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

[rightwinger]

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

Yet nobody much wants to live in a real democracy.

Why would anyone want to live in a real democracy? There is no real democracy on the planet. Thankfully so

 

[mudwhistle]

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.

Tried and to date have failed miserably.

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.​

Unless Single Payer becomes law. Then the Public Option will become history.

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.​

Course the Public Option is only a sheep in wolves clothing. The real goal is a single payer program which Obama said on the record he supports.

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?

Which is where the lie comes in...premiums will be raised at the behest of the government through taxes. We will be forced to pay for coverage. Lawsuits around the country are focusing on this simple fact.

Nobody should be forced to buy a product....but the government defends this in court by calling it a tax. So is it insurance or is it a tax? What happened to Obama's promise not to raise taxes on 95% of Americans?

 

[Greenbeard]

You're using underpants gnome logic, and not very well at that:

1. X, Y, Z are features of the public option
2. ???
3. Single-payer!

But as I just pointed out--using the actual text of this new public option bill--X, Y, and Z aren't features of the public option. Your initial premise has no basis. Which makes step two even more puzzling.

Nobody should be forced to buy a product....but the government defends this in court by calling it a tax. So is it insurance or is it a tax? What happened to Obama's promise not to raise taxes on 95% of Americans?

If you don't buy insurance, you face a $695 (or 2.5% of income if it's higher) penalty or tax. That is, people who have insurance under the new law (~94% of the population) don't pay it.

 

[mudwhistle]

You're using underpants gnome logic, and not very well at that:

1. X, Y, Z are features of the public option
2. ???
3. Single-payer!

But as I just pointed out--using the actual text of this new public option bill--X, Y, and Z aren't features of the public option. Your initial premise has no basis. Which makes step two even more puzzling.

Nobody should be forced to buy a product....but the government defends this in court by calling it a tax. So is it insurance or is it a tax? What happened to Obama's promise not to raise taxes on 95% of Americans?

If you don't buy insurance, you face a $695 (or 2.5% of income if it's higher) penalty or tax. That is, people who have insurance under the new law (~94% of the population) don't pay it.

An obvious deflection. This will be mandated so ether they pay premiums or they collect benefits....which means redistribution of wealth. Ether way...it's a mandate against the rich which makes it still unconstitutional.

It's not cut and dried like you claim. And you're only answering the questions you want to.

 

[Greenbeard]

An obvious deflection. This will be mandated so ether they pay premiums or they collect benefits....

You do the former so you can do the latter. That's how insurance works.

It's not cut and dried like you claim. And you're only answering the questions you want to.

What's not cut and dried? And what questions do you have?

 

[mudwhistle]

An obvious deflection. This will be mandated so ether they pay premiums or they collect benefits....

You do the former so you can do the latter. That's how insurance works.

It's not cut and dried like you claim. And you're only answering the questions you want to.

What's not cut and dried? And what questions do you have?

Single payer is the problem.....it's gonna be slipped in. Obama won't rest until it is. Don't be so naive to assume he won't as much as everyone was naive to assume that the Public Option was history.

Insurance companies are finding out what's in the bill after the fact. They claim that it will put them out of business because the government is the only entity that can afford to offer insurance under such conditions......and as soon as the conditions warrant it....benefits will be cut to keep expenses down....thus rationing will be instituted. It happened here in TN with Tenncare and it's happening in Mass.

The simple fact that the bill took over 2000 pages to explain the program means it's not cut and dried....not to mention that these people in Washington have zero credibility. They've already shown their hand and they've made several compromises that will eventually be pulled once the program is fully implemented....if ever.

 

[rightwinger]

An obvious deflection. This will be mandated so ether they pay premiums or they collect benefits....

You do the former so you can do the latter. That's how insurance works.

It's not cut and dried like you claim. And you're only answering the questions you want to.

What's not cut and dried? And what questions do you have?

Single payer is the problem.....it's gonna be slipped in. Obama won't rest until it is. Don't be so naive to assume he won't as much as everyone was naive to assume that the Public Option was history.

Insurance companies are finding out what's in the bill after the fact. They claim that it will put them out of business because the government is the only entity that can afford to offer insurance under such conditions......and as soon as the conditions warrant it....benefits will be cut to keep expenses down....thus rationing will be instituted. It happened here in TN with Tenncare and it's happening in Mass.

The simple fact that the bill took over 2000 pages to explain the program means it's not cut and dried....not to mention that these people in Washington have zero credibility. They've already shown their hand and they've made several compromises that will eventually be pulled once the program is fully implemented....if ever.

LOL

We can't even get a public option......Now the slippery slope is leading to single payer

You all know what is next.......SOCIALISM

 

[mudwhistle]

You do the former so you can do the latter. That's how insurance works.



What's not cut and dried? And what questions do you have?

Single payer is the problem.....it's gonna be slipped in. Obama won't rest until it is. Don't be so naive to assume he won't as much as everyone was naive to assume that the Public Option was history.

Insurance companies are finding out what's in the bill after the fact. They claim that it will put them out of business because the government is the only entity that can afford to offer insurance under such conditions......and as soon as the conditions warrant it....benefits will be cut to keep expenses down....thus rationing will be instituted. It happened here in TN with Tenncare and it's happening in Mass.

The simple fact that the bill took over 2000 pages to explain the program means it's not cut and dried....not to mention that these people in Washington have zero credibility. They've already shown their hand and they've made several compromises that will eventually be pulled once the program is fully implemented....if ever.

LOL

We can't even get a public option......Now the slippery slope is leading to single payer

You all know what is next.......SOCIALISM

We've already had that since WWII.

Social Security.....you know...

Give the Dems enough time and they'll find a way of getting it installed.

 

[Greenbeard]

Single payer is the problem.....it's gonna be slipped in. Obama won't rest until it is. Don't be so naive to assume he won't as much as everyone was naive to assume that the Public Option was history.

Again, there's nothing to respond to here because there's no factual or rational basis for this fear. I get it, you're afraid of single payer. But as I went through above, all of your rationales connecting the public option to some future single payer system fall apart when you actually look at the proposal being suggested. So what else is there to say?

Insurance companies are finding out what's in the bill after the fact. They claim that it will put them out of business because the government is the only entity that can afford to offer insurance under such conditions......and as soon as the conditions warrant it....benefits will be cut to keep expenses down....thus rationing will be instituted. It happened here in TN with Tenncare and it's happening in Mass.

First of all, the government isn't offering insurance under the law (except under the existing programs like Medicare and Medicaid, which don't just allow anyone who wants to to sign up). That's why this new public option bill even exists. Arguably the law should've included a public option because it was one of the most popular components of reform but ultimately it didn't.

Second, you're making two cross-cutting arguments here:

1) The mandates on insurers (the primary one people complain about being a benefits mandate that requires a minimum level of coverage be offered) are too tough.
2) Insurers will slash benefits to meet the mandates.

You're essentially telling me that this onerous benefits mandate will lead insurers to...slash benefits. So in your worldview that would be...good? If that made sense (which I don't think it does), it would essentially undo the benefits mandate in the first place. Which I take it you'd be in favor of. So what's the problem?

The simple fact that the bill took over 2000 pages to explain the program means it's not cut and dried....

So "it" refers to the law? Well, you're right, there's a lot in it.

 

[mudwhistle]

Single payer is the problem.....it's gonna be slipped in. Obama won't rest until it is. Don't be so naive to assume he won't as much as everyone was naive to assume that the Public Option was history.

Again, there's nothing to respond to here because there's no factual or rational basis for this fear. I get it, you're afraid of single payer. But as I went through above, all of your rationales connecting the public option to some future single payer system fall apart when you actually look at the proposal being suggested. So what else is there to say?

Insurance companies are finding out what's in the bill after the fact. They claim that it will put them out of business because the government is the only entity that can afford to offer insurance under such conditions......and as soon as the conditions warrant it....benefits will be cut to keep expenses down....thus rationing will be instituted. It happened here in TN with Tenncare and it's happening in Mass.

First of all, the government isn't offering insurance under the law (except under the existing programs like Medicare and Medicaid, which don't just allow anyone who wants to to sign up). That's why this new public option bill even exists. Arguably the law should've included a public option because it was one of the most popular components of reform but ultimately it didn't.

Second, you're making two cross-cutting arguments here:

1) The mandates on insurers (the primary one people complain about being a benefits mandate that requires a minimum level of coverage be offered) are too tough.
2) Insurers will slash benefits to meet the mandates.

You're essentially telling me that this onerous benefits mandate will lead insurers to...slash benefits. So in your worldview that would be...good? If that made sense (which I don't think it does), it would essentially undo the benefits mandate in the first place. Which I take it you'd be in favor of. So what's the problem?

The simple fact that the bill took over 2000 pages to explain the program means it's not cut and dried....

So "it" refers to the law? Well, you're right, there's a lot in it.

I never said insurers would slash benefits. Obama already has named board members outside of his cabinet to handle reviews on who will get coverage and thus treated and who will not. The insurers won't have a say in it anymore...much like they won't have a say in who they will insure with the removal of preexisting conditions.

And you can't trust Obama after his takeover of GM, Chrysler, AIG, Goldman Sachs, Fannie Mae and Freddie Mac.

Nothing is stopping him from taking over another industry. He's already got a stranglehold on the petroleum industry now. Recent history indicates there won't be any evidence till after it's already happened.

Even though you are good at presenting the facts in the program but not all of the facts....you must be really gullible or blissfully ignorant if you think he won't repeat what he's already done in the last couple of years.

 

[Cuyo]

Single payer is the problem.....it's gonna be slipped in. Obama won't rest until it is. Don't be so naive to assume he won't as much as everyone was naive to assume that the Public Option was history.

Insurance companies are finding out what's in the bill after the fact. They claim that it will put them out of business because the government is the only entity that can afford to offer insurance under such conditions......and as soon as the conditions warrant it....benefits will be cut to keep expenses down....thus rationing will be instituted. It happened here in TN with Tenncare and it's happening in Mass.

The simple fact that the bill took over 2000 pages to explain the program means it's not cut and dried....not to mention that these people in Washington have zero credibility. They've already shown their hand and they've made several compromises that will eventually be pulled once the program is fully implemented....if ever.

LOL

We can't even get a public option......Now the slippery slope is leading to single payer

You all know what is next.......SOCIALISM

We've already had that since WWII.

Social Security.....you know...

Give the Dems enough time and they'll find a way of getting it installed.

"Socialism" is more of an element of a system, then a system in itself. I don't know of any existing system that doesn't have some elements of "Socialism." And you're correct that during the FDR years (Not necessarily just after the war) we made decisive moves to incorporate more elements of what you call "Socialism."

A degree of Socialism is necessary to stabilize the economic system and maintain order. What you forget is, when you sink the ship, everyone goes down. Socialism can also serve as a catalyst for the private sector (Interstate highways, e.g.).

You are correct that single payer could correctly be identified as a "Socialist" program, but it is not "Socialized medicine." Single payer healthcare is the standard system used by the world today, not because it's a power grab or a means of control, but because it makes sense.

Just the same, it's not on the table right now, and never has been during this administration. You cannot really chastise the Administration for something they haven't done yet.

 

[mudwhistle]

LOL

We can't even get a public option......Now the slippery slope is leading to single payer

You all know what is next.......SOCIALISM

We've already had that since WWII.

Social Security.....you know...

Give the Dems enough time and they'll find a way of getting it installed.

"Socialism" is more of an element of a system, then a system in itself. I don't know of any existing system that doesn't have some elements of "Socialism." And you're correct that during the FDR years (Not necessarily just after the war) we made decisive moves to incorporate more elements of what you call "Socialism."

A degree of Socialism is necessary to stabilize the economic system and maintain order. What you forget is, when you sink the ship, everyone goes down. Socialism can also serve as a catalyst for the private sector (Interstate highways, e.g.).

You are correct that single payer could correctly be identified as a "Socialist" program, but it is not "Socialized medicine." Single payer healthcare is the standard system used by the world today, not because it's a power grab or a means of control, but because it makes sense.

Just the same, it's not on the table right now, and never has been during this administration. You cannot really chastise the Administration for something they haven't done yet.

I can if he's already voiced his support for it. His own words convict him.

Don't make me pull up the youtube vids supporting this fact. I don't have the time right now because I have to open the store in a bit.

You can't continue to defend this guy just because the latest issue is at the stage where he hasn't done it yet. All of the other takeovers were at that point once too....until it happened....but then it was too late.

My biggest fear is once a new program is law it doesn't take much to tweak it till it's what you originally intended. You just have to be slick about it and not do it all at once. The UK started out with a low VAT but now it's currently 20%.

Obama cannot be trusted......remember only a couple of weeks before he took over GM he lied that he was not going to. In any court a witness that lies that blatantly automatically loses credibility and all of Obama's actions add weight to this assumption.

 

[The Rabbi]

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).

You have managed to quote something which does not support your contention.
And actually you end up supporting my argument that "public option" will make things worse, not better.
Thanks!

 

[Greenbeard]

You have managed to quote something which does not support your contention.

Trying out your Jedi mind tricks or something? They're not working.

 

[The Rabbi]

You have managed to quote something which does not support your contention.

Trying out your Jedi mind tricks or something? They're not working.

It's called "logic" and "argumentation." No wonder they aren't working on you.
The fact remains that the gov't programs reimburse at sub par rates, which are made up by private insurers, which reimburse at a higher rate. The article you cite says exactly that. Allowing more people to go on a plan that reimburses at a low rate will not help the health care system in this country at all.
There is little question about all this, btw. It is pretty well established.

 

[Greenbeard]

The fact remains that the gov't programs reimburse at sub par rates, which are made up by private insurers, which reimburse at a higher rate. The article you cite says exactly that. Allowing more people to go on a plan that reimburses at a low rate will not help the health care system in this country at all.

What is says is that hospitals operating efficiently profit off of Medicare patients and those not under financial pressure don't. Meaning Medicare reimbursement rates are only problematic for for hospitals associated with higher rates of wasteful spending. Which indicates that if providers were pressured to control costs, they could and your premiums could be lower than they are (and certainly rising far more slowly). The problem, of course, is that providers have little incentive to reduce wasteful spending and payers don't have enough leverage to encourage them to.

Which is where the public option comes in. As long as customers have no choices other than private payers that negotiate (inflated) reimbursements to providers, providers are safe in protecting the status quo. The public option reimburses according to a fee schedule (Medicare + 5% and indexed from there). If providers want to avoid watching customers switch from private payers to the public option (which providers would want to avoid since the fee schedule is invariably lower than private reimbursements), they must halt the constant reimbursement hikes and work to minimize the public/private payer differential. In other words, it changes the incentives in the payer-provider negotiation process to put downward pressure on rate increases, instead of upward pressure (which exists now).

What you seem to be missing is that the point isn't to get everyone on a public option, it's to give private payers a bargaining chip to use to keep their own reimbursement rates down. Lowering prices for everyone.

 

[The Rabbi]

The fact remains that the gov't programs reimburse at sub par rates, which are made up by private insurers, which reimburse at a higher rate. The article you cite says exactly that. Allowing more people to go on a plan that reimburses at a low rate will not help the health care system in this country at all.

What is says is that hospitals operating efficiently profit off of Medicare patients and those not under financial pressure don't. Meaning Medicare reimbursement rates are only problematic for for hospitals associated with higher rates of wasteful spending. Which indicates that if providers were pressured to control costs, they could and your premiums could be lower than they are (and certainly rising far more slowly). The problem, of course, is that providers have little incentive to reduce wasteful spending and payers don't have enough leverage to encourage them to.

Which is where the public option comes in. As long as customers have no choices other than private payers that negotiate (inflated) reimbursements to providers, providers are safe in protecting the status quo. The public option reimburses according to a fee schedule (Medicare + 5% and indexed from there). If providers want to avoid watching customers switch from private payers to the public option (which providers would want to avoid since the fee schedule is invariably lower than private reimbursements), they must halt the constant reimbursement hikes and work to minimize the public/private payer differential. In other words, it changes the incentives in the payer-provider negotiation process to put downward pressure on rate increases, instead of upward pressure (which exists now).

What you seem to be missing is that the point isn't to get everyone on a public option, it's to give private payers a bargaining chip to use to keep their own reimbursement rates down. Lowering prices for everyone.

OK. SO you admit that
a) A public option will reimburse at lower rates than private payers.
b) Health providers will not want to accept public option money if they can get enough private money.

The result of just these two things, as you've already admitted, will be that fewer providers will accept public option money and thus will limit choices for insureds (there goes "if you like your doctor you can keep him."). Also that public option will be cheaper--and free to insureds in many cases--and thus will suck the higher risk patients out of the risk pool. This will drive up costs to the pool. That increased cost will be paid for out of public tax money since the riskiest cases will not be able to pay enough themselves.
Added to this, and never mentioned, is the fact that insurance companies can offset their lower premiums by revenue from their investment portfolio. A public option by definition cannot do this. All revenue must come from earned premiums. The only way to offset higher premium cost is by taking public tax money.
This is bound to happen. There can be no other way.

As for your last point: Do you honestly think government negotiators are better than private negotiators? Your contention is belied by the very fact that private insurers now reimburse at higher rates than Medicare/Medicade. If what you said was true, they would already be competing. But it is not true.

 

[jeffrockit]

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."

You are going on the assumption that govt HC is competitive. As it is not based on my previous explanation, thye are not. Since govt provides no such competition in what is true level playing field competition, that is a mute point. The other poster stated that Govt HC will increase competition when in fact there is none because govt has an endless pool of money at their disposal. No one responding seems to grasp that as no one has argued against that point. Nice way of avoiding the actual debate.

 

[Greenbeard]

OK. SO you admit that
a) A public option will reimburse at lower rates than private payers.

Admit it? That's the point.

During the debate last year, the original public option in the original House health care bill (H.R. 3200) was robust, like the one being proposed in this new bill. It relied on a fee schedule pegged to Medicare rates + 5%. However, when that bill went through markups and was debated, the consolidated bill that emerged (H.R. 3962) contained a weaker public option in which the public option's rates were negotiated with providers, just like any insurer. Once they abandoned the notion of relying on a set fee schedule--i.e. a robust public option--most of the value of the proposal was lost. And ultimately no public option was included in the bill that became law last March.

b) Health providers will not want to accept public option money if they can get enough private money.

Providers would prefer patients whose payers reimburse at higher rates, meaning they'd take actions to prevent seeing patients switch out of private insurance and migrate to the public option. That, too, is the point.

The result of just these two things, as you've already admitted, will be that fewer providers will accept public option money and thus will limit choices for insureds (there goes "if you like your doctor you can keep him.").

The public option doesn't exist at present. Thus "if you like your doctor you can keep him" is completely inapplicable to what we're talking about here. If you switch to a new payer, of course your provider network may be affected. What will the provider network for the public option look like? Under the bill this thread is about, initially it will be the Medicare provider network, though those providers will be able to opt out of the public option if they wish. If it does have access issues, then it won't be a very popular choice and there's no need for you to fear that somehow it will attract every customer in the market.

Also that public option will be cheaper--and free to insureds in many cases--and thus will suck the higher risk patients out of the risk pool.

Starting in 2014, no insurance pools price for risk. A higher risk customer isn't going to pay any more in a private insurance pool than is a low-risk customer buying the same product.

The public option isn't free to anyone, it operates by the same rules as every plan in the exchanges. People between 133% and 400% of the poverty line get premium subsidies which they can take to any insurer they wish. But they pay a portion of their premiums that's determined by their income. And, as already noted, the exchanges will have risk adjustment mechanisms, whereby insurers who happen to get higher-than-average risk pools receive payments to offset their additional costs.

Added to this, and never mentioned, is the fact that insurance companies can offset their lower premiums by revenue from their investment portfolio. A public option by definition cannot do this. All revenue must come from earned premiums. The only way to offset higher premium cost is by taking public tax money.

What do you estimate is the quantitative impact on premiums of float revenue?

As for your last point: Do you honestly think government negotiators are better than private negotiators?

No. That's why I don't want a public option with negotiated rates. If there's going to be one, it should be the one Woolsey is proposing here in H.R. 5808--one where reimbursements are set by the Medicare fee schedule, not negotiators.

Your contention is belied by the very fact that private insurers now reimburse at higher rates than Medicare/Medicade. If what you said was true, they would already be competing. But it is not true.

Medicare isn't competing with anyone. We've been through this--review the posts above. You don't have the option to leave your insurer and buy into Medicare. Your insurer knows that, your providers know that. Thus your relationship with them and their relationship with each other is not affected by Medicare.

 

[The Rabbi]

You agree with everything I posit and then somehow wish for a different outcome.
Never happen.