Democrats & Liberals Archives

No Public Option, No Reform

Health insurance companies, conservatives, Republicans and some Democrats - they are all for health insurance reform, but are violently against the public option. This is an incoherent approach. Without a public option the system we have now will remain pretty much as is There will be no healthcare reform.

Republicans and some so-called moderate Democrats are against the public plan. Why? They claim that the public option would provide unfair competition and take over from private insurance companies. These are the same people that say the government can't do anything well. Now they tell us that the government is so efficient and does things so excellently that it would provide unfair competition to the brilliantly managed health insurance industry!

These naysayers are the same people that constantly broadcast the virtues of capitalism, free markets and competition. And here is an example where President Obama wants to introduce competition and they are screaming their objections.

Ezra Klein makes the argument clear:

....... If the public plan works, then private insurance will work better as well. In this telling, the simple existence of the public plan forces a more honest insurance market: Private insurers need to offer premiums closer to their marginal cost, and they have to cut administrative costs, and they have to work on their reputation for cruelty and capriciousness. The existence of another option changes the market. Individuals will have access to private insurers, but they'll no longer be stuck with them.

What's wrong with that? Competition from the public option will improve the whole system and bring costs down. Terrific boost to capitalism!

Without the public option, there will be no true competition. The huge insurance companies will be in control. The cost of healthcare will zoom. More people will go bankrupt from excessive healthcare expenses.

There can be no true reform without a public option. If the public option can't be achieved without the complaining senators, let's get it done with a simple majority.

Posted by Paul Siegel at June 15, 2009 6:13 PM
Comment #282996

If the health program that evryone is talking about is anything like state workers comp then your better off just treating yourself.T
he doctors or for the company’s and you just should see your co and see if your alright!!!!!!!!!

but in this case you would have to see your goverment which one of these is the greater evil?
This whole ideal is crazy.
If this country really hopes to reform health care inforce the laws on your buddys and anyone else make people accountable for there actions.
drive out illegals and arm all american citizens for i feel they must fight for there freedom once again as government has gotten to big and corrupt.
our own government is to intertwined with big bussiness all over the world. america’s only hope is to break all ties with big bussiness and have a government in place which thinks of the people first. For no company, corporation, or persons can do what these corporations due in other contries and then claim to be part of the human race and had these corporations acted with any compasion there would be hardly any trouble in the world all they had to do was be fair and not so greedy….How do we as a country over come these horable acts and our goverment just looks the other way. we need to close nafta and we need these company’s back in the united states and we need this done A.S.A.P. we have allowed to many forein nations to infiltrate or industries and look were it has placed us……….I blame Congress and the senate for this as they have been payed to have the forthought to see how things fold down the road but i guess they have been to busy kissing ass and wiping there noses


Posted by: shane at June 15, 2009 7:40 PM
Comment #283003

Paul Excellent article but no fair using the “C” word when talking about capitalism. Competition is no longer a component of capitalism. The insurance companies think competition is selling across state lines, not real competition from a “can’t do anything right” government.

Without a public option healthcare will be reformed just as bankruptcy was “reformed” just prior to the financial meltdown.

Posted by: j2t2 at June 15, 2009 10:46 PM
Comment #283006

Absolutely. As part of the public plan provision, to make it work, there also has to be measures to prohibit private carriers from cherry picking, like offering coverage only to people 19-27 yo or requireing check ups before extending coverage.If they do not want to play,fine.

Posted by: bills at June 16, 2009 12:02 AM
Comment #283017

President Obama mentioned limiting lawsuites as a way to cut costs.

If we get a national system, we should cut out the lawyers and make a system more like workmans’ comp, with predetermined settlements and largely w/o lawyers. Let’t put the schysters out of business.

Unfortunately, the Democrats in congress are up to their necks in schyster money and are unlikely to follow the President’s lead. Unfortunate also that President Obama lacks the experience, leadership or will to put them in line.

So we may get the worst of it - a socialized system with lawyers calling the shots.

Remember, lawyer are like beavers. When they get into the mainstream they dam it all up.

Posted by: Christine at June 16, 2009 8:10 AM
Comment #283030

“If we get a national system, we should cut out the lawyers and make a system more like workmans’ comp, with predetermined settlements and largely w/o lawyers. Let’t put the schysters out of business.”

Christine why is it you would not like to see those that should not be practicing medicine out of the profession as well? The AMA doesn’t regulate the Doc’s, nor does any other entity except the Shysters.

Posted by: j2t2 at June 16, 2009 10:03 AM
Comment #283031

How would the “public option” be paid for?

Posted by: kctim at June 16, 2009 10:08 AM
Comment #283035

I do not understand how the public option is going to do any of the reforms we need.

We have a mixed insurance system now (public and private) and provider costs have skyrocketed because the approach does not contain costs. How can just adding more people to the public side help the equation? And public option leaves in place the employer based system that discourages any insurance reform on the private side.

Tort reform is difficult to do in the U.S. given our right to jury trial. The Scandinavian compensation model for malpractice (used by France) would be impossible to sell to the lawyers here.

The only good I see in the public option is that a subsidized system might be able to crowd out the private system and essentially lead us to single payer. If that is the case then it might work as either the payer, the provider or the patient must be given an incentive to contain cost. But just look at the distain against HMO’s when it is the payer that does the cost containment and you will see that this is the least preferred cost container. And if single payer is the real goal of public option then this administration is being very disingenuous.

Posted by: George at June 16, 2009 10:28 AM
Comment #283037

7. In 2006, what percentage of the U.S. Senators are lawyers?

A. 53%
B. 25%
C. 90%
A. 53%

8. In 2006, what percentage of the U.S. Congressmen are lawyers?

A. 36%
B. 95%
C. 50%
A. 36% Quite a few!

Posted by: Rodney Brown at June 16, 2009 11:15 AM
Comment #283038 “Shyster” :)

Posted by: Rodney Brown at June 16, 2009 11:24 AM
Comment #283043

Kctim asked “How would the “public option” be paid for?”

Well if the Republicans have their way we’ll tax working peoples insurance benefits. But the Democrats are ideologically opposed to taxing people. (Do you see a little class warfare here or something?)

Posted by: Mike the Cynic at June 16, 2009 2:58 PM
Comment #283045

Am just curious how the “public option” will be paid for, thats all.

If the Dems are ideolically opposed to taxing people (which goes against everything Dems stand for) how are they going to pay for the plan? Print more money out of thin air?

And is it a real “option” where I can choose if I wish to contribute and participate? Or is it a Democrat “option” where I am forced to contribute even if I don’t want to participate?

Posted by: kctim at June 16, 2009 3:13 PM
Comment #283046


I’ll take option ‘B’…how much do I win?

Posted by: Marysdude at June 16, 2009 3:38 PM
Comment #283049


IMO rotten doctors and rotten lawyers have a symbiotic relationship. The lawyers sue for cash. There is little relationship between payouts and actual neglegence. The bad doctors and lawyers often collude to keep secret what happened. Indeed, doctors with lots of malpractice should be eliminated, but then we would have to judge by actual practice rather than who can be made to pay.

The Scandinavians have a decent system that does not feature the kinds of lawsuits we suffer. IMO, our best doctors are better than theirs, but their worst are eliminated more rapidly. On average, it works about the same, but it is a lot cheaper and, BTW, they live longer than we do on average.

Posted by: Christine at June 16, 2009 4:03 PM
Comment #283050


The threat of catastrophic lawsuits is not a good way to improve the practice of medicine or anything else. It gives doctors incentive to practice defensive medicine and obscure mistakes.

No matter what you are doing, there will be errors. A smart system learns from errors. In order to do that, you need good feedback and reasonable expectations.

Our adversarial system sets up a kind of no-learn binary system. Either you pay a crippling amount of money or you get away with your mistake. It is like swatting local dogs with a newspaper randomly a few days after you find out some dog has crapped on the rug. The only thing you can expect them to learn is to avoid you.

Workmen’s comp has reduced workplace injuries remarkably because it puts real estimates and cost on mistakes. Although it seems crass to put a value on suffering, it is the way to reduce it and innovate.

Posted by: Christine at June 16, 2009 4:15 PM
Comment #283059

I think this may be my litmus for whether Obama fails or not. Failure to get a meaningful public option, with an eye on curtailing the rising cost spiral, is in my opinion, a failure to meet a major objective of this president. If he fails at that, I may give up hope.

Posted by: gergle at June 16, 2009 7:20 PM
Comment #283087

“In my opinion, the government should never compete with private businesses”

Why should capitalist enterprises fear competition? Isn’t that what the system says it is based upon.

Posted by: j2t2 at June 17, 2009 8:36 AM
Comment #283089

Christine - that argument about lawsuits is a red herring that those on the right are using to gin up fear over socialized medicine. Judges are in place to throw out frivolous lawsuits (not that all of them do their job). If your mother or father were killed by gross negligence of a medical institution what price tag would you place on that? What if you had breast cancer and the doctor removed the wrong breast? What price would you put on that? What if your child died from malpractice, what price would you put on that? Not to mention, what happens when someone is denied coverage by their insurance company because they say that the condition was pre-sxisting and someone you love dies of cancer when they could have been treated? It’s easy to blame lawyers because some are unethical. It’s easy to point out a couple of ridiculous cases where someone gets a large settlement for a minor situation. Legislating for the exceptions tells people that when they have a real case or a real complaint that they just don’t matter that much and that we have to protect the financial integrity of medicine for profit more than have justice done for someone who has been wronged in the worst way possible.

Has anyone thought to take a look at the unethical practices of malpractice insurers? Are they any more ethical than the for profit medical insurance industry that only cares if you survive so you can pay outrageous premiums? Are they any more ethical than AIG? Doubt it. They are raking doctors over the coals and exacting huge profits and I’m sure their CEOs make 20 times what the doctors that pay them do.

Posted by: tcsned at June 17, 2009 8:55 AM
Comment #283101


Competition against the guy who makes the rules, enforces the rules, creates the playing field and regulates your activities?

Ezra’s article about choice and competition is misleading. That’s because very few end users buy their own insurance; it’s provided for them by their employer. The government will be able to attract large numbers of “customers” to its public plan not based on competitive benefit but based on what tax rate it charges businesses that do not provide private insurance. That’s why I think public option can only be a trojan horse for single payer.

And that’s what I don’t understand. Why don’t we cut the crap and just debate single payer? Single payer is a better option to the mixed private/public system we have now, a system that gives no one the incentive to contain costs. I personally feel that giving the payer the incentive to control cost is the worst of three choices (the payer, the provider, or the patient), but we can’t have a decent debate on the other two alternatives until we debate the single payer.

If this is a crisis then we are wasting valuable time.

Posted by: George at June 17, 2009 10:29 AM
Comment #283119

How does one expect to take lawyers out of the system when most of the politicians are lawyers? Doesn’t matter which party they are from the lawyers in this country are the ones ruining it because of greed. Why else would Obmama not want a cap on malpractice lawsuits, less money for the law firm if there’s a cap right?

Posted by: Victor R Romano at June 17, 2009 2:34 PM
Comment #283124

Capping settlements is a red herring as I mentioned above. It would do nothing to reduce health care costs. What price would you put on your mother’s life? On your wife’s life? What price would they put on your life if someone wrongfully caused your death? I wouldn’t cap it because it should be up to a judge and jury to decide how much a human life is worth.

Posted by: tcsned at June 17, 2009 4:52 PM
Comment #283135

There are inevitable mistakes, actual negligence and criminal malpractice. We should not mix them up.

In any human system, mistakes will be made by even competent and good people. The idea is to design the work so that mistakes are minimized. It is the basis of quality improvement. It works by analyzing the process. It requires free flow of information and honest feedback. It is nurtured by empowering those closest to the problem to solve it and by ensuring as much as possible that those making decisions also have responsibility for them. It is crippled by threats of massive penalties and it is destroyed by arbitrariness.

Malpractice litigation as it works today is almost diametrically opposed to allowing improvements in quality. It punished and rewards arbitrarily. It moves the consequences of decisions very far away from the practitioner. Penalties are massive and capricious.

You asked me how much the lives of my loved ones would be worth. It is a hard question that I could not answer as an individual, or more to the point, I would say limitless. As a society, we cannot allow that. We should be clear about the “worth” as repugnant as that sounds to us. That is what workmen’s’ comp explicitly does and that is what European health care systems do at least implicitly.

Consider the problem with vaccinations. Vaccinations save the millions of lives. Hundreds of people might suffer some negative side effects. Yes, if it was my kid I would be outraged. But we cannot allow this kind of thinking. It is literally backward. We have to think forward. If you are given the choice of risking an infectious disease which has a 25% change of killing or crippling you, or taking a vaccination which has a 0.25% chance of killing or crippling you, which would you choose?

The law tends to punish initiative. You will not suffer for what you did not do, so if you come up with a lifesaving medicine that will save 1000 but kill one, from a strictly calculating point of view you are better off not saving those 1000.

Posted by: Christine at June 17, 2009 8:41 PM
Comment #283142

“Ezra’s article about choice and competition is misleading. That’s because very few end users buy their own insurance; it’s provided for them by their employer.”

More so in the past than today George. However that is a problem in that with so many changing jobs more often today, so many whose employer cannot afford to pay for healthcare, and so many that get laid off and lose the insurance it is time to remove it from the employer. I would think this would make the employer more competitive in the marketplace as well as benefit the ex-employee and the employee.

Lets face it George the private insurance companies have screwed up big time with all their reasons to not provide what they say they are providing , health care coverage. There has to be some point in time where we realize it has gotten worse not better over the years due primarily to insurance companies. Why treat them like some special entity because they are private not public? They have brought this mass of confusion on the patient, the doctor and the hospital. I laugh when those on the right say ” the government will decide not the doctor” as if the doctor and patient do so now. It is the insurance company that determines the treatment in most cases, causes the red tape and makes the profit without the risk as they have passed the risk to the doctor.

“And that’s what I don’t understand. Why don’t we cut the crap and just debate single payer? Single payer is a better option to the mixed private/public system we have now, a system that gives no one the incentive to contain costs.”

I don’t know about you but unless it is absolutely necessary I do not go to the Doctor. If I am sick and need to go on the weekend I wait until the next week. You seem to suggest that having a health problem requiring treatment, tests and waiting in the doctors office while missing work or Oprah is something most of us look forward to, I don’t believe most of us do. The capitalistic mindset that we see here is not the correct mindset for health care IMHO. Perhaps if we look at the problem in a democratic mindset or if you prefer a socialistic mindset instead of a capitalistic mindset the need to keep cost down will be more of a “who wants to get sick” thing, or a little less convenience for those that pester the medical staff with petty concerns.
Those that should be charged with keeping the costs down should be those in the health care field. If expensive equipment and specialties were shared by doctors and hospitals instead of competing with each other costs could be contained. It is the profit motive that causes each hospital to buy expensive equipment to compete with each other until there is only a handful left to control the market and raise prices. You have made workable suggestions in other threads that support this, such as following AMA recommendations to keep the malpractices costs down.

Posted by: j2t2 at June 17, 2009 10:59 PM
Comment #283180


‘As a society’ we cannot afford NOT to allow limitless suits for wrongful doings. Once limits are set, those entities who regulate and insure will adjust their programs to fit, and malpractice will increase exponentially.

Posted by: Marysdude at June 18, 2009 11:41 AM
Comment #283181


More so in the past than today George

According to the 2005 National Health • Interview Survey data, among persons ages 18-44, 67% are covered by private health insurance, 24% are uninsured and 10% have Medicaid or other coverage. For ages 45-64, 77% have private coverage, 13% are uninsured, and 10% have Medicaid
or other coverage. For persons over 65 years of age, 59% have private coverage
[in addition to Medicare], 28% have Medicare only, 6.3% have both Medicaid and Medicare, and 1% are uninsured (Adams, Dey & Vickerie, 2007:7).

You are correct that the stat has declined in the past 10 years, but people with employer provided insurance are still by far the largest block of potential customers for the public “option.” Only the decision will be made by the CFO of their company based on the difference in cost between providing the insurance or paying the new tax for companies that don’t provide insurance. It won’t be made by the employee themselves based on the public option being a better product (i.e. competition).

As for private insurance screwing us, it’s really not about the private insurance companies. And it’s not about the 100m or so covered by public plans. It’s the dynamic between the mutliple financial streams that is screwing us. All you have to do is look at the first 3 years of Medicare, the first public plan introduced, to see this. In the first 3 years of Medicare total healthcare spending doubled in this country. And I think it has been doubling every 4 years or so since. Where there are multiple fiancial streams providers will merely shift costs from one system to the other instead of not incurring them. That’s the advantage of a single payer system; cost have to be controled based on the amount the single payer and patient are willing to pay.

And that’s my problem with public option. Unless it leads to single payer, it won’t contain health care costs. So let’s skip this whole public option bs and look at single payer. I’m not a big fan of it, but it’s better than what we have got right now with the mixed system that is out of control.

Like you I’m not a big user of health care even though I spend, along with my employer on my behalf, a ton on it per year (about $15k/yr for my family). I also think the patients are the best of the three (payer, provider, or patient) to control his/her health care costs. Therefore, I would prefer solutions that give individuals the financial incentive to contain cost. As you noted from another thread I also like solutions that give the providers the incentive to contain costs. Both of these methods are preferable to having the payer contain the costs outside of the health care decision process.

I think we can do much better than single payer, but there’s little chance of even debating those options until the folks supporting single payer get their day in the sun.

Posted by: George at June 18, 2009 12:10 PM
Comment #283190

George the system as it stands now has an incentive to increase profits and raise costs. The insurance companies,the drug companies, the for profit hospitals, medical equipment manufacturers etc. want to have the cost to continue to go up. Health care is a business,ran like a business and that is the problem. While that may sound good to some the problem is the cost savings only go to the shareholders and company executives in the form of profit. Health care has become a fight for profits not a fight for health care.

Insurance companies have put the burden onto doctors in their system to contain costs by rationing health care to the doctors patients. If the doctor is more worried about making money he can do so on the backs of his patients, or he can provide good medical care and should it exceed the amount paid by the insurance company it will come out of his pocket. What do you think will happen the biggest share of the time?

I pretty much agree with you on the public option as a step towards a single payer plan but I am in favor of a single payer plan. The only reason I don’t shout my disgust with the public option is it causes me to smile to watch those favoring the capitalist health care system draw back in fear of competition.

Posted by: j2t2 at June 18, 2009 2:10 PM
Comment #283210

Paul, right on, as usual.

The only reasonable alternative to a public option is to require the for-profit insurance companies to a) insure whomever applies to them for insurance with no “pre-existing condition” exemptions and b) charge exactly the same premium as charged to any other insured in the same age and location of residence category.

But of course the for-profit insurers will scream bloody murder about THAT because that’s an important part of their strategy to reap enormous profits for little if any risk or cost.

A third alternative would be to require them to become “cost plus percentage of savings” contractors to the states, permitting them a reasonable profit for doing what is, after all, simply administrative paper-shuffling with no actual value-add to the process.

Think about it: they don’t deliver or provide treatment; in fact it is to their advantage to prevent medical treatments from taking place if that would reduce their profit, or encourage other medical treatments whether efficacious or not, if that will increase their profit.

The only thing standing in the way of universal coverage, not to say nationalized medicine, is the for-profit insurance companies and their water-carriers in Congress.

Posted by: Daniel Defoe at June 18, 2009 6:49 PM
Comment #283220

No reform is better than Obama reform. I think there needs to be reform and here’s my plan. If no one had insurance, cost would immediately and dramatically decrease, therefore I propose eliminating insurance altogether. You pay as you go. I know medical equipment cost a lot of money, R&D and all that. How do other industries deal with technical innovation and research? The cost is spread over their entire market. Take out insurance and there are no profits to pay share holders, no wages to pay company executives or masses of employees and agents. They could find a real job producing something and quit leaching off the wretched masses who think insurance is some sort of inalienable right.

Posted by: Paul at June 18, 2009 9:01 PM
Comment #283244

As we watch healthcare being chewed up by the dogs of the industry, there needs to be one meme shouted from the rooftops.

If congress proposes healthcare reforms, it must be tied to their healthcare. They cannot be allowed to accept any healthcare from lobbyists or agencies that isn’t in their government plan. If it’s in their plan, it has to be in ours.

Any lack of parity is unacceptable. If it is good enough for America, it’s good enough for Congress.

Repeat, Rinse, and Repeat.

I’m sending this meme to my Congressman, so should you. No more excuses. If not done, recall elections should be held.

Posted by: gergle at June 19, 2009 3:58 AM
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