Health Care: The Public Option Fallback
Maine Senator Olympia Snowe's idea of creating a public option as only a fallback if private insurance companies fail to produce genuine competition seems to be gaining currency at both ends of Pennsylvania Avenue at the moment. Today's Washington Post has new details on how a "trigger" would work:
...in recent days, the White House has aggressively pursued a deal with Sen. Olympia J. Snowe (R-Maine), a member of the Gang of Six. She favors a slimmed-down bill that would take effect more slowly and would create a public insurance plan only if private insurance companies do not offer better coverage at lower rates. Under Snowe's "safety-net option," aides said, private insurance companies would be asked to develop plans affordable to 95 percent of the population in a given state or region.
In areas where private firms do not comply by 2013 -- when people are scheduled to begin entering a new federal insurance exchange -- a nonprofit insurance plan sponsored by the government would be added to the list of private options.
What is "affordable"? We we noted yesterday, that is a key question underpinning the entire health reform effort. Here, from yesterday's NYT, is Snowe's idea:
The public insurance plan would be offered in any state where fewer than 95 percent of the residents had access to affordable coverage.
Congress would define “affordable” with a sliding scale based on income. Under a proposal being considered by the Finance Committee, Medicaid would be extended to anyone with income less than 133 percent of the poverty level ($29,327 for a family of four).
For people with incomes just above that level, insurance would be considered affordable if they could find a policy with premiums equal to no more than, say, 3 percent or 4 percent of their income. For people with incomes exceeding three times the poverty level ($66,150 for a family of four), insurance might be deemed unaffordable if the premiums were more than, say, 12.5 percent to 15 percent of their income.
The theory here, of course, is that this is another way of reaching President Obama's stated goal for a public option, which is to keep insurance companies "honest." And it is an idea that White House Chief of Staff Rahm Emanuel has been flirting with for months.
Insurance companies are likely to go along as well. They backed a similar trigger mechanism when it was used with the Medicare prescription drug program a few years back: The government would be allowed into the market only if private insurance companies weren't competitive enough on their own. That "trigger" has never been pulled. But for those who advocate a public plan, this is likely to be seen as the weakest possible option, short of dropping it altogether. It would be, in their view, a mirage.
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1
The theory here, of course, is that this is another way of reaching President Obama's stated goal for a public option, which is to keep insurance companies "honest."
No it isn't. The public option is a way to keep the insurance companies "honest." Having it apply to fewer people is not "another" way, it is simply a weaker version of the same way.
If you have 10 state highway patrol cars on a given section of highway, checking for speeders to keep drivers "honest" and you decide to reduce the number to 5, and only place them in areas that have a qualifying percentage of traffic accidents, that isn't "another" way of keeping drivers honest.
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2
BTW, I like you, KT, but a post like this is borderline embarrassing. You are completely missing the forest for the trees.
Insurance companies are likely to go along as well.
You think? You think that insurance companies will "go along" with a plan where people are mandated by law to purchase their product as long as they don't charge more than 15% of people's incomes? You don't think the insurance companies wrote the provision, knowing full well they can game the system six ways to Sunday and continue making profits hand over fist?
There is NO theoretical explanation for these "trigger" mechanisms other than to stave off competition for the insurance companies. None.
Here is your story, KT: The WH appears to be okaying a "death with dignity" poison pill for the bill. The WH wants to test the resolve of the Progressive Caucus. Rahm most likely believes that the Progressive Caucus, unable to explain how this is a faux public option to their constituents, will fold and a bill will pass. Plan B? He can blame any failure on the Progressive Caucus.
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3
Are you frickin' kidding?
First of all, I can find a cheap policy right now. It won't cover anything, but they'll sure take my money. So the devil is really in the details of whether we can control coverage, not whether we can get policies in people's hands. The industry would *love* a mandate that I pay 15% of AGI to buy a policy, if they get to decide what it covers.
Second, the real point of this is that it shifts the focus to "areas." Ie., if the trigger gets pulled, it only gets pulled regionally, and your "public option" is just a Rhode Island public option, or whatever.
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4
thanks for the direct delivery of Rahm's talking points, Karen.
Like a good lap dog, you don't even bother to mention that "premiums" are just one segment of the "affordability" equation, and that co-pays and deductibles can (and likely will) be so high as to make it "trash insurance" -- people will be forced to buy insurance that sends them to the poor house anyway.
Nor do you bother to note that the only way a public option can "compete" with Aetna and Blue Cross is if its large enough to bargain effectively with drug companies and health care providers. The "piecemeal" approach makes that virtually impossible.
Try doing less stenography, and start asking questions of people who actually care about health care, rather than your beltway buddies who care only about scorekeeping.
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4.1
Um, did you read my post yesterday? it's linked here, and it addresses all of those points.
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4.2
nice try Karen, but doing a blog post yesterday doesn't mean you get to do stenography for Rahm today. Indeed, the fact that you supposedly understand that "affordability" is not a function of premiums, but a function of overall "out of pocket" expenses, makes the uncritical repetition of stuff like this especially problematic...
Congress would define “affordable” with a sliding scale based on income. Under a proposal being considered by the Finance Committee, Medicaid would be extended to anyone with income less than 133 percent of the poverty level ($29,327 for a family of four).
For people with incomes just above that level, insurance would be considered affordable if they could find a policy with premiums equal to no more than, say, 3 percent or 4 percent of their income. For people with incomes exceeding three times the poverty level ($66,150 for a family of four), insurance might be deemed unaffordable if the premiums were more than, say, 12.5 percent to 15 percent of their income.
(and btw, your piece yesterday said nothing about the need for the public option to be national, rather than piecemeal...)
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5
square1;
You know, I'm not embarrassed. I'm scared. They're yanking the guts out of this bill, and the MSM is walking around parroting the line their being fed about how this is intended to just be a different way to do the same thing. I honestly don't believe KT is so stupid she doesn't see that this is plainly intended to weaken the bill, but all we get are some weasel words at the end about how the progressives are just going to whine about it being a "mirage."
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Obama has a simple choice to make, he either sides with the liberals in his party, or he sides with one Republican. It doesn't surprise me, given his record to date, that he is having such a momentous struggle making up his mind.
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7
KT, are you getting ready for tailgating? Why else be up this early today? But I'm just checking to make sure pre-existing conditions / claims denials will still be banned finally. That must come first and I doubt ins. cos. will play nice here so don't assume anything (remember the joke about when we assume something). “Affordable” private plans still suck if we can't use them (and why still talk about HC as a thing to buy instead of public safety, my familiar TP…I'm offering you an escape clause, Karen, take it already… but I digress). If only the Dems had started out with single payer and *then* “compromised” to public options. It's like playing prevent defense now, a bad move. That aside, I'm bringing smoked sausages and fresh sangria (chilled overnight) to my friend's tailgate. And you, KT?
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8
Saw KT talking with Andrea M. The Beltway has its story and everyone coyly tells us that their "source" in the WH.... Tweety wants the Progressives to back off and Olympia Snowe is the go to girl.
Bipartisanship ( aka caving in to the Republicans) is alive and well. Only Nancy Pelosi is pushing the PO.
The stage is set for Obama to dump the DFH crowd. I'm guessing they think we will have nowhere else to go come the next election. They'd be wrong.
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9
KT:
Looks like some of us need a little more sleep before we comment on this. Having had eight hours and a cuppa, I'm more curious than enraged.
Could you apply your experience and skills to sussing out exactly what scope of coverage this 15% of AGI will buy? if this even looks like it could be "the deal" everyone will need to know, right away, what they can expect from "reform," and how loosey-goosey the requirements will be on a curiously acquiescent insurance industry. Without these specifics we're being offered a pig in a poke.
Also, what does this do to the total cost of "reform" if we've set the parameters for public support of those who can't afford private coverage?
Inquiring minds want to know.
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9.1
Thank you, FO, for being the one of the few commenters this morning who didn't kick the messenger.
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unfortunately, it's hard to even speculate on the answers to your and deconstructiva's questions here until we see the other big piece of the bill: how many people get coverage. if too many people are left out, as i wrote yesterday, none of this is going to work. (We also don't know, precisely, what will be in the package of minimum guaranteed benefits.)
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it's interesting that this idea for a trigger should be coming from a senator from maine, because that state has one of the most dysfunctional insurance markets in the country. (something i'm presuming snowe is also considering as she negotiates.)
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i've been looking for a good link to this, and can't find one. (any help, commenters?) but my understanding is this: they tried to put in some insurance market reforms a few years ago, by putting into place community rating (where you can't discriminate against people for the status of their health) and getting rid of the insurance companies' ability to deny coverage for pre-existing conditions. but they did it without requiring everyone to have insurance. premiums went up, and younger, healthier people started dropping their coverage. that left sicker and more expensive people in the pool, so premiums went up even faster. a vicious cycle. at least that is my understanding of how it has worked.
.i'd love to hear from some of our mainers as to whether my understanding of all of this is accurate.
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9.2
KT, if the ideal public option is enacted, i.e. without trigger, when would the bill have envisaged it coming into play? Is there some time limit to the trigger being exercised.
Is there an argument that if the trigger is there, at least the structure will be in place to activate the trigger subsequently or alternatively change the conditions of the trigger?
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9.3
The insurance companies will do their best to make sure that it is a trigger that never gets pulled.
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9.4
…Karen, I'm not from Maine (and never kick messengers) but found their Dirigo program, is this what you mean? http://www.imakenews.com/cppa/e_article001211154.cfm …this has link to ME dirigo agency (I'd gladly post more links but have had trouble posting two or more links in one reply, but others here do. What's the secret?) and am still digging b4 I leave for game (google term “dirigo health insurance maine community rating”…finding lots of stuff)…
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9.5
I will urge the democrats in the house to vote against it. This is a joke. It will make things worse, not better. Just go ahead and pass a small bill banning pre-existing conditions, and rescission.
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Then give up for another 15 years. A bill making people poorer, big pharma, and HMO richer is not worthwhile even if it makes Olympia Snowe and Rahm Emmanuel happy. Last I checked, nobody gives a toot what they want. -
9.6
I be gettin' ri' tired o' yer whinin' 'bout "kickin' th' messenger", KT.
It be li' ye don't be realizin we be knowin' ye're NOT just th' "messenger".
Ye're decidin' wha' th' message be goin' t' be, fr'm th' many message options 'vailable t' ye. Ye've decided no' t' carry th' message regardin' single payer; ye've decided no' t' carry th' message 'bout wha' a strong, open public option would mean. Ye've decided no' t' carry th' message 'bout th' windfall health "care" corporations be receivin' as a result o' th' current proposed "reform". Ye've decided no' t' carry th' message 'bout lots o' aspects, KT - ye're th' one in charge o' wha' message ye be carryin', an fer whom ye be carryin' it.
Then, ye be composin' th' message yerself - decidin' wha' ye be goin' t' put in, wha' ye be goin' t' leave out, wha' ye be goin' t' be glossin' o'er, an' who ye be goin' t' be presentin' in wha' light.
An' finally, when ye be deliverin' yer bucket o' bilge, an' we be gettin' riled up 'bout yer lack o' journalistic integrity, ye be cryin' 'bout just bein' a "messenger".
They be crocodile tears, lassie, an' I lost patience wi' ye'rs 'long time ago.
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9.7
What I think is interesting is that despite a Public Option being popular in Maine, and that big small business trade group pushing Snowe to support the PO and truly help small businesses, she is willing to openly stab them in the face.
I think this is the first time in history Republicans have completely ignored small business groups.
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10
Once again, my gut reaction to commenters is to defend the insurance companies. Do you think that the nature of the commenter's arguments might have something to do with it?
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One of the problems as I see it is that no one has any clear idea of what constitutes a 'fair' return on investment. Are the insurance companies gouging the public? Absolutely. Are they sabotaging reform in order to maintain their profit levels? No question. Will solving that problem magically make health care affordable? I have serious doubts.-
10.1
PD...
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The issue isn't "insurance company profits", its how those profits are realized through "murder by spreadsheet", i.e. how massive sums are spent on "underwriting" and finding ways to deny care --and deny payment for care, rather than on actually providing health care itself.
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And while there are "solutions" to these problems, they generally require a massive restructuring of the entire health care infrastructure (try forcing doctors to operate as part of a massive health care conglomerate like Mayo or Kaiser!) and/or a massive governmental regulatory bureaucracy.
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Insurance companies make money by providing as LITTLE care as possible per premium dollar. That's a lousy framework if you goal is to provide health care itself. -
10.2
I think it is unfortunate that KT thinks people are just kicking the messenger here. My beef isn't with the substance of the message. I'm glad that KT blogged about Snowe-WH efforts to cut a deal. I just think that the context in which she placed it was seriously flawed.
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11
FlownOver:
Your question is premised on the idea that they can be mandated to provide a reasonable level of coverage at that 15% AGI. I agree, this is an issue for discussion -- in fact, I would be surprised if the insurance companies don't give a good bit at this level. They will be willing to trade because:
1. This "triggers" nonsense effectively takes single payer off the table for decades. The public option was always intended to be a trojan horse for single payer. This fixes into place a system dominated by private insurance, where the public can step in and provide coverage only regionally, in circumstances where the insurance companies may be happy to allow it to happen.
2. Obligatory participation at up to 15% of AGI.
3. Like all industry players, they know they can roll things back and game the system in the long run.
So, yeah, if this is the best we can get, let's get as much from them as we can in terms of immediate concessions. But let's stop pretending this is going to be anything like a substitute for the public option. That's just a lie.
Paul Dirks:
There's a lot rolled into what you're saying. Maybe you could unpack it for us a bit.
I'm not criticizing the insurance companies. I think there are better mechanisms for controlling costs and providing coverage, but they work as designed - they provide coverage for profit.
That said, the issue is not what constitutes a "fair" return on investment. No one is talking about price control. The issue is that the market has settled on denial of coverage as the best way to maximize profits, ie., they sell people an insurance product that people think will cover them, and then they don't pay when the bills come in. This is not caused by greed, it's caused by perverse incentives in the industry. And, like all pseudo-regulated industries, they make money by making their product so confusing that people don't understand what they're buying. That's what's unfair. If they could provide me with affordable coverage that actually got me health care when I needed it, I wouldn't care how much profit they were making.
Anyway, sorry if my tone offends. But when I hear people talking about mandating participation at 15% of AGI but not giving me any clear answers about how they are going to fix the problems with the system, I get really angry. Like I said before, I can pay 15% of what I make for crappy coverage already.
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11.1
the problem isn't with the 15% of $88,000 crowd -- the insurance companies can provide more than adequate coverage with premiums like that. And despite Karen's concerns for the "millions of families" who would not be eligible for subsidies because they are (like KT and her family) in the top tier of wage earners, the real issue is what happens to those who are forced to buy into the health insurance parasite plans that will be designed to deny them as much coverage per premium dollar as they can get away with.
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11.2
They can, but they don't, and they won't.
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11.3
rhymer:
The intent of my question is that knowing the level and scope of the benefits is necessary to have any idea whether a 15% AGI max is reasonable. You're exactly right that a cap means nothing without an acceptable mandated level of benefits.
The responsible approach would be to decide, as a matter of public policy, what benefits we should expect and what dollar level is a reasonable demand on ratepayers – then set a "trigger" that requires the private carriers to meet that standard. This presumes effective regulation to prevent an unacceptable level of claim denials, with the public option as the consequence of noncompliance.
All in all, there's more than enough potential for loopholes in this concept to explain the insurors' acceptance. Anyone want to bet the senate will ever favor us over their industry cash cows?
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12
KT,
Unlike pluk, I'm not interested in kicking anyone. But presenting this as just another approach to the public option is disingenuous. The fact that it happens to be the White House's talking point doesn't mean you need to repeat it as if it might be true.
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That's like, at least $700 per month for median income families. That's not including copays and the like. Yeah, most of us normal people can fork over $700 a month, no problem. That's just a little less than my rent payment each month.
Meanwhile, read this piece by dday on how Karen's favorite Republican Arnold Scwartzenegger screwed children of working families while giving health insurance companies a tax break after shutting down the California version of CHIP, Healthy Families, a program the covers health insurance for California children. After he closed the program, within two weeks there were 30,000 kids on the waiting list, and the program was going to start dropping kids out of the program at annual renewal.
All of a sudden, Arnold and the Republicans came up with this brilliant strategy of increasing copays and premiums for families and giving Health Insurance companies a big tax break. So they opened up the program again and everyone was happy, and innumerate journalists swooned and celebrated, and working families got screwed. And the yacht owner still have their tax break, too.
Read this disgraceful Republican flimflam, it isn't very long.
D-Day: Insurance Companies Make Out Like Bandits In CA Healthy Families Legislation
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Oh, and I did read yesterday's post, and it's not what I'm talking about.
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15
Let us say someone makes 50,000 dollars a year.
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An employee will pay out of pocket 15% of their AGI of 50,000 which is 7,500. That is saying the company they work for does not pay anything at all towards their policy. The average policy in America costs something like 13,000 according to CBO figures for last year. The “trigger” would be put into place. Because for these employees the “trigger” would go into effect, because they reached the maximum limit of 7,500, and still have 5,500 yet to pay on the policy.
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The report also says on average, an employee, currently pays 30% out of pocket, or 3,900, towards their company policy. In this scenario, the “trigger” would not be put into place because the employee still has 3,600 to go before he reached the maximum “trigger”.
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For a real case scenario, I used a family member's real figures. This person makes 50,000 per year. Their portion of healthcare is 3982.02 per year. The company pays, using the figures above on average, 9,017.98.
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No matter how you slice and dice it all, it seems it works out to be the same. But, it does not address the real problem, and that is cost. The cost of healthcare is far out-pacing COLA in most all cases. The average policy is rising 110% each year. We must get a handle on the cost of healthcare first.
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Passing Tort Reform is a must. Opening the State to State competition of insurance companies must also occur. We also have the problem that pre-existing conditions are now being treated at the whim of the insurance companies, and they can cancel someone if they believe they are “costing the insurance company too much money”. I also believe that portability of the insurance policy needs to take place, eliminating COBRA. Put price controls on the amount that Physicians and Hospitals can charge.
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Then, if the cost of healthcare insurance is not more in line with other industrial countries, allow the “trigger” to occur and open up a public option to put further pressure on the private insurance companies. But, we also have to provide incentives to doctors to not order every test under the sun. Instead of paying by visit, pay by outcome. If the Physician keeps let's say someone with Congestive Heart Failure out of the Hospital, he gets a “bonus” for each day, month or year he keeps someone out of the hospital. Instead of paying him each time the patient goes into the hospital. Hold hospitals to the same outcomes.
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Putting the "Public Option" in from the start of reform only puts a bandaid on the underlying wound that is eating up most, if not all of us. When in fact a total over-haul of the system is needed.-
15.1
There is so much to acknowledge and agree with here --both as matters of fact and of policy contention--- that I don't have time to do so, since I'm about to go to the Green Market a few blocks up from us in Manhattan with Lovely Bride (who wants fresh fruit from the farm NOW).
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Thanks so much for the intelligent, thoughtful, fact-filled discussion of this important issue, Rustydog.
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Our country is better off for having this kind of discourse between political opponents. -
15.2
Did you remember to take your meds for once Rusty? So nice to see reasoned, substantive discussions! On both sides!
I'm a died in the wool liberal and agree with pretty much your whole post. Controlling costs as a whole is key. Public option does not help if we just shift the burden to the government. Eventually, someone is paying that bill. And all this profit isn't just going to the insurance companies, it is also going to the docs.Combining this trigger plan with real price controls is the way to go. It passes mustard politically, avoids saying the scare tactics of the government running your health care, while finding ways to really reign in the spiraling costs. We need to not only take on insurance, but take on docs, take on hospitals, take on drug companies. It is all connected. We can't just make the insurance companies the great scape goat.
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15.3
I fully agree with Stuart and Holly ... , this is a really well reasoned write up by rusty, and I also agree with all of it. This is the way our discussions should go, whether we agree or not, we should not be disagreeable.
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Good stuff rusty, will it be too much to ask you to keep it up?
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16
http://online.wsj.com/article/SB10001424052970204619004574322401816501182.html
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I think this pretty much explains Dirigo and how it has worked out for Maine.-
16.1
I just read that, too. Most critiques of dirigo I'm digging up have a strong conservative bent. You'd probably love them, rusty, but others here....? Well, I'm going to take KT's friendly advice of "don't shoot the messenger" and let someone else post those links. Good luck.
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16.2
thanks, rusty. the one thing that that piece does not address, however, is whether the system might have worked if everyone had been required to have insurance. health economists i've talked to think it would have.
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16.3
BTW, the Maine experience was one reason Massachusetts DID insist on an "individual mandate." And while Massachusetts has had some funding problems, my understanding is that it is working, and will work better once it is fully implemented.
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16.4
Rusty, I have a serious question. What value does big for profit give us? Do you really think stock options, exec salary, profits are not done at the expense of care?
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16.5
I agree Karen, mandating is key as well as everything else. If we do not include everyone, someone who is young, healthy and pretty much disease free is such a lower risk to the insurance plan, whether it is public or private.
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It is basically the same situation we have with Social Security. We have to have 2 or 3 workers paying into the system, in order for 1 person to receive benefits.
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In the case of insurance, 2 or 3 "physically well" people, who use less of the benefit than average must pay into the fund so that the 1 person who uses over the average amount can also afford their premimum.
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But, will someone that is healthy pay into a system that gives back very little benefit to them? Why not continue the current practice of just going to the ER when needed? This I think is why the mandate portion of reform is required. -
16.6
That''s really what makes health reform such a fascinating subject, in my opinion, Rusty. Everything is connected to everything else, and if you don't get it all right, none of it really works as well as it could. You change one feature of the system, and it has consequences on everything else.
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16.7
…gotta run…good luck, KT, with this and your team today (Longhorns?)
Maine's superint. of ins., 3-17-09 Congressional testimony
http://energycommerce.house.gov/Press_111/20090317/testimony_kofman.pdf -
16.8
"Rusty, I have a serious question. What value does big for profit give us? Do you really think stock options, exec salary, profits are not done at the expense of care?"
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Two things trifecta, simply, choice and efficiency. Choice as the basis if I choose to have the cadillac plan, I can do so if I want. I believe in competition in a free enterprise, capitalist economy. I do believe that private companies will find a way to do it cheaper and more efficiently than a government program will do it. I think private companies will find better ways to do the same thing, spuring on growth and innovation. I have seen so many great advances in Healthcare over the past 30 years personally, I do not want to see that hindered.
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I believe that a private company will take all steps necessary to make it the most efficient possible. The incentive being profits or return on investment. And, if overall they make poor choices they simply go out of business, and we as a tax-payer do not continue to fund their mistakes. This is why I was so against the GM / Chrysler bailout. Now we have the feeling it is "too big to fail", and what does that do in the future? -
16.9
I whole-heartedly agree with you Karen. The more you dig into this, the more you see exactly what you said, "Everything is connected to everything else, and if you don't get it all right, none of it really works as well as it could."
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My biggest fear, and I think the fears you have seen expressed in the town hall meetings was simply that. If our government leaders do not get it right, then how bad will that affect me? Do I stand to lose a great health insurance plan in order for 20 or 25% of those who do not currently have insurance, be given the opportunity to get affordable health insurance.
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I am willing to take the risk, but I am also not stupid and want the best laid out plan in place from the start. Not some piece-meal plan that comes crashing down for all of us. -
16.10
My biggest fear, and I think the fears you have seen expressed in the town hall meetings was simply that. If our government leaders do not get it right, then how bad will that affect me? Do I stand to lose a great health insurance plan in order for 20 or 25% of those who do not currently have insurance, be given the opportunity to get affordable health insurance.
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How reasonable.
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Given the corrupt nature of our current legislature, I'd say that's more than reasonable --how prudent, even. -
16.11
Rusty the insurance companies will always be able to cater gold plated insurance for people like you that want and can afford them.
Why do the insurance companies not want the Public Option? Because they are afraid that thrifty people will decide that they would rather save money and opt for a plan that will really cover all their needs and they do not need a private room etc.
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17
"Insurance companies are likely to go along as well."
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Serious question-Or what?Say a LAW is passed that the Insurance Industry (or Big Pharma, or the AMA) doesn't want to "go along" with; what exactly is the threat here?
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18
Karen, I also want to take this opportunity to thank you for your continued re-visiting of this very important issue. I greatly appreciate your "digging" and spurring on our discussions within the threads of every one of your posts. It brings to us a positive and creative discourse, allowing our individual voices to be heard.
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You are truly, despite past statements and disagreements I've had, a great journalist. Your personal investment in this issue shows clearly, but you remain objective as well.
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Again, thank you.
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(And stuart, please say hello to the "Green Jobs Czar" when you shop at the "Green Market")
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19
The writing is on the wall and it's apparent that any real reform is not going to happen. Long live the status quo!
At this time, I will quote that great Canadian philosopher, Leonard Cohen:
Everybody knows that the dice are loaded
Everybody rolls with their fingers crossed
Everybody knows that the war is over
Everybody knows the good guys lost
Everybody knows the fight was fixed
The poor stay poor, the rich get rich
Thats how it goes
Everybody knowsEverybody knows that the boat is leaking
Everybody knows that the captain lied
Everybody got this broken feeling
Like their father or their dog just diedEverybody talking to their pockets
Everybody wants a box of chocolates
And a long stem rose
Everybody knows -
20
We've reached that point when compromise is required, which means the liberals have to do the compromising, because no one else will. Besides, we aren't even asking them to. Most of the MSM are too busy focusing on the liberals, and wondering out loud when they, the "hard Left," are going to compromise. We can't expect them to spend any time focusing on the "hard right", or any of the Blue Dogs. What strong arm pressure is Obama's team putting on them?
Many of us were criticized when we saw Obama hiring nothing but members of the centrist cult, when he first started. Now we see the fruits of that labor.
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20.1
No matter what, we always have to remember this:
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When Republicans are in power, 'bipartisanship' means that Democrats have to cater to the will of Republicans.
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When Democrats are in power, 'bipartisanship' means that Democrats have to cater to the will of Republicans.
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And where has this compromise gotten us, when Olympia Snowe is probably the only Republican vote we'll ever get in either house, even after chucking the public option and instituting the trigger?
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21
Anyone who thinks the Insurance Companies will make insurance affordable to all Americans on their own is clueless and deluded...
These Corporations are all about profit, and no imaginary "trigger" is going to make them suddenly people friendly or reduce their profits.
A seriously stupid column Karen!
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22
OK, honest question:
The purpose of a "triggered" public option is to goad the insurance companies into doing the right thing.
But the purpose of a simple public option is to do the same thing by giving consumers more choice and creating a more competitive market.
So what is the additional benefit of the triggers in terms of policy. (I understand the political benefit, which is that Snowe as a Republican is prohibited from voting for the basic public option.)
In other words: The trigger will be a complicated piece of legislative contraption. What does the additional complexity give us, in terms of market competition, that we don't get with a vanilla public option?
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22.1
In practice we probably get nothing. The industry gets sufficient complexity to maneuver in the back rooms and avoid the conceptual trigger ever being pulled.
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22.2
I also don't see anything that precludes a private carrier's continued incentive to deny coverage.
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22.3
That should be "deny claims." I guess denying coverage would be precluded, if that has any real impact.
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22.4
Well, I'm guessing that the actual purpose of the trigger is prevent it from ever really being triggered.
.
But for the sake of argument, assume the trigger is well-designed and would really create a public option if the insurance companies don't provide affordable coverage etc.
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Either the insurance companies can compete against that, or they can't.
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If they can, they can also compete against a plain public option. If they can't, the trigger would theoretically go into effect -- so why not just have the public option in the first place?
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I just don't see what the trigger buys us, other than extra complexity. The mind-set seems to be, well, we're not going to get a sensible plan, so let's go with a weird rube-goldberg plan.
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23
My main problem with dropping any public option is the policies insurance companies sell will only be as good as the regulators that oversee them (and fwiw that is why I oppose letting cross-state competitition--insurers will get their claws into some easy to bribe state like South Dakota and sell policies that don't really cover anything out of there).
As we learned over the past 8 years, we had plenty of laws to stop people like Madoff, and prevent all the massive leveraging and fraud in the mortgage markets. What we didn't have was regulators who took their jobs seriously (because as Republicans they are fundamentally opposed to the slightest business regulations).
The regulation will end up being all over the place if it is just a bunch of rules keeping these businesses on the level. If it is an actual financial floor on the playing field like a PO could provide, it wouldn't be as easy to just sell us junk and tell the disinterested regulator that all the t's are crossed.-
23.1
pafro wrote: "My main problem with dropping any public option is the policies insurance companies sell will only be as good as the regulators that oversee them"
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I think that's the key problem. The republican playbook ever since Reagan has been to put people in charge of government agencies that are opposed to the regulations they are supposed to enforce. Eventually the republicans are going to be back in power. When that happens new right wing regulators could eviscerate the health care reforms that are based solely on regulation.
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24
What did allowing the financial system to regulate itself get us?
There already are public options on the market and the private sector is doing quite well.
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25
"When Republicans are in power, 'bipartisanship' means that Democrats have to cater to the will of Republicans."
And if they don't their patriotism is questioned. Usually they vote in droves for bipartisan bills.
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"When Democrats are in power, 'bipartisanship' means that Democrats have to cater to the will of Republicans."And if they don't they are accused of being extremists and ideologues. In this case one, maybe two Republicans, vote for the bill. Maybe it is just me but I don't really see any "balance" in this, assuming of course that balance is a quality of bipartisanship.
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25.1
amen, amen, amen. Of course this wouldn't need to be true if the Democrats would grow a spine.
But if this gets the blue dogs besides Collins and Snowe, it will be worth it. It also puts off the panic about the public option.
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