What exactly do you think a "public option" is, anyway?

[Phoebe Loosinhouse]

This term is being batted about and I have the feeling that a LOT of people don't really have a clue what a public option is in the first place.

Here is a good short piece to read with great links that will bring anyone up to date
http://www.campusprogress.org/fieldreport/4010/public-option-enemy-1

Particularly interesting in that link is the link to the guy (Jacob Hacker) with the original proposal about public options written in January 2007. It has acted as the blueprint ever since. I strongly, strongly urge everyone to read it you will get a firm grasp on what a "real" public option is.

http://www.sharedprosperity.org/bp180.html

Basically, my synthesis -

A public option is similar to Medicare
It is run by the government and has a large component of government funding - subsidies, business taxes, etc.
It is open to and available to anyone who does not have other health coverage
It is like a partner to Medicare and would negotiate both treatment and drug costs in order to keep costs down
**********************************************************************************************************************************

When is a Public Option NOT a public option?

When it is not funded by the public! A public option needs to have a source of funding from the getgo. It is the only thing that will guarantee a Public Option's long term survival. A person needs to understand that if the Public Option is initially availble to those without private insurance, it will be made up in large part by people who have been without coverage and a large number of those will be comprised of the previously "uninsurable" by the private companies. A Public Option will suffer from reverse cherry picking initially.

People who (in my opinion) want to have a weak Public Option that will be doomed to almost immediate failure, often propose that the Public Option must be self-funding from premiums only from the onset. That could possibly be a long-term goal, but it simply cannot be the case from the beginning, if ever.

Eliminating public funding is one of the biggest garden paths the compromisers are led down. It's a road to failure.
*************************************************************************************************************************************
Co-ops are NOTHING like a public option. They could be part of a larger exchange in order for the private companies to drive down their own costs and remain competive, but in no way shape or form do they replace a public option.

[havocmom]

1. Rec-ed and

:popcorn:

This should be fun to check back in on later this evening.

[Phoebe Loosinhouse]

2. Really? I thought this was a pretty non-controversial OP. nt

[havocmom]

3. Would be if not for fact that DU seems over-run with indrustry posters and freepers

I wanted to keep an eye on the rec #s cuz there are some boo-birds flying about of late ;)

It's a great OP, Phoebe. Deserves much consideration. You have offered lots of fodder for people to use in LTTE and posts at other forums.

[karynnj]

4. The controversy may be that, even though that 2007 plan sounds good,

it is wrong to day that just because it was called a "public option", that everybody meant that. This assumes that the public option is at least partially funded via public funds. One question is who is eligible for it.

From many discussions of the various public options in the bills written, I have thought that the subsidies are dependent on a person's or family's economic situation and can be applied to any plan and the public plan would have to set rates that recover all its costs.

I think it is appropriate to link the subsidies to people - I also think that if the private companies have to take people without pre-existing conditions, the combination of the subsidy and the fact that they will no longer be assessed incredibly high rates, many of those without insurance will go to private companies as well as to a public option. It might be good to have a mechanism that can compensate any company that insures significantly more risky people.

Incidentally, I recommended this thread, because it is an excellent op and a discussion that needs to happen.

[dana_b]

5. thank you for bringing this up n/t

[Oregone]

6. I think the "Public Option" is dressing atop a Nixon salad

http://www.youtube.com/watch?v=iGKkPEvD2OM

The more you talk about the dressing, the less you notice the leafy greens

"{the reform} is a partnership between the Administration and private health insurance industry. For the private insurance industry, the Administration's plan offers a windfall of billions of dollars annually." - Ted Kennedy

[freddie mertz]

10. Thanks for fabulous link.

It is a never-ending struggle, isn't it?

[Oregone]

11. Certainly when the players keep trading masks too

:)

Ted Kennedy there was for single-payer and Nixon was for mandated, subsidized, and privatized insurance (the current reform, more or less so).

Somewhere, the country lost its bearing.

[freddie mertz]

12. It's a tragedy. My father worked with Ted on HC in those years

He was a very strong, very well-placed advocate for single-payer.

He was convinced that the Clinton plan of 93 was fatally flawed and would not work, but I was living out of the country when most of that went down, and his health failed shortly after that.

I used to hope that HE would live to see universal health care in the US.

Now I doubt that I will ever live to see it.

[ayeshahaqqiqa]

7. You made a good summary

I think the co-ops would be required to be part of the Health Insurance Exchange. My fear would be who would be operating them. Insurance folks? Would the co-ops really make things competitive or would they be used to take on the less profitable insurance risks? Even though the bill as written now indicates that insurance companies have to be willing to take anyone if they are part of the Exchange, I could see changes being made so they wouldn't, or changes that would gut the concept of the Exchange altogether.

[Clio the Leo]

8. Thank you, I've been looking for something like this to send to friends. NT

[Phoebe Loosinhouse]

9. You're welcome. You know what is interesting about that first article?

I found that after searching tons of Google pages for the best, clearest, most succinct description/discussion of "public option". That story was written by a FRESHMAN AT HARVARD. Campus Progress is I guess the collegiate arm of the Center for American Progress. That young writer did a better job and provided better sourcing and context than I have seen evidenced by any mainstream MSM writer. Amazing!

[havocmom]

17. Young writer possibly not yet tainted by the pull of power and money?

There's a reason for the old saying 'out of the mouths of babes' ;)

Oh, and a Thursday :kick:

[Phoebe Loosinhouse]

13. Evening kick.

[slipslidingaway]

14. Great question and you might want to read the Bait and Switch

articles by Kip Sullivan and follow the links.

Thanks for asking the question :)

Also I posted several links here...

Uniquely American Solution - What is it ? Why is it being pushed?
Some talking points from the Herndon Alliance and published on the Third Way site...
http://journals.democraticunderground.com/slipslidingaway/63


Bait and switch: How the “public option” was sold

http://pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%e2%80%9cpublic-option%e2%80%9d-was-sold/

“Public option” refers to a proposal, as Timothy Noah put it, “dreamed up” by Jacob Hacker when Hacker was still a graduate student working on a degree in political science. In two papers, one published in 2001 and the second in 2007, Hacker, now a professor of political science at Berkeley, proposed that Congress create an enormous “Medicare-like” program that would sell health insurance to the non-elderly in competition with the 1,000 to 1,500 health insurance companies that sell insurance today.

...Hacker predicted that his proposed public program would so closely resemble Medicare that it would be able to set its premiums far below those of other insurance companies and enroll at least half the non-elderly population...


...For example, on June 23, Hacker testified before the House Education and Labor Committee that “the draft legislation prepared by special tri-committee promises enormous progress.” He went on to enumerate all the benefits of a “public option.” Yet the House tri-committee proposal bore no resemblance to the public plan he described in his papers and that the Lewin Group analyzed. Later, when Kaiser Health News asked Hacker in a July 6 interview why “your signature idea – a public plan – has become central to the health care reform debate,” Hacker again praised his “public plan” proposal and offered no hint that the “public option” so “central to the debate” was very different from the one he originally proposed.

Ditto for Hacker’s allies. Representatives of Health Care for America Now (HCAN), the organization most responsible for popularizing the “public option,” repeatedly describe the House and Senate HELP committee bills as “strong” or “robust,” always without any justification for this claim, and have repeatedly failed to warn the public that the “public options” they promote today are mere shadows of the “public options” they endorsed in the past..."


Reply to critics of “Bait and switch: How the ‘public option’ was sold”

http://pnhp.org/blog/2009/08/08/reply-to-critics-of-%e2%80%9cbait-and-switch-how-the-%e2%80%98public-option%e2%80%99-was-sold%e2%80%9d/


I stated that a “public option” with zero to 10 million enrollees might not survive and, if it did, it would have little effect on health care costs and the number of uninsured and underinsured. I criticized the leaders of the “public option” movement for failing to notify the public that the mousey “options” in the Democrats’ bills bear no resemblance to the huge “public option” originally proposed by Hacker and celebrated by HCAN...

...But once again an articulate policy entrepreneur appeared on the scene to sell a market-based alternative to single-payer that would leave the insurance industry at the top of the health care food chain, and once again the Democratic leadership fell for it. This time the entrepreneur was not Paul Ellwood. This time the policy entrepreneur was Jacob Hacker, a professor of political science at Berkeley. Just as Ellwood and the Jackson Hole Group had before him, Hacker said enhanced “competition” among insurance companies was the solution to the health care crisis. (The name of Hacker’s latest paper is “Healthy competition.”) This time enhanced competition would not come from “managing” competition, but from the creation of a “public option.” This time the coalition that promoted the alternative to single-payer was not the Jackson Hole Group, but HCAN, assisted by a sister coalition called the Herndon Alliance.

The Herndon Alliance was founded in 2005 by many of the same groups that would create HCAN in 2008. The Herndon Alliance paved the way for HCAN’s promotion of the “public option” with some laughable “research” claiming to find that Americans want a “public-private-plan choice” approach and don’t want a single-payer system. I have written elsewhere about the bogus “research” conducted by the Herndon Alliance. Suffice it to say here the Herndon Alliance cooked up a new and more insidious version of the “political feasibility” argument..."

[andym]

20. Hacker seems to believe that his vision of the public plan is similar to proposed versions

Read http://institute.ourfuture.org/files/Jacob_Hacker_Public_Plan_Choice.pdf written in 12/08, before the current legislation was written. He discusses Obama's and Baucus' initial plans (which sound a lot like the HELP committee version), and concludes that they will satisfy his principles for success.

Whether his analysis is correct is open to debate however. Some of his suggestions, such as possible payments to private insurers to keep the sickest patients, thankfully did NOT make it into the current legislation.

[slipslidingaway]

21. As Kip Sullivan mentions in the first article Hacker's comments

began to change last year.

Many thought the idea was good, but as it was refined by the various campaigns, it also became weaker. The idea that it could provide real competition to private insurance companies and control costs was also weakened as access to the "Medicare Plus" plan became more restricted.

Now we see the CBO scores saying that Maybe 10 million will be enrolled by 2019, Howard Dean used the figure of between 5-10 million in the plan by 2019. More tax subsidies will be used to purchase private insurance and going to the bottom line of for profit companies.


CAF Blog Chronicles Impact of Hacker Health Care for America Plan on the Evolution of the Edwards and Obama Health Proposals

http://www.ourfuture.org/files/documents/evolution-of-the-healthcare-debate.pdf

"...But if the rules for public-private competition are poorly thought out, an inefficient private system will simply suck subsidies from the public sector, sullying the promise of universal coverage..."


Bait and switch: How the “public option” was sold

http://pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%e2%80%9cpublic-option%e2%80%9d-was-sold/

"...Until last year, Hacker and his allies were not the least bit shy about highlighting the enormous size of Hacker’s proposed public program. For example, in his 2001 paper Hacker stated:

Approximately 50 to 70 percent of the non-elderly population would be enrolled in Medicare Plus…. Put more simply, the plan would be very large…. ritics will resurface whatever the size of the public plan. But this is an area where an intuitive and widely held notion – that displacement of employment-based coverage should be avoided at all costs – is fundamentally at odds with good public policy. A large public plan should be embraced, not avoided. It is, in fact, key to fulfilling the goals of this proposal. (page 17)

In his 2007 paper, Hacker stated:

For millions of Americans who are now uninsured or lack … affordable work place coverage, the Health Care for America Plan would be an extremely attractive option. Through it, roughly half of non-elderly Americans would have access to a good public insurance plan…. A single national insurance pool covering nearly half the population would create huge administrative efficiencies. (page 5)



....How did the mouse replace the elephant?

How did the “Medicare Plus” proposal of 2001 (when Hacker first proposed it) get transformed into the tiny “public options” contained in the Democrats’ 2009 legislation? The answer is that somewhere along the line it became obvious that the Hacker model was too difficult to enact and had to be stripped down to something more mouse-like in order to pass. Did the leading “public option” advocates realize this early in the campaign? Or midway through the campaign when the insurance industry began to attack the “public option”? Or late in the campaign when they found it difficult to persuade members of Congress to support Hacker’s original model? Whatever the answer, will they find it in their hearts to tell their followers their original strategy was wrong?

I suspect the answer is different for different actors within the “public option” movement. Hacker surely knew what was in his original proposal and surely knows now that the Democrats’ bills don’t reflect his original proposal. Hacker and others familiar with his original proposal were probably betrayed by the process. As the “public option” concept became famous and edged its way toward the centers of power, they couldn’t find the courage to resist the transformation of the original proposal into the mouse model.

For other actors within the “public option” movement, ignorance of Hacker’s original proposal and of health policy in general may have led them to rely on more knowledgeable leaders in the movement. Their error, in other words, was to trust the wrong people and, as the “public option” came under attack, to cave in to group think. This error was facilitated by the “public option” movement’s decision to avoid mentioning any details of the “public option” whenever possible..."

[Jakes Progress]

15. Agreed but I would add

that it should be open to anyone.....period.

It shouldn't be limited to those who do not have insurance. Without this caveat people with lousy insurance would be stuck paying for insurance profits.

[dflprincess]

16. Exactly

if the public "option" (which apparently won't be an option for most of us) is truly going to complete with the private companies and "keep them honest" :rofl: it a) needs to be open to anyone who wants to opt in and b) should provide better and easier access to care than private plans do.

The option as described in HR3200 has some pretty hefty out of pocket expenses (depending on income) that are as bad as many private companies these will still prevent people from getting health care until they are too sick to put a visit to the doctor off any longer.

The best "public option" would be to open Medicare up and see to it that, after paying into the system, you won't get slapped with additonal charges at point of service.

[Phoebe Loosinhouse]

19. I agree with you

The major question most have had is why go to the trouble and expense of creating a second public option when we have a perfectly fine one ready to go? I imagine it was to distinguish it from Medicare, but to what end?

[slackmaster]

18. Good explanation - K&R

:kick: