Public Option Premiums
would actually be higher on average than those charged by private companies participating in the new health insurances exchanges. At least, that is the surprising conclusion of the Congressional Budget Office, which Politco's Carrie Budoff Brown found in its assessment of the new House bill.:
Here's the key passage from page 6:
Roughly one-fifth of the people purchasing coverage through the exchanges would enroll in the public plan, meaning that total enrollment in that plan would be about 6 million.
That estimate of enrollment reflects CBO's assessment that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges. The rates the public plan pays to providers would, on average, probably be comparable to the rates paid by private insurers participating in the exchanges. The public plan would have lower administrative costs than those private plans but would probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees. (The effects of that “adverse selection” on the public plan's premiums would be only partially offset by the “risk adjustment” procedures that would apply to all plans operating in the exchanges.)
UPDATE: Ezra Klein's take on the CBO rationale.
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1
Well, since these people are often "uninsurable" now is this an apples to apples comparison? If insurers had to take these people with pre-existing conditions, and were left to their own devices, how much would they charge to them?
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1.1
Agreed. But it does suggest the that public option won't be as attractive a choice as many of us assumed it would for relatively healthy people who now lack coverage.
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By the way, our WordPress program is refusing to post PDFs for me. I will post a link to the full CBO report when I can get the High Sheriffs to make one for me. -
1.2
It also explains why it would have such a (relatively) low enrollment.
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1.3
This sounds like an EXCELLENT argument for Medicare +5 rates. Oh wait, thats right I forgot. We "didn't have the votes" for that one.
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So much BS man I swear.
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2
Does this not depend on the form the public option takes? Open to all. Open only to select few who can't get/afford other insurance, this restricting the size of the pool. Medicare +5. It matters.
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2.1
Medicare+5 is not in the House bill, and the Speaker has indicated that she believes it doesn't have the votes. The CBO scored the actual bill.
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2.2
pelosi told david rogers she is not going to allow a floor amendment on the medicare+5 public option, also known as the robust public option:
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http://www.politico.com/news/stories/1009/28919.html
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Key quote:
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“I'm not big on showing weakness. It's not my thing,” she said in the interview. “I don't like to have predictable losses.” -
2.3
"Medicare+5 is not in the House bill, and the Speaker has indicated that she believes it doesn't have the votes. The CBO scored the actual bill."
That may be true, but it would put the "fiscally responsible" Blue Dogs in an awkward position if it were shown they were pushing a less fiscally responsible bill. And Weiner was on Maddow last night making precisely that point:
Visit msnbc.com for Breaking News, World News, and News about the Economy -
2.4
Drat, didn't let me embed, although the preview did. Here's the video link to Maddow and Rep. Weiner:
http://www.msnbc.msn.com/id/26315908/vp/33543276#33543276
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3
less management of utilization by its enrollees and attract a less healthy pool of enrollees
AKA less denial of benefits for treatment.....
I still find it ironic that the defecit hawks on the ones holding out for more expensive solutions......
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4
Only in KT's world would it be "surprising" that a less healthy risk pool would pay higher premiums.
Politico's "analysis," which KT dutifully parrots as a good Villager, is comically stupid. In all sincerity, if I was an editor and I saw that a writer was this confused despite months and months and months of reporting on this very issue...I would fire the writer on the spot. Do I really need to explain the idiocy of comparing projected PO rates to projected private exchange rates (with the PO) in order to analyze the utility of a PO?
SZ has done yeoman's work in trying to get the Swampland contributors to grasp that, when you are discussing national health care/insurance reform, any meaningful analysis must compare system-wide costs and benefits under today's system to system-wide costs and benefits under alternative "reform" systems. Apparently SZ has not succeeded.
SZ is far more patient than I am. My tolerance for Beltway bullsh-t is at an all-time low.
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4.2
Au Contraire, the CBO drew a straight-forward factual conclusion about projected premiums (I'm not agreeing or disagreeing with the specific projections).
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Politico's analysis -- which you tacitly endorsed by linking to them without further comment -- was that the CBO report:raises doubts about Democratic promises that a government-run insurance plan would provide a lower-cost alternative to consumers.
If you agree with this statement, then you clearly do not understand the rationale for the public option.
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Democrats have never promised a lower-cost alternative. What they strongly suspect is that the existence of a public option will hold down the cost of premiums across the board, both by allowing people to enroll directly in the public option and by forcing private carriers to only charge competitive rates.
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This is the aspect that both you and Politico completely ignore. What would the private carriers' rates be without the PO? Lower private carrier rates may be a sign the PO is working not failing.
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Regardless, it isn't proponents of the PO who are "promising" an outcome. After all, if proponents are wrong and the government can't competitively administer the program then people simply will not sign up.
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It is the opponents of the PO who are promising that the very existence of a government-provided insurance option represents such an existential threat to our society that they are willing to filibuster the entire package to prevent it.
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5
Karen, thank you for posting this.
This is presuming that the Public Option will only attract the unhealthy. I looked at the basic plan for the house and it looked really good to me. Why would not a lot of small business like a plan like this for employees?
True that Medicare Plus FIve is out, but is there anything that stops them from starting negotiating at Medicare Plus SIx rates?
I thought the idea of the Public Option competing on a level playing field was that the risk was going to be shared.
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5.1
Karen, thank you for posting this.
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Yes, the world needs more uncritical regurgitation of Politico spin. -
5.2
sq.,calling out stuff in disagreement is one thing. Calling out another commenter for politeness is another. I also doubt getting in Karen's face is going to make her do what you want, but I digress.
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6
Does it matter? The WH opposses it anyway. They still want the trigger to prop up President Snowe
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7
This is all pure conjecture in my opinion. Yes, it could happen, but the assumption that the public plan rates paid to providers would "on average, probably be comparable to the rates paid by private insurers participating in the exchanges" is just that, an assumption. What if the public plan is able to get slightly lower provider rates? I'm not yet convinced that can't happen. And who knows, perhaps a few relatively healthy people may opt to join the public plan to get away for the excessive "management of utilization" by private insurers.
Also, even if the public plan premiums start out higher, I can see the public plan administrator. a.k.a. the goverment, doing everything under the sun to keep those premiums lower than what they would have been without this bill...I'm sure CBO will keep supplying numbers that will force the government's hands on this. That could be enough to keep premiums from rising at the unsustainable levels they keep going up at now.
Renegotiation of provider rates could also lead to some lowering of the public plan premiums as time goes on, which could in turn force down premiums for the private plans in the exchanges. As long as premiums stay affordable, why should it be a problem even if the public plan premiums remain a tad higher than those for the private plans in the exchanges? I would be fine with that.
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8
square1, I thanked her because I think that this will get a lot of attention, and Karen does not have a closed mind and does look into argument's commentators make and will post if she finds this wrong.
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9
Be sceptical about much of Politico's offererings. They post breathless stuff slightly better written than Drudge.
I know, I know: Villagers are loath to be hard on fellow inmates.
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9.2
I should also say I have found Carrie Budoff Brown's health care reporting to be very good. I recommend it to all of you guys.
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10
"The surprising conclusion of the Congressional Budget Office, which Politco's Carrie Budoff Brown found in its assessment of the new House bill.:
That estimate of enrollment reflects CBO's assessment that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges."
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Do you people actually read and comprehend what you write? Apparently not.
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This is what Conservatives have been saying about any insurance reform from the beginning. If you first do not go after health care costs and insurance rate costs, then the so-called "reform" is going to end up costing people more than what they are currently paying, or in most people's cases, not pay for something that is so expensive and beyond their means to pay for it.
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As stuart has said over and over, "why is the cost of health care insurance for Americans over twice as much as the other OECD countries in the world"? Simply ask that question first before going into a 1990 page bill that will not solve any problems what-so-ever except cause the cost of health care insurance to at minimum double.
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If you first do not tackle the problems that are causing the problem in the first place, such as non -competition amoung health insurance companies, then you solve nothing with this reform.
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Open up State to State selling of insurance, the same as it is for car insurance and any other type of insurance out in the open market place. You MUST first do this one simple change before you will see any deep cuts in the price of health care insurance. While you are at it, put into place Tort Reforms on a national level, it surely could not hurt anything to try.
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Look at abuse and fraud now, especially to Medicare. Cut the waste and abuse out of that system to set up a model for any future public plan to follow, using Medicare as the basis. If there is indeed so much waste, abuse and fraud in the Medicare system, won't you have the same situation under another Government backed insurance plan?
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Wake up people!! Wake up before it is too late and the imbeciles in Washington change your own health care insurance today, hoping to make it better in the future. The Government has never made anything better. It has always made it more expensive, and the tax payer has always ended up holding the bag.-
10.1
State to State selling can only be done under the condition that the policies must all cover the same things. Example some states allow policies that do not cover maternity care, others will not. If this is not regulated then the policies will gravitate to the lowest common denominator, I.E. the weakest policy.
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10.2
Prehaps, allthingsin...
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But if Federal Regulations are enacted with these reforms for State to State, then that will in and of itself solve your problem. -
10.3
And we will have the GOP crying about Government intervention into State's Rights. It is one big circle.
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10.4
Competiton among insurance companies has little to do with the underlying costs of health care. In fact, experience shows that the more insurance companies you have in an area, the less control they exert over provider charges. The only thing the insurance companies control is their own profitability -- and they do that by offering poorer coverage for less money to healthier people.
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Insurance companies are not the problem in US health care. Nor are greedy hospitals and doctors or spoiled, clueless patients.
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The problem with health care in the US is that all the players are operating in a flawed model that doesn't have a hope of delivering appropriate treatment to everyone who needs it without bankrupting his family, company and country.
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The idea that competition among private insurers can control costs is a conservative fantasy that is misguided as liberal faith in "the public option". No successful national healthcare plan depends upon competition among payors (whether insurance companies or individuals) to control costs -- not one.
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Health care reform in this country was doomed as soon as legislators and policy experts defined the problem as "the uninsured". That guaranteed that the only solution considered would be more of the same dysfunctional model that got us here. We do not need to build another story onto a structure with a crumbling foundation by creating yet another program.
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What we need is a different foundation -- one that sweeps away employer-paid, private insurance as the centerpiece and focuses on getting appropriate care for all. We need one plan that applies to everyone. I don't care whether it is single-payer, tax financed (Canada, China, or Japan), all-payer, employer/employee paid private sickness funds (Germany or France), or individual payer, private insurance (Switzerland or the Netherlands); the point is it should be a national plan with the same basic provisions for all qualified citizens/residents. The plan should also include provision for supplementary policies to cover more than the basics.
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In other words, what we need is some sort of public plan ...with private options.
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11
No, State to State insurance reform IS a major proposal of the GOP. It is the Dems who have been fighting against it.
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11.1
But this still does not get around pre-existing conditions and the poor. who can't afford insurance as is. Assume premiums can be cut by 25% this will still leave a good number unable to afford the premium. Any thoughts, Rusty?
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11.2
Yes it is, but there is no mention of regulating what can be sold. The GOP knows that if they can get it without regulation then the insurance industry can sell what they like without State control. If the Feds Regulate it they will scream State rights, Government take over, Government control, Socialism, the whole ball wax.
Do or don't, you know it will be a mess.
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11.3
Simply cutting the cost as I have said will at least lessen the burden on the tax payer so that the subsidies and credits the poor will recieve are less "taxing" on the rest of us. Yes?
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I would also be in favor of spending money on the set up and training for community clinics. You can hire Nurse Practioners and Physician Assistants at half the cost of an MD or DO.
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Anything that will help to bring down costs in my mind works. Rather than just throwing good money after bad with the current bills as proposed. There will be a critical shortage of health care workers, that needs to be addressed, which I am glad to see the House bill does put some effort into, but I do not think it is enough.
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Plus, I think the "deal" Obama made with the Drug Cartels know as Pfizer, Bayer, et al should be investigated and reviewed. There is a tremendous amount of savings to be had within this one component as well, but Obama sold us all down the river on that one. -
11.4
Rusty,
Your 2nd post is right on point. Unless we do something to lower the costs of providing care, this bills proposed will do nothing to lower the growth rate of health care.
So the real question is what is the primary reason for "health reform". Coverage for everyone or lowering costs. If anything, the bills address the former without really addressing the latter.
As far as being sold out. Don't blame Obama, blame Congress. Big Pharma has more lobbyists than even the insurance industry and they are making sure their interests are protected. Even Henry Waxman got taken to the woodshed by his own committee when he went after Big Pharma.
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11.5
State-to-State insurance reform is another diversionary tactic that has nothing whatsoever to do with the underlying problem. Those who think that salvation lies in making more high-deductible, inadequate coverage available across state lines ignore the evidence that already exists about these plans.
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Affordable premiums do not equate with affordable care. 78% of bankrupts last year had health insurance and yet 62% listed medical debt as a precipitating cause of their insolvency. The recent hearings about underinsurance should illustrate just how illusionary (some would say dilusionary) it is to think that such a plan could do anything to mitigate escalating costs. Extending more inadequate policies to more people wiould not help anyone but insurance companies.
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Insurance companies are not about health care, they sell financial products to as many buyers as they can find. Whether or not those products actually pay for the care the subscriber needs is not a concern of the insurance company...but it should be a concern for us as a society.
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12
KT -- You seem to be caught in a bit of a dilemma. On the one hand you have a number of astute commenters who see the banality of this analysis and question how you could just simply repeat the drivel without first casting a critical eye. Yet, your response does not deny this circumstance, it simply points out that they have gotten the authorship wrong as if knowing the source would somehow negate the original assessment.
However, you seem frustrated by the number of times you've had to repeat your response, while at no point do you actually address the issue, regardless of who you attribute this lapse in logic to, it still remains faulty. My question to you is why would the media take any one's analysis at face value? Why would you pass along any information that you had not critically reviewed? I thought that was the premier rationale for the old media. Isn't this what you claim when you deride the rise of the citizen journalist? Isn't this what is written by every supercilious villager who laments the days of abundant jobs and foreign bureaus? If the value you add is not the expert critical eye, if we can't count on your ability to discern the truth and pass along validated information, then what is the value of the media and why should we care whether or not you are on your way out?
Apparently, you are now saying that it is all a myth, the media has no purpose beyond gossip mongering and stenography, because it clearly can't get out of its on way to police itself when one of its own steps out of line from covering news to manipulating it, as in the case of fox. Now you cannot even verify the information to ensure that we are getting an accurate read on the myriad parts on which we must base our decisions. I am left with one simple question -- what good are you?
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12.1
“…why should we care whether or not you are on your way out?”
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Dee, read KT's last post; there's analysis there. At any of your fave media sites you'll find many “pass along” stories of others' quotes. KT's probably been quoted often. Hopefully you or I have too (okay, probably just you or stewart, et al). However, re: your quote above, are you really saying you want KT to leave? Or Amy? Or Jay? I don't. Just asking. I've read the recent stories about Starfleet Command here possibly laying off more people. Forbes has already started the beheadings. The Fed and biz news channels are trying to tell us the recession ended yesterday, but too many people are still out of work; let's NOT add to it, k? -
12.2
...that's stuart, my bad. I'm watching "Family Guy" clips on hulu. At least I didn't write "stewie".
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12.3
Drivel? Dee, weren't you the one defending CBO here the other day? Have I mentioned it's their analysis?
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12.4
Why, yes, here it is!
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Dee in Columbia wrote at 2:26 p.m. October 27:
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http://swampland.blogs.time.com/2009/10/27/the-public-option-five-reasons-harry-reid-went-for-it/#comments
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Oh so now the wingnuts want to throw the CBO under the bus! That's not what they were saying when CBO numbers bolstered their cause. They couldn't wait to tout their numbers when it came out over a trillion dollars, even though you were willing to focus on partial reports and unrevised figures. But of course now that the numbers are not in your favor, in fact show up your lies for the lies the rest of us always knew they were, the CBO has the credibility of some old hack scribbling on the back of a napkin. Let's face it, conservatives are absent anything even close to resembling integrity. They want to win regardless of how shameless they have to be in order to do so. They touted CBO as a non-partisan, unassailable research -- but now that they don't like the numbers they want to destroy the representation of the in favor of what that faulty industry report that got laughed out of the room? -
12.5
Ow! That's gonna leave a mark.
I'm not sure I put much stock in this new CBO guesstimate based on some pretty broad assumptions, but I can't fault KT for reminding commenters of what we've said recently. If nothing else, it's a tribute to her willingness to take comments seriously.
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12.6
I guess I hit a nerve, and here I was wondering does anyone actually read these posts. Obviously, that's both a yes and a no. First off if you had actually read and understood what I wrote you would have noticed that I didn't defend CBO -- I used CBO to attack conservative hypocrisy! They are the ones that touted CBO when their analysis supported GOP positioning and the moment it did not they threw them under the bus, which is hypocrisy of the highest order.
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Second, if you read and understood my post, I wasn't saying that KT should lose her job. I was pointing out that despite KT saying numerous times that CBO, not politico was the author of the analysis, at no point did she address the larger assessment that the analysis was flawed. So I am asking is she saying that if CBO says it then no further questioning of the analysis is in order? Are we at the point when the media admits that they are stenographers and that all of the rationale's for having a media filter is actually nonsense because they don't critically vet the material they pass along?
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Now if you want to make this argument about something it's not that's your choice, but don't drag me into it, because I don't come here to defend or knock the information presented, I come here to assess the role the media plays in the stories it tells. You may not want to reflect on the impact of what you do, but since the impact of what you do affects my life then I feel an obligation to review how well you do your job and point out if and when I think you've done it poorly. If you don't think I'm qualified or have no right to pass judgment on that, then please tell me who you think is supposed to -- because they are not doing it. Do you think that you should have an unfettered right to free speech and then no responsibility for the impact of what you say? I think not.
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13
CBO's semi-speculation appears to have no real handle on the extent of private insurance administrative inefficiency. The modest and conjectural risk of slightly higher premiums in the public plan is up against the reality of the status quo, where premiums are already rocketing upward and will assuredly continue to do so.
The knee-jerk jerks in opposition to reform – largely for zero-sum political motives – propose only restricting Americans' right to jury trials (a demonstrably ineffective"government takeover" of our civil law system) and the interstate sale of junk insurance issued in states that let the insurance rabbits guard the consumers' lettuce.
I know which of those risks I'm wiling to run.
Also, consider this: Congress will still exist after the bill is passed. If the reform in practice needs tweaks, tweaks can be made with far less sturm und drang than we're seeing with an initial overhaul.
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14
As I noted earlier, I am unable to post links to PDFs at the moment, but if you want to see this report from the Congressional Budget Office, you can download it yourself by following this:
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http://www.cbo.gov/doc.cfm?index=10688 -
15
Hooray! The High Sheriffs have given me a link to the CBO analysis. I've also imbedded it in my original post.:
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http://timeswampland.files.wordpress.com/2009/10/hr3962rangel.pdf-
15.1
CBO expects that the Centers for Medicare and Medicaid Services (CMS) will soon announce payment rates and changes in payment rules for physicians' services and other services that are set on a calendar year basis. (what was taken out of the bill so that Democrats can show that the cost of this bill is less than actual)
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Those payment rates and rules may differ from the current-law assumptions underlying CBO's baseline projections. If so, CBO will update its estimates of Medicare spending under current law to reflect those changes and will revise these preliminary estimates of the impact of H.R. 3962 to reflect the effects of the new rules on spending under current law and under the bill..
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I'm sorry, but what the CBO is dealing with are only those items in this bill which are written, but not what will eventually happen. Everyone knows that there will NEVER be any cuts made to Medicare or Medicare Advantage. Over 500 BILLION of the supposed "cuts".
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Couple that with the increase in cost to cover those who they plan to enroll into Medicaid, and you have a budget for this project of over 1 TRILLION dollars.
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"Yes we can"!!! "Change we can believe in"!!!!
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16
I posted a response to you KT in 12.6. But I'm sure it won't really matter because you've already established a pattern of changing the subject rather than respond to my challenges to journalistic ethos. Rather than explain how my assessments of your job performance differs from reality you choose to defend against something that I am neither asserting nor would be right in asserting had i done so. Too bad you don't use that same kind of strategic energy to break out of the village walls. You and your brethren seem to be content to wallow in a comfort zone of cynicism rather than recognize that it creates a bias that forces you to discount any change you may encounter and virtually smother it with neglect before it has a chance to flourish. Moreover, you must think it so beyond the pale to point out this obvious flaw in the way you do your job that you've attempted to ostracize me from the group by asserting I have done you wrong in a way that I have not, or am I to believe that a Harvard grad needs this much work on her reading comprehension?
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17
Dear Dee in Columbia MD & Square 1,
Perhaps I'm missing the boat here but I fail to understand your comments or the comments which demand Karen (and others) to have a high content of analysis in all their posts. If they were out and out lying, I could understand the rage that seems to exist behind some of the comments about what they say but Karen is reporting what seems to be relatively new information to us. Does she have to provide critical analysis of everything she believes is interesting? Shouldn't Karen (Or Ms Tumulty depending on the level of formality one wants to take with this forum
) be allowed to post items of interest which we can use for our own analysis of the situation or is that taboo because we can locate it 'somewhere' on the Internet?I thought this was a blog. Not an article in a magazine. A place where the journalists from the Time magazine can share what they believe is relevant or important for us to be aware of when making our own decisions. I wasn't aware they were supposed to analyse everything and then spoon feed us what they think we should think about things.
I understand it's on a prominent magazine's website. I understand that these are professionals with years of experience and I understand that the standard of service we expect might be higher than on say 'Joe's blog for plumbers.' But it's still a blog right? A place where we can learn about things in the media which are happening right now and what is catching the interest of our journalists who we will read in the future.
That's where I'm coming from. Am I wrong? Should I expect a higher standard? Should I expect each post to be article worthy?
Now, in full disclosure, I even enjoy Mr Scherer and Mr Klien's posts on a regular basis. I guess that makes me a heretic to some commentators.
, Although, in my defense, I think Mr Scherer's blog titles could be less sales pitchy and more to what they are about. For what it's worth, I think this blog is awesome and I'm lucky to have it! Ok, this and the daily show.
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17.1
demand Karen (and others) to have a high content of analysis in all their posts.
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That isn't my demand. If she wants to simply post a link without further editorializing, there is nothing wrong with that. But I will assume that she AGREES with the linked info and analysis.
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In this case, KT tried to weasel out by saying that this is the CBOs, and not Politico's, conclusion, but that isn't true at all.
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The CBO merely made a prediction. One can agree or disagree with their prediction, but it was Politico that went further (with KT's tacit approval) and drew several indefensible and unsupported conclusions from the CBOs analysis. Politico's "logic" is so far off that it either demonstrates a willful intention to mislead their readers or a stunning ignorance of the issues that are involved. -
17.2
Square, this is the precise sentence from CBO's report. (You might have found the sourcing confusing because CBO refers to itself in the third person.):
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That estimate of enrollment reflects CBO's assessment that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges.
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To me, this is a surprise. I did not anticipate that people who enroll in the public plan would be paying higher premiums than people who buy private insurance through the exchanges. As to challenging CBO's methodology--well, I don't see the flaws in it. Perhaps some of the commenters would point those out to me.
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CBO is working with a computer model that was many years in the making, having been undertaken by Peter Orszag, when he was CBO director. (You can find a lot of background on that if you take a look at their website.) It is considered the best, most unbiased arbiter in this debate. Its score is considered the definitive word. And its analysis is very much in line with the model used by Jonathan Gruber at MIT, who is an expert I respect. To the degree I have any expertise in this, it does not compare with CBO's. -
17.3
KT: I find it mildly surprising that the PO is, on net, expected to attract a less healthy pool of enrollees. I expected that if insurers couldn't kill the public option they would do their damnedest to dump the sickest and most expensive patients on the government's dime. But I thought that dynamic would be mitigated by a lot of young and healthy people choosing the PO.
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But if the CBO's assumption is correct then it is entirely unsurprising that the CBO would also project that premiums would be higher for the PO.
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But the point that you keep missing is that there are too many moving parts in the system to compare individual elements to each other. At least unless you plan on performing a rigorous statistical regression analysis.
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Our nation does not contain one, single risk pool. It is an aggregate of hundreds or thousands of pools. It doesn't make any sense to compare apples to oranges. It only makes sense to ask questions like: What were we collectively paying in health insurance before? What were we collectively receiving in benefits before? How much did the services we received collectively cost us? Now how do those answers change with health care reform?If the existence of the PO brings down overall costs while providing MORE and FASTER services for the nation as a whole, why would I care if some policies are more affordable than the PO? And why would the PO be discredited simply because it doesn't drive every other carrier out of business?
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17.4
Square: See Ezra's take below. It makes sense to me as an explanation of why the public option population will likely be sicker as a whole than the people who buy from private insurers.
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And while I agree that things won't work out exactly like CBO predicts, I also think their prediction is probably the best thing we have, for the reasons I laid out above. I also think they are worth reporting, because they are so influential in driving the policy discussion on Capitol Hill.
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18
I find it interesting that the CBO has assumed such a major role in the HCD. Funny, we never heard of the CBO when it came to a war of choice? If we look at our troop dispositions around the world it is striking to see how we are positioned all around the globe. Has the CBO done any work on those costs? On defense boondoggles? On cost overruns? But when it comes to giving the less fortunate in our society help with health care the calculators come out.
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18.1
Bitter: CBO was also a huge factor in the last health care debate. Their numbers did a lot to sink the Clinton health plan.
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19
"would actually be higher on average than those charged by private companies participating in the new health insurances exchanges."
Surprising to WHO?
For weeks I have said HC Reform means:
1 ) Higher premiums
2) Less service
3) higher taxesThere is nothing in the history of entitlement programs to make anyone with an ounce of sense believe they could run the entire health care system anywhere near efficiently.
Questions is will liberals apologize to insurance companies for the crap they have been shoveling about greed and profiteering?
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19.1
For weeks I have said HC Reform means:
1 ) Higher premiums
2) Less service
3) higher taxes
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Freeper, I have to give you credit for being willing to display you utter ignorance without shame.
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Too bad your complaints have no bearing on reality as:
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1. Without reform, premiums will continue to skyrocket.
2. The CBO, as well as Medicare, tells us that the government is less likely to "engage in [...] management of utilization by its enrollees." IOW, private carriers are much more likely to try and screw insureds out of coverage and doctors out of payment for services.
3. The public option is not an entitlement program and is funded by enrollees' premiums, not taxes.
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Feel free to continue to peddle factually-devoid rantings. -
19.2
square1:
The post from KT said premiums would be higher with a public option, so maybe you should point your name calling to her.
And I will say again 1) higher premiums 2) higher taxes 3) lower services
Having liberals like you name call does not change the inevitability of the above. If you want to see stupid, check the mirror. All the budgeting acrobatics and won't change 1 & 2 and the end will be 3.
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20
Thank you very, very much for responding to commentary, KT.
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21
I've added an update with Ezra Klein's take on the CBO rationale.
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You can see it here:
.
http://voices.washingtonpost.com/ezra-klein/2009/10/wil_lthe_public_plan_have_high.html-
21.1
You may find this hard to believe given my comments above, but I am NOT in favor of this bill. I agree completely with Ezra's assessment and would go further: that progressives should walk away from the table if they can't get Medicare +5%.
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If I was too harsh earlier, I apologize, but I still think the linked piece at Politico is 100% spin, as it attempted to smear the public option qua public option. Again, not criticizing what the CBO said, just what Politico made of it.
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In fact, the CBO analysis, if true*, merely shows what many progressives have long suspected: that if you take the core features of a public option (e.g. a large, nation-wide enrollee pool, the purchasing power of the federal government, low administrative overhead, and reduced "management of utilization") and eviscerate them, guess what? The PO is no longer effective. This doesn't prove Democratic "promises" were wrong. It proves that if you want to do something correctly then proper implementation matters.
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The WH and Blue Dogs have conspired to shrink the PO down to the size that you can drown in a bathtub. I think this is a particular mistake for the WH, as Obama will ultimately be judged on how well it works, not on whether it passed with bipartisan support.
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*There are legitimate reasons to question the CBO's claims regarding the relative risks of the enrollee pools. Mandated Medical Loss Ratio floors, if retained in the final legislation, would possibly cap the insurers incentives to siphon off all the young, healthy potential enrollees.
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22
Shorter: providing health care to the sick is more expensive than just collecting premiums from healthy people. Fortunately, "conservatives" have a solution for all those sick uninsured. Rep. Grayson...?
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23
Karen, I thought the Public option would compete on all levels of insurance not only the basic plan. I did not realise the government would not offer other plans to spread the risk. I have been trying to find out if the House Public Option limits the how it negotiates but I am not smart enough to navigate the bill as written.
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Square, the Senate Finance by offering the young and invincible plans managed to siphon off this group. Big win for Insurance Companies. -
24
@square 1 - 17.1
(Sorry for the delay in replying, I'm on East Australian time).
Ah, I understand. Thanks for the clarification.
----
So, if this propsal does not allow the government to either negotiatie payments or take the healthy young demographic, why is it on the table?
Maybe someone can help me out here, if America is the land of the exceptional it must mean that all the people are exceptional. Therefore if you put those exceptional people in government (or companies) what they deliver must also be exceptional because it's run by these people. Therefore, shouldn't an insurance plan implemented by exceptional people in either government or a company be, well, exceptional?
If that's the case, how come the rest of the world's 'unexceptional' people (because we're not Americans) can run a public option for our entire countries without this much difficulty?
(It's true I jest at Freeinpa's expense! But seeing she / he is a true capitalist, I'm only as evil as some parts of Wall Street.
) -
25
I want to see this legislation pass for 2 very important reasons. First, I want to see as many Americans as possible obtain decent health care coverage. Secondly, President Obama needs a win right now to establish momentum for the rest of his agenda. However, I'm pessimistic that any versions of this bill will actually "bend the curve" enough to prevent a health care financial crisis six or seven years from now. Even the medicare +5 option will not really have enough clout to force providers to seriously cut their prices. These bills do provide some money for reducing fraud and encouraging efficiencies. However, the only countries that have successfully contained costs are those who have instituted a version of single payer or have strictly regulated the industry. The U.S. isnt ready for that yet, but we may be in several years.
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