Agreed. There’s going to be a huge political outcry to fix inadequate subsidies (which still aren’t indexed to medical inflation) and–if the exchanges are successful–to expand the exchanges. But if we lose the public option, we are unlikely to get it back. I share your concern that the risk adjustment is weak. This imperils the solvency of the public option because it is likely to be the main beneficiary of risk adjustment. Hopefully someone is proposing an amendment with the Dutch mechanism.

Why do so many ostensibly intelligent people like Silver keep coming up with such absolutely ludicrous ideas and think they are viable?

Remove the public option, and the exchange goes from a bad place to buy health insurance to an awful, even more expensive place to get health insurance.

But that exact same outcome is just as likely with an ineffective and watered down PO.

With this “Health Care Bill” the public is ALWAYS optional.

bill sucks. gonna get worser. if I’m halfway progressive senator i have a tough time deciding whether to vote for it.

So what do you suggest we do Jon? This seems like another ” you’re going to get f@cked and not even kissed, and there’s nothing you can do about it” post. Any activism by the FDL community is useless? The outcome is inevitably bad?

I consider myself progressive, and I know damned well how I’d vote if I were a Senator. A big, fat, NO. Wish I were one, but at least I have been calling and emailing mine hoping they’ll do it for me. *g*

We need COBRA extension in the SENATE Bill.

The HOUSE bill permits anyone on COBRA or state-extension of COBRA to continue on their group-rate insurance plan (of course the individual has to pay the premium) until the exchanges start.
That is a huge benefit that is COST FREE for the government because it allows the unemployed, who include many over 50 who CANNOT get insurance in the marketplace because of pre-existing conditions, to continue coverage.

I really like the idea that if they do settle on these “exchanges” or whatever, then the Congress has to give up their gold-plated health-care plan and buy their healthcare exclusively on the “exchange”. Gaurn-damn-tee you that they’ll be both first-rate care and easy to access if that’s the only health care available to those ass-hats.

And the public option, as currently constructed, would only enroll 3-4 million people-

Yeah, I think the actual target number removes the hyphen and “million.”

Peter Principle?

I don’t believe in the Peter Principle because I’ve seen scores of middle managers promoted well beyond their level of incompetence. I prefer the Dilbert Principle.

Not suggesting it is applicable in Silver’s case.

Heh. Thanks for increasing my popular culture IQ.

I have concluded that we are all going to be had until the entire populus is so fed up with the self-interested crooks in both Houses of Congress that they do the will of the people or face certain loss at the polls. That is a long way off. 80% of the country has no clue or interest in what goes on in Congress and 10% are so misinformed that they are their own sabatours. The scary part is not knowing what we will have left to save by the time most people realize how badly they have been betrayed.

Nate Silver believes progressives should trade the public option away…

I believe progressives should trade away Democrats who are bought and paid for by the healthcare industry and elect Congressmen and Congresswomen who will refuse to be.

I believe progressives should come together to ressurect a grassroots movement that brings this about.

Then we won’t be yammering on and on in places like this about the enormous gap between what the Democrats promise us on the campaign trail and what they actually deliver instead once the checks for the lunches with the K Street crowd are collected and paid for.

Eventually by us, of course.

Beerfart,
Be concrete. Why would you vote against it?

I’m of two opinions.
1) Single Payer is the ONLY model that makes financial sense. The public option as currently configured is a flaccid set of compromises welded to a set of giveaways that make repeal of Glass-Steagall look stingy.

The P.O. model has been gamed to serve an infintessimally small segment of society.

2) That said, we need some movement on health care reform in this country. Rather than push for an all-or-nothing solution, we need some change. Removal of pre-existing conditions is a big one.

Besides which, trade with whom? The Rs say NO to everything.

The public option never really existed in that it was designed at best to be available only to a small fraction of the population. The important issue as Sen’ Widen has emphasized is real competition. A universal mandate without real competition is going to be a loser politically for the Democrats and the GOP will on the right side of this this one politically. I’m afraid that this is blowing up in the Dems faces. The only practical way to get real competition is a public option that is available to anyone who wants to sign up for it. And that’s clearly not going to happen. What will happen is that something, however bad, will be negotiated with those now holding the leverage, just so the Dems don’t have to crash and burn with no bill. Obama (Rahm) and the leadership backed the Democratic Party into a corner.

So, the Democrats have finally settled on HCR we can believe in: the insurance companies go unscathed and get more healthy customers, while the taxpayers through the PO will subsidize the sick. How could the insurance companies have any complaints? That they do suggests to me that Washington and the insurers are secretely gaming us. Do I have a right to be so cynical? And you know what the best part is? The same taxpayers who will subsidize the sick (and I really do think that sick people should receive care in this country, even if they can’t afford it) will see their private insurance rates skyrocket each and every year. Thanks for the memories, Democrats, your majority will be short-lived.

I suspect the trend toward low-information voters is a one-way street, so the likelihood of a mass uprising to hold our leaders accountable is nil. The U.S. government will collapse beneath the weight of it’s own crapulence before that happens.

Our MOST IMPORTANT next task is 100% public funded elections, with no corporate money allowed for underwriting, advertising, subsidies, etc. The unintended consequence of this is that FauxNoise will become even more valuable – unless election reform also requires balanced political discussions. Yes, the Ron Pauls, Alan Keyes and Lyndon LaRouches will get a seat at the table.

It’s too easy to game the US electorate with our current model. Of course, John Roberts was placed on the Supreme Court to prevent the possibility of virtual corporate entities not having any limitations.

Prohibiting corporate donations would require that legislators pass a bill detrimental to their own selfish interests. Nice idea but DOA.

Umm, no.

Mr. Walker is responding to a Nate Silver post, and explaining why he thinks Mr. Silver is incorrect.

There’s no “OMFG we’re doomed” aspect in this post.

There is no such thing as real competition without a strong risk adjuster. Without it companies only “compete” by doing everything to dump sick people.

Mr. Walker.

you have written about the problems with risk adjustment before. I try to follow the healthcare debate closely, but I must admit that “risk adjustment” seems fairly opaque. Do you have a post that helps folks to educate themselves on this matter?

Nate Silver has no credibility – sure he predicted the general election well, but that was easy – my outbox shows I got just as close as he did. He’s gotten everything wrong in the past year (unemployment, bought the summertime lie that the public option was already buried.) Also I saw him on Maddow and he looks like he needs to get more fresh air.

You push for the best bill that can get a simple majority in both houses. You do that with the progressive block strategy and by putting pressure on Reid.

They can pass a much better bill with only 50 votes in the Senate. They really don’t want to that. We must force them into a situation where the have no other choice. At that point right before they are about to go 50 vote solution all the conversadems will likely fold because they want to keep their power for next time. Either way you need to force to gore the filibuster and the idea the 58-60 most conservative member of the Senate has all the power in Washington.

My admittedly shallow comprehension is that insurers (public or private) are subsidized to offset the higher risk of accepting applicants with preexisting conditions.

Here you go. http://fdlaction.firedoglake.com/2009/10/30/dutch-health-system-shows-necessity-of-strong-risk-adjustment-mechanism/

Click on the link to the Dutch minister of health plain language explanation of their risk adjuster for regular people. The best thing I have seen written about the issue.

The idea is to basically move money around on the exchange such that no insurance company is being paid for how many people they have but for how sick those people are. The goal is for the insurances companies to really seek out sick costumers and find a way to treat them cheaply without them leaving for another company.

Book Salon up at the Mothership with Barbara Ehrenreich’s Bright Sided: How the Relentless Promotion of Positive Thinking Has Undermined America hosted by Tom Franks

thank you.

The public option never really existed in that it was designed at best to be available only to a small fraction of the population

The public option exists for everyone. We are all part of “the public”. It’s just that, unlike all other industrial democracies, we only have the option of opting for private coverage.

Unless, of course, you receive Medicare, Medicaid, are in the military or are a vet. And is anyone [aside from the libertarian fanatics and extreme right wingnuts] calling for that to be dismantled?

The conservatives are always yammering about expanding the individuals’s freedom of choice—unless and until, in doing so, it takes a bite out of the healthcare industry’e capacity to limit what they have to cover and pay for when the public has no choice but to pick one of their private plans.

That’s why they try to reduce this fight down to the “principle” of fighting “socialism”.

I saw this post by Nate Silver late yesterday, thought it made little-to-no sense, and left some commets.

First, was this one:

Yes, as Nate suggests, “suppose that you’re Blanche Lincoln.”

First, you’re feeling extremely vulnerable as you face re-election next year, what with so many Arkansans not liking you very much and all.

Joe Conason at Salon reports: “Lincoln is at last feeling serious pressure from Democrats as well. The man who brought the free clinic to Little Rock – along with “Countdown” host Keith Olbermann – is Lt. Gov. Bill Halter, who could be encouraged to enter a primary against her should she uphold the Republican filibuster.”

Yup, if you imagine that you’re Blanche Lincoln, you’d go on the Senate floor this afternoon and admit that you’re afraid of “those socialists lib’ruls” who are very serious about supporting a primary challenger against you if you get in the way of a public health insurance option.

Then I provided this link to a poll showing doctors supporting the public option, got into an argument with a troll or whatever, and left this comment:

Mike said “The poll is bogus. Only 17% of physicians are members of the AMA, and this poll was conducted only among AMA members. The AMA is a sell-out, just like the AARP is.”

——

Wrong. Just because you squeeze it out your anus, it doesn’t make it so.

To any thinking person who clicks on the link I provided, you will see that Mike is talking out his a$$, as the doctors who were polled by researchers at Mount Sinai School of Medicine in New York were not members of the AMA:

“When polled, ‘nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options,’ says Dr. Salomeh Keyhani. She and Dr. Alex Federman, both internists and researchers at Mount Sinai School of Medicine in New York, conducted a random survey, by mail and by phone, of 2,130 doctors. They surveyed them from June right up to early September.”

The article goes on to add that most of the physicians who are members of the AMA support a public option, too.

That the PO might become available to more people in the future seems to me a very tenuous thread on which to hang the hopes and needs of millions. And the thought of forcing millions to buy insurance from and subsidize companies that have rescinded thousands of policies out of sheer greed (after having accepted money from the same patients they dropped) is galling.

I’m very skeptical that the PO will be opened to more people in the future. That’s something the insurance industry, flush with millions in premiums paid by millions of new, healthy subscribers, will fight tooth and nail with financial blandishments to Congressmen and slickly packaged disinformation sold to the MSM.

Sanders’ amendment in the Senate and Kucinich’s amendment in the House are two more: they would automatically waive ERISA regulations for states that pass single payer legislation.

Does the Dutch system include a public option? The reason I ask is because the Dutch are having a problem containing costs (like Massachusetts).

The way I read the CBO’s comments is that the public option will raise gross Federal health care expenditures and function like a subsidy for private insurers, taking the patients they would rather not insure off their hands. The public option’s premiums will be higher than those of private insurers by necessity. It’s rather like paying a ransom.

I’m not sure it’s good to go down that road with companies that practice rescission, taking money from patients for years and dropping them when they get sick. I think it’s time we rescinded their comfy little blood money racket. Ban rescission, pass guaranteed issue and repeal McCarran-Ferguson. It’s true that they’ll continue to raise premiums. But our response to the inevitable public outcry should be sure and swift: a single payer option along the lines of HR 676 or the regulations you describe above (which, as you rightly note, would be difficult to frame for the public and just as objectionable to the health care industry).

On a national average the dutch system is slightly on the high end but still cheaper than about a half dozen countries. It is well with in the first world norm. They do pretty well on cost containment.

It should be and can be expected the current healthcare regimes entrenched interests will not cease over next five years to work in the fixes and sliders they desire. WashingtonDC is fully open to money politics influence and should Congress manage to pass HCR and WH signs off on it here in 2009 still 2015 is a long way off.

Taking out pre-existing condition denial is meaningless unless pricing of any such coverage is closely governed and moderated. It is doubtful any such authority will be created by this bought and paid for Congress. We cam expect for profit insurers to escalate pricing schedules in ways that will force exclusion based on sticker price ratcheting. Expect it.

I agree that this is a bad trade; it’s an example of theory making it from an idea to a political suggestion.
Silver is great at analyzing polls; that’s his forte. Of course he should have his 2 cents, but when people like him – smart – try to move from their expertise to more general politics, they show their ignorance on the subject.

I looked at the Dutch risk adjustment primer. I recommend it to anyone who wants to understand this moving part in the mechanism. It is vital. Tnsurers can’t be stopped from cherry-picking except through the profit motive.

The primer sets out a capsule history of the Netherlands’ move to managed competition (marcopolo asked about this). In the 1990′s they introduced market forces, and private insurers came to serve the wealthiest third of the population. In 2006 they abolished state-run “sickness funds” and sent everyone into the for-profit market.

But the Dutch appreciated the problem of risk selection, the “death spiral” problem. The primer explains how customers’ risk profiles are determined; how insurers are incentivized to reduce costs; and how risk adjustment payments are made before and after each year, to balance fairness with incentives. I don’t know how well it works, or how aggressively it could be used in or adapted to the US, but it certainly flags the problem. As Jon said, the payments are about half the insurers’ revenue stream. They are funded through sources identified in the primer. But something like baseball’s “luxury tax” could be imposed here. In fact the Senate bill has rebate mechanisms in place.

I’m no fan of for-profit health insurance, but I don’t want to be stuck with an indecent, manipulable for-profit system. We really should know more about how other countries make the profit motive more serviceable.

In Saturday’s debate, Chuck Grassley went on about the Senate bill’s failure to curb adverse selection. It is good to know what he’s talking about and see if there is room for improvement — without his help, to be sure, but we see all the time how hard our politicians make it for us. I don’t view this as an excuse.

He is another University of Chicago allumni