Why We Need a Public Health-Care Plan

[Mr. Big Dog 10,747]

That's my problem with Obama's plan - not so much of a radical reform as a papering over the cracks.

The focus is on getting everyone covered, I'm less convinced that there's as strong a commitment to address the root problems and lower costs.

The problem is that if you lower the costs - if the American people spend less on health care - then someone must be getting paid less. And that someone will put up the fight of a lifetime - and spend billions of your dollars and mine - to make sure that this isn't happening.

[Trumplestiltskin 5,791]

On balance, I'd take the NHS (or the French system) anyday over the PPO I have now.

[one...two...tree 2,762]

Ron,

I'm all for insurance reform, but I doubt any progress could be made because currently, those insurance companies have been very successful with capital....taking care of their customers is secondary. IMO, it is a conflict of interest...insurance companies cannot serve two masters. Could we put a cap on their profit margins? How do you envision insurance reform that wouldn't be rejected by Republicans and the insurance companies as an infringement on their ability to do business?

Edited June 24, 2009 by Col. 'Bat' Guano

[scandal 951]

Otherwise, if you claim a private insurance market is a good thing - then strengthen that market place. Level it, permit new entrants, do some trust-busting. This idea that we will improve competition with a special "uber-private" plan (public, yet autonomous and competing with private plans) makes no sense to me.

The public payer model is not what's best, by anyone's standard. It's simply what's politically expedient and which was proposed as a way to get something through Congress. I'm certain those who propose it would actually prefer a single payer plan if they thought they could get the votes. Hence my gut feeling that Republicans are right, it is a hidden agenda towards single-payer. That would be fine by me, I would just like a little more honesty in the debate.

I will be the first to come right out and say it - a single payer system is what will surely deliver the most efficient service. Is it perfect? No. Is it better than we have today? Yes. Will it cost less than what our system costs us today? Yes. Will it improve our overall quality of health indicators? Yes. Does it have a chance to be implemented in the US in the near to mid-term? I'm afraid not.

With the single payer option off the table - it simply isn't going to happen - let's look at alternatives. What would it take to get to something at least near universal coverage solely in the private marketplace? Requiring private insurers to cover anyone regardless of pre-existing conditions, age, etc. Is that going to happen? Realistically, not in my lifetime.

So, where, if not in a public pool, do you capture those uninsurable in the private marketplace?

Is universal coverage all it takes to get this monster we've allowed the private industry to create and have us pay for tamed? Certainly not. There are a number of other issues to be addressed - such as the compensation practices for medical providers. As long as they are paid on a per-procedure basis, you better believe that patients will have more procedures performed on them than actually necessary. That's how doc makes the money. Can't blame him for making his living. And then there's the rather difficult issue of medical malpractice liability that needs to be addressed in a way that protects patients while not exposing medical providers to undue burdens. Many tests and procedures are performed today not only because that's how doc makes the money but also because that's how doc covers his behind for potential later medical malpractice cases. And there are more issues to look at and tackle.

None of these issues, however, address the 30%+ in red tape that this inefficient, wasteful current private enterprise system sucks out of our overall healthcare expenditures.

One last thought: What really bugs me is how profit rather than public health is front and center of our current system. That's just wrong, in my opinion. We don't focus on profit over safety and security when looking at public services such as police and fire fighters.

Excellent points, Big Dog.

You really do see the bigger picture of the problem here, I agree with you almost entirely. I also think that these fears of trillion dollar deficits are concerning, but at least somewhat misplaces. We waste so many billions on our current model directly. And even worse - we waste even more through lost productivity in our overall economy. Imagine that that all the uninsured and under-insured (those technically insured but afraid to seek out treatment for fear of copays, higher premiums, etc.) got the treatment they needed. All the arthritic and diabetic etc . patients who got the meds they need. If they were all suddenly 100% at their best at work, and not taking sick days and suffering carpal tunnel etc. Overall American GDP would have a direct net benefit, productivity would rise, corporate profitability would grow, tax revenues increase. We are paying a massive hidden social and economic cost by not having an effective national insurance system.

So, where do I not agree? On this

So, where, if not in a public pool, do you capture those uninsurable in the private marketplace?

Why do we need a public pool for this? Why can't we regulate the private providers to insist that they MUST offer coverage, even for pre-existing conditions and other currently uninsured categories? Clearly we'd need a model that offers some cost sharing, subsidies, caps, floors, what have you. But rather than today's outright denials, at least we would bring these people into the fold. Look- we do this in other industry. Cable and cellular and telecom providers are mandated by Congress and the FCC to provide service in rural areas where the economics would probably dictate that AT&T, Verizon, etc. would otherwise not offer service. We didn't require a public telecom carrier to compete with them. I'm still looking for a compelling reason why we are using 'increased competition' as an argument for a public pool. I think it's disingenuous and is masking the true reason Democrats are proposing it, which is as a stepping stone to a single-payer model. I can even respect that agenda, but I hate the deception. I wish Obama, Reich, HHS Secretary Sibelius, and all the Democrats on the Hill would treat us like adults and give us the real reasoning, rather than playing this charade.

[scandal 951]

Ron,

I'm all for insurance reform, but I doubt any progress could be made because currently, those insurance companies have been very successful with capital....taking care of their customers is secondary. IMO, it is a conflict of interest...insurance companies cannot serve two masters. Could we put a cap on their profit margins? How do you envision insurance reform that wouldn't be rejected by Republicans and the insurance companies as an infringement on their ability to do business?

Why call it 'infringe' on their ability to do business?

Why not call it regulate their business? As we do for so many other industries?

Consider the example I just gave to Big Dog. We regulate (through the FCC) cable and telecom providers. We insist that they offer rural service even if the marketplace economics would have dictated otherwise.

Look, I'm not naive of the lobbying efforts by the insurance companies, drug companies, AMA. They love the current system which is a disaster for the rest of us. We'll need to fight the lobby and the Republicans in the pocket of the lobby. But for heaven's sake - I would think that arguing for a purely private market, but a regulated one with robust competition, would be an easier sell to the American people (and Congress) than this public plan which is proving so controversial anyway!

[Trumplestiltskin 5,791]

The basic problem though is this idea that healthcare be treated like a service rather than a necessity to ensuring the well-being of the population. We have public education and emergency services - seems that healthcare should fit into that philosophy somewhere...

Its a little comical (in a morbid kind of way) to imagine what it would be like if you had to buy specialised fire insurance for your home so that a corporate fire department would show up to put out a house fire.

"I'm sorry sir, we are the closest fire house to your location - but I'm afraid your home isn't part of our service network. I'd be happy to connect you to Econo-fire so that one of their representatives can help you".

Later, as you sit sifting through the smouldering ashes of your home - an elderly guy on a 19th century fire-engine driven by pack mules shows up to say that its not his fault and that he responded within the 2-hour window, provided by your policy (but that a fire caused by you cooking popcorn wouldn't have been covered anyway).

Edited June 24, 2009 by Private Pike

[one...two...tree 2,762]

Ron,

I'm all for insurance reform, but I doubt any progress could be made because currently, those insurance companies have been very successful with capital....taking care of their customers is secondary. IMO, it is a conflict of interest...insurance companies cannot serve two masters. Could we put a cap on their profit margins? How do you envision insurance reform that wouldn't be rejected by Republicans and the insurance companies as an infringement on their ability to do business?

Why call it 'infringe' on their ability to do business?

Why not call it regulate their business? As we do for so many other industries?

Consider the example I just gave to Big Dog. We regulate (through the FCC) cable and telecom providers. We insist that they offer rural service even if the marketplace economics would have dictated otherwise.

The airwaves are public domain...completely different can of worms, Ron. Insurance companies have been tremendously successful, in terms of profit. How are you going to argue that they need to be regulated in such a way as to hinder that profitability?

[Down With PMP 0]

"We" don't need a public healthcare plan. The uninsured and uninsurable need a public healthcare plan.

"We" like what we have.

[rebeccajo 14]

"We" don't need a public healthcare plan. The uninsured and uninsurable need a public healthcare plan.

"We" like what we have.

Imagine if your employer took it away from you.

[Mr. Big Dog 10,747]

So, where do I not agree? On this

So, where, if not in a public pool, do you capture those uninsurable in the private marketplace?

Why do we need a public pool for this? Why can't we regulate the private providers to insist that they MUST offer coverage, even for pre-existing conditions and other currently uninsured categories?

I don't believe that's a realistic strategy. Public health options are viable and efficient. That is proven in many developed countries around the globe. The viability and efficiency of a private insurance based model (regulated or not) is something one might think could possibly be shown. But there is no proof out there whatsoever that it is indeed possible. In fact, we've played with this model for decades in the US and are where we are today - at a point where we either acknowledge or must accept from the data that this system is neither sustainable nor viable nor effective. So why would any sane person keep fiddling with this failed exercise rather than adopt a model we know works reasonably well and much more cost efficient that what we have today?

The advantage of having a private and public option running parallel - if there really is one - is for the private marketplace to show that it can effectively outperform the public option. We'd get the best of both worlds. From all one reads in the news these days, it doesn't seem that the private industry is especially confident about it's abilities, however. I mean, they're scared to death to compete with the incompetent government. Well, you know what they say, if you can't run with the Big Dogs, stay on the porch.

[Down With PMP 0]

"We" don't need a public healthcare plan. The uninsured and uninsurable need a public healthcare plan.

"We" like what we have.

Imagine if your employer took it away from you.

Then, I become one of the uninsured. Were I to develop an illness during this period, I'd then become one of the uninsurable.

The uninsured and uninsurable need a public plan. The rest of us don't.

Which is just what I said above, except you made me use extra words. Please pay attention next time, I don't have all day.

[scandal 951]

The airwaves are public domain...completely different can of worms, Ron. Insurance companies have been tremendously successful, in terms of profit. How are you going to argue that they need to be regulated in such a way as to hinder that profitability?

We regulate banks, brokerages, and now even hedge funds will come under regulator oversight. There are no "public domain" airwaves there.

We regulate companies for adherence to environmental standards (EPA) and workplace safety (OSHA).

Reckless profitability is not a good enough reason to stay out of the hands of regulation and oversight.

Massachusetts has a private-based model that works. I am not familiar with all the details, but I don't believe there is a public plan. There is a mandatory fee put on people who have incomes above a certain level but who refuse to buy private coverage. That fee is used to buy them a mandatory policy, but I believe it is still provided through private insurance. Why can't we do something like that nationally?

Mitt Romney, the architect of the MA plan, was on one of the Sunday shows this weekend. He's against the public pool, and suggested the MA plan as a model. I think that makes sense. It's a universal plan that covers all residents and seems to be successful. I probably need to learn more about it, but at this stage it makes more sense to me than what's being proposed in Washington. Any MA residents with first hand knowledge want to comment?

[Down With PMP 0]

Massachusetts has a private-based model that works. I am not familiar with all the details, but I don't believe there is a public plan. There is a mandatory fee put on people who have incomes above a certain level but who refuse to buy private coverage.

Hey genius, that's a giveaway to the insurance companies. Let me guess, you work for Aetna?

Health care is not health insurance.

[Mr. Big Dog 10,747]

"We" don't need a public healthcare plan. The uninsured and uninsurable need a public healthcare plan.

"We" like what we have.

Imagine if your employer took it away from you.

Then, I become one of the uninsured. Were I to develop an illness during this period, I'd then become one of the uninsurable.

The uninsured and uninsurable need a public plan. The rest of us don't.

Which is just what I said above, except you made me use extra words. Please pay attention next time, I don't have all day.

Couple of points:

1) I used to like the employer sponsored plan I had up until last year. It's no longer available as an option to choose from so now I am stuck taking a plan that I don't much care for. And I don't know whether that plan will cease to be offered next year in favor of something even less desirable. In this boat, I am not alone.

2) If you like what you have, you keep it. That's the approach. There's no guarantee that your employer will continue to offer this plan you like but then again, look at point 1, that guarantee doesn't exist without a public option either.

3) If a public option for uninsured and uninsurable persons is introduced, why should a technically insurable not be able to choose that public option?

Edited June 24, 2009 by Mr. Big Dog

[Trumplestiltskin 5,791]

The only reason you wouldn't choose the public option is if it were substantially crappier than what you had already...