It Is Not Reform Without Public Option (Guest Voice)
It Is Not Reform Without Public Option
by Jim Bell
There has been a lot written lately about the possibility of scratching off the public option from the health care proposal now working its way through congress. What, then, can be implemented to control the rampant and out of control cost escalation since the health insurance giants have demonstrated that they are powerless to control these rising costs? We now have an absence of universal coverage and an industry-wide policy of denying coverage because of pre-existing conditions (among other reasons). Both of these factors, plus the health insurance companies’ deep pockets insure that health care costs continue to rise much faster than the current inflation rate.
Health care cost increases have outpaced inflation rates since the insurance companies got involved in health care to begin with. And health care has never been universal during that same time period (not that it was universal before, because it wasn’t). Still, insurance companies have amassed huge profits. And although it is not a bad thing for any company to make a profit, this profit further contributes to our skyrocketing health care costs. Add to this all of those people without insurance who must go to emergency rooms to get medical attention and you begin to get an idea of the disaster we now know of as the American health care system.
Most of us already knew this much. But when you realize that everything in the economy is connected in some way or another you begin to see that this problem has a ripple effect that extends out beyond healthcare into other vital areas of our economy. Everyone in the U.S. knows how uncomfortable it is to have your doctor tell you that you cannot have a treatment, a medical procedure or a prescription because it isn’t covered by the insurance. We also know what it is to have the doctor tell you that the reason for this denial is always the cost. Maybe you work for a small business that cannot afford a very comprehensive policy. And lately, it has become possible that you, the employee cannot afford the policy which provides the kind of coverage you need. It doesn’t really matter what the reason is. Maybe you need more care because you are aging. Maybe a member of your family has developed an expensive health maintenance issue.
Just this last year health insurance doubled for many and many of us were faced with higher costs for less coverage. If you are a small business owner, you may not be able to afford health insurance for your employees. That places your employees in the emergency room set. This has to stop. This is such a blatant problem that the government is stepping in and is working on reform. That’s nice. In the beginning the health insurance companies publicly joined the bandwagon and said, “Yes! We need to reform our health care system.” We aren’t reading statements like that from the health insurance industry anymore. This has turned into an old fashioned political dogfight.
Some argue that if the government enters the health care arena we will wind up with long lines and bureaucratic problems much like we have when we go to the DMV to renew our license plates. While that may conjure up bad images of long waits involving taking a number and waiting forever, Who wouldn’t much prefer that to finding out they have cancer and that they cannot get it treated unless they can find a way to come up with $40,000 because they don’t have health insurance? And who wouldn’t also prefer dealing with bureaucratic nonsense to having to come up with a $2,500 up front cost because of the conditions laid out in their current health insurance policy.
There are also those who are afraid that the public option is simply a way for the government to step in and completely eliminate the insurance companies from health care all together. So what! If the insurance companies want to stay in the health care business they should find a way to help provide universal care without costing the average citizen almost half their family income. American public health figures don’t stack up well on the world scale as it is. Sadly for the insurance companies, the competitive nature of the free enterprise system demands such efficiency that some potential customers will almost certainly be left out. And yes, to the health insurance companies we are customers—not patients.
Nobody wants their health care decisions made by some bureaucrat instead of collaboration between them and their doctor or doctors. The same people, who voice this concern out of fear that the bureaucrat in question might be a government one, forget that they are already in that position, only the bureaucrat they deal with now is working for the insurance company.
This brings us back to the latest development in Washington, which is the news that the public option may be scrapped. If this actually happens can we still call it reform? Which of our health care problems can possibly be fixed if we cut out the public option? Will we get universal coverage? How about affordability? Will the newly reformed system be able to exert any kind of cost control? Will it be possible for small businesses to provide employee health care?
Fixing our ailing health care system without the public option is no where near realistic. Our current system is not producing quality national health care anyway. On the world scale, we are lagging behind in life expectancy, cancer rates and infant mortality rates.
What kind of actual reform can we possibly achieve without the public option? It is naive to place stock in any solution that resembles the status quo. If we don’t find a way to address our out of control rate of rising health care costs we will eventually be in the situation where all we cannot afford health care at all.
Jim Bell blogs at The Sensible Approach. Guest Voice posts do not necessarily reflect the viewpoint of TMV or its many writers.
19 Responses to “It Is Not Reform Without Public Option (Guest Voice)”
Good post, Jim. I agree with you, obviously, and get regularly demonized by both readers and ahem, staff, for my opinion. So for those commenting on the thread, two questions:
What value does an insurance company add to health care?
My second question stems from a discussion on another thread, of decoupling insurance from routine care by using catastrophic care coverage only, and letting all routine medical costs be the patients' sole responsibility. My question, as one who has explored exactly that option, what's the cheapest “catastrophic” insurance policy you've found, say for a 30 yo woman and a 50 yo man? I have not found them to be affordable or a realistic option. Seems the insurer wants just about as much for catastrophic care as comprehensive.
Touching [sic] cartoon, but the facts are otherwise. It's certainly relevent mentioning, given that the public option is the primary feature of the Dem effort and having so much attachment by the febrile nowadays.
About the only thing you can honestly claim (though the supporters refuse, in addition to stooping to all kinds of poor behavior) is that the public option is the core, the literal heart of what is being sought, which is partial (incremental) federal takeover of health care in the USA rather than all of it at once, which the public rejects (especially given the Dems' and activists' misbehavior and misdeeds to date this year).
In fact, something I've mulled over as an alternative to what is being done now, if the Democrats cease and desist their current craziness and intelligently decide on what they want to do, is to scrap not only the stupid behavior but all the non-essentials, and redesign their propsal to consist not only primarily but exclusively on the public option.
This is the invasion and conquest of Russia, the latest and rashest military opening of a front before securing any others. Fine, but it can be pulled off (and in the 1940s, the Soviet government in fact dabbled with peace feelers, did they not?) Strip out the non-essentials. Quit wasting time and effort on Leningrad and the Ukraine; throw everything at the key objective only, Moscow, the “center of gravity” …
Plus, it's finally honest if they do this, as well as bold, and we'll see if they have confidence and honesty, for a Change [tm]. Make it all about the public option and (rigged) competition with the private providers, a Government Motors created all from scratch rather than taken over and highly modified.
Be honest and grown-up, for a real Change [tm]. Make it an up-or-down vote on the public option alone.
[shrug] If the Dems actually were honest and grown up like this, and behaved intelligently and forthrightly for a Change [tm], they might surprisingly have more public support than the ever-lowering support they currently have — more support than many an accurate observer of public opinion might be led to believe.
That's what it always has been about. No, not the Big Lie that “reform” requires the public option (nobody of any intelligence has ever believed such a lie). But federal takeover, within the current Dem effort, federal takeover being the real issue here, obviously requires the public option. It's the core of what you want. So why not admit it and revise your effort and hold a straight up-and-down vote on it, alone? (Rather than be dysfunctional and worse…) The rest (and more takeover) can come later, any time. (There is no rush, children, particularly if you want to play chess and win like a python rather than bungle it imagining wrongly you are a tiger. There is no quick check and mate here.)
Get rid of all the other junk and pursue just the core, the public option — if you can and if you dare.
* * *
“What value does an insurance company add to health care?”
Integration and economies of scale. You know, like government if government were the middleman (intermediary). (What did you expect me to say, “Excessive profits and executive compensation?” [grin] Of course, while there may be insurer misdeeds, government would also be malevolent, and is in the position to be more so. Switching intermediaries will exchange one set of problems for another…)
“[W]hat's the cheapest “catastrophic” insurance policy you've found, say for a 30 yo woman and a 50 yo man? [...] I have not found them to be affordable or a realistic option.”
I haven't actually been able to get catastrophic care for years, as state laws and the nature of the market result in more elaborate, more costly programs. Typically in the $300s monthly for an individual. Family rates can often exceed $1000 monthly. All I can say is that with automobile insurance (real insurance, not comprehensive automobile care, maintenance, tune-ups, etc.), in some places the differences in the deductible levels have not amounted to much as a proportion of income, so I have had leeway here, but obviously even the cheapest insurance is likely to be a problem of truly low income people or those who, say, are unemployed.
“[T]he public option may be scrapped. If this actually happens can we still call it reform? Which of our health care problems can possibly be fixed if we cut out the public option? Will we get universal coverage? How about affordability? Will the newly reformed system be able to exert any kind of cost control? Will it be possible for small businesses to provide employee health care?”
Of course it is still reform (the Dems are enamored of misusing words and could call anything “reform”…).
What could they do instead?
How about:
Community rating legislation (state-wide, region-wide, nation-wide);
Uniform benefits packages (kept minimal to keep it affordable);
Subsidies or vouchers to those who need it to afford “insurance” [sic; health care];
Inter-state and multi-state policies and “insurance” organizations;
Etc.
All of those are true reform measures that constitute definitive positive progress and address known problems.
But if government displacement of the private sector is what you want instead, the public option is for you.
I am fairly certain that is completely false and that costs began to outpace inflation with the creation of medicare. Either way, I would like to see some evidence to support that assertion.
The author also fails to explain how, exactly, a public option reigns in costs or even reduces the rate of increase above inflation. The Democratic bill is not even revenue neutral, particularly when one considers it its partially paid for with medicare benefit cuts.
Andy:
A Kaiser Family Foundation analysis, “Trends and Indicators in the Changing Health Care Marketplace,” reports that, with the exception of 1996, annual increases in insurance premiums have been at least double overall inflation since 1988. Beginning in 2002, insurance premium increases each year have been at least three times greater than workers' earning increases.
Well…..It would appear that Socialism is More Efficient than Capitalism, since every modern nation, (and some not so modern), take care of ALL THEIR PEOPLE and clearly are not breaking the bank with Nationalized Medicine. No nation wants our stupid capitalist institutionalized corruption for a healthcare system.
Face it now or face it later, Socialized Medicine is the ONLY answer. There is no room for profit in healthcare, besides profiting on the vulnerable is immoral anyway.
Healthcare aside, IMO the insurance industry as a whole is merely a scam that should be eliminated anyway.
I still say, if Obama and the Dems in Congress have anything resembling gonads, they should zero in on the public option (which is what the liberal Democrats are militantly demanding, anyway, and which most of the other Democrats support, too), strip out all the other garbage they've been hurriedly cobbling into a junk pile, and just go with the public option alone. That always has been the key issue of theirs all along.
What are they afraid of (in addition to knowing the public recoils from a rush to 100% federal health care)?
“No nation wants our stupid capitalist institutionalized corruption for a healthcare system.”
They don't want government like Detroit's either.
That's a cheap shot, but also perfectly appropriate, differing from FedCare mainly just in matter of degree.
Relevent:
http://pewresearch.org/pubs/1317/would-american…
http://pewresearch.org/pubs/1293/health-care-pu…
[No surprise why...]
http://people-press.org/report/532/obamas-ratin…
DLS–
It's not a cheap shot…It's just FACT!
“They don't want government like Detroit's either”– Are you saying Americans are incapable od honest government? Must have been because of a Capitalist cultural influence called GREED!
Face it, Capitalism as we know it is dying
I was going to post a comment in response to this question:
Which of our health care problems can possibly be fixed if we cut out the public option?
But DLS pretty much beat me to it with a list of many other ways those goals could be addressed.
I'll also point out that in the post itself, the author is claiming that the public option is necessary for some goals which it doesn't even address at all, especially universal coverage. You don't get universal coverage with a public option, you get it by mandating universal coverage. The current HR 3200 has such a mandate in it, and there's no reason that the mandate couldn't be retained while losing the public option.
Greendreams,
Naturally. The cost of healthcare is increasing, outpacing inflation and GDP (average of 2-3 times inflation over the past couple of decades). This has been the case since the 1960's. It stands to reason that premiums must increase too. If health care costs are rising at 2-3 times the rate of inflation rates why wouldn't premiums similarly increase?
So the problem isn't insurance premiums – the problem is the cost of healthcare. As long as the cost of healthcare keeps rising, so will insurance premiums.
Andy
Surely you see the answer right?
Private insurance companies stand to gain IMMENSELY by increases in the higher cost of healthcare. Does an insurer care if the cost of an MRI is %1000 percent higher in the US than in Japan? Of course not. Because they are operating on a cost plus basis.
It's basic economics really. Would you rather skim 20% from a $100.00 MRI or 10% from a $1,000.00 MRI?
To quote a long lost comedian. This isn't brain science or rocket surgery.
What exactly is the incentive (you may have heard of incentives in business) to reduce costs when those reductions will appear on your bottom line?
It's Econ101 really. And oddly enough, the concepts of marginalizing incentives versus maximizing incentives are very “conservative” if we view the word with any meaning.
Then again, we are dealing with folks who couldn't define socialism if their lives depended on it so perhaps this is a total waste of time.
I've been making that argument for weeks. The current plan guarantees both more premiums and unchecked rise in costs. It's a win/win situation for private insurance. In fact, it's almost like they had a hand in writing these bills….
oh wait a minute, they did.
Its not automatically Theft without the public option, with it it certainly is.
There is ground for compromise and bi-partisanship, but not with a public option in the mix. Time for some real reform not to mortgage the future more than we already have. 9 Trillion now folks, not the & million that the administration predicted.
Without Tort reform it's a joke!
“DLS pretty much beat me to it with a list of many other ways those goals could be addressed”
Thanks for noting I've posted this stuff. I'm not expecting credit for it and the tone I have been using on this site lately has nothing to do with “lack of recognition” of such things [chuckle]. Rather, though I'm not completely surprised at the progressively worse behavior of the Congressional Dems and recently of Obama on health care and issue after issue during this hectic year of theirs, I am surprised at how bad they really are, and what they believe they can do that escapes public scrutiny and concern (and worse), as well as the problems related to the lefty faithful nevertheless, including on this lefty site, that accompany it. It goes beyond surprise and mere frustration. [scowl]
“There is ground for compromise and bi-partisanship, but not with a public option in the mix.”
The public option is obviously an attempt at federal takeover of health care (the incremental move of choice, rather than extending Medicare to children or greatly raising eligibility criteria for S-CHIP or Medicaid, or absorbing Medicaid into Medicare, other examples I've given and some of which ought to have been considered in 1993, but weren't). Yes, it's going to introduce bad things (some of which are never going to be recognized or at least acknowledged or admitted by lefties no matter what, some of which are effectively concealed from many people because of cost shifting*). However, this is the main, the central, object sought by the Dems (many less-fervent as well as fervent lefty Dems), and that's why I say that one long-overdue instance of plain, sound logic and honesty by them should be to strip away everything else (which a “compromise” would involve) and just have a straight attempt or “shot” at a bill that sets up the public option (with perhaps at least mere token related things to reform insurance, to make the rigged, bogus “competition” and “reform” at least partially meaningful, and partially honest).
* Note something that many don't realize, but which is likely one reason why the private insurers are being retained in the current effort, as they would be in the case of Medicare for All. It's not merely to keep providers nominally private to assuage public concerns and to ensure continued fuel for lawsuit abuse, to satisfy a major Dem interest group.
Specifically with not only Medicare but likely with the public option and related legislation, or soon afterward, could be an increase in what happens now with Medicare, as a claimed way to “cut costs” with Medicare. Namely, when people not on Medicare attain the criteria for qualification, there is often a long waiting period first, during which the person's own (private) insurance is the “Primary Provider” and is the first payer for any claims. (Keep that terms “Primary Payer” and “Medicare Secondary Payer” in mind, those of you who are capable!)
What this is, of course, is deliberate cost-shifting (and a form of government mandate) of costs for Medicare patients from Medicare to the private insurers during this “primary payer” period. Medicare is cost-shifting whenever “secondary payer” status is in effect.
In addition to claims like Nanci Pelosi's in general that doctors and other providers, and the pharma companies, “can do much more” to lower costs, do not be surprised at all if future Medicare changes, sooner than you might expect, include the extension of the time that someone else will be the primary payer. Extending this period has been sought before and likely will be sought again sometime.
As I've said about other things, before: YOU ARE WARNED. Medicare will likely be second payer, longer. That's an easy cost-shifting mechanism that explains why Dems would retain private insurers — using them to “cut Medicare costs” by an obvious means.
http://www.medicareinteractive.org/page2.php?to…
http://www.cms.hhs.gov/MEDICARESECONDPAYERANDYOU/
http://questions.medicare.gov/cgi-bin/medicare….
Etc.
The cost of healthcare includes the cost of insurance overhead and profit. That's the problem, and the opportunity. The “low hanging fruit” of saving money is reducing the 31-37% overhead, profit and inadequate cost control caused by the private insurance model. As many have noted here and elsewhere, nonprofit options are cheaper wherever they have been implemented, meaning everywhere except here.
Next
That's preposterous. Absent insurance coverage, people go to the ER for trivial complaints. That costs more than paying for them to see a doctor. There is no legitimate argument for why we should pay for both the doctor visit and the insurance company profit. Insurance companies do not deliver health care.
Tort reform doesn't work. That is proven by the states that have capped malpractice (malpractice insurance rates went up in those states) and by the CBO under Bush, which found no projected savings from such “reform.” People who are hurt or whose loved ones are killed by incompetence, negilgence or corruption deserve their day in court and are granted it by the US Constitution. Period.
DLS, I agree the Dems should show some spine and pass what they truly believe will help, not what the insurance industry or its GOP lapdogs want. The rest of your diatribe about the “federal takeover of health care is pure talking point trash. The government already writes millions of checks. That's all we're talking about. Remember? Assess the claim, pay the doctor. That's all we need. Doctors and hospitals deliver health care now and will continue to do so, regardless of who pays them.
CS (“you get it by mandating universal coverage”). I do not want the insurance companies to be given guaranteed customers who must by law buy their product. Forced profit for check writers? How does that help us? It's like mandating that everyone must buy a money order to pay for a service they want to buy. I don't want the extra cost and overhead of an intermediary between me and my doctor. What I want specifically, is a nonprofit risk pool to cover extraordinary or unanticipated medical costs.