geez, this is a big duh! baucus et. al, are bought and paid for, and their vote bribed by the health care industry to protect their profits and salaries and campaign coffers. unfortunately, many of us know this and it would seem the only ones who do not realize “they have no clothes” are these self same republicans in sheep’s clothing calling themselves democrats!

Yes…

No robust public option. NO DEAL.

We can’t afford mandates with nothing in the way of out of control price hikes.

I was gonna say “Duh!”, too, but you beat me to it…it’s the lazy way to say it, but it communicates MOST effectively. Especially something as simple as this.

If anyone is watching the markup, you may need suspenders for your jaw. We have Dem’s (e.g. Mendez) arguing against changing prescription reimbursement rates for dual eligible seniors (eligible for both Medicare and Medicaid) from Medicare to Medicaid rates. This will give enough money to close the donut hole and provide another $50b. Carper is another one here defending the poor drug companies.

With dems like this who needs rethugs..

The author assumes that we want to pay for our right to have health care. We do not. We demand it is provided for by our government and paid for by taxes. If we do not have such, we will never have any reform, and there will never be any health to worry about.
Of course baucaucus won’t do anything for holding back profits. He is being bribed, and makes money from the profits. He doesn’t make enough as a senator, so he is taking bribes to kill people.
Murder is the charge. His constituents will have to decide if they appreciate that about their senator. Montana won’t be home any longer. He will be forced to live in a compound, protected by his insurance company friends.
No one in this country should have to buy insurance for their health. This one part of all the “plans” is a criminal conspiracy. Please remember to point that out?

Mandate + no public option = Policy/Politics/Cost disaster

It’s really quite simple. Delivering health insurance through private enterprise doesn’t make sense. The vaunted ‘invisible hand’ doesn’t work in this type of situation.

The parties’ interests are compeletely misaligned, all kinds of information is private to one side or the other, the payor is largely distinct from the user of the service, decisions have super-high salience and typically take place when people are at their most emotional; as with all insurance, time works against you (insurer has huge incentive to deny payouts later), risk pooling dynamics favor monopolies…

That’s one reason the current system is so convoluted. It’s also a major reason that the reform is so convoluted as well.

As so many have argued so eloquently, snipping the Gordian knot with Single Payer makes the most sense. In the absence of that, the only angle that will make a meaningful difference in the current debate is a strong public option, which has some of the benefits of Single Player. All the other “goodies” depend on it. Without it, this will be an enormous debacle for Obama and the Democratic party in general.

Thanks Rahm. Thanks Barry.

Pharma Donations to Mendez and Carper:

Mendez $174K
Carper $139K

Not a surprise.

“Delivering health insurance through private enterprise doesn’t make sense.”

I’d clarify that “MANDATING” health insurance through private enterprise doesn’t work! The financial burden in imposes, with no protections, is a gift to the insurance industry and an assault on citizen’s basic liberties.

You could emphasize the point more strongly. The Swiss, Dutch, French, Germans, etc., intimately regulate practices of health insurers. The minimum terms for a qualifying insurance contract, for example, would make a US insurer’s head spin over the agony of lost profits. (Never mind those crucified on that altar.)

The American insurers’ holy bible of 1400 exclusions would be burnt as heretical. They would face stiff fines or worse for refusing to issue a contract to a paying applicant, for excluding coverage for pre-existing conditions, for rescinding an issued contract, for unreasonably delaying payment or for demanding pre-approval of a specific procedure.

The US’ health payments scheme is like driving a Hummer at highway speeds through the 18th century back streets of Boston. The European model is like driving a VW turbo diesel down the Autobahn. The collateral damage so ruthlessly enacted and accepted here would be unheard of and criminalized in Europe.

IANAL but forcing people to buy something seems illegal to me. I have no doubt that some group will sue if this goes through.

Please help me understand how the public option will restrain costs of premiums.

The House versions do not restrain premiums — they specifically allow for increasing premiums beyond any restrictions if there is a risk of severe financial risk to the plan — either private or public.

It is right there in the version of the bill reported out of Energy and Commerce (not in the original hr3200 draft) in Section 209.

The only way for premiums to remain low is for the government to pay out of general revenues that it does not seem to have now for Medicare alone.

REALLY, I want to support this but I am not stupid and want to understand.

If you drive, you’re forced to have auto insurance. If you own a home, you’re forced to buy homeowners insurance.

I suppose it is necessary to go through the Baucus plan carefully. But I agree with those above that Baucus signaled from the beginning that he was equal parts shill for the insurance, medical, and drug companies on one side and for Obama on the other. This whole exercise has nothing to do with the health of Americans or keeping down costs. It has from day one been about the health of that iron triad of the insurance, medical, and drug industries.

The Max Tax fails to close the Medicare Part D doughnut hole. Just voted down in markup 10-13. Baucus, Carper, Menendez voting with the Repubs

If you drive, you’re forced to have auto insurance. If you own a home, you’re forced to buy homeowners insurance.

Sounds good but what is the follow up here? If you breathe, you’re forced to have health insurance? The point is that you don’t have to own a car and you can rent but you can’t stop breathing.

But somehow this seems different to me and I believe that a lot of people will think so. Many young people chose not to have health insurance and I think that should be their right, although unwise.
If you can’t afford something, then you can’t afford it. Period.

Please help me understand how the public option will restrain costs of premiums.

It won’t. In theory, it might have if it had been made widely available and its rates had been based on Medicare’s. But even if a public option survives, it is likely to be kept small, delayed, limited in availability, and burdened by higher rates.

Driving is technically a choice. The fact that almost all people have to drive in order to work doesn’t count. Only homeowners with a mortgage are required to have insurance by the noteholder. If the homeowner holds title to the home s/he can choose not to insure the home.

Here in Arizona, mandatory auto insurance laws have resulted in 20% of drivers not complying with the law– this number is considered to be around the national average… Also, mandatory auto insurance is based upon having liability insurance to protect OTHERS you may hurt.

Interesting that the Mass ‘individual mandate’ folks exempted 20% of the uninsured from penalties… Not that the numbers being the same means much.

Perhaps the government should enforce it by having inspectors at the entrance to interstate highways — would be no different than giving the IRS free reign to pass along our private tax records to some new health care bureaucrat beholden to the private insurance companies…

And homeowner’s insurance exists as mandatory ONLY if YOU do not own the home 100% — the bank or other lender demands it for their protection, not yours.

You do not own the home (note the foreclosure crisis) — are you suggesting we do not own our own bodies?

We fought for decades to get Roe v Wade and have battled continuously to protect that right since then.

Points taken

The whole mandate argument is fundementally inchoherent because of the presumption that managing health care finances through insurance companies is a rational way to do this. That is the fundemental flaw and any attempt to make something that irrational make sense is only more confounding.

This is a planned raid on the pockets of the average American to benefit connected industries. You have to wonder what industry is next in line to claim a percentage of everyone’s income. Before we impose a mandate to purchase health insurance as a requirement to live in this country, we need to revise the Constitution – change “RIGHT to life” into “PRIVILEDGE to live” (as long as you pay your Blue Cross premium).

While it is being alluded to I would like to point out that the prime reason for health care reform was not a matter of being kind to our citizens, and giving them the security that other industrialized nations somehow manage to provide at a much lower cost. No, the primary reason originally was to control the enormous and ever growing percentage of GDP devoted to health care, which is threatening to wreak total havoc on our already extremely unstable economy. This plan does not accomplish that purpose, leaving aside the human cost. It would be sheer folly to pass a plan that does, in fact, not accomplish anything, and most likely will only worsen the situation.

If you don’t have a robust public option than the system needs strong heavy handed cost control and pricing regulation. Baucus’s plan has neither.

none of the bills currently in play do.

A robust public option was meant to be the mechanism to control health care cost instead of pricing regulation. The idea was to have a public option that would not dominated the market, but would dramatically reshape the marketplace. A strong public option which could sell insurance plans at cost would provide the competition needed to discourage private insurance companies from gouging costumers. A public option would also allow the government to introduce and encourage the adoption of delivery system reforms which could hopefully produce high quality, low cost health care. If the reforms work for the public option, the hope is that they will be copied by private insurance companies.

is there any policy analysis to back this up? i think it’s just wrong, for a bunch of reasons (like the unnecessary administrative overhead a public option in a multi payer non-system does nothing to address, like the public option was indeed originally designed to dominate the market, etc) but the biggest one is that selling insurance at cost does not provide competition. competition in the health insurance market is based on controlling costs by denying care. repeating neoliberal talking points doesn’t change the fact that market competition sometimes leads to a race to the bottom and health insurance is one of those cases.

anyway, i’d love to see the analysis.

Jon, did you notice that Levey and Oliphant did not mention the words “public option” until 20 inches into this 30-inch article and then gave it only one sentence before moving on to the Baucus bill’s co-ops?

[…]

The House bill also features a new government insurance program — or “public option” — that advocates believe could offer consumers a lower-priced alternative to private plans and, in turn, pressure insurers to rein in premiums.

The Baucus proposal, which addresses widespread industry and business opposition to a new government plan, would instead set up a series of nonprofit health insurance cooperatives.

These may not offer much relief to consumers, however. The nonpartisan Congressional Budget Office has concluded that the co-ops outlined by Baucus “seem unlikely to establish a significant market presence in many areas of the country.”

That means that premium relief for consumers would depend on a series of indirect steps Baucus and other Democrats are pushing to nudge down medical costs and change the way insurers market their policies.

[…]

That’s it. That’s all they say about the public option.

I did not say it was correct, I did say that was the argument made for it.

Jacob Hacker, creator of public option idea, “The current proposals really hinge on the public plan to provide a source of long-term cost control and to limit the federal government’s liability for health care.”

http://money.cnn.com/2009/09/0…..2009090412

I’m beginning to rethink this axis of evil thing…US – Russia – China maybe? No universal health care here, no none here either.

thanks very much for the reply. what do you think? in your opinion, is it correct?

i know that’s what hacker is now saying — but is there any analysis to back it up? seems very strange to me based on his earlier work and as i wrote above, makes no sense at all to me. maybe i’m just stupid or missing something though and would really like to be educated on the subject if that is the case.

I believe the devil is in the details. Even a plan like the one in the House with a strong public option would be far from my own choice.

I think you could have a system that works. If you had very tight consumer protections, a very strong ombudsman with the power to enforce them and levy huge fines for violations, no cost control regulations but a robust national public option.

If it was up to me I would throw everything at the wall to bring down price. A basic minimum plan everyone was in by default. Supplemental or separate insurance in a highly regulated exchange (with private and public options). Only non-profit insurance companies, Fix minimum medical loss ratio at 91%. An ombudsman with the power to directly take funds from any plan to pay a claim, etc…

is it fair to say that as far as you know there is no significant policy analysis to back up the competition claims above?

Even a plan like the one in the House with a strong public option would be far from my own choice.

but do you think the house bill po will compete to bring down costs — that was the question.

If it was up to me I would throw everything at the wall to bring down price

then why do you chose a multipayer system? where is your analysis to show this is the most effective way to bring down price?

p.s. fair warning: i will save my objections to your use of the qualifier “strong” for another day. i’ve already peppered you with enough questions for one day. thanks again for taking my questions seriously and for responding.

The two simplest things we could have done to bring down costs: Single Payer and Medicare Drug Price Negotiation. That was the low hanging fruit.

That said, if we could get any kind of Public Option passed, I suspect that we could find some ways to save taxpayers money. For instance, we could open a new HMO called Saiser Sermanente in every state that has just one or two dominant insureres.

There are also delivery system ideas which aren’t getting much discussion such as increasing incentives for new medical graduates to practice in underserved areas, and increasing incentives for doctors to join high-efficiency medical groups.

looking at all the systems in the world. I think the French system offers the best overall package. There are cheaper, there are fairer, and there are some high quality for select individuals.

They use a system of basic care being single payer government run with the option to buy additional coverage.

The CBO says the House PO would be 10% cheaper. I think that is more than enough to develop large market share and compete.