What the Public Option Actually Does

Of course, Jokeline stacks the deck on the public option -- he doesn't want to discuss the "Hacker" publci option that will actually control costs, but rather the extremely weak version that is now part of HR 3200.

Here is what progressives are demanding (and its not the BS that the Klein twins present as the public option....) from the letter sent to Obama by the chairs of the progressive caucus...

Any bill that does not provide, at a minimum, a public option built on the Medicare provider system and with reimbursement based on Medicare rates-not negotiated rates-is unacceptable. A plan with negotiated rates would ensure higher costs for the public plan, and would do nothing to achieve the goal ofproviding choice and competition to keep rates down. The public plan with set rates saves $75 billion, which could be lost ifrates are negotiated with providers. Further, this public option must be available immediately and must not be contingent upon any trigger.

http://theplumline.whorunsgov.com/letter-from-house-progressives-to-obama-on-public-option/

We don't care what it does and doesn't do anymore.
It makes the right people whine. A lot.
Further, it is a line in the sand: is government run for the "public" like me that fought for this president and Dems in general, sent in money, knocked on doors, made hundreds of phone calls; or is the government run for insurance companies and tea baggers?
Somewhere between 50-70% of people want this thing. If we can't get it now our government doesn't exist for us and probably will slip even farther from protecting our interests going forward.

Ezra Klein's article is a perfect example of what happens to people as soon as they go "legit," they start contradicting themselves, in a single article. I suppose he is in search of the ever elusive middle ground when he suggests that at the same time the public option introduces competition, it doesn't reduce costs. Competition leads to lower costs is the theory I'm familiar with. This is like saying a goat is not really a goat.

How on God's green earth did you get from public option to "a system where every doctor and nurse was employed by the government."

Also, I don't think you know what "single payer" means.

And you're against a public option because the Republicans are against a public option which makes some Democrats oppose the public option? Now that's good policy makin'!

But they are not the same as cost control. Cost control happens when we use less treatment, need less treatment, or pay less for treatment, and the public plans under consideration don't really do any of those things. In fact, the bills under consideration don't do any of those things, though I think they're a useful first step. This step in health-care reform is largely about expanding coverage and creating a structure — with universality and the exchanges and so forth — that will make cost control easier down the road. None of the bills, on their own, really do all that much to control costs.
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But price controls WILL control costs. But, neither party is set to pass legislation that addresses cost control. Even Tort Reform would go a long ways on cutting cost of not only insurance, but what we are charged for the treatments. Malpractice insurance is just as out of control as Healthcare insurance. But, our esteemed lawyers will lobby for keeping it as is. And we know that most lawyers are lobbying like crazy with the Democrats to not touch Tort Reform.
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Republicans due to their rigid beliefs that Government should not control costs, let the free market adjust accorndingly.
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Democrats will not introduce legislation to control costs because it would define that the "Public Option" is simply not needed.
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Either way, Americans as a whole get screwed.

@ pafro- the first line of your post it what makes this an absurd argument for me. We are supposed to be rational and reality-based community. I can't say that I am averse to the sentiment that anything that causes repubs pain is worth doing, but it's not how policy should be made.

@Derek, I knew this complaint about Klein was coming. Previously treated as a visionary writing some very intelligent and thought provoking articles now treated as a sell out because he has either moderated his position or is not as strident as he once was. That's a shame, it seems to me - and certainly no incentive for any of these intelligent commentators to flood the so-called MSM if all that is going to happen is they get called sell outs. The adage that competition reduces costs is a typical market-based philosophy that is sometimes right and sometimes wrong. It is not necessarily true in all cases and given that, as Ezra explains, the public option in the current bills (which, let's face it is the highest it's going to be at this moment in time) is limited to a certain tranche of people it should certainly not be assumed that it will in this case. The exchanges should be where the bigger costs control comes in, with the increased bargaining power of individuals and small businesses.

Joe Klein:
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Disregarding for the moment the strange incoherence of your support for government-run insurance (single-payer) but not a government-run insurance plan (public option) because of your contention that the latter may lead to government-provided health care, but the former will certainly not...

I still believe that insurance reform and the expansion of coverage are too important to let lapse right now, even if a triggered public option isn't included.

Then why not just pass national regulatory prohibitions on rescission, and denial of coverage, institute statutory premium and out-of-pocket expense caps, establish perpetual portability so that coverage can be kept forever regardless of one's employment, and be done with it?
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That would entail no onerous individual mandate, no government-run anything, no anti-globally competitive business mandate, nothing but insurance reform as you describe.
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That would surely be a political winner with no downsides whatsoever, right? No public option, just completely regulated-into-affordability health insurance?
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What's wrong with that plan, Joe Klein? Something about costs...?
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No public option, no mandates. Period.
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Asking the public to sign on to a requirement that they personally, individually pay for a health insurance industry bailout, without providing a cheap, public insurance option that negotiates with the power of Medicare behind it is bad policy and political suicide. You're asking Democrats like representatives Anthony Weiner, Jerry Nadler and Carolyn Maloney to be killed in primaries in my state if they vote for such an abortion. We love these people, but if they're arm-twisted into this bailout, they are going to be hit, hard. Make no mistake: Progressives in the House are threatened if they support insurance industry bailout legislation that every single one of us individually mandated citizens will remember at tax time.
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When you say the right-wing smear campaign has succeeded and moderate Democrats, and a few stray Republicans, who might otherwise vote for health care reform won't do so, you forget that its much, much easier for Progressives to keep their seats by voting against another industry bailout than it is for centrist Democrats to hold on for another two years. If you're right about the right-wing smear campaign, we can reliably predict that Rahm's Blue Dogs will largely lose their seats next year anyway, so why should the Progressive Bloc take a chance on losing theirs?
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If you want to prohibit insurance discrimination, go ahead and propose it, we'll vote for it. But if you want to pass legislation designed to keep centrist Democrats in their unpopular seats through industry dollars, you need to give mandate-burdened people a way out, which is why a strong public option is a requirement of any legislation that we will support.
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At the end of the day, it's either real reform with mandates, or it's harsh regulations on insurance without new burdens individuals and businesses. If the "moderate Democrats, and a few stray Republicans, who might otherwise vote for health care reform won't do so", then we need to ask "What have these people ever done for us"?
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Well, Joe Klein? What have "moderate Democrats, and a few stray Republicans" ever done to deserve such power over ordinary people's health and lives?

im struggling not to call an absolute imbecile here. Why are you even talking about the public if don't know the first thing about it?
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first of all, if you're talking about a trigger, you're no longer in the policy realm. you're just talking about politics. And second of all, having a trigger PLUS a state-based public option is about the worst combo you could ever have.
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The reason you have so few insurance companies is the costs of entry into the industry. you're saying we should be making those 'coe' investments for each state instead of just one larger investment that is sustainable.
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you're saying that (implying) that the health exchanges should be state based. which means because they will lack clout, insurance companies won't have an incentive to join. which defeats the whole purpose of reform. prices will climb. Rescission will continue.
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i won't even waste any more energy resources on this fairly idiotic piece.

Couple of questions for Joe:

1) What does unfair competition from a public option mean?

2) Why can't I just have a choice between paying my premiums to my private insurer as I do now and paying taxes to the government in exchange for Medicare instead? Seems to me that if the private insurer really wants to keep me they'll offer either more generous or cheaper coverage.

This entire post is useless as the public option is dead. The Blue Dogs say no...

http://www.political-buzz.com/

This is incoherent. #2 is a reason to oppose the option to enroll in Medicare before age 65 only if you believe the environment is such that right-wing smears wouldn't start if you were not proposing that. But we all saw what happened there.

#1 seems to me plainly incoherent, since it presupposes that a Medicare extension would work so well as to make "competition" impossible. Really? Then you are just saying that the value of competition in HC is nil: why is it a goal at all to have a competitive market in HC? #1 is worthless as an argument since it concedes the opponent's premise.

"A line in the sand is for setting the perimeters of sandcastles not the parameters of debate."

I hope this stubborn unwillingness to even look at things from a different perspective is just a by-product of youth, because then it means you have the ability to learn that there may really be a bigger picture at stake. I recognize that many of you were still watching sesame street the last time this debate was televised, but that doesn't mean you can't look up the history and become more informed about how transformational legislation happens, rather than relying on the bloggers and partisans that have never held public office, been part of an advocacy campaign and actually brought about change in the real world of politics.

Some say that the my way or the highway approach to politics worked for George Bush -- I guess they have already forgotten how badly that turned out. In 1993 we failed to compromise. We let ego and power plays dictate the outcome and we ended up empty handed and out on our a$$. Democrats were dispatched from office and who took the hit? It was poor people with welfare reform and the crime bill. As much as folks applaud Bill Clinton, all he could do was to push Republican leaning programs like NAFTA and afterwards we ended up with eight years of Bush.

So now many of you are poised to do it all over again -- that's insanity! More importantly, this absurdity is generally only pushed by those who either have health insurance or at an age where it is not their most vital concern.
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The bottom line is that a trigger is perfectly reasonable and acceptable. How is it that the same people who argue against a trigger on the grounds that health care reform is so urgent that we can't afford to accept 80% of what we want and wait another two or three years for a trigger to kick in the rest -- but say its okay to trash all of our reform efforts and have nothing at all and wait another four to eight years to make it happen. Do the math! On what planet is that the most effective use of time and resources? Tell me that the high way option isn't the dumbest strategy ever pursued.

Especially, since phasing in a public option even if it was to pass today, would take several years while the restrictions on industry's worst activities, like prohibitions on cherry picking, pre-existing conditions, and subsidizing those who are locked out by cost and preventing them from dropping coverage on people when they get ill could start day one!
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The most important aspect to remember is the ability to lay a foundation that the other side can't remove. If it fails this time you can pat yourself on the back that you stopped the hated centrists and the GOP can pat themselves on the back because they stopped the dreaded liberals. And those of us who really need reform get screwed. But so what because you worked for Obama and you want it your way or not at all.

I'm sorry, but its just stupid and selfish and don't claim to be acting on behalf of the 47 million uninsured, because frankly, this all or nothing anthem is the perrogative of elites not those struggling to get by. If you really have their interests at heart, then you support the bill, and you come back to tomorrow and fight to make it better and before you know it it will be exactly what you want. Who knows, when they go to do entitlement reform maybe they'll revisit it then. But if your are going to spout off and demand change then understand what it takes. Understand who it effects. Understand who you hurt with your rhetoric.

Now I recognize that some in the progressive caucus see this as a means to wrestle power away from blue dogs. to settle old scores with Lieberman (which I wish we could indulge in that moment) despite the fact that the average uninsured American doesn't know who the blue dogs are. Frankly, this is no different than the GOP who have made defeating health care a strategic imperative because politically it makes it harder for them to regain majority status if the Democrats win on this issue. The bottom line is no one is thinking about what's at stake to the ordinary American. We can't call ourselves any better than the right if we are willing to sacrifice the people for political gain. I thought that's what set us apart from them, but this debate has forced me to rethink that assumption.

Elvis -
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How did you take one example of high cost in McAllen and extrapolate that to "tort reform doesn't work"? Do you not concede that there are many possible cost inflators in the health care system, and that the cost of malpractice insurance might be a contributing factor?
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Health care costs in Texas may not be low, but I live in Texas, and I can remember when tort reform was passed. Prior to tort reform, doctors were leaving the state en masse, searching for greener pastures. After tort reform, they came back.
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Not saying tort reform is the answer, only part of the answer. Democrats should not be so obstinate on the issue.

Joe:
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I would be opposed to a system where every doctor and nurse was employed by the government.

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How did you get from the public option to a system where every doctor and nurse was employed by the government? You do realize that the public option is a public insurance option, and not a public healthcare option? I don't care how many dominoes fall, it could never reach a point where doctors and nurses were employed by the government, even if we transitioned completely to single payer. It would still function just like Medicare and Medicaid, not the Armed Forces.

Joe chanelling Ezra, Ron Brownstein telling Andrea Grrenspan that going for the PO is a loser; Chuckie T pushing same meme : it goes on and on. Modified Limited Hangout on full display: let's satisfy the Republicans, take what we can get (there's pragmatism for you) and the "Centrists a la Harold Ford" will find that magical center where they will get run over - according to WaPo's Eugene Robinson.. Brownstein even refers to Lieberman to support his "cave in is better that stand up trope". If one thinks Lieberman is a reliable vote on any with or without PO bill...I have an island...

Medicare, a public option, hasn't turned into "a system where every doctor and nurse was employed by the government," so why would a public option for people under 65 have that result?

But to extend your mistaken point:

The only health care system that employees doctors and nurses is the VA. Are veterans receiving bad care?

I still don't understand why we're so fixated on insurance as our answer to everything in regards to Health. We don't use our auto insurance to pay for our 3,000 mile oil change, or our 50,000 mile check-up. Why are we so dependent upon the insurance and their network of doctors and hospitals to manage our routine health care?

Instead, why don't we take the money we would be pumping into all these tax credits and public options and set up a national flex spending account that each of us owns? Each of us can contribute to it so can our employers as well as the government. Then with these cards we can go to ANY hospital and ANY doctor that we choose.

We can use this to pay for our eye care, our dental care, our normal health care. That way we can have a TRUE market driven competition that is health providers and health care consumers, instead of processing middleman (who has oligopoly powers) against everyone else.

We then use insurance for exactly that, insurance against major health issues, there by keeping the premium down.

I highly recommend the book "undercover economist" and the chapter on the health care system in Singapore for reference.

I was going to post some research that shows "defensive" medicine, where doctors do needless tests to protect themselves from malpractive lawsuits, only accounts for between 1 and 2% of all money spent on healthcare but there is so much evidence of the futility of tort reform rendering savings that I suggest everyone google to get all the info out there.

People forget that many lawsuits are thrown out by judges before they even get to discovery. And that if the damage awards are too over-the-top, they get reduced by judges. And that juries have heard lots and lots of testimony about specific cases. And that the Mayo was never successfully sued until recently.

Tort reform is just another smokescreen that Big Insurance uses to take the heat off of themselves.

Re: "Tort Reform"

I have few problems with this subject.

First, people keep bandying about this term as if it has any meaning. It doesn't. Talking about "tort reform" is like talking about "health care reform". It is no more possible to talk about the effects of "tort reform" as it is to talk about the effects of "health care reform." Unless you get into the details of what reforms you are talking about, all discussion is meaningless.

Second, with all due respect, most people do not understand what, if any, problems they are trying to solve. In my opinion "too much litigation" is not sufficiently clear.

Third, when people do try to articulate the existence of a problem, they rarely, if ever, provide any data to back up their claim. Doctors practice "defensive medicine"? Doctors order too many tests because of the fear of a lawsuit? What data? And how collected?

Fourth, legally, most people don't have a flying f---- what they are talking about. They don't know the substance of existing tort law, and medical malpractice in particular (i.e. what it takes to prove liability). No do they know what existing procedural legal safeguards are in effect. Or know the economics of litigation (i.e. what actually makes lawsuits expensive and how to minimize those costs).

What the public option will actually do is allow those of us currently struggling to pay for private medical insurance to dump our overpriced, claims-denying plans and finally be able to buy insurance that will pay for medical care instead of paying the salaries for claims agents that do nothing but find ways to deny claims. That's why the insurance industry is spending millons a day to stop it -- because they know that millions of America's like me will immediately abandon private insurance coverage and they will lose incredible amounts of money. I personally, will be first in line. I'll trade my Blue Cross Blue Shield insurance card with a $5,000 deductible for a US Government Medicare card any day!! I can't wait!

I am a Norwegian, living in Norway. We have Universal Health Care.
Hospitals are mainly owned by the regions and given budgets by the government. No bail-outs if they can't keep them.
Private physicians run their own businesses, like lawyers etc. Some income is directly from patients, some is refunds from the governments. There is a limit to what a Norwegian pays for prescription medicine and treatments, above that is refunded by the government.
Hospital stays are free. Going to the ER is NOT.

When His Majesty King Olav V had an eye problem in the 80s, he went to a public hospital to have it done.

Joe: glad to read your response and its even tone noted.

What I find hard to accept is why the PO cannot be one of the choices. You point to built-in advantages. Well, the federal govt has built in buying power ; the vets (God Bless 'Em) have services - which they have undoubtedly earned. Why can't those with lower income have a program that helps them and is not profit oriented? You know, basic healthcare without $2000 a day private rooms.

The response I get is that if we had a public option the floodgates to that choice will be open. What is so wrong with that?

Does the US exist to protect corporations only?

Is Matt Taibbi the only one to tilt at windmills? (Irony intended).

Prof Baltasar:

So your King goes to a local hospital. Well we have the same here. One of the principal architects of the Senate plan has used a public hospital right here in Washington. The staff are all govt employees. Its a rather pokey outfit called the Bethesda Naval Hospital. Not much to speak of but very popular with a lot of our politicians.

I can't go there, except when I am on a stretcher, and not sure that even that will help.

"I oppose it, for the moment, for entirely pragmatic political reasons..."
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Considering a majority of the public wants a public insurance option, what you are saying is that if industry can buy off enough of our elected representatives to threaten needed reform, the practical thing to do is get behind industry's efforts to undermine needed reform. Glad to know who's side you're on, political pragmatism wise.