurance market.

In sum: The whole reason I cast the public option as “centrist” is because I believe it is a modest form of government intervention in the marketplace that could: 1. provide a safe haven for those who run into obstacles in the private insurance market; 2. give government an alternative (or a supplement) to regulation in making sure that private insurance companies live up to their promises; 3. foster competition where it doesn’t exist; 4. give government at least some additional bargaining power to hold down public costs.

A final bill without the public option could still be worth passing. But I’d rather keep fighting for a public option while it’s still a possibility than to give up on it altogether. If health-care reform passes, many citizens will judge it by whether it provides them with new opportunities to get better coverage. They understand that this is precisely what the public option does. That’s why the polls show such broad support for it.

Update, 5:00 p.m.: Speaking of Ezra Klein, he put up a good post on the Dutch system this afternoon.

By E.J. Dionne  | October 6, 2009; 9:49 AM ET
Categories:  Dionne  | Tags:  E.J. Dionne  
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The government is an unfair competitor: thats why the healthcare reform bill is over 2000 pages and includes all sorts of taxes and mandates. No company can write rules that require participation and mandate receipts regardless of service or value (taxes). To maintain otherwise is disingenuous.

Posted by: bruce18 | October 6, 2009 10:37 AM | Report abuse

A public option is essential for people who are presently "uninsurable". I am an insurance agent, and due to pre-existing conditions, I am uninsurable. Actually, that is a bit misleading. For $1800.00 per month, my wife and I can get coverage, but it excludes what is wrong with us, so it is pretty useless.

Posted by: COLEBRACKETT | October 6, 2009 10:51 AM | Report abuse

Who says that Medicare underpays? By what standard? If healthcare providers lose money by taking Medicare patients, it's only by comparison to what they would make from private insurance companies -- that provide no incentive to control the cost of service. Would a public option be "predatory"? You bet! That's the idea: to run the private insurance companies out of business unless they can cut their premiums -- which everyone agrees are too high. So EJ is right that the only viable option is to regulate private insurance at the NATIONAL level like a public utility. Or try a "natural experiment." The "experiment" would be to make a public option (Medicare)available only to people 50-65. Then wait 5 years and see how we like the results. Why hasn't anyone thought of THAT?

Posted by: forrest1 | October 6, 2009 11:02 AM | Report abuse

Some things won't change unless the government steps in. Unfortunately our government is actually in cohouts with private companies so much so that public decency, humanity and respect are too easily sacrificed for a dollar. Personally I don't see why medicare, which already operates like a basic kaiser Permanente health plan, can't be renamed and expanded to cover everyone and the tax we already pay for it be increased incrementally based on income so that the elderly and extreme poor aren't raked over. The state and feds should not be double taxing us for health care. Medicaid and medicare benefits need to be combined somehow since th ebiggest benefit of medicaid is long term care assistance. The drug companies and private insurers need to be better regulated and streamlined anyway in order to eliminate unnecessary waste and treatment protocols. Single payer systems work in other countries because the people see a value in preserving human dignity. Co-ops and these seperate public options will never work here because the government insists on maintaining the status quo to cater to big business and greed. At some point the American public needs to stop being selfish and the government needs to just crunch numbers and stop just throwing mess on top of mess in order to create a confusion just so they don't have to do anything at all.

Posted by: lidiworks1 | October 6, 2009 11:05 AM | Report abuse

I wonder if Holland's constitution gives their Government the authority to participate in healthcare and health insurance?

The U.S. Constitution pretty clearly does not give the Federal Government the authority to do so.

Why no discussion about amending the Constitution to give the Federal Government the authority to do this?

Posted by: MDLaxer | October 6, 2009 11:08 AM | Report abuse

Much appreciate both of your columns, Mr. Dionne. They're smart, informed and informative, and well written.

The public option is essential... it does amaze me that those who believe in the "market" oppose another player competing. Plus, the record on health care of the free enterprise system here is dismal... we need deep government involvement, regulating, and providing health insurance.

My concern is that we're ending with hodge-podge legislation, including punitive mandates on individuals, not completely universal coverage, and odd labyrinths of coverage.

We'd be better off just going to single payer. It's the moral, just, and humane thing to do. And if it puts the health insurance companies out of business... so what? They don't deserve to continue, with their price-gouging, non-coverage, excessive profits, harmful policies, etc.! They shouldn't even be allowed to be players any more!

Posted by: Astrogal | October 6, 2009 11:32 AM | Report abuse

The argument that the government public option plan would be unfair competition carries no weight in our society. Monsanto controls 90% of the soybean agriculture in this country and if a farmer plants his own seed and the wind blows the pollen from his field to a neighboring Monsanto field, he gets sued by Monsanto. 80% of the sub prime loans that led to the collapse of our economy one year ago in September 2008 were created and caused by Country Wide Loans, Wall Street (including Goldman Sachs) and their associates. A total capitalistic scam, no matter how you look at it, that includes the worthless “financial weapons of mass destruction” derivatives, and the 1.3+ trillion dollar AIG loss that was dumped on the taxpayer by Wall Street (who took this socialized loss money to pay their CEO’s and pay off Congress). The Health Care Industry charges somewhere between 20 and 30% for their services to insure that they make at least a 15% profit and can afford the %1.6 million/day they're paying their lobbyists and Congress. The "health care" that they provide is nothing but a PR front to justify their profit above all else business plan. In my state, 30 to 40 % of all claims are denied; health care for those who need it is not good for the bottom line so that the consumer either can't get it or they get pushed out of the insurance they think they have. And the health insurance cost increases have no apparent limit. I trust Medicare--it's fair, and it delivers what it advertises to the unhealthiest part of our population. The Wall Street and the Privatized Health Care Industries are fair? They’ll do anything and everything that they can get away with to come out on top—fairness has nothing to do with their operational code of ethics.

Posted by: dtgo | October 6, 2009 11:40 AM | Report abuse

if the repubs want to keep government out of healthcare -ok. let's end medicare, medicaid, the V.A. and coverage for all federal employees who are registered rebulicans. let's not wait - let's do it TODAY!

Posted by: boblesch | October 6, 2009 12:00 PM | Report abuse

A minor point: the Dutch system is actually a step back from the single-payer plan that was in effect until 2003 when a conservative political party made the substituion of private insurance for the existing Medicare style system a condition for their support for a center-right governing coalition. Although it is still early days, a recent study by Duke health specialists concluded that none of the promises made (restraining health costs, improving outcomes, etc.) have occurred. In fact, health costs have climbed faster under the new privatized insurance plan than under the bad old government run reimbursement system.

The Dutch system may be better than our current Godawful system, but it is no magic bullet. And given the power of the insurance/health industry lobbyists, I can't imagine that this country would ever regulate the private insurance system as tightly and effectively as the Netherlands has done.

Posted by: SmokyMountainCarpenter | October 6, 2009 12:00 PM | Report abuse

Well in order to make your proposal work you will need complete government control of all aspects of medical care.

The government will need to take over the hospitals, fire and rehire at a smaller rate the nurses, fire and rehire all of the doctors at less money, and prohibit them from engaging in private business, pay off their student loans since they won't be making enough to pay them off and live, take over all of the drug companies so that the government can get the drugs to treat the patients.

Well I am sure there is more to do but then unlike Obama I am not a minor unimportant god, so I really haven't thought beyond those restrictions I can see.

Go ahead, have at it, I am sure the government can own and run the health care system for a lot less money, look at Cuba, they do a great job, if you like living like a Cuban, no money, no jobs, no future, sort of like being a democrat here.

Obama Nation is what we are.

Posted by: kl305 | October 6, 2009 12:08 PM | Report abuse

a better idea - expand medicare to cover ALL CITIZENS who wish to enroll - and bill us all based on our ability to pay - say - a flat percentage of adjusted gross income.

make the new medicare a non-profit with publically posted salaries.

to fill the new jobs - hire the displaced insurance company ex-employees.

it will put an end to the highly disfunctional and wasteful medicade system, end greed in the current insurance system and give everyone the same coverage. - why - because we are all human beings who deserve equal treatment.

Posted by: boblesch | October 6, 2009 12:13 PM | Report abuse

Do I want government bureaucrats deciding on my health care? You bet I do! Because the other choice is to have corporate bureaucrats deciding on my health care. I have some control over the government bureaucrats: I can vote out their bosses who tell them what to do. I have no control over the corporate bureaucrats. They can do what they please, and pay off politicians to stay out of the way.

Government bureaucrats will charge a few percent for the administrative work they would do, which is like what they do for Social Security and Medicare. Corporate bureaucrats now charge 30% to pay their CEOs hundreds of millions of dollars and billions to their investors.

"Health care" companies do not do health care. They simply collect premiums from us, get the bills from doctors and hospitals, decide how much they are going to pay, and pay it. They are just pass-throughs. And they skim that 30% right off the top while doing it. Of course they are going to fight tooth-and-nail against a government-run health plan: It would make them irrelevant and put them out of business. And of course they don't want to give up that cushy gravy train.

In all the talk-show bickering, these simple facts above are being obscured. The health care companies don't care about us. Like all corporations, they are in it to make money. And what an easy way to do it. Why should their ease and comfort be at our expense? Get rid of these corporate bureaucrats and let health care be run by people we have control over - our elected officials

Posted by: shadowmagician | October 6, 2009 12:18 PM | Report abuse

The column continued to express opinion rather than to provide facts which are strangely lacking in the whole debate.

I hear about obscene profits of insurance companies. I recently read that they were about 3% as opposed to much higher profits for other segments of the health care industry. While top executives may be making "too much" most other costs are similar to government costs.

If the public option is not heavily subsidized, where is the saving? I am not persuaded that government can do the job more efficiently. For starters, you can't be fired from government simply because you are incompetent. You can from a private company.

There is plenty of evidence that government bureaucrats are as ready to deny care in Medicare as the insurance companies. From government there is no effective redress. Insurance companies are more ready to reconsider. That is, the appeal process is simpler and decisions are changed.

Another question. What proportion of your income is appropriate to spend on health care? Bills in Congress suggest something on the order of 20%. Too high? Too low?

Posted by: tpmphil | October 6, 2009 12:19 PM | Report abuse

Health care in the US costs $6000 per person which is more than twice that of any other nation, including those with nationalized health care. Yet, we rank 37th in quality. so we pay more and get less in return, while insurance companies earn record profits. If a public option forces those folks out of business and we therefore get better health care for less money (as other industrialized nations do), will we really shed a tear for those companies? Why is it a bad thing to force private insurers to charge a fair price or go out of business?

Posted by: adifferentpointofview | October 6, 2009 12:36 PM | Report abuse

boblesch, you are right but the programs you mention won't be cut. The people doing the complaining want programs cut for poor people who have no one to speak for them, not for themselves. I've worked in government for 18 years now, and the first thing my boss said to me was "people always complain about government spending, except when it concerns programs they get."

Posted by: realadult | October 6, 2009 12:43 PM | Report abuse

Providing health care efficiently saves lives and saves money.

Nobody can collect the money to pay for health care as cheaply as the government can through a national sales tax, and nobody can deliver high quality care and medications as cost effectively as the VA.

Everyone shopping in the United States would pay pennies on the dollar supporting public health care, citizens, immigrants, 40 million visiting tourists annually, the rich, poor, everybody contributes, this would be the ultimate risk spreading pool.

Paying for public health care using sales tax revenues would be billions of dollars cheaper each year than using private insurance and it would be a prudent cost effective way to spread risks while paying for health care as it is used instead of increasing the national debt.

America’s Veteran Administration is the largest, lowest cost; best outcome producing at any cost, health care delivery system in the US, it uses the world’s best medical software, and it has been controlling the problems with access, cost, quality, and malpractice successfully for years.

All government funded costs could be reduced drastically, while producing better patient outcomes, if distributed only through civilian government hospitals using the proven VA systems.

This solves the Medicare, Medicaid and all other government funded quality and cost control problems that no one will talk about, while giving seniors free care and medications, which would be an infinitely better deal than we have today.

Everyone choosing public care could have it no restrictions, no insurance, no co pays, free period.

Employers who select public care for their employees would not be required to pay for or have any further involvement with health care.

A National Health Care System could also take over states and local government’s health care systems to assure operating standards and relieve local funding problems while providing total transferability for patients.

Making high quality health care easily available for consumers and employers while saving taxpayers hundreds of billions of dollars annually is easy for everyone to understand, and the CBO to demonstrate, if the President, legislators and the media will allow people to hear the facts.

Let’s compare this common sense dual system that would allow unlimited choices, ultimate freedom, and always free public care would be available, to the reforms being proposed by Mr. Baucus’s legislation, or anything else being proposed by anyone from the President on down.

Then let’s use simple straight forward legislation to make these changes happen that will give us high quality fiscally responsible health care reform.

Posted by: BillWatson1 | October 6, 2009 12:44 PM | Report abuse

Public Option....Well if we use Medicare as the model here is a fact from CBO
The Medicare Report shows that the HI Trust Fund could be brought into actuarial balance over the next 75 years by changes equivalent to an immediate 134 percent increase in the payroll tax (from a rate of 2.9 percent to 6.78 percent), or an immediate 53 percent reduction in program outlays, or some combination of the two. Larger changes would be required to make the program solvent beyond the 75-year horizon."

Healthcare company profits range between 5-6% of revenue. The total profits of all healthcare companies is less than 1% of the total healthcare costs. Do you really think a Public option will significantly bring down costs?

Posted by: rhino2 | October 6, 2009 12:52 PM | Report abuse

A majority of Americans support a public
option. As such, why are those holding
elected office in the House and
Senate NOT supporting what their constituents want?

They are obviously in the pockets of the
insurance industry, and not working for
their constituents.

Therefore, kick them out of office and
replace them with those who will do the
job they are elected to do.

Posted by: Sirius2 | October 6, 2009 1:27 PM | Report abuse

The government is by the people, for the people.
The insurance company is by the investors, for the investors.

Which one will you trust with your health?

Posted by: CarterSTC | October 6, 2009 2:16 PM | Report abuse

Your friend is a bit blinkered. Health care expenditures in the US this year are about $6,800 per person per year including the uninsured. Most everyone else operates systems better than ours for under $3,000 per person per year. That's the problem. Cost "shifting" is a diversion. The issue is the cost. Our for profit system is irretrievably broken and we don't want to fix ity so we go along until it fails becasue we can't pay the bills any more which won't be that much longer by the way.

Posted by: jhadv | October 6, 2009 2:29 PM | Report abuse

With so much emphasis on the Public Option I was certain the plan had to be in text format somewhere, but I could not find it. So, I sent an email to my Senator asking for a link to the text so I could review it.

There is NOTHING. The public option is still in the "evaluation phase." My Senator wrote, "As both the House and Senate work to achieve health reform, the public option proposal has taken several different forms, including insurance cooperative for consumers."

Until we know WHAT the Public Option is, how are we supposed to know how it works; it if can be effective along side other insurance policies, and if there really will be a cost savings for Americans?

How can we even evaluate the worth of a plan that doesn’t exist?

Posted by: asmith1 | October 6, 2009 2:31 PM | Report abuse

Health care in the US costs $6000 per person which is more than twice that of any other nation, including those with nationalized health care....... Posted by: adifferentpointofview


Of course we do; we're the only nation in the industrialized world that provides free health care to millions of illegal aliens and their illegitimate jackpot anchor babies.

Nearly all other industrialized nations with government involved health care have reversed birthright citizenship and deny illegal aliens access to all tax funded benefits because they knew the abuse and fraud would bankrupt the system. Such a pity the US hasn’t figured that one out yet.

The US government offers better pre-natal, delivery, and post natal care to illegal aliens than it does it’s own citizens. That’s something you will NOT see in any other industrialized nation – which is an excellent example why health care in the US costs $6,000 per US CITIZEN PERSON, which is twice that of any other nation.

Posted by: asmith1 | October 6, 2009 2:42 PM | Report abuse

Just because their needs to be reform,doesn't mean Obama and the Dem's should use 'another crises'to bring in more orwellian government control into American lives.wake up people.

Posted by: votingrevolution | October 6, 2009 2:57 PM | Report abuse

The public option is the only option and every single senator or congressman who argues otherwise, like Baucus, has been paid off. Pure and simple. The free market has had its day when it comes to health care and, like Wall Street, it failed miserably unless you're one of the relative few in the industry making money hand over fist off the suffering of others. So let the senators and congressmen haggle all they want. One thing, though, is certain: Those who vote against the public option won't be coming back to Washington for a return visit. We're going to dump every one of those bums and turncoats from both parties.

Posted by: Byrd3 | October 6, 2009 3:08 PM | Report abuse

Your friend is right, of course. For tactical reasons.

Pushing for a public option now is just pointless and will just kill the whole reform effort. The country is stacked against the "public option." Maybe without justification, but that's the way life goes sometimes.

Pass what you can now, and come back later, for cryin' out loud.

What a bunch of babies the liberals are. If you dont give them EVERYTHING they want, they just start cryin' like a bunch of schoolgirls.

Posted by: trenda | October 6, 2009 4:05 PM | Report abuse

Much of the continued opposition to health care reform comes from the insurance industry and it has nothing to do with the public option. Indeed, without the public option, ending pre-existing condition and loss prevention practices will increase health insurance prices for everyone. There is another way to do this, although it involves compromise. Here is what I propose:

- Drop restrictions on pre-existing condition and loss prevention clauses

- Drop individual mandates

- Adopt a Public Option restricted to people dropped from coverage and families with a member excluded for a pre-existing condition, with automatic enrollment in the public plan upon such a dropping or denial with the insurer contributing 70% of the premium to the government as a consequence and annual automatic reapplication and continued insurance company funding until the individual or family is covered.

The alternative to this, if pre-existing condition and loss prevention clauses are prohibited, is further consolidation, greater regulation (including eventual price regulation) and eventual enactment of single payer insurance with health insurance company administration.

Posted by: michaelbindner | October 6, 2009 4:24 PM | Report abuse

Oh, I hope government is an unfair competitor, since otherwise the game is rigged the other way.

Posted by: michaelbindner | October 6, 2009 4:30 PM | Report abuse

Once again Obama has lied. He has stated that Arnold Swartzenager supports his health care plan, when he has publicly stated that he doesn't.

Posted by: mike85 | October 6, 2009 4:32 PM | Report abuse

The public option is the only option and every single senator or congressman who argues otherwise, like Baucus, has been paid off........

How can anyone be "paid off" for not supporting an option that is little more than brain stroming?

There is NO public option, it is a series of every changing proposals that no one in Congress can agree on - even within a party.

I wish someone - anyone - would post a link to the bill/amendment that is known as the Public Option - even if it is only in draft format.

Posted by: asmith1 | October 6, 2009 4:56 PM | Report abuse

Canada learned the hard way that in to expedite health care reform, you have to privatize it.

Switzerland learned that when the central government set some umbrella guidelines, i.e. non-profit organizations; then leave the health insurance market compete you have the best of all possible worlds.

And in the U.S. we learned the hard way that you can't reform public schools; just replace them with Charters and voucher like subsidies; forcing them to compete with private schools.

We also know that once a bureaucracy gets set up, it takes nukes to get rid of the damn thing no matter how badly it performs or redundant it has become!

Posted by: Common_Cents1 | October 6, 2009 5:29 PM | Report abuse

Public option is an absolute must. All of the lies and scare tactics have been exposed. The Republican supporters of public option have more to say for themselves than lowlifes like Max Baucus and the blue-dog Democrats. There is no excuse for losing a vital reform due to the tantrums of small numbers of hysterical psychos. Rev. Bookburn - Radio Volta

Posted by: revbookburn | October 6, 2009 5:57 PM | Report abuse

CarterSTC said:
"The government is by the people, for the people.
The insurance company is by the investors, for the investors.

Which one will you trust with your health?"

Unfortunately, neither is to be trusted. But in a pinch, I would be better off trusting market forces. At least the Government provides some watchdog service over private industry (when push comes to shove, anyway). If the Government takes over Health Care, there is no watchdog.

Those who trust Government are either naive or have nothing to lose.

Posted by: primegrop | October 6, 2009 6:16 PM | Report abuse

Why are there so many self hating Jews in the senate and big city mayors who try to ignore history??? Feinstein , Boxer ,Schmuer, Bloomberg etc,

October 6, 2009

Marek Edelman dies at age 90

( The last surviving member of the
famed Warsaw Ghetto Uprising of 1943 in Nazi-occupied Poland died last Friday.

Living testament to the necessity and sanctity of self-defense, Mr.
Edelman was part of the original group of resistance leaders in Warsaw who
decided to stand up for their land and people, and fight back with all they had.

Their battle began with the Germans' forced deportation of Warsaw.
Edelman labored with several hundred other freedom fighters to put a stop to the
deportation, and to protect those who remained in the Warsaw Ghetto.

Often fighting with nothing but handguns, revolvers and homemade
explosives, the Jewish Polish resistance remains one of the best and most moving
examples in history of the precious right of self-defense.

_Click here to visit Luke's blog, read the article, and join your fellow
gun right supporters in discussing the significance of this man's life_
F51DF16851ACC048F2BCE1F83415F7C) .

Posted by: Tiegerplumbing | October 6, 2009 6:41 PM | Report abuse

The idea that there is some sort of strict dictomy between the public + private sectors in the United States is a pernicious lie and Grassly should be commended for his honesty.

Private individuals and organizations invoke public resources and interests to acheive their selfish ends every day. The absence of this support inevitably denotes failure in the "free" market: Woe betide the private corporation without lobbying acumen.

There is no free market; there is no public sphere. They are just highly imperfect models that - ironically - our Constitution and tradition of governance largely render irrelevant, despite the sideshow of ideological arguments about their proper roles.

Our founders felt that the proper role of the people was to be governed, and that the proper role of the powerful was to govern. Whether this relationship was expressed through private corporations or public institutions was immaterial to them, interchangeble parts being so much the better to confound the little people.

The same elite run both, via a revolving door between them.

And one can easily invert their roles. The US is a corporation that distributes its returns - accumulated via taxes on the people - to wealthy shareholders represented by its Congressional board + presidential CEO; private corporations are the government, where rights of free speech and association - among others - are routinely trampled under foot to control employees who pay the taxes driving corporate profit.

A circular flow model, though perhaps not what economists have in mind.

At any rate, the public option may disrupt this cozy arrangement, because it could be a public institution with public ends - like Medicare. Such an aberration is rarely countenanced by the powerful in America, and is predatory from their view point: It could upset the game - predators do not survive without prey.

Posted by: joe_stumpo | October 6, 2009 6:46 PM | Report abuse

TO: bruce18 who wrote:
“The government is an unfair competitor…”

Perhaps, but that is why we need it, because insurance companies aer unfair competitors as well.

People don’t understand that, say for instance your salary goes up 5% per year, but the insurance premiums go up 8% per year. That makes it nearly impossible for you to get a raise, because insurance companies beat you to it.

So, if you’re a consumer, even if you don’t chose the Pubic Option, it will still affect how insurance companies do business, and it will force the insurance companies to reduce their premiums and deal with their insured more fairly.

Posted by: lindalovejones | October 6, 2009 6:59 PM | Report abuse

forrest1 ~ one more time ~ most health care in this country is vended by nonprofit or government owned or operated facilities and organizations.

The "nonprofit" groups and facilities are also referred to as "nonstock" corporations, or by such terms as "public charitable trust", or "foundation", and so forth.

Virtually all the hospitals in the country are the property of counties and cities, universities, foundations, and churches.

The program being put forth by the federales will destroy the nonprofit sector of the medical industry leaving only Big Pharma and a handful of highly regulated stockholder owned firms in charge of the financial end of the business.

And you people call yourselves Democrats?

Look at what's going on ~ the talking points don't count. Obama and his corrupt regime are targeting your health for destruction.

Posted by: muawiyah | October 6, 2009 7:10 PM | Report abuse

rhino2 said:

“Healthcare company profits range between 5-6% of revenue. The total profits of all healthcare companies is less than 1% of the total healthcare costs. Do you really think a Public option will significantly bring down costs?”

Over a five year period, the CEO of United Health Care receive $342 million in compensation. Not one penny of that was profit for his company. And that’s just one executive at one health insurance company. So, yes, I think a public option could significantly bring down costs.

Posted by: hgillette | October 6, 2009 7:22 PM | Report abuse

The government already delivers a higher quality, lower cost product than the private sector -- it's called Medicare.

Looking north and across the Atlantic and Pacific there are similar systems that deliver higher quality at lower cost. The same is true even of those systems that are private.

Our insurance system just plain sucks for ordinary consumers and tax-payers.

As far as "unfairness" goes, it's unfair to American consumers and taxpayers that we have to subsidize a dead-beat industry for their cr-ppy business model, and cr-ppy product. They and our bloated financial sector are bringing the entire economy AND the free market in other sectors down on our heads.

Unfair isn't depriving CEOs and shareholders of blood money and their anti-trust exemptions. Unfair is killing 40,000 Americans a year and putting countless other working and middle class families into bankruptcy just to protect the life styles of some rich and infamous blood suckers.

Posted by: JPRS | October 6, 2009 7:29 PM | Report abuse

Uh, people, it's not my responsibility to pay for your health care. It's yours. I'm not rich, but get your hand out of my pocket. Please stop trying to pay for your health care with other people's money.

But I'll keep an open mind. Let's see whether any really viable plan comes out. I just don't see how a public option can be financially viable without being a major income redistribution scheme. I won't mind something that spreads cost over a person's lifetime, but I'm pretty sure what we will see is a way to give the 75% or so of the population that contributes almost nothing to the funding of the government healthcare paid for by the dwindling upper-middle class (it will dwindle more with Obama labor policies further choking business).

Posted by: OhMy1 | October 6, 2009 7:46 PM | Report abuse

Why are healthcare providers crying about medicare rates? I am sure they are way higher than France / UK. So, what is the opportunity cost for healthcare providers? Stop doing what they are doing and start another business in US? That is not an option. They can't move to France or UK and still get way less money. So, they will have to agree to make less money and there is nothing wrong about it. Just because they have managed to keep demand fragmented and lobbied govt to have control on supply side, it does not give them a birth right to earn 2-3 times more than rest of the industrialized world for equal or inferior results.

Posted by: tarang_72 | October 6, 2009 8:13 PM | Report abuse


There are more ways to "redistribute wealth" than through the tax code. When we spend twice as much as everyone else for the same or worse health outcomes, it means that a whole lot of wealth is being transferred to someone else for no good reason. People are being bankrupted, dying, and having their incomes siphoned off into an inefficient patchwork system simply because it makes some people very, very rich.

Hundreds of millions in political campaign spending, and billions of dollars in ad revenue for large media conglomerates may not show up on your W-2, but effectively those expenditures are a kind of tax on your income.

That's money that ordinary people are putting into the system that's being directed into activities that have absolutely nothing to do with actually improving the health of customers.

It's actually a strong argument for getting health care out of the hands of employers and into a heavily-regulated market, so that people can see the true cost of the status quo.

Posted by: JPRS | October 6, 2009 8:16 PM | Report abuse


You both deserve crappy care. To speed you both to your ultimate rewards.

You libs won't guarantee patient care under ObamaCare -- because you know you will SCREW UP.

Congrats on your spineless-ness.

Posted by: russpoter | October 6, 2009 8:38 PM | Report abuse

OhMy1 "Uh, people, it's not my responsibility to pay for your health care. It's yours. I'm not rich, but get your hand out of my pocket."
WellPoint and its affiliates Anthem Blue Cross and Anthem Blue Shield, the nation's largest insurance company, netted $2.5 billion in profits last year. WellPoint's affiliates, Anthem Blue Cross and Blue Shield are now suing the state of Maine to force them to pay 18.5% higher premiums on their insurance policies and guarantee Anthem Blue Cross and Blue Shield "appropriate" profit margin.

This is only one example of the Private Health Care Industry having their hand in our pockets in a very big way. They have to raise the rates, it's costing them a lot to pay off our Congress, and they're doing it with your money.

Posted by: dtgo | October 6, 2009 8:38 PM | Report abuse


WellPoint and its affiliates Anthem Blue Cross and Anthem Blue Shield, the nation's largest insurance company, netted $2.5 billion in profits last year


And that is LESS than was STOLEN by FRAUD in Medicaid/Medicare.


Posted by: russpoter | October 6, 2009 8:46 PM | Report abuse

The government ought not be thought of as a competitor, but as protector. Other nations don't allow any profits in health-care insurance. Other nations operate insurance as non-profits. WE THE PEOPLE ought to demand the same business practice. The so-called public option is a small step towards reforming the insurance industry.

It is common practice among for-profit insurance companies to deny coverage and deny claims. That drives people away for proper health-care because they simply cannot afford to pay huge medical bills. There is no real data for uninsured, but I imagine there are plenty of sick uninsured people, who try to live with a serious illness. That is not compassionate treatment for a wealthy nation.

Posted by: rmorris391 | October 6, 2009 9:52 PM | Report abuse

Having worked in hospitals and clinics forty years, I cringe when I hear how the government is an unfair predator. Medical care is now an industrial complex, we are more in the horse and buggy days of care. People are dying because no average American can afford today's hospital charges. Rich and political men just don't pay their bills--the government or their businesses pay it for them. How it got this way is past discussion. The same way Wall Street get the way it is? Greed, lack of supervision,and what laws regulated them have been repealed. Medicine needs help badly now and Sen.Baucas (Aetna is his biggest campaign contributor) is not working for the American public, but for his next election's piggybank. His state represents 2% of the population, but his actions will harm 98%. Impeachment is too good for him. Medicare is a good public program which is hated by Insurance companies because it is a good public program. Someone come to their senses!

Posted by: drzimmern1 | October 6, 2009 9:59 PM | Report abuse


You both deserve crappy care. To speed you both to your ultimate rewards.

You libs won't guarantee patient care under ObamaCare -- because you know you will SCREW UP.

Congrats on your spineless-ness.

Posted by: russpoter


Without realizing it you're advocating Single-Payer.

There's still time for you to complete that GED, russpoter.

Posted by: JPRS | October 6, 2009 10:15 PM | Report abuse

When former Republican Senate Majority Leader, Dr. Bill Frist, has come out in favor of the public option, and stresses that it is NOT socialized medicine, it kind of lays bare the real root of Republican opposition to this. They want Obama, and the country, to fail.

Listen to the good Doctor, conservatives, and do something decent for your families for once, okay?

Posted by: B2O2 | October 6, 2009 10:37 PM | Report abuse

Thoughtful people opposed to the "Public Option" should be quiet and let The Party fall into their own trap. This idea that the "Public Option" is somehow going to be so competitive that it throws responsible insurers out of business is ridiculous. Face it, the government of The Party, by the Service Employees International Union, for the Proletariat just isn't going to be able to run it competitively. Realistically, the "Public Option" health insurer will end up as an employer of last resort for Party insiders and public employee unions that have no incentive to control costs. It will also become another government welfare program for contractors that cannot compete elsewhere. The public option is going to end up with so much administrative burden and poor cost control that it's rates will be high, helping the well run private insurers make even more money. Now, do you have any clue why private insurers are keeping their mouth shut. The Party's public option organization is also needed to issue policies to those who cannot get insurance due to their misfortune, bad health practices, or lack the ability to file claims properly. In other words, the group that no one else wants to insure.

Posted by: raym39 | October 6, 2009 10:51 PM | Report abuse

The last time I read the Federalist Papers,it was very clear that monarchy would not be allowed in America. So therefore, why are the 535 most powerful public servants(Congress/Senate) entitled to the best healthcare in the country, but only engage in caviling about the cost when an option in a bill would grant the same level of healthcare to the general public, the people who voted for these legislators to protect the public good.

Posted by: cmc317 | October 6, 2009 11:09 PM | Report abuse

Health reform without a public option that underpaid Americans can afford is useless. However, a public option that America can afford is questionable. We must get our sick economy fixed before taking on any trillion dollar projects. If the ailing economy is not put on the road to recovery, nothing else in this country is going to matter. This will be a once wealthy nation in third world status with nothing but debt that cannot be paid. Fix the sick economy first.

Posted by: johntu | October 6, 2009 11:37 PM | Report abuse

Of COURSE a public option would deliver health care more efficiently than the present private insurance companies. It can pay providers the exact same rates that the current private companies do, but charge lower premiums to their customers. How?

1) By not having a thick layer of middle and upper management that have to be lavishly rewarded for basically being a cog in a middleman skimming operation. And

2) By not having to spend many hundreds of millions of dollars putting up inane and pointless print, broadcasting and other forms of advertising to fight with the other middleman skimming operations.

It's such basic math. I don't know why no one with a big mouthpiece is laying it out there. Perhaps it's so obvious what efficiency advantage the public option would have that no one is bothering to state it. But if that's the case, I don't understand why it is having so much trouble passing. Other than the fact that most of our Congress is working for the insurance industry rather than the American people, of course.

Posted by: B2O2 | October 6, 2009 11:40 PM | Report abuse

If we all agree that Medicare is wonderful, why would we deny its benefits to the rest of the country? That is what we are currently doing. Canada in the 1960s was in the same place we were. They kept expanding their Medicare until it covered everyone. And they have run it extremely well - 1/2 the cost of our medical care and it covers everyone. Does that sound appealing, America? If not, why not?

Posted by: johnsonc2 | October 7, 2009 12:08 AM | Report abuse

The longer this debate drags on the more we continue to tear each other apart. I've got to hand it to the corporations who managed to turn essential social issues such as health care and employment into a partisan political divide. Not even Satan is that capable.

I also have to hand it to corporations for managing to control our Congress and the White House through high level lobbying and campaign bribes. Our system, right and left components of it, appears to be beyond repair at this point.

The public option is the watered-down version of legislation, but that's not enough for the opponents. They have to kill any chance that middle America may have at achieving social equality and a fair treatment.

Posted by: Single_Payer | October 7, 2009 12:11 AM | Report abuse

The government ought not be thought of as a competitor, but as protector. Other nations don't allow any profits in health-care insurance. Other nations operate insurance as non-profits. WE THE PEOPLE ought to demand the same business practice. The so-called public option is a small step towards reforming the insurance industry.

It is common practice among for-profit insurance companies to deny coverage and deny claims. That drives people away for proper health-care because they simply cannot afford to pay huge medical bills. There is no real data for uninsured, but I imagine there are plenty of sick uninsured people, who try to live with a serious illness. That is not compassionate treatment for a wealthy nation.

Posted by: rmorris391 | October 7, 2009 1:12 AM | Report abuse

Right now it is the insurance companies who are unfair by witholding care for people they don't want to cover and cancelling policies they don't want to pay. If you think that's OK, then you should try and find insurance with a pre-existing condition and see who will insure you. The answer is: Nobody. So which competitor will take care of these people?

The fact is that healthcare is a moral issue and the first point of agreement should be that everyone should have access to health care. Health care is not a for-profit sport. How much profit is enough for the insurance companies when increasing costs make care unaffordable and shorten people's lifespan?

The "fairness" of the public option is that everyone is guaranteed affordable coverage. The only other option is to force the insurance companues to insure everyone for an affordable rate. How do you think they'll feel about being forced to lose money on their policies? They will spend millions to avoid, defer or otherwise eliminate this requirement.

For those who still think that government shouldn't be involved in the private sector, I hope you will cancel your medicare policies, stop using public roads and other transportation, and will stop using the Post Office and send all your mail and packages via UPS or FedEx. You probably also shouldn't get cable TV or a telephone - all heavily regulated and controlled by the government; and no more water or electricity for you.

The message here is that government has a meaningful role in those areas where individual rights to life, liberty and the pursuit of happiness are threatened. Health care is such an issue, and only heartless insurance companies would argue otherwise.

Posted by: pricetheo | October 7, 2009 5:48 AM | Report abuse

"The government is not a fair competitor," Grassley said. "It's a predator."

Well- this is a hoot !

Easy to make ignorant statements and get away with the lies and distortion when you have a DUMB DOWN Nation.

Let us not forget-

Murdoch/WSJ: Dumb it Down Mr.President!

Dumb it Down so Grassley can get away with absurd comments such as this!


Posted by: sasha2008 | October 7, 2009 9:41 AM | Report abuse

Kudos for quoting Cappy McGarr from his Times OpEd piece. But you omitted an important point: either a public option or tight government regulation is required to prevent private insurers from cherry-picking small businesses and individuals who are healthy, leaving the exchanges to cover the chronically sick and the pre-Medicare old folks. According to McGarr, that's what happened in Texas, and is why the exchange-like entity he ran failed.

Posted by: bhmingus | October 7, 2009 1:01 PM | Report abuse

either a public option or tight government regulation is required to prevent private insurers from cherry-picking small businesses and individuals who are healthy, leaving the exchanges to cover the chronically sick and the pre-Medicare old folks.


This seems like the fundamental flaw in mandating coverage. If you're not allowed to cherry-pick and you're not allowed to selectively raise premiums on the people you frequently pay out to, there is no way to come out ahead. The only way to win becomes to reduce the frequency and magnitude of the payouts, which is something insurance companies have no control over (assuming coverage is mandated). The entire business model of insurance is predicated on the idea of collecting good risk and weeding out bad risk. If insurance companies aren't allowed to do that anymore, I don't think they will continue to exist at all. What would be the point?

Posted by: ponkey | October 7, 2009 1:45 PM | Report abuse

I have S.S. Disability that does include Medicare, but I worked for 35 years & paid dearly for S.S. as well as payed to the government for disability Ins. I'm sick of people saying that all on disability are lazy good for nothings. I tell you what you take my blindness & my pain from a degenerative bone disease & I will take your good job & complain about you.

My husband has no Insurance because we can't afford it, but we are both against the government taking 5 hundred billion dollars from what we all paid into all our working lives & use it to cover people that have no insurance. There has to a better way to afford insurance for all, without stealing money that all people paid into S.S.

Any President that can take over Auto Manufactures, take over the Banking Industry, should also be able to force the Insurance Companies to bring their prices under controll, also let people buy Insurance across state lines & also make any Insurance Co. be unable to say no to people with pre-existing conditions.

As I said there has to be a better way to pay for insurance for all, than to rob S.S.
since S.S. is going broke by 2017, if you believe President Obama.

Posted by: wildfire1946 | October 7, 2009 5:50 PM | Report abuse

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