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We’re announcing the creation of Public Option Please, a non-profit organization dedicated to ongoing advocacy for universal health care. The director of the project is Eve Gittelson, NYCEve, whose advocacy for Nataline Sarkisian was key to getting CIGNA to reverse their decision after they denied her a liver transplant.
One of the things that has confounded me about the online organizing model is its dependence on the passion of the moment. All opponents really have to do is wait until the wave of outrage passes — whether it’s over health care, or AIG bonuses, or anything else that touches off heated public sentiment — and the battle ground is empty once again. Money pours quickly into online ads that are never well-targeted enough, nor are the buys big enough to have any impact, and then the impulse passes. It feels good for a moment, but rarely has any ongoing value.
How do we change that? How do we translate that passion into ongoing, meaningful activism that brings the fight to the lobbyists and the stakeholders who will launch themselves on Capitol Hill to take back every gain that is made in any health care reform bill even before it’s passed? How do we fund it? How do we organize it? How do we transform the energy that surrounds today’s political battle into a movement?
I’ve been wrestling with that question a lot. And that’s why we are launching POP today as an advocacy organization with these goals:
- Reframe the debate in human terms — health care is a human right. This is fight against bloodless corporate interests and the cost is human lives. We need to say that.
- Reach out beyond the hard-core political audience to young people who are inspired to shape their future.
- Advocate, as Eve has done for years, for those who have been abandoned by the medical industrial complex.
- Hire a lobbyist to be on Capitol Hill to fight the battle on an ongoing basis where it will continue, day in and day out, long after a health care bill has passed.
- Win the passage for a public option now–with the knowledge that it’s just the beginning.
The art for the campaign was designed by Justin Kemerling, who was one of the artists featured in Shepard Fairey’s Manifest Hope exhibit. In the coming days, we’ll be announcing an art contest and with celebrity judges and featuring YouTubes of musicians, artists and ordinary Americans demanding a public option. We’ll be taking up the cause of those, like Nataline, whose lives are considered acceptable losses in the quest for corporate profits.
Marshall Ganz recently said that progressive health care activists need to engage the public and to take to the streets. "I don’t know a single significant social change accomplished in this country that hasn’t involved civil disobedience at one time or another," he recently told Laura Flanders. In the past week, people in Minnesota and in Philadelphia have engaged in nonviolent civil disobedience and were arrested to demonstrate their commitment to this cause. And last night, many watched as Keith Olbermann made a passionate, personal, hour-long plea for health care reform.
It’s in the air. People are ready for it. Please visit POP at publicoptionplease.com and let us know what you think. You can buy stickers designed by Justin, or donate and receive a special signed, limited edition poster he designed for the campaign. The proceeds will go to fund POP’s ongoing campaign to achieve health care for all.
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healthcare is a human right. not a civil right. (i expect that was what was meant, but it’s important to say)
Thank you Jane! And Hello to NYCEve, Eve Gittelson! I’ll surf there and say hello and thank her for ALL of her efforts. She needs to know from all of us that we have her back.
And hello again, Selise. We all should use ‘Healthcare is a human right, not a civil right’ on all of our FACEBOOK walls and as a quote tag on our emails…
-bleuz
Health Care is one of the Big Five human (civil) rights in a decent society:
a decent society guarantees:
food
shelter
health care
education
employment
This health care battle is one front in a war against corporate capitalism — (aka “corporate communism” most recently)
Thanks, Bleu. You have been doing incredible job.
Jane,
I love the work you’ve done but the name you’ve chosen is really odd if the issue is long term. “Public Option” is a very now term that has such difuse meaning it will probably drop from discourse in six months or a year.
Just my $.02
Michael
Already got an email with info for purchasing POP stuff and look forward to getting it.
CNN’s political ticker published my comment to the story “Key health care vote set for next Tuesday.”
http://politicalticker.blogs.c…..t-tuesday/
Petition here: http://boldprogressives.org/majorityvote/p-e1
And here: http://boldprogressives.org/majorityvote/p-e-typ
Be careful to not add another calf to the Veal Pen. Advocacy groups need to become democratic in nature and thus rooted in communities for them to avoid the traps that lead to a Veal Pen. Folks tend to become more mobilized and dedicated when they are bought into setting the agenda and fashioning the political campaign.
Thanks Jane. I’ve got to try… can’t just be just a whisper in the wind.
You’ve seen this already, I’m thinking? Many of us FDLers responding to your emails last week about Reid.
http://boldprogressives.org/majorityvote/p-e1
-bleuz
This is great! Thanks Jane and all others who work so hard for us all!
Hey Knoxville! How ARE you?
Thank you, too! ;-)
-bleuz
Our lobbyist won’t have bribe money only Net Roots support to persuade politicians that we can deliver votes energized votes that show up to Dem Primaries.
I’m not sure sure who will win cash or energized voters.
Joined earlier and sent some dust.
I agree with selise. Health care is a human right.
I’m good!
Jane’s petition to Reid was different from the new Bold Progressives’ petition, right?
I remember Jane’s petition also giving us an opporunity to write a letter to Reid, which I took great pleasure in writing!
Bold Progressives’ petition doesn’t give us that same opporunity, unfortunately.
By the way, I’ve heard from a columnist at Arkansas News who says that he saw the FDL Action ad to tell Lincoln and Ross to stop doing the bidding of the insurance companies several times during evening news programs and that he thinks it can have an impact on the final passage of real health care reform!
a normally understandable caution but . . .
that aint happenin’
Energized voters must be mobilized to demonstrate the level of strength behind their position in order to leverage the power of their numbers. Showing up with a lobbyist who promotes good ideas is insufficient.
This is all wonderful news and very exciting. Open up the big progressive dome tent! Come on in!
I would love more data on your disappointment with ads, jane, I think the long term effect / impact may be better than you think. And it’s one of the only ways we have to get our message outside of our bubble on our terms / framing. As po as i am, I just love chipping in on a good ad in any purple or red district.
I do think we should try to do more radio… particularly on/during the right wing talk shows. Something like that Ross Lincoln ad breaking through the hypnotic hate cycle during Limbaugh would really shake things up, imo. Especially over time. Of course some of that ad buy time is as pricey as television, but we can find real deals in the radio market too. I know I have.
1> Reframe the debate in human terms — health care is a human right. This is fight against bloodless corporate interests and the cost is human lives. We need to say that.
Why oh why aren’t progressives in the House demanding this type of bill first? Then forming health care legislation around its passage?
I will never understand this simple misstep.
Veal Pen will happen unless steps are taken to prevent it from happening. Nonprofits enter into mission creep and staff become more concerned with their meal ticket than the campaign(s) at hand. Often access to electeds or administrators is predicated upon playing ball with them. The system has adapted an immune response to non-corporate advocacy and we need to adapt to survive and be effective.
So we get mobilized and organized Rome wasn’t built in a day.
Seconded
amen.
I know I’ll probably get blown up here, and I’m not trying to be argumentative, but you’ve pointed out that health care is a human right, and I know what you mean, but you haven’t said one word about health insurance.
Health care is what the doctor and pharmacy provide you. Health insurance is how you pay for it – if you can afford to buy a policy.
I’m afraid if you talk about health care as a human right, you’re compelling doctors and hospitals, rather than insurance company CEO’s to take the hit.
I’ve never heard anyone say insurance is a human right.
I agree with Selise, too!
Access to quality health care is no less important than receiving a good education.
Without access to quality health care for all Americans, we don’t all have an equal opportunity to succeed and achieve the American dream.
Apologies to the artist, but the first thing that came to mind was desperate hands reaching for help. Inherently weak place to come from. Why not convey strength and generosity of spirit? (I can see RWers adding captions like “Change? Got any change?” Yikes.)
JMO.
That is great news, Knoxville. Thanks for that report. We heard that but it’s good to have it confirmed.
Semantics. Everybody here knows what we’re talking about. The generalized topic is health care reform, as seen and heard on every medium possible. The reform part is how people pay for their health care. You seem to want to play word games.
POP!
This is wonderful news. Thanks so much for including us, Jane. Looking forward to progress on all fronts!
You said you did not know if the President was born in the US of A because you were not there. How do you know health care is a human right?
If we envision a democratic, participatory society, government and economy, when we need to model our organizations on those fundamental principles and learn from the dead end that is the Veal Pen.
In my local work in San Francisco, advocacy nonprofits are almost as much of an impediment to delivering progressive change as DLC Democrats like Gavin Newsom and his corporate toadies are.
you think the pre-compromise from comprehensive, universal healthcare (aka hr 676 single payer expanded and improved medicare for all) last summer is what progressive healthcare activists, and progressives in general, wanted and supported? when the moveon leadership joined up with hcan and nyceve petitioned the leadership to consult with the membership, you think that was wrong? wasn’t that just what marcos is advocating for, “democratic in nature”?
not trying to start a fight, i hope you know my respect for you. and i understand that there have been threats from obamaco for progressive activists, think tanks and media to not push for single payer but still…. i do think marcos’ comment is worth some thought. jmo and ymmv of course.
How about we replace it with a guy with an automatic weapon, promoting a position of strength? Open hands can also mean “come, join us” and “we offer ourselves,” both of which are symbols of helping.
that is awesome!
hey jane, thanks for changing the title! i love the “health care is a human right.”
best of luck with the new campaign.
I expected to catch flack, but not from this angle.
I’d like to point something out that everyonem, even the progressvies miss;
from a time before we rose to walk on 2 legs there has been universal health care, whence the strong and healthy provided protection and care for the young and weak
a pack of wolves, a pride of lions, a hurd of buffalo, primates and others demonstrate this universal care, this is why they travel in packs and schools, flocks and schools
we were taken from the concept that we need to care for the weak among us when we started allowing corporations control over our lives
corporations don’t believe in universal health care, the might provide it if we force them but it is in the nature of our evolution to provide for the weakest among us, it’s how we evolved but more then that;
it’s one of the most important reasons we evolved
We’ve already said please, and that doesn’t seem to get the goods. This is a power game and the only thing that electeds understand is the raw threat of power, threat to their power.
I’ve been doing progressive activism for the past 25 years, cutting my teeth on the anti-apartheid movement, one that we won. Unlike the hippies that sucked the oxygen out of the progressive room until the early 1990s, those who thought that 1968 was a model for organizing and insisted we do it their way, my take is that we know what does not work, and we should avoid that, trying other approaches.
Becoming a member of the veal pen is a function of being dependent on risk-intolerant big donors.
POP is set up to be small donor driven. Consciously to avoid that.
That is what I do best.
That’s a pretty broad brush you’re using. I don’t consider my activities since coming out of Nam in 70 as having sucked the air out of anything.
A grin to share, with thanks to friends with Progress Michigan. They send out a daily cartoon to help us all keep our endorphins balanced. In this fight, we’ve got to refresh ourselves with grins, like LLN here on FDL. Go to this site and sign up for their daily — and MUCH NEEDED — grin, eh?
http://progressmichigan.org/page/s/5amfunnies
(today’s a re-post from Boulder; the cartoon’s cutline:
“I imagine the health insurance industry define laughter as a pre-existing condition.
No health insurance for you!”)
And a snark to share, re Tom Delay’s departure from Dancing with the Stars.After I heard the news, the song, “I Won’t Dance” popped into me head and stayed, a la earworm all day. Of course he had to leave the show. He’s got two right feet. For balance, dexterity, ya need a right and a left. Bi-partisan? Oh yeah.. bipedal. My, what will he do now? His Cadillac health insurance will have him doing pirouettes in no time. The rest of us? Not so much.
-bleuz
I would just like to know in what Founding document health care OR health care insurance is listed as a right. It’s not in the Declaration or the Constitution or the Bill of Rights. I must be missing something…
There’s a fairly new United Health building in Indianapolis…built on the blood of those they refused to cover, no doubt.
Jane, it is also a disease found in organizations that do not conscientiously renew themselves, that are dependent upon the personality of one individual and in which the issue becomes identified with that person and vice versa.
Organized labor, for instance, has a contributor base of millions, is technically democratic, but is the fattest, most immobile veal calf in the pen that is wasting away from an auto immune disease.
Jane, you and FDL have been an inspiration in this fight for health care reform. I think your list of strategies is mostly right on. I have also been thinking in terms of needing a public interest lobbying group (actually I worked for one once years ago in Sacramento doing state politics). But the funding is critical. It has to be able to be effective.
The only thing I would add or contest with your strategies is the first one – framing in human terms. That will appeal to progressives, but I think it is largely meaningless to the corporate interests and many of the politicians who are much more Machiavellian in their thinking. They have abstracted humanity in terms of power blocs and they are not particularly interested or moved by individual tragedy.
I think we also need a strategy of framing the debate in terms of economic and social effects. The right gets a lot of traction out of scaring people about increased taxes, and how much universal health care will cost, how much Social Security costs, how much Medicare costs. In fact a single payer health care system with an purposeful intention of spending less on unneeded treatment, economies of scale, less fraud and waste, can be enormously beneficial to the economy as a whole and even to commercial interests. We need to get information out about how such programs can pay for themselves in both abstract (quality of life) and concrete terms.
I have already joined the publicoptionplease.com project, but unfortunately have no money to add right now. Thanks again for your work.
“One of the things that has confounded me about the online organizing model is its dependence on the passion of the moment. All opponents really have to do is wait until the wave of outrage passes — whether it’s over health care, or AIG bonuses, or anything else that touches off heated public sentiment — and the battle ground is empty once again. “
This is a very astute observation. Playing the “long game” is a much smarter (and ultimately more effective) approach. Go POP!
Fixed it for ya.
probably my usual don’t comment purdy problem. it is a good caveat. and Jane certainly doesn’t need defending. just don’t see how the detectors/senses that enabled her to define the Veal Pen (see Keenan, Nancy) would allow her to get sucked in. frankly, suspect if we knew the whole story surrounding the cutting off of her funding a few months back, we would learn she was given the oppty to stfu, pick up the pom-poms, and climb on in
you and I will continue to respectfully disagree on the political realities and landscape that has us fighting for this particular PO and yes, my sister, I know we’re on the same side
Dragon, in the post-1970s, when the solidarity and direct action movements of the 1980s and early 1990s, Central America, South Africa, ACT/UP, Queer Nation andEarth First! were at their peak, my experience was that so many of the most entitled generation ever (most all white, str8, male and middle class and upwards) to walk the face of the planet felt that it was their god given right to tell us how to win the contests they could not.
We need to be sure that there is healthy exchange between the younger, middle aged and older demographics so that the expertise, experience and talents of those diverse perspective can inform one another rather than dominate, taking special care to ensure that voices usually marginalized are at the table as peers.
On the plus side, the hippies made our food so much better, I can indulge some of their more narcissistic antics.
oooh POP goes the weasels !
A geodesic dome.
I think we should be saying Health Care is a Human Right and a Religious Mandate. Make preachers take a stand.
My 2 cents
And hello right back to one and all!
This is a good idea. All 5 goals are right on the mark.
Blue Texan’s regularly scheduled post is up and ready: “Jeb Bush: Stop Blaming My Brother for Driving the Country Off a Cliff”
Healthcare is a religious mandate.
With this issue, it’s entirely appropriate to ask, “what would Jesus do?”
There’s an inconsistency in your title. If a public option is a right, you shouldn’t have to say “please”. Sounds a little like Oliver Twist asking for more porridge.
Alan, the trolls slink in here too, sadly. George Lakoff would have a field day with their (ahem) rhetoric. Stay awhile; they’ll subside, k? Their circumlocution outs them every time.
Small typo in the first point.
I can’t argue with that point. In 2002 a group of peace activists joined with the local Quakers to protest the invasion of Afghanistan and the pending invasion of Irak. Most of these activists were in their 50s and 60s, white, straight and middle class. When St Pete for Peace emerged from those vigils in early 2003 we were pleasantly surprised that we were joined by folks of all ages and persuasions. The demo most ignored today is mobile youth. Online and face to face have been the methods of choice for organizing these folks. There is a new movement but it’s splintered by locale. A few, like World Can’t Wait and United for Peace and Justice, have been instrumental in organizing progressives over the last 8 years.
Health insurance is just one option for paying the providers. If health insurance were to shrivel up and dry I would consider it to be party time.
With solar panels…. no cocktail weenies will be served.
UPJ and A.N.S.W.E.R. are the sectarian leftist pilot lights. They are always burning fuel, waiting to spark the masses, but they don’t do ongoing organizing. ANSWER especially is a Stalinist relic.
But their model is also of diminishing returns. I emailed ANSWER to beg them to focus their upcoming mobilization on health care, not the war, not israel, not darfur, just health care. Nobody wants to be sitting in civic center plaza with single issue leftists exhorting through a tinny fed back microphone that if you don’t support them, you are racist, sexist, classist, homophobic so that the message is an oleo of muddle…heard nothing back.
You mean like Teabaggers?
I haven’t heard anything from ANSWER in ages.
I’m obviously further to the left than you are so we’ll have to agree to disagree on some points. SPFP learned long ago that single issue events didn’t do well.
edit: single issue
eventsgroupsYeah, but now everyone is focused on health care and there is a real chance right now to make a positive difference in people’s lives by siphoning hundreds of billions of our dollars back from the health care vampires and into making people’s lives better.
If that’s not leftist, in the policy sense I don’t know what is. But the Stalinist control exercised by the politburo of ANSWER is problematic and stunts the growth of a coalition because Stalinists are the vanguard and you’re not.
That said, if you came of radical age when the Soviet Union was thriving, you’re probably a leftist. If you came of age as it was crumbling or after it fell, you’re probably an anarchist. As socialism and communism are failed solutions to 19th century problems, anarchy offers up a much more liberating (and effective) radical framework.
Proposal from Dean here: Expand Medicare to cover everyone over 50 right away. Link:
http://www.usnews.com/articles…..tions.html
A side effect of this would likely be earlier retirement from lots of folks who now are only working to maintain their insurance. This would have a positive impact on employment for those under 50 and those over 50 wanting to work.
It is nothing but a winner for Dem’s and could hold off the predicted losses in 2010.
Why not simply pass HR 676 and be done with it. Then there’d be no problem for the Dems in 2010.
Strength to you means automatic weapons?
Weird.
Open hands can mean a lot of things to a lot of people. I said what came to mind for me.
Although I don’t dispute that access to health care should be a guarantee paid for by society members through taxes, it is a little more tricky to show that this guarantee is a right. It is nevertheless true that assuring that guarantee, whatever its nature may be, does impose a cost. It is also true, that the nature of this guarantee and the most efficient way to meet its cost are two completely different sorts of notions, and can be considered separately.
The current debate deals with the most efficient way to meet the cost of health care, accepting that it should be guaranteed for all. This aspect of the debate is already clear and has most recently been confirmed by the CBO which says that the PO, with reimbursements tied to Medicare scales, reduces the cost of government subsidies for the currently uninsured by $85 billion when compared to a plan that excludes the PO. The reason being that the PO offers lower premiums. Additionally there are further savings for all other purchasers of plans with a PO, such as employers and non-subsidized individuals.
As to whether access to health care is a right, this notion certainly warrants some arguing and it must engage in that argument because many people in this country would challenge that notion. It certainly isn’t a self evident right such as the right to live peaceably and to speak one’s own mind freely, if for no other reason than that these rights carry no associated costs.
No one really doubts that health care should be available to all, what seems to be more contentious is the means of providing that access. The principle group opposed to the PO argue that enterprises that engage in profit making and in free competition can produce any product or service more efficiently, ie, cheaper. This may or may not be the case, although I doubt it. Insurers have only one task and that is to make a payment from a pool of other people’s money for a service rendered by some one else. Now how is 1,300 separate companies exacting a profit for making this simple transaction more efficient than a single entity making this same simple transaction for free? Anyway as made clear from the above the evidence just doesn’t bear that out.
This argument is in any case beside the point because currently insurance companies, as corporations, are not in the business of paying for health service, rather they are bound by a fiduciary responsibility to make the greatest return for their investors And many times this responsibility requires that they engage in practices that have nothing to do with paying for health care and all to do with generating those profits..
Works for me. I don’t honestly know the “best way” to proceed but I know for sure that it does not involve the continued monopoly dominance of the private insurers. I continue to hope that single payer becomes a reality.
The human stories are so important. I was listening to Al Franken yesterday at the hearing for Jamie Leigh Jones. What made it so powerful and real was his concern for the individual. That’s what matters most, really, in all of this: ending the horrible stories we hear about people whose live are destroyed (or ended) and finances decimated by a heartless for-profit system. I feel fortunate that I have not yet become a victim of our insane health insurance system and will fight to make sure that positive change occurs.
i don’t think we disagree so much on the political landscape. it’s the policy i have a problem with — not because it’s not perfect (and i think leaving 17 million without anything is worse than letting tx opt out), but because i just don’t think it will work. hope to be wrong, but can’t support a strategy for a policy i think is designed to fail (it is certainly not designed to provide “health care for all”). really really wish there could have been some discussion about that. anyway, i will wish all your efforts great success, even if i can’t in good conscience always join them.
We should have let Jesusland opt out in 1861.
Jesus would not have Caesar pay for his healthcare.
God made health care a religious issue in order to test our faith in free market capitalism.
I’m reminded of my favorite subway graffito of all time (Herald Square stop, mid-1980s):
Revolution Now Please
Public Option
PleaseOr Else We’ll Put Your Political Gonads In A Fucking Vise And Twist.I don’t thinks that the energy or attention span of bloggers will be zapped any time soon, regardless of the outcome of the current struggle for the PO as part of the heath reform effort.
Just seeing the influence such an effort has made and acknowledged by the MSM confirms this medium as the vehicle people have been searching for to have their voices make a difference in furthering what they want. Nor do I believe that people will give up their voice when faced with the task of tackling the other problems that lay ahead and about which people are rightfully concerned and informed about.
Several lessons come to mind:
- Grassroots advocay in the petitioning our local and congressional elected officials does have an impact.
- Republicans can be largely relagated to irrelvancy when dealing with important problems. They are just nuts.
- Obama has been shown to lack any leadership in the health reform effort, while conversely the allies in this effort have been found among certain congressmen and the TV (mostly MSNBC)
- The passage of the PO would be a huge achievement which goes to the very heart of major corporate interests. This effort has pitted the forces that are rightly opposed by their mutually exclusive interests, the public as against the corporations.
- Most problems facing the country when dealted with in an informed way have relatively straightforward solutions
- The looting of the public for the benefit of the financial sector is the result of Obama and his acolytes and these people should be seen for what they are. This is a timely concern whose solutions are currently being discussed in Congress and whose main advocate is Prof. Elizabeth Warren. She is petitioning the public to be engaged in the effort to install measures to protect consumers and reign in financial firms from parctices that have devastated the economy.
These lessons do give one hope that the ability to deal with our problems can be directly influenced and shaped by the public.
Jane, while I think your idea about starting a new organization that will not be part of the veal pen to facilitate a health care reform movement is a good one, I’m very sorry to see you commit to the PO-advocacy strategy as its foundation.
I’ve written in the past (here,
here,
here,
here, and
here),
about what a mistake PO-advocacy has been even from the viewpoint of getting a robust PO. Advocacy for it, rather than for Medicare for All has opened the way for the slicing and dicing we’ve been seeing in Congress that has come so close to killing any meaningful reform this year.
Advocacy for it, has also sapped the intensity of the support for health care reform, since many progressives can’t get excited about the PO, because 1)it’s not clear that even a Jacob Hacker type of PO would work, and 2) they’re pretty well persuaded that a Medicare for All, single payer insurance system is the best alternative available for us, and they just feel very badly about supporting anything else.
I don’t think people who hold this view wouldn’t settle, and happily, for a Hacker-type PO plan as a political compromise for 2009, and as a first step to Medicare for All. However, I don’t think we would ever try to persuade people that this is a solution that the United States ought to have, or that it ought to aim for.
So, while I wish you well with your endeavor, because of the great contributions to health care you’ve already made, and I think you will make in the future, I am still very, very, sorry that Eve, Marcy, and yourself have decided to continue to make them in the service of the PO, and not in support of Medicare for All.
The Veal Pen once upon a time was able to work the insider/outsider strategy, where a more radical activist outsider group would put pressure on for the ideal solution, and the nonprofit insiders would negotiate with power to get a half measure.
This delivered half measures for a few decades, but the system adapted an immune response that included neutralizing them in a Veal Pen. When you start from an insider half measure and negotiate down, you’re limited by the frame you’ve forfeited to opponents of reform.
The more the frame of the debate can be controlled from the outset, see David Letterman, the more effective an advocacy movement can be. Agreed that the Public Option will arguably do more harm than good. And it might make sense to forgo the mandate and public option and just do the business practices reforms to staunch the bleeding and moving forward frame the debate around Medicare For All as effectively as has been done for the PO.
Intellectually honest PO supporters will have to admit that all is not necessarily be smiles and sunshine on the PO as will pass Congress. There is also legitimate debate over whether getting a toehold on reform is a good strategic move. We’ve also got to admit that we’re wedged in a position from Obama having negotiated with himself first, allowed the framing to escape the side of real reform, and as a result are playing at a disadvantage right now.
Amnesty International USA already has an initiative promoting health care as a human right, which deserves some love, support, and attention.
For me, here’s the corollary: Profit-driven health care financing is a human rights violation.
Perhaps POP and AIUSA can realize synergies in this pursuit, so long as POP stays true to the principle that a public option can only appropriately serve as a transition to a genuinely nonprofit health care financing system.
That of course would place POP squarely at odds with Obama, who plans to be the “last president” to work on this issue. Fukuyama much?
Jane, in response to an e-mail from Eve this morning, I clicked on the Public Option Please link, and was distressed to find this as a “reward” for donating $25:
As I told Eve, anything with Obama’s mug on it is NOT considered a “reward” by me, and would discourage me from giving.
Just sayin’
Note to Jane, ES, Jason — we have new allies to thank:
Did you see/receive this?
http://blog.sojo.net/2009/10/0…..re-reform/
I’ve also been working with a task force of allies and church groups in PA to do outreach to the uninsured/underinsured in PA..but its work is distinctly NOT political in any way.
-bleuz
Hi marcos, I agree with most of your post, but not with:
I think that depends on the PO. I think a Hacker-type PO would do more good than harm, and would be happy to settle for it as second best; but I would never advocate it as the preferred solution to the terrible problems we see.
Ralph,
Why mobilize
– all the anger against the health care atrocities and injustices,
– all the hope for a solution, and
– all the people for a movement
advocating a half measure?
I just don’t get that?
I’m saying arguably, not certainly. Even the best thought out policies can have unintended consequences and we should not allow pride to blind us when it comes time to evaluate and tweak what we’ve fought for.
I’ve done the grind of helping elect local officials and running progressive policies through the grinder both legislative and ballot measure, and over that time, my hubris has been humbled.
We all need to beware of hubris, yet in the end we all also have to act on the basis of our best estimates of how things will work out.
You don’t recognize the phrase “LIFE, liberty and the pursute of…? Oh never mind.
Yes, you are missing something
I just see lots of progressives, all with the best intentions, advocating crafting policies with multiple moving parts and expecting it to just work well the first time out of the box. That unsupported sense of self confidence is something that turns off conservatives to progressives and reminds me of the sectarian stalinist leftist groups who couldn’t organize a picnic pontificating on what’s going to happen after the revolution when they were in charge.
Trailing legislation exists for a reasons like these, where the countervailing political forces will ensure that the final product is not the most effective policy-wise, but the most effective politically-wise. We need to have a plan for how to get the outcome from this process that points us in the right direction for the forthcoming, more comprehensive steps.
I don’t know enough yet to conclude that I have the same quarrel with POP that I do with HCAN and other groups that disingenuously oversell the efficacy of HR 3200. That could change.
It is as simple as the nose on your face
We don’t have health care in this country what we have is health insurance
Health ins is like the death insurance model. You are set up for fees based on your ability to be healthy. Once you are sick then you are considered a liability and are either charged more or dropped.
A health care system is a system of community primary health care clinics, no hassle admittance and referral to more complex physicans, and hospitals. This is practicing medicine for medicine sakes not because you can make millions
By the way, Jane’s post (inadvertently, I’m sure) fails to cite last week’s New York civil disobedience arrests at Aetna, by straight-up Medicare for All activists, as the very first of the current crop of CD actions.
Typical conservative or whatever persuasion you are. You are just babbling. You string on words after words and you convey no meaning. Better to wait until you have something concrete and intelligible to say.
The very essense of the PO is that it is simpler and cheaper than a for profit plan and therefore by definition has less moving parts. Just devote yourself to something easier for you to understand.
marcos, you said:
That’s why I’ve been distrustful of the PO from the beginning. It’s a wonk’s solution, just as Baucus’s compromise is a wonk’s construct. The HR 676 bill, on the hand, is simple, short, and solves the insurance problem and the moral problems that have arisen out of insurance. If we just passed it we could get on with real health care reform, i.e. reform of the wasteful and ineffective practices of the providers.
Ralph, I wasn’t suggesting that. Even a robust PO is a half measure and may not work as you well know. The only thing that’s worth going into the streets for is Medicare for All, “Everybody In, Nobody Out.”
Right, another reason why only Medicare for All will do it for us. A PO is only a compromise; you don’t start a movement to get a compromise.
gamd521, marcos’s style is a bit complex, and I see why you think he may be a conservative gracing us with his presence. -:) However if he’s referring to current PO bills versus Medicare for All, which is what I was referring to, he’s quite right.
HR 3200, the House’s PO bill right now is roughly 1050 pages in length and has lots of moving parts. Also, CBO forecasts that it would have only 10 million people in it by 2015.
In contrast, the Conyers-Kucinich enhanced Medicare for All bill, HR 676, is 30 pages long, and could be implemented fully by 2011 covering all 307,500,000 of us.
The Medicare for All bill is a lot simpler than any PO bill we’ve seen yet.
Yes, I went back and checked out those bills too and you are quite right. I suppose I owe him an apology which I gladly extend.
My larger point though is directed at the fact that having kept the PO alive to this point has been no small task. And to the extent that it has come about it has been due I think largely through the efforts of bloggers.
At this late date I suppose the best thing would be to recognize the shortcomings of having to patch the PO onto some remnant of the system as it stands now with the full intention of continuing the effort.
It goes without saying that in adition to these shortcomings, such as having to take on sicker cohorts that private insurers were unwilling to cover, the effort to undermine the success of the PO by the private insurers will be enormous.
The mere passage of the PO cuts deeply into the profits that would otherwise go to private insurers as proposed bythe Baucus bill which is being touted by many in the MSM as the next best option. So passing the PO in any permutation will signify the relative strength of public pressure over corporate interests. This would be a lesson that would not be lost on either side.
gamd521, I agree that the PO is alive in part because of the efforts of bloggers and also think that Jane’s untiring efforts, along with Eve’s have had a lot do with thwarting the Administration’s efforts to take the PO off the table. Honor is certainly due to the efforts of all who have kept the PO alive.
But I think that what also has to be recognized is that the efforts of single-payer advocates have also kept the PO alive. Surveys show that the PO has majority support among the public. However, surveys also show that a majority of Americans still support Medicare for All. the obvious conclusion is that majority support for the PO exists because a heavy majority of PO supporters are only PO supporters secondarily, and are Medicare for All supporters primarily. They see the PO as a step toward Medicare for All, or even confuse it with Medicare for All, which is why they support the PO.
This brings me back to the point I want to make. I think that the majority of Americans will react well to a PO if it is strong enough to deliver good service and to make a difference in the insurance market in holding down costs. But if it doesn’t do that, I’m afraid they will view it as a failure, and also again but into the Republican meme that the Government can’t get anything right. If that happens the PO won’t be a step toward Medicare for All. Instead it will delay its coming until a new generation get over the anti-government conclusions that will be drawn from it.
So, I do not agree with your final paragraph above. If we get just any PO passed, we will pay the price in 2010 and succeeding elections. If we lose in 2102, moreover, the PO will not even be implemented. So, I think it’s essential for us that progressives vote against any PO that’s not a very strong one, and then come back next year for Medicare for All. I also think that a very strong PO is unattainable in the absence of a serious effort from progressives to get HR 676 passed, simply because I don’t think that the blue dogs would ever agree to a really effective PO unless the Insurance and drug industries were scared out of their minds at the possibility that HR 676 might pass. In short, I think that PO advocacy will not produce a good PO. Only advocacy of HR 676 or S 703 (Bernie Sanders’ Senate Medicare for All bill) would produce a compromise on a robust PO of the kind Jacob Hacker wrote about.
That’s why I replied to Jane as I did earlier.
Let’s try to get a bit into specifics so that we can determine what features of the PO are worth supporting, or if it is just not worth supporting at all for the reasons you give. If a PO were to come about I maintain that the next would follow:
-the 47 million or so currently uninsured would be eligible for the PO and as the CBO has determined it would lead to government savings of $85 billion from the cost of having to subsidize some segment of these uninsured. The reason being that a PO run plan has lower premiums than a private plan. This measure alone would drive private insurers apeshit because this deprives them of enormous profits.
-in theory after an initial government outlay of money this group will become viable through premiums.
-it’s not clear whether other purchasers, such as those currently covered by private insurers will be eligible to purchase the PO plan. If they can then this group will in effect become the predominant group, whereby a large segment the population is receiving publicly managed insurance that is paid for by premiums. Not a single payer exactly but close.
You will need to enlighten me a bit as to how the different version the House and HELP bills vary as to their overall conditions for the PO because in actuality this outcome seems very likely.
Now I don’t quarrel with you at all that the preference of those supporting the PO is a single payer arrangement tied to Medicare. Nor did I mean to imply that anything less than this version of the PO is what I understood. I am just not sure how far removed from the above scenario some versions of the PO plans being comtemplated actually are.
Gamd521, how do you know what “the PO” looks like when there are many variants floating around with different characteristics, and how can you comment on the nature of a policy that has yet to be nailed down?
You’re not saying that these disparate policies will all have the same effect, are you?
FoxNEWS says that anyone who disagrees with them is a communist, socialist or fascist, depending on the need of the moment. I’d hope that we’re better than that.
I am an anarchist because I’ve seen the left fuck things up repeatedly but am still a radical democrat. My activism is in local electoral politics because I am sick of the disempowerment that is protesting. Along with a wide variety of folks from all walks of life, I’ve been part of a neighborhood movement to take San Francisco away from rapacious corporations who view our City as a strip mine and are dumping their tailings in the rest of the City. Together, we’ve won elections, won ballot measures and passed laws that shift the dollar signs from corporations to people on health care and housing amongst other issues.
We’ve seen all sorts of social welfare programs “value engineered” to the point where they’re almost designed to fail. That is a potential pitfall in any bureaucracy that the government runs. That is not an argument against the government running it, but an argument for identifying patterns of sabotage to progressive initiatives which have hobbled further progress for the past 30 years so that we don’t repeat those errors.
In other words, simplicity is elegance, and these bills are neither simple nor elegant.
The PO remains on the table because 2/3 of people support it and it is very difficult for Congress to cross 2/3 of the electorate. Not that they won’t do it, but its not simple.
gamd521, OK. Let’s discuss specifics.
I don’t think the point here is the 85 billion in savings over 10 years. Even if it is true, a big question in any 10 year forecast, that’s a miniscule annual savings of $8.5 billion per year, only less than one percent of current Government expenditures on health care. The bigger issue here is how many people would be covered by the PO, whether their premiums would be very much lower than private industry, whether the PO could develop a good enough provider network to actuully serve people, and whether the POs in HR 3200 and Senate HELP would actually survive. Kip Sullivan addressed these questions in July. I urge you to read his carefully reasoned article, I think it is persuasive in arguing that the PO in either of these bills will have a great deal of trouble surviving, that it will have little effect on prices, and that it will have enrolled only 10 million people by 2015 provided the CBO estimate, which seems to have a very shaky foundation, is correct. Overall, Kip makes the case that the POs in these two bills are too weak to drive insurance prices down. You might also consider that since the PO won’t even be operative for another 3.5 years or so, at current double-digit increases in private insurance prices we will have sustained price increases between 40-50% relative to today before anything has a chance to bend that curve.
I don’t understand this reply, what it’s based on, or why it’s important. I don’t think CBO forecasts any decrease in subsidies as time goes on, do you?
I think this is the big issue.
As I interpret HR 3200 and Senate HELP, the PO is limited to those who can’t get insurance at their place of work. Others don’t have the PO as an option. Now, if a PO passes, and Ron Wyden’s Amendment establishing a national exchange with unrestricted eligibility also succeeds, then we have a situation, like the one assumed originally by Jacob Hacker, where everyone would be eligible for the PO, and there would be some chance for substantial growth in enrollees. Even then, however, this would not fulfill all of Hacker’s crieria for success, as Kip Sullivan makes very clear in his article, and it wouldn’t come close to guaranteeing that the PO would get anywhere near the 129 million enrollees forecast by the Lewin Group, assuming Hacker’s criteria were fulfilled. BTW, to put this in context, as near as I can make out from looking at different sources and population statistics private insurance now covers about 168 million people.
That too, is covered in Kip’s article. BTW, Kip has a second article answering critics. He also has a great piece on Senate HELP, another on the chicken-egg problem, and critiques of HR 3200 here, and here. This last also compares HR 3200 and Senate HELP POs with Medicare showing that neither are like Medicare.
That’s covered in the last link above. Neither PO is like Medicare and neither is likely to evolve to Medicare.
Hope this gives you the links you need to answer the questions you raised. Btw, I think you may be interested in the whole question of savings that might be forthcoming if we passed HR 676. I’ve covered that in a recent diary.
Again as with your friend you seem to wander around in incoherence but in his defense I think he must have been an anarchist as well.
You don’t need to cut open every apple to know that there are seeds inside that goes along with the definition of being an apple.
Similarly if a plan is a PO then by definition it is both a single payer, ie simple, and cheaper to manage because payments are made without diverting a portion to profit. Or has the definition changed by living in San Francisco as an anarchist or radical democrat or some other appellation.
You must also have cognitive dissonance by entertaining both the need for a pure simple scheme that applies your local needs while being managed by the central government, or do you intend to fund your single payer plan exclusively from your neighborhood fund drives?
Apparently you have not familiarized yourself with the 5 plans since you don’t know in which fundamental and irreconcilable ways they differ regarding the PO they contain. It is not much of a leap to expect that as PO they will at least bear some family resemblance to each other. If they are unable to function with out profit while being self sustainable and affordable so that it covers all the currently uninsured then that plan no longer fits the definition as laid out for a PO.
Your implication that advocacy for a plan that covers the entire population with San Francisco thrown in, whether it is a single payer or a PO, can be accomplished by local means is belied by the fact that it was largely accomplished by people on the net exerting nearly coordinated pressure with the help of the means we are employing at present. But enough of this.
I have gone over the article you cite and find it unpersuasive. It complains that transitioning in a PO plan into the current system is both futile and insufficient toward reducing costs. The reason being that the barriers are somehow intrinsically insurmountable. Well none of these barriers seem to be insurmountable. The feasibility of this transition, however, seems to require rigorous mathematical analysis which one presumes has been done.
As to the requirement for a pre-populated pool to start the PO plan;
Mention is repeatedly made that only 10 million people will ultimately be recruited into the PO plan out of the currently existing (pre-populated) 47 million people who have no private insurance, because they either can afford insurance but have been excluded or they can not afford it.
It poses no insurmountable problem to identify what the nature of this 47 million population is and the risk they pose in terms of medical costs. This is a problem for statistical analysis but certainly doable. Regardless of this, whatever prompted those cited 10 million people to opt for the PO plan can be used to lure the remaining 37 million people currently w/o insurance into the plan. Presumably it was the lure of lower premiums in the PO plan.
So much for the enrollee critical mass objection.
The other requirement, that people opting for the PO plan receive sufficient government subsidies to meet their premiums is really the crux of the matter. The other complaints are basically administrative ones and pale by comparison.
It is these subsidies that represent the bulk of ongoing government expenditure and will determine the feasibility of the plan. The threshold subsidy that is needed presumably will assure that all participants in the PO plan can pay 15% below the average reimbursement to providers. That number can be calculated.
Now will providers be willing to receive this level of reimbursement? Yes they not only will but they must in order to keep the cost of delivering health care down, as long of course as this level of compensation will allow them to keep operating. If not then the subsidies are adjusted upwards. Again whatever the ultimate level of compensation, it needs to comport with two objectives; one, that it be lower than private reimbursement and two, that it be sufficient to lower the oft mentioned long term expenditure on health curve. This level of compensation can be calculated as well.
Looking back, providers levied the same objection when Medicare was being initially proposed but their fears were soon dispelled when the volume of patients they had coming into the system allowed for plenty of revenues to end up in their pockets.
All agree that the PO is a second best option to the single payer concept, but as currently proposed there is nothing to preclude its viability as long as it satisfies the two criteria of including a critical mass of people in its plan and being affordable in terms of the subsidies needed in order to be able to keep its premiums below that of private insurers.
One doesn’t need to mull over the political ramifications of possible failure of the PO plan and instead make sure that it is structured so as to succeed. Nor is there anything inconsistent with being an advocate for a viable PO plan now and for the single payer concept eventually soon.
Perhaps you are a rocket scientist and can hit a moving target from a moving body, but that is above my pay grade.
Nonsense. Do not put it past the corporate congress members to slather an unworkable version of a public option onto a corporate welfare bill. Look at other social welfare programs, medicare advantage, prescription coverage, welfare, unemployment to see how the safety net can be set up to have both holes and spikes.
The public option will only challenge insurer dominance if it has certain characteristics, characteristics which are not guaranteed to be in the final bill.
Is your suggestion that one of the five plans will emerge out of whole cloth and be passed through the conference committee and signed by the President? Or is it more likely that each policy contained in each of the five plans can be combined in myriad ways? The complexity of so many policy and political variables in play makes it impossible to predict what the final outcome will be.
You misunderstand. Most people on this list have never worked to elect a candidate to office, have never had to work a policy through the legislative process, even a more simple watered down local process, and make that policy work as law, I am not suggesting that localities go it alone. Rather, I am suggesting that my experience sheds light on the lawmaking process which leads be to think that from your armchair, you misunderestimate the complexity of fashioning policy, especially complicated policy, and as such, do not account for the proclivity of the sausage grinder to crank out contradictory policies in one fat bill.
You then write:
So long as it satisfies the two criteria. How do you know that the final bill will satisfy the two criteria? And if it does not satisfy those criteria, then it will be a PO that does not work.
I am generally sympathetic to your reservations and I am myself more an anarchist than anything else, you can not rely on people being either altruistic nor pragmatic.
I am an MD and I beleieve that most people in the health care field are smart enough to know that costs need to come down and sacrifices need to occur. Most providers will not be digging in their heels and few are enthralled by private insurers.
I also think that even legislators can be made to bend to public will and demand. It seems more likely now than in the past due to the advent and use of technology to generate real time pressure as well as real time fund raising. I realize that a Pyrrhic victory is meaningless as a goal, but if it comes to be adopted the PO will show to people, that will identify with having taken part in it’s achievemnt, that they have had a say in the outcome.
I think that the general sense of being a part of the effort that permeates this site has had tangible effects. I believe that the idea of hiring a paid lobbyist to advocate directly with congress is maybe the offshoot of the belief that real power can be drawn from the grassroots. I guess we’ll have to see.
Hi gamd521, You say:
I don’t think Kip Sullivan claimed that the barriers were “intrinsically insurmountable,” Rather he gave a number of reasons why he thought the PO couldn’t be successful. Specifically, he pointed out that: 1) it would not use Medicare rates so the price advantage would be less than expected, 2) that it wouldn’t be able to establish a good network of Doctors to service patients because in each State it would have too small a pool of patients to offer (divide 10 million by 50 and you get a small number compared to what the big insurance companies cover); 3) it would have relatively high over-head, compared to Medicare, because of the need to market against the insurance companies and less market power to get favorable advertising and promotional rates; 4) it would have relatively high service costs also because, given its small size it would have to pay providers, and for other reasons I won’t mention. In other words, Kip provided an analysis of why the PO would fail. It is noty enough for you to just dismiss his analysis above or say you don’t agree. You can refuse to agree all you want, but it is not true that he claimed that the PO would fail because of its intrinsic features, but rather discussed how those features would mix with market conditions to defeat it. If you want to have credibility against this analysis you have to take the time to critique it and show that it is wrong.
Also, your presumption that rigorous mathematical analysis was done to show that the transition is feasible is not the case. According to its analysis of HR 3200, CBO says that it assumed that 10 million would sign up for the PO by 2015. It never says how they arrived at that conclusion. It never presents any mathematical analyses or simulations to back up its forecast. However, assuming that its forcast is correct for the sake of argument, do you understand how little competitive pressure would be exerted on the major health insurers by 10 million people in a PO plan priced marginally lower than the major insurance companies. The CBO does and it gives very little credit to the PO for bending the cost curve. According to CBO its effect on prices would be marginal six years from now. In six years at current rates of increase in the private insurance market we will have insurance price increases of 60-70% over today’s prices, HR 3200’s PO or not.
You argue against the critical mass objection by saying:
Again, you’ve made a very questionable presumption. HR 3200 assumes that 17 million people will choose to remain uninsured because they’d rather do that than pay the cost of insurance not covered by a subsidy. That leaves a market of 30 million people. When CBO says that 10 million will enroll in the PO by 2015, they’re also saying that the privates will have recruited 20 million for themselves. Now, I’m sure the PO insurance organization will survey people to find out why they prefer the privates, and they’ll advertise based on what they find to attract more people and get them away from the privates.
They’ll have some price advantage, probably 5 or 10% in the end, but they’ll most probably have a provider network disadvantage, an advertising disadvantage, and also a benefits disadvantage because the private insurers will offer marginal benefits to attract younger and healthier people to deny them to the public plan and to drive up its costs. So, I don’t think that it’s very likely that millions will flock to the PO, and that its market share will rise rapidly over time. Instead I think that the privates will beat them down over time and that they won’t be able to develop a critical mass or stay in business. In fact, I agree with Kip that the 10 million forecast by the CBO is so much BS and that when the plan gets started in 2013, they will be very likely to attract a few million and even a minimal provider network. By 2015 that plan will be toast, and we’ll all be agitating for Medicare for All.
Next you say:
First, the Government subsidies being proposed will apply equally well to the public and private sector. There is no bill on the table now that provides subsidies only to the PO.
Second, you’re wrong to say that the other points made by Kip are “administrative” in character. Whether the PO will have a provider network that can compete with the privates is not Administrative.” Whether the PO will be have sufficient money to be competitive in marketing itself against the privates is not “Administrative.” Whether it can attract enough people is not “Administrative.” All these and other objections of Kip’s are substantive economic issues affecting whether the PO will be able to stay in business. They have nothing to do with “Administrative Factor, and you do nothing for your credibility by characterizing them this way.
Further when you say that the subsidies “presumably will assure that all participants in the PO plan can pay 15% below the average reimbursement to providers” you are just blowing smoke. There is no provision in any of the bills to either assure this, or even suggest that it may come about.
When the PO starts up it will have no enrollees — nada. It will have to attract some. If it goes to Doctors and Hospitals and says we’ll reimburse you at 15% less than your average reimbursement if you sign on with us, they will ask: How many more clients can you provide me? The PO will then have to say, right at the moment I have none, but two years from now we expect to have a lot of customers if you come with us, I think the providers will laugh. This is the chicken-egg problem. You’ve given absolutely no reason to believe that it can be overcome.
Moving on:
There’s nothing in these bills that requires providers to keep costs down, and no reason to believe that they will accept the compensation you suggest when the Po has very few patients compared to the private insurance companies. You’re assuming the providers will decide to subsidize the PO relative to the private insurers. That just won’t happen. Nor will it happen that subsidies will be adjusted upward. Again there’s no provision in these bills to do that. In fact, much of the pressure we are seeing in Congress now is to hold down the subsidies so that the bill can be deficit neutral or even present a bit of a surplus. So your view that the subsidies can be adjusted isn’t based in fact.
Next:
That’s true. But the POs under consideration are not Medicare. Medciare began with 45 million enrollees on Day 1. I’ve already pointed out that the PO won’t be delivering very many more customers than now to the providers — only 10 million by 2015 at most. During the period 2013-2015, the private insurers will be delivering 20 million new customers to the providers. Why should the providers give better rates to the PO than to their better customers, the private insurers?
And moving to your final points:
As I’ve argued, there’s little chance that the inadequate POs we see in current bills will reach critical mass. Also, there is now pressure on affordability because the Baucus committee cut the size of the subsidies relative to the House Bill. Also, the bills being considered don’t take effect until 2013. By that time, the rise in insurance premiums will make the subsidies even more inadequate.
Finally your point about not worrying about the political ramifications of a failed PO would be a good one except that we don’t have the power to make sure that the PO is a good one. A good PO would have followed Hacker’s conception and would have pre-enrolled 50-60 million on Day 1.
The best we’ve been able to get so far is the HR 3200 bill, and in that PO there would be no enrollees on Day 1, and a very good chance that the PO won’t be able to survive. So, without an adequate PO alternative we have much to be concerned about, since a failed PO will neither bend the cost curve, nor persuade people that the Federal Government can be an effective instrument that the American people, working together, can use to better their lives. Since this is at the center of the progressive credo, these PO bills give us much reason to worry that we are facing a generational setback if we continue to support them.
Hi there, sorry I’ve been a bit tied up. Just a few rebuttals form my end.
I will focus on the basic aspect of managing risk, the need to spread the risk among both high and low risk participants. For this you must have sufficient participants so as to assure that the resulting premiums are affordable.
Point of disagreement or contention:
That not all 47 million eligible for the PO will prefer it to private insurers given that its premiums are lower.
You give no justification for accepting that claim. Further, it is precisely those 47 million that are our pre existing group. Also, they will have lower premiums than any private insurance plan regardless of where they live. Their premiums are set by dividing 47 million by the aggregate cost of their care, and this premium is calculated beforehand to be lower than that of the private insurer. These lower premiums will apply even if you want to scatter the PO participants hither and yon.
The first relevant question is what level of subsidy will be needed to assure that premiums will be lower than private insurers, given the nature this group’s ability to pay all or part of the premium. That number is not hard to arrive at and if it hasn’t been done, then the CBO numbers are worthless.
I don’t see what other issues matter. It goes without saying that before you put the PO program, or any program, in place you set it up first. But what’s the big deal? If setting it up takes a year then fine.
So you send out pamphlets to 47 million people telling them that you will provide them health insurance that is cheaper than anyone else’s. It makes absolutely no difference what the risk of any participant carries, they will all similarly opt for a cheaper plan.
Based on this, you go to the providers and tell them that they will get so many more patients and in return they will charge them a little less.
That‘s it plain and simple. The only difference between the PO and the single payer is one of scale. The fact that private insurers are opposed to the PO applies to an even greater extent to their opposition to the same program at a bigger scale.
Lastly, although a bit tangently, regarding Medicare. Medicare filled the nitch of very sick and costly elderly whom private insurers wouldn’t touch. Similarly the PO fills the nitch for the uninsured and if some insured are also eligible for it all the better.
However, the elderly would never be able to pay their elevated costs in premiums so the government took up the entire cost through taxes on every one else. Medicare is an entitlement for the elderly, all other people have to pay premiums for their health care. So analogizing to Medicare is not always accurate.
Hi there, sorry I’ve been a bit tied up. Just a few rebuttals form my end. I will focus on the basic aspect of managing risk, the need to spread the risk among both high and low risk participants. First you must have sufficient participants so as to assure that resulting premiums are affordable.
Point of disagreement or contention:
That not all 47 million eligible for the PO will prefer it to private insurers since its premiums are lower.
You give no justification for accepting that claim. Further, it is precisely those 47 million that are our pre existing group. Also, they will have lower premiums than any private insurance plan regardless of where they live. Their premiums are set by dividing 47 million by the aggregate cost of their care, and this premium is calculated beforehand to be lower than that of the private insurers. These lower premiums apply even if you want to scatter the PO participants hither and yon.
The first relevant question is what level of subsidy will be needed to assure that premiums will be lower than private insurers, given the nature this group’s ability to pay all or part of the premium. That number is not hard to arrive at and if it hasn’t been done, then the CBO numbers are worthless.
I don’t see what other issues matter. It goes without saying that before you put the PO program in place you set it up first. But what’s the big deal? If setting it up takes a year then fine.
So, you send out pamphlets to 47 million people telling them that you will provide them health insurance that is cheaper than anyone else’s. It makes absolutely no difference what the risk is that any participant carries, they will all similarly opt for a cheaper plan.
Based on this, you go to the providers and tell them that they will get so many more patients and in return they will charge them a little less.
That‘s it plain and simple. The only difference between the PO and the single payer is one of scale. The fact that private insurers are opposed to the PO applies to an even greater extent to their opposition to the same program at a bigger scale.
Lastly, although a bit tangently, regarding Medicare. Medicare filled the nitch of very sick and costly elderly whom private insurers wouldn’t touch. Similarly the PO fills the nitch for the uninsured and if some insured are also eligible all the better. In contrast though the elderly would never be able to pay their elevated costs in premiums so the government took up the entire cost through taxes on every one else. Medicare is an entitlement for the elderly, all other people have to pay premiums for their health care. So analogizing to Medicare is not always accurate.
Hi there, sorry I’ve been a bit tied up. Just a few rebuttals form my end to our last exchange form a day or so back.
I will focus just on the basic aspect of managing risk, ie, the need to spread the risk among both high and low risk participants, and the need for a sufficient number of participants so as to assure that the resulting premiums are affordable.
Point of disagreement or contention:
-That not all 47 million uninsured that are eligible for the PO will prefer it to private insurers since its premiums are lower. And in fact that only 19 miilion will.
You give no justification for accepting that claim. Further, it is precisely those 47 million that are our pre-existing group. Also, they will all have lower premiums than any private insurance plan regardless of where they live. Their premiums are set by dividing 47 million by the aggregate cost of their care, and this premium is calculated beforehand to be lower than that of the private insurers. This is true even if you want to scatter the PO participants hither and yon.
The first relevant question is, what level of subsidy for PO participants will be needed to assure that premiums will be lower than private insurers, given the nature this group’s ability to pay all or part of the premium. That number is not hard to arrive at and if it hasn’t been done, then the CBO numbers are worthless.
I don’t see what other issues matter. It goes without saying that before you put the PO program in place you set it up first. But what’s the big deal? If setting it up takes a year then fine.
So you send out pamphlets to 47 million people telling them that you will provide them health insurance that is cheaper than anyone else’s. It makes absolutely no difference what level of risk any participant carries, they will all similarly opt for a cheaper plan.
Based on this, you go to the providers and tell them that they will get so many more patients and in return they will charge them a little less.
That‘s it plain and simple. The only difference between the PO and the single payer is one of scale. The fact that private insurers are opposed to the PO applies to an even greater extent to their opposition to the same program at a bigger scale. That opposition has to be overcome in either case.
Lastly, although a bit tangentially, regarding Medicare. Medicare filled the nitch of very sick and costly elderly whom private insurers wouldn’t touch. Similarly the PO fills the nitch for the uninsured and if some insured are also eligible all the better. However, the elderly would never be able to pay their elevated costs in premiums so the government took up the entire cost through taxes on every one else.
Medicare is an entitlement for the elderly, all other people have to pay premiums for their health care. So analogizing to Medicare is not always accurate.
Hi there, sorry I’ve been a bit tied up. Just a few rebuttals form my end to our last exchange form a day or so back.
I will focus just on the basic aspect of managing risk, ie, the need to spread the risk among both high and low risk participants, and the need for a sufficient number of participants so as to assure that the resulting premiums are affordable.
Point of disagreement or contention:
-That not all 47 million uninsured that are eligible for the PO will prefer it to private insurers since its premiums are lower. And that in fact that only 10 of the 47 million will.
You give no justification for accepting that claim. Further, it is precisely those 47 million that are our pre-existing group. Also, they will all have lower premiums than any private insurance plan regardless of where they live. Their premiums are set by dividing 47 million by the aggregate cost of their care, and this premium is calculated beforehand to be lower than that of the private insurers. This is true even if you want to scatter the PO participants hither and yon.
The first relevant question is, what level of subsidy for PO participants will be needed to assure that premiums will be lower than private insurers, given the nature this group’s ability to pay all or part of the premium. That number is not hard to arrive at and if it hasn’t been done, then the CBO numbers are worthless.
I don’t see what other issues matter. It goes without saying that before you put the PO program in place you set it up first. But what’s the big deal? If setting it up takes a year then fine.
So you send out pamphlets to 47 million people telling them that you will provide them health insurance that is cheaper than anyone else’s. It makes absolutely no difference what level of risk any participant carries, they will all similarly opt for a cheaper plan.
Based on this, you go to the providers and tell them that they will get so many more patients and in return they will charge them a little less.
That‘s it plain and simple. The only difference between the PO and the single payer is one of scale. The fact that private insurers are opposed to the PO applies to an even greater extent to their opposition to the same program at a bigger scale. That opposition has to be overcome in either case.
Lastly, although a bit tangentially, regarding Medicare. Medicare filled the nitch of very sick and costly elderly whom private insurers wouldn’t touch. Similarly the PO fills the nitch for the uninsured and if some insured are also eligible all the better. However, the elderly would never be able to pay their elevated costs in premiums so the government took up the entire cost through taxes on every one else.
Medicare is an entitlement for the elderly, all other people have to pay premiums for their health care. So analogizing to Medicare is not always accurate.