Somebody clue me in: Why is there so little concern for how the Public Option will be financed?

[iwannaknow]

Last edited Wed Oct 23, 2019, 08:48 PM - Edit history (1)

In the most recent debate, there was a lot of back-and-forth about how M4A would be financed. Am I missing something, or is the PO somehow a freebee as far as the national budget is concerned? What happens when folks see how much less they will have to pay for the same medical care and flock to it in droves, especially those with more health issues? Who will pay for that? Middle class Taxpayers?

[Act_of_Reparation]

1. Because...

1) It is a less dramatic departure from the status quo than M4A, and therefore less of a challenge, both intellectually and emotionally.

2) Look at who is promoting the Public Option and who is promoting M4A, and which group TV hosts and debate moderators tend to favor.

[oldsoftie]

2. Butteigeig has shown how he proposes to pay for Medicare for those who want it.

I'm not sure if that equates to a Public Option.
But ANY option would still be cheaper than MCA

[Blue_true]

20. Buttigieg's plan leaves out the insured, Medicare and The VA.

His plan still costs around $2 trillion. If he is not careful, companies that currently insure employees will dump them into Medicare for All that want it, drastically running up the cost of the plan. Warren's and Sander's plans prevents the dumping.

[SterlingPound]

29. 100%

I dislike his take on this completely.

It has seemed awfully weasely since the first interview I heard with him

[oldsoftie]

66. But including everyone costs far more from the start than any revenue increases.

Revenue estimates from new taxes are always over estimated. The tax increases on the wealthy will NEVER raise nearly enough to pay for the MCA. And then we have to also consider all the OTHER programs being proposed.
The people keep telling the candidates that many of them LIKE their current benefits and do NOT want to change. Warren said in the debate that she's never met anyone who liked their plans. Almost everyone I know likes their plan. They are a large number of voters. "You may like your current plans, but we're going to take them away & give you a BETTER one". Nobody is buying that.
Ignoring those voters is courting disaster.

[Blue_true]

67. I have said that Warren will have to tax the middleclass.

But a family of four that has to pay premiums and even employees that are chipping in 20% on their premiums will come out ahead if the tax is 3% or less. There are also people that would buy insurance if the premiums were lower, those people likely would welcome the tax, given that it will be far lower than a premium and they will get full medical coverage in the bargain.

Buttigieg is looking to cover the uninsured with the approximate $2+ trillion gained from revolking the tax scam and negotiating drug prices, that money would also be available under Warren's plan.

I believe it all boils down to how Warren sells her plan once she breaks out the numbers. I believe that she can sell it because, unlike Bernie, I believe she is putting some behind the scenes sweat capital into devising a workable plan. Since healthcare was and is going to continue to be a campaign issue, she had to say what she would do before fully flushing out the numbers, but the more I think about it, the more I believe that she will come up with an impressive plan.

[oldsoftie]

69. Warren will certainly do better than Sanders. His campaign has stagnated.

His numbers topped out before he had his heart attack. Thats it. even if he shows running 3rd or 4th, thats it. Others are rising, he's not. But i will bet he will stay all the way to the end again.

[Blue_true]

71. Bernie will stay in until the end and embitter the people that still

support him at that point, so much so that they would be willing to see Trump get re-elected. I don't think that he wants Trump to win, it is just that I don't think that he has enough self-awareness that if he takes things too far, that result has a large chance of coming to pass.

[iwannaknow]

63. Thanks. I'll check that out.

[ritapria]

3. The Public Option can't be financed

The private insurers would price out the high-risk people they don't want to insure in the first place ...The tax payers would have to foot the bill ...The Red Ink would flow .. The quality of Health Care for the people who really need it would suffer ……….Then we would end up with President Tom Cotton - or some such asshole ………...

[wasupaloopa]

13. Bull shit! The private option is insurance like private insurance. The government is the insurer.

Individuals will pay premiums. Those unable to pay are still covered. Insurance companies are regulated by the ACA and that will not change.

Insurance companies cannot select customers based on need for care.


My observation here only. The lies that come from the Bernie campaign and his supporters rival the lies that trump tells his base.

I would hope to high hell Bernie drops out soon so we can have meaningful discussions about issues with the realistic, honest candidates.

[PhoenixDem]

55. +1000 n/t

[ddr007]

56. Sorry, you're wrong.

Companies can and do select customers based on need for care. They have different levels of policies. A person that needs little care can select the bronze policy that takes care of all their needs at low cost. A person who needs more extensive care needs to buy the more expensive gold policy. The company tells you to select the policy that is "right for you". You can hear their grin as they know that the policy that is right for you will cost 90% of your salary. That's how they select customers.

The public option will be priced lower than the gold policies so that the cost of needy patients will be born by tax payers while the insurance companies will keep the patients that have medical costs less than than the premiums. The reason that nobody asks about this is that the discussion is driven by the companies. They like the public option because it increases their profit due to eliminating expensive claims. M4A takes the profitable healthy patients away as well, so they push any narrative that might make voters question the plan.

[iwannaknow]

57. Great response!

[Politicub]

70. Under the ACA, insurers are not allowed to deny anyone coverage. The ACA is a powerful law

in many ways. Yes, it does need improvement, more generous subsidies, and especially, a public option.

But we need to debate the merits of M4A, the public option, and the ACA without using falsehoods. Your characterization of the ACA is wrong.

I sincerely suggest that you take a closer look at the law. There's a lot to it, so it may take a while. But in sum, it eliminated the notion of pre-existing conditions, prohibited insurers from denying anyone coverage and it swept away all of the junk insurance policies. All policies must be comprehensive in scope and include free preventative coverage.

This is important: it was also intended to be a platform on which to build. Those plans were interrupted by the republicans, but the law still stands. The law is massive in scope and is woven into all parts of American health care, from insurance to delivery of services. It isn't something that can be unwound easily. That's by design.

M4A, which is a completely new paradigm for healthcare and Medicare in name only, would require wholesale overhaul of a massive body of law built over decades.

Yes, it would be peachy keen to have a system with no copays or premiums. I haven't seen anyone share the details of how to get there. Most of the things I read about the bill is a laundry list of benefits without anything about how to get form here to there.

I don't care about the cost. If we can afford such a large military and defense budget, we can afford to care for all Americans. That's not my problem with m4a.

The public option is a more realistic path forward than a wholesale rip and replace of everything that has come before. I hope Senator Warren becomes more open to alternatives to the Sanders approach.

[stopdiggin]

4. I'll also point out that this is kind of a trap

The public (and media) always CLAIM to be concerned about costs and budget issues .. and want details about how were going to PAY for this and that. But as soon as you start actually GIVING them plans and details .. .. In about 5 seconds the old eyes glaze over and it's either back to GOT, or "well, I just think ..."

So .. if YOU'RE into details, fine .. but if you think that detail is going to either help or hurt a candidate ...
(Note all the "concern" joe sixpack is expressing over those skyrocketing deficits since the tax cut. Crickets.)

[spooky3]

10. Agree. And, if a candidate says taxes on middle income people will be raised to

pay for something, EVEN IF other payments are reduced by MORE than the taxes and benefits are increased, Republicans will pick up and repeat endlessly only the "increased taxes" part of the comment. Many voters will not take the time to go beyond this and will write the candidate and the plan off.

Candidates HAVE to play cards very close to the vest because of this.

Also, presidential candidates' plans will NEVER be passed as-is; they are not legislators. There will be many compromises, even if Democrats hold both houses of Congress. So, why should candidates take the heat for the most negative parts of the current draft of their proposals? The point of having the plans is to show potential voters the directions of your leanings, where you would like to head, etc.

[stopdiggin]

11. Trump. Candidacy almost devoid of detail ...

and clearly (even to supporters) lying and untruthful about half the time ....
No Problem!!

[Blue_true]

24. Republicans get graded on a curve. We have to work to get every answer right.

That unfortunately is how Americans, wit large, treat democrats in relationship to republicans. We can whine about that, or we can figure out how to make our proposals palatable to Americans.

[wasupaloopa]

14. You have no conclusive evidence that taxes will replace current expenditures at a lower amount. All

you have is talking points.

The argument for M4A is wishful thinking. It has not been studied by a private entity.

[spooky3]

15. Nothing in my post claimed anything about any candidate's specific plan or piece of legislation.

In addition, if Congress WANTED to, they could legislate controls on deductibles and other out of pocket costs to make the guarantees you want. So they COULD control these.

I don't think it's likely to happen but there are many other changes that might happen IF Dems control Congress and the White House.

[wasupaloopa]

18. What happens when folks see how much less they will have to pay for the same medical care

and flock to it in droves, especially those with more health issues?

[Blue_true]

25. What you pointed out ALREADY has happened with the ACA.

But the ACA is now more popular with Americans than ever. What happened early on WAS people with serious illnesses that could not get affordable insurance finally got insured in a way that they could seek medical care once the ACA passed. So in a way, we have already absorbed the burst of sick people you imagined. Now it is time for us to take the next step forward and start insuring people so that they seek healthcare BEFORE they get really sick.

[wasupaloopa]

39. It is my belief that illness has it's cause in lifestyle choices. Diabetes is a good example.

Try supporting plant based food choices on this board. You get the canine teeth argument and a bunch of other reasons why people eat meat.

I don’t get sick and I am 73. I am a vegetarian. I exercise and live a low stress lifestyle. I am a Buddhist and I think that generosity, loving kindness and knowledge are part of a healthy life style. I do yoga and meditate.

I think the above helps me prevent illness. I don’t need doctors to tell me how to take care of myself.

By contrast we are bombarded with pharma ads that teach us our health depends on a drug. It some cases it is true. In many it is not.

Our society’s accepted norms on lifestyle are killing us and is a cause in the high cost of health care. It is the demand for treatment that fuels the market based health industry. Single payer will only pass those costs onto even the healthy through taxes and that is perfectly acceptable here.

[Blue_true]

43. I live in the South. No need to lecture me on how people make unhealthy choices.

It is more common to see overweight people here than ones that have their weight under control. We have decent sidewalks, miles and miles of them, but very few people jog or even go for a brisk walk. We have a very large number of mordidly obese people, I am talking about layer upon layer of fat and their legs rubbing together almost to their ankles. When I look at some people here every day when in public, I wonder how they can walk.

I believe that a large part of our healthcare cost problem is related to choices that people make, over-eating or eating high calorie, fat and salt laden food, smoking and drinking too much alcohol.

I believe that one thing that we can do is put physical education back into schools, starting in Pre-K. We need to have kids working out a minimum of 30-40 minutes each school day. When I was in school PE was a central class of my day and was done just before lunch. There were no overweight boys, but there was one overweight girl. The PE classes have to be taught by professionals who studied for teaching PE and nutrition in college and have degrees, no meatheads that didn't make it to the NFL, NBA, MLB, NHL or MSL and fell back on getting a certificate to "teach" PE classes to make a living. I believe that we have to impact people early on about nutrition and fitness, once they are out of elementary school, if they are not forced into a regimen, it is too late. Also, PE classes need to be fun for all the kids, no bullying and no PE instructor making kids "compete" in a destructive way.

On what people eat. I think that there are bad food choices that people can make. But I don't think any choice that a person makes is bad if done in moderation. I am more of a mixed diet person, my diet includes meat, fresh fruit and vegetables. I seldom eat beef or pork, but eat a lot of defatted chicken. Today for example, 65% of my diet was fresh fruit and vegetables, 5% was bread, about 10% was low fat meat and 20% was water. That is roughly where I am at every day, with some variation around the numbers above in each category, some days for example I drink more water and eat less fruit. I don't do relaxation procedures per se, but I shoot for calmness during my workouts and that seems to work for me.

[Humanist_Activist]

68. Ahh, just world theory with a sprinkling anti-medical science thrown in...

you really just removed yourself from this argument.

Why should anyone listen to you?

Not to mention you have everything literally backwards here, if "demand based" market economy is the driver of the US healthcare system, then why is it that in countries with UHC systems, such things don't occur when costs are lowered?

Healthcare doesn't work in a market economy precisely because its based on need. I know of no one who likes going to the doctor, and plenty who should but don't because they are afraid of costs.

[Blue_true]

23. What our candidate needs to do is put numbers to it.

A decent (not perfect) health insurance plan for a family of 4 in my county costs around $1400-$1700 per month, that is $16,800-$20,400 per year. The median annual wage in my county is around $56,000 before taxes.

This is why we must attack with numbers. Say a husband and wife BOTH (not the case in my county, but I will use it as an assumption anyway). Say that their federal taxes were raised a gross 10% to pay for MFA. They would pay $10,200 more in taxes. BUT, they would not have to pay $16,800-$20,400 in health insurance premiums. The suck for us comes in if their employer is picking up most of the tab for their premiums, then our plan is a sure loser unless we drop the extra tax to below 2% (most employers have employees foot 10-20% of their monthly premiums, the low end would be $140-$170 per month for the couple, so at a extra tax of 2%, our plan would cover them without them having to worry about deductibles or copays, so they come out ahead).

[blm]

28. Take total costs for Great Britain's NHS then multiply it by 5 or 6.

I think we have about 5 or 6 times the population.

[Blue_true]

32. Between 5 and 6 times. I think someone said that England has 60 million.

But if Scotland, Wales, and Northern Ireland are added in, the multiple may be under 5.

But you make a good point, either Great Britain, or closer to home, Canada and set the factor at around 10x.

[Celerity]

48. U.K. Population (LIVE) 67,641,928

https://www.worldometers.info/world-population/uk-population/

[Blue_true]

49. So the multiple would be right at 5.

Your idea is one that our politicians that are trying to estimate costs should adopt. One caveat, we are the fattest, least fit society on earth on average, some of our healthcare spending results from that situation.

[Celerity]

50. What idea? All I did was give the population figure.

I do think the public option is by far the best stance to adopt to get elected in the general, and I think MFA is an election loser, BUT I also think that even if we hold the House, even increase our grip with 20 or so more seats, AND also take back the Senate 51-49 or 52-48, the public option will still not pass.

Big Healthcare (ie Doctors, Nurses, Hospitals), Big Insurance, and Big Pharma will toss in hundreds of millions to fight it, to poison the well. We have far too many House moderates, centrists and even (thank god only a few) a handful of conservatives in swing/purple/pink/red districts and far too many centrist Senators in our Democratic Caucus to get the votes. We have 108 House members who belong to one or more of of the moderate/centrist New Democrat Coalition, the moderate to conservative Blue Dog Caucus, and the very problematic, bi-partisan, partially RW-funded No Labels Problems Solvers Caucus. The majority of them will probably never vote for the public option (or enough will not so it is still blocked), especcially after it is smeared for a year on every possible level of political discourse and adverting and website/'news' lathering up.

Over the next twenty or so tears, the total US expenditure on healthcare will be at least 110 to 120 TRILLION dollars at current and projected rates of increase. Even at smallish margins, that still means trillions upon trillions in profits involved and at risk via public option. There is NO WAY the superstructure of power and control will allow that to be taken off the table. We should try and try and try and try to pass it. It is the RIGHT THING to do. But the realist in me sees very little chance of it happening.

[Blue_true]

53. I must have gotten you mixed up with someone else. I do that more now, hell, soon I may

start to drink alcohol, who knows?

I believe that Doctors and Nurses won't be all behind keeping the system we have now. Many that I have met seem to be sensitive to the issue of healthcare costs.

Look, entrenched interests in any area of the economy will fight change if they are making money. But it all boils down to how well we explain things to Joe and Jill Sixpack. We can't trip over ourselves again and give republicans talking points like "you can keep the Doctor you now have" or "you will know what in the bill once you vote for it". Republicans killed us during the ACA fight with sloppy statements from our side. We can't let that happen again.

I believe the best course is to build on the ACA by raising the income cap to qualify for subsidies and pushing preventative medicine harder, even rewarding cities and towns for promoting fitness and healthy eating and getting results in both areas. In my area we have three good-sized hospitals, two across the street from eachother. They compete for some of the very same patients, though one is s trauma center (gunshots, serious injuries), most of their volume is from the same types of patients, mostly elderly on Medicare. What we can do is create a mechanism where they have to compete on both costs and quality of outcomes. And we need to encourage people to take better care of their health by working out, not smoking, drinking moderately and avoiding regularly over-eating (sometimes food is just good and we are going to overeat, but that should not be every day).

[Celerity]

54. totally agree on what you suggested, and I want to clarify I did not mean to imply ALL

members of those 3 groups will fight it (the public option), just that the HUGE money spenders will.


The 3 groups I mentioned (there are other too) again are:

Big Healthcare (some doctors and nurses, like you said, will not fight it, and some even really want a MFA type system),

Big Insurance (although all of that group will fight, or nearly all)

and

Big Pharma (all or almost all of them will, however)



If you want to really see foxes in the henhouse

please, I so urge you, read my reply to an OP (and the OP too to see what I was replying to) back 3 months ago

it (my reply) is very long, detailed and documented (it is also so depressing, at least for me, as it shows how utterly controlled our politics are)

https://www.democraticunderground.com/1287207761#post9

[emmaverybo]

38. Not really a good model. Well publicized problems with NHS. Canada a much better model.

[iwannaknow]

58. So true!

[EveHammond13]

5. take it from the military. done.

[snowybirdie]

6. Probably

because so far these plans are just esoteric exercises. Let's first get Democrats elected.

[abqtommy]

7. I haven't noted any lack of concern over Public OPton financing. I'm seeing quite the opposite,

in fact. Your use of the words "lack of concern" don't fit well with the "lot of back-and-forth" you reference soon after. I find I focus more on the opposing language than the balance of your op and you soon lose my attention.

[phleshdef]

8. My understanding is it would mostly be financed by middle to higher income people who buy into it.

Its just an insurance pool like an insurance would have but with zero profit motive and, if Medicare/Medicaid is an example, something like 2% in overhead costs. The thing about it is, the bigger it gets (the more people that participate in it), the lower premiums will be and eventually private insurance will die a slow but steady death. Then we basically have the equivalent of Medicare for All.

[iwannaknow]

62. I see it that way too. Unfortunately, insurance companies know this and

will sick (no pun intended) their lobbyists on Washington because a public insurance expansion will be seen by them as an existential threat.

[phleshdef]

64. Anything we wanna do is like that.

[Midnightwalk]

9. It's a buy in so not completely government funded

I’d expect it to work like the same as the ACA sliding subsidies. That is you would pick the government plan and still pay premiums like today but at a lower cost.

The claim is it can be run cheaper by eliminating insurance company profits. Maybe the government could be more effective negotiating prices.

Why is paying premiums better than paying taxes? In one sense it isn’t. But it makes people feel they get a choice in how to spend the money vs being told choice is being taken away.

The one downside of not immediately getting the people with work insurance into a public plan is I would guess that is a healthier population that would help average costs.

I think we need to be doing more to directly address medical costs. I don’t think either plan will address costs fully and it is an issue that most people would be behind.

[thesquanderer]

12. re: "With the PO, the government would be footing the entire bill, not just the subsidies."

No, public option would be just like any of the current ACA plans... you'd pay a premium, which would be subsidized if your income is below a certain amount. In theory at least, the premium would be lower than the current choices, because the current choices are for-profit companies who are looking for a return for their shareholders, while the public option would be non-profit.

[iwannaknow]

60. Good point!

[WestIndianArchie]

16. Easy

The same way we finance open ended wars, 800 plus military bases, bank bailouts in the trillions and um tax cuts for the wealthy.

[Demsrule86]

17. It is relatively inexpensive...and you are talking about taking workplace insurance from those

who have it With MFA...also there would be subsidies and premiums with a public option...we know how it will be financed...there was a plan when the ACA passed. But putting the entire country on one medical plan and destroying the insurance industry is a big f'ing deal...and it will be costly. Of course, it will never happen and go down in flames like Clintoncare...but my fear is we lose the ACA in the attempt.

[betsuni]

22. Yes, there had to be a plan or congress wouldn't have passed the ACA with a public option.

Also, ACA with public option was in the last Democratic Party platform. Shouldn't be too hard to find out.

[whistler162]

19. Currently I pay about 2.5% plus deductable

I would expect to pay between 5 and 10% for a public option to cover everyone and it would be worth it.

Demographic - State Employee - Union - < 60,000/year - 7 years from retirement.

[ecstatic]

21. Don't hospitals charge off the uninsured, which leads to them not paying taxes

due to excessive "losses?" They'll no longer be able to deduct those losses. The gov't can get the money from the added tax revenue.

[TheRealNorth]

26. No you don't

[SterlingPound]

27. 1st, because it isnt a freeby and we all know that taxes will go up!

And mostly because no matter what Warren or anyone else says on the campaign trail for how it will look like; once it reaches the subcommittee, and the committees, and then when the full body has their say and then when it gets kicked over to the Senate for their say it wont be the same.


And I am tired of pretending that it will just for gotcha points

and when the rest of the developed world also has some form of M4A and have figured out how to pay for it

I have faith we can get it done in the end.

[blm]

30. I just said above - Take England's costs and multiply by 5 or 6.

That should get to the figure we’re dealing with, roughly.

[SterlingPound]

31. as a total cost or per person?

found it up there missed it before
and I agree.

[blm]

34. Their total budget for NHS. We have about 5x the population.

Last edited Tue Oct 22, 2019, 11:56 PM - Edit history (1)

Maybe 6. Add an extra 10billion for gun related injuries, though.

[SterlingPound]

35. what we need to do is push for the best care package possible

dental, medical, THE WORKS!

because no matter what the program is or what it costs the GOP will start downgrading it and cutting costs
no matter the costs, or benefits.

and it will last the battle of attrition longer.

[blm]

40. Here's a chart for NHS

[blm]

42. So that's approx 145billion US dollars x 6. 870billion

If we shoot for a system with better overall care like Canada’s then it would be approx $1.6 trillion.

Since we’re spending FAR more than that now........

[wasupaloopa]

36. That "rest of the world" argument needs to be examined. In many ways we are

not like the rest of the world. Also there are poor countries without health care programs in the rest of the world.

There is not one fact based argument for single payer in this country. No one can point to a study that supports the claims made by M4A supporters and by single payer supporters.

I wish there was. I wish we could point to an independent study that supports single payer for our country. As it is there is no real credibility in what Bernie and Warren are saying.

You can’t expect the country to give up the bird in the hand for the two in the bush. Americans can weight the arguments and make up their minds.

I would like to see a single payer system in this country where all stakeholder’s issues are satisfied. But today there is no roadmap how to get from here to there. There has been no table where knowledgeable people sat down to lay all the parts on the table.

You have a big job ahead of you if you want single payer in this country. Right now there are only unsubstantiated talking points. You can’t sell the American people on “trust me.”

[blm]

37. You were pointed to Physicians for a National Health Program and you

rejected everything at the site because you don’t believe they know as much about the healthcare industry as you.

[wasupaloopa]

41. They are a political group in my estimation. No better than doctors for new drugs if there was one

You need people from all disciplines to weigh in on this.

If you must know, I would not put my medical life in the hands of M4A and single payer supporters on this board. Neither will the American people. They are more discerning.

[SterlingPound]

45. I link others to that site as well

great info there for all to enjoy

[SterlingPound]

44. 2 to 3 % administrative cost is all the argument you should need

no private sector can match that!

[democratisphere]

33. The real problem with American Criminal Healthcare is the price gouging cost.

Price controls must be implemented and locked in for office visits, procedures, emergency room visits, hospital stays, prescription drugs and everything else associated with the healthcare system. Surgeons will no longer be able to afford the construction of $50,000.00 wine cellars built in their homes under a new sane cost healthcare plan. Get wall street and the wealthiest out of our healthcare and we might all have a fighting chance for good health and financial survival! Any politician that says everything will be free this and free that should not even be considered as a Presidential candidate because they don't understand the meaning of deficits and debt!

[Skidmore]

46. Because many are engaging in magical thinking

that increases in taxes on the wealthy will pay for any changes in the Healthcare system. Neither of these things happen with a Republican controlled Senate and a clearly stated campaign by the Democrats on whatever program is finally adopted.

[Gothmog]

47. A public option will not cost $30+ trillion

[AllyCat]

52. Right.

[AllyCat]

51. Because I pay $250/mo plus deductibles and co-pays

For the crappy, employer-provided coverage I have now. Just assuming that money will go to pay for decent coverage for everyone.

Oh yeah: deductible next year goes up to $7000/year and premiums to $300/month.

[stopbush]

59. Because it will never happen.

[iwannaknow]

61. Not if insurance lobbyists have their way?

[iwannaknow]

65. I'd like to see a side-by-side comparison

[Gothmog]

72. Support for a public option has been increasing, and for Medicare-for-All has been decreasing

Link to tweet