You mean freshman level microeconomics doesn’t give a complete Rx for what ails our health care system Impossible.

O.T. Jim Messina’s pathetic sneak preview of the 2012 campaign. For some strange reason, 2010 is hardly mentioned. Maybe Messina needs to spend less time trolling Georgetown in his black Porsche convertible and more time talking to real people.

I had an insurance agent tell me one time that the companies offer car insurance as a loss leader occasionally just to get folks in the door and buying the product so they can turn around and sell you other products that you can’t afford

Just like the Used Car dealer, you’re buying one product every year or so and they’re selling the product thousands of times

Insurance is the ultimate moral hazard product: ins corps make most profits by collecting premiums and denying payments.

The American People deserve a health care system based on the VA Hospital system. They at least have a system where they negotiate a drug price based on their enourmous buying power. And they have one of the most modern medical records system (with lots of security)! The people would just love the kind of health care where you aren’t always worried that you or a loved one is just one illness away from bankrupting the whole family!!

Another issue that seems to be MIA is that forcing Seniors to research, assess and choose among health insurance “products” annually is, in itself, pretty outrageous. I’m continuing to care for one aging parent, who is in no position to assess & choose anything, much less fight his way through the complexity of health insurance.

Make the kids do it for Seniors? Sure, ok. But some Seniors simply don’t have any relatives to help them – a phenomenon will increase as the boomers get older. Then what? Who “chooses” for them?

I haven’t seen this addressed at all anywhere. There is already a raft of problems for Seniors when they hit the “donut hole” on their Medicare prescrpition coverage. Many Seniors still don’t know about – or are unable to retain the info – about the donut hole, and some end up caught short when it hits them. I know some Seniors who have to forego meds because of it.

Saying “for shame” doesn’t begin to cover how dysfunctional and pernicious this is.

Here’s a recent anecdote from a family friend.
Friend has extremely dire symptoms that I don’t need to describe, but they were very alarming and possibly life-threatening. Family physician tells them to go to ER.
Friend checks with insurance co. and is told that if they end up not being admitted, they will be responsible for entire bill.
Somehow I doubt this is clearly explained when you’re shopping for insurance.
Nor covered in Econ 101.

That’s precisely the point. To enhance the knowledge gap betw buyer & seller so that seller gets more profits.

Yeah, exactly. And to think that Tea Party Seniors were manipulated into demanding this treatment, all in the name of so-called “free market.” Makes me wanna scream some days…

Indeed, and there’s more and more of this kind of thing happening to citizens who have allegedly “good” health care ins. via their workplace. We are all paying more for much less. It’s one thing if you have enough time to investigate your options, but when there’s an emergency, people often cannot do “due diligence.”

It’s all very well for conservatives to rail progressives on the false notion that we “want something for free.” That’s hardly the case.

What I want is for the friggin’ Death Panel Ins Companies and their obscenely highly paid CEOs to stop jerking their “customers” around and permit them access to affordable and reasonable health care. It’s a flaming joke, and it’s only going to get worse, not better.

A blast from the past: Cass Sunstein’s coauthor of Nudge, Richard Thaler,
with a 2009 curse-on-both-your-houses blast at the public option.

Recall how AIG facilitated the Federal Reserve doing a backdoor bail out of banks and even those not even in this country? The same banks that won’t lend? Who in their right mind would trust their health and their future to the bankster owned and operated insurance companies? I want direct access to a qualified doctor, not a bankster middle man.

Given the low ethics of insurance companies, the type of people who go into selling insurance, and the absence of regulation, can you imagine the predatory practices older Americans will be subjected to if Paul Ryan’s wet dream of insurance coupons ever replaces Medicare?

Sounds like a noir version of “Deal or No Deal.” Without the comedian-host and the briefcase-toting starlets. Or the prizes.

I wish that, while President Obama was telling everyone what an awesome idea loosely regulated private health insurance exchanges were during the health care debate, more liberal economists would have forcefully pointed out how the entire underlying concept was totally flawed, when it could have made a difference

no reason you should know, as it was mostly before you came to fdl. but lots of commenters here were questioning pointing out what totally flawed concept it was (and that in weakly regulated market a public option would be a failure) — and quoting some of the best analysts in the country. even had a couple of true health care experts here to point that out. however, since most were single payer advocates or activists, nothing said made a damn bit of difference.

“sphere of deviance, (ideas so plainly wrong, radical and fringe that they deserved no hearing at all).“

Worse than that there were long-time supporters and contributors who were effectively badgered away from FDL for pointing this out. Significant amounts of the vitriol came from Jane directly, until she eventually came around without the faintest mea culpa. She even held a fundraiser for an SP promoting Senate candidate essentially out of smugness and antipathy toward readers trying to shift the debate to solutions that might actually work. The last holdout was Jason, with whom we had several spirited debates.

For all the ballyhooing about the “Veal Pen” that was going on at FDL at the time it was hard to escape the idea that FDL was every bit as caged in it as everyone else until very, very late in the game. In so far as the HCR issue goes.

Significant amounts of digital ink spilled over what was “politically possible” with sometimes outright hostility toward what was “functionally required.”

That fits. Mr RedWA and I saw the tail end of that show often and still have no clue what is happening.

As to medical costs, I ask my doctor. She deals with it every day and I once a year or so.

Really? Jane was against the Public Option and Single payer?

When? Please provide links. My recollection is very different, as in:

As far as I remember Jane was for the Public Option (and stopped promoting single payer, because it appeared a hopeless cause).

I wish that, while President Obama was telling everyone what an awesome idea loosely regulated private health insurance exchanges were during the health care debate, more liberal economists would have forcefully pointed out how the entire underlying concept was totally flawed, when it could have made a difference

It’s not like Obama was ignorant or even earnestly trying to fix health care. All relevant problem solving ideas were purposely excluded from the debate and the bill because it would have cut into the health care cartel’s profits.

Having had several aging parents & in-laws who I helped through final illnesses and the general weakening of competence in the years preceding, I find it difficult to imagine what the elderly would do if they had to deal with insurance options. It was hard enough to keep straight what pills they had to take daily.

On the other side, I’ve had to buy insurance on the private market over much of my lifetime. It became more and more difficult, because the insurers and the market changed so much over time. Luckily my spouse got a job with benefits just as the last viable option went belly up.

I’ve tried to help my kids purchase private insurance as they aged out of ours, and the lies, the fine print, the amount of stuff that’s uncovered that they don’t tell you about, is absolutely mind-boggling.

The degree of sheer cruelty — dare I say sadism — in the Ryan proposal is really unappreciated, even on the liberal blogs.

What I want is for the friggin’ Death Panel Ins Companies and their obscenely highly paid CEOs to stop jerking their “customers” around and permit them access to affordable and reasonable health care.

Me too, OIG, but thanks to O’Sellout we have at least another ten or twenty years with these evil motherfuckers calling the shots. There is no excuse Barry O’sellout can make for betraying us on the Public Option to the tender mercies of these sons of bitches – who will gladly bankrupt every last one of us. HCR truly showed that Obama was a corporate whore whose sole purpose is to sell the middle and working classes into indentured servitude.

Messina could also spend less time talking to his mentor, Senator Baucus, and the health industry lobbyists who are cosseted by Baucus. But, that’s not going to happen, either.

I like the image of selling car insurance as a loss leader – but the fact is that in my years in the business they never had a loss. Yes they claimed a loss – but that was always before “investment return on premiums not yet returned as claims” was counted in the calculation. Indeed reinsurance deals were done to hide the profits in off shore subs and SPC’s.

Instead, we have even supposedly “liberal” writers, like Ezra Klein, not only promoting greater plan design “flexibility” on exchanges … but also the desire to force every American to shop for insurance on the exchanges, including seniors, by ending Medicare.

Ezra Klein is a sleazeball looking for access and a better MSM job than the one he currently has. Along with Yglesias, he was instrumental in helping Obama jettison the PO — by repeatedly lying about its importance and impact.

No. She kept slogging the Public Option despite the fact that it was a hopeless cause from the outset (it’s a broken policy whether it passes or not) and after it was obvious that the fix was in at the White House.

Late in the game she came out against the ACA generally, like many of us did, because it was obvious that it was worse than doing nothing. It in fact got a little amusing there for awhile when FDL had largely turned ship on the ACA while it’s primary HCR writer (Jason) was still shilling for it.

Pretty sure Jane was consistently pro-single payer, and then, when TPTB killed that off immediately, she advocated for the PO as loud as anyone.

Jason, on the other hand, because he was getting a paycheck from AHIP (IIRC) was and is a complete tool. He doesn’t seem to post much since the ACA was signed into law.

Worse than that there were long-time supporters and contributors who were effectively badgered away from FDL for pointing this out.

true.

however, at this point, and as much as possible, my preferance is to leave the personalities out of it.

my objection is only that i can’t abide to have the people who DID object, both to to the fact-free (and worse bs filled) policy advocacy, totally written out of the narrative. especially here.

(it’s a broken policy whether it passes or not)

Your assessment? Or someone else’s?

sorry no. i’ve got the links if you need the evidence, but as i wrote above that’s not my preference.

Very true – many many actuaries wrote on this crazy idea that renaming the visit to your insurance agent or broker an “Exchange moment” was going to lower costs (and Doctors wrote on the need for single payer) but national media give no one who opposed on the ground it was ineffective any platform to get that view out there. Indeed Mass proved it was nonsense and that was ignored in favor on a Prof of Economics at MIT that had a model (Prof. Gruber) but had no experience in the industry.

Even health actuaries, to prove they were credible, had to pull an efficiency of exchange comparison assumption out of the air – of course choosing a very low effect but they had to show an effect. Actuaries are businessmen mathematicians with a bit of legal, econ., and international background – experts in nothing if you will – just the folks that know how the business works. And they never got a mike – of course those employed by the health ins could not speak out – but there are many retired that tried.

Meanwhile I have high hopes for Vermont’s legislator doing something before the insurance companies in Vermont get to those folks and stop a statewide single payer plan.

Ezra Klein is a sleazeball looking for access and a better MSM job than the one he currently has. Along with Yglesias, he was instrumental in helping Obama jettison the PO — by repeatedly lying about its importance and impact.

Spot on, econo. In about 30 years Ezra will be David Broder and Yglesias will be George Will. In the here and now they are both utterly useless pieces of shit.

There is absolutely no reason to read the Washington Post again.

Smart move :-)

off the top of my head:

1. empirical evidence (has never worked when tried). 2. expert assessment (for example from people like elizabeth warren’s co-authors). and 3. common sense — a public option in competition with private insurance (as was the concept) in a weakly regulated market would be a dumping ground for the sickest of us. 4. common sense — because there was never any serious policy analysis provided (using gruber’s “analysis” based on bogus ahip data doesn’t count). 5. the on the shelf decent public option concept (stark’s americare) was never considered.

i’d be happy to debate the issue if you want to.

WTF. Ya mean ins corps also make profits thru investing on the float? /s

Have you caught on that Gruber’s models were also used for VT PO?

i’d be happy to debate the issue if you want to.

Which issue?

You are very wise, selise. My preference isn’t to re-engage in the pie fights over who said or supported what during the HCR debate on FDL either.

The blame on ACA ultimately becoming such a festering pile of shit lies entirely with Obama – it was his “signature” policy accomplishment, after all.

A good question -

The public option was the path to single payer that forced premiums down – and everything about the original design that accomplished that premium decrease was killed along the way – fewer allowed to opt for it, and if opted for there controls put on it so it could not pressure prices because that would be unfair . Indeed HHS is asserting design authority that was taken out of the public option – but they seem to think they have some wedge into the discussion for policies on the exchanges. I doubt that will survive to 2014.

At the end of the day there was not a damn thing in HCR that was worth a $600 billion welfare grant to the insurance companies, or the loss of 60 plus seats in the House. The only good that we now have from the fight is a law that will spend a lot of money beginning in 2014, money that can be re-purposed for a basic care single payer.

i live in MA and actually did advocate in favor romneycare (evidence, i hope, that i did not have an a priori bias against non-single payer alternatives if they were up for a vote). MA was an experiment in a small state that should have been able to pull it off if anyone could (we used to have pretty decent state regulation). and have had to deal with both buying insurance on and off the exchange (with two pre-existing conditions and chronic monthly health care bills well above the premiums).

experience is a great teacher.

Tangential– Public Service Announcement: There won’t be anymore of this if we keep having more occurrences of this and this and no one knows what’s going as there is no health care protocol that can reverse the damage done by radioactive and acute chemical poisoning. Ask questions. Track down the answers. Fact-check. Demand accountability. Post at Radiation Nation.

…and everything about the original design that accomplished that premium decrease was killed along the way

Amen.

yes.

but haven’t followed VT as closely as i should. more focused on on local efforts (which if our massively D controlled state gov was marginally responsive to the wishes of the electorate, we’ve have already). well, we’d also have our clean election law (passed by the electorate before it was torpedoed by the state ledg 80% D and then killed with romney’s help).

If they could place the bet, they’d try to make money on the over/under for how long it takes hospice patients to shake loose their mortal coil.

And I thought I worked in a sleazy industry…

broken policy from the get go.

Sorry, but that’s just not the case — if you’re saying that a robust, properly designed public option would have been no better than what we wound up with. We’ll just have to disagree on that.

The public option (Stark) should have been the idea discussed – but the PO was not quite as bad off as your points would suggest – the underwriting rule change would have stopped the dumping of the sick folks on the PO (except to the extent lack of funds made them shop for the PO).

The public option was the path to single payer that forced premiums down

a link to the analysis for that would be greatly appreciated. although that claim was made many times over many months, and i asked many times, i was never able to get any explanation of exactly how that was supposed to work.

My fave part of VT Option C, the most generous one, is a footnote to a table that sez 30% “cost saving” is +/- 10% or numbers to that effect. I presume the +/- 10% means 10 percentage points, not 10% of 30%. And when have cost savings come anywhere near the low end of the high band. PoS.

As a provider of health care I’d like to add a little to this. Medicare Advantage plans are nothing more than a con job.

Firstly most people on medicare think they are signing up for just their part D prescription. That is the first part of the con. What really is happening is they are getting their part D but they are also agreeing to be in the advantage plan.

Secondly they are only allowed to sign up or get out of these plans during open enrollment (Nov). These advantage plans lure people on them by promising them expensive medications, dental plans, eye care etc then after open enrollment closes they will change their plans to not cover those things. I have seen this happen to patients.

Lastly these plans are notorious for not paying providers. Doctors, home healths, DMEs etc. are refusing patients more and more who have these advantage plans. The largest home health in my state in the last year or two dropped all of their patients on medicare advantage plans. Another large one followed suit shortly after.

I don’t know much about exchanges. I can say that as a small business it is difficult for me to provide insurance to my employees. The costs have gone up 20%/year for the last 3 years. I have no negotiating power with insurance companies. Hospitals get much cheaper deals because they have a larger group of employees and can negotiate because insurance companies want their large pool of money. For me its kind of here’s your insurance take it or leave it. I don’t know if exchanges will help or not but at least they may give smaller business a bit more leverage.

a properly design po, for example as in stark’s americare (it’s not like i’m claiming all po based plans were fatally flawed), was never on the table as far as i’m aware.

rather than just disagreeing, i’d love to see some policy analysis to show otherwise. even at this late data, i’ve love to have reason to change my mind. but if that’s too much, it would help if you would tell me of at least one bill that you think would have worked so i have a clue what you mean by “a properly designed po”. (i can give you the analysis for stark’s americare if you want it).

So here’s the history of HMOs. In the early 90s, corps woke up to the fact that they would have to account for the PV of promised future med ins costs (FAS106). So first corps cut off all med benefits for retirees. Then they instated HMOs, which were basically gate keepers to deny treatment. Then they instated copayments. All this kept U.S. med costs at 16% of GDP (still 1-1/2 times per capita of next nearest country) for several years, after rising steadily for most of the prior post-WWII period. But then the ratio started rising again.

PO, no matter how well designed, would provide no better outcome than that, with all the adverse selection problems that selise points to.

which bill are you referring to?

a properly design po, for example as in stark’s americare (it’s not like i’m claiming all po based plans were fatally flawed), was never on the table as far as i’m aware.

Well, we agree after all :-)

True – I’m also in Mass (Newton) – and hoped there was something I was missing that would make the reform work.

But as you know, costs have not been controlled, we insure via minimal benefit policies so as to get that 97% coverage, we have a group that prefers to take a state tax hit rather than get insurance (logical actually), and the group trying the “different payment methods/incentives so as to control cost” blew up last year when the medical providers could not agree on the changes, despite a few groups of providers being on board – but then the changes that were proposed were as fact free in terms of cost savings as Prof. Gruber’s spreadsheet. Indeed the fact he is still on the “Connector” board means there is little hope – I offered my time to the board – for free – but they were more interested in less change oriented volunteers.

PO, no matter how well designed, would provide no better outcome than that, with all the adverse selection problems that selise points to.

When you write “no better outcome than that” are you referring to extent of insurance coverage, provision of health care, cost of health care, or what?

The PO cost savings was based simply on being able to offer the coverage without the 20 to 30% excess markup for dividends and salaries for un-needed functions and at un-needed levels. That of course assume large group sized response – which is why the GOP kept trying to make the eligible group smaller and smaller.

costs have not been controlled,

Problem in a nutshell. & never will be in the U.S. bc the med ins ind is too politically powerful.

I agree with this.

Cost control.

And measured the way I did in my comment, costs weren’t controlled, but rather ratio of med costs to GDP was held steady by rising # of peeps who didn’t get treatment.

OK

Given structure of ind, i.e. knowledge gap, vulnerability of patient, financial control that ind has of pols, if you squeeze cost balloon here, it will just find a place to bulge out somewhere else. That is efficiency gains are an illusion.

The actuary that designed the plan is clearly noting his distrust of the Gruber model – but the key is that even without the Gruber savings, single payer – which is the end point after a stay in “exchanges” – is better care at less cost with future cost controlled via the prospective budget. It is a clone of the Taiwan system he designed and installed a while back that is working quite well.

It is Good to have a good end point.

But like yourself, I was amused to see him signal so clearly about the Gruber model savings! :-)

adverse selection problems

but, but, but …. this can be controlled by regulation. /s

not even in a D administration with larry summers heading the econ team (deregulation-R-us). don’t even want to think what would happen in an R administration.

phew! sigh of relief!

many thanks.

p.s. i even posted a diary in favor of stark’s po — no bs, i really did support it: DrSteveB: Strong Public Option: 100% Coverage & Cost Control

True – the PO as in Stark had no prospective budget control, as is proposed for Vermont, so any savings would have been a one time thing – but there would have been a initial savings.

my very sincere thanks for your efforts.

true

There was no bill – the Mass Connector set up a “panel” to come up with suggestions on payment changes that would incentivise cost control and payment for quality of outcome rather than number of services performed.

It blew up – I do not know if they are still even meeting.

I must leave now this great thread (its one of the few things I actually know something about). Till tomorrow!

there is a lot of physician support for single payer. it’s the insurance industry (for others: the “I” in FIRE) that is the main political opposition (big pharma, medical device industry are some of the others. but insurance is the big one).

thanks for the info.

Ezra Klein is a sleazeball looking for access and a better MSM job than the one he currently has. Along with Yglesias, he was instrumental in helping Obama jettison the PO — by repeatedly lying about its importance and impact.

Thanks, buzz, for saving me from write the same thing. What a miserable, excerable little prick that guy is.

while it’s primary HCR writer (Jason) was still shilling for it.

Yeah, but Jason was on the payroll at HCAN so he was getting paid (handsomely, I presume) to shill for it.

Boy am I glad that dick is gone from the pages here.

This is wonderful — but most of it escapes me.

Is there a good analysis of the Health Care Insurance options which is less than 50 pages?

I have a sense that looking at the limits of the free market paradigm for economic organization is like looking into an abyss. If this doesn’t work for health care, what else doesn’t it work for? How do you traverse this space? Where are the philosophical pitons?

i think ecahn is referring to the concept of a po in competition on an exchange (not something like stark).

The middle class has to buy crappy private insurance, and what do they get in return?

A nifty computer program that gives the illusion of saving them money.

Tell me how this is going to burnish the liberal brand.

Without antitrust provisions to protect consumers from these companies, the exchanges wont be useful.

Health Care Solution. Complete Health Care for all U.S. residents, paid by a payroll tax of say 10% or 15% of gross income. And since Companies are now people, this would apply to them!

Pretty sure Jane was consistently pro-single payer, and then, when TPTB killed that off immediately, she advocated for the PO as loud as anyone.

Jason, on the other hand, because he was getting a paycheck from AHIP (IIRC) was and is a complete tool. He doesn’t seem to post much since the ACA was signed into law

I shall emulate selise’s tantric restraint regarding your first statement.

Regarding the second statement, Jason worked for HCAN, and even those of us who clubbed him about the head and neck on a regular basis would not equate that organization with AHIP. We don’t hear from him much now because he works for PCCC, which stands for Progressive….something something something.

Agreed – this crap just goes round and round the cranium. Who wants to shop for health insurance? What an absurd concept.
Rich people will get this all sorted out by their underlings, and for the rest of us its “you figure it out, you’re on your own.”

I’m reminded of smug neoliberals such as Matt Miller, droning on about the need for everyone to have “skin in the game,” as if trying to survive in this grubby Darwinian economy wasn’t enough of a bone-crusher. It might be a crude reduction, but I really do believe people who say things like that have never had a real job their entire lives.

I would only add, as selise has noted, that strong advocacy for single payer, and even strong critiques of PO proposals (there was never such a thing as “the” PO), were never in my experience censored on this site on that basis alone.

i started writing a reply to ralphbon’s comment about censorship and it got way too long, complicated and worse, bordered on violation of my comment @26. think it was better left unpublished and i’ll just say that “never” is not quite the word i would use and also that imo there are more ways to censor than comment deletion and/or banning.

The health care industry made out like bandits. The health care cartel keep their monopoly (with an added captive market, and government subsidies thrown in for good measure), along with their bogus, immoral, and overpriced products. The American people continue to get ripped off for their health care unlike anywhere in the industrialized world. And now Obama is still telling Americans that health care costs (Medicare, Medicaid) are the problem and the main driver of the deficit, to justify more cuts to their social safety net. WTF is wrong with this picture?