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.

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.

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.

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.

“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.”

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:

“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.”

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:

“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.”

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:

“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.”

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:

“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.”

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:

“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.”

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.

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.

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.

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.

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.

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.

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.

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:

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.

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.

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.

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.

“-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.”

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.

“-in theory after an initial government outlay of money this group will become viable through premiums.”

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?

“-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.”

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.

“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.”

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.

“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.”

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.