The Public Option in Congress Is Now a Sham. Who Cares If Lieberman Kills It?

[nightrain]

Author-- Miles Mogulescu


The so-called "public option" -- as it remains in the bills being proposed in the House and Senate -- is a fraud and a sham. It bears no resemblance to the "robust" public option originally sold by its supporters as the most pragmatic, "uniquely American" multipayer way of achieving affordable universal health care, instead of importing successful single payer models from other democratic capitalist countries which provide better health to its citizens at considerably lower costs.

The pygmy public option now being proposed in the House and Senate will not be a viable competitor to mandated private insurance.

• It will not put any meaningful pressure on private insurance companies to moderate their premiums.
• It will not have the market power to pay lower fees to doctors and hospitals than private insurance and will thus not be less expensive than private insurance.

• It will not even be available to most Americans.

• Since it will be unable to effectively compete with private insurance, it will end up with few, if any customers.


At this point, it really doesn't matter whether or not a final health reform bill includes this type of public option in name only. The public option, as it's now being proposed in the House and Senate, will have no meaningful impact. If Joe Lieberman or other corporate Democrats kill this meaningless public option, it will make no difference in the lives of most Americans. With or without a fraudulent public option, millions of Americans who will be required to buy insurance or pay a fine will see their premiums skyrocket as there will be no effective limits placed on how much private insurers can charge the customers whom the federal government will make buy their product.

--snip--


As Kip Sullivan, a long-time fighter of universal health care, has argued articulately, the devolution of the public option from a robust proposal projected to cover over 129 million Americans and lower insurance costs to a sham public option that will at best cover 6 million Americans in 10 years and have no impact on lowering insurance costs is a case of "bait and switch".

The "public option" was initially proposed by Yale political scientist Jacob Hacker and Campaign for America's Future leader Roger Hickey as a more politically "pragmatic" alternative to the long-time progressive goal of establishing universal single payer health care (as though insurance companies and their paid-for Congressional allies wouldn't fight against a robust public option as hard as they would fight against Medicare for All).

Hacker and Hickey laid out 5 criteria that, they argued, were essential to the success of the public option.

1. The PO had to be pre-populated with tens of millions of people by shifting all or most uninsured people, as well as Medicaid and SCHIP enrollees, into the PO, so like Medicare, it would represent a huge pool of enrollees on day one.

2. Only enrollees in the PO, not in private insurance, would be eligible for government subsidies.

3. The PO and its subsidies would be available to all nonelderly Americans (not just the uninsured and employees of small businesses).

4. The PO would pay Medicare reimbursement rates.

5. The insurance industry had to offer the same minimum level of benefits that the PO offered.


If these criteria were met, the Lewin Group (a subsidiary of health insurance giant United Health) projected that the public option would enroll 129 million Americans, have overhead of 3%, pay hospitals 26% less and doctors 17% less than the private insurance industry, and have premiums 23% below the private insurance industry average.

That was the "bait." Now came the "switch." The puny public option proposals that are still on the table in the House and Senate meet only the 5th of the 5 criteria for an effective public option and eliminate the first 4 criteria. They are not pre-populated; subsidies go to both the public option and private insurance; large employers are barred from buying into the public option; and the public option is not allowed to use Medicare rates but must instead negotiate rates on a provider-by-provider basis.

The result is that instead of enrolling 129 million Americans and decreasing insurance premiums, the sham public option being proposed in the House and Senate will enroll between 0 and 6 million Americans and will cost more than private insurance.

It's time that organizations which supported a "robust" public option tell their supporters the truth: that the public option in the House and Senate bills bears no relationship to the public option they have been fighting for. (Instead, the Health Care for American Now blog praises the public option in the House bill as "a strong competitor to private insurance, keeping prices down and attracting customers.") Its time that "progressives" in Congress like Anthony Weiner, Alan Grayson, Jan Schakowsky, Raul Grijalva and Lynn Woolsey admit to their constituents that, with no help from President Obama, they've lost the battle for a "robust" public option. Media figures like Keith Obermann and Rachel Maddow, who've been vocally talking up the public option, should be reporting the truth about the pitiful public option that's left on the table.

As it stands now, the sham public option in the House and Senate bills serves only one purpose. It gives political cover to progressives and liberals in the House and Senate to vote for mandates that will use the power of the federal government to force uninsured individuals to buy inferior and over-priced private insurance or be fined by the IRS by being able to say, "Well, at least the bill contains something called a public option," even if it's a public option in name only. Better that Joe Lieberman's filibuster threat forces Congress to drop this sham public option from the bill. At least, then, progressives and liberals will have to squarely face up to the implications of their vote and decide if this type of "health care reform" is really in the interests of the American people, or indeed, in the interests of the Democratic Party.

As the final bill takes shape, it's going to be a close call whether this type of mandated "health insurance reform" with no price controls on premiums is better than no reform at all.



http://www.huffingtonpost.com/miles-mogulescu/the-public-option-in-cong_b_340501.html

[still_one]

1. After 8 years of bush, this is what the Democratic party has become?

It is either time to bring in new people to the Democratic party, or start considering third party candidates

[eridani]

30. Or start running against incumbents in primaries n/t

[yurbud]

88. that's the best way to go

[still_one]

111. That is what I meant by saying bring new people into the party /nt

[pattmarty]

74. I just think I'll pick up and become an ex pat.

[nightrain]

79. It's very tempting isn't it??

[Dr.Phool]

98. I talk to a woman, daily, at the dog park.

She's from Poland, in her mid 40's, divorced with a bi-polar son in his early 20's.

She can't get any insurance of any kind from any company, for herself or her son. She says that whenever she needs a procedure done, she flies to Costa Rica.

I did some checking, and found that you can buy into the Costa Rican national health plan for $100 per month. I asked her how she got into their plan. She said that she didn't.

She flies into San Jose, and uses the private hospital. Pays out of pocket. And the kicker is, the flight, hotel, and treatment are cheaper than if she paid for care here. And she gets a vacation to boot. The first time, she asked if she should call them back for test results in a few days. They said "no need" come back in a couple of hours, and they'll have all the results.

And, we've got this overpriced, inefficient mess here to deal with.

[nightrain]

109. amazing isn't it what others have managed to provide for their people!

And, exactly right.... we have this mess here that keeps on getting worse. Particularly for those of us who have to deal with the bureaucracy and duplication to provide care.

So sad and scary that Obama said he was going to be the last President? to deal with healthcare! I genuinely hope he isn't if this is what we get!!

[youngharry]

113. Time to leave the Democratic Party

After fifty years of helping Dems get elected---1000s of phone calls and doors knocked on--to say nothing of the 100s of dollars given--it is now time for all good men/women to leave this corrupt and inept Party.

ENOUGH IS ENOUGH OF THESE LYING SHYSTERS THAT DO NOTHING BUT BLOW SMOKE AND TALK WITH MIRRORS.

[AlbertCat]

100. After 8 years of bush, this is what the Democratic party has become?

And 8 years of Clinton with a rabid Repug Congress...

don't forget Poppy Bush for 4 years

plus 8 years of Reagan and "reagan democrats"

3 times 8 is 24 +4....28 years of being essentially yelled at in the back seat.


We can see the difference in the "20th century Dems" and what we need today in the Progressives vs the established Dems. A normal Dem platform these days seems radically left.... even if a majority of the population agrees with a lot of the progressive view. (What average person would have complained about Universal Health Care? It's really only a prob in the Corporate netherworld of the Capital Building.)

[grantcart]

2. This guy for one

"The fact is, this is real reform, Dean emphasized. "That's all I really care about, is real reform. ... It's not the kind of reform that I would have loved, but this is pretty good stuff, and it really is going to make a difference."

[Oregone]

3. So what?

If he wanted to keep his following he shouldn't of ran around polishing this turd and shilling at any cost. Sorry to say it.

Dean mixed his language far too often, calling the "public option" plan a single-payer system. It was an outright lie and he took a deserved hit to his credibility.

[nightrain]

4. nah, not Dean, although I initially supported him--are you aware that he

was instrumental in getting biologicals a 12 year reprieve from becoming generic? This was his work, on the side, this summer as an advisor to a "global law firm that is advising the Biotechnology Industry Organization, the influential trade group".

Reference--
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6129724

[HughMoran]

92. Nice - throw Dean under the bus now

Woot!! There's no limit to the stupidity of some...

[nightrain]

96. he makes mistakes at times. sometimes big ones, and I think it's okay to call him out for it

when it happens.

How would you like to be experiecing breast cancer, but you can't afford the brandname drug, it's not in the fomulary of your plan because Dean and others made an impassioned plea to Congress on the part of the biologic companies to extend the length of time until it became a generic? That's what he did.

That still okay with you?

[HughMoran]

97. I read the arguments about the patents and changing the rules midstream

The drugs should be subsidized until the laws can be changed. As someone with several patents, I would be beside myself if they suddenly said that my patents would expire tomorrow. Besides the competition being able to now use my designs, the thousands of dollars in time and money to get those patents would have been wasted as well.

[nightrain]

104. they originally had ?6 years, like all drugs. It wasn't anything like overnight.

[eridani]

31. He was right last week. He's wrong this week

No bullshit "high risk pools"! Just put them into Medicare like Dean was talking about a couple of days ago.

[Bluenorthwest]

39. Dean has been intentionally wrong before

A few years ago during the Kerry cycle, Dean went on some TV show and claimed that the Democratic Party Platform had a plank opposing equality for GLBT people. There was no such plank. Now, his office was very responsive, and apologetic, but it became clear that either he had not so much as read the platform of the Party of which he was chairman, or that he told that lie to hook some bigot votes on the TV tube. Either way, Howie has been on thin ice ever since. This is politics. He trashed my community for convenience or his own stupidity. Now he looks for a choir of approval?
I remember his spewing about the platform, I will never forget. Ever. He never went on TV and apologized nor did he correct his lie. He told it and walked away, claiming to be sorry for attacking millions of Americans so causally. He is not what I call a consistently decent person, which is why America rejected him for leadership roles. Rejected. Rejected. Rejected. Homophobia and a weak relationship with the truth.
Any reason why one should forget slanders against one's own for the sake of some politician who can not get elected outside of his tiny wee state? Any at all?

[NYC_SKP]

5. Well, Miles Mogulescu can eat shit and die. Alan Grayson is happy, Dean is Happy, I am happy...

And DUers who can thing for themselves are happy:

Like this DUer, Phoebe Loosinhouse:

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=132x8723453

TOP 14 PROVISIONS THAT TAKE EFFECT IMMEDIATELY

1. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE — Reduces the donut hole by $500 and institutes a 50%
discount on brand-name drugs, effective January 1, 2010.

2. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) — Creates a
temporary insurance program until the Exchange is available for individuals who have been uninsured for several
months or have been denied a policy because of pre-existing conditions.

3. BANS LIFETIME LIMITS ON COVERAGE—Prohibits health insurance companies from placing lifetime caps on coverage.

4. ENDS RESCISSIONS—Prohibits insurers from nullifying or rescinding a patient’s policy when they file a claim for
benefits, except in the case of fraud.

5. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 27TH BIRTHDAY THROUGH PARENTS’ INSURANCE— Requires health
plans to allow young people through age 26 to remain on their parents’ insurance policy, at the parents’ choice.

6. ELIMINATES COST-SHARING FOR PREVENTIVE SERVICES IN MEDICARE—Eliminates co-payments for preventive
services and exempts preventive services from deductibles under the Medicare program.

7. IMPROVES HELP FOR LOW-INCOME MEDICARE BENEFICIARIES—Improves the low-income protection programs in
Medicare to assure more individuals are able to access this vital help.

8. PROVIDES NEW CONSUMER PROTECTIONS IN MEDICARE ADVANTAGE— Prohibits Medicare Advantage plans from
charging enrollees higher cost-sharing for services in their private plan than what is charged in traditional Medicare.

9. IMMEDIATE SUNSHINE ON PRICE GOUGING—Discourages excessive price increases by insurance companies through
review and disclosure of insurance rate increases.

10. CONTINUITY FOR DISPLACED WORKERS—Allows Americans to keep their COBRA coverage until the Exchange is in
place and they can access affordable coverage.

11. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance
program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.

12. HELP FOR EARLY RETIREES—Creates a $10 billon fund to finance a temporary reinsurance program to help offset the
costs of expensive health claims for employers that provide health benefits for retirees age 55-64.

13. COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for a doubling of the
number of patients seen by the centers over the next 5 years.

14. INCREASING NUMBER OF PRIMARY CARE DOCTORS — Provides new investment in training programs to increase the
number of primary care doctors, nurses, and public health professionals.

:applause:

PREPARED BY OFFICE OF SPEAKER PELOSI – OCTOBER 29, 2009

[nightrain]

6. yeah, there are some nice carrots. Are you aware that the cost for

an individual making more than 43K for just the premiums could be up to 12% of income, plus the copays and up to 5K per year in costs!? That's just not affordable, and is a windfall to the insurance corporations.

We get a few health insurance reform carrots until 2013, then an individual mandate to buy insurance! Nicer deal for the corporations. And this proposals is primarily open only to the uninsured, not "public".

Long-term, this is not sustainable for middle-class folks....

[Oregone]

10. "Long-term, this is not sustainable for middle-class folks"

Its not sustainable for a nation. Health care costs will soar with subsidies and mandates, just like they did in Mass (which is $13,800 a year for a family premium).

Yeah, you might cover everyone, but the nation won't be able to competitively manufacture a product. And what is the cost? A yoke on the back on the middle class. Any remnant of an American Dream is gone, as college savings dissolves into annual premiums.

Thats my crystal ball call. I guess no one knows a damn thing until another decade goes by on exactly how this will manifest. This is a large experiment, lacking a lot of solid evidence behind the purported methods of driving down costs. As long as its "uniquely American"

[nightrain]

13. yep, I agree, on that greater, more macro level as well...

[dflprincess]

14. Ah, but by the time most the people figure out just how badly we've been had with this deal

the politicians who forced it on us, including Obama, will have moved on. No doubt a good many of the Congress members will be working as high paid lobbyists for the very companies they sold us to with this bill.

[nightrain]

17. possibly, but that's why it's so important to get out the details now

before the kool-aid takes over...

[dflprincess]

21. Exactly

or before both the House and Senate have passed bills; had their conference committee and have sent what ever POS they agree on off to the president to sign.

[nightrain]

23. yep, I have very very mixed feelings about the possible filibuster...

I can see where there are some insurance reforms, but that doesn't really mean health CARE reforms.

This House proposal is still totally unaffordable for middle income people. I can see $100/month or thereabouts for 1 person, but certainly not 4-5 times that! I have much better uses for a minimum of 5K! Gees!

[eridani]

34. $125/person is what is in HR 676

That would be subsidized where necessary, of course.

[nightrain]

45. yeah. But not 12% of income! That's absurdly high. For 1 middle income person

$100-150/ month is affordable. $5000/year divided by 12 = >$400/month. Not going to be many takers.

[pattmarty]

77. Plus the god damn deductibles AND co pays. This is a fucking steaming................

............piece of shit and DU'ers that say different are either high or well off with "Cadillac" insurance.

[eridani]

107. Exactly my point

HR 676 also allows subsidies for those who can't affor $100-150/month.

[pattmarty]

75. AND the Republicans will have a political gold mine that'll keep on giving.

This sure as shit IS NOT the party of FDR or LBJ. This has become the party of "centrist" DLC types with lawyers and Wall st execs ponying up most of the campaign money for the Dems. Fucking shame on the "Democrat" party. There are only a handful of Reps and Senators that can truly call themselves Liberal/Progressive.

[JDPriestly]

105. And the voters will vote against Democrats in a backlash for having

lied to them and put them in a worse financial and healthcare access situation than they were before.

Nancy Pelosi needs to answer first to American families. The military budget should be cut and the healthcare insurance budget increased. That is the way to rebuild America.

[nightrain]

110. amazing isn't it how money cn be found to kill brown babies and people, but not for real health CARE

[John Q. Citizen]

62. Very well said and I agree with your analysis.

[rollingrock]

15. The deductibles, co-pays and premiums will be very high

despite the so-called 'subsidies.' the subsidies only apply to the premiums, not the co-pays or the deductibles. and there's nothing to stop the insurance companies from charging much higher rates to people who have what they define as 'pre-existing conditions.'

[JDPriestly]

103. nightrain, you are correct.

Congress has to do better than this. We have to get more progressives and fewer Blue Dogs in Congress.

How much are we spending on Afghanistan and Iraq? And what return do we get?

Our money goes to a war machine, and I honestly don't know whether we need it. The government, regardless of which party is in power, lies so much about our "national interests" when it comes to foreign policy that I have become totally confused.

No one has satisfactorily explained why we are in Iraq or Afghanistan.
If after all these years, we have not defeated Al Qaeda, then we need to ask what we are doing wrong. Does Al Qaeda really exist? Or is there just a loose kind of group of terrorists who share the same philosophy. It is very hard to fight a loose organization with the kinds of troops we sent in and the strategies we are using. If we are doing everything right, we need to ask ourselves whether defeating Al Qaeda is really what we need to be doing. It seems to be costing too many lives, too much money and taking too many of our resources.

If we are actually in these countries to support Israel or to throw Iran off balance or to safeguard Pakistan's nuclear weapons, then we, the American people should be told this.

Otherwise, we should pull out of Afghanistan and Iraq, leave the people to their own designs and provide affordable healthcare for every American with our wealth. Providing affordable healthcare for all Americans will create jobs here -- not in China or Afghanistan or India or Timbuktu.

[Cant trust em]

7. It can certainly be improved, but I'm fairly happy.

[nightrain]

19. how so? could you afford to pay these costs privately? You aren't concerned about the massive

financial windfall for the insurance corporations? And the 3 year delay?!

[Cant trust em]

24. Have you seen anything that refutes the claim that...

Medicare under-reimburses doctors and hospitals for their claims?

If so could you post here or PM me?

Thanks.

[nightrain]

25. actually, it's my personal experience as a healthcare practitioner that Medicare rates for

my type of work is low. Not unlivably low, but quite low.

[Cant trust em]

27. So that's not a concern for you?

I'm trying to sift this stuff out before I weigh judgment.

[nightrain]

28. It's a concern, certainly on the macro level, but I'd rather first see

that people get health care, and then we worry about the cost. People have been deferring care for years, not getting meds, not getting mammograms, etc. I'd address that before the cost issue. It's an ethical thing for me...

[pattmarty]

78. Then you must be HIGH or not very bright, maybe both.

[dflprincess]

"Begins" to close the donut hole?

Why not just close it? Per a congressman (whose name I forget) on Stephanie Miller's show, it will take 10 years to close the donut hole completely - and he thought that was just wonderful that they had really given seniors some real reform on that. They opened it all at once, it can be closed just as quickly.

I notice that you didn't mention that it the bill requires most of us to continue to buy crappy products from the crooks who broke the system (so much for "keeping them honest"); allows premiums to equal 11% of income; and permits annual out of pockets ("cost sharing") to $5K for singles and $10K for a family ("cost sharing" amount may increas each year). "Cost sharing" does not include premiums and uncovered expenses (adult dental, vision).

The bill may extend coverage but the high out of pocket expense means there are a lot of people who will not be able to afford to access care.

[NV Whino]

18. The goddamn dounut hole is $4300!

And they're knocking $500 off? That's not a carrot, that's a farce.

[dflprincess]

20. They really do think we're stupid don't they?

You have to wonder how many seniors won't get to see the donut hole get closed - especially if they can only afford their medication for part of the year.

[eridani]

35. Yes, and to judge from DU, they are right. n/t

[flyarm]

93. the whole damn thing is a farse! It is a scam ..nothing but a damn scam! eom

[Aragorn]

26. and Pelosi would never mislead us would she?

SOME of these things will help Medicare patients - but they are already on a public, single-payer plan. I just retired after 26 years of medicine, almost exclusively with uninsured, Medicare, or Medicaid. I hope that gives some perspective, even credibility.

The exceptions to the above:
2) "Permits" these people to purchase insurance. No financial aid.
3) This IS potentially good for people who have very expensive illnesses, but would it be enforceable on existing contracts? That would be unconstitutional. As it stands now these folks typically are on Medicaid, at the least,when they hit their limit. Now they stay on private insurance? Well, that is good for everyone but the very sick person.
4) More or less the same outcome, for the same reasons.
5) So, is this cheaper for anyone, is the question. I happen to have looked into this again just yesterday, and it's not for my family anyway. If the cost is the same, parents could pay for their kids' insurance or keep them on their own policy. No financial advantage either way. BFD.
9) "Discourages"? BFD. Shop around people. Unless you are sick already. Good luck with that. (see #2)
10) Oh thank you for letting me continue to pay 4-5 times what I paid when I was employed. How about some help finding a JOB!
11) This appears to be another part of the bill which would shift cost back onto the patients. (see #2, 3, and 4 above)
12) Helps employers (corporations) and encourages increased national unemployment.
13) No cost help, but worse care at already over-worked CCCs. BTW the ones I worked with were horrible, and often functioned simply as a funnel to some regional inpatient (hospital) system, at increased expense to the patients.
14) Even if doctors in training could be persuaded to do this, against all trends of the past many years, and you got a 100% increase in graduating medical students to do it, this is 4 years away at a minimum. Hardly an "immediate" effect.

If this bill is passed as described it is a total sham. But you can always get a second opinion until you find someone who says what you want to hear.

[nightrain]

29. thanks for your perspective. Glad you took the time to refute the points..

I was too tired to address each of them!

This bill has some nice little things, but mostly is a POS.

[eridani]

36. #9 sort of reminds me of Conyers' sternly worded letters to Rove--

--when Rove and others blew off subpoenas.

#14 is good, and should be a separate bill, IMO.

[eridani]

33. Not a single one of these is worth mandated insurance.

The community health centers, primary care doctors and extension of family benefits to 26 year olds could each be separately accomplished.

[Jakes Progress]

49. Dude, you're using press release from a congress person for proof.

What you have there is the advertising copy. Read the fine print.

It's not affordable. It's not sustainable. Currently we pay twice or more for less coverage than other advanced countries. With this bill, we will pay even more. The insurance company profits will soar to Exxon levels.

You've been screwed and just don't know it.

[nightrain]

50. These are primarily INSURANCE reforms. Nice, worthy, but not provision of health CARE.

Since I am more well-rested now I will reply to the list you gave today.

Please address the high cost of this plan to middle income people and the unaffordability issue.

[John Q. Citizen]

60. nobody claimed that everything was awful. Just that in balance, it's not worth doing.

Pelosi even stripped the one single amendment in the bill that might have been a redeeming factor, The amendment that would allow states to put in their own single payer system if this bill turned to be as bas as many people think it is.

So there is no way out if this passes. We will be stuck with an insurance industry that will be almost all powerful, anointed as the official product of the United States and with so much cash to bribe our Dem leaders with we will be trapped forever.

i'm sorry that real debate elicits name calling from you. Phoebe is a great DUer, I believe she's sincere and she's thoughtful, but we disagree on this bill.

The bill has more bad than good, and so much more bad that it's not worth doing.

[bluestateguy]

8. Comes across a little whiny

nt

[nightrain]

9. where?

[dflprincess]

11. I grind my teeth whenever I hear some politician say we need an "uniquely American" solution

for health care.

We have an "uniquely American" system now - it doesn't work.

[Oregone]

12. The same

And no, it didn't sound any better when Obama said it either.

[nightrain]

16. indeed. As if Americans can't learn from others... it's a cover for not doing the hard work

of making more drastic systemic reform, which is what is called for.

[natrat]

42. it's not just that-the high level of corruption makes meaningful legislation impossible

[nightrain]

46. exactly. good point.

[John Q. Citizen]

64. It's code for "My constituents are really stupid!"

[niyad]

22. let's see--45k dead each year from lack of health care--whatever bill passes won't take

effect until 2013.

45,000 x 3=135,000 (give or take a few thousand, two months left to go this year, and who knows WHEN in 2013) but that's okay, because we'll have some pathetic, "uniquely american" pos "reform" that is going to break us.

oh, I am just thrilled.

oh wait, the damned thing hasn't passed yet--who knows what the final bill is going to look like-- I, for one, am not holding my breath.

[inna]

32. KR

[juno jones]

37. Where are the numbers?

I see nothing in there about the supposed 'subsidies' and what income levels they will effect. How much means testing will people need to go thru to qualify for them?

I sure as hell can't afford premiums and pay up to $5000 a year for care. Paying premiums wipes out any extra money I make that could go for my care. Even if I can get subsidies, I know how this shit works and I'll have to prove once again to some bureaucracy that I am deserving of their help. I'm sick of this and the damn platitude chanted like a mantra, 'poor people will be subsidized'. How poor and how much and what do we have to go thru to get it? Devil's in the details...

[nightrain]

48. link to the bill and some summaries--

http://www.centerforpolicyanalysis.org/id57.html

[BrklynLiberal]

38. This is why I am so disappointed that people like Howard Dean and Rep Weiner are saying that it is

something worth supporting.

[Bluenorthwest]

40. Howard Dean will say anything for any reason

This is why I'd never vote for him for national office. He got on TV a couple of years back and said that the Democratic Party Platform opposed gay rights. Yep. Of course it did not, but Howie wanted to say so for the sake of the bigots. Either that or he was unaware of the platform of the Party of which he was chairman, and it a full tilt bigot himself who would assume our platform was also bigoted.
That was the last benefit of the doubt I'll ever give Howard Dean. All I can say about him is that he's better than the unabashedly bigoted Tim Kaine, current chair of the DNC. Even Howie is better than that hate monger.

[NorthCarolina]

41. Practical Amendments to add to the Pending Legislation: Term Limits and Campaign Finance Reform n/t

[elbram]

43. Is Dental health covered?

I have not heard/read any mention of it.

http://www.rollcall.com/news/34231-1.html

[nightrain]

47. I haven't checked... here's a link to the bill and some summaries...

http://www.centerforpolicyanalysis.org/id57.html

[4dsc]

44. I'm with Miles, PO sucks and shouldn't even be considered

Single payer is the only option that represent real reform. All other plans being offered by Obama and the democratic party are SHAMS at best.. I will not support the party if this POS legislation becomes law.

[stray cat]

51. So Liebermann should be a heroic figure for DUers if its that bad of a bill

[tridim]

54. Holy Joe AND the Republicans are both heroes to the chicken littles.

Of course they will deny it, but it's true. They're all fighting against the Democrats who are trying to get HCR for people in dire need.

[nightrain]

55. what's so great about this bill? if you are a middle income person and

had to pay for insurance totally, could you afford it? Minimum of 12% of your income???

[tridim]

61. It's not perfect but it is significant reform

The final bill will also have the PO. I'm still not sure what you people are complaining about.

I'm not fighting for the Republican side, I'm fighting with the Democrats who are attempting to finally make health care affordable for everyone. I'm unemployed and can't afford any insurance now, so 12% of my U.I. is about $70, which is affordable.

[nightrain]

63. well, good that you will get a substantial benefit. That's important. I can now see

why you are so earnest. Sorry you are unemployed. Must be rough.

There are significant numbers of employed people who make a moderate income and for whom this insurance arrangement is not affordable. 12% out of pocket is significant and unaffordable. That amounts to about 5K for the premium, plus 5K for deductibles and copays per year.

An affordable healthcare policy would be about $100-150/month.

This is a gigantic windfall to the intermediaries of our money (insurance companies).

How is that good healthcare policy?

[John Q. Citizen]

66. This is a Republican Bill. If it were a Democratic Bill it would look like Medicare,

which was passed by the Democrats.

It would look like Social Security, which was passed by the Democrats.

Both of those are tax based government run programs.


This bill is a "market based solution" bill. Are you so young you don't know that's code for Republican?


No, I am not going to support this Republican free market based solution bill. Give me a solution that's tax funded and looks like Medicare.

That way I will know that it's a Democratic solution.

[tridim]

67. Boner and Holy Joe hate it, and it was written by Democrats.

It is certainly NOT a Republican bill.

[John Q. Citizen]

71. Boner and Holy Joe voted for Obamas Treasury Sect Defense They are Republicans too!

And that's a Republican Bill.

It looks like the Secretary of Defense, that bill does.

It looks like the Sec. of the Treasury.


It's a "market based solution" bill.


It's a Republican Bill. Is that why you love it?

[pattmarty]

81. Come on, look at fucking Medicare in 1965 and look at this............

..........piece of shit that STILL is not in it's final form. Jesusfuckingchrist, this IS A Republican bill. Even that ass hole Nixon was trying to get a national healthcare bill back in the 70's.

[chadmak09]

84. sure seems like a repub bill.

it helps corporations more than the people.

[nightrain]

86. sad, and probably true. Well put!

[flyarm]

95. +10,000..i wonder as well is it the young that are supporting this shit because they are just so

ignorant about real health care? or they just don't think they need it? because i just don;t think anyone that is in their 40's , 50's 60's 70 's and up could possibly know what we know ..and support this shit .

Or they are on someone's payroll and are put on these boards to sell this bullshit.

No one could be dumb enough to look at this and to have had health care and hospitalizations or a family member ill , or had surgery's or even child birth..or a disease..and support it.

This is just garbage..total unadulterated garbage.

[Rozlee]

106. I'm at the point where I'd welcome a filibuster that would shoot this bill down in flames

and send the Repubs back to face their constituents, many like those in LIEberman's state of Connecticut, who support the PO by over 60%. If it gets more liberal Democrats elected or any Democrat who promises a robust PO or single-payer, it would be worth it. Polls say even among Republicans, a slight majority supports HCR. I may be painting a wishful scenario, but I'm so deeply disappointed by this. My son and his family are uninsured and my daughter-in-law has terrible problems with diabetes and blood clots in her leg that almost caused amputation at one point. And it would all have been avoided if she'd had regular doctor's office visits and check-ups, but as usual, with no insurance, things got to the point where she wound up in an ER with sepsis and almost died, and developed gangrene in her leg to boot. I'd rather have no PO than have one that pays the lion's share to the middleman, the insurance companies. Because once that happens, it'll be almost impossible to untrench them.

[nightrain]

57. For many reasons I think Lieberman's a snake. But, about this

bill... get substantive...

[ProleNoMore]

52. Many DUers Whined When Progressives Warned That This Would Be The Outcome

Sometimes the truth hurts and many willingly become ostriches.

[JTFrog]

99. Reports, incredible as they may seem, are not the results of mass hysteria!!

Something about Halloween around here :shrug:

[nolabels]

108. Holloween is dead and gone, so at this point nothing is better than anything

:hi:

[opihimoimoi]

53. Miles Mogu and those that follow are lost in the haze/mist of Reason and Sanity

The Pubs like to delve in Mootness abd Minutiae

They never have good solutions...

They only whine and make the atmosphere Negative

Them Pubs are insidious connivers...they LIE CHEAT STEAL

Never Trust them Pubs..;.they FOOL to RULE

[nightrain]

56. seems that you're saying I'm a Republican? You're mistaken. Solid progressive. Read

journal.

[opihimoimoi]

70. No such intent to imply Pubness on your part...LOL :o)

My ire is toward the GOPiacs suffering from Advanced GOPia

who lose their ability to REASON and use LOGIC normally

[nightrain]

73. thanks for the clarification! Much appreciated because of the

knee-jerk attacks against those of us who have struggled for REAL health CARE reform for more than 30 years get attacked as being against health care reform as Repubs.

This bill is the manifestation of the payoff to Congress by insurance corporations and big Pharma.

[John Q. Citizen]

68. This is a Republican bill. If it were a Dem Bill it would look like Medicare!

[bain_sidhe]

58. Next up, Mogulescu's "Emily Litella" moment?

According to this post by Bruce Webb at Angry Bear, more people than you think - if not most people - will be eligible for the the exchange, and therefore the public option. That renders most (although, granted, not all) of the rest of the post moot.

Some key excerpts from the Angry Bear post: After quoting from the language of the bill itself, Webb explains

Well that is clear enough, an individual meets his responsibility requirement by showing he is covered under his employer plan, his spouse's employer plan, perhaps a parent's family plan or by a range of other public insurance plans. And in any of those latter situations the employee can opt-out of new employer coverage offers. But one of these opt-out possibilities is somewhat hidden here, that is the one that allows any employee to opt-out of employer coverage altogether and get an individual or group plan through the Exchange, including the PO, because in doing so he would meet the requirement of (A), the Public Option is explicitly defined as a QHBP. So where did the idea that the PO was only for the uninsured and was so limited to a fraction of the population arise?

Well a couple of places. First as noted the expectation is that most new employees without health insurance would simply enroll in whatever employer supplied plan level that met their needs, and that those who failed to do so would simply be auto-enrolled by the employer as provided in Sec 412 (c)

(more bill quoting)

And then, what's more, if you *do* opt out and purchase your insurance on the exchange, the employer must pay a portion of that cost

If the employee does opt-out during that 30 days he is not "enrolled" and so falls under the definition of "exchange eligible individual" as defined in Sec 302. At which point the provisions of Sec 411 (3) kick in:

(3) CONTRIBUTION IN LIEU OF COVERAGE.—
Beginning with Y2, if an employee declines such offer but otherwise obtains coverage in an Exchange- participating health benefits plan (other than by reason of being covered by family coverage as a spouse or dependent of the primary insured), the employer shall make a timely contribution to the Health Insurance Exchange with respect to each such employee in accordance with section 413.

In short you are 'exchange eligible' unless you ACCEPT enrollment or ALLOW yourself to be auto-enrolled. On my reading there is no such thing as a lockout for any given individual, if you want the PO you can get it, though not without taking some positive action.

[nightrain]

59. eligiblity doesn't mean it's affordable. There's a individual mandate

to purchase.

There are subsidies for lower income people--that's great.

Now, for middle income people, take a single person, not covered by other programs, nor an employer-- If the income is more than 43K/year, the premium rate is up to 12% of income. Then add the copays and deductibles of up to 5K/year.

So, we're at 10K minimum out of pocket now...

Is this affordable for someone making about 43K? No.

[bain_sidhe]

82. Good point

and affordability is an issue. I'm pointing out that one of the main arguments being used against this plan isn't true, and that fact would likely affect most of the other stuff too.

[Nikki Stone1]

65. Someone owes me coffee

We had a bet.

[Nikki Stone1]

69. My HCR predictions from my missing thread "I know that many of you read other boards"

The public option, whatever it is, will be a fig leaf to cover up what is essentially a Federally enforced purchase of an inferior product, which does not guarantee excellent health care but does guarantee excellent profits for insurance companies. We're being made to pay corporations for our very existence on this earth. I think there will be more bills along these lines.

For those who are indigent or uninsurable, the government (ie, our taxes) will pay the insurance companies. And it's the middle class and working classes who really pay the taxes in this country, not the wealthy, and it is these classes that will be paying the taxes to support the public option for indigent and uninsurable. So in the end, the full cost of healthcare for everyone is being carried by the middle and working classes who will also have to pay the insurance companies. Since healthcare must be "self-sustaining" (i.e., not cause debt, unlike wars and Wall Street bailouts), it has to be paid for up front. Much of that is coming from US, the taxpayer, and some is coming from Medicare cuts, even though the Democrats are not really talking about that. My gut instinct is that Medicare will eventually be transferred to this new system, so that we will be paying insurance companies until we die. And the health insurance company death panels will continue to exist.

This health care scheme involves:

1. Mandates, especially for the young (18-30 year olds) who don't get sick much. Their premiums will support the the care of everyone else: the old, those with pre-existing conditions, and the like. Wait until those young Obama voters realize that they will have to spend their own money buying insurance, unless their employer carries it for them.

2. Taxes on the middle and working classes for a "public option" so that the hospitals don't lose so much money to charity cases.

3. No real cost controls. The public option is not real competition since most Americans won't be eligible for it.

The key is the mandates. Without them, the whole scheme falls apart. Without the buy-in of the young and healthy, insurance companies can't afford (so they say) to insure older and sicker people and still make a profit. This is why Obama had to be either misinformed or lying when he said no mandates (except on children) and no new taxes if you make under $250K.



Anybody care to disagree now?

[BrklynLiberal]

72. ....

:cry: :cry: :cry: :cry: :cry:

[Nikki Stone1]

89. I'm so sorry.

:(

[debbierlus]

76. At what point do we oppose the bill entirely....It is where I am at...

[nightrain]

80. I know...... it's close. Good to see you.

[chadmak09]

83. KILL THE BILL!!

Hate to say it, but this bill deserve a quick death.

I hope to heaven it fails.

This is not reform, its more problems for america.

Forcing insurance on people was the goal of all this.

This is why single payer was never even considered.

Obama has sold us out.

He will hide behind comments like "this bill helps some people".

But what about the many many many more americans it hurts because they are forced into private insurance that they cannot afford.

I dont think Obama gives a care since he will jst chalk this bill as a "victory".

Only a victory to HIS CAMPAIN, NOt american regual citizens.

I had really started to hope we had a good chance at real reform.

I spent lots of time calling my representatives to get them to support health reform.

Now I have to deal with the embarrassment of calling them again and asking them to vote no to this plan.

What a dissapointing bill and what a loss for the american people.

[nightrain]

85. yeah, after all the time, money and effort, we get a POS bill.

[Faryn Balyncd]

87. The GOP has conned us into pushing THEIR kind of bill...only WE'LL GET STUCK WITH THE BLAME when the

....middle class wakes up & realizes how WE sold them down the river to Big Insurance.

By screaming their opposition to the Romneyization of American healthcare the we are now peddling as "reofrm" the GOP gets the best of both worlds:

They get corporatist legislation at least as bad as what they would have passed, had they been in power & on the hot seat, and they get to blame the disastrous results on us, once the shit hits the fan.

[SandWalker1984]

90. Time to kill the MANDATES

I read the following story regarding the Pelosi version of a public option and it is a SCAM.

Because they will limit the number of people that can access this version of a public option, because many of those that do will be people with pre-existing conditions & already shunned by the health care corporations, the PREMIUMS ARE EXPECTED TO BE HIGHER THAN THOSE OF PRIVATE INSURANCE. Congress is setting up the public option to fail - leaving us with MANDATES to buy expensive private insurance, just what the corporations wanted all along.


Public Option, RIP?The Congressional Budget Office explains the perils of compromise and the limits of its own interest in health costs.
By Timothy NoahPosted Friday, Oct. 30, 2009

I've had a bad feeling since Tuesday that Connecticut Sen. Joe Lieberman's pledge to filibuster any variety of public option eliminated its chances of becoming law. Continuing recalcitrance from moderate Democrats didn't help, either. But I never figured that the final death blow would come from the Congressional Budget Office.

Here's the killer sentence, spotted by Politico's Carrie Budoff Brown on Page 6 of the CBO's analysis of House Speaker Nancy Pelosi's "blended" House bill: " public plan paying negotiated rates ... would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges."

Whaa? Most analyses of the public plan, including mine, have assumed that even the watered-down "level playing field" version (i.e., the version in Pelosi's bill and also—with an "opt out" provision slapped on—in Senate Majority Leader Harry Reid's yet-to-be-scored Senate bill) would set premiums lower than private insurers. But the CBO says that's wrong.

More specifically, here's what the CBO says: "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.)"

SNIP

The CBO is saying that a public option that was required to be self-sustaining financially and that was barred from aligning its doctor and hospital fees with Medicare's—as Pelosi's level-playing-field version would be—would see its role as sanctuary doom its role as price competitor. Private insurers would engage in aggressive "management of utilization by its enrollees," i.e., dumping or avoiding the people most likely to need the services of doctors and hospitals, leaving them no place to go except the public option. This would drive down private insurers' costs and drive up the public option's. The CBO acknowledges that Pelosi's public option would have lower administrative expenses than private plans. But because its ability to drive down doctor and hospital fees would be somewhat inhibited by its level-playing-field structure, its cost advantages would be outweighed by its cost disadvantage in serving a disproportionately unwell population.

In short: Private insurers have been fretting that a public option would doom them, but the CBO is saying the opposite: Private insurers would doom (or at least put at a significant disadvantage) the public option.

This is a nightmare scenario that Paul Starr, the sociologist and Hillarycare veteran, has been warning about for some time. "Over-constrained," Starr wrote this past June in the American Prospect ("Perils of the Public Plan"), "the public plan could go into a death spiral ... as it becomes a dumping ground for high-risk enrollees, its rates rise, and it loses its appeal to the public at large." I've long thought that Starr was being too pessimistic because Congress would never design a public option this vulnerable. According to the CBO, however, that's just what Pelosi did.

Please read the rest of the story at
http://www.slate.com/id/2234175/pagenum/all/#p2


THE PUBLIC OPTION, AS PROPOSED IN THE HOUSE BILL, IS DOOMED TO FAIL AND PELOSI KNOWS IT!!!!

THE INSURANCE CORPORATION CEOS MUST BE LAUGHING THEIR ASSES OFF AT HOW STUPID WE ARE.

WE NEED TO KILL THE MANDATES IN THIS BILL OR, IF NECESSARY, THE BILL ITSELF UNLESS YOU WANT TO BE CORPORATE SLAVES TO THE INSURANCE INDUSTRY.

[gorfle]

91. As I have said for a long time...

The government of bank bailouts, auto industry bailouts, and insurance company bailouts IS NOT going to destroy the US Health Insurance Industry.

A robust public option would destroy the US Health Insurance Industry, because people would flock to it and abandon private insurance. This would result in the loss of tens of thousands of health-insurance jobs and the loss of billions of dollars of investments in the HI industry.

So, our government will make sure that the Public Option is too expensive except for a few poor people who can get government subsidies to make it cost effective.

[ooglymoogly]

94. The sneaky parts of this bill are a danger to democracy as we once

knew it. The bill is a sham, an Orwellian nightmare and must be defeated. The outcome of this bill was decided from the beginning, the rest has been just show and noise. The greedy screaming that if even 1 cent of the 90 cents on the dollar, that is nothing more than theft, is conceded. The crime bosses are winning this battle hands down and the politicians are falling all over themselves to lick their boots for a few shekels and selling us down the river.

[nonis]

101. Feeling let down and counted out

Obama and many of the Democrats have let us down and given the
Republicans and insurance companies a boost. He promised us
change and give us  more of the same. I'm embarrassed that I
believed him and gave him my time and hard earned money to get
him elected. The only consolation is he has turned out to be
the lesser of two evils and with the failure of HCR, inaction
on Don't ask-don't tell, and the two wars we're in, even that
may be a stretch. If the Tea Party people weren't such nuts
I'd join them. We have now been screwed by the people we voted
for and that hurts. Fool me once...

[lumberjack_jeff]

102. I think it WILL compete, and over time it will dominate the exchange.

The CBO believes that the public option will be more expensive because it will deny ("manage") less care than the private competition.

The subsidies are set up such that most people don't care what it costs - the government effectively caps your premiums.

Employees of companies can opt out of their group plans and choose to participate in the exchange.

Those three things will influence more people to participate in the exchange and choose the best plan within it, regardless of costs. That best plan will be the public one. As it begins to dominate the marketplace, it will exert greater pressure on private insurers to both cut margin as well as improve quality of coverage.

I am very optimistic, and I really hope that Obama is presented with a bill as close as possible to the house bill.

[nightrain]

112. not so likely that it will compete well when the premium etc costs are higher

and the participants needier. Competition in health care really doesn't exist. It's a monopoly in most areas. Pelosi's bill probably will have little impact.

I don't think it's smart public policy to transfer our common individual funds to private corporations via the subsidies.

This crappy amalgamation is a miniscule perversion of what Hacker proposed as a public option.

Pelosi's bill adds another layer or two of bureaucratic fragmented duplication and complexity for healthcare practitioners to deal with. Dumb. No systemic improvement, but a regression.