Why we need a public option!

[Bern80]

Nearly 59 million lack health insurance: CDC - Yahoo! News

Call it what you will, a public option providing free preventative health care is cost-effective, providing long term benefits to individuals and the nation as a whole.
The effort by some, in particular those who hope to develop publc policy along ideological guidelines, will put even those with excellent private insurance at risk should a pandemic or worse come to America.

Free?

The word should be "available."

availability and affordability are not the same thing.

 

[skookerasbil]

 

[Greenbeard]

I think the public "option" will work to eliminate the private option completely. Any private insurance companies left will be puppets of the government so limited in what they can offer as to being ridiculously regulated.

The public option will have the benefit of a taxing authority to provide its needs so that it will completely undercut the private insurance companies and they will not be able to compete.

The public option proposed last year was funded the same way as every other exchange-participating plan: through premiums set at a level sufficient to cover benefit payouts and administrative expenses. Cash infusions were prohibited by statute (" (3) NO BAILOUTS- In no case shall the public health insurance option receive any Federal funds for purposes of insolvency in any manner similar to the manner in which entities receive Federal funding under the Troubled Assets Relief Program of the Secretary of the Treasury.") and appropriations beyond a single start-up amount were not authorized by the legislation.

The real potential of the public option wasn't in destroying private insurers but rather in shifting the balance of power toward them in payer-provider reimbursement rate negotiations. It had promise but ultimately it seems like an attempt to indirectly accomplish what all-payer rate setting accomplishes much more directly. If I had to pick between an entirely private insurance market with all-payer rate setting on the provider side and an insurance market with a public option but no all-payer rate setting, I'd take the former. But I suppose there are political and implementation issues that swing the balance back toward the public option.

 

[Revere]

Greenbeard is a liar who should be nowhere near decisionmaking involving people's lives.

Your regulator, the government, doesn't compete with you with the intent to keep you around.

And the notion that it won't need bailouts is a bigger lie.
Just like every other entitlement, future generations would be indebted to pay for this, long after liars like Greenbeard are gone.

 

[Immanuel]

I think the public "option" will work to eliminate the private option completely. Any private insurance companies left will be puppets of the government so limited in what they can offer as to being ridiculously regulated.

The public option will have the benefit of a taxing authority to provide its needs so that it will completely undercut the private insurance companies and they will not be able to compete.

The public option proposed last year was funded the same way as every other exchange-participating plan: through premiums set at a level sufficient to cover benefit payouts and administrative expenses. Cash infusions were prohibited by statute (" (3) NO BAILOUTS- In no case shall the public health insurance option receive any Federal funds for purposes of insolvency in any manner similar to the manner in which entities receive Federal funding under the Troubled Assets Relief Program of the Secretary of the Treasury.") and appropriations beyond a single start-up amount were not authorized by the legislation.

The real potential of the public option wasn't in destroying private insurers but rather in shifting the balance of power toward them in payer-provider reimbursement rate negotiations. It had promise but ultimately it seems like an attempt to indirectly accomplish what all-payer rate setting accomplishes much more directly. If I had to pick between an entirely private insurance market with all-payer rate setting on the provider side and an insurance market with a public option but no all-payer rate setting, I'd take the former. But I suppose there are political and implementation issues that swing the balance back toward the public option.

Are you quoting the bill itself with that "NO BAILOUTS" information or something else?

The "administrative expenses" that you mention are not something that the government has to worry about, they simply pass those expenses off on the tax payer or should I say our great grandchildren at the moment. And if the tax dollars collected in a given year for this legislation are insufficient to cover the expenses, the government simply passes the short fall off on to future generations just as they are doing with Social Security, not to mention every other social endeavor the government attempts. It is called the deficit and right now, this country is drowning in red ink.

If the government insurer does not have to cover the same kinds of expenses (one of those expenses being taxes that the insurers have to pay) that private insurers have to cover then they can undercut the private market to such an extent that the private market will either go out of business or lose money and lots of it. This will work as a downward force on private plans and eventually drive private insurers out of business completely which will then mean that the so called public "option" will be the only "option". That in my book is not an option at all.

Eliminating price competition is only one part of the problem. Another problem is that when the government has driven the other insurers out of the market, then the government will dictate to the providers (as they already do with Medicare) what the providers will receive for their services. There will be no "negotiating" as there is in today's market between the health care provider and the insurers. The government will inform the providers what the government will pay and that will be all that there is to it. That will in effect drive the quality of health care down the toilet and force good doctors into other professions or retirement.

For those that claim corporations do not pay taxes, according to their financials AETNA paid nearly $625 Million last year. UnitedHealth Group paid nearly $2 billion in taxes. Those are "expenses" that the government would not have to match which would give the government insurance plans a huge advantage.

AET Income Statement | Aetna Inc. Common Stock Stock - Yahoo! Finance
UNH Income Statement | UnitedHealth Group Incorporated Stock - Yahoo! Finance

Plain and simple, a private corporation cannot compete with governmental competition. However, that does not mean that the government provides quality service by any stretch of the imagination.

Immie

 

[shintao]

Only about 12 million American citizens who want health insurance can't afford it.

Government can't guarantee 310,000,000 people all the health care they want.

Your argument is a loose as a 99 year old man with bowel problems.

1.Show proof that, "Government can't guarantee 310,000,000 people all the health care they want."

How about basic supply and demand for starters?

Private medicine is currently unable to supply facilities to meet the demands of society. Government has shown it can meet supply for a demand through several American diseases in the past, many I listed earlier.

 

[shintao]

Free?

The word should be "available."

availability and affordability are not the same thing.

Affordibility and supply are not the same thing.

 

[shintao]

i could appreciate the want. where's the need?

"Lost Labor Time" Costs U.S. $260 Billion Each Year.

Estimated 18 Million Adults With Chronic Illness or Disability Are Not Working.

 

[hortysir]

How quicky the right forgets the huge price increases the Insurance cos have treated us to over the last couple of decades while their profits were off the charts.

They will game us to death until we have a public option that will threaten their ability to act like a monopoly.

How big of a price increase?
How much is their profit margin?

 

[Greenbeard]

Are you quoting the bill itself with that "NO BAILOUTS" information or something else?

Yes, that's from the bill passed by the House last November, H.R. 3962 (the final, post-mark-up, iteration of the original, H.R. 3200).

The "administrative expenses" that you mention are not something that the government has to worry about, they simply pass those expenses off on the tax payer or should I say our great grandchildren at the moment. And if the tax dollars collected in a given year for this legislation are insufficient to cover the expenses, the government simply passes the short fall off on to future generations just as they are doing with Social Security, not to mention every other social endeavor the government attempts. It is called the deficit and right now, this country is drowning in red ink.

Again, the public option wouldn't be funded like Medicare or Social Security. Medicare is partially funded by premiums. A public option would be entirely funded by premiums; that's a requirement of the law. Tax revenues play no part in its operation, beyond the refundable tax credit offered to anyone with income below 400% FPL buying coverage in an exchange. Or as the legislation itself read:

(a) Establishment of Premiums-

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

(A) in a manner that complies with the premium rules established by the Commissioner under section 213 for Exchange-participating health benefits plans; and
(B) 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.​

(2) CONTINGENCY MARGIN- In establishing premium rates under paragraph (1), the Secretary shall include an appropriate amount for a contingency margin (which shall be not less than 90 days of estimated claims). Before setting such appropriate amount for years starting with Y3, the Secretary shall solicit a recommendation on such amount from the American Academy of Actuaries.​

​

Eliminating price competition is only one part of the problem. Another problem is that when the government has driven the other insurers out of the market, then the government will dictate to the providers (as they already do with Medicare) what the providers will receive for their services. There will be no "negotiating" as there is in today's market between the health care provider and the insurers. The government will inform the providers what the government will pay and that will be all that there is to it. That will in effect drive the quality of health care down the toilet and force good doctors into other professions or retirement.

That's the key feature of the robust public option (i.e. the original version found in H.R. 3200): it starts with the Medicare provider network, though providers may opt-out, and it pegs reimbursements to Medicare rates + 5% for the first few years. The negotiated rates public option, which would be much less effective, was what eventually passed the House. And of course ultimately no public option became law.

As I've argued before, the idea behind the public option was never that the public option would became the only insurer or that all insurance would eventually reimburse at rates set like Medicare rates (not least because the proposed public option was limited to the exchanges, which is not where the large majority of people will be buying their coverage). Instead, it would've put pressure on private insurers and providers alike to start controlling costs. The reason, of course, is that since the robust public option would have reimbursed at lower rates than private insurers, its premiums would be lower.

Insurers would face pressure to negotiate lower reimbursement rates to keep their own premiums down and providers would have an incentive to grant lower rates, lest more customers flock toward the public option (an outcome that would lower reimbursements to those providers more than would granting private insurers lower--but still higher than public option--rates). As I said above, the intent wasn't for it to take over the market but rather to reshape the landscape in which the insurer-provider negotiation takes place. In one sense, it would have given private insurers cover (and leverage--something payers lack in many areas) to start bringing down rates. The public option would be most effective if it actually had relatively few customers but succeeded in narrowing the gap between its administratively set rates and the average negotiated private payer rate. That's the most important point that was never stressed enough: the point of the public option was to change the way private payers and providers interact with each other, not scoop up everyone's customers.

Now, as I mentioned, all-payer rate setting can close the gap between the private (negotiated) and public (administratively set) payments and overcome the cost-driving influences of provider consolidation in numerous markets in a much less cutesy way. But that would require lots of effort on the part of states (only Maryland currently has an all-payer rate setting system in place), whereas a public option would be a problem for the feds alone. But at very least, using all-payer rate setting instead of a public option would presumably assuage your fears that there's some plot afoot to destroy private insurance, even though it's arguably more heavy-handed.

 

[Revere]

What I said, the public option was designed to price private insurance out of existence. Your regulator holds your head under water because it can run up all the debt it needs to, while you suffocate.

Rate setting is government imposed shortages.

 

[Chris]

Every other industrialized nation in the world has national health insurance, and they pay HALF per capita what we pay for healthcare. The French have the best system, it is a combination of public and private insurance.

 

[Revere]

Every other industrialized nation in the world has national health insurance, and they pay HALF per capita what we pay for healthcare. The French have the best system, it is a combination of public and private insurance.

Why should government tell you how much health care you should buy, and how much you should accept to provide health care services?

 

[hortysir]

Every other industrialized nation in the world has national health insurance, and they pay HALF per capita what we pay for healthcare. The French have the best system, it is a combination of public and private insurance.

Move to France

 

[Political Junky]

Every other leading nation manages to do it.

 

[hortysir]

Every other leading nation manages to do it.

I prefer to promote economic growth for private companies and provide non-government jobs instead....rather than vice-versa

 

[Revere]

Every other leading nation manages to do it.

Which nations that are "leading" ours have better health care than we do?

 

[Chris]

Every other industrialized nation in the world has national health insurance, and they pay HALF per capita what we pay for healthcare. The French have the best system, it is a combination of public and private insurance.

Why should government tell you how much health care you should buy, and how much you should accept to provide health care services?

Because it's the best way to provide healthcare for everyone.

It should be just like the fire department and the police.

 

[Chris]

Every other leading nation manages to do it.

Which nations that are "leading" ours have better health care than we do?

The French.

 

[Revere]

Every other leading nation manages to do it.

Which nations that are "leading" ours have better health care than we do?

The French.

Exactly what are they "leading" us in?