**UPDATED [1:56 PM] with additional polls.
It shouldn't be that hard to conduct a decent poll on the public option, but so many pollsters seem to be getting it wrong. Let's go through what I'd consider to be five essential ingredients in conducting a good poll on the public option:
1. Make clear that the 'public option' refers unambiguously to a type of health insurance, and not the actual provision of health care services by the government.
In general, this is a concept that a lot of people seem to be unnecessarily confused by (although I suspect that a lot of the "confusion" is deliberate). The recent NBC/WSJ poll gets this wrong, referring to a "public health care plan" rather than a "public health insurance plan". So does this Rasmussen poll, which refers to a "public health insurance company".
2. Make clear that by "public", you mean "government".
The phrase "public" is somewhat vague and could conceivably be confused for something like a non-profit cooperative, which is a far different approach to tackling the health care problem. Including the phrase "public" in the question wording is probably fine, but it should be supplemented by the term "government". The Kaiser Family Foundation Tracking Poll, for instance, adds some ambiguity to what is otherwise a very well-worded question by describing "[A] public health insurance option to compete with private health insurance plans". I don't think this provides quite enough information to the respondent.
3. Avoid using the term 'Medicare' when referring to the public option.
On the other hand, it's quite possible to provide too much information to the respondent. Medicare is a popular program, and I'd consider using it as a reference frame when referring to the public option to be somewhat leading. This is particularly so given that the public option proposals actually being considered by the Congress would have some important distinctions from Medicare, such as probably having their premiums benchmarked to those charged by private providers (if the proposal were literally to make anyone eligible for Medicare, I might feel differently). Kaiser has found that support for the public option is a few points higher when it is referred to as a Medicare-like program. The CBS/NYT poll, among others, violates this premise.
4. Make clear that the public option is, in fact, an option, and that private insurance is also an option.
Here's another issue that a lot of pollsters are having trouble with. The Rasmussen poll blurs the distinction most blatantly, by referring to "[A] government health insurance company to compete with private health insurance companies". It is not at all clear from this wording that eligible consumers would have a choice between government-provided and privately-provided insurance policies. Likewise, the ABC/Washington Post poll ("Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans?"), would be better if it made clearer to the respondent that the public/government option provides consumers with a choice of health insurance alternatives. The FOX News poll suffers from a similar flaw.
5. Ask in clear and unambiguous terms whether the respondent supports the public option -- not how important they think it is.
As I wrote before:"Importance" is a notoriously vague concept in public opinion polling and may be separate and distinct from asking someone whether or not they support a particular policy. How might someone respond to this question, for instance, if they had particularly strong feelings against a public option? Would they say that it was "not at all important", or would they say that it was "extremely important"? Conversely, how would someone respond if they had a weak preference for a public option, but didn't consider it an especially important component of health care reform?
NBC/WSJ had previously used this phraseology, which I criticized at the time. Unfortunately, it was resurrected by MoveOn.org in a poll conducted through SurveyUSA. "Importance" and "support" are not by any means synonymous concepts.
So, who gets it right?
Regrettably, almost all of the polls on the public option succumb to one or more of these sins. However, there are two exceptions. One is the Quinnipiac poll, which asks:Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans?
This is a perfect question. It makes clear that the public option is an insurance program, rather than a program to provide health care services. It uses the less ambiguous phrase "government" rather than the more ambiguous phrase "public". It makes clear that the public option is a choice. It avoids leading the respondent by comparing the public option to Medicare. And it asks in unambiguous terms whether the respondent supports or opposes the proposal.
62 percent of people support the public option in Quinnipiac's August 5th poll, versus 32 percent opposed.
Another is the Time/SRBI poll, which asks:Would you favor or oppose a healthcare bill that creates a government sponsored public health insurance option to compete with private health insurance plans?
This poll has 56 percent in favor of a public option, and 36 percent opposed.
The Economist/YouGov poll is in something of a first-runner-up category, asking:Do you favor or oppose having a "public option" which would allow individuals to purchase health insurance coverage from the government?
In the Economist/YouGov poll, 41 percent favor the public option and 33 percent are opposed.
This is not a bad question, but it arguably violates criterion #4, as it leaves it somewhat ambiguous as to whether individuals would continue to have a choice of private insurance in addition to the "public option", a fact perhaps reflected in the unusually high number of undecideds (27 percent) in the poll. In addition, this is an Internet-based poll, and at the present time I do not consider Internet-based polls to be especially trustworthy.
I would strongly urge people to cite the Quinnipiac or Time/SRBI polls when making reference to public sentiment on the public option. Not coincidentally, these come up with broadly similar results, showing between 56 and 62 percent in support of the public option, and 32 to 36 percent opposed. The other polls run the gamut from slightly to deeply flawed.
Errata: I had originally also described the ABC/WaPo poll as passing all of our tests, but failed to recognize that it in fact violated criterion #4. My apologies for the confusion.
8.24.2009
How to Poll on the Public Option
@ 12:40 PM
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139 comments
I am finding it very difficult making any sense of any of the healthcare polling. I don't think the pollsters are doing anything to help anyone understand this issue at all or to help understand what public opinion on the issue is. I understand why some of the conservative pollsters may want to do a bad job on the issue, but I don't get why decent but liberal pollsters are doing so badly on this issue.
Nate-
Even the ABC/Post poll fails criteria #4. This means that the only poll that you say should be acceptable gives the public option a +30% rating.
This is very helpful--finding future polls that adhere to these requirements will help determine what the level of public support for a public option is, and how it is changing.
This is very helpful--finding future polls that adhere to these requirements will help determine what the level of public support for a public option is, and how it is changing.
Agreed.
Unfortunately polling seems increasingly intended to produce a newsworthy result instead of an accurate reading. I don't think the pollsters are stupid or clueless, I think they are devising questions they hope will be picked up by the MSM in order to boost their credentials and ultimately their business.
It doesn't have to be partisan, but pollsters get paid for polls.
I'm glad I'm not the only person to be frustrated by the wording of these polls. Doing Polling companies not have writers/journalists or at least English majors to help then craft the questions? I've taken a few polls and have been shocked at how badly worded the questions were. I told one pollster that a question made no sense which confused her to no end.
If we're not asking the right question how can we determine what the American people want?
Jeffrey,
You're right. Should have had more coffee before I posted this. Post is now fixed.
Nate:
1. Make clear that the 'public option' refers unambiguously to a type of health insurance, and not the actual provision of health care services by the government.
At the same time, you need to relate that the present Obamacare bills allow the government to determine what coverage will be included in the government and private plans. Thus, if you do not have the cash to pay for an uncovered procedure yourself, you will be denied that procedure.
2. Make clear that by "public", you mean "government".
AMEN! The entire purpose of the marketing term "public option" was to make it less clear this is government insurance.
3. Avoid using the term 'Medicare' when referring to the public option.
Amen again. It is so refreshing to deal with a liberal polling analyst seeking to clarify rather than muddy polling questions.
4. Make clear that the public option is, in fact, an option.
Is this really accurate, though? In reality, Obamacare's government insurance will be provided multiple comparative advantages as Obama himself was compelled to admit. These comparative advantages are designed to put the competition out of business and leave Obamacare as the only option.
To be accurate, the description of the plan should note that the public option would be subsidized by the government and would reimburse doctors and other health care providers at far less than their normal fees. If those facts are noted, I think we can allow the respondent to determine whether Obamacare is really about options or is a rigged game.
If you get into the weeds of polling people about individual features of Obamacare, a pollster will need to ask a series of questions about all interrelated features.
While respondents may approve of a generic gift by the government of seemingly free health insurance, I would suggest the numbers would change significantly if they also knew that the government was going to set the coverage of all insurance and were going to subsidize the government insurance and give health care providers a pay cut.
It's Choice, Choice, Choice. That's the critical wording that was used in the Survey USA poll. And it's what matters to the American people.
"Thus, if you do not have the cash to pay for an uncovered procedure yourself, you will be denied that procedure."
Because that is completely different from the current state of affairs.
Or maybe not so much at all.
Well clarified post.
If you could use the term "erratum" since you are only correcting one error that would make it even better
In this case, is it really possible to get an accurate view of public opinion?
Using the exact same definition, one could believe that a public option is good or bad depending on factors such as “will health care rationing increase?”, “will health care costs increase or decrease?” and “will this mean that the government has a right to influence my life-style choices?”.
I believe that most respondents, told that the plan will be good, will be in favor of it and those that are told that it will be bad would oppose it.
Personally, if I thought that a public option would improve care, help the uninsured, reduce costs, improve health care outcomes and not intrude excessively into my private life, I’d be for it.
As a side note, once a company’s health insurance costs are significantly higher than the fee they’d pay for not offering insurance, there may be a large number of people that do not end up with the public option by “choice”.
Lol at BDP, giving Nate a big fat 'Amen' when he makes points that BDP agrees with, and then moaning the hell at any points that don't agree with his point of view.
Anyhooo, I think Bill R raises an important issue for those wishing to frame the debate from a liberal point of view. Every 3rd word out of a liberal mouth this fall should be 'choice'. That and cost. Make it clear that it is a choice, and it will afford people an opportunity to get cheaper health insurance, and will allow Americans to be more confident about their health insurance when and if they need them.
BillB-
As a side note, once a company’s health insurance costs are significantly higher than the fee they’d pay for not offering insurance, there may be a large number of people that do not end up with the public option by “choice”.
If your employer ceased to subsidize your coverage, you would still have the choice of purchasing a private insurance plan, just like millions of Americans today in the highly-competitive health insurance market...
If the "public option" is enacted, then the biggest difference would be that if you don't like the choices offered by private companies, you'd have the additional option of purchasing coverage from a government-sponsored non-profit plan.
The only purpose of polling on this issues is to determine how to "Sell" the plan you favor.
It's not possible to be objective and find out what the public "really" wants using a poll format.
Nate, I can understand not considering a Zogby online poll reliable, but YouGov/Polimetrix actually has a decent record over the last two elections. Also, the erstwhile Harris Poll is now, I believe, also online only. They also did pretty well in the last presidential election.
In reference to Bart DePalma's post:
I don't quite understand the argument that the "public option" is flawed because it forces private health insurance companies to actually innovate and become more cost effective. The bottom line is, we have a private health insurance-dominated system now, and it costs 15.9% of our GDP per year (the highest of any country in the world) and we rank 41st in terms of life expectancy, according to the CIA World Factbook. Of course the public option is rigged a game! The game has been rigged against us, the citizens, for the last 30 years!
On that note, I would like to call everyone's attention to a website that is currently organizing a March on Washington to show support for the president's healthcare reform plan, specifically for the public option. The url of the site actually violates #3 of this excellent post - but, hey, we are very well intentioned. Please join us and attend what will hopefully prove to be an historic event. The web address is:
www.marchformedicare.org
Thanks!
BDP: These comparative advantages are designed to put the competition out of business and leave Obamacare as the only option.
Do you work for one of the unbelievably wasteful, red-taped filled insurance companies that are driving health care costs through the roof along with the legal system forcing astronomical amounts of malpractice insurance on doctors? Just curious.
The current insurance and health care companies will be forced to shed some of the waste to stay competitive when there is a government subsidized health care option available.
Personally, I'm not sure there is a better way to force this kind of change in the industry but the lobbyists and big pharma will spend until the cows come home to keep the status quo which lines their pockets quite nicely.
I'd prefer this solution didn't require tax dollars, however, I've also not seen an alternative proposal for a solution to the health care crisis that doesn't require public funds and is proven to work efficiently and effectively.
The fact that you have to thread a mine-field just to inform poll participants enough to get an informed decision is proof of the utter failure of the media to tell people in a straightforward manner exactly what is IN this bill and what isn't!
Of course support goes up if people realize:
1. The bill does NOT eliminate private health insurance.
2. It is NOT "socialist government medicine" (i.e. like expanding the Veterans Administration health care system to cover everyone -- or like Great Britain).
The misinformation campaign of the right-wing is entirely DELIBERATE and it's being supported and fostered by the media.
Apparently the rich don't want anybody but them to have affordable health care and the morons of the tea-bagger movement are so incredibly ignorant they haven't a clue what's actually in the program --- they're just against it.
Democrats just need to pass it and then as the hysteria winds down in 6 months or so -- start pointing out all the lies of the right wing: "Notice that there are NO government death panels? Notice that contrary to what Bill O'Reilly may have told you that your health care provider HASN'T been taken over by a government coup?
Notice that contrary to what some ass-hat like Rush Limbaugh may have said, Grandma has NOT been set out on an ice-flow to be eaten by polar bears?
But it is "Medicare-like". This is important because (a) most people know Medicare is an insurance plan (vs. say VA which is care), (b) people understand that Medicare covers some things and not others using "bureaucrats" to decide (just like every Insurance company), (c) using "-like" helps to frame that it is not Medicare, but is similar, (d) the Government would presumably negotiate rates for both together to get a larger pool.
Calling it "Medicare-like with different premiums" would be quite accurate and help people understand what it is and is not.
Rezendes is completely correct in spirit and facts when s/he says "I'd prefer this solution didn't require tax dollars, however, I've also not seen an alternative proposal for a solution to the health care crisis that doesn't require public funds and is proven to work efficiently and effectively."
The best policy should be the policy that is debated, but so far we have a public option or no changes. The former isn't the best policy because research points in the direction of single payer. The latter isn't the best policy because of the variety of issues brought up by everyone from politicians to commenters and bloggers.
I'm all for any plan with empirical (not public) support. Lets put them all on the table, run the numbers, and use the best. The health care crisis is a crisis with an objectively correct solution. There should be no debate, just honest analysis.
But yes, I know, I'm describing a dreamworld.
Bill R. said...
It's Choice, Choice, Choice. That's the critical wording that was used in the Survey USA poll. And it's what matters to the American people.
I believe that Nate is suggesting methods of making the polling on Obamacare more and not less accurate.
How precisely does Obamacare's outlawing of my current HSA policy as soon as it expires in the next year as well as all health insurance that does not comport with the mandates of the new unaccountable health insurance czar can in any way be truthfully called an expansion of choice?
A note to those who claim the public option will wipe out private insurance: do your homework.
Private companies have competed with government programs for services for centuries. Only if the game is truly rigged does it stop competition. The problem here is that when a public option comes in, the poorly run and extorting companies will suffer, the rest will simply do better. Most private insurance companies have had no incentive to improve, especially as they often control local markets. Having real competition will force them to provide better services than the public option, and then they will do fine. The ones that cannot should have been wiped out years ago and only weren't due to monopolies and rigged "choice". This is the shot in the arm the industry needs. It is also the shot in the arm the providers need, since the cushy back-scratching will have to end.
William said...
In reference to Bart DePalma's post: I don't quite understand the argument that the "public option" is flawed because it forces private health insurance companies to actually innovate and become more cost effective.
How is that? No private insurer can legally duplicate the Obamacare government health insurance "innovations" of setting the coverage of its competitors, obtaining government credit, tax payor subsidy in the Kennedy bill and compelling health care providers to take a pay cut.
If Walmart did this to its competitors, Justice would be prosecuting the retailer for predatory anti trust violations.
Canada has a single payer system. They spend 9.7% of their GDP on healthcare per year, and rank 9th in terms of life expectancy, according to the CIA World Factbook. The respective stats for the U.S. are 15.9% of GDP per year and a ranking of 41st. That seems pretty "empirical" to me.
Bravo William.
@BDP:
It is disingenuous to call a reduction in fraud and deception a reduction in choice. When society prohibits you from engaging in con games and robbing banks to earn a living, we do not call that a reduction in your choice of career fields. If your insurance company is no longer able to earn a profit once their morally reprehensible practices are outlawed, and therefore must go out of business, Obama will have taken a predator out of the market and thereby done you and all of the predator's other duped customers a favor, not a disservice.
That was my point William.
Currently we are arguing over empirically inferior plans.
Tony C:
To what "fraud, deception and con games" are you referring?
How, precisely will Obamacare resolve them?
If "fraud, deception and con games" are your problem, why not simply enact a simple statute to address them and drop the rest of Obamacare?
Bart DePalma:
With all due respect, this isn't the retail sales industry we are talking about, where the most that is at stake is the price of your flat screen TV. This is an industry that provides essential life services to an entire country.
Nate, defining an issue w/making clear about this and making clear about that is all well and good assuming one is dealing w/a fairly intelligent electorate ie birthers, death panels, fixednoise the #1 cable news network lol etc.
So Obama should concentrate mainly on the independents. Otherwise maybe some very, very simplistic Ross Perot health care charts. ;)
Just sayin'
Bart DePalma says "If Walmart did this...", but that is exactly what they do. They work with their vendors to get the lowest price, always beating them down by threatening to go elsewhere. They use the size of their market to do this. Hmm, sounds just like what the Public option will do. Further, Walmart subsidizes some products (e.g. prescription drugs) as "loss leaders" - kills the competitors, but it is legal. Walmart gets tax breaks as well. But, the public option will get more because those will be for people who cannot afford normal premiums; Walmart gets this through accepting food stamps and the like.
Regardless of the public option, insurance companies will likely be stopped from the most predatory practice they have enjoyed so far: "pre-existing condition" clauses that allow them to both deny coverage on job changes, and to dump someone with a large claim later (by finding anything they can call a pre-existing condition not listed in the application).
Jeffrey said -
"This means that the only poll that you say should be acceptable gives the public option a +30% rating."
Please say that it leads by 62%-32%. It is very easy for people to deliberately overlook the + sign and then start stories that the public option only has 30% support.
I would like to see separate polling on the prospect of "universal access to healthcare insurance" distinct from "health care reforms" involving preexisting conditions, etc.? I would ask, "do you support the idea that the government (i.e. taxpayer) should subsidize access to healthcare insurance for all American citizens?" If you agree with this – and given that millions of Americans are without coverage and many loosing their coverage each day, I do support this concept – then the public option probably makes sense (it does to me anyway). If you are opposed then you are probably also opposed to simply giving billions to private insurance companies as well. I am not sure that the public option is quite the critical factor that the media makes it out to be.
"No private insurer can legally duplicate the Obamacare government health insurance "innovations" of setting the coverage of its competitors, obtaining government credit, tax payor subsidy in the Kennedy bill and compelling health care providers to take a pay cut."
ONE right wing talking point you won't see emphasized! As if anyone in America gives a FLYING DAMN about the poor, poor insurance company profits! Screw them and the horse they rode in on!
"If Walmart did this to its competitors, Justice would be prosecuting the retailer for predatory anti trust violations."
You wonder whether people who talk like this have had their heads stuck in a log for the last 20 years! Gee! Does Walmart use anti-competitive pricing and tactics, and use their monopoly power to beat up state and local governments and government regulators to get millions in tax concessions? You Bet!
And anyway, why should any middle class person mind if the bloody insurance companies have to compete with government? If government is cheaper, then SCREW THEM! Let them go to the wall! Why should we pay more for health care to line their pockets!
Oh, but we can't have THAT! That would be "socialism" *gasp! Cue fainting fit!*
I.e. that would be just like Medicare and not even as "socialistic" as the Veterans Administration health care system -- which is PURE "socialized medicine" because it has its own health care providers and hospitals and nursing care facilities -- all owned and run by Uncle Sam.
Yet curiously you don't see all the right-wing veterans groups up in arms about how horrible it is that we have pure "socialized" medicine in America and how the VA hospital system "undercuts" the poor impoverished insurance companies.
62% to 32% is a slam dunk! Think up how to sell it while you're laying on the couch at the Vineyard this weel then PASS THAT BILL, Obama.
@BDP:
Existing insurance companies routinely deny claims they are legally required to pay, and then pay if the claimant files a lawsuit or presents a credible threat of a lawsuit in the form of a letter from an established attorney's office. This is a deceptive practice, and a breach of contract, but the only way to punish companies for a breach of contract is to win in court, and they make sure that is impossible by fielding an army of lawyers no firm can take lightly, along with the carrot of a settlement that admits no wrong-doing but pays reasonably well.
This is gaming the system, and a con game: They promise you coverage, then play chicken with your contract, denying you coverage until you have spent enough and involved attorneys to convince them you won't back off, at which point they usually capitulate, paying the claim, plus 50% for damages plus attorneys fees.
Now THEY know they are liable for the coverage, but because most people cannot interpret the legalese of their contract or their denial of coverage, and because most people assume (mistakenly) that a big company would not tell a brazen lie about whether they were liable or not, and because most people have never engaged a lawyer in their entire life, most people eat this crap. Especially those in the at risk populations: Elderly, ill, poorly educated, lower middle class citizens.
This is a con game; the insurance companies are exploiting people that trust them to tell the truth and trust them to honor their contracts as written. This is not like any other purchase because you don't know the quality of your insurance until you NEED insurance, and by then it is too late to discover you have put your trust in people that have no morality with regard to the law and contracts, and base their actions only on the statistical profit or losses that can be expected.
For profit insurance companies have become an immoral system. This was not true when they acted like utilities and were satisified with gross profits amounting to 5% of revenue and were paid like accountants; but they were corrupted. In the modern insurance company, the more pain, suffering and death they create by denying claims and making the contract more complex and dropping people that become unhealthy and by throwing ever more hurdles in the way of getting them to pay valid claims, the more profit they make.
The modern insurance company is now adversarial to the health of their clients. They want clients thay pay premiums and never make claims; as soon as a client seems to break this profile they look for any excuse to drop them. This is what makes it an immoral system that must be stopped.
They have done it to themselves in the name of greed.
As if anyone in America gives a FLYING DAMN about the poor, poor insurance company profits! Screw them and the horse they rode in on!
Yeah, they don't right now...but they don't know what they're rooting against. Just like you, you blithering idiot.
That attitude, which exemplifies the anti-business, anti-profit agenda of this Administration, will likely be what does in this country economically.
To you, Obama, and all your ilk, anyboday who makes a ****ing dime in this country is a profiteering ass-hat born of the seed of Satan. When an incompetent, corrupt, and mindless government completely drags this country into the shitter, you'll be longing for the days when people could actually make a buck without fear of rebuke - or better yet, having to fend of the frothing-at-the-mouth anti-business mobs with pitchforks fueled by the fear-mongering rhetoric you and your ilk use against anything "capitalist" in this country.
I have two issues with this. First, you try to make the point that the two polls you identified are reasonably close at 56% and 62%. To get this result it was almost foreordained that you had to ignore the MoveOn/SUSA poll. Yet the wording of that poll does not violate your 5th rule. The question in that poll was not "How important do you think the issue of the public option is?" but rather "how important do you feel it is to give people a choice of both a public plan administered by the federal gov't and a private plan for their health insurance--extremely important, quite important...". While you could argue that people who support it but don't think it's very important might be discounted, you simply cannot logically make the case that people who do not support the public option would say that it's important, nevertheless, for people to be able to choose between it and private plans. And with the combined total of "extremely important" (58%) and "quite important" (19%) totaling 77%, it's hard to argue that there's a consensus among the polls.
Also, I'd argue that the fourth rule is flawed in that the word "option" is in the name "public option" about which people may have misconceptions that the polling is supposed to get around. I'd argue for the use of a word like "choice", "choose", or even "pick".
@Mule:
anyboday [sic] who makes a ****ing dime in this country is a profiteering ass-hat born of the seed of Satan.
No, we have no problem with people earning money, and no problem with people becoming millionaires or billionaires. Unlike you we don't think all profits are created equally; and unlike you we don't think profits derived by causing other people pain and suffering and death should be tolerated simply because the numbers are impressive.
I do not begrudge Jim Carrey, Brad Pitt, Julia Roberts or the Black-Eyed Peas or the Rolling Stones or Stephen King or the majority of the 450 thousand restaurateurs in this country a dime of their earnings. Or most businesses, for that matter, because most businesses present a win-win-win proposition for their customers, their workers, and their owners/investors.
When Brad Pitt acts in a picture he wins, the investors win, the people working on the picture win, and the audience wins.
What "our ilk" is opposed to is businesses that find ways to profit at the expense of their customers or workers or investors or society, and insurance companies have fallen into that category, along with oil companies, polluters, drug companies and for-profit hospital chains.
Personally, I consider "our ilk" to be the circle of sane people, because you have to be insane to think that explicitly exploiting people for profit is an acceptable business model.
I agree that it is nice to have the best questions and accurate polling data to look at.
But the reason the "public option" is getting trashed in many circles, has more to do with the Administration (Obama and Co.) not getting solidly behind it and explaining to the American Poeple what it will do in no uncertain terms (and what it won't do). And saying it IS essential.
And the reason they aren't doing that, is because they are allowing Congress to take the lead in creating the legislation.
And the reason they are doing that, is because they know many in Congress do not support the public option and would rather kill reform, than work to pass it; if that reform includes a public option (including many democrats).
And the reason they don't support it is because the insurance companies own them. They have given some in Congress so much money, and have lobbied them so hard, they are scared to death to oppose those same companies.
Which is why you are beginning to hear about trying to get this passed with 50 rather than 60 votes in the Senate.
What its come down to, is power. Who has it, and who does not. We're about to see if big insurance has more power, than the American People.
If the answer winds up being big insurance, then the democrats are out!
Cugel said...
"No private insurer can legally duplicate the Obamacare government health insurance "innovations" of setting the coverage of its competitors, obtaining government credit, tax payor subsidy in the Kennedy bill and compelling health care providers to take a pay cut."
ONE right wing talking point you won't see emphasized! As if anyone in America gives a FLYING DAMN about the poor, poor insurance company profits! Screw them and the horse they rode in on!
What do you do for a living? Would you be saying the same thing if the government nationalized your industry, destroyed the equity in your company profit sharing plan and then cut your pay by over 30%? Socialist theft is only fun if you are not the kulak being robbed by the state.
In any case, I did not argue that private health insurance companies could not compete against the government simply because the government entity was non-profit because it is really a non-issue.
My wife worked for a private HMO that Florida allowed to compete with Mediciad for Medicaid insured. The HMO had no problem making a profit even though they were paid around 5% less than Medicaid for each patient because the Medicaid bureaucracy was awful. Florida eventually tilted the scales so far in Medicaid's favor that all private insurers left the program. This is the precise intent of Obamacare.
If Obamacare created a health insurance plan managed by the government bureaucracy without any government subsidy and which pays its providers at market rates, it would be bankrupt before the voters get to rectify their error in the White House in 2012.
BD: "If Walmart did this to its competitors, Justice would be prosecuting the retailer for predatory anti trust violations."
[W]hy should any middle class person mind if the bloody insurance companies have to compete with government?
The reason why we have anti-trust laws is because predatory practices destroy competition and you are left with a monopoly controlling your goods and services and the price you pay for them.
I.e. that would be just like Medicare and not even as "socialistic" as the Veterans Administration health care system -- which is PURE "socialized medicine" because it has its own health care providers and hospitals and nursing care facilities -- all owned and run by Uncle Sam.
Ask injured veterans returning from the war what they think of the treatment they received from Obamacare's progenitor in the VA hospitals - rats and all.
MuleRider, you seem to have the attitude that anyone who sees abuse is being anti-capitalist, which is absurd. Although a pure free market should self-regulate, we never have had a free market in anything - that is a theoretical model. Too many markets are regulated 1st of all. In the case of insurance, there are too many local and State laws to make it an even playing field - insurance companies cannot easily cross State lines. 2nd of all, customers do not have much freedom, since the process of selecting insurance is complex and multi-layered (employer sponsored for one) and so works against normal demand. Individuals have no power and little access in this market. So, it is very unbalanced - no level playing field for any party.
You could argue against all regulation, but regulation works because although the market will self-correct, it will do massive damage in the meantime. Regulation is like building dikes against flooding; flooding will happen sooner or later and "self-correct", but we may not be willing to tolerate the level of damage.
Purely government run systems are often broken (for the same reason as monopolies), but mixed systems can work very well. The private sector will cherry pick (as have Fedex and UPS, airlines, private train systems, etc) and leave the government stuck with less valuable markets.
Tony C. said...
Existing insurance companies routinely deny claims they are legally required to pay, and then pay if the claimant files a lawsuit or presents a credible threat of a lawsuit in the form of a letter from an established attorney's office.
Fraud and breach of contract is currently illegal. Having the government nationalize the health insurance industry hardly makes fraud and breach of contract disappear. There is a very large and thriving legal service community dealing with the exact same denial of benefit problems with Social Security, Medicare and Medicaid.
1. Make clear that the 'public option' refers unambiguously to a type of health insurance
So does this Rasmussen poll, which refers to a "public health insurance company"
-----------
Nate, why does Rasmussen get this wrong?
I think people know quite well that Blue Cross/Blue Shield is their health insurer, not their doctor.
How on earth would someone taking the Rasmussen poll be confused into thinking this "government insurance company" is their health provider?
That makes no sense at all. The Rasmussen poll directly accounts for the confusion you are worried about.
Maybe you just do not like the results.
2. Make clear that by "public", you mean "government".
The phrase "public" is somewhat vague and could conceivably be confused for something like a non-profit cooperative
---------------
Nate, why do you think Obama and the Democrats call it the "Public Option"?
I agree it is deceptive, but that is why they chose it.
They know that "Government Option" or "Government Plan" sends off warning bells to people.
"Government-run Health Care" is a deal-breaker.
The phrase "public plan" or "public option" is as generous as you will get in terminology.
If you called it a "Government Plan" you would lose 10 points of support immediately.
This strategy was designed around NOT calling it a "government plan".
Given that this is the terminology that pundits and politicians have adopted, calling it something altogether new in a survey would only introduce new bias, not remove it.
Doesn't all this really prove that public polling of policy is useless. If people are not actually familiar with an issue, they just respond to their gut reactions to the words themselves. If slight (non-substantive) changes in question wording changes answers to a great degree, all that really shows is that people don't know the underlying subject matter. If they don't have an informed opinion, then they really can't know whether they will actually like any specific policy that is implemented. Changing the question itself to a more neutral phrasing eliminates some obvious biases, but does not get rid of the underlying ignorance.
Nate - you write "62 percent of people support the public option in Quinnipiac's August 5th poll, versus 32 percent opposed."
By your own criteria, you should have probably said "government-sponsored/run/whatever"
BTW - I my father and two close friends in the VA system, spanning the Korea, Viet Nam and Iraq wars. All three are happy with the level of care provided ... though they all bitch about the bureaucracy.
Mark said...
"I'm all for any plan with empirical (not public) support. Lets put them all on the table, run the numbers, and use the best. The health care crisis is a crisis with an objectively correct solution. There should be no debate, just honest analysis."
I agree, Mark, but our country doesn't work that way. Our system gives weight to vested interests. They have the ability, and the right, to make their case to elected officials and to the voters. So, how do we choose "the objectively correct solution", and who gets to set the metric for determining "objectively correct"?
We desperately need people like Nate to help separate the wheat from the chaff when the lobbying gets intense. Cut through the lies, and point out the lies. Make sure that your elected representatives see your enthusiasm. This sort of issue is decided by who cares and how much they care.
@Nate -- how about adding a sixth criterion in view of the loaded nature of the word "compete". For example, the Quinnipiac poll question:
Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans?
could be rephrased as:
Do you support or oppose allowing individuals to choose being covered either a government health insurance plan or a private plan?
The word "compete" arguably blinds the interviewee to the substance of the question. Including it raises the politico-eco arguments about free enterprise vs socialism -- essentially inviting non-experts to focus on a touchy-feely response to a much broader question.
[typo correction]
Do you support or oppose allowing individuals to choose being covered either by a government health insurance plan or a private plan?
Nate, have you read the recent article in the Atlantic by David Goldhill entitled "How American Health Care Killed my Father"?
http://www.theatlantic.com/doc/200909/health-care
He makes the case that current reform efforts are a Band-aid at best and do not address underlying incentive-structure issues. His alternative plan:
1)Universal, government-mandated catastrophic health insurance.
2) Mandatory health savings accounts for day-to-day medical expenses.
3) Government provided, no-interest loans for expenses, like appendectomies, which might drain the balance of a health savings account but aren't technically considered "catastrophic".
I'd love to hear your opinion on the matter.
"there are two exceptions. One is the Quinnipiac poll, which asks:
Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans?
----------------------
This is a terrible question because of the first phrase.
"Do you support or oppose giving people the option of being covered..."
That is what people hear.
The "support or oppose" is too far from "government health insurance plan"
When read, it feels like you are opposing giving people the option of getting coverage.
Of course 62% would support giving people the option of getting coverage.
That is not the issue.
This violates a prinicipal rule of survey question design.
1) Provide the response option AFTER the policy statement so there is no confusion about what you are agreeing with or opposing.
Example:
"As you may or may not know, there is a proposal before Congress that would provide people the option of selecting a government (or public) health insurance plan, which would directly compete with private health insurance plans."
Do you support or oppose this proposal?
In this example it is clear what you are supporting or opposing.
The Quinnipiac Poll wording is awful.
You are justifiying the outlier because you like the result.
Bart DePalma said...
This is the precise intent of Obamacare.
Too much Fox News Bart - or you really do work in the health care insurance/big pharma/ medically related legal field.
Mulerider... Big oil, big pharma, the insurance industry - they have all feasted for decades on the pockets of Americans to a degree that would be impossible NOT to see as abuse.
This is not a Republican/Democrat issue - this is an issue concerning all Americans. Unfortunately, those making the decisions (Congress) are more than 99% Republican or Democrat. The lobbyists will spend more ill gotten money (obtained at the expense of all of us) to "convince" Washington what needs to be done so the corporations who hired the lobbyists will be allowed to continue pillage and plunder the American people.
Make a dollar, make a million, make a billion, but if it is done with deceit and dishonesty, I can only hope a flaming sharp stick finds your eye and the hospital refuses to treat you because your insurance company says you have a previously existing condition!
This issue also isn't about how much money anyone has, it is about doing what is right in the face of stern opposition that has benefited from the status quo for so long. They feel they are entitled to continue to reap the rewards because that's the way it's always been done.
Change will occur over time and whether you agree or disagree with the current administration, be thankful that some of that change is taking place now. Will there be mistakes made - yes. Has any administration EVER not made mistakes - no. If some respectable form of health care allows the American people to have affordable access to reasonable health care then that is a chance I'm willing to take.
If people really wanted to see radical progressive reform in this country, they would not be voting within the two parties that have wholeheartedly put us right where we are today.
@William said...
"I don't quite understand the argument that the "public option" is flawed because it forces private health insurance companies to actually innovate and become more cost effective."
William, 61% of major health plans are non-profit. They other 39% earn a profit margin of 3.2%. That is lower than Wal-Mart, which is the most efficient retailer in the world.
There simply is not a lot of cost savings in the insurance industry.
Insurance company profits are 1/200th of health care spending.
Their administrative costs are lower per subscriber than Medicare (although higher as a % of spend).
Why? Medicare covers more chronic conditions and major surgeries, where administration economics are better.
Private insurance companies cover more routine docter visits where the administration economics are just different.
The cost issue is the redundant and wasteful procedures that insurance companies are FORCED to cover by state regulations.
"We rank 41st in terms of life expectancy, according to the CIA World Factbook."
After you control for homicide and auto accidents, we rank #1 in life expectancy.
You are misleading people.
We drive more, have big fast highways and we have a lot more guns and willing users.
You cannot penalize our health care system for those factors.
Do some multivariate analysis and control for those factors and...
We have the highest life expectancy at birth in the world.
Oh, one other factor that brings down US life expectancy...
We save more pre-mature babies.
In Europe and Canada, pregnancies with major complications are almost always terminated. They simply will not cover high-risk birth conditions.
We also have a higher incidence of multiple births due to increased availability of invitro fertilization and fertility drugs.
Unfortunately, our practice of saving high-risk babies also means that more are born who eventually die. This counts against us.
In other countries they are never born because they are aborted.
That helps their statistics.
So you tell me, does that make us a less humanitarian nation with a bad health care system?
It makes us the EXACT opposite.
The life expectancy argument is one of the most misleading and unfortunate arguments used by people who simply repeat what they are told.
You have to think for yourself and do some critical reasoning.
@MidPointMan:
YOU are the one misleading people, your figures are wrong, or lies. The big four health insurance agencies pay out only 80% of their revenue in claims so their gross profit is 20% of revenues; and you neglect to mention that their salaries and perks are not counted as "profit", and their "administration" costs are about 50% over the administration costs of Medicare.
Also, the World Health Organization rates us 37th in the world in terms of healthcare based on objective outcomes such as in-hospital infection rates, medical mistakes, death rates from various diseases, number of visits required to resolve a medical issue, and on and on.
Either you don't know what you are talking about, or you are purposely misleading people.
Bart De Palma…
You are to this comments section what Rasmussen is to polling.
If you are going to continue to flog your talking points as “objective” don’t you think the first step would be to stop calling any reform plan “Obamacare”?
Assuming you have health insurance, what’s to prevent your employer deciding that health insurance is too expensive to continue to underwrite, and cancels it next year? With things the way they are, there would be nothing you could do.
If you pay for your own insurance, surely the increase in premiums every year (coupled with a decrease in coverage) is appalling to you, unless you are made of money.
So I don’t understand why you are so rabidly against reform. Perhaps you can explain that here, instead of ranting (yet again) about “Obamacare”.
Bart DePalma said...
Ask injured veterans returning from the war what they think of the treatment they received from Obamacare's progenitor in the VA hospitals - rats and all.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Actually Obama is trying to to fix/improve the abomination that was exposed by the Walter Reed scandal which happened under Bush's watch.
And suspect most veterans are very happy w/their care in VA hospitals/clinics. Would welcome that poll as many health care experts use the current VA system as a model of efficiency.
And BDP, as a (7) year army veteran assume you would be quite familiar w/the military health care system, eh.
take care
p.s. please don't tell me cheney/bush let down our Iraqi veterans by 1) starting a bogus war and 2) not caring for injured veterans upon their return from said war as this wouldn't concur w/the Rep national security/country first meme of the last (8) years ...
Nate Silver…
Please stop giving credence to crap-polling coming from Rasmussen. Fairness does not require giving nonsense equal time, which is what Rasmussen’s polling has become. If you feel the need to mention him, do so, but only obliquely, such as—
“On this topic, Rasmussen has returned a typically outlier result.”
No need to go into chapter and verse—we all know what Rasmussen’s polling looks like.
Pragmatus said...
Bart De Palma… You are to this comments section what Rasmussen is to polling.
Why thank you. It is generous to compare my humble efforts to the most accurate pollster in the business.
You have to think for yourself and do some critical reasoning.
Methinks you ask waaaaaay too much on a forum filled with myopic, propaganda-spewing, self-aggrandizing far-lefties.
Bart De P…
I notice you didn’t bother to respond to my serious questions to you.
Which is in itself a response…
YOU are the one misleading people, your figures are wrong, or lies. The big four health insurance agencies pay out only 80% of their revenue in claims so their gross profit is 20% of revenues
Of course, he didn't quote gross profit. You do understand the difference between net profit and gross profit, don't you?
Hell, I want a single-payer system, but responding to arguments with inane arguments like this does not further our goals.
Gross profit is not operating profit. It does not include payroll costs, tax payments, interest payments, or any other overhead.
Why aren't all you liberals in a tizzy over the obscene profits in the Beer, Wine, and Spirits industries? They make a killing year after year, and it's a proven FACT that their product is directly and indirectly responsible for thousands upon thousands of ruined marriages and wrecked households, lost jobs, vehicle deaths, murders, rapes, and other aggravated assaults.
I don't see you all trying to take them down...them and their "profiteering"...done at the expense of millions of people's lives and their livelihood.
Yeah, that's what I thought. You son-of-a-bitches like to cherry-pick your cause and then stumble to give a coherent answer when someone points out a double-standard in your line of thinking.
Mule Rider said...
You have to think for yourself and do some critical reasoning.
Methinks you ask waaaaaay too much on a forum filled with myopic, propaganda-spewing, self-aggrandizing far-lefties.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mule, just wondering if a progressive troll at a conservative site, if there is such an animal, ever posted a top ten most despised conservative poster list at said site and then took his balls and left saying he would never return.
Just wonderin'
And taking into consideration your infamous 538 past, I will take your above post under advisement. ;)
take care
Uh-oh…
Sounds like Muley is dusting off his fish-gutting equipment.
Steady there, Muley. Go have a cup of tea, and afterwards you can play with the tea bag and pretend it’s the real thing.
:o) :o) :o)
Sounds like Muley is dusting off his fish-gutting equipment.
Steady there, Muley. Go have a cup of tea, and afterwards you can play with the tea bag and pretend it’s the real thing.
:o) :o) :o)
Calling some of you libs out for your hypocrisy and invoking the insult "son-of-a-bitches" is hardly teetering on the "making threats" threshold or necessitates the urge to chill.
You want critical thinking? Well, you got it. I'm asking you to explain your absolute hysterical disdain for the "profiteering" of the health insurance industry while remaining silent on the "profiteering" of the alcohol (beer, wine, and spirits) industry.
So far, no takers. Nor do I expect to find any...not one that can lay out a rational defense, that is, of cherry-picking one as "bad" and the other as "good," or at least "okay."
How much confidence should anyone ever have in polling if the pollsters cannot come up with a simple question that would induce a respondent to say Yes, No, Sometimes or I Don't Know?
As a lawyer, I would observe that the same mistake is made by pollsters that is made by lawyers drafting contracts - they try to put too much into a single sentence, rather than having several simple sentences which convey the desired message.
I would like to see a single payer plan. As a compromise, I would like to see a robust public option which would be available to all and which would essentially be Medicare (although purchased by those people under 65 at a fair rate to pay for itself).
If I were to draft a polling question, it would go something like this:
"Would you support a "public choice" for health insurance? That "public choice" would permit - but not require - people under age 65 who don't have Medicare, to buy Medicare from the government at a price that would pay for the cost of health care."
Most people with Medicare like it and don't want to see it messed with. But would a 70 year old object to allowing her 50 year old daughter or her 25 year old grandson to buy from the government the same coverage she has? (And especially for those who think that Medicare is private insurance - who the hell are they to say a private insurance program cannot be offered to those under 65?)
Most people claim to like their private insurance, mainly because they don't have to use it. Once they try to use it, they'll see how great it is. But making it clear that the public plan is a choice that they can reject should comfort them.
Many people confuse government health care coverage (payment) with government provided health care. By saying this is Medicare for all who want it, it is clear that this is not government provided health care.
Those of you who disagree with my premise of what such a public option would consist of can weigh in. But it shouldn't be hard to ask questions geared to support for: single payer; public option; reform of insurance companies only; etc.
Really, 2 or 3 simple sentences constructed to ask a simple question should give clear answers as to what the public thinks. If clear answers are what polling is about.
Do they pay pollsters? If so, why?
Points 1, 3 and 5 seem reasonable, but it's a bit depressing to think that the people being polled might be SO obtuse that the example nitpicks in 2 and 4 would make any difference. How can you assume that such people would even grasp the concept of "health" or "insurance" in the first place? There's no harm in clarifying further, of course, it hardly seems necessary. Or maybe I'm the one being obtuse?
@Bart DePalma:
I would suggest the numbers would change significantly if they also knew that the government was going to set the coverage of all insurance and were going to subsidize the government insurance and give health care providers a pay cut.
Brat,
What the WTF are you talking about?
The proposed plans are not "going to set the coverage of all insurance." They do include minimal standards for coverage that insurance companies would have to provide.
This is only reasonable and fair. Otherwise, insurance companies would game the system by offering low-priced policies that had $20,000 deductibles or that didn't cover diabetes. Those companies would then cherry-pick the least expensive clients, leaving the government to pick up the tab for older, riskier, more expensive clients. And those of us who needed insurance wouldn't be able to afford the premiums that the Public Option would be forced to charge.
Insurance companies which wished to provide better coverage than the Public Option would be welcome to compete on that basis. In many foreign countries, many companies thrive by doing just that.
As to your second point: all insurance companies seek to "give health care providers a pay cut." It's called negotiating terms of payment. If the government is better at it than the insurance companies, then the companies should either learn to compete or go out of business.
Mule Rider said...
Why aren't all you liberals in a tizzy over the obscene profits in the Beer, Wine, and Spirits industries?
(The rest of your rant you can take to your mommy!)
Actually consider he fact that these companies actually provide a product that is accurately described delivered! I've never ordered a Captain Morgan's and Coke and then had a bartender tell me - sorry no Captain for you but you'll pay the same price - oh and you get no drink. These industries are well regulated and pay taxes at a level that verge on extortion. If you need to point your finger elsewhere rather than provide a solution for the problem we are all discussing then choose tobacco - they fit in quite nicely along with the lawyers and insurance industries that have caused health care costs to spiral out of control.
Now, before you haul your butt up to the top of your soapbox to claim your self righteousness - no I'm not a liberal, no I'm not a Republican, no I'm not a Democrat, yes I have a brain that I do use for something besides blaming and belittling others. Bring a solution to the table with you or quietly watch from the sidelines with the rest of the mindless cattle who believe that Fox News is quoted from the bible on a nightly basis!
By the BTW, there's a great op-ed piece in yesterday's WaPo, by TR Reid: 5 Myths About Health Care Around the World. Accordion to Bob Somerby, he has a book coming out, entitled The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care.
Rezendes said...
[incoherent rant]
I'm sorry, was there a cogent response and defense in there for NOT tackling the alcohol industry for its "obscene profits" in spite of its "deleterious impact" on society while doing exactly THAT to the health insurance industry?
If it was, I sure missed it...
Muley…
Is there a liquor industry reform bill before the Congress? No? Then perhaps that’s why nobody is focusing on that topic.
Perhaps I can ask you—since Arkansas takes much more in federal money (welfare, crop subsidies, Medicaid etc) than it returns in taxes, what have you done to reverse that tide, and make Arkansas pay its way, rather than be such a dead lump riding the public dime?
pooplin: Fabric used exclusively to hide ulterior motives by GOP.
Is there a liquor industry reform bill before the Congress? No? Then perhaps that’s why nobody is focusing on that topic.
Way to deflect the question and keep hiding your hypocrisy/double-standard on the issue further.
Perhaps I can ask you—since Arkansas takes much more in federal money (welfare, crop subsidies, Medicaid etc) than it returns in taxes, what have you done to reverse that tide, and make Arkansas pay its way, rather than be such a dead lump riding the public dime?
Personally, I don't receive a dime of welfare, crop subsidies, or Medicaid, and I pay far more in taxes than I could every hope/dream to receive in benefit. So, personally, you have no argument against me.
But I'd be all for reducing/eliminating all those "handouts" to those "dead lump" Arkansans so that it evens out and they're paying their way.
Problem is, from your side of the argument, you'd hear far more howling from all the left-leaners in the state getting handouts than the conservatives that are there getting one.
By the way, I no longer live in Arkansas.
Mule Rider said...
[incoherent rant]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mule, as you are one who wrote the book on incoherence ie as you say, myopic, propaganda-spewing, self-aggrandizing far-right wingnuts ...
Priceless!
take care
Muley…
But you didn’t answer the question, which was what have you done to achieve a revenue neutral Arkansas?
Are you proud that your state is the #2 rathole for federal cash (behind Mississippi)?
I’m beginning to think your “conservative principles” are all hooey.
MuleRider must not realize that Health insurance is related to people's lives, selling products is not. Alcohol, when used properly is no worse than any other "luxury". Getting treated for a life threatening disease is a very different matter. We pay insurance to protect ourselves against the catastrophic costs of health care if/when we need it.
Alcohol is a free market by the way. There are suppliers from all over the world and any vendor can compete on price or quality. Health insurance is sadly not a proper market.
I've noticed the term "Obamacare" being hammered on over and over by certain parties (you know who you are, BDP). This is an obvious attempt to create a counter-meme to the successful "public option" meme.
If you feel inclined to respond, I suggest you counter this by hammering at least as hard on the term "public option".
By their deeds ye shall know them....
Tony C., thanks for summarizing perfectly the tactics of these for-profit insurance companies. In my case, I supposedly had "one of the best" PPO plans. In addition to all the tricks you mentioned, they also drowned me in paperwork, so that the ball would always be in my court. Its just another way for them to delay the payment that was due to the physician. Delay, delay, delay is their strategy. Of course, then the physician's office will send the bill to the patient. The insurance company just hopes that you panic and pay the bill so that they won't have to.
The greed of Big Insurance has made reform the only way forward.
@ POLITICAL WIRE:
Bonus Quote of the Day
"I want a public option too!"
-- Senate Finance Committee Chairman Max Baucus (D-MT), on a conference call with Montana Democrats last night.
say WHAT ???
I do hope that is true though...AND that he will FIGHT for a real workable public option
Attempting to define a politically neutral poll on US healthcare options is fundamentally misconceived. This isn't like measuring true voting intentions or crunching baseball statistics. The healthcare debate in the US is a high-stakes (15% of the biggest economy on the planet ~and~ your childrens health to boot) political battlefield. Defining the terms of the debate is half the battle. There's no neutral ground here, which isn't the same thing as saying that none of them are outright lies.
@Mule
You think those two industries should evoke the same response simply because they're (supposedly) both profitable and harmful? That's like arguing that hippos should be treated like dogs simply because they're both quadrupedal mammals.
If you're genuinely having trouble making a distinction between insurance and alcohol, then I don't know where to begin to educate you. All I can say is that I feel sorry for your local bartender.
For that matter, if you really think that the entire argument for the proposed healthcare reform amounts to "current industry practice is profitable to some extent and harmful in some unspecified way", then adequately informing you is probably not feasible within the limits of this comment thread. And certainly not worth the effort.
But of course, you aren't genuinely confused, just trolling for responses by absurdly broadening one aspect of the argument for health care reform in order to present a silly strained analogy. And you got a number of bites, so here's a pat on the head for you.
Sacto Joe said...
I've noticed the term "Obamacare" being hammered on over and over by certain parties (you know who you are, BDP). This is an obvious attempt to create a counter-meme to the successful "public option" meme.
If you feel inclined to respond, I suggest you counter this by hammering at least as hard on the term "public option".
Why would I use your spin term "public option" that even Nate recognizes is meant to obfuscate?
What is wrong with Obamacare?
Are you afraid that Obama is dragging his government health insurance down in the polls or that his government health insurance is dragging down Obama?
I personally use the term to chain Obama to his disaster of a government health insurance plan. Obamacare awoke folks to just how far left Obama is in reality.
@Bart
"Obamacare awoke folks to just how far left Obama is in reality."
Almost as far left as Nixon.
Bart De Pee…
Interesting that you don’t answer any queries about your own health insurance situation. All you can do is blab talking points.
Again, the questions for you are—
Do you have employer provided health insurance? If so, what will you do if your firm decides to no longer provide that insurance? (There’s no law which says they have to keep it up, and besides, the GOP violently opposes any such mandate.) Also, are you comfortable getting less and less in the way of health care because of insurance company limitations (read: rationing) which increase every year?
If you pay for your own insurance, are you comfy with the premiums skyrocketing year after year?
We know you can blather—how about addressing some issues, for once?
Bart De Pee…
I thought so. You have demonstrated the customary GOP discussion skills, which consist of screaming as loud as you can and then flying off like a witch as soon as the talk turns to substance.
You guys follow a very long tradition of such propaganda practices—developed and honed to perfection in the 20th Century by Goebbels, Stalin, Mao and lastly Newt Gingrich.
@Muley,
I'll be your Huckleberry. First off, Keep your government hands off my BACARDI! That is the national drink of Puerto Rico and how dare you suggest such a RACIST policy of SOCIALIZING ethnic beverages. I would have NEVER imagined such things from a person like you.
Second, in all seriousness, health care is a necessity while alcoholic beverages are NOT! Your argument is nullified.
NEXT! NO SOUP FOR YOU!
@Muley,
You know what, I have an even better example than what you came up with. We have have been so caught up on health-care, us progressives we have lost our focus on what really is important. We should go after them too.
There is a major monopoly operating right underneath our noses. They have been allowed to corner the market in production. How dare they?!?
This trust controls the production of the air and water we breath. There is no capitalism or regulations. We are at their mercy.
How did we allow the PLANTS AND TREES corporation operate in such a manner without regulating them too? WE MUST TAKE A STAND! This trust must be broken.
---------------------
What other examples you might bring up? Whatever argument you might say it doesn't change the fact 47 million don't have adequate access to health-care! A necessity. Tell me what your plan is. Put-up-or-shut-up.
Wait, we don't breath water, but you should catch my drift. Wait again, I am making assumptions I should not be making when talking to Neanderthals.
DAMN, I shouldn't have said that. I just insulted the Neanderthals. I hate trying to be so politically correct.
It must've been past your bedtime. I should have known your momma told you it was lights out in your basement bedroom a couple of hours ago. Silly me. Maybe we should try this again tomorrow? Unless you are in school, of course.
The Constant Challenge of Creating an Effective Left Flank
"I believe we ought to follow in creating that left flank:
1. Understand that whether we like it or not, the progressive movement's fate, at least for the next few years and probably longer, is inextricably tied to Obama's. As mad as many of us progressives get at Obama over certain policy or strategic failures, we have to understand that him failing as President hurts the entire progressive cause. In case you didn't notice, LBJ's and Jimmy Carter's failed Presidencies did not usher in eras of progressive reform, they moved the country inexorably to the right. As President from the more left party, most Americans saw them as liberals even though LBJ was decidedly un-liberal on Vietnam, and Carter was the most conservative Democratic President on economics since Grover Cleveland in the 1800s. But progressives were struck with their failures anyway and paid the price. People who think Obama is failing because he's following a more moderate path, and that eventually helps us move in a more progressive direction, are fooling themselves.
If Obama fails on health care (and, by the way, I consider failure to be either not passing a bill, or passing a bill that doesn't work for the middle class), we won't see another attempt at serious health care reform for at least another generation. If he fails at doing something big on climate change, we probably won't be able to get anything done on it until it is too late to make a difference. And if his economic policies fail, regardless of demographics moving in our favor or Republican extremism, all Democrats will be punished at the polls, and the far-right that has taken over the Republican Party will probably come into power. And this isn't just about the long term, either: for every percentage point Obama's approval drops, we probably lose another two or three House seats in 2010.
Progressives' strategy, then, should not be to attack Obama personally, to undermine voters' confidence in him, but to shore up the backbone of progressives in Congress -- and in his own administration, because I guarantee you, policy debates between more and less progressive staffers are held every day at the White House. If Obama makes a bad policy decision, we shouldn't hesitate to push back or encourage progressives in Congress to do the same, and if White House staffers are pursuing destructive political strategies (see the "left-of-the-left" quote), we shouldn't hesitate to bang on them. But our goal should be to do all this while still holding up hope that Obama will move in the right direction, and to praise the hell out of him when he does."
And now for more RIGHT WING BULLSHIT: Fox News, NRO, Limbaugh run with "death book" smears
I'm sure Louis DePalma and DonkeyGaper will find plenty to fart about.
PaulK said... They work with their vendors to get the lowest price, always beating them down by threatening to go elsewhere. They use the size of their market to do this.
It's not only WallMart that does this. This is exactly what the private insurance companies do right now. They negotiate fees with health providers based on the threat of taking their large client base elsewhere. Of course, with a near universal pool the government will be more efficient and won't use this bargaining power to line the pockets of executives and stock holders.
More astute leadership and ideas from the GOP!
Sen. Jim DeMint says America headed to becoming like Iran.
Sen. Jim DeMint (R-SC) appeared on Hugh Hewitt’s radio show today to continue his near daily rants against President Obama. DeMint, who has repeatedly boasted that he will “break” Obama by defeating health care reform, has made a habit of comparing government under Obama to fascism. This time, DeMint told Hewitt that immigrants from Iran tell him that America is going “down the road” to the type of government they had fled from...
Who needs to worry about "tilt" with idiots like these at the helm of the GOP... oops, that sounds cocky and this is all too important for cocky.
Huckabee to ‘keynote’ Electromagnetic Pulse conference.
and this just makes me chuckle
One very large problem polling support of the "public option" is that there are more than 1 public option. It makes a huge difference if the public option reimburses at rates set by the government (most of the house plans) or has to negotiate the rates from the providers (the blue dog compromise).
The first example, obviously the government cost is much less and the public plans are quite a bit cheaper than the private ones (good) ... but its not clear (at least to me) how much of these costs will be passed on to people with private insurance (bad ) and some people will have to move from private insurance to public insurance ( see the end of
http://www.factcheck.org/2009/08/keep-your-insurance-not-everyone/
)
The second option (might) seem more fair , but (according to CBO) will result in plans that have very little difference in cost with private insurance. Of course this means the number of people who currently have private insurance and will be forced into the "public option" will be close to zero. I would guess that conservatives would complain, and liberals hope, that the second plan would someday morph into the first plan.
These are two very different options.
"some people will have to move from private insurance to public insurance"
should say
some people will not be able to keep the private insurance they currently have
Sorry about that.
Tony C. listed some ways that the insurance companies game the system, but he missed some other key practices in our current health-care maze that work against the consumer.
For one thing, most consumers cannot get clear info on which to choose insurance plans. At many places of work, the employee is allowed a choice of insurance plans. You may be allowed Blue Cross, a Consumer-Driven Health Care option, and another HMO/PPO choice.
Great! But...try to get enough info on which to base your decision, and you'll run into a bureaucratic buzz saw. It just doesn't work. It's even tough to get a list of the doctors covered by the local HMO's network. Can I keep my currant doc if I switch plans? Who knows? So...the consumer's left in the dark. That's no free market.
Secondly, there's the wide disparity in the cost of procedures. Your insurance company has negotiated the cost of a procedure down from the hospital's nominal charge. If you don't have insurance, you have no bargaining power. The difference can often be a factor of ten; the middle-class person with insurance has a procedure priced at $700 dollars (of which s/he pays a small portion, maybe $100 bucks); the working poor person, without insurance, must pay $6000 dollars for the same procedure.
This is part of why medical care drives people into bankruptcy in the US. Market forces simply don't work when it comes to health care.
One basic question, is whether health care is a right (like Freedom of Speech) or a commodity (like alcoholic beverages). If it's a right, then nobody should be denied health care based on an ability to pay. If it's a commodity, then the fact that some people cannot afford it is just too fuppin bad.
In many industrialized countries, health care is explicitly a right. In the US, some people think of it as a commodity. But most people don't exactly agree: if 47 million Americans can't afford to go to a bar every day and knock down a six-pack, that's okay. But if they can't afford health insurance, then that's a problem.
I think most Americans view it somewhere between "right" and "commodity." The question is where, on that line between the two extremes, most people would place it. I guess we'll find out after the August recess.
National polling on this issue suffers from the same flaw as national polling during a presidential campaign. It's not enough to know that, say, the Public Option enjoys a 62-32% advantage nationwide. It'd be nice to know the state-by-state breakdown. How does it poll in NE, AS, MT--the Blue Dog states? If it polls above 50% in every state represented by a Democrat in the Senate, then Obama and Reid should be able to twist arms and get their votes. If not...well, that's why assembling a winning coalition can be tough.
@Dave:
yes, gross profit does not include salaries. That is why even a non-profit "leader" can pay themselves a million dollars a year, because profit to them is not profit to the organization.
So all this tells you is that NET profit is meaningless. It was gross profit that paid the $11M a year salaries, it is gross profit that pays for the $6M a year CEO office rent, it is gross profit that pays for the jets, the limos, the extravagant multi-million dollar parties in exotic venues, the bonuses, the multimillion dollar salaries to other executives in the C suite.
When a company is working on 5% margin, as insurance companies did in the early 70's, gross profit cannot afford these extravagances.
Since premiums are increasing at three times the rate of inflation (i.e. 9% per year), the FACT that insurance companies CAN work on 5% margin says that 5% of revenue is enough to pay everybody in the company typical 1970 salaries inflated to 2009 dollars. So if we take your figure of 3.5% profit, and 20% gross, that means 12.5% of all revenue is being paid in excess compensation versus 1970. Worse than that, we know premiums have inflated by a factor of ten in real dollars, which means the excess compensation is literally everything we were paying for insurance in 1970 plus 25%, in today's dollars.
Bottom Line: net profit in a business tells you nothing if the leadership is corrupt and redirecting profits into their pockets, the pockets of the board and top-level officers, and to pay for their royal lifestyles.
One more item they are leaving out...
They need to consistently differentiate whether the person has insurance or no insurance or they HAVE insurance but have had to actually use it significantly in the past.
The real issue going on, that polls don't identify
is that the people who have insurance but haven't had to use it significantly aren't aware of the problem. (doc visits and broken arms don't count, they are common)
Those people who DO have insurance,
but have currently or in the past dealt with a difficult issue, these are the people who have the problems with insurance.
My wife has an autoimmune disease called Sjogren's, this has had a significant impact on us. Its a subtle problem that the typical doctor won't diagnose. However, it is there, 4 million people have it, and it takes much testing to find...much less the right balance of care and meds to deal with or repress the symptoms...there is no cure at the moment.
Now if 4 million people have this one disease, how many have others over a lifetime? Insurance doesn't deal with this if it can help it...doesn't pay.
That and pollsters don't identify this.
So you get either they don't have insurance or you get most healthy people saying they are satified their insurance. Its not black and white.
@Mule:
Why aren't you liberals in a tizzy...
Beer, wine and alcohol are consumed by adult choice, even if that adult is being infantile.
At least for me, I don't want to be big brother to the people; I don't want to be a nanny telling them what they can and cannot do; it is none of my business what people drink or smoke or whom they choose to fuck.
What IS my business, and I think everybody's business, is to protect the weak from the strong; it is the responsibility of Americans to stop exploitation, fraud, deception, theft, violence and coercion perpetrated upon other citizens.
The consumption of alcohol is an adult choice made by the majority of adults. Getting drunk does not fall into the wheelhouse of me protecting the weak from the strong; it falls under the heading of protecting people from themselves and that is not my job.
When companies start using their financial strength and armies of lawyers to exploit workers or customers or investors, then its my job, and that is the situation we are in with health insurance, drug companies, and for-profit hospitals in the USA. When people are given the choice of bankruptcy or death it is worse than being robbed at gunpoint: At least a mugger only gets your watch and wallet, the hospitals take everything.
@Matt:
All true; this is because of the distorted supply/demand curve in the market, and another reason it must be regulated. You cannot negotiate with a doctor because their waiting list is months long, meaning their supply of patients is essentially infinite. If you don't want to pay, the next guy will.
You cannot negotiate with the ambulance driver because typically, your need is infinite and the supply is ONE ambulance, plus the fact that when you are in shock, bleeding, or unconscious, it is difficult to haggle over the price.
Markets distorted by essentially infinite demand (drugs) or essentially infinite supply (of patients) or essentially zero available time for bargaining (the ER or ambulance) will exhibit essentially infinite prices.
In this case, "essentially infinite prices" mean the prices are only controlled by externalities unrelated to the supply and demand; like laws or how much people earn. So the price of critical care in a life threatening situation becomes simply "everything you have," or the maximum the average patient can pay.
These infinities distort the moral aspects of the health care system as well, by making the rich the preferred customers regardless of the severity of need. In other words, the poor and middle class suffer and literally die so the rich can be treated for acid reflux or acne or get plastic surgery. There is no prioritization system to treat those with the greatest need first.
Health care is not like any other product; only about 5% of it is consumed by actual choice. 95% of patients in hospitals are there with their lives on the line, and that is not a system in which free market principles work to create efficiency, low prices, innovation or high quality or great service. It is essentially institutionalized extortion: You will pay what we say, follow our rules, or you (or your spouse, or your child) will die.
@Muley and all,
After rereading my posts I would like to extend apologies to all for being somewhat childish. We all can benefit from a civil discourse. I stand by my original argument that Health-Care is in a category of it's own and can not be compared to alcohol, tobacco, etc.
P.S. I get a little "wild-up" when talking about this topic, but that is not an excuse. Feel free to slap me next time.
Since premiums are increasing at three times the rate of inflation (i.e. 9% per year), the FACT that insurance companies CAN work on 5% margin says that 5% of revenue is enough to pay everybody in the company typical 1970 salaries inflated to 2009 dollars. So if we take your figure of 3.5% profit, and 20% gross, that means 12.5% of all revenue is being paid in excess compensation versus 1970. Worse than that, we know premiums have inflated by a factor of ten in real dollars, which means the excess compensation is literally everything we were paying for insurance in 1970 plus 25%, in today's dollars.
I made no such claim, just pointed out that your rebuttal was long on invective, short on cited facts.
Progressives should not be acting like freepers. It disrespects our ideals and it disrespects Nate.
@Dave:
Sorry. You were defending MidPointMan who claims 3.2% profit margins; and as I have pointed out repeatedly, net profits are a misleading indicator of efficiency or prudence in corporate governance. The fact that the megasalaries and insane perks come out of gross profit means we need to look at gross profit (or margin) as the telling reported component, and fortunately, we have several examples of relatively prudent governance as comparison points: The past, Medicare, the VA, and the other countries.
I will also point out that MidPointMan was being disengenuous in talking about preemie survival rates and such; Europe, Australia, and several old world countries all do exactly as we do for babies, the disabled and the elderly; only typically with better outcomes.
To Muley's point about alcohol company profits, for a start, you have a completely free choice over whether or not you consume the brewers products. Now take Health Insurance, firstly, you aren't even, most people at least, aware of how much you are paying for your health insurance. Most people would regard health insurance as a necessity, rather than a luxury, as they would view their alcoholic beverage purchases. This results in the health insurance industry taking advantage of its insurees. (at least from the view of many of those who are insured). I think the insurance companies do have people over a barrel somewhat.
****disclaimer*****
this is not to say that the alcohol industry is not an entirely immoral and bloodsucking industry often. Just its far easier to not take part in the alcohol industry.
Pragmatus said...
I notice you didn’t bother to respond to my serious questions to you.
You offered some comments, not questions, about why I did not desire government intervention to stop the inflation in my health insurance premiums.
I have an HSA and thus do not suffer from the normal health insurance inflation because I am compelled to spend my own money to purchase health care that is not preventative or catastrophic and thus curb my own demand.
One of the reasons I vehemently oppose Obamacare is that it will outlaw my HSA, mandate insurance with even more costly benefits and thus result in more health insurance inflation. Then an unelected and unaccountable health insurance bureaucracy will be compelled to ration my care using their standards and not mine.
To hell with that!
Matt said...
@BD: I would suggest the numbers would change significantly if they also knew that the government was going to set the coverage of all insurance and were going to subsidize the government insurance and give health care providers a pay cut.
The proposed plans are not "going to set the coverage of all insurance." They do include minimal standards for coverage that insurance companies would have to provide.
Let me see if I get your point. Obamacare is not going to set the coverage of all insurance except for the part of the legislation where they set the coverage of all insurance?
Bart DePalma said... I personally use the term to chain Obama to his disaster of a government health insurance plan. Obamacare awoke folks to just how far left Obama is in reality.
Quixote said... Almost as far left as Nixon.
Good comparison.
In reality, Nixon completed the Great Society and put it on a regimen of steroids. The last attempt by the government to run the economy that is at all comparable to Obama's socialism was Nixon's socialist wage and price controls.
Nixon was the primary catalyst for the conservative revolution in the GOP.
I would add a sixth criteria, which would be a follow up question for respondents who disaprove of the public option asking whether instead of the public option they would prefer single payer, or greater regulation of the existing healthcare providers, maintaining the status quo or don't know/don't care. We often hear on the news that X% of the public disapproves of President Obama's handling of healthcare, but not whether the respondents think the plan is going too far or not far enough. With polls showing self-identified liberals range from 15-30% of the population, this could be a significant chunk of the disapproves.
I, myself, am lukewarm on the public option because I think it's just one more patch on a broken system. What I think would actually work best would be a Canadian-style single payer system (with adaptations, of course). If we do public option now, we'll just have to come back with another patch in ten or twenty years. It's like fixing a roof. You can patch it and patch it and patch it and patch it, but sooner or later you're gonna need a new roof!
BDP said
'In reality, Nixon completed the Great Society and put it on a regimen of steroids. The last attempt by the government to run the economy that is at all comparable to Obama's socialism was Nixon's socialist wage and price controls.
Nixon was the primary catalyst for the conservative revolution in the GOP.'
---------------------------------
I do find it amusing how any unpopular GOP President immediately becomes a 'non conservative' to right wing bloggers.
I think at best BDP is using a selective reading of history. For a start the right wing revolution began in 1964 with the nomination of Goldwater. Also remember that Nixon got his start as a red baiting member of HUAC. Now it is true that in some ways Nixon was more moderate as President than his pre Presidential career might suggest he would be. But remember he had a Democratic Congress to work with.
When given less restriction from Congress, he really was quite a conservative (In a bad way) President. The way in which the Vietnam War was continued, the use of national gurad at Kent State, and his SCOTUS nominations (save for Harry Blackmun possibly) are evidence of his more conservative side.
markymark said...
BDP: 'In reality, Nixon completed the Great Society and put it on a regimen of steroids. The last attempt by the government to run the economy that is at all comparable to Obama's socialism was Nixon's socialist wage and price controls. Nixon was the primary catalyst for the conservative revolution in the GOP.'
I do find it amusing how any unpopular GOP President immediately becomes a 'non conservative' to right wing bloggers.
I do not care what politicians call themselves, but rather how they govern.
Nixon called himself a conservative, but governed according to the voter sentiment of the times, which was most definitely left of center.
Clinton called himself a moderate, but governed according to the voter sentiment of the time, which was most definitely right of center. Any misapprehension as to the view of the voters was cured in 1994. IMHO, the post 1994 Clinton was the second most conservative President after Reagan in the post FDR era.
Thus, I think Clinton was a far superior President to Nixon because his governance was far closer to my own views regardless of his party. (Although both men were personally low lifes).
I think at best BDP is using a selective reading of history. For a start the right wing revolution began in 1964 with the nomination of Goldwater.
The opening shot was in 1964, but voters were not ready at that time for a conservative counter revolution and Goldwater was crushed. The Rockefeller wing of the party remained dominant. It was another four election cycles before voters had enough with the fallout from their 60s and 70s flirtation with the New Left and finally realigned in 1980. Even that realignment was not complete until 1994.
Also remember that Nixon got his start as a red baiting member of HUAC. Now it is true that in some ways Nixon was more moderate as President than his pre Presidential career might suggest he would be. But remember he had a Democratic Congress to work with.
You need to recall that tough internationalism and anti communism was a bipartisan effort in the days before Vietnam. It was not until after Vietnam sundered the country that the Dems went isolationist and engaged in appeasing the communists.
You may want to review Nixon's domestic policies. For a conservative, they were a horror show. LBJ's Great Society programs were dramatically expanded, the EPA was created, taxes and spending soared and then there was the insanity of wage and price controls. This was not a "moderate" record in any sense of the word. Nixon campaigned from the right and governed from the left.
This will probably get missed now that the thread is in debate mode, but is the "choice" phrasing misleading, particularly if we're going to make a clear distinction between Health Care and Health Insurance.
I have never once chosen my health insurance provider. The Operations team at my company chooses and then just tells us what it is and that plan/insurance is better than the last one.
And to be honest, though I read and follow this all the time, I can't tell if the Exchanges or any of the Public Option proposals change that dynamic.
Is the public option really coming along with some new ability for an employee to go select and sign up with any provider they want? (good) Or will it just mean my HR director will be telling me how great the new Public Plan is now that our company has gone to that whether we want to or not? (bad)
I do not care what politicians call themselves, but rather how they govern.
That's a load of crap. You regularly defend Dumbya and trash Clinton, even though you call Clinton "the second most conservative President after Reagan in the post FDR era." What you care about is your party being in power.
Another thing I'd like to see posted is regarding cost efficiency in the US compared to abroad.
I keep seeing our health spending compared to the net result of our healthiness (life expectancy, etc.). But that combines two things together - the efficiency of the care services that were provided AND the effectiveness of those care services relative to better health.
For example, is the cost of each MRI lower in the US, but the US just orders way more MRI's than we really need t6o be healthy? The difference matters.
I'm sure the US spends WAY more on housing, food and clothes than are needed to be sheltered, well nourished and protected. This doesn't make the US more inefficient at shelter or food delivery. It means we're a rich nation that spends more than we "need." (not an excuse, just different than efficiency)
I suspect with Health Care, a lot of what we "buy" is because we WANT those services, even if they those services do not make us healthier. We like the idea that we're doing "everything possible" to "cure" a situation. Kind of the same as those who say a TV is a "must have" item, not a "want."
@BDP
You wanna cease and desist with the 'Obamacare' Troll?
Muley said,
"By the way, I no longer live in Arkansas."
Kicked you out, did they?
Hey be honest Mule, some jackbooted agents must have showed up at your door a few months back and warned you to tone down the threats, right?
Just askin'
@Vern:
For example, is the cost of each MRI lower in the US, but the US just orders way more MRI's than we really need t6o be healthy? The difference matters.
I believe it was TR Reid (linked above, but here's another, since he's on a book tour) who reported that an MRI is lots cheaper in Japan than in the US--like, 100 bucks vs. a thousand.
In the US, we're overcharged and we get substandard care. It's the best of both worlds!
@markymark:
When given less restriction from Congress, he really was quite a conservative (In a bad way) President. The way in which the Vietnam War was continued, the use of national gurad at Kent State, and his SCOTUS nominations (save for Harry Blackmun possibly) are evidence of his more conservative side.
With all due disrespect to Tricky Dick, you can't blame him for Kent State--at least, not directly. The National Guard is under the control of the states (until it's called up by the President for use in wartime or other emergencies); in Ohio, they answered to Governor Rhodes.
Now, the demonstration was precipitated by Nixon's widening of the war into Cambodia. And Nixon's and Agnew's confrontational rhetoric had inflamed passions throughout the country. So he had some indirect responsibility.
Ideology aside, Nixon's whole political life was one of division. Whether it was by calling Helen Gahagan Douglas a commie, or by keeping an Enemies List, his game was "divide and conquer." More than Viet Nam, or Watergate, or any other symptom evident in his public life, that is why he was bad for America.
Too bad. He was bloody brilliant. If you could've combined his smarts and Reagan's personality, he could've been the second-greatest Republican in history.
Re: the Kent State massacre as I currently live less than a mile away from the shootings. Was a sophomore in hs living just outside Kent, May 1970. My sister had a boyfriend going to KSU who decided to stay home on Monday.
Cause and effect:
Thurs ~ Nixon announces the U.S. illegally has troops in Cambodia.
Sat ~ The KSU ROTC building is burning.
Mon ~ KSU administrators decide not to cancel classes even though the (2) main roads in and out of town, KSU is located a stone's throw from downtown Kent, Rt. 59 and State Rt. 43 have been barricaded and in essence closed.
The OH National Guard, many of which had been called up a couple wks earlier to deal w/a Teamsters wildcat strike were already in a bad mood.
So yea, if Nixon hadn't violated the constitution by having a secret military operation in Cambodia.
If the brain dead KSU president hadn't decided to not cancel classes on Monday.
ie Nixon was totally at fault for creating the atmosphere which caused the incident ie a clueless/scared National Guard commander giving the order to fire on defenseless college students over a football field away from the troops.
Tin soldiers and Nixon coming,
We're finally on our own.
This summer I hear the drumming,
Four dead in Ohio.
And yes, besides the fact he totally botched Vietnam more than it was already botched by LBJ and the fact he violated the constitution every which way to Sunday ie Watergate. Nixon basically was a Democrat, god love him.
Yea, he was more progressive than Clinton and had Nixon got a bj from an intern, he would have resigned instantly lol as Goldwater would have shown him the door, like he showed him the door re: Watergate ie either resign in disgrace or be convicted at your impeachment hearing!
No wonder Clinton drives Rep wingnuts crazy ;) Monica gave him a bj and he beat the rap lol.
Oh the humanity.
p.s. saw a progressive sign 2/3 years ago which read: Somebody give Bush a blow job!
I digress ...
@Vern:
Perhaps a combination of both. I have always had the option of opting out of employer sponsored coverage; and I have always taken that. (My wife works for a Hospital and their insurance is far better than anything I have ever been offered.)
So presumably you can still opt out of the corporation sponsored coverage and take the public option if you think it is the better value.
However, it is likely that, unless the public option has some obvious downside for its patrons, it will suck so many people out of the private plans that they collapse, or corporations don't bother with a group plan anymore.
I would expect the logical outcome to be that corporations start providing an "allowance" for health care, which slowly declimes over the decades either through normal inflation or explicit reductions a few percent at a time. The idea would be that you could use your allowance on any plan you want, private or public.
I would expect this model because it would allow corporate chieftans to use an allowance toward a more comprehensive private plan than the public plan, while still being able to claim they provide some sort of health care benefit.
Ultimately (20 years?) I expect a decent public plan to drive the majority of health care insurers out of business; really comprehensive health care insurance will become a niche department within larger insurance companies offering life, property, liability and other such insurance.
If the "public option" turns out to be a complete facade, as I suspect and fear it may (considering the trillion dollars at risk here), very few people will get into it, and it will do a lot of damage, because corporations will STILL switch to the allowance model and start reducing their health care coverage to whatever low-water mark is set by the public option.
I still hope it passes, however.
@Vern:
To your next post: We spend twice per capita on health care as Britain or Australia.
Optional consumer-driven services for healthcare are about 5% of health care costs; 95% are involuntary tests, procedures, surgeries, drugs and hospitalizations. By "involuntary" I mean the only alternative is extreme suffering, disability or death. If you break your arm, getting your arm set is not optional.
Just one bad car accident will cost more than all the voluntary health care done in a day, for a small hospital.
The other 40 or so industrialized countries are just as cautious and do just as many tests and just as much voluntary medicine as we do; we don't get more MRI's, blood tests, or colonoscopies than anybody else.
The vast majority of health care (and I have done the accounting for hospitals) is essentially involuntary; it just costs us more.
Man I really hate having been right about Senator Kennedy. RIP
@Tony C.
Thanks for the replies.
Sounds like you think I'll have choice - for 20 years or so. Then it will be a monopoly and no one will be able to even break it up because it will be a government monopoly.
That doesn't sound comforting.
Why not focus reform on using the government to prevent the rigged situation that leads to monopolies instead of have the government become the monopoly itself?
@Vern:
Why not use...
I am not sure it can be done. The problem with any insurance is a 100% conflict of interest on the part of operators; every claim they pay is money off their bottom line.
About the only thing I can imagine you do is regulate the gross profit margins for insurance companies, at perhaps 10% of premiums; which is equivalent to saying they must pay out 90% of all premiums in either claims or, on a quarterly basis, partial refunds of premiums (or perhaps co-pays) if the paid claims did not reach 90% of revenue.
Then this is akin to a minimum wage law; the insurance company cannot increase its profit one penny by denying claims, which pretty much removes the incentive to do that. Then their focus for increasing real profit becomes:
1) Growing their ensured base;
2) Improving their efficiency.
The first goal will encourage better coverage for the dollars (but alas, not smaller premiums); the second will encourage a greater reliance on computers and fewer personnel.
Although this would not be that much different than a minimum wage law, there would be screams of socialism and it would be a difficult bill to pass. The screams of socialism would come from people appalled at the idea of putting a cap on earnings. Even though it is just a cap on margins to limit consumer exploitation, earnings can still be in the billions; but I doubt that is how it would be seen.
This approach would still be capitalism and permit private insurance to compete for customers and products. But, as the minimum wage and OSHA prevent employers from "competing" based on how severely they can underpay and endanger what is often a captive work force; this approach would prevent insurance agencies from competing based on how many claims they can deny and prevent.
@Vern:
There are advantages to having the government be the monopoly.
1) It doesn't have to market,
2) It doesn't have to mark stuff up to make a profit,
3) The top salary is around $150K,
4) No expensive perks or bonuses to pay,
5) It is neutral; it has no profit incentive to deny coverage or services,
6) It has the power to be inherently fair and even-handed.
These are the reasons for making many functions government functions. We don't want our inspectors (food, drugs, buildings, hospitals, playgrounds, schools, and on and on) to have their salaries or job existence depend on how many inspections are either passed or denied. We want them neutral and objective. We don't want our judges paid by how many people they convict, or our police paid based on how many people they arrest.
I think, we don't want our health insurers paid based on how many excuses they can invent to deny people coverage, and that is the situation we are in now.
Medicare, while being popular and probably a good way for dems to use to describe health insurance reform as Nate has previously pointed out, Medicare is NOT analogous to "public option" as currently proposed in most versions of bill. Medicare is highly subsidized by govt, similar to social security in that govt pays for not out of some trust fund of ones contributions (like 401k) but by taxes on younger workers to pay for older peoples benefits because older people receive much more out of Medicare benefits than they put in. So if you tell older people that public option will be like Medicare, they would rightly assume that the public option will be highly subsidized by govt, with the premium paying customer only paying a small portion of the true cost of the health coverage.
This confusion contributes to the repub and senior opposition to the plan as they see big govt spending will be needed to provide Medicare level of health insurance subsidies; with the cost of this huge govt expenditure either taken from current Mecicare benes or more taxes on everybody (really only younger people)
Another thing about Medicare differs from proposed public plans is that Medicare is essentially a monopoly for older people's health insurance, unless they are over 65 and are still working or they are lucky enough to get VA care or retiree benes form uinon/employer(and even then they likely just get a supplement to Medicare rather than full-blown coverage current employees get). And so analogizing proposed public plan to Medicare gives the impression that the public option is not a choice, but instead, the way insurance would be provided for all yonger people not in an employer plan, an essemtial govt monopoly for the currently uninisured (this is how I would read the analogizing public option as Medicare as a choice for all, not just those over 65).
While putting choice in the poll question mollifies things a bit, there is way too much ignorance and confusion about this issue to be cleared by one question, and certainly comparing public option to Medicare, despite Medicare's popularity, does not help matters.
The best analogy I can find is to explain how this health insurance reform bill proposals, with a public option, is like and dislike school vouchers.
Repubs understand school vouchers, repubs like vouchers. Repubs hate public schools, so public option scares them....so lets meet in the middle, and I believe this is what this bill does.
The House bill creates a Health Insurance Exchange, the Senate, "gateways". Like the school market, people who can afford and whose kids can get accepted into private schools, can use their green money to buy great education at best schools for their kids on the open market. Or they can move to a rich neighborhood with good public schools (not to confuse things, but I think the public school in a rich suburb school analogy is a bit like employer based health insurance, it comes "automatically" to those that chose to move into a certain area(work jobs with a certain employers) and have the chops/earnings to get into the neighborhood (get a job with an employer with good benes), but it is not a very "portable" education option (or health insurance option).
Should you like a neat house on a lake 5 miles away, you may be end up out of the "good" public school district and into a school that has few lakeshore people like you and a whole lot of school breakfast kids that live across the tracks from the lake.
So wouldn't you rather enroll your kids in private school in central location (or even online school} so you move houses without losing your kids good school option.
Private schools give you a bit more portability, but they assume your kid can get into the club. Big if, because, even all the green money in the world might not get you in if you are the wrong ethnicity, your kid is rebellious etc...in this way it is like a rich person having a pre-existing health condition and trying to buy private health insurance on the open market, good luck
So into this mix we introduce the health exchange, and for those of lower income, we introduce school vouchers, or in the health insurance reform bill we call subsidization of premiums in the health insurance exchange/gateway. If your are working and making enough to not be on Medicaid, but are still fairly low income, we give you vouchers for your health insurance premiums (jsut as Repubs would give poor kids vouchers to use at public or private schools). Within this exchange you can chose a public insurance plan (public school) or a private plan (private school).
If you are of a good income but just can't get in the club because you are in the Mafia or your kid has three eyes, the govt helps out and says, anyone insurance provider/school that wants to be in the exchange, must take all comers. So the govt does not subsidize the schools or the insurance providers per se, but govt does say to the private insurance companies (private schools) if you want a pool of possible 50 million new customers have your institution as one of their options for health insurance (schooling) and you want to possibly get the best and healthiest of the young and current uninsured (un-schooled)finally paying premium (tuition)to you, then you must let in all who apply and who can pay (on their own or through a combo of govt subsidized vouchers and their own premium contributions) into your insurance plan(school).
The people in the exchange with low enough income to get govt money, get to spend it like school vouchers, they get to chose from public or private options.
One thing that is not correct about this analogy is this: public schools are completely paid by local, state and fed govt/taxes. However, as I said above, the public health insurance option will essentially a stand-alone, lightly subsidized institution, more like the post office than a public elementary or high school. Public university might be a bit closer to what public option health insurance would be, in that they get money from student (premium payers) corporate research projects, alumni gifts, patent income and from state and local govt. And private schools compete just fine with public colleges. But still, public university are much more subsidized than the public health insurance option will be, so really post office is best analogy...basically pays for itself by fees of its customer, has private competitors for many of its services, provides an offcial govt duty with offcial govt sanction.
The other thing worth mentioning is the govt wil interfere with the insurance choices within the health exchange. The govt will say the insurers (school) must take all comers and charge them all about the same premiums, and because govt money is involved in the subsidies to make health care affordable for lower income people, govt will put some conditions on what is offered in the exchange. This is similar to govt conditions on private schools that take vouchers are subsidized in some form such as charter schools. Govt says you can't teach religion of govt dime, so it restricts time and place of religious education. Govt will also require some curriculum standards. In a similar way, govt will place requirements on any private insurers that want to be in health exchange. It works for school vouchers, why not health care.'
When my repub friends realize that public option will not be heavily subsidized, that subsidy for low income can be spent on public or private options...they have little objection except this: okay, so this bill is not taking out private insurers directly but will lead to this eventually. Wow, at least that is rational point, maybe a bit overblown and hypothetical, but rational.
I then can give them historic examples in other countries' health insurance regimes where public and private mix has lasted for years without taking out private insurers and also show US examples in other industries (public/private colleges, post office package delivery/DHL,Fed Ex,UPS, cops/ mall security/body guards/private detectives, ADT/brinks, the list goes on...) I also mention that private insurers currently successfully compete against many large and might non-profits such as Blue Cross/Shield and co-ops in some regions. Competing against a non-profit competitor is not an automatically a death knell for private industry any more that YMCA has been to private gyms/clubs.
As Bill Clinton said, "in conclusion", why can't a poll question be more than one line? Given the great confusion, ignorance, emotion on this issue, can't we have a poll question that describes, in bullet pt, the basics of the health insurance reform bill that is out of committee in the house:
- bill will create a health insurance exchange that will make insurance coveage available to all who chose, no one can be rejected for pre-existing conditions, or other reasons
-health exchange will create a large pool (of individuals and small business employers that want to provide health insurance) that will be able to get competitive options from private insurers (and public insurers) because of the pool's large numbers, equivalent to large unions or employers who get much better deal from private insurers than small businesses or individuals do.
- health exchange will establish basic min rules for the insurance plans of all insurers that wish to vie for the business from those in this pool, health insurance exchange
-people with employer based health insurance or govt medicaid, medicare, or VA insurance can keep this insurance, its their choice.
-health exchange includes any private insurers that chose to offer plans within exchange and will also include public chose to buy insurance thru exchange
-public option will be a govt run insurance provider that is similar to a non-profit organization.
- govt subsidy to make health care affordable for lower income people will not be a subsidy of the public option, but rather to provide those shopping for insurance vouchers that they can spend where they chose.
-some Medicare reforms, most that are common sense ways to make needed, no death panels
after this is laid out, then the question should be asked if the
There is one more criterion: make it clear that the public option's operating costs would be paid for by those who chose it, not simply by taxpayers in general. Using a word like "buy", "purchase", or "pay for" is enough to satisfy this criterion. Economist/Yougov passes, both Quinnipac and Time fail - Time is worse because "government sponsored" gives specifically the wrong impression, they should say "government run". But, since this point is less important than "choice"/"option", Quinnipac is still the best poll out there.
@Nate: Did you see Mark Blumenthal's critique of your post?
http://www.pollster.com/blogs/the_public_option_no_perfect_p.php
Thoughts?
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