Under no circumstances will a patient be dicharged from the hospital before it’s safe to do so. This decision is made by an MD only and he is fully responsible for this decision. First, an MD has no interest in jeopardizing his patient nor in being sued for negligence.

As to to the availability of providers, I either heard or saw that Medicare enrolled doctors would cover PO patients initially but could if they wished opt out if they pleased.

Also I don’t see where the impasse lies in the PO entering a market to compete in this case for enrollees as such. Not taking into account the need to attract the right mix of enrollees as regards to their risk. I mean I’m sure HHS is able to handle this task, since the’ve done it before.

Now I am completely in favor of a single payer system but if a PO is what we’re going to get then it is, I believe, incumbent on us to do all we can to make it work.

It may be that private insurers will hasten their own demise with their ever increasing burden on enrollees. And if we are out of options then establishing a successful PO may be what we are left with.

The PO wants to claim market share by offering to spend 95% of the premium dollar on services for all enrollees regardless of their ultimate cost and it will accept all comers. The private insurers will spend less of the premium dollar on services and will set premiums commensurate with risk, and will further set additional obligations on its enrollees.

The terms for each plan should be required by law to be stated clearly. Since it is a foregone conclusion at this point that private insurers are not going to give up their lucrative business anytime soon of their own volition then the terms of the competition need to be set out clearly.

The market being disputed is 50 million give or take and the group most sought after by both plans are the healthier prospective enrollees. It may be that they will face initially slightly higher overall costs from the PO but this cost can be expected to fall as more of the healthy enter the plan.

Currently this seems to be where we are at and the success of the PO may hinge on its ability to capture market share. The legal requirement that enrollees be given the clear terms under which each plan operates should be required at the very least..

From Jacob Hacker on down, no PO advocate has written a paper describing how the PO is supposed to be set up. This would be like telling me in great detail what you plan to do on the other side of the river without once telling me how you plan to cross the river.

that’s a great question, one we have not been giving much if any attention to. i’d also like to see some info on this — how does an insurance company break into well established markets? what are the critical issues that determine success?

anyway, thanks for asking the question.

I’m sure you’re as aware as I am that there isn’t one word about any of this in the House bill (now HR 3962). All the House bill says is that the Secretary of HHS “shall provide” a “public option.” How in the world does anyone even hazard a guess about who will participate and whether the PO will limit patient choice of doctor or kick patients out of hospitals early?

I posted an open letter to CBO’s director on the PNHP blog on October 2 in which I asked CBO to publish the methodology it used to determine the characteristics of the PO that it has reported to members of the House. The next day I sent the letter, return receipt requested, to Elmendorf. I didn’t expect Elmendorf to answer me. My main purpose was to educate the public. In any case, I haven’t heard from Elmendorf.

I sympathize with the bind CBO has been placed in by PO advocates. From Jacob Hacker on down, no PO advocate has written a paper describing how the PO is supposed to be set up. This would be like telling me in great detail what you plan to do on the other side of the river without once telling me how you plan to cross the river.

I think CBO should have had the courage to say they need more information than is available in the House and Senate HELP Committee bills to determine anything about the PO, and until the authors of the bills provided more information CBO was going to predict zero enrollment in the PO. CBO did that make that prediction for the Senate HELP bill, then inexplicably went on to estimate other characteristics of this non-existent PO.

Kip Sullivan

But who can actually say with certainty how all of the variances and differentiation between all of these contending plans will shake out? Who in hell can even begin to guess at the unintended consequences?

I appreciate Mr Walker’s ongoing analysis, but what he continues to prove is that this “reform” is going to be one colossal cluster-fuck. Any sane society would look for the elegantly simple solution … the one that is based on humanity, fairness and solidarity. We should be ashamed for having allowed our politics to become so crass and cynical.

http://www.obamasquagmire.com/?p=3929

i actually do think the public option in a multi payer system is fundamentally flawed policy (which is why i ended up being an hr 676 extremist). was just trying to provide info on what hacker’s original plan was, since i suppose that might not be a spectacular FAIL. the other proposals we’ve seen are for a very weak po, that i do think will ultimately fail to control costs (costs being total national health expenditures).