Ben Nelson, the Nebraska-based centrist Democrat who's vote will almost certainly be among the most difficult for President Obama to get in his push for health-care reform, yesterday signaled that he might support a public-option -- but only if it has a so-called "trigger" mechanism under which the plan would kick in after 3-5 years if certain, as-yet-unspecified conditions were met. The "trigger" has also been floated by Maine's Olympia Snowe, who may be just as essential a vote for the White House.
As with most things on health care, the devil is in the details of a trigger plan. However, there are versions of a trigger compromise that progressive Democrats ought to be willing to accept.
And what, pray tell, might those conditions be? The most obvious is that a trigger couldn't be overly tolerant of further growth in health insurance premiums. For instance, suppose that the trigger were triggered if the average cost of health care for a represenative cohort of adults rose by more than inflation + 0.5 percent over the next five years. Health insurance premiums, according to an estimate by the Commonwealth Fund, are expected to increase at an annual rate of about 5.5 percent over the next dozen years, whereas inflation typically runs at between 2 and 3 percent. If premiums were to grow at 3 percent per year instead, that would save the typcial family about $5,000 per year by 2020. This is not trivial.
But secondly, the insurance companies would need to have real reason to fear the trigger. And that means having a public option that, if it were triggered, would be able to negotiate at Medicare rates, or perhaps Medicare rates plus a small premium of 5 to 10 percent. This is how the public option was originally envisioned -- but the provision appears to have been stripped from the version of the House bill passed by the Energy and Commerce Committee, which arguably represents about the maximal bill that a sufficient number of Blue Dogs would be willing to accept.
Indeed, if the public option were "softened" by having to negotiate at prevailing private-industry rates, and particularly also if it had to offer premiums at prevailing private-industry rates, it is not clear how much good it would do. It would just be another plan in a market of increasingly undifferentiated plans. Perhaps it would be able to generate some savings in terms of administrative and advertising costs -- although if premiums were indexed to private-industry norms, this would result in a profit for the government (not necessarily a bad thing; it would reduce the debt) rather than having any direct impact on health care costs for families.
In other words, given a choice between a "robust" public option that would be subject to a trigger, and a non-robust public option that would be prevented from leveraging much of its negotiating power but would be in place from Day One, the former would probably be the better choice for Democrats -- particularly as the mere specter of a robust public option could have a lot of deterrent value for the private insurers. Of course, this is an artificial choice: progressives want a public option that is both robust and immediate. But it's not clear that they have the votes for one.
The other worry that progressives have about the trigger is that it could be compromised -- meaning cancelled -- by some future, presumably more conservative Congress. I'm not sure, however, that this concern is warranted. For one thing, once the trigger became law, it would probably have to overcome a Democratic filibuster to be overturned. Even under somewhat worst-case scenarios for the Democrats, they are unlikely to be in a situation in the near future where they wouldn't be able to muster up 40 votes in the Senate. For another, so long as a Democratic president remained in office, even 60 votes might not be enough -- such a proposal would probably require 67, in order to overcome a Presidential veto. And for a third, the Republicans would be on the wrong side of the politics. Americans might be a little bit daft when it comes to the impact of various proposals to reform the health insurance system, but a bill which sought to overturn a de facto cap on the growth of health insurance premiums -- which is what a well-structured trigger plan would be -- would not be very popular.
I don't mean to sound naive here -- and I'm sure that this is not the sort of trigger mechanism that Ben Nelson has in mind. But if Democrats insist on a public option, they ought to recognize that (i) the public option has already been significantly compromised and (ii) there may be better compromises available -- some of them involving a trigger.
9.07.2009
A Trigger -- With Teeth?
@ 3:37 AM
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One of the other challenges with a trigger would also be that it would likely be only a temporary deterrent for insurance companies unless written correctly. If the bill basically says "In five years, if stuff hasn't improved, the government will start competing with you and you will lose money", then the smart bet is for the insurance companies to play ball for 5 years until that deadline passes, then go back to gouging people again. If the goal is a long-term cut in costs, the trigger couldn't just "go away" after some artificial amount of time.
Ironically, this problem is simply the inverse of one of the arguments used AGAINST the public option wherein the public option drives all the private insurers out of business with low prices, then stops being efficient because there are no competitors that its new customers can switch to (this presupposes that all government monopolies are inherently bad).
How about the deterrent that a trigger is bull#*$& and we voted in record numbers for better than this?
I think the fear that a trigger will not really be a trigger are more real than you argue.
First, just because the Democrats hold a majority does not mean they will fight for it or that enough of them will fight for it. I think many progressives believed they fought for it already -- and are exhausted and disenchanted as evidenced by the lack of energy and passion this summer.
Additionally, the terms of the trigger can be renegotiated, just like the expiring tax cuts, by "reasonable" exceptions due to exigencies and circumstances in the future and so the threshold set in the past should no longer hold, etc. At the very least, insurance interests will argue so, not to mention that whether the conditions for the trigger have been met or not will likely be muddied resulting in the trigger not being fired. Why would one believe that this would be any more effective than the numerous warning letters issued to government contractors who get their contracts renewed despite continued bad behavior.
One of the main points of disagreement between Kennedy and Carter in the 1970s was over staging in universal healthcare with triggers and Califano's proposal to trigger a mandatory cap to contain hospital costs was a non-starter (see Quadagno 2005, p. 127-130). I fail to see why in reality this would be any different.
Finally, just like stimulus programs, the organizational infrastructure of a public option would not just snap into action because the trigger threshold had been met. Here, too, there is plenty of opportunities for money-wrenching.
The public option is a trigger. If the existing insurers keep their commitment, then the public option will be small; if not, then the public option will grow. The "robust" public option is a continuous adjustment mechanism, which, IMHO, superior to a threshold trigger mechanism if one thinks of it as a 45-degree line vs. a "S-Curve" that tracked policy response on one axis to problem severity on the other.
In the end, if one thinks there is a problem with the healthcare/insurance system, you would advocate stringent threshold criteria guaranteed to be crossed. In which case, why not pass the public option now. If you don't feel the system needs change, then you will advocate lax criteria that will not be breached, in which case the trigger is meaningless.
the trigger concept is the dumbest thing i've ever heard. it would be like if firemen showed up to a house and saw that only one room was burning and said, "Hmm, let's wait until the whole house is on fire."
I still haven't heard a cogent argument against the trigger. Frankly, I think many progressives are enamored with an immediate public option primarily for its ostensible symbolism. Anything short of this immediate public option is being wrongly perceived as "defeat." That sentiment has propagated like wildfire recently.
Certainly, as Nate and other commenters have noted, a trigger would need to have teeth and not be contingent on an arbitrary time frame (i.e., no expiration date).
Also, I would not dismiss a fear that the terms of the trigger could be renegotiated in the future, but I would say that that's a fear that is unlikely to come to pass, primarily for the reasons Nate articulated in the post: renegotiating the terms so that they are more favorable toward the industry would be politically untenable. It should not be lost in the debate that the public is nearly unanimous in their disdain for what's perceived (rightly, in my opinion) as exorbitant and unethical insurance profits.
Ultimately, given that the Democrats' greatest current sticking point on the immediate public option is paying for it, I think the trigger should absolutely be on the table, and given serious consideration. Because with sufficient bite, the trigger could achieve what the immediate public option would achieve, but at a lower up-front cost.
Bottom line: If a symbolic victory is the goal, then clinging to the public option is understood. But, good policy would not automatically be sacrificed with a trigger. Potentially, good policy could be attained at a lower initial/implementation cost with the trigger approach. It is indeed all about the details.
Ben Nelson and Olympia Snowe agree on something. If Obama wants 60 votes, this is the way ot get it
I'd like to join the rest of the 1st world. I want health care. Not corporate welfare care.
As nothing seems longterm these days... A trigger looks like a defeat. The republicans can claim victory, and the democrats would have to say that although health care is a pressing problem for 45 million americans we won't address it for X# years.
Nate's argument is a good one for getting what could be the best longterm reform, but doesn't address the shortterm problem. My guess is that politicians don't look 5 years down the road.
If one accepts that excessive insurance premiums are a problem, why even bother with a measure which assures that these already-excessive insurance premiums will continue (in the example given) to grow even more excessive at a somewhat reduced rate.
Sure, the trigger is a so-called "savings" for consumers when compared to an unreformed system. This "better than nothing" argument seems to have become a staple lately for the demoralized Democrats. Passing anything at all will help the party, but I'm not convinced it'll help anyone else.
It strikes me as a self-fulfilling prophecy to say "we can't pass an adequate health care bill, so instead of fighting for it let's signal that we'd accept a load of watered-down crap to save face, and hope that we can revisit this, um, sometime next decade when we're in a position of strength instead of just having the presidency and a legislative supermajority."
Because this kind of idea worked out so well with the AMT.
Interesting article. I have one small bone to pick.
How exactly is determining reimbursement rates for medical procedure by legislating them negotiating? That seems the exact opposite of negotiating.
Is it just me, or has the idea of providing insurance to those who can't currently afford it dropped off the map?
Coercing private insurers to refrain from raising premiums above inflation is all well and good, although it presupposes that private insurers have that price flexibility (especially under the other relatively non-controversial provisions like not being able to deny coverage or charge more for pre-existing conditions). But there are millions of people who can't afford insurance at the rate it's presently at, much less one that "only" grows with inflation for the next 3-5 years.
If they're going to do a trigger, then I say they do one with some meaning: make it based on the number of uninsured people. If in 3-5 years a certain percentage of legal residents are not covered by health insurance meeting some minimum levels of coverage (whether private, or state-provided), then a federal plan will be extended to them.
I appreciate all these 'so and so won't vote for this and that' type stories, but another important thing to take into account is what are they prepared to support a fillibuster on. Nelson's vote becomes a lot less important if he is happy to vote for cloture on a filibuster against something less than a bill he would vote for. If he is happy to fillibuster a bill that includes a public option sans a trigger, thats a whole different kettle of fish.
I don't mean to sound naive here ... too late.
Anyone else sense the irony in Nate's belief that the trigger might work because the Dems won't get rolled a few years from now?
Democratic cowardice is the reason why we are even having a discussion about a trigger and why 60 is the number to pass any bill, not 51. Given Obama's unwillingness to engage in hardball, Dick Cheney style, the enduring power of conservative Democrats in Congress, and the Party's eternal spinelessness, the smart money bet is that any trigger would definitely be cancelled.
Republicans are right to fear a public option, even one that is watered down. Once the government gets in the door, it will be impossible for future administrations to undo. By the natural law of bureaucracy, the program will slowly expand, until it takes the entire health care system (which I'm hoping for).
Any delay, especially one contingent on future Democrats doing the right thing, is a defeat.
Seems logical to me dude!
RT
www.privacy-web.pl.tc
These Rube Goldberg schemes are all premised upon the belief that a trojan horse can successfully be embedded in legislation.
What Nate seems to intuitively recognize that much of the leftist cognoscenti fails to recognize is that putting a trojan horse inside another trojan horse isn't going to fool anybody. The trigger becomes the new focal point, and thus, will again fall of its own weight.
I thought you were making complete sense until you discussed the risk of a trigger being overturned (or weakened) by a subsequent Congress. When you said, "...Democratic filibuster..." I had to laugh out loud. Such an animal does not exist. The Democrats (my party) has not had the spine to filibuster anything meaningful in memory.
There is nothing to prevent a more conservative Congress from changing any reform bill that does not immediately have positive impact that makes it as popular as Medicare.
I believe we will have health reform in name only or that has minimal actual impact. And, it will delay actual reform because nobody will have the political will to sail these rough seas again within the next 10 to 20 years.
I am truly depressed about how this has gone.
A number of objections but primarily this....
Under a trigger/national regulatory regime, the insurance company influence over congress would balloon to a degree unfamiliar to people from more progressive states. here in Alabama the legislature is positively owned by Blue Cross/Blue Shield (84% of our market) and Alabama Power because of those companies' monopoly interest in controlling state level regulation. Nationally, we have seen the political power of the insurance giants strangle and nearly kill a popular health care initiative over the past few months. They have an unlimited financial ability to influence the political process and their interest in doing so would exponentially increase under the regime you are describing. You would transform the US into the banana republic we are here in Alabama.
Secondly, $5,000 per year per person is already too high - premiums need to go down, not up. The problem is not just the insurance companies but the entire insane medical industry. We must have a national program strong enough to take on every aspect of our current system.
A GOP filibuster on a respectable health insurance reform bill supported by the President, the voters, and a majority of both houses of Congress would be an excellent illustration of the respective roles of the two parties and would also hark back quite appropriately to civil rights filibustering. I think the Democrats should stop wetting themselves at the mere mention of the word.
I'm sure Republicans love the idea of a trigger option because it allows them to spend the next 3-5 years running against the prospect of "death panels" and socialism.
We know that Republicans would simply repeal the legislation the moment the retook the majority and deregulate the insurance industry (returning us to discrimination based on age, sex and preexisting conditions).
The only think they'll leave intact is the mandate that everyone buy insurance.
I'll take a weaker public option now over a stronger trigger. As Christian very aptly put it above;
The public option is a trigger. If the existing insurers keep their commitment, then the public option will be small; if not, then the public option will grow.
I would add, it seems easier to me to improve a weak public option later-- with the ability to negotiate fees as Medicare does and charge premiums based on costs rather than prevailing private insurance rates-- than to protect a trigger from getting watered down to nothing by future bought politicians like Ben Nelson.
In the meantime an over-charging public option pays down federal debt. As mandates kick in and American consumers and businesses feel the burden the current demogogery will fade and people will once again ask why we're diverting so much extra money into the health care sector.
@Dennis:
I just want to point out something very important to note:
The public option that is being considered now won't even be in full effect until around 2013. That's 5 years anyways. If we set up a permanent trigger that was able to initiate in 3 yrs that would work better if insurance companies can't keep cost rates down. If they hold the rates down for a decade and then start to increase them, fine the public option kicks in to fight that, if they say honest than the public option looms over them in case they "try something". I think it's the best proposal because it can pass and will have an overall more robust option
Sorry Nate but you simply don't understand the working of legislation. The trigger can be made useless with a simple six word change. Maybe it will happen in conference, maybe it will happen a some last minute admendment to some no name farming bill. If you create a trigger you create a 80 million dollar lobbying campaign to cripple it quietly.
I hope BO and the House are as closed minded as all the commenters here. Better chance of killing the public option and getting some reasonable universal health care. Daniel hit the nail on the head. A public option is anti-competitive. And besides that, I'd much rather deal with a private insurer than with a totally insensitive (and incompetent) government.
Jinchi, you'll find that very few Republicans support any mandate to buy insurance, either employer or individual. An employer mandate would increase the cost of employing people, hurting the economy and diverting money that otherwise could be paid for wages.
The only purpose of an individual mandate is to force young and healthy people into the pools to subsidize the heavy consumers of health care.
The conservative view is freedom of choice.
This Van Jones incident unmasks Obama for the radical he is. It also shows how comlicit the media has been in the coverup.
Despite making the most outrageous of statements, including racist remarks against white and being part of the absurd and radical "truther" movement (akin to being a Holcaust Denier), the mainstream media did not pick up the story of this radical, racist Communist being part of the Obama Adminstration until he was forced to resign due to the determined efforts of the one large scale media outlet willing to investigate Obama, Fox News.
This has shone as much of a light on media bias (and explains the surge in ratings for conservative media outlets) as it does on the truly radical nature of the Obama adminstration. Obama cannot claim ingnorance again like he did with Rev Wright and militant Pentagon bomber Ayers. His closest of advisors, Valerie Jarrett, is on youtube extolling the virtues of the Commie Racist Jones, saying "we have been following him for years."
More and more the people are beginning to suspect that Obama is the Manchurian Candidate and drip, drip, drip he is losing the trust of the Amercian People who are not prepared to have a radical occupying the White House (regardless of the color of his skin).
petekent01 (on twitter)
And for a third, the Republicans would be on the wrong side of the politics. Americans might be a little bit daft when it comes to the impact of various proposals to reform the health insurance system, but a bill which sought to overturn a de facto cap on the growth of health insurance premiums -- which is what a well-structured trigger plan would be -- would not be very popular.
2005 bankruptcy bill.
max
['That wasn't popular either.']
@Rudy-- I see nothing wrong with requiring everyone to buy health insurance as long as they are entitled to buy low rate catastrophic policies, keyed to their age risk. There is a health care insurance problem that needs to be fixed. Cherry-picking insurance companies are a real problem. Insurance is unavailable to people who have merely consulted a psychologist in the past five years. People lose their jobs and therefore their insurance. Fixing the problem, however, does not involve employer mandates, public option and caps on co-pays and deductibles.
We are lost in the weeds here in these type of discussions. The facts are that what is being proposed will significantly increase the demand for health care (insuring another 47 million people, lowering costs, etc) while also simultaneously and artificially lowering the supply of practitioners (lower Medicare reimbursements, pressure on providers to work harder for same or less pay, not addressing tort reform, not attracting practitioners to rural areas, etc).
The end result HAS TO BE severe rationing and major dissatisfaction with what is wrought. See this excellent video from ABC News on the
situation in Canada.
http://www.youtube.com/watch?v=q9GMKK_fWKg
A "trigger" is nothing more than a bait and switch. It is bait to dump the public option from conference. The switch or trigger would be ignored or otherwise legislated away when the industry fails to control costs. How many times will the public fall for congress' guise of compromise that is nothing more than doing the bidding of its industry masters?
The most obvious is that a trigger couldn't be overly tolerant of further growth in health insurance premiums. For instance, suppose that the trigger were triggered if the average cost of health care for a represenative cohort of adults rose by more than inflation + 0.5 percent over the next five years. Health insurance premiums, according to an estimate by the Commonwealth Fund, are expected to increase at an annual rate of about 5.5 percent over the next dozen years, whereas inflation typically runs at between 2 and 3 percent. If premiums were to grow at 3 percent per year instead, that would save the typcial family about $5,000 per year by 2020. This is not trivial.
A couple observations...
1) Medicare and Medicaid expenditures are rising at the private rate or higher. Health care inflation has more to do with the health care system offering more drugs and treatments and the unlimited demand created by an insurance system than whether the insurance is private or public.
2) The Obamacare mandates on private insurance will increase premium inflation beyond its present trajectory.
3) Thus, any Obamacare trigger that compels private insurers to cut their premium inflation in half from prior projections after mandating that they increase their expenditures is simply a rigged system to backdoor government insurance at a later date.
4) The only way you reduce health care insurance premiums is to ration health care. You have four choices here: Have a private insurance insurance bean counter do this (standard private insurance), have a government insurance insurance bean counter do this (Medicare/Medicaid), have a doctor do this (HMO), or have you do this (HSA).
5) I prefer to make my own decisions or, if necessary, have my doctor do this through an HMO. However, current state and federal mandates have all but outlawed HMOs and Obamacare insurance mandates will outlaw my HSA, leaving only what you acknowledge are "undifferentiated plans." Is this what Obama considers to be competition or, as is more likely, Obama does not care a fig for competition and is seeking alternative ways to a single payer government system with no alternatives?
I'm puzzled by the lack of imagination in finding revenue streams.
The pool of poor and uninsured is riddled with people in poor health, obesity, diabetes, heart problems that are outcomes of consuming toxic crap they are conned into buying, Cheetos, Little Debbies, oceans of useless sugar waters and high fructose corn syrup slop.
Why can't we stop defining it as food and slap on the same tax structures we apply to booze and cigs? Call it an application of 'make the polluter pay'.
What is 10 percent of the combined revenue stream of the consumable swill sector? I bet it adds up.
It could be a deft move shifting focus away from insurance lobbies to the Little Debbie lobby, likely to be a bit less effective.
The other critical missing element I see here in Massachusetts is how the touted state plan is really just corporate welfare for the insurance and health care lobby.
I have been unable to find any information online here that allows to compare plan structures in the critical distinction between plans that resemble the Mayo Clinic and emphasize prevention and sound health practices over the misguided notion that endless batteries of expensive and over imposed 'tests' at 500 plus dollars a pop is somehow good care.
This is an information asymmetry that favors exploitation and cloaks any attempt to make a truly 'free market'.
What we seem to have is some reluctance on the part of both the right and the left to admit that many of the constituents who are the focus of concern are self damaged waddling wrecks, disasters waiting to happen.
The right doesn't want to insult its obese health impaired trailer park constituency by citing their usual personal responsibility axiom and the left must think it is un PC to acknowledge how the low information poor are killing themselves from bad personal habits.
Taxing the polluters would make sugar water and edible crap more expensive causing some to abandon it while at least factoring in the hidden public cost of allowing this intolerable status quo.
You may be naive, can't say. I am definitely cynical, though.
The trigger option is nothing more than raising the price of avoiding the public option by two more election cycles. Since most terms without the trigger didn't start phasing in until until 2013, this was money insurance concerns already intended to spend. So actual additional cost to them is probably very little.
A bird in the hand is worth two in the bush - is not the right saying for this. This is the possibility of a bird in the hand three hunting seasons from now (actual bird subject to details, price may vary, bird may not be hunted for two hunting seasons, definition of bird subject to change without notice). All three hunting seasons must be bought in advance. Wealthy owner of hunting preserve has three years make hunting licenses impossible or simply kill the birds himself first. My dog will look at me like I'm crazy.
Trigger option is half-cocked.
I'm not opposed to a trigger, if it's implemented well. Russ pretty much echoes my feelings about the timing. I'm also skeptical that the Democratic leadership would allow one of the key components of what would surely be a historical legislative victory to be subsequently euthanasized through procedural arcana. I mean, I know the Democrats are spineless, but I still believe they have some principles. I think Nate is probably right. The GOP would need an absolute tidal wave of electoral success to even think about repealing this before it goes into effect, and that ain't going to happen anytime soon. The absolute worst-case scenario for the Democrats right now is that they lose control of the House in 2010.
One more thing. We shouldn't base our decisions about the quality of this bill on how the GOP will spin it. No matter what, public option or not, trigger or not, the Republicans will decry any meaningful reform as a failure, Nazi policies, etc. The demagogues who would frame a public option trigger as the defeat of socialism, or some such nonsense, would spin any relative success or failure of health care reform as a victory for Real American Values (tm), and that's exactly why their opinions are meaningless and shouldn't be considered in this debate.
I just realized that Warren Buffett is like the poster child for how this must play on wall street.
He is a major holder in Coca Cola and Dilly Bars and both feed the success of Berkshire Hathaway.
The other critical element of his holdings is the insurance industry. He is a demon for research and is obviously just working a pattern that is as fat as the 300 pound sugar slurping cheeto chowing wrecks who are the seemingly intractable problem.
Warren gets em coming and going.
Here is a cogent argument against a trigger.
If we can't pass a robust public option, with a left of center Democratic President, 256 Democrats in the House, and 59 Democrats in the Senate, what the blank makes you think a trigger will be imposed on the health insurance industry in the future?
We're going to have fewer, not more, democrats in Congress in the future. The Democrats are at the peak of their power; right now! WE gave them that.
So future Congresses will be lobbied even harder, and given increaseing sums, to prevent any potential trigger from being forced on the industry.
Wake up and get a clue and accept human nature for what it is.
If we don't get a robust public option of some type now; we never will.
Progressives need to stand their ground. And the President needs to support them.
If that means no bill, than no bill it is. As more and more baby boomers retire and go on medicare, the health insurance industry will die a slow painful death anyway over the next decade. If there is no individual mandate.
Then they will be screaming for reform.
hi all.
Sorry to intrude with an o/t question, but I was wondering if anyone could point me to source that lists the popular vote totals for each Senate race since 2002?
Been googling and poking around, but can't seem to find an easy to use data collection.
Thanks.
The more complicated this gets the more it becomes an all or nothing proposition. It reminds me of some of the 'kicker' clauses my state puts into oue legislation. Sounds great in theory and placates the conservative right but in the long run it doesn't take into account varying circumstances.
Any exception to a public option is just a trojan horse designed to circumvent true health care reform.
Here is a thought. Why bother with a trigger for a government option, why not go the whole hog, and have a trigger for a single payer system?
The thing that has me dead-set against the so-called trigger plan is that is that the trigger is delayed for 5-3 years! Five years in which the Insurance Giants can continue to rape the American consumers! This is not only outrageous but criminal in how obvious it is to give yet another get out of jail card to the Insurance Giants. The CEOs of these companies make over $100,000 a hour. I bet if you gave them a short trigger they could come up with ways to maintain health care cost in less than a million dollars time.
Can someone please tell me why it would take 5 years for the insurance companies to come up with ways not to gouge, rob, and steal the American People blind? They knew Health Care Reform was coming - God knows they sunk so much money into trying to defeat it that every American will have to pay back in the form of higher Insurance Premiums. The fact that this trigger date is so far in the future tells me this is a Bad, Bad Idea whose goal is to simply kick the can far enough down the road in the hopes that it can be overturned or ignored. The thing that most people amazingly forget about the Bush Administration is that the country had a lot of good laws aimed at businesses already onthe book but that the Bushies decided to ignore or not prosecute them.
Senator Nelson you need to shove your Big Insurance Companies' Bribery money back in your pocket because it's clear for all to see!
As the comments in this thread amply demonstrate, even among relatively well informed people, the "Public Option" is almost completely misunderstood.
The Public Option is NOT free healthcare for the uninsured. It is not even subsidized healthcare for the uninsured. It's one more insurance plan that would compete on an insurance exchange with all the other insurance plans. It is not projected to start out by massively undercutting current insurance providers; the cost controlling functions it would provide are intended to be realized over the long term, not by suddenly pricing all private insurance companies right off the market.
Those of you who are saying that "we need to cover the uninsured now!" and such like have simply not bothered to inform yourselves as to the details of the various bills before Congress. Even if the Public Option were completely scrapped, we would see almost exactly the same increases in coverage of the uninsured as are projected *with* the Public Option.
In my entire lifetime I've never seen a political debate where both sides were as woefully uninformed as this one.
I'm not sure what's going on,but a number of things don't make sense.
We know that (other than demographics) the problem is overutilization. The insurance companies have little if any control over this. They can do a few things like standardized billing, but that won't solve the problem that the incentives are wrong.
Since the insurance companies couldn't meet a strong cap if they wanted to, there probably won't be one.
The government hasn't shown any great skill a restraining inflation in Medicare and Medicaid. How is the public option more than a band aid. They might hope to catch a break by stealing the insurance companies' margins, but then what? Everybody on Medicare we can't afford, tampering with which would be political suicide?
The insurance companies can't be replaced over night. What would we do,nationalize them?
Universal coverage may be needed to combat adverse selection, but we probably can't afford it. For one thing the uninsured and underinsured utilization should rise to meet that of the current insured. That's a lot of money and when was the last time a new entitlement came in under budget? What happens when we discover what this will really cost, after we're already committed.
Some simple questions - suppose by magic everybody was covered by Medicare starting tomorrow morning. What would it cost now? What will it cost in 10 years? Where is the money going to come from? How large a subsidy for lower incomes would it take? The Massachusetts experiment has gone amazingly well except for subsidies and cost control, but these problems unsolved will inevitably be fatal and relatively soon.
We don't have enough primary care physicians and nurses to expand coverage, as Massachusetts has discovered.Once again the incentives are backward. They encourage doctors to become specialists,and a bunch of expensive specialists has to eat, so they'll arrange for their services to be needed. This is a major cause of overutilization.
A sane possibility would be to pass cost controls with teeth and phase in coverage as they demonstrated they worked. And also to restrict denial for preexisting conditions, recission and the like and expand COBRA.
But cost controls will only work if we change the incentives.
In the long term, the news may be good. medical science will soon have effective treatments for a number of budget busting chronic diseases. Cure Alzheimers, congestive heart failure, Rheumatoid arthritis and diabetes, and you'll get real savings. Of course as we all know, in the long term we'll all be dead.
markymarksaid"Here is a thought. Why bother with a trigger for a government option, why not go the whole hog, and have a trigger for a single payer system?"
i like that idea.
but i think health care reform is already doa.
our country can really suck. people are dying and we call saving their lives commie or nazi.
bureaucracy is always more favorable than highway robbery at the hands of an insurance co.
If somebody told you that there is a plan out there that is guaranteed to double your health care costs over the next 10 years, that's guaranteed to result in more Americans losing their health care, and that is by far the biggest contributor to our federal deficit, I think most people would be opposed to that.
Well, that's status quo. That's what we have right now.
That was Barack Obama, at his press conference on July 21, 2009.
A trigger mechanism is a great idea - if you think the status quo is tolerable, as long as it doesn't get any worse. But as you can see here, the President's official position (with which I happen to agree) is that we don't just need health care reform in case things get worse; we've been needing health care reform for years. It's already too late for triggers.
Health care needs to be more accessible to more people, and that needs to happen now. Accepting a trigger is admitting that the current system is alright.
The current system is not alright.
President Obama, it's been five years since I've had health insurance. I just went to the emergency room last week and needed an MRI which cost me thousands of dollars when I'm already up to my eyeballs in debt, all because there's no health insurance plan that's affordable to me.
I'm above the poverty line. I went to college. I have a job. In all other respects, I'm doing okay. But if I can't see a doctor for a goddamn checkup before you're out of office, so help me, I'm moving to Canada.
-Jon
Quixote said...
A GOP filibuster on a respectable health insurance reform bill supported by the President, the voters, and a majority of both houses of Congress would be an excellent illustration of the respective roles of the two parties and would also hark back quite appropriately to civil rights filibustering. I think the Democrats should stop wetting themselves at the mere mention of the word.
----
I agree - I don't understand why Democrats get their panties in a knot over a fillibuster. Take a good Health Care Reform Bill to the floor and if the Republicans vote to fillibuster make them do it. I don't mean a paper fillibuster but a real bring the cots in "Mr Smith Goes To Washington" fillibuster. One of the smartest moves that Clinton ever did was when he stared down the Newt causing the Federal Government to close. The Newt thought he had won but the American People turned dramatically against him. Clinton won the day by making the Republicans look like what they truly are - the party of "No" and obstructionism.
PeterKent is being cute again. What communist did you ever see publishing a claim that business can do a far better job than the government in dealing with the future climate changes. Van Jones was pushing that claim in 2008.
Van Jones overreacted as a young man to the Rodney King verdict but has recovered. There is a stark difference between a communist and a former communist and there are a number of conservatives who can attest to this.
See Wikipedia on Jones.
Check Wikipedia.
@ NU'69:
NU'69 said:
"I hope BO and the House are as closed minded as all the commenters here. Better chance of killing the public option and getting some reasonable universal health care. Daniel hit the nail on the head. A public option is anti-competitive. And besides that, I'd much rather deal with a private insurer than with a totally insensitive (and incompetent) government."
I hope for your sake, NU, that you never get ill for a long time. You don't want to find out what your insurer won't pay for AFTER you get sick. The whole idea of a public option is to make sure your so-called "great insurance plan" stays that way. All insurers have to be kept honest by SOMETHING tough hanging over their heads.
....Oh, and college graduate in 1969?....! What are you, around 62 or so? If I do the math, that makes you the very person most vulnerable to insurer shenanigans. When people reach 50 years of age, the actuaries begin to red-flag them for cancellation or denial of coverage for pre-existing conditions.
What's the matter with you, dude? Are you that secure with your insurance carrier or just in a state of denial? Or do you think that because of who you are there is some sort of "special deal" cut just for you? I don't get it.
Poor thing. I'll bet that was YOU I saw on You Tube shouting obscenities at the town hall meetings. If not, that was certainly your demographic.
The fact that we're even talking about a "trigger" for the public option is just evidence of how badly Obama has screwed the pooch on health care reform.
From day one, Obama has approached reform from a position of weakness, not strength, and with a spirit of conciliation, not negotiation. He went out of his way to embrace and include the insurance companies, and exclude progressive voices, from those White House "panels" he did, and he has repeatedly praised and refused to criticize conservatives in Congress and in the health care industry who are clearly opposed to real reform. He took single-payer off the table at the beginning of the process, even as an initial bargaining point from which he could have negotiated down, and now it looks like he has made the public option negotiable, as well. He cut deals with big Pharma, and he has made sure to kiss the asses of conservatives every step of the way (though he's done that on every other issue since he took office, so I guess I shouldn't be surprised that he's doing it here, too).
Even if Obama was serious about real reform (and I'm not at all convinced that that's true), he's gone about it in an incredibly weak and stupid manner. He gave up much more than he needed to, much earlier than he needed to, and he's gotten very little if anything in return.
Look, I know that real reform was always going to be difficult, and we were never going to get everything we wanted, but there's no excuse for ending up where we are now. Whether it's due to Obama being a corporatist sellout, or just inept and weak, the chance of real reform is all but gone, and I don't know if it can be salvaged at this point.
While I'm against this Public Option, I don't see how we can force employers to cover Part-Time employees (which HR 3200 does) without offering the cheaper cost of a Public Option. By not offering the cheaper alternative, we're forcing employers to either substantially cut their work force or accept an uncontrollable cost increase. (I blog about this at blog.galleysonline.com)
A trigger will be seen as nothing more than a Trojan Horse for the Public Option, which itself is an ill-defined thing, but something that a vocal majority of the people instinctively opposed.
This business with the disgraced former Green Jobs Czar coming on the heels of L'Affaire Gates have combined with the historical sense of unease over who Obama really is, making it increasingly likely that Obama will never be permitted to pass legislation as complex and far-reaching as Health Care Reform during the balance of his term.
He is finished.
Even with simple stuff, as tricky Communists and Radicals are culled from his administration, the public doubt will reach a point where anything initiative associated with Obama will instantly fail, be DOA. His motives will be suspect.
The former Axis of Evil has bared its fangs. Iraq and Afghanistan chew up lives while being on the edge of abyss.
Obama sucks at being President; he is failing at his tasks.
Petekent01 (on twitter)
@ PeteKent:
...and in your "perfect scenario", then, your girl Sarah Palin wins the White House in 2012 and makes things all better, right?
Dude, you better adjust your meds. You're still ranting.
I really fail to see how the house's stated refusal to back anything that does not have a public option is going to square with this trigger business. Something will have to give in conference committee, and I doubt Snowe and Nelson and Baucus will filibuster a conference committee vote. It will get Snowe and Collins, pass and be signed with great fanfare by Obama this year.
IMO, they blew it from the start: Medicare for all is a simple and coherent and easily soundbite friendly plan, and would draw massive support, as it would force the white wing crazies to attack medicare, a hugely popular program, esp. among the seniors who vote more in mid-terms.
Of course, that would draw all of the sustained fire of the insurance and pharma lobbies and all of the senators who are sucking at their teat. A move like that would require a 65-70 seat dem senate. Remember, it took LBJ 68 senators to pass medicare and civil rights in 1965.
Nothing will truly change in this country until there is true campaign finance and media reform. Until then, we are tinkering at the margin, and have laughable foaming idiots labeling the most innocuous and meek legislation as akin to Hitler and Pol Pot and Stalin. Of course, these drooling morons don't have a clue that they would be long dead if there actually were a Hitler or Pol Pot or Stalin in power, but so long as the government keeps its hands off their medicare, I guess that is alright...
@blue revolution:
Will it be eaier for PK to adjust his meds if there is a public option;=}
Oh, and if I had a dollar for every time Pete Kent has declared Obama DOA on this site (think it started in about February 2008 and is getting close to 200 now), I would have enough for a very high end meal for me and my honey at one of them fancy liberal SF restaurants us socialist muslim fascists love to frequent...
Here's a $1000 bet for PK or any of the other trolls if you are man enough to take it: Dems pass health care reform (something we will both hate, you because it is too much, me because it is woefully inadequate and in thrall to the corporate interests) by the end of the year, probably with some form of public option trigger.
Second $1000 bet: Dems end up with the same or more senators in 2010 than now, probably pick up 2-3 and at least 240 in the house, with all the losses being in the blue dog dems in name only category...Harry Reid will lose, and that is good riddance
Bets?
Oh, I won't bet on this one, but it is not impossible that with an increased majority in the senate next term, the dems would move to remove the filibuster, or at least restrict it, esp. if the GOP is using it pell mell on every piece of legislation that comes down the pike. If they have 63 members, they could get 50 plus 1 to remove the filibuster, which after, is not in the constitution, but is simply a senate rule and can be removed by majority vote at any time.
That one I will not bet on, but it is not beyond the realm of the possible after 2010.
In my scenario Obama will be so politically weak as a result of the apparent failures of his polcies domestic and foreign that virtually any Republican could beat him, including a GOP ticket that includes Sarah Palin.
The point of the observation is not to be predicitve, but rather to illustrate how dire things appear for Obama and the Dems at the moment.
He cannot even speak to the kids without putting his foot in his mouth because of the Marxist tinge to his communication strategy and his adminstration in general.
petekent01 (on twitter)
Codswallet…
Let’s take two statements of yours—
“We know that (other than demographics) the problem is overutilization.”
“We don't have enough primary care physicians and nurses to expand coverage…”
How can you have “overutilization” if you don’t have enough primary care physicians and nurses?
You are talking out of both sides of your mouth.
The problem is not “overutilization”. This is a right-wing red herring. The chief problem is the enormous waste ($300 billion annually) that the insurance companies piss away every year. If that money were redirected towards health care the problems of cost escalation would be solved overnight.
Further, a “trigger” is not the answer. Why? Because the GOP will say “NO”, and even if it somehow passes it will be dragged off into the weeds and murdered before it is slated to take effect. We will be back where we started, except that the GOP will emboldened to kill any and all proposals coming from either the White House or the Democratic Party.
I have to agree that the real problem now is spinelessness on the part of the Democrats. They will never have the kind of clout they have now—the presidency, a vast majority in the House and 59 senators—and yet they are dawdling, frittering and trembling in the face of their opponents.
If Obama does not come out and say “I will veto any bill that does not have a public option” then everything will fall apart. Progressive independents will desert the Democrats and anything else Obama tries to do will be hogtied and stonewalled by the GOP simply because they know they have the power to do it.
Last chance, Democrats. It’s all riding on Obama’s speech on Wednesday, and his speech (and his presidency) is all riding on the public option.
PeteTwit…
Don’t you ever shut up?
I also see that Bart De Pampers is back with his “Obamacare” drivel. He flew off in a cloud of sequins yesterday when it was pointed out to him that he has no real health care coverage. He believes that if he winds up with cancer or the like all he’ll have to do is call up his local GOP and they will drop everything and run to his rescue.
trittico—
Everything from 1996 on is here. Scroll down.
I can see postponing the public option IF Congress also included the cooperatives...but ONLY if the these coops were national and there were only a very few of them (3 maybe), so they had the size and clout to negotiate some serious price breaks from providers.
Waiting to see if the insurers will fall into line is a waste of time. Waiting to see if cooperatives will work as their proponents suggest may be worth while.
I like this blog and iwell viset agen thank yuo
http://www.forexqs.blogspot.com
Melancholy Korean said it best:
"Democratic cowardice is the reason why we are even having a discussion about a trigger and why 60 is the number to pass any bill, not 51. Given Obama's unwillingness to engage in hardball, Dick Cheney style, the enduring power of conservative Democrats in Congress, and the Party's eternal spinelessness, the smart money bet is that any trigger would definitely be cancelled."
No strong public option, no more support from me for the Wimp-o-cratic Party.
Let the Republicans come back into power for a while. Fine. If that's what it will take for progressives to get taken seriously and for the popular progressive ideas that this country needs to finally be put into practice before it's too late, that's fine.
I'm tired of being used like a cheap Tuesday night whore. Making calls, knocking on doors, donating more money than I can afford. For what? Nothing but invertebrate non-sense about how having the presidency, a huge House majority, and 60 votes in the Senate isn't enough. Excuses. Nothing but b.s.
Republicans reveres its base. Democrats despise theirs.
Fine. No more calls, door knocking, donations. Progressives need to play hard ball. The Democratic Party is the problem, not the Republicans. Republicans are too far gone; they can't really help themselves, at this point, and there's certainly nothing we can do about them.
But we CAN do something about the Dumb-o-cratic Party.
100 House progressives must stick together and KILL any health care bill without a strong public option -- as they've promised to do. Otherwise, not only will health care in America be doomed, but also the progressive movement, for decades to come.
Keep up the pressure. No public option? No health care bill.
No respect for progressives? No more activist base to carry water for the Democratic Party.
Some words of Lincoln’s might be useful for Obama to consider. The first quote was in response to a caller who urged the President to find a way to compromise with the radicals in the South. Lincoln knew there was no such thing as “compromise”—
“Give them personal liberty bills, and they will pull in the slack, hold on, and insist on the border state compromises. Give them that, they’ll again pull in the slack and demand Crittenden’s compromise. That pulled in, they will want all South Carolina asks.”
Then he spoke about the duty he had to his party, and the duty to the people who had elected him—
“By no act or complicity of mine will the Republican Party become a mere sucked egg, all shell and no principle in it.”
Rather than throw over his principles in a vain attempt to reach some useless bipartisan agreement, Lincoln declared: “I would sooner go out into the backyard and hang myself.”
President Obama faces a similar test this week, and he is under less pressure than Lincoln was under. His decision won’t involve plunging the nation into civil war. Real health insurance reform is the defining issue of our day. If Obama cannot stand up to principles on this issue, he deserves the support of no one.
Read your Lincoln, Mr. President. Say it—“I will veto any bill that comes to me without a true public option.”
@ Pragmatus:
US Senator Tom Coburn, R-OK, who offered to help a woman in dire straits (she faced bankruptcy with $400,000 in health-care debts to care for her ailing husband) help from his senatorial office as long as she didn't ask for help from the government(yeah, that really happened! Check You Tube).
This is apparently part of PK's health-care reform...you knock on your neighbor's door asking for money (assuming they don't call 911 on you).
Of course all of this progressive nashing and wailing could look very silly in a couple of days when Obama stands up and gives a strong pro healthcare reform speech. I do think this is one of those times when he needs to 'govern in poetry' to paraphrase Gov. Cuomo. He needs to sell the principles clearly and concisely, and tell the country why this needs doing now.
As a progressive, who would like to see, and still thinks that, a government option as part of a strong final bill, I am not about to lose sense and reality if it doesn't get passed. A strong bill that passes with strong health insurance regulation IS a strong step forward. Its not the final goal, and honestly I don't think any Democrat would think that it is. But its another step towards the final result.
Here is a question to ponder over- whats worse, a bill with no government option at all, and the inevitability that the issue will come back, or a bill with a triggered government option. A triggered government option threatens a repeal at some point in the future if election results head the wrong way. But it does avoid necesarilly having to make the argument for a government option again.
Its much easier to just pass a strong government option bill, and hold the threat of a single payer system over the heads of the insurance company if they don't play ball.
If Obama says at some point in his speech Wednesday—
“If any bill comes to me without a public option I will veto it.”
—a storm of approval will sweep the country. People will be dancing in the streets. As it stands now, all the progressives, in fact anyone hoping for real reform, are afraid that the president is going to compromise, dither, waffle, temporize—and leave them in the lurch. So they all mill about in uncertainty.
Put an end to the uncertainty, Mr. President. What we need to hear is a statement by which there can be no doubt where you stand. But you have to make the stand, and spell it out in unadorned simplicity. It will require an enormous amount of courage.
But that’s why we elected you.
The trigger mechanism is like pointing a gun at a criminal that you both know is unloaded. Loading the gun is what gets people's attention.
Pass the public option.
markymark - Maybe you're right. Maybe these last several months of appeasement and capitulation are not how it is going to end up. Maybe Obama has a miracle up his sleeve. Maybe Obama is going to give an incredible speech and spend the next month fighting hard for a strong public option which can bring about real reform.
At this point, believing that seems a lot like believing in Santa Claus and the tooth fairy.
Obama blew it. Period. I've been going to rallies and making calls for health care reform. The people who oppose it are NEVER going to compromise. They are never going to cut Obama any slack. By continuing to cede ground, all Obama is doing is making himself look weak and emboldening his opposition even more. He needed to start from an uncompromising position of strength. But he didn't. He started from a weak position and has been giving ground steadily from there. It's pathetic.
So pardon me for thinking that Obama will continue doing what he has done ever since his FISA flip-flop last year and cave in to the Republicans and the big corporations. What evidence do we have that anything else is going to happen? None.
If I'm wrong, I will happily admit it. But based on everything that's come before, those of you who are expecting more from Obama might as well be expecting Santa Claus to show up and give you everything you want.
the trigger concept is the dumbest thing i've ever heard. it would be like if firemen showed up to a house and saw that only one room was burning and said, "Hmm, let's wait until the whole house is on fire."
While I think that triggers are a bad idea and a public options (or better yet, single-payer) should be what we move towards, this is a pretty bad analogy. Firemen do wait for triggers to fight fires, that trigger being either an alarm or a 911 call.
@ the democratic activist:
The time now is not to falter, activist, but to re-direct your efforts. Senators Nelson, D-Nebraska, Dorgan, D-North Dakota, and Baucus, D-Montana are Dems in name only and need their comeuppance. Look at how a possible primary challenge made Senator Bennett of Colorado shape up. We are in this for the long haul.
As has been previously posted, President Johnson needed a supermajority Senate to pass civil-rights legislation. The biggest obstacle then was a group of segregationist Southern Democratic senators, many whom chaired of the crucial committees overseeing passage of any legislation.
(Democratic committee chairs stubbornly fighting progressive legislation? That seems oddly familiar.)
No, the Democratic Party does not need to go as far as the GOP in reigning in its moderates, but the Blue Dogs, whenever possible, on certain issues, need to know who is in charge of the party. To quote Texas columnist Jim Hightower, "the only thing in the middle of the road is a yella stripe and a dead armadillo."
Unfortunately, the many of the Southern Blue Dogs are lost already; 2010 signals an impending switch to a GOP toolbag in many of those seats. But outside the insane asylum of the low-growth South, there is still hope to change the nature of the Senate, just enough to get this thing passed.
In the meantime, you can also press for the public option on a state-by-state level, for a courageous governor to do the right thing by the people of his or her state, with the backing of the federal government. Few things will scare insurers more than a big state with a strong public option. If it is shown to work, then it represents the wave of the future.
Until then, don't lose hope. Just one look at the lunacy on the other side of the aisle is enough to see the alternative.
One more thing that I keep forgetting:
Rasmussen still links to this pollster analysis from 11/5. When all the votes were counted, the pollsters tied for 6th on 11/5, CNN and Ipsos/McClatchy, were closest to the final result.
Back on 11/5, Obama led by 6.1% when Nate did his popular vote update. He ended up with a popular vote margin of 7.3%.
My comment back on 11/5. There were an additional 3 million plus votes to be counted in California, but there weren't quite as many total votes still to be counted as I thought there might be.
70% of Americans want a public option.? Your article is a negotiation with the insurance industry and not one between Americans.
Nate, you're sounding particularly naive on this one. Medicare for All is the clearly the equilibrium that we are trying to move towards; lower costs longterm.
Viewing this as a stochastic game, this article continues to move us into a less advantageous state space...
And don't respond with the, "What? Little old me.?" line. With such consensus among the public, consent is being manufactured:
http://en.wikipedia.org/wiki/Manufacturing_Consent:_Noam_Chomsky_and_the_Media
If a trigger is what the sausage making takes, then why isn't it a trigger for a real "public option", i.e "single payer" aka "VA-for-all-who-want-it" or maybe "some basic wellness care for all"?
(I'd pay for it via an national land value tax (apportioned among the States) on the land value portion of real-estate not actively used for a primary residence, nor food production. After all, the land value tax is the only tax which has no economic deadweight loss.)
Consider the formulation that basic elementary school education is a right (either de facto as a result of truancy laws or de jure because of state constitutions which guarantee it), therefore we have public education funded by taxes, rather than elementary education insurance.
Consider the "right to counsel". Because it is such a fundamental right, for those who cannot afford it, it is provided not by legal representation insurance but by a public defenders office.
Consider that we don't have food insurance, even if we might all agree that in some natural law sense that everyone has a right to not die of starvation. Instead, we have a basic safety net, ostensibly to protect the right to not starve to death.
How much basic health care is morally equivalent to elementary public school education or the right not to starve to death?
Compare this:
Do we only send kids to school because their getting really dumb?
Do we only go to the doctor we're getting really sick?
We mandate that kids go to school because the social costs of dumbos and worse the real life cast of Lord of Flies committing crime and getting hurt is too great.
Have we reached the point where the social cost require that we really need to mandate that everybody goes to the dentist and doctor on a regular basis?
On the other hand, there is relatively little variation in the amount of food or elementary eduction that is required. In other words, the dispersion around the mean is pretty narrow.
But only some aspect of health care have a very narrow dispersion.
A. Basic wellness - narrow variation and predictable
B. Chronic care - narrow and predictable for those with certain conditions.
C. Accidents and unexpected Major Illnesses - wide variation and not necessarily predictable (lots of people are pretty healthy and luck and safe, some require some more care, a tiny portion of unlucky people have a really huge bill.)
Each of these parts is different and requires a different "social insurance" scheme.
We've gotten to this mess of a debate because no one has cut to the chase about the underlying data, nor about the underlying moral issues.
First, what actually is the moral point.
Second, what actually does the data show about the distribution of health care and kinds of health care.
BlueRevolution said...
US Senator Tom Coburn, R-OK, who offered to help a woman in dire straits (she faced bankruptcy with $400,000 in health-care debts to care for her ailing husband) help from his senatorial office as long as she didn't ask for help from the government(yeah, that really happened! Check You Tube).
~~~~~~~~~~~~~~~~~~~~~~~~~~
Yea, the irony was rich! too funny, not the woman's situation of course which was heartbreaking :(
Coburn, who's totally against any form of govt. run health care was letting his senate staff ie govt. assistance ;) try to help this woman in dire need.
Yes Virginia, that's what govt. was created to do, help we the people who can't help themselves, what a concept! Just like the U.S. Supreme Court is supposedly the last line of defense for the little guy against the large corporations! er "Big Brother"
Lest we not forget, politicians are just public servants to we the people. Unfortunately today's politicians have become cowardly slaves to special interest lobby corporation money.
Jefferson, Lincoln, Teddy and Harry are rolling over in their graves!
carry on
@BlueRevolution-- No, I'm sorry to say I have not been out there with middle America at the townhalls. I'm totally with them though! You guys are the fringe. Wake up! Let's do something sensible with universal health care and not all the tripe by the commenters here. But go bid with all this total shit you're peddling
Nate, some of the posts here have grabbed my attention and really call for your skills at statistical analysis. What will the effect be on private insurance companies of our aging population moving unto Medicare as their primary insurer? Does the "greying of America" reduce the customer pool for them? Will they react by seeking a mandate (individual or business)? Will that result in a government run program to control rates? Will the fact of having to compete for fewer customers result in them having to lower prices on their own? What might the timeline be?
Are you up for it, Nate? C'mon. Help me out here.
@NU '69....
Ha ha, called you out, and you took the bait, buddy. I never thought I'd be so lucky.
This is who we are dealing with, boys and girls, a person who is in a place to most need health-care reform:
---aged 50-64, too young for Medicare, which is SINGLE-PAYER HEALTH CARE
---often likely already has at least one health-related problem that his/her insurer is probably about to begin to refuse to cover)
---often a veteran of the armed forces, and therefore a recipient of VA benefits, which is also SINGLE-PAYER HEALTH CARE
---once in a long while, even a recipient of Medicaid, which is, again, SINGLE-PAYER HEALTH CARE
...but he, like too many people, stridently votes AGAINST his economic interests (with the GOP) because he believes that dreamy lie peddled to him by the Republicans. Giggling schoolgirls can't be told not to follow bad boys around, either, I guess. Too bad.
These are the people who shouted down Democrats in August, who physically intimidated people with other viewpoints, who scared the Blue Dogs back into the kennel from whence they came, and who sometimes brought loaded guns to Obama rallies.
If this is an accurate picture of your so-called "middle America" then we are all lost.
Hey, and what's with the cuss words? Are you mad now? Say the 's' word too many times and Nate's web masters might begin to remove your posts. Careful, buddy. Your blood pressure is rising. What's that? It's not covered by insurance? Oops.
@markymark
Despite my "nashing and wailing," I agree with you that the big O could still get a decent bill.
As he showed during the campaign, Obama has always been a better counter-puncher, and while I don't think it was the administration's strategy to get pummeled for the whole summer over health care, I do think making a big speech at the end of the process, as opposed to the beginning, like Clinton, is sound.
Nate's analysis on the probable effects of the speech makes a lot of sense to me. If Obama does well Wednesday and gets a decent bounce in the polls, then the Dems have even less reason not to ram through the strongest. most partisan bill possible, and we can forget all the midsummer madness.
We'll all know if a trigger or co-op becomes actually useful - the insurance company and their lobbyists will all start hating it, calling it socialist, and the teabaggers and town-hall howlers will scream to kill it.
NU'69 said...
There is a health care insurance problem that needs to be fixed...(f)ixing the problem, however, does not involve employer mandates, public option and caps on co-pays and deductibles.
So, what are your suggestions? All you continue to rant about is how the public option is not the solution without providing any statistical analysis to validate your points.
I hope BO and the House are as closed minded as all the commenters here. Better chance of killing the public option and getting some reasonable universal health care. (...)I'd much rather deal with a private insurer than with a totally insensitive (and incompetent) government.
Yep, proves my point. Typical talking points from those who "Want America to fail." Where are your recommendations for fixing the issue? Or will you come back with some more TEA Party dogma of government incompetence, or the insurance industry's favorite "government run health-care is evil."
No, I'm sorry to say I have not been out there with middle America at the townhalls. I'm totally with them though! You guys are the fringe. Wake up! Let's do something sensible with universal health care and not all the tripe by the commenters here.
This one was over-the-top and I finally had to respond. Once again, no solutions from someone who just wants this administration to fail, and through extension, wants American to fail. You consider the CRAZIES shouting down any reasonable discussions with their ignorant rhetoric of "death panels," "socialism," "Nazi" Middle American just goes to show what kind of person you really are, and where you stand on the issues. Middle America stands behind the public option. Middle America doesn't believe in the lying lairs from the right wing media.
The CBO estimates the public option will save the US government over $150 billion versus doing nothing. Other studies suggest the savings may be even higher, here and here.
Until you present legitimate arguments to prove your points, and back them with independent analysis, you sir, are a NUTTER.
I love all these comments about how we can't afford health care reform and the other things the President is trying to do. Maybe we need to RAISE TAXES and join the rest of the 1st world countries.
lairs=liars
Nate:
But secondly, the insurance companies would need to have real reason to fear the trigger. And that means having a public option that, if it were triggered, would be able to negotiate at Medicare rates.
BTW, Medicare/Medicaid compensation schedules are not "negotiated," they are imposed. The AMA endorsement of Obamacare was obtained after the government agreed to raise the current compensation schedule.
Agreeing to a government takeover of all health insurance in exchange for temporary relief from government compensation schedules for Medicare and Medicaid is rather short sighted on the part of the AMA. Do the doctors think their leverage vis a vis the government will improve when all that it left is government health insurance?
Bart DePalma said...
Nate:
But secondly, the insurance companies would need to have real reason to fear the trigger. And that means having a public option that, if it were triggered, would be able to negotiate at Medicare rates.
BTW, Medicare/Medicaid compensation schedules are not "negotiated," they are imposed. The AMA endorsement of Obamacare was obtained after the government agreed to raise the current compensation schedule.
~~~~~~~~~~~~~~~~~~~~~~~~
Nate didn't say Medicare/Medicaid compensation is negotiated, he said, a public option that, if it were triggered, would be able to negotiate at Medicare rates.
Again, attention to detail BDP, attention to detail!
take care
verity025 @ 5:47am said it all.
Maybe a trigger is the best compromise. The conservatives think it is a backdoor into a single-payer system, and the liberals think it is a sell-out to the insurance companies.
Sounds pretty good to me. A two-way conspiracy theory with so many victims on both sides.
@ Bart de Palma:
The goal is forcing humane corporate behavior, not the elimination of all private health insurance. What many of us are looking for is the price equilibrium seen in San Francisco, where an affordable city-run public option forced Kaiser Permanente, the big HMO, to behave like an insurer should. BTW, Kaiser is still alive and kicking in California.
I agree with the earlier posts which stated that the threat of a public option must be real in order for the insurers to behave.
It's in the best interest of doctors to support reform because, in part, the evil bureaucrats so hated by the right actually work for the insurance companies, getting in between doctors and patients' care and ordering doctors to carry out only what they pay for. I am forever amazed that you never seem to fear the insurance bureaucrat, who has more power over your life and death than most government officials ever will.
In any case, doctors need to be paid for results, not on the number of tests they run, and not be encumbered by some clown paid to raise company profits by interfering in private primary-care decisions.
The other Elephant in the Room Besides Single Payer. Is profit caps for basic care, with open profits for supplemental care, and no connection with employment. This is the German & Swiss Bismark Model. This was very succesful for the Swiss, in particular, who have universal health care for all at the same price as they were paying previously (11% of GDP). In the U.S. there would likely still have to be some small profit for basic plans (1-3% of revenue), but anything over the "cap" would get rolled into lowering basic premiums. Instead of "punishment" for cadillac plans, the upper classes could still get them at a premium and thus have no reason to claim "gov't takeover!" Anyone have a clue why this isn't even being considered? Is the insurance lobby just hoping anything that passes will do nothing to limit profits? Is the single-payer camp so stuck on getting a "toehold" with a public option that they would rather just add to the mess or leave it as is?
BlueRevolution,
Great job at outing that NUTTER. I normally try to ignore posters I might disagree with because I try to give them the benefit-of-the-doubt. We shouldn't be intolerant of different points of views, so I hold back until they get out of hand.
Eventually, most of them will out themselves with their own talking points, and no validity to their arguments.
The hypocrisy coming from the right media is astounding. "The public option will eliminate private insurance, but on the other hand private insurance is more efficient and cost effective." "Keep the government hands out of my medicare, but the government can't be trusted providing health insurance." "I don't want to pay for lazy Americans health care, but it is OK for them to continue to go to the ER for colds and other minor ailments because somehow I'm not paying for that."
And so on, and so on, and so on.
I don't know what happened , but it appears that everyone has left. Must be the holiday, for all of you non-socialist who weren't aware, Labor Day.
Great speech by Obama today in Cincinnati, by-the-way. Did the whole "fired-up" thing. Eloquently as usual, but somewhat lacking in substance. Didn't clarify what would be acceptable in a final bill for health-care reform, but didn't expect him to.
I'm sure he is leaving that for Wednesday night.
The premiums for health insurance have already gotten too bloated. The trigger Nate suggested, no future rises faster than inflation, just preserves the current bloat.
The trigger should be One half the inflation rate or better for every one of the next twenty years. If the inflation rate is below 2% in any year than the trigger should be the inflation rate minus 1%. And that includes years of negative inflation.
This is for the total cost of medical care, not just insurance premiums. The insurance people say they are our best hope for holding prices down, so that's why we should protect them form being driven out of the market.
This formula, should the insurance companies succeed in preventing the trigger from being pulled over the next twenty years, just might allow the United States to have per person health care costs that are only 125% of those in the next most expensive country rather than 150% as it is now
I will agree to the trigger if the Republicans will agree to a windfall profits tax on health insurance companies.
Is it a deal?
Pragmatus
How can you have “overutilization” if you don’t have enough primary care physicians and nurses?
You are talking out of both sides of your mouth.
there is no contradiction. Most of the resources aren't doctors, You don't need to be a doctor to operate an MRI. There's no one to one relationship between healthcare services and primary care physicians. In fact, the lack of primary care physicians is a factor in increased cost and utilization. The role ends up being filled (partly) by specialists, who cost more and spend more on tests.
The problem is not “overutilization”. This is a right-wing red herring. The chief problem is the enormous waste ($300 billion annually) that the insurance companies piss away every year. If that money were redirected towards health care the problems of cost escalation would be solved overnight.
It isn't and it wouldn't. $300 billion sounds about right, though some or that would be spent by a public option substitute.
Medical spending in 2009 will be $2.5 trillion. 16.2% of that is "other", which includes insurance companies. That's $405 billion, so the numbers work.
Costs are increasing
at around 7% a year, so your $300 billion would pay that increase for 2 years. Then what?
I'm all for getting rid of the insurance companies, but clinical services at 21.4% and hospitals at 31.1% are the largest shares of costs. Prescription drugs are 10.1% and Nursing homes 5.9% (Home health care 2.6% and other personal care 12.7%).
Some interesting facts: 10% of the people account for 66% of the costs and 1% for 22%. So it's not the public overutilizing. It's the medical profession using the sickest part of the population as a piggy bank. It's easy to order a few more tests for someone who's going to be tested anyway. Who's to say what the right amount of treatment is. Medicare and the insurance companies will pay for all sorts of unnecessary treatment if it's coded right. It's not their money.
Insurance costs even without any changes rise and would fall in step with Hospital care an Clinical services, but the reverse isn't true.
In 1970, health care spending was $75 billion, 7.2% of GDP. Now it's $2.5 trillion 17.6% of GDP. projections for 2018 are $4.3 trillion, 20.3% of GDP or $13,100 per person.
Codswallet…
I still disagree with you about overutilization, except in the case of end-of-life care. And some of that is the result of personal decisions by the aged, who very often insist on everything being done to save their lives. But the real expense juggernaut is due to those who can’t speak for themselves, and then the doctor is under the obligation to do everything possible to extend their lives.
I disagree that it’s because doctors are using the very sick elderly as a “piggy bank”. I don’t know of any doctor who would operate that way. I suppose there are some, but I seriously doubt such physicians can be blamed for the explosion of costs we are currently experiencing.
My conclusion is that all significant cost pressure comes from the insurers. Doctors typically employ two or more people just to do deal with insurer rigmarole—who get salaries and benefits, and require space to be rented to accommodate them. You have disparaged the $300 billion figure, but if you look at what’s currently spent annually on health care ($2.4 trillion) that waste figure is one eighth of the total. Since it has been increasing as a percentage I think we can expect it to continue to do so, because the insurers don’t give a rat’s ass about waste, as long as they have premium payers they can throw it on. Then they have ridiculous salaries to pay their executives, plus profits to scare up—you need look no further to find out why costs are mushrooming.
We have an enormously expensive system, and we have an enormously expensive system because we have an enormously wasteful system, and we have an enormously wasteful system because it is run by private insurers who are accountable to nobody. That problem is at the very heart of all the troubles with health care this country experiences.
I think the general problem with including a trigger is that it will be terribly difficult to write one robust enough to withstand the inevitable gaming insurance companies will do to keep it from being tripped (not necessarily bashing the insurance companies in this particular instance, but they have a BIG incentive prevent a public option from becoming a reality).
Furthermore, from a long term perspective, a public option creates an entity which can then be modified/enhanced as needed in the future, whereas a "triggered" public option, no matter how wonderful, may never come into existence (especially as a nonexistent entity could easily be eliminated by a subsequent administration once public awareness on the issue wanes). This talk of "triggers" sounds like a convenient way for opponents to kill a public option while looking like they support it. Better to have a public option become part of the healthcare landscape and let details of its structure be hashed out down the road.
I just heard that my friend's niece died suddenly of epilepsy at 21 years old, because she outgrew her parents' insurance. She died 6 months later because she couldn't afford the $800 a month epilepsy pills.
One possible compromise is go allow a small population under 65 to buy into medicare at private insurance market rates. Since Medicare costs much less to administer than private insurance, it runs a surplus, which we use to shore up the finances of the system. You let just enough folks, say age 59 to 64 whose premiums just make up the shortfall.
The outcome is positive. Better care for out middle age constinuents, and more money to help benefit the Medicare trust fund and keep it robust.
By allowing a larger or smaller age group in, Medicare controls its finances and assures it's healthy. Never needs to sign up the whole country, but just enough to keep its balance sheets in the black ... and incidentally provide some stiff competition for the insurance companies.
The only triggers that will end up being pulled in this scenatio is the one on the gun I buy if I get seriously ill with no health insurance. Not sure if that one would be pointed at my head or at my Senator's.
No need for a trigger, competition will be an ongoing trigger as someone else here has already noted, and look how well the budget-balancing triggers worked once the heat was on...
This is all ridiculous, searching for a way to get anti-health-reform Senators to vote for "health reform" in quotes so they can look like they are doing something. Let's have a real vote on a real bill, and let everyone take a clear stand. Then the real trigger -- the next election cycle -- can be used to determine whether they've done the public will. Anything else is just inside-politics nonsense.
Where are the savings generated by adding 47 million new customers?
Surely, adding in such a group should result in an initial decrease in insurance costs by spreading the costs amongst a larger group.
But if Democrats insist on a public option, they ought to recognize that (i) the public option has already been significantly compromised and (ii) there may be better compromises available -- some of them involving a trigger.
Nate, are you insane? The public option IS the compromise. The ideal is single payer or even government-run health care. The public option is the center.
The Dumbocrats should have just campaigned on Medicare for all.
Pragmatus said:
If Obama says at some point in his speech Wednesday—
“If any bill comes to me without a public option I will veto it.”
—a storm of approval will sweep the country. People will be dancing in the streets. As it stands now, all the progressives, in fact anyone hoping for real reform, are afraid that the president is going to compromise, dither, waffle, temporize—and leave them in the lurch. So they all mill about in uncertainty.
Put an end to the uncertainty, Mr. President. What we need to hear is a statement by which there can be no doubt where you stand. But you have to make the stand, and spell it out in unadorned simplicity. It will require an enormous amount of courage.
But that’s why we elected you.
Amen, brother.
My largest concern with this path (the trigger), which im not sure if it has been noted above or not, is that the Insurance companies have already (per many people, their rates have gone up 10-30%). So at this point, they are artificially raising prices in anticipation of the inflation + .5% option, which then does consumers no good.
Its the same crap as the credit card companies raising interest rates before the credit card bill goes into affect
What about a trigger? The earliest a public option would come available is 2013 in any of the committee passed legislation. I don't know why it would take 4 years to plan (Medicare went into effect in 30 days), but that should give private insurers plent of time to adjust. Therefore, this should be the latest date the trigger would be pulled, should conditions warrant. The trigger should remain in continuous effect there after, with a robust public option being available on Day One if conditiona are met. Of course, the conditions on private insurance need to be stringent regarding cost, coverage, and choice available. So stay strong Progressive Dems, but continue to listen. A trigger for the Public Option, may be acceptible, but only under a narrow range of specifications.
Nate - how come you always think Prgressive Dems have to keep giving in? Why shouldn't Dems like Nelson have to "compromise?" What might induce them to give in? It would look bad for them, if they were the ones who stopped healthcare reform. Are they really in such a great position, if a large swath of people who voted for them before decide to walk.
For the folks oppossed to a trigger bc it take too long...don't most of the "public option" bills call for a 2013 implementation. Also, it's not like every person will have this as an option. CBO estimates about 10M enrollments by 2019
(source: http://voices.washingtonpost.com/ezra-klein/)
As Andrew Sullivan writes..since the GOP has been over-the-top (Death panels etc)simply passing a bill to hit some key issues (pre-existing conditions/portability) and not have the world end or grandma die will build support for Obama's reforms.
Has anyone seen what "buying into medicare would cost?"
The worry that you and I ought to have is that subsequent Administrations are quite likely to weaken any "trigger" option so as to make it worthless.
A robust public option has to be on the table, right now. Private insurers have lied, and they've paid off politicians, and they've got no intention of doping anything any differently. We're seeing people die every day via the "death panels" already set up and fully operational at every private insurer. They must be brought to an end.
I spent too much of my misspent life in and around Capitol Hill.
I don't see Congress beset by health care lobbyists being able to "trigger" the trigger except in two scenarios:
An independent commission does it like in military base closure; or
A trigger that lets state legislatures individually "opt out" of the public option if they believe it isn't needed in their state---so South Carolina doesn't have a public option---I'm a Darwinist.
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