The Democrats Want Higher Taxes And Have The Public Option Back On The Table

[The Rabbi]

If that were the case, what would be the point?

Sometimes I feel like David Duchovny's character from Zoolander: "Are you serious? I just told you that, a moment ago."

Read.

And yes, it is true. You can easily look that up by reading the bill, it's very short. Look up H.R. 5808 on THOMAS.

`(2) OFFERING THROUGH EXCHANGES-

`(A) EXCLUSIVE TO THE EXCHANGE- The public health insurance option shall only be made available through Exchanges established under this title.

`(B) ENSURING A LEVEL PLAYING FIELD- Consistent with this section, the public health insurance option shall comply with requirements that are applicable under this title to health benefits plans offered through such Exchanges, including requirements related to benefits, benefit levels, provider networks, notices, consumer protections, and cost sharing.​

Sometimes I feel like Gunnery Sgt Hartman:
What is your major malfunction, numbnuts?

I asked what the purpose of having a gov't entity in the insurance market would be. And you respond totally off topic.

 

[Greenbeard]

Linking to the post where I already explained in detail what the purpose would be is off topic?

 

[Cuyo]

The Public Option isn't really an option at all.

It needs to be changed to "The Public Mandate" because insurance companies can't compete nor can they stay in business because regulations are going into effect next January intended to put them out of business.

Soon all insurance companies will be gone and Uncle Sugar with be the only option left.

But why not? I thought the government was inefficient? Surely the private sector will be offering the better deals.

They are. BUt they have access to tax money that private companies dont.

So? What does that have to do with selling insurance? They have a capacity to insure far more people than any individual private insurer, but since it's premium funded and (according to conservative think) is extremely inefficient, why wouldn't you conclude it will cost more for the same coverages?

 

[rightwinger]

But why not? I thought the government was inefficient? Surely the private sector will be offering the better deals.

They are. BUt they have access to tax money that private companies dont.

So? What does that have to do with selling insurance? They have a capacity to insure far more people than any individual private insurer, but since it's premium funded and (according to conservative think) is extremely inefficient, why wouldn't you conclude it will cost more for the same coverages?

So which is it?

Is the Government too incompetent to insure Americas health or a super competetor that private companies can't compete with?

 

[Political Junky]

Now they're floating stories that support their attempts.

CBO: Public health option would save $68 billion through 2020 - The Hill's Healthwatch

CBO: Public health option would save $68 billion through 2020
By Julian Pecquet - 07/22/10 11:16 AM ET

Creating a public option that all Americans could choose would save $68 billion through 2020, according to a new analysis by the Congressional Budget Office.

The analysis was included in a letter to Rep. Pete Stark (D-Calif.), who along with Reps. Lynn Woolsey (D-Calif.) and Jan Schakowsky (D-Ill.) is introducing a bill this week creating a public option in the state exchanges that start in 2014.

The new CBO report scores lower savings than the public options discussed during the healthcare reform debate because they were tied to legislation that differs from the law that was enacted in March.

The bill has more than 100 Democratic co-sponsors but faces strong opposition from the insurance industry, and physicians and hospitals worried that it would bring down payment rates.

Sorry, I'll trust the CBO over the opinions I read on here.

 

[Political Junky]

They are. BUt they have access to tax money that private companies dont.

So? What does that have to do with selling insurance? They have a capacity to insure far more people than any individual private insurer, but since it's premium funded and (according to conservative think) is extremely inefficient, why wouldn't you conclude it will cost more for the same coverages?

So which is it?

Is the Government too incompetent to insure Americas health or a super competetor that private companies can't compete with?

Cons support corporations over individuals' well being.

 

[rightwinger]

So? What does that have to do with selling insurance? They have a capacity to insure far more people than any individual private insurer, but since it's premium funded and (according to conservative think) is extremely inefficient, why wouldn't you conclude it will cost more for the same coverages?

So which is it?

Is the Government too incompetent to insure Americas health or a super competetor that private companies can't compete with?

Cons support corporations over individuals' well being.

I never saw anyone fight so hard for insurance companies

 

[The Rabbi]

Linking to the post where I already explained in detail what the purpose would be is off topic?

Yes. Because you didnt explain it.
And your rambling incoherent explanation somehow fails to realize that rates are high PRECISELY BECAUSE gov't (Medicaid/Medicare) reimburse at such low rates doctors must make it up on private insurance.
So this "solution" will actually make things worse. People on a "public option" will have fewer choices as fewer physicians accept the public option care because of low reimbursement rates. The existence of more ultra low reimbursement rates will cause those remaining doctors and health orgs to raise rates for everyone else to subsidize those paid out of public option. As the reimbursement from private companies go op, so do their rates. This throws more people on to the public option as they cannot afford the higher premiums. Eventually everyone is on the public option and gov't will mandate that physicians take it.

In the real world a private company attempting to reimburse at below market rates would go out of business since no one would accept their coverage and insureds would find better plans. But the gov't cannot go out of business.
The public option is a stalking horse for single payer and we have just proven it.

 

[The Rabbi]

So which is it?

Is the Government too incompetent to insure Americas health or a super competetor that private companies can't compete with?

Cons support corporations over individuals' well being.

I never saw anyone fight so hard for insurance companies

I'll take private companies over government mandates anytime.

 

[Cuyo]

So which is it?

Is the Government too incompetent to insure Americas health or a super competetor that private companies can't compete with?

Cons support corporations over individuals' well being.

I never saw anyone fight so hard for insurance companies

The arguments are so ridiculous and easily defeated... It's astounding they've picked up any traction at all.

 

[The Rabbi]

Now they're floating stories that support their attempts.

CBO: Public health option would save $68 billion through 2020 - The Hill's Healthwatch

CBO: Public health option would save $68 billion through 2020
By Julian Pecquet - 07/22/10 11:16 AM ET

Creating a public option that all Americans could choose would save $68 billion through 2020, according to a new analysis by the Congressional Budget Office.

The analysis was included in a letter to Rep. Pete Stark (D-Calif.), who along with Reps. Lynn Woolsey (D-Calif.) and Jan Schakowsky (D-Ill.) is introducing a bill this week creating a public option in the state exchanges that start in 2014.

The new CBO report scores lower savings than the public options discussed during the healthcare reform debate because they were tied to legislation that differs from the law that was enacted in March.

The bill has more than 100 Democratic co-sponsors but faces strong opposition from the insurance industry, and physicians and hospitals worried that it would bring down payment rates.

Sorry, I'll trust the CBO over the opinions I read on here.

Because they have such a great track record at predictions, right?
Health Care Reform Cost Estimates: What is the Track Record? | The Foundry: Conservative Policy News.

 

[Greenbeard]

And your rambling incoherent explanation somehow fails to realize that rates are high PRECISELY BECAUSE gov't (Medicaid/Medicare) reimburse at such low rates doctors must make it up on private insurance.

There isn't much evidence to indicate a significant cost shift associated with the existing public payers. In its last report to Congress on Medicare payment policy, MedPAC pushed back against this suggestion pretty hard (all emphasis is mine):

"Why are profit margins on privately insured patients so high? Is it because hospitals under financial stress tend to have significant Medicare losses, which force them to have relatively high private-payer prices? The answer is no. We find instead that hospitals under financial pressure tend to control their costs, which makes it more likely that they profit from Medicare patients. In fact, we find that Medicare margins are lowest in the hospitals with abundant resources (i.e., low financial pressure). Therefore, it appears that hospitals are raising prices when they have the market power to do so. As revenue rises, costs rise, and Medicare margins fall. Our key findings are:

• Costs vary widely from hospital to hospital.
• An abundance of financial resources is associated with higher costs.
• Higher costs cause losses on Medicare patients.
• As a result, hospitals with abundant financial resources tend to have Medicare losses.
• In contrast, hospitals with limited financial resources constrain their costs. Medicare payments are usually adequate to cover the costs of these financially pressured hospitals.

The Commission has argued that high profits from non-Medicare sources permit hospitals to spend more, and nonprofit hospitals tend to do so (for-profit hospitals may retain a larger share of their revenues as profits). The causal chain is as follows: A hospital’s market power relative to insurers, payer mix, and donations determines its level of financial resources. When financial resources are abundant, nonprofit hospitals spend more, add employees, and increase their costs per unit of service. High costs by definition lead to lower Medicare margins because costs do not affect Medicare revenues (which are based on predetermined payment rates). Therefore, when costs increase, Medicare margins ((revenue – costs)/revenue) decrease. In other words, income affects spending and costs per unit of service. Hence, if Medicare were to increase its payment rates, hospitals might spend some or all of that revenue rather than use it to lower the prices charged to private insurers. [. . .]

The data indicate that the hospitals with the largest Medicare losses tend to be in better financial shape than other hospitals. From 2002 to 2006, hospitals with low Medicare margins had median total (all payer) margins of 4.6 percent compared with 3.4 percent for hospitals with high Medicare margins. In addition, net worth for the high-cost hospitals rose by 17 percent from 2004 to 2006 compared with a 14 percent rise for low-cost hospitals. While causation may flow in both directions to a degree, the data suggest that the primary reason Medicare margins are inversely related to private-payer profits is that high non-Medicare profits are followed by high hospital costs.

It may appear odd that hospitals with high costs have high total profit margins. In a typical industry, high profits are not associated with high unit costs. The hospital industry is different, however, because of the dominance of nonprofit providers, the influence of payer mix, hospital and insurer market power, and the effect of investments and donations on hospital finances.

Increasing Medicare payments is not a long-term solution to the problem of rising private insurance premiums and rising health care costs. In the end, affordable health care will require incentives for health care providers to reduce their rates of cost growth and volume growth."​

So this "solution" will actually make things worse. People on a "public option" will have fewer choices as fewer physicians accept the public option care because of low reimbursement rates.

You argue this at the same time you argue it will be an attractive option for most people in the individual market.

The existence of more ultra low reimbursement rates will cause those remaining doctors and health orgs to raise rates for everyone else to subsidize those paid out of public option.

Therein lies the feature that distinguishes the public option for Medicaid or Medicaid: it's an option. Medicare and Medicaid are not open to you, thus their payment policies don't affect the relationship between your payer and provider. There is no credible threat that if they don't control premium increases you'll go buy insurance from Medicare because you can't do that.

That's the entire reason cost shifting can even occur, theoretically (though, as I said, there's limited evidence that it happens to any significant degree). You cost shift from A to B because B can't join A. If B could join A then, as you correctly point out, cost shifting would encourage him to do so.

Now imagine A is an available option (that is, an open public option, instead of the closed off Medicare). Since A reimburses at a lower rate than B, a provider would have very little incentive to take actions to shift B to A. Medicare + 5% will cover provider costs, meaning there's no necessity and nothing to be gained from attempting to drive up premiums on non-public payers. In fact, the incentive for the provider is now to reduce his own markups on medical services for private payers, allow them to control the growth in their own premiums, and reduce the disparity in premiums between public and private options.

Then private payers continue to have abundant customers and since they pay more (though, if all goes well, not too much more) than the public option, providers are better off. In other words, easing their upward pressure on private payer premiums ultimately helps providers financially because it prevents an exodus of customers from private plans to the public plan (which, again, reimburses less).

Cost shifting in such a situation makes absolutely no sense and certainly isn't financially necessary.

In the real world a private company attempting to reimburse at below market rates would go out of business since no one would accept their coverage and insureds would find better plans.

There is no "market rate" for provider reimbursements. Different payers will pay the same provider different rates for the exact same service. That is, unless you have all-payer rate setting (which, as I said earlier in this thread, I'll post a thread about in the near future).

 

[PatekPhilippe]

They say when your enemy is eating himself alive the best thing to do is pass the salt.



They can't admit to it because of Obama's promise to cut taxes for 95% of us....but most of the Dems still want to boost our taxes and now they've been looking at bringing back the Public Option again. They've been talking about it for a few weeks now.
There are some Democrats calling for keeping the Bush tax-cuts but they seem to be the ones that are the most in trouble in their states.

More Democrats Call for Keeping Tax Cuts - WSJ.com

House Progressives Push Reid To Put Public Option Back On Table

Fuck that!!!!!!!!!

 

[jeffrockit]

It doesn't drive them out of business, it forces them to be competitive.

They could always consider cutting executive salaries, DC Lobbyists, physician kickbacks, campaign contributions

No..just kidding
They would never do that

How can a private, for profit company, be forced to be competitive against a govt (taxpayer) funded business. The private co has to make a profit to survive and the govt does not. The private business has to earn the money it makes and the govt business just keeps taking from the taxpayer to fund its entity. No way you can consider that fair competition.

Thank you for admitting that the government run plan would be more efficient and cost less

Life is not always fair.......it is not fair when you are denied coverage because of a pre-existing condition
it is not fair that you lose your health insurance when you lose your job
it is not fair that you pay significantly more for insurance if you own your own business than if you work for a large employer

The well used Liberal mantra of "fairness". I admitted no such thing in my response. I completely refuted your contention that it would make HC insurance "more competitive" as there is no competition with the govt and their endless pool of money. The cost numbers continue to go up even with the HC plan in its infancy. The fact is the govt can't run anything cost effective. Medicare was stated to cost 12 million by year 1990. In actuality, the cost was 107 billion by that year. Tell me again how the govt plan will cost less.

 

[mudwhistle]

Greenbeard.....your explanation is quite lengthy so I decided to respond without quoting you in an attempt to be more to the point.

It seems that in almost every program the Democrats have started...Cash For Clunkers...their Jobs bill....mortgage assistance programs....they are both expensive and ineffective at solving the problem they were advertised to have addressed. I don't see Health Care being any different.

The Public Option is a total misnomer. It is advertised as an option but regulations in the Health Care bill were put there to make Single Payer the only option within a few years...maybe sooner. Insurance providers have looked at the mandates in the bill and they recognize that simple things like waving preconditions and requiring higher percentages for claims as a percentage of their total operating expenses will put them out of business within two to three years. They know when the regulations kick in next Jan. they'll have to raise premiums just to maintain enough cash on hand to meet the new requirements. This will open them up for the usual Marxist tactics of the Obama Administration. Once this starts a takeover will soon follow. Insurance companies will be labeled as rich greedy jerks that need more regulations.....and the regulators will quickly regulate those rich greedy jerks into a corner and out of business. Single Payer will be soon to follow.

You see the government will become a competitor to insurance companies....with an almost limitless ability to ether borrow or print money. Insurance companies will be in effect regulated by their competition. They have to raise premiums to meet their requirements but the government will be exempt from those requirements so they won't be operating on an even playing field. Insurance companies will be able to offer better coverage but their prices will be too high for anyone but the rich to afford. Soon even this will be demonized and laws will be put in place to outlaw buying your own insurance as is the case in Canada. Then the government will be in the position to dictate to us rather then simply provide an alternative.

 

[rightwinger]

How can a private, for profit company, be forced to be competitive against a govt (taxpayer) funded business. The private co has to make a profit to survive and the govt does not. The private business has to earn the money it makes and the govt business just keeps taking from the taxpayer to fund its entity. No way you can consider that fair competition.

Thank you for admitting that the government run plan would be more efficient and cost less

Life is not always fair.......it is not fair when you are denied coverage because of a pre-existing condition
it is not fair that you lose your health insurance when you lose your job
it is not fair that you pay significantly more for insurance if you own your own business than if you work for a large employer

The well used Liberal mantra of "fairness". I admitted no such thing in my response. I completely refuted your contention that it would make HC insurance "more competitive" as there is no competition with the govt and their endless pool of money. The cost numbers continue to go up even with the HC plan in its infancy. The fact is the govt can't run anything cost effective. Medicare was stated to cost 12 million by year 1990. In actuality, the cost was 107 billion by that year. Tell me again how the govt plan will cost less.

Sorry you aren't allowed on both sides of the fence here...

Either the Government provides a better more cost effective product that private insurerers can't compete with

Or as you say....."The fact is the govt can't run anything cost effective."

 

[Greenbeard]

Insurance providers have looked at the mandates in the bill and they recognize that simple things like waving preconditions and requiring higher percentages for claims as a percentage of their total operating expenses will put them out of business within two to three years.

Which is why they get three big things in their favor:

1. An individual mandate to prevent adverse selection;
2. Government subsidies to shore up their pool's cash reserves; and
3. Risk adjustment to correct for differing risk profiles between pools (since underwriting won't be used to do this anymore)

All of these (including medical loss ratios, for that matter) have been tried either in states right here in this country or in other nations around the world and they don't drive insurers out of business. This isn't uncharted territory.

You see the government will become a competitor to insurance companies....with an almost limitless ability to ether borrow or print money.

No. Only risk adjustment payments to the public option are allowed:

`(iii) LIMITATION ON FUNDING- Nothing in this subsection shall be construed as authorizing any additional appropriations to the account, other than such amounts as are otherwise provided with respect to other health benefits plans participating under the Exchange involved.​

Insurance companies will be in effect regulated by their competition. They have to raise premiums to meet their requirements but the government will be exempt from those requirements so they won't be operating on an even playing field.

No. The public option would be subject to the same rules as private insurers.

`(B) ENSURING A LEVEL PLAYING FIELD- Consistent with this section, the public health insurance option shall comply with requirements that are applicable under this title to health benefits plans offered through such Exchanges, including requirements related to benefits, benefit levels, provider networks, notices, consumer protections, and cost sharing.​

That includes funding all of its costs through premiums, even if that means raising them:

(1) ESTABLISHMENT OF PREMIUMS-

`(A) IN GENERAL- The Secretary shall establish geographically adjusted premium rates for the public health insurance option--

`(i) in a manner that complies with the premium rules under paragraph (3); and
`(ii) at a level sufficient to fully finance the costs of--

`(I) health benefits provided by the public health insurance option; and
`(II) administrative costs related to operating the public health insurance option.​

​

Insurance companies will be able to offer better coverage but their prices will be too high for anyone but the rich to afford.

Why do you think that is?

 

[mudwhistle]

Thank you for admitting that the government run plan would be more efficient and cost less

Life is not always fair.......it is not fair when you are denied coverage because of a pre-existing condition
it is not fair that you lose your health insurance when you lose your job
it is not fair that you pay significantly more for insurance if you own your own business than if you work for a large employer

The well used Liberal mantra of "fairness". I admitted no such thing in my response. I completely refuted your contention that it would make HC insurance "more competitive" as there is no competition with the govt and their endless pool of money. The cost numbers continue to go up even with the HC plan in its infancy. The fact is the govt can't run anything cost effective. Medicare was stated to cost 12 million by year 1990. In actuality, the cost was 107 billion by that year. Tell me again how the govt plan will cost less.

Sorry you aren't allowed on both sides of the fence here...

Either the Government provides a better more cost effective product that private insurerers can't compete with

Or as you say....."The fact is the govt can't run anything cost effective."

He's right and he can claim that.

Government insurance will at first be cheaper....but it will also add to the debt.

They can tax your insurance payments.....which is a little surprise they'll be springing on us soon....which can bring in revenue.....but any payments they pay out will be a net loss. They'll be paying out a dollar and getting back a quarter.

Anything an insurance company pays out can be taxed. There will be no government payout but they will be taking in that same quarter. So add up 20 million quarters....that's alot of bread. But add up the net loss of 75 cents 20 million times in the Public Option.....that's a big-time loss. Then multiply that by and average of about $5000 per beneficiary.....that's a net loss of say $75 billion dollars per year as opposed to a net gain of $1.25 billion per year with private insureance. Single payer any way you look at it is a very bad deal. It doesn't matter how much this may drive the costs down because they can never make up the loss without raising taxes and the government because of all of their extensive regulations will only end up jacking the price of everything up.

 

[editec]

Funny how much people pretend to care about public opinion, isn't it?

Yet nobody much wants to live in a real democracy.

 

[rightwinger]

The well used Liberal mantra of "fairness". I admitted no such thing in my response. I completely refuted your contention that it would make HC insurance "more competitive" as there is no competition with the govt and their endless pool of money. The cost numbers continue to go up even with the HC plan in its infancy. The fact is the govt can't run anything cost effective. Medicare was stated to cost 12 million by year 1990. In actuality, the cost was 107 billion by that year. Tell me again how the govt plan will cost less.

Sorry you aren't allowed on both sides of the fence here...

Either the Government provides a better more cost effective product that private insurerers can't compete with

Or as you say....."The fact is the govt can't run anything cost effective."

He's right and he can claim that.

Government insurance will at first be cheaper....but it will also add to the debt.

They can tax your insurance payments.....which is a little surprise they'll be springing on us soon....which can bring in revenue.....but any payments they pay out will be a net loss. They'll be paying out a dollar and getting back a quarter.

Anything an insurance company pays out can be taxed. There will be no government payout but they will be taking in that same quarter. So add up 20 million quarters....that's alot of bread. But add up the net loss of 75 cents 20 million times in the Public Option.....that's a big-time loss. Then multiply that by and average of about $5000 per beneficiary.....that's a net loss of say $75 billion dollars per year as opposed to a net gain of $1.25 billion per year with private insureance. Single payer any way you look at it is a very bad deal. It doesn't matter how much this may drive the costs down because they can never make up the loss without raising taxes and the government because of all of their extensive regulations will only end up jacking the price of everything up.

Once again, you are debating slippery slope fantasies unsubstantiated by anything other than your predictions of doom and fear mongering

Fact is insurance companies have tremendous overhead and they create tremendous overhead in the paperwork they require from doctors. They add nothing to your health, they are just a mechanism to funnel money. For that, they take a hefty cut
Add to that the obscene executive salaries, money spent on lobbyists and political payouts and you have an industry who's primary function is to protect their profit