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What's the Public Option, Again?
Joe Raedle / Getty Images
Yes, a new poll shows strong support for a health-care public option. But even the pollsters aren’t sure what it is. Why Congress should ignore the survey and do the right thing.
Advocates of including a “public option” in a proposed health-care overhaul got a major boost Tuesday from a Washington Post/ ABC News poll showing strong support for the idea. Even as congressional Democrats have been largely united in support of the overall shape of a reform package, the public-option issue has proven divisive. Centrist members tend to oppose the idea, even though virtually all analysts indicate that it would save money, thus meeting one of their key goals. But for left-wing members who aren’t thrilled with the generally pro-industry shape of the reform package, the public option has become an ideological touchstone—so much so that there are persistent threats of left-wing defections if the measure doesn’t materialize in the final bill.
Probably the most important thing about the public option is that whether it’s created or not, it won’t have any impact for good or for ill on the lives of most people.
A positive poll result strengthens the case that moderates, who tend to hold relatively vulnerable seats, should let the left more or less have its way on this one. And that’s good news. Proponents of the public plan have developed a tendency to exaggerate the significance of this debate, but they’re still right on the merits. At the same time, on another issue that tends to divide the Democratic caucus—the idea of an excise tax on pricey insurance plans—the moderates have the better case. In an ideal world, liberals will win on the public plan and moderates on the tax. Still, the poll raises the question of whether the public—and, indeed, the pollsters—understands what the public option is.
Probably the most important thing about the public option is that whether it’s created or not, it won’t have any impact for good or for ill on the lives of most people. If you’re in the military or a veteran or poor enough for Medicaid or old enough for Social Security or get health insurance through your employer, the public option has nothing to do with you. But for the minority of Americans who are currently uninsured, or who buy insurance on the individual market, it could make a big difference. All the different Democratic proposals agree that such people should be helped through the creation of a regulated health-insurance exchange. The exchange will function, essentially, as one giant risk pool (just as the employees at a company form a risk pool) which should bring premiums down, on average. But to make this work, it’s vital that everyone participates. Otherwise, people with below-average health needs will drop out, and premiums will skyrocket. Thus there will be a mandate that everyone who doesn’t already have coverage buy some. And, in turn, there will be subsidies to ensure that coverage is affordable.
But buy coverage from whom? Well, from private insurers who’ll presumably be offering an array of plans that conform to the regulators’ definition of minimum acceptable coverage.
This is where the public option comes in. Liberals say that in addition to whatever private industry wants to put on the table, people participating in the exchange should be able to enroll in an insurance program run by the government. For one thing, such a program would be an additional mechanism, alongside the regulators, for keeping private insurers honest. For another thing, such a program could use its leverage to pay reimbursement rates to health-care providers that are modeled on Medicare’s rates. These are lower than what private insurance (which, being more fragmented, can’t bargain as effectively) pays and thus could save money and control costs.
This whole set-up is, frankly, too complicated to explain in a poll question. But according to the Post’s poll, 57 percent of Americans say they would support “having the government create a new health-insurance plan to compete with private health-insurance plans.” Of the 40 percent who are opposed, 45 percent say they would change their minds “if this government-sponsored plan was run by state governments and was available only to people who did not have a choice of affordable private insurance.”
The preference for a state-run plan seems to evince a lack of understanding of the policy issues. This might work well enough for large states like California, Texas, and New York. But a program that insures only a relatively small fraction of the population of a small state like Vermont or Montana might be too small to be viable. Insurance needs scale to spread risk. What’s more, state-based plans would, in most places at least, lack the leverage necessary to bargain effectively with providers, thus defeating one of the major motivations for creating a public option.
The business about limiting eligibility to people who don’t have a choice of affordable private insurance suggests confusion on the part of the pollster. Under all proposals, people currently insured through their employers or existing government programs would be ineligible. At the same time, under all proposals everyone will be eligible for a level of subsidies designed to make insurance affordable. So this proposed modification to the plan would either change nothing, or else it would exclude absolutely everyone from the public plan. The question, in other words, doesn’t really make sense. Most likely whoever put the question together was simply confused, and respondents just played along.
This is a reminder, most of all, that public opinion polls tend to be unreliable when unfamiliar questions are asked. The public, moreover, isn’t composed of policy wonks. And the news sources most people rely on barely even try to explain policy specifics. Consequently, it would be exceedingly unwise for politicians to pay an undue amount of deference to poll results when outlining major policy measures. What will make health reform popular or unpopular at the end of the day will be whether or not people feel that it works for them. A public option should make reform work better, and that’s the best reason—both politically and substantively—to include one. Fragmenting it into state-by-state bits will make it work worse, and that’s the best reason not to do it that way. These programs won’t even be implemented until 2013 or beyond, by which point people will have long forgotten how they thought they felt about the various provisions back in the fall of 2009. At the end of the day, health reform that improves people’s lives will be popular, and reform that doesn’t won’t be.
Matthew Yglesias is a fellow at the Center for American Progress Action Fund. He is the author of Heads in the Sand: How the Republicans Screw Up Foreign Policy and Foreign Policy Screws Up the Democrats.
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The public option is a gov't. run health insurance plan, like medicare, which eliminates the middle man, and thus the gouging by the insurance companies.
It makes sense when considering it will put exorbitant profits into healthcare , where it belongs, along with rolling back Bush bailouts for the rich, and the waste fraud and abuse investigations.
Brilliant thinking....this way they don't take the profits and reinvest in new medicines, cancer research and many other forms of research. Once the government has control, we'll spiral into a system of complete ineffeciency. Folks, we control our own destiny's here. If a brand new, liberal administration is singing a song that sounds great....it's not a good thing. We will find out the hard way!
If you think the insurance companies are using their profits to "reinvest in new medicines, cancer reserach ...." you probably also own some new property in the Evergladees.
I am an independent candidate for president. My Health care program, creatively written here does not involve insurance companies or any government bureaucracy. My program will straighten out health care and rejuvenate our economy.
Our economy, as heartbeat, is near collapse; the dollar is in the dumpster for months, and could permanently go lower; one prob limb, the growing rolls who lost their health care insurance along with their jobs.
My Loose Penny Program, presented here, is a capital injection that will instantly begin to repair our economic muscle, but to create actual jobs, mission critical diplomacy is required.
President Obama needs to get off the fly around health care campaign trail, wipe down the makeup on his eyelids with cold cream and summon all our fast foods, supermarket; Target and Wal-Mart CEO's to the White House to ink my proposed infusion solution.
That is the only thing wrong with this proposal. It is mine, and personally I have an expressed stake in the political process. Were his advisors only willing to set that issue aside!
Obama went to Cairo and Copenhagen. He can meet with KFC. Your loose pocket change will make the critical health care diff rinse.
Every chain must participate in my Loose Pennies Program, regardless the size of their enterprise. My purpose: an additional two-cents in the cash registers of many thousands of locations nationwide, wherever we fast food eat and shop. For every item registered over the counter we want two pennies extra, added as patriotic gratuity.
This proposal is not for a government mandate. Anyone can refuse to pay the voluntary two cents gratuity. Burger, fries and a drink totals six extra cents, pennies off the pavement. Regardless what we purchase at the market; we are only pitching in some loose change out of pocket. 40 items at the supermarket could easily add up to $150. Does another 80 cents inhibit your generosity?
A worker chosen by the workers to represent them can meet with the managers to approve the total pennies for everything out the door the week before, dividing that total by everyone's hours worked.
Then we include up to $2 dollars extra for every hour in the worker's paychecks. A 5 % deduct for a Medical Malpractice Pool is also on my planing board, which employers don't have to match, so their sticker prices won't rise from any extra cost of doing business. The chains won't be squeezed from our Medical Assurance pay raise, that, a plus minus spreadsheet wash!
The worker's pay increase doesn't come out of management's pocket, but work place production will grow. When someone quits, the crew might ask the boss to leave them pick up the slack, so they earn more money!
The overage, beyond the $2 dollars hourly extra in every pay, goes to interest bearing Medical Savings Accounts, with the worker's name on his or her portion. Two dollars an hour in a forty hour week is more than $4000 a year. There are other possibilities because the prime issue is Health Care.
The president can ask everyone on the low end of the economic chain to divide their bounty as follows, at least what I will do as president: the President can order the $2 an hour extra be a take home half in cash, with the balance going to really grow these proposed Medical Savings Accounts, a health care solution for at least ten million uninsured people.
More than ten million of the uninsured people will have medical care access guaranteed. The medical savings account, as a health care solution beats health insurance!
Insurance companies are dedicated to making money, not protecting the sick from financial disaster. When an insurance company cancels your policy because you have an expensive disease, they don't refund your premium. But with a Health Assurance Savings Account, when you quit or get fired from the job, your medical savings account goes with you!
After a year behind the fast food counter, a 40-hour per week worker could have more than two grand in their Health Assurance account. Ten million uninsured people at the bottom of our economic food chain might not have health care insurance but all would carry Health Assurance. In the event they don't feel right they have access to medical care, and a second opinion, because the money to pay is there! When it's your money, unneeded procedures evaporate.
Other companies, besides the fast food chains could have the "public Lev option" of creating medical savings accounts, in lieu of providing an insurance policy for their workers. A sensible choice solution eliminates the insurance company monopolies. A worker could opt out of his company's insurance policy. The employer's end would go into his paycheck, a raise in take home pay. The half the worker was paying would still be withheld, and go into the worker's Medical Assurance savings Account.
Is there any government bureaucracy involved in my program? Is my proposal a thousand pages of unreadable language?
This two cents program works for the medical professional, too. You agree to the fee, the doctor swipes your Medical Assurance card and the money is debited from your Health Assurance account. The Dr.'s cost layer represented by his required compliance with the insurance company bureaucrat is out of the mix.
This proposed over-the-counter voluntary two-cent gratuity, $344 dollars monthly doesn't bash government. These out of pocket pennies go to the working not so rich, without intrusion. Government bureaus are by-passed, except to investigate anonymous complaints about businesses that may be cheating their workers.
In all the dry cleaners add a nickel to every shirt pressed, a dime for every dry cleaned piece. In all the family operated dry cleaners, medical savings accounts will replace the worker's share of their family's health insurance.
This 2 cents extra covers 90% of all the minimum and lower wage jobs in USA, juicing the recovery by pumping the bottom of our economic chain, enriching the people most likely to purchase goods with their money! The fresh dollars these people spend will create jobs.Those in low echelon hourly jobs, working 40 hours a week will have $80 extra weekly in his or her pay envelope, the diff rinse between scraping by and getting ahead; the advantage of $76 after a 5% set aside for our Medical Malpractice Pool, $40 in their pay with a minimum $36 earmarked for Health Assurance savings.
Millions of uninsured not so rich people building Medical Assurance Accounts will directly benefit from this voluntary deal. We gain from tipping our pennies to working folks, as these millions of uninsured won't be crowding emergency clinics for care, which we all pay for, a tremendous savings for the taxpayer!
Emergency health care cost is infected by the actuarial projections of how many uninsured people might use an emergency room walk-in for care during the course of any year.
Working people in min-wage jobs with Health Assurance accounts pay for their access on a need-to-be seen basis. In addition to medical savings accounts, the two cents gratis could secure a million mortgages near default, a contribution to neighborhood health as deserted house disease is a cancer that devalues the whole street.
For the rest of our uncovered citizenry, doctors and dentists must be allowed the volunteer opportunity to do tax deductible charity, treating them. A charity patient is anyone without insurance. The plan: doctors do $50,000 in charitable medical services and deduct the $50,000 off the top of their federal tax. Then, after all the deductions, the doctors take an additional half off their bottom line; twenty-five thousand or half, whichever is greater.
Medical professionals could perform $100,000 in charity and deduct $50,000 off their tax, and because they only owed $49,000 in taxes, earn a one thousand dollar income tax credit. This health care approach cost effectively makes sense.
Doctors won't be at the mercy of an insurance companies,' take it or leave payment for services rendered. People suffering from unaffordable premiums, with pre-assurance from their physicians, will begin to cancel their overpriced insurance policies.
Every doctor will have a waiting list of patients waiting to be classified as charity. Doctors will have more patients, their work incentive, Freedom of Income Tax.
Isn't this one-line change in our tax code easier to digest than a thousand page med-reform stick-it-to-us vaccination, unread even by its authors, our congress? Would insurance company's shills show up at town hall meetings screaming, "It's a communist plot! Down with their two cents for medical savings accounts?"
Every doctor and dentist will have a sign on the door: "No insurance? I'm here."
These ideas will enrich our economy from the bottom up, possibly save a million mortgages, and insure access to health care services for many, if not all the millions of uninsured people, whilst leaving the rip off insurance companies out.
Let us for a moment refocus on the 2 cents per item becoming a two dollar an hour raise. Instead we make the pay raise one dollar an hour and the other dollar into the Medical Savings Account. That is approximately $2000 a year in each. Now lets deduct $5 a week from the pay checks and put that into a Malpractice insurance pool. (But without an insurance company as the pool is 'owned' by the people coughing up the $5.)
Doctors and dentists, the med professionals are invited to participate with $5 per visit. Then we establish a reasonable award for all the different malpractice possibilities, allowing the aggrieved party to get a lawyer in the event there is a disagreement. This lowers the cost of a Doctor being a Doctor and gives us a chance to develop a public access data base that identifies doctors who are repeat malpractitioners.
Lets deduct $5 a week from the Medical Assurance Savings Accounts to go into a catastrophic coverage fund. You are working for five years at Burger King. You are an assistant manager. You started out flipping burgers and stayed with your Medical Assurance Savings. You have kidney failure, need dialysis while waiting for a kidney transplant. That is catastrophic.
The long-term solution to our health care prob limb is free medical education for doctors, dentists, and all related personal, our goal one hundred thousand doctors graduated every year until we have one family doctor for every thousand people. A national marijuana tax could fund this program, as could a three per cent reduction in military expenditures. Politishinz are good at identifying issues but fold their intestinal fortitude as those who finance their campaigns govern the solutions.
In that light, the above proposed change in our tax code, encouraging doctors and dentists to treat the uninsured as a deductible charity, could not pass either House of our current congress absent a million person public outcry first.
Robert J. Samuelson wrote, in the Monday, September 14, 2009 The Washington Post:
"Americans generally want three things from their health-care system. First, they think that everyone has a moral right to needed care; that suggests universal insurance. Second, they want choice; they want to select their doctors -- and want doctors to determine treatment. Finally, people want costs controlled; health care shouldn't consume all private compensation or taxes."
The above Loose Penny Solution covers all of these issues. On Sixty Minutes, September 13, president Obama repeated, "All Americans will be required to have insurance, but those who can't afford it will get subsidies." Health Assurance Savings accounts are a better idea.
Obama's plan: Subsidizing an insurance policy creates a whole new layer of bureaucracy which is unaffordable and unnecessary.
I am the unknown poet, a long-time candidate for president, roasting in the sun.
Once upon a time our Fourth Estate was independent, standing watch, reporting true. Today's corporate approach to politics locks out the unknowns who seek public office, a primary reason there aren't any candidates. You announce, "I'm a candidate." The editor's don't ask, "What are your ideas?" But, "Show us twenty million dollars." And without access to buckets of ducats, the access to broadcast speech, to present their platforms is also blocked. Blog in the bog, dog.
We need to renew our politics, starting with the reestablishment of our First Amendment Right to televised political speech. Upon this essay, I requested e quill time of our television networks, to give my independents' response to president Obama's health care speech to the congress, which was broadcast by the networks and cable networks aired live, September 9, 2009.
I have to prepare my petition for the court. The issue of my First Amendment Right to speak will go to the Supreme Court.
michaelslevinson.com
I expect gross ugly fascist ef be eye sponsored attacks on the above, ignoring the program and attacking the author, but it would be interesting to read an honest response.
If what you say is true it make you wonder how every other western democracy can do it ,yet America cant?
Did you read this post or understand what it said.
The public option is NOT going to affect most of the people the US. They will continue to be covered by their current plans (including the private insurance plans). It will offer insurance to those who have no health insurance and will keep the premiums for those folks reasonable by including competition from the public option.
PLUS, how much of the profits of private companies are reinvested and how much goes into the pockets of the executives? You answer that question and you'll see why we need a public option!
@Natural-Selection -
Lay off the Fox News.
Insurance companies don't invest in research or medicinal development, drug companies do.
And nothing about the public option will put a dent in their incredible profits.
Dummy up.
I live in Canada where we have so called "socialist" medicare. It isn't folks. We pay for it through our taxes. We don't have problems with recission, preexisting conditions, copay, denial of claims, etc. We have direct relationships with our doctors with no government bureaucrat interfering. People do not die waiting for care. There is no rationing of care. My brother was diagnosed with severe blockages to his heart; he had quadruple bypass surgery 4 days later. No charge, and will be home tomorrow after 6 days in the hospital. My taxes are comparable to yours. Seriously. What is everyone so scared of? And today Joe Lieberman was complaining, at a meeting of the Senate Homeland Security Committee that Canada was looking after Canadian citizens first and suggesting that Canada was shortchanging the U.S. by not yet supplying the H1N1 vaccine. Rich on two counts: 1) the vaccine was just approved in Canada today so no Canadian has yet gotten it and 2) the vaccine has been produced in that home of "socialist" medicine, Canada, where there has been investment in medicines and research. The ignorance of some people is unbelievable; most of us in Canada shake our heads at the scare tactics of the health care insurance giants in the U.S. (aided and abetted by the Republicans I might add). A wealthy nation is a health nation. Look after each other. Don't be so darn selfish.
Health insurance companies are investing profits into new medicines and research?! I think not. Drug companies, perhaps. But that's a different breed of cat.
Meanwhile Medicare itself isn't all that great for us older folks. My wife and I (far from unique) have long carried a secondary insurer to get us by, especially where medications are involved. And now that I've suddenly become involved in a lot of serious treatment, I find that coincidentally my secondary (private) insurer is raising both my deductible and my co-pay costs.
@Marionetta:
"Look after each other. Don't be so darn selfish."
I agree completely. The only problem is that these are Americans you are talking to. Being selfish is their shtick.
I'm not sure what you're thinking/saying, here.
As the post to which you're replying stated, the proposals involve public health *insurance*, not any direct change to the actual health care providers. And the health insurance companies are doing little, to put it mildly, to invest in medicines, research, etc, by any standard, let alone in a comparison to what the government invests. Who do you think funds most of the research? Plus, with universal coverage, there will be that many more patients (i.e. customers) for new medical technologies, increasing and stabilizing the market for new health care innovations.
As for efficiencies, there is hardly anything less efficient in our health care system than the private health insurance companies. These companies provide no actual health care service, yet extract 20 % of every health care dollar for overhead -- from exorbitant executive compensation, to advertising, to political lobbying. I'll take a system where these overhead costs are reduced down to less than 5%, such as with Medicare.
The following full fledged carefully spelled out program is a better solution than the Public Option:
I am an independent candidate for president. My Health care program, creatively written here does not involve insurance companies or any government bureaucracy. Enjoy the read.
Our economy, as heartbeat, is near collapse; the dollar is in the dumpster for months, and could permanently go lower; one prob limb, the growing rolls who lost their health care insurance along with their jobs.
My Loose Penny Program, presented here, is a capital injection that will instantly begin to repair our economic muscle, but to create actual jobs, mission critical diplomacy is required.
President Obama needs to get off the fly around health care campaign trail, wipe down the makeup on his eyelids with cold cream and summon all our fast foods, supermarket; Target and Wal-Mart CEO's to the White House to ink my proposed infusion solution.
That is the only thing wrong with this proposal. It is mine, and personally I have an expressed stake in the political process. Were his advisors only willing to set that issue aside!
Obama went to Cairo and Copenhagen. He can meet with KFC. Your loose pocket change will make the critical health care diff rinse.
Every chain must participate in my Loose Pennies Program, regardless the size of their enterprise. My purpose: an additional two-cents in the cash registers of many thousands of locations nationwide, wherever we fast food eat and shop. For every item registered over the counter we want two pennies extra, added as patriotic gratuity.
This proposal is not for a government mandate. Anyone can refuse to pay the voluntary two cents gratuity. Burger, fries and a drink totals six extra cents, pennies off the pavement. Regardless what we purchase at the market; we are only pitching in some loose change out of pocket. 40 items at the supermarket could easily add up to $150. Does another 80 cents inhibit your generosity?
A worker chosen by the workers to represent them can meet with the managers to approve the total pennies for everything out the door the week before, dividing that total by everyone's hours worked.
Then we include up to $2 dollars extra for every hour in the worker's paychecks. A 5 % deduct for a Medical Malpractice Pool is also on my planing board, which employers don't have to match, so their sticker prices won't rise from any extra cost of doing business. The chains won't be squeezed from our Medical Assurance pay raise, that, a plus minus spreadsheet wash!
The worker's pay increase doesn't come out of management's pocket, but work place production will grow. When someone quits, the crew might ask the boss to leave them pick up the slack, so they earn more money!
The overage, beyond the $2 dollars hourly extra in every pay, goes to interest bearing Medical Savings Accounts, with the worker's name on his or her portion. Two dollars an hour in a forty hour week is more than $4000 a year. There are other possibilities because the prime issue is Health Care.
The president can ask everyone on the low end of the economic chain to divide their bounty as follows, at least what I will do as president: the President can order the $2 an hour extra be a take home half in cash, with the balance going to really grow these proposed Medical Savings Accounts, a health care solution for at least ten million uninsured people.
More than ten million of the uninsured people will have medical care access guaranteed. The medical savings account, as a health care solution beats health insurance!
Insurance companies are dedicated to making money, not protecting the sick from financial disaster. When an insurance company cancels your policy because you have an expensive disease, they don't refund your premium. But with a Health Assurance Savings Account, when you quit or get fired from the job, your medical savings account goes with you!
After a year behind the fast food counter, a 40-hour per week worker could have more than two grand in their Health Assurance account. Ten million uninsured people at the bottom of our economic food chain might not have health care insurance but all would carry Health Assurance. In the event they don't feel right they have access to medical care, and a second opinion, because the money to pay is there! When it's your money, unneeded procedures evaporate.
Other companies, besides the fast food chains could have the "public Lev option" of creating medical savings accounts, in lieu of providing an insurance policy for their workers. A sensible choice solution eliminates the insurance company monopolies. A worker could opt out of his company's insurance policy. The employer's end would go into his paycheck, a raise in take home pay. The half the worker was paying would still be withheld, and go into the worker's Medical Assurance savings Account.
Is there any government bureaucracy involved in my program? Is my proposal a thousand pages of unreadable language?
This two cents program works for the medical professional, too. You agree to the fee, the doctor swipes your Medical Assurance card and the money is debited from your Health Assurance account. The Dr.'s cost layer represented by his required compliance with the insurance company bureaucrat is out of the mix.
This proposed over-the-counter voluntary two-cent gratuity, $344 dollars monthly doesn't bash government. These out of pocket pennies go to the working not so rich, without intrusion. Government bureaus are by-passed, except to investigate anonymous complaints about businesses that may be cheating their workers.
In all the dry cleaners add a nickel to every shirt pressed, a dime for every dry cleaned piece. In all the family operated dry cleaners, medical savings accounts will replace the worker's share of their family's health insurance.
This 2 cents extra covers 90% of all the minimum and lower wage jobs in USA, juicing the recovery by pumping the bottom of our economic chain, enriching the people most likely to purchase goods with their money! The fresh dollars these people spend will create jobs.Those in low echelon hourly jobs, working 40 hours a week will have $80 extra weekly in his or her pay envelope, the diff rinse between scraping by and getting ahead; the advantage of $76 after a 5% set aside for our Medical Malpractice Pool, $40 in their pay with a minimum $36 earmarked for Health Assurance savings.
Millions of uninsured not so rich people building Medical Assurance Accounts will directly benefit from this voluntary deal. We gain from tipping our pennies to working folks, as these millions of uninsured won't be crowding emergency clinics for care, which we all pay for, a tremendous savings for the taxpayer!
Emergency health care cost is infected by the actuarial projections of how many uninsured people might use an emergency room walk-in for care during the course of any year.
Working people in min-wage jobs with Health Assurance accounts pay for their access on a need-to-be seen basis. In addition to medical savings accounts, the two cents gratis could secure a million mortgages near default, a contribution to neighborhood health as deserted house disease is a cancer that devalues the whole street.
For the rest of our uncovered citizenry, doctors and dentists must be allowed the volunteer opportunity to do tax deductible charity, treating them. A charity patient is anyone without insurance. The plan: doctors do $50,000 in charitable medical services and deduct the $50,000 off the top of their federal tax. Then, after all the deductions, the doctors take an additional half off their bottom line; twenty-five thousand or half, whichever is greater.
Medical professionals could perform $100,000 in charity and deduct $50,000 off their tax, and because they only owed $49,000 in taxes, earn a one thousand dollar income tax credit. This health care approach cost effectively makes sense.
Doctors won't be at the mercy of an insurance companies,' take it or leave payment for services rendered. People suffering from unaffordable premiums, with pre-assurance from their physicians, will begin to cancel their overpriced insurance policies.
Every doctor will have a waiting list of patients waiting to be classified as charity. Doctors will have more patients, their work incentive, Freedom of Income Tax.
Isn't this one-line change in our tax code easier to digest than a thousand page med-reform stick-it-to-us vaccination, unread even by its authors, our congress? Would insurance company's shills show up at town hall meetings screaming, "It's a communist plot! Down with their two cents for medical savings accounts?"
Every doctor and dentist will have a sign on the door: "No insurance? I'm here."
These ideas will enrich our economy from the bottom up, possibly save a million mortgages, and insure access to health care services for many, if not all the millions of uninsured people, whilst leaving the rip off insurance companies out.
Let us for a moment refocus on the 2 cents per item becoming a two dollar an hour raise. Instead we make the pay raise one dollar an hour and the other dollar into the Medical Savings Account. That is approximately $2000 a year in each. Now lets deduct $5 a week from the pay checks and put that into a Malpractice insurance pool. (But without an insurance company as the pool is 'owned' by the people coughing up the $5.)
Doctors and dentists, the med professionals are invited to participate with $5 per visit. Then we establish a reasonable award for all the different malpractice possibilities, allowing the aggrieved party to get a lawyer in the event there is a disagreement. This lowers the cost of a Doctor being a Doctor and gives us a chance to develop a public access data base that identifies doctors who are repeat malpractitioners.
Lets deduct $5 a week from the Medical Assurance Savings Accounts to go into a catastrophic coverage fund. You are working for five years at Burger King. You are an assistant manager. You started out flipping burgers and stayed with your Medical Assurance Savings. You have kidney failure, need dialysis while waiting for a kidney transplant. That is catastrophic.
The long-term solution to our health care prob limb is free medical education for doctors, dentists, and all related personal, our goal one hundred thousand doctors graduated every year until we have one family doctor for every thousand people. A national marijuana tax could fund this program, as could a three per cent reduction in military expenditures. Politishinz are good at identifying issues but fold their intestinal fortitude as those who finance their campaigns govern the solutions.
In that light, the above proposed change in our tax code, encouraging doctors and dentists to treat the uninsured as a deductible charity, could not pass either House of our current congress absent a million person public outcry first.
Robert J. Samuelson wrote, in the Monday, September 14, 2009 The Washington Post:
"Americans generally want three things from their health-care system. First, they think that everyone has a moral right to needed care; that suggests universal insurance. Second, they want choice; they want to select their doctors -- and want doctors to determine treatment. Finally, people want costs controlled; health care shouldn't consume all private compensation or taxes."
The above Loose Penny Solution covers all of these issues. On Sixty Minutes, September 13, president Obama repeated, "All Americans will be required to have insurance, but those who can't afford it will get subsidies." Health Assurance Savings accounts are a better idea.
Obama's plan: Subsidizing an insurance policy creates a whole new layer of bureaucracy which is unaffordable and unnecessary.
I am the unknown poet, a long-time candidate for president, roasting in the sun.
Once upon a time our Fourth Estate was independent, standing watch, reporting true. Today's corporate approach to politics locks out the unknowns who seek public office, a primary reason there aren't any candidates. You announce, "I'm a candidate." The editor's don't ask, "What are your ideas?" But, "Show us twenty million dollars." And without access to buckets of ducats, the access to broadcast speech, to present their platforms is also blocked. Blog in the bog, dog.
We need to renew our politics, starting with the reestablishment of our First Amendment Right to televised political speech. Upon this essay, I requested e quill time of our television networks, to give my independents' response to president Obama's health care speech to the congress, which was broadcast by the networks and cable networks aired live, September 9, 2009.
I have to prepare my petition for the court. The issue of my First Amendment Right to speak will go to the Supreme Court.
michaelslevinson.com
I expect gross ugly fascist ef be eye sponsored attacks on the above, ignoring the program and attacking the author, but it would be interesting to read an honest response.
Whoops it got posted twice. Sorry about that.
michaelslevinson.com
My only question is why this abuser of writing space is allowed to torment us with his rants? Where are the reviewers of the comments posted when you need them? I refuse to read this guy's crap and so should everybody else on general principal!!!
If you cannot say it in 1 or 2 paragraphs you need to rethink your position.
Presidential candidates don't post on TDB.
The piece is a careful delineation of how we, the people, without a government bureaaucracy can eliminate the lobbyist power of insurance companies; how to cover most if not all of the millions of people who don't have insurance, and the long term solution.
There isn't any ranting, nor are you tormented. (Maybe demented).
I created a giant work of art that was written in design to perform on world wide television, with every line a delicate sensible rhyme, like old blind Homer, but this time around for all the world's peoples at home together - a giant "Thriller" World Peace . Will the poet author of prophetic worlks make it. Peace.
The "mull tie ling well" poem begins with Adman and Even in the Gar Den ov Edum. It wouldn't hurt you to visit youtube.com/poetprophet and see your story of creation.
These posting, explaining carefully worded solutions to prob limbs you have difficulty understanding is a side light.
michaelslevinson.com
I have simpler.
File your taxes, you get a book of 12 monthly vouchers for every social security number on the tax return. Insurance companies are required to provide at least one program for the value of the voucher that meets a base-line standard.
* You want a cadillac plan? Fine. You get a voucher ( say for $140 ) you gotta come up with the rest out of your ( or your employer's ) pocket
* No mandates ... hey you have a book of vouchers, why wouldn't you buy?
* Illegal aliens? Uhm. well if they are FILING taxes ... well, you pay taxes you get the benefits attached to paying taxes. No taxes no vouchers.
* Insurance company denies me that $1500 test? Heh. I tell em "Okay. End of month I am leaving and taking my vouchers, my wife's my kids, my parents and my siblings. You can enjoy losing $1000-2000/mo for a single $1500."
Like banks and ATM fees. Many insurance companies will still not cover it. But some will. And the strongest will survive the marketplace.
* pre-existing conditions just disappear. See you have to be uninsured while that condition occurs. Or uninsured at anytime during the last two years. We got vouchers ... in 2 years time NO ONE will be vulnerable to pre-existing.
* You allow recidivism as well as other questionable practices. Rather than stop it via fiat, you use a different tactic to get the insurance companies to practice right.
Net payment terms. Have recidivism, paid net 90. Have every single possible goodie the progressives think are cool and"socially correct" you get paid net 3. Interest on millions of dollars for 3 months can do a whole lot of encouragement.
* cost curve containment. You start the vouchers a tad high for the year 2012. But from that point it is set at a 2% growth. Again same example, $140 year one, $142.80 year two. No faster growth without a super-majority ( 66% ). The insurance companies in 10 years better get their costs under control or by then they will be losing money. Because they WILL offer that basic package for the voucher amount.
* Notice in all of this. Other than making the marketplace consider the trade offs between offering and practicing the way they want and getting paid for their vouchers faster ... who is in charge?
Washington? Nope.
The Insurance companies? Nope
The Employers? Nope
The person whose names are on the vouchers? YEP
Which by the way is why Congress did not consider vouchers.
See the Progressives do not LIKE those nasty companies in charge of healthcare. But they ALSO do not LIKE those foolish people to be in charge either. THEY want the power so THEY can decide what the public needs. Cause the public proved how stupid they are back in 2004 by re-electing Bush.
So in the best interests of the people. It is better that they are not allowed to choose.
Notice also, this whole plan could easily fit on 12 pages. The next $500 is how to pay for it.
Will a public option, like Medicare, also pay providers only 80% of what the service costs? Private insurance makes up the difference today. Who will make up the difference when those under 65 have the same deal? Prices will either go up for the productive few who buy private insurance, or services will be cut for everyone. But, to your point, paying more and getting less will sure teach those greedy insurance companies.
Way to over simplify. First, under the new plan no one would be without insurance so those costs wouldn't be transferred to those with insurance. Secondly, the reason only 80% is paid is because each hospital bill is viewed and certain things will be deemed unneccessary and thus will not get reimbursed, which this could be fixed by tort reform but i digress
Or a better question may be, like medicare did, will this new scam drive healthcare costs up 1000%?
Who do you think pays when someone without insurance needs health care and cannot afford to pay for it??? Let's not pretend not to know the truth - we need health insurance reform and a public option is the only way to get real reform. It will bring down costs because less people will turn up in emergency rooms without the ability to pay.
Who will deem certain procedures unnecessary? How will they determine what is unnecessary and what is not?
More people will end up in the emergency room under a public option. Unless we can add more doctors to see more patients people will not be able to see their primary care provider and will end up in the emergency room. Look at Massachusetts.
Privately health insurance plans. I doubt seriously most will afford them in five/ten years.
We all know the U.S Health Care Insurance System is in serious trouble. Inefficient, redundant and expensive, it has potential to ruin the country. Unfortunately, the multiple solutions currently proposed do not address one of the main problems we face - a health care insurance industry that is quickly converting to a for-profit ownership. While private non-profit managed care dominated the U.S. health care landscape 20 years ago, today a for-profit model dominates1. This needs to stop now if we are going to preserve the possibility of a solution.
The primarily non-profit based system that worked in the 70's and 80's flowed from the Health Maintenance Organization Act, which helped create a diverse group of private, but non-profit HMOs. They were chartered by government and financed in part through government-sponsored zero-interest loans and grants. This process helped launch many of the health care insurance companies that exist today. In return for their investment Americans received effectively delivered health care with local community issues and priorities addressed, and without an overt profit motive affecting policy.
Unfortunately in the late 1980's regulators were convinced by suspect data and simplistic reasoning to permit many of these non-profits to convert to for-profit status. We can look to New York State as a demonstration of the results of such conversions from non-profit to for-profit. Today, New York's for-profit health plans spend 7.3% less of their premiums on health claims2, 1.5% more on administration overhead2, and significantly less on community health and service to the public2,3. This totals $815 million health care dollars in New York alone, diverted from health care due to these for-profit conversions2. For-profit models there posted 8.1% underwriting gains (i.e., profit) versus the 2.3% gains posted by non-profits2. There is also another significant hidden cost to the public. In response to a changing business market, non-profits apparently begin to change their policies to be more consistent with for-profits compounding the damage these conversions cause2.
Today, more than one half of insured Americans are enrolled in for-profit health plans4 and more than half of the non-profit Blue Cross and Blue Shield plans have already been converted5. This new system works overtime to ensure increasing profits for Wall Street while quality of care suffers6 and costs skyrocket. The Robert Wood Johnson Foundation found that from 2001-2005 health insurance increased 30% for Americans7. Keehan's "Health Spending Projections Through 2017" finds that we spent $7,900 per person on health care in 20078. Again, the numbers are undeniable. We are not just getting sicker as some would have you believe; we are also feeding the profit line of for-profit health organizations that used to spend put excess revenue back into health care. Benefits proposed by pro-conversion capitalists that were to be gained through consolidation and market efficiencies have proven illusory5.
Historically the "private" aspects of this model supported healthy competition amongst health care systems, spurring improvements in performance, pricing and delivery. The non-profit aspects helped to ensure that profiteering and predatory contracts and policy would not encouraged by investors or Wall Street's preoccupation with the quarterly report. While non-profits generally plough their excess revenue (i.e., profit) back into achieving their charter mission, it not always so for profit-based companies. They are under no such moral obligation, and there are powerful incentives to increase the profit line on the balance sheet. A return to this public/private partnership represents the only viable long-term solution that fits squarely within the United State's powerful version of regulated capitalism. It would resonate with recent American history and our current national temperament, one which recognizes a need for competition, but is clearly tired of the excesses that obsession with profitability brings. We desire both competence and responsibility, and understand that companies should make enough money to be healthy and grow in the process
If the Federal Government or the California State Assembly cannot find a meaningful solution the California State Initiative System might have the power. Californians might stop any further conversions to for-profit ownership through an initiative. It also might establish a new charter for the development of new non-profits, similar to the first, but without the loopholes. But, this time they would stay that way; no more bait and switch after receiving interest-free loans at taxpayer expense. This new charter could help solve problems from the ground up and correct some of the mistakes of the last two decades. Simply putting 6-8% of health care premium dollars back into health care would be a good start.
Bibliography:
1) Gabel, J. 1997; Ten Ways HMOs Have Changed During the 1990s: Health Affairs. 16: 134-145
2) Treo Solutions. Benefits for nonprofit health plans to a region. Alliance for Advancing Nonprofit Health Care at: www.nonprofithealthcare.org
3) Barrish SR. Non-Profit Health Insurers: The Story Wall Street Doesn't Tell. Alliance for Advancing Non-Profit Health Care at: www.nonprofithealthcare.org
4) BASIC FACTS & FIGURES: NONPROFIT HEALTH PLANS (2008) Alliance for Advancing Nonprofit Health Care at: www.nonprofithealthcare.org
5) Schramm CJ (2004) Dispelling the Myth: Why conversions of Blue plans to for-profit don't make sense. Alliance for Advancing Nonprofit Health Care at: www.nonprofithealthcare.org
6) Schneider EC, Zaslavsky AM, Epstein AM (2005) Quality of care in for-pro%uFB01t and not-for-pro%uFB01t health plans enrolling Medicare bene%uFB01ciaries. The American Journal of Medicine 118, 1392-1400
7) Alliance for Advancing Nonprofit Health Care at: www.nonprofithealthcare.org
8) Keehan, S. et al. Health Spending Projections Through 2017. Health Affairs Web Exclusive W146: 21 February 2008
It's my impression that T.R. Reid, whose recent book and PBS program are about health care around the world, also thought something like this, which sounds like the Swiss system, was a good fit for this country.
The irony is that in losing non-profits like Blue Cross of California, we ended up not only with a company whose incentives are wrong, we got massive foundations funded by payments required as a condition of converting to for-profit status. Between these foundations representing the liberal elite's ideologies common to that world and the financial avariciousness of the shareholder insurance companies, the regular folks received the worst of two extremes.
Once again, the Nanny State is going to pretend to be Robin Hood, and ends up being Boyz N Da Hood.
Yes, because we all know it's the health insurance companies that are funding "new medicines, cancer research and many other forms of research. "
While we're on the subject, take a look at the pharmaceutical companies (the ones that actually DO the stuff you're talking about) and compare how much they spend on research and development as opposed to marketing and profit. You could learn something. Though I doubt it.
Big Pharma typically spends nearly 25% on promotion, but only 13% on R&D. In 2004, total promotion (such as advertising) in the pharma industry was around $30 billion.
That's exactly right Connie. In addition, that 13% doesn't all go to making new drugs to fight deadly diseases. A lot of it goes to making very minor adjustments to patented medications in order to facilitate a process called 'ever-greening' whereby essentially the same drug is repatented over and over, with the tiniest of changes. Further, big pharma spends a lot of that 13% searching for yet another cold and flu medication (that can barely beat a placebo in a double blind test) or new varieties of viagra.
Although it is free-market heresy to even think this, it is the government, not private industry that provides funding for the most important drug research.
Read the following by Dr. Marcia Angell, who is a Senior Lecturer in Social Medicine at Harvard Medical School. sShe is a former Editor in Chief of The New England Journal of Medicine, the country's most prestigious medical journal.
Second, the pharmaceutical industry is not especially innovative. As hard as it is to believe, only a handful of truly important drugs have been brought to market in recent years, and they were mostly based on taxpayer-funded research at academic institutions, small biotechnology companies, or the National Institutes of Health (NIH). The great majority of "new" drugs are not new at all but merely variations of older drugs already on the market. These are called "me-too" drugs. The idea is to grab a share of an established, lucrative market by producing something very similar to a top-selling drug. For instance, we now have six statins (Mevacor, Lipitor, Zocor, Pravachol, Lescol, and the newest, Crestor) on the market to lower cholesterol, all variants of the first
Her full essay is available at: http://www.nybooks.com/articles/17244
What do you want to do bring on another french style revolution???? real people (not just fox teabaggers) in the united states want proper healthcare without risking bankruptcy. real people want greedy business exec's to quit ripping them off, real people want their government to think of solving this problem instead of listening to the lobbyists who have no one but their employers interest at heart. obama is closer to any one to solving the problem that has haunted government and that the insurance industry has successfully fought off for over 40 years I say do what the people want, deserve, and what is best for everyone.
Unfortunately for you, the real people you are talking about were at tea parties, and you have nothing but disdain for them. If you've given up on real people I don't know what your options are. Take a minute to figure out why you bought into the line from MSNBC about how participants in the tea parties shouldn't be thought of as people - do you really intend to dehumanize people for non-violent expression of opinion? Then give some thought to how "what the people want" and "what is best for everyone" are two very different things. That's where the hand work of health care policy lies. You've got only one kidney available for transplant, does it go to the healthy 85 year old or the 25 year old drug abuser. From the patients perspective you are the death panel.
MNEMOS is so right here. I went to a Tea Party and met folks from all walks of life. Lib, Conservative, moderate etc. I cam home and found out I was a "Tea bagging racist" I was stunned at the disparity of what I saw and what the MSM tried to tell my "lying eyes" what I saw. Please pay attention to facts folks not a smear campaign by the freaking WH and the MSM to make middle America into the enemy!
There were real people at the tea parties - unfortunately, many were given and believed wrong information.
Private insurance companies make decisions that affect the health and well-being of their insureds - and they make those decisions based on their bottom line. Is that what you want? Don't you know people whose doctors prescribe medication or procedures and then they have to fight with their insurance companies to get what they need. That's a bureaucrat between you and your doctor.
You don't like MSNBC - fine. Just don't get all your information from Fox!
I hate to break it to you, you are on the death panel anyway. If you are an elderly person, you will not get that kidney under anybodies healthcare plan as it stands now. matter of fact, you might lose healthcare all together. I suggest you read you healthcare pamplet because it's just as long and confusing as what congress is doing.
Besides, what about if you're HIV, Hep C, Cancer Survivor, heart transplant, high blood pressure, overweight or had menatl health problems in the past, you are dropped, so don't tell me healthcare is perfect as it stands. And for the record, teabaggers where a bunch of racist bastards.
Who pays for your plan? Rich people? (Also known as employers) The public option is a ploy for the government to take over more of the private sector. The lies and the fuzzy math coming out of Washington is not what people voted for in November. What happened to transparency?
Not just 57% of the people. Also 62% of doctors, unless you count the ones that prefer single payer to public option. Add them and you get 72% of doctors, per the AMA.
Mr. Yglesias, we understand what the public option is, even if we don't know all the minutiae. We also understand what the health insurance companies are and how they operate, without knowing all of their minutiae. We know what we want, even if you don't.
Think about it. If the legislators don't even know what it is in general terms - and they don't, if you think you know what it is, you're assuming it is whatever you want. It's not a question of minutiae - nobody knows in even general terms. That is the real flaw in the poll he's pointing out - there's no real question. Or more precisely the question is equivalent to "Do you like your favorite color?" That doesn't tell you anything about whether people like green, red, yellow, blue, or whatever.
The Wash Post/ ABC poll is a hack poll.
Glenda, it's refreshing to see you post a cogent, well-support argument, rather than a baseless assertion. Keep up the good work.
LOL
Its pretty well known all news network polls are bullshit, ask a fox poll, 90% against, ask a cnn, its around 50/50, ask abc or nbc 90% in favor.
You would suggest maybe Rasmussen?
I think this is the essence of what's meant by "transparency". People don't need to read all 1,786 pages or whatever, but they do need to understand the basic premise of the plans, not just some marketing drumbeat about how it's good or bad or how we have some moral imperative to do it, whatever it is.
The left insists the public option will keep the insurers honest and make health care better for the entire country, the right insists it will gobble up the private sector. Neither of these results is possible if the public option is only available to those who can't get into some other group plan.
I'll bet if the poll question was "The public plan will not make your life any better or any worse - are you for it or against it?", the answer would be, "Why bother?"
America is gradually being returned to being a feudal society, after a brief glimpse at being a democratic society with FDR's "New Deal," which has been largely abrogated by the Republican Party and the greedheads in corporate boardrooms, in banks and on Wall St.
The tragic fact is that while the richest few continue to get richer at an accelerated rate, more and more working Americans are falling into poverty (see the front page of any newpaper in America today about this fact).
The healthcare insurance companies are like raiding groups of feudal times, who would rape, pillage and destroy a village and then move on to the next one. Wall St. and the Banks are like entitled suzerains, who work their serfs to death, while living off their labors.
America is fast becoming an economic nightmare run by the plutocratic sociopaths, and it may take more than an election of the Democratic Party to reverse this on-going human tragedy.
You're even nuttier than i imagined.
Glenda is correct! Here are the sample numbers:
"The sampling comprises 33% Democrats, as opposed to only 20% Republicans."
Eurydice, here was the question as posed:
8. Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans? (pretty vague heh.)
Not, "Do you support the democrats plan for a public option?"
because as we all know, this poll is skewed to help dems sell a bill of goods that the majority do not want.
go here for accurate recount oe the numbers on this poll.
http://hotair.com/archives/2009/10/20/wapoabc-poll-uses-skewed-sample-to -show-public-option-support/
Therefore, 47% was comprised of independents. How skewed, indeed!
I don't think you understand how polling and sampling works. The reality is there are several recent polls that show only about 20% of the public identifies themselves as Republicans. Also, ~35% identifiy as Democrats. So that says this poll is a very accurate snapshot of the American public as a whole. If you polled the same amounts of Dems and Reps, THAT would be a skewed poll.
Also, by NOT using the word "democratic" in the question posed they surely skewed the answers further to the left.
Moron!
That question is actually more than appropriate because they didn't try to polarize it.
Yeh, these pollsters, like just prior to the last Presidential race when I received the telephone call for some national poll. Things went along pretty well for about three questions then it was stump the chump time.
The question, from this nice young woman was: "Regarding the upcoming election how likely are you to vote?" The choices:
a) likely
b) somewhat likely
c) not likely
d) undecided
My response: "I am definitely going to vote!"
It was unfortunate that after repeating these lines a few times, along with my further response was that SHE should decide which answer best reflected my honest response. I had enjoyed speaking with her and regretted when she hung up on me.
I can't say if the poll was skewed to help Democrats or not, but the question as posed is certainly misleading - it leads the respondents to assume that they would be the beneficiaries of this competition.
Not sure how "to compete with private health insurance plans" is misleading, if that is indeed what the plan is intended to do. If the poll said, "that will be cheaper than," then that would be misleading...
tfe912, the misleading part is the assumption that the issue will personally affect the person being polled. A lot of people have the impression that the public option will be an alternative for everybody. If the public option will only affect a very small subset of the population, it's not likely the person being polled will have a personal interest in it - and if he doesn't have a personal interest, his answer might very well be something different. It's like asking "Do you support or oppose having the government repair the highways?" and not mentioning that they mean the highways in China.
I've been working for single-payer systems since 1992--tabling, signing petitions and attending protest rallies. the longer the current debate goes on, the more unclear it becomes as to what the final result of 'reform' will be--or what the public option is about. Is the public option going to be a sort of augmented Medicaid for middle-class people who can't buy conventional insurance? My insurance is horrible--but is reform going to help me move to another carrier? Is it going to cut costs or mandate price controls on the big insurers? Is reform going to hold my current insurer's feet to the fire by eliminating 'cherry-picking' of young healthy customers and 'granny-dumping' people over 50 (many of my friends are in this boat--too young for medicare but priced out of private insurance). Will the reform fix the current insurance practices of denial of coverage, recissions, and blocking 'pre-existing conditions'? Will my coverage (lousy as it is, but expensive) be considered a 'cadillac plan' eligible for taxation? There are contradictory answers coming out of various corners, and I don't like the sort of behind-the-scenes stuff happening in the reconciliation of the two bills.
Olbermann nailed the problem in his 'special comment' episode. If Obama had gone forward with a 'Medicare for all' proposal, there would've been enough understanding and support from people at large to keep the insurance co's and big pharma from being able to stop this reform. The mess that we see is because of all the attempts to buy off big stakeholders. Now that Big Pharma and AHIP are revealing their true colors and attempting to block any reform, it's clear that Obama couldn't write a check big enough to buy them off.
WaPo/ABC poll uses skewed sample to show public-option supportposted at 10:55 am on October 20, 2009 by Ed Morrissey
My first clue that the new WaPo/ABC poll had big problems in its sampling came from question 38 of the raw data released by ABC last night, the generic Congressional ballot. Most polls have that within the margin of error; both Rasmussen and Pew have it at a dead heat. The WaPo/ABC survey has Democrats winning that matchup by twelve points, 51%/39%.
That tends to discredit much of what the Post reports this morning:
A new Washington Post-ABC News poll shows that support for a government-run health-care plan to compete with private insurers has rebounded from its summertime lows and wins clear majority support from the public.
Americans remain sharply divided about the overall packages moving closer to votes in Congress and President Obama's leadership on the issue, reflecting the partisan battle that has raged for months over the administration's top legislative priority. But sizable majorities back two key and controversial provisions: both the so-called public option and a new mandate that would require all Americans to carry health insurance.
Independents and senior citizens, two groups crucial to the debate, have warmed to the idea of a public option, and are particularly supportive if it would be administered by the states and limited to those without access to affordable private coverage.
But in a sign of the fragile coalition politics that influence the negotiations in Congress, Obama's approval ratings on health-care reform are slipping among his fellow Democrats even as they are solidifying among independents and seniors. Among Democrats, strong approval of his handling of the issue has dropped 15 percentage points since mid-September.
The sampling comprises 33% Democrats, as opposed to only 20% Republicans. That thirteen-point spread is two points larger than their September polling, at 32%/21%. More tellingly, it's significantly larger than their Election Day sample, which included 35% Democrats to 26% Republicans for a gap of nine points, about a third smaller than the gap in this poll. Of course, that's when they were more concerned about accuracy over political points of view.
Remember when I wrote that poll watchers need to remember the recent Gallup poll on party affiliation? Gallup polled 5,000 adults and found that the gap between Democrats and Republicans had closed to the smallest margin since 2005, six points, and had been reduced more than half since the beginning of the year. For the WaPo/ABC poll, though, their sample gap has increased almost 50% during that time.
Given that skew, it's hardly surprising that they find a 57% approval rating for Obama, up three points since last month, almost the entirety of the gap increase since the last poll. His 48% tie on health care should be a significant disapproval instead, and the 45%/51% slide on the deficit has probably expanded at the same rate as the deficit in a survey with a realistic sample.
However, even that support seems rather ... murky. In question 6, "Overall, given what you know about them, would you say you support or oppose the proposed changes to the health care system being developed by (Congress) and (the Obama administration)?", only 45% said they approved, while 48% said they disapproved. The public-option question gets asked in this manner:
8. Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans?
I'd call that more than a little biased. The "compete with private insurance" is a political claim by ObamaCare advocates. The private insurance industry competes within itself, just as all markets do. The government plan would not compete, but would undercut prices while getting subsidized on losses, while the same government imposes "fees" and new taxes on insurers. It's no more "competition" than it would be to have Wal-Mart run the retail business and assess fees on its "competitors" for the privilege of existence.
On that question, the public option gets the exact same numbers as Obama's approval ratings. Consider the implications of that in regards to this skewed survey.
Liberals hide behind a mask of morality to force upon the american people something which has never been popular in this country, socialism.
Thinking that the public option is anything other than socialistic medicine is very naive. Its ultimately the first big step to the liberals ultimate goal of making this country a socialistic dystopia.
Come in out of the rain. If there was any definition of what a "right to medical care" was, it could be a part of the social contract without being a stepping stone to socialism. With clearer definition, people could make informed decisions. The way to rip off the mask of morality is to force people to define what is being discussed, so the choice can be between something other than "No" and a blank check. The heart of the issue is Democrats asking for a blank check - because they don't want any limits in what they are asking for and are comfortable with a step toward socialism - and Republicans saying no, because a blank check makes no sense.
Conservatives hide behind the mask of fear to start wars.....c'mon VP
Yes because all conservatives love war and a liberal has never supported any war, ever, EVER EVER.
mnemos
Statement of Congressman Ron Paul
United States House of Representatives
More Government Won't Help - September 23, 2009
Government has been mismanaging medical care for more than 45 years; for every problem it has created it has responded by exponentially expanding the role of government.
Points to consider:
1.) No one has a right to medical care. If one assumes such a right, it endorses the notion that some individuals have a right to someone else's life and property. This totally contradicts the principles of liberty.
2.) If medical care is provided by government, this can only be achieved by an authoritarian government unconcerned about the rights of the individual.
3.) Economic fallacies accepted for more than 100 years in the United States has deceived policy makers into believing that quality medical care can only be achieved by government force, taxation, regulations, and bowing to a system of special interests that creates a system of corporatism.
4.) More dollars into any monopoly run by government never increases quality but it always results in higher costs and prices.
5.) Government does have an important role to play in facilitating the delivery of all goods and services in an ethical and efficient manner.
6.) First, government should do no harm. It should get out of the way and repeal all the laws that have contributed to the mess we have.
7.) The costs are obviously too high but in solving this problem one cannot ignore the debasement of the currency as a major factor.
8.) Bureaucrats and other third parties must never be allowed to interfere in the doctor/patient relationship.
9.) The tax code, including the ERISA laws, must be changed to give everyone equal treatment by allowing a 100% tax credit for all medical expenses.
Laws dealing with bad outcomes and prohibiting doctors from entering into voluntary agreements with their patients must be repealed. Tort laws play a significant role in pushing costs higher, prompting unnecessary treatment and excessive testing. Patients deserve the compensation; the attorneys do not
10.) Insurance sales should be legalized nationally across state lines to increase competition among the insurance companies.
11.) Long-term insurance policies should be available to young people similar to term-life insurances that offer fixed prices for long periods of time.
12.) The principle of insurance should be remembered. Its purpose in a free market is to measure risk, not to be used synonymously with social welfare programs. Any program that provides for first-dollar payment is no longer insurance. This would be similar to giving coverage for gasoline and repair bills to those who buy car insurance or providing food insurance for people to go to the grocery store. Obviously, that could not work.
13.) The cozy relationship between organized medicine and government must be reversed.
Early on medical insurance was promoted by the medical community in order to boost re-imbursements to doctors and hospitals. That partnership has morphed into the government/insurance industry still being promoted by the current administration.
14.) Threatening individuals with huge fines by forcing them to buy insurance is a boon to the insurance companies.
15.) There must be more competition for individuals entering into the medical field. Licensing strictly limits the number of individuals who can provide patient care. A lot of problems were created in 20th century as a consequence the Flexner Report (1910), which was financed by the Carnegie Foundation and strongly supported by the AMA. Many medical schools were closed and the number of doctors was drastically reduced. The motivation was to close down medical schools that catered to women, minorities and especially homeopathy. We continue to suffer from these changes which were designed to protect physician's income and promote allopathic medicine over the more natural cures and prevention of homeopathic medicine.
16.) We must remove any obstacles for people seeking holistic and nutritional alternatives to current medical care. We must remove the threat of further regulations pushed by the drug companies now working worldwide to limit these alternatives.
True competition in the delivery of medical care is what is needed, not more government meddling.
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Its sounds to me you want to enter a market with none of the risks, thats not capitalism.
To make on omlette you have to break a few eggs, and to operate in a market you have to incur risks. Come talk to me when your bussiness is off the ground (if it ever even gets there) and we'll see how you feel about the heavy tax burden choking your small bussiness to death while you still live the plebeian lifestyle, then we'll talk about the benefits of socialism.
The author assumes that the "public option" would only be relevant to those not covered by other gov't or employer plans. A big chunk of people unfortunately but hardly a majority. However, how many people would like to switch jobs, start a business, etc but stay in a job that isn't optimal because of their health insurance? If they actually had another affordable means of obtaining insurance, they would be better off. This would make for a more efficient labor market (why must my health be tied up with my job?) but is bad news for private insurance profit-takers.
What is the solution for Americans with out health care if we do not have a public option? I do not fully understand the plan,but I do know if my spouse dies......I am without insurance in six weeks. I could never afford to pay for cobra or a new plan.
I find it interesting that a college student is not permitted to enroll in school unless they have medical insurance. If a parents plan isn't available they can pay $1,200 for a plan that covers even prescriptions.
In a ten year period my family spent $16,000 on braces and dental bills. We finally quit going to the dentist, Dentures are next.(I forgot to add we have no dental insurance).We cannot afford the bi-focal glasses we both need. We do not have eye coverage either.
I do not have any answers,but, the way things are do not work so well.
A heart surgery cost my family member $100,000. None of this makes sense to me anymore.
You actually touched two different edges of the reason this is so difficult.
First, braces, in most cases are not medically necessary, yet we pay for them so our kids have a nice smile. If it was not necessary, why should someone else pay for it than you?
Bi-focals? Maybe the same. Not absolutely necessary. It is a fact of nature eye site deminishes with age for many. So again, why should someone else pay for you to have bi-focals?
Heart surgery, that probably saved your family members life. And it was expensive. As a wealthy. compassionate country, we should find a way for everyone to have coverage for this.
Life was simpler when we had no treatments for most health concerns, eh? Now that we have them, everyone wants them, regardless of cost.
Diseased teeth contribute to a diseased body. And if we're going to expect our aging population to work more years before they can collect Social Security or Medicare, it might be nice if they could see what they were doing.
Again, what the left is so afraid of is real democracy.
I have sent the following to my representatives in Washington DC, "No provision of this bill shall be in force in any state that doesn't accept the bill by an affirmative vote by the state's legislature". And when I say no provision I really mean no provision including any tax in the bill. This should satisfy everyone. It passes the so called public option the left wants and it gives the people the right to say no which should appease the right.
The state legislators are in fact the watch dogs of the people.
Power to the people.
The term "socialism" is used as a scare tactic by those who for reasons beyond comprehension want to allow private enterprise to gouge consumers.
When it comes to "socialism" or a government mandate to do things, it is the private healthcare insurance companies that are practicing it. They are exempt from anti-trust laws! They are allow to cherry pick who they will insure! They are allowed to deny coverage to premium payers on their made up excuse of "pre-existing conditions."
The private healthcare insurers prey on the American public, much like wolves do on livestock. The big difference is that wolves only take down enough livestock to feed themselves, while private insurers can never get enough.
Their is no reason why the American people can't institute a healthcare program that protects everyone at reasonable rates that won't bankrupt them or the nation. Many other nations do it at half the cost that our corrupt system does.
If a public option brings down these private insurers rates (or the companies themselves), I say godspeed!
The term socialism isnt a scare tactic, it is what it is, an attempt at social engineering.
Insurance companies are supposed to be private enterprise, therefore its not social engineering because a person can only enter in with an insurance company by their own free will.
It sounds to me like you hate the free market and the idea a bussiness can run their bussiness however they please, so basically you are in favor of socialism, which if you are, just say so, dont dance around this notion that somehow you want to engineer society but you're not a socialist, thats like a capitalist saying he wants his bussiness run by the government, it makes no sense.
The moral problem with institution a GOVERNMENT healthcare program (you used the word american) is that its paid for by people who dont want it. You're stealing money from people to pay distribute it to someone else, if that isnt socialism, i dont know what is. Thats not even talking about all the problems that arise with insituting such a program. Its just more corporatism.
I don't want to fund a useless war, but my tax money goes to that "cause" That is steeling money from people to pay distribute it to someone else...the people that run the war machine...Perhaps you think that is socialism as well...
If that war is unnecessary then yes, it is. Or at the very least socialistic in nature, and plays into the larger scheme of corporatism or the "war machine" as you might call it.
The private health insurance industry is not even close to a "free market" situation. Firstly, the ability to access healthcare services is hardly a "take it or leave it" good. It's not like a company that sells shoes, or bread, or cars....they are optional goods. If one doesn't fall into a health program covered by the gov't, s/he must either buy into the private insurance market or opt out and, except for those who are quite wealthy, essentially go without healthcare. This isn't the same as deciding not to invest in those cookies at the grocery store.
Also, a central tenet of the free market system is that the consumer has more or less equal bargaining power to that of the supplier, and that the consumer has the ability to weigh one option against another (i.e., should I buy a Dell, HP, Apple, etc.). For most of us in the private market, we have to take what our employers offer. We are limited by the plans we can access (and many voluntarily remove themselves from the market for certain types of people, according to health status, age, gender, etc.). Additionally, in some states, one health plan holds an essentially monopolistic position, covering almost every resident in the state. That hardly breeds the organic competition that would be present in a true free market system.
And, probably the largest inverse of a free market is the fact that health insurers are financially incentivized to NOT provide the very "product" they are selling. I don't have to tell you this, but this is the opposite of the ideals of capitalism, in which a producer of goods would WANT to sell as many goods as possible in order to make a profit.
So...if someone dislikes the current, private health insurance industry, it's not because they "hate the free market"; it's because they hate having to buy into a backward, corrupt system just to be able to afford to see a doctor, and even after paying a significant amount for premiums, deductibles, and co-payments, could still be denied care or dropped from a plan.
So basically your saying this over regulated market needs to be regulated some more? Do people ever even consider the idea that insurance is so expensive because it is so regulated? For example every state basically decides what the insurance companies operating in their state must cover. The problem with this is it takes away consumer choice and forces the insurance company to raise their prices because it raises the cost of doing example, take example if i were to go out and get insurance, i would be covered for cataract surgery or hip replacement, i am 20 years old, when would i ever need a procedure? If you took away such state requirements i could go out and buy a plan that would cover only the stuff i need, and it would be much more affordable to me. This regulation also stops small start up insurance companies because they are forced to cover things which a would be consumer might not want or need, it ultimately benefits large insurance companies who have the large amounts of cash it requires to cover their asses.
Another problem is that insurance companies arent allowed to do bussiness across state lines, this leads to each state having only a few companies operating in their respective state, essentially giving each insurance company a monopoly in their respective state, also because a company must also be licensed to sell insurance in said state, so large insurance companies are protected from having a real free market and it helps them keep costs up. There are plenty of things you can do about the cost of insurance without needing control, because, although with good intentions, control ends up being a much larger problem, rather than a cure.
As far as the incentive not to provide coverage, thats why we have fraud laws to protect consumers, if you enter into a contract with a bussiness they are be obligated to up hold their end of the deal, however the consumer needs to be wary and read his contract thoroughly to ensure they are getting what they expect, and pay for. However since they are protected from competing the shit companies stay in bussiness and are propped up by state legislation.
Matt, here's why you're spreading erroneous information. Here's why you're a liar. Read carefully.
You write: "... or get health insurance through your employer, the public option has nothing to do with you."
NOT TRUE for the millions of employers who will save money by DROPPING health-care coverage for their workers and instead paying a fine or payroll tax. At that point, their previously insured employees...and NOW SUDDENLY UNINSURED employees...get dumped into the government system.
So, whereas Obama said there would be a choice, the above leaves no choice.
Your dishonesty is appalling, but then you ARE a Democrat, so perhaps appalling dishonesty, your stock in trade, is to be expected.
Well said.
"A Government big enough to give you everything is big enough to take everything" This says it all. The Public option is merely the first step to take out the insurance companies and leave us with no other options. We must stand up NOW and let our elected leaders know (again) we do not want YOUR ideas of health reform.
Paranoid much?
Its only paranoid if you think the government can do no harm.
However if you have common sense then you know they can and that government control in general is bad, and leads to unwanted consequences.
The public option is the new leitmotif of the left. It means everything to these people. It has taken on religious proportions, and has replaced global warming as the rallying point for their outrage. The lack of a public option allows them to maintain the high level of rage which is strangely the basis for their happiness. If you give it to them you are actually taken something more important away.
Could someone explain to me how the public option would
a) have a lower cost while also
b) compete on a level playing field with private insurance
Matt claims that a public option would not be able to lower cost if operating on a state by state basis. This would require the Federal government to exempt the public option from state regulations. I agree that portability of insurance across state lines could lower insurance premiums, but current reform proposals do not allow this for private plans - so where is the level playing field?
Same comment for requiring providers to accept public option patients at medicare rates - this uses the tremendous market power of the medicare program to demand rates providers won't give to private insurers. Again, this could cut the cost for the public plan, but it is not a level playing field.
As I look at this, if the public option works on a level playing field - without special regulatory exemptions and requiring providers to give all insurance companies the same rates for the same services - it probably doesn't reduce the cost of insurance very much. If it is given a biased playing field (e.g. ability to sell across state lines, etc.), it destroys the private market. The public/private hybrid being proposed just doesn't make sense.
"Could someone explain to me how the public option would
a) have a lower cost while also
b) compete on a level playing field with private insurance"
Pretty simple. The difference is rather basic - the incentives for private insurance companies are towards reducing service and increasing waste, so that is what they do. In a public plan, the administrators get paid standard salaries, and are rewarded for providing services. In a private insurance company, the administrators pay themselves obscene salaries, and are rewarded for not providing services. The result is that since the 70s the private insurance companies overhead has gone from 5% to 30%, and medical costs for the "insured" has become the leading cause of bankruptcy. During the same time public insurance overhead has remained 3%, and their customers are extremely satisfied with their coverage.
Think of it this way - while you don't like the idea of public, universal health care, are you really willing to waste $300B/year, and suffer inferior service, just to afford the waste and inferior service provide by private insurance companies?
There was a time when police and fire protection were provided by private industries. That didn't work out either, for pretty much the same reason.
Matt,
You and I rarely agree. But when you said ...
"At the end of the day, health reform that improves people's lives will be popular, and reform that doesn't won't be."
That is mostly true ( Unemployment in double-digits will over-rule that statement. And frankly, if unemployment is at 5% universal health care can probably suck and the people will still be ecstatic ).
The problem facing the Democrats at this moment is this.
All the plans call for healthcare to start in 2013 or 2014.
This means big parades and shouts of hoorah we passed universal healthcare!!!!
Only what will the people see? Nothing. Nada. Zilch. Zip.
If anything the only part they will see is the BAD part because what kicks in BEFORE 2013 is the *fees* and cuts.
So come the election of 2012 as the Democrats are standing and praising how they passed and overhauled health care ... and the voters are sitting going ... " errr ... nothing happened., your over haul sucks!"
You can get out the broom for a sweep.
And if it is passed via budget reconciliation ... scheduled to take effect in 2014?
Expect the President to be standing on the podium swearing in his replacement knowing his replacement won on the platform of "What was passed via budget reconciliation is fair game to CANCEL via budget reconciliation." And his whole legacy will be gone by the end of Jan 2013 ... with not a single filibuster vote.
The public option should be an expanded Medicare program for those under age 65, paid for by taxes or subsidies from the Treasury and Federal Reserve,
That would be much cheaper than expanding private insurance and also guarantee universal coverage, like they have in every other Western nation.
Invalid point to mention all the other western states.
Why?
Guess what? Not one of those western states ... not ONE is much above the equivalent of either New York or California.
The often mentioned French system? If France became the 51st State it may not even be in the top FOUR state economies in a normal time. It would be behind Calif, New york, and often Texas and Florida.
What you are proposing here is a health care system for EVERY SINGLE European country ... both western AND Eastern, PLUS about another 50 million people.
Let me clarify. We talk about 42 million uninsured people. 42 million is HALF the population of Germany. 2/3 of the population of France.
We are NOT like other western countries.
We are what the European union WANTS to be.
A Federation ... not a nation ... a Federation of soverign states.
The UNITED States, not the United STATES.
We need a healthcare system for US and our needs. Not one that matches what every little podunk country like France does.
Well said.
I would differ only in that opening-up Medicare for public enrollment could be paid for through typical insurance premiums, and should be, allowing Medicare Part E(veryone) to compete with private insurance companies.
Having such a not-for-profit approach would minimize the costs associated with subsidizing those who can't afford coverage, while pressuring the private companies to keep their plan costs within reason, as determined by the market.
People have an adequate general understanding of the public option and surveys show that support increases the more the option is explained to respondents.
Yes Congress should do the right thing ...pass government run universal health care for all Americans.
"universal health insurance"
there's a difference.
The insurance and health care currently offered in the US benefits the wealthy and the insurance business...We do not need to reinvent the wheel. Expand Medicare to cover everyone.
Medicare is going broke, as is Social Security. Government programs are unsustainable and the only way these programs can be funded is by raising taxes.
Or have people pay fees, "premiums," should they wish to enroll in a Medicare Part E(verybody) insurance plan, where the premiums could be slightly higher than cost to 1) make the non-profit solution less competitive as a giveaway to the private insurance vampires, and 2) help pay for subsidized enrollees and Medicare, in general.
"Medicare is going broke, as is Social Security." this is incorrect. Both Medicare and Social Security are doing fine - they are fully funded for many decades, and after that they _might_ have to cut benefits a few percent (or raise fees a few percent).
What's really hilarious is that their payments to make up the shortfall in the Medicare payments to doctors in order to get them on board are not being handled as part of the 'reform'...
When Bush kept the war costs separate, that was nothing short of criminal, even though it was totally visible. Now these hypocrits are doing the same thing.
Thank you.
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