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BeckyDem

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Member since: Thu Feb 9, 2017, 01:31 PM
Number of posts: 2,557

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The 'Public Option' on Health Care Is a Poison Pill

Some Democratic candidates are pushing it as a free-choice version of Medicare for All. That’s good rhetoric but bad policy.
By David U. Himmelstein and Steffie Woolhandler
October 7, 2019

Health care reform has been the most hotly contested issue in the Democratic presidential debates. Bernie Sanders and Elizabeth Warren have been pushing a single-payer Medicare for All plan, under which a public insurer would cover everyone. They would ban private insurance, except for items not covered by the public plan, such as cosmetic surgery or private rooms in hospitals. The other Democratic contenders favor a “public option” reform that would introduce a Medicare-like public insurer but would allow private insurers to operate as well. They tout this approach as a less traumatic route to universal coverage that would preserve a free choice of insurers for people happy with their plans. And some public option backers go further, claiming that the system would painlessly transition to single payer as the public plan outperforms the private insurers.


That’s comforting rhetoric. But the case for a public option rests on faulty economic logic and naive assumptions about how private insurance actually works. Private insurers have proved endlessly creative at gaming the system to avoid fair competition, and they have used their immense lobbying clout to undermine regulators’ efforts to rein in their abuses. That’s enabled them to siphon hundreds of billions of dollars out of the health care system each year for their own profits and overhead costs while forcing doctors and hospitals to waste billions more on billing-related paperwork.

Those dollars have to come from somewhere. If private insurers required their customers to pay the full costs of private plans, they wouldn’t be able to compete with a public plan like the traditional Medicare program, whose overhead costs are far lower. But this is not the case: In fact, taxpayers—including those not enrolled in a private plan—pick up the tab for much of private insurers’ profligacy. And the high cost of keeping private insurance alive would make it prohibitively expensive to cover the 30 million uninsured in the United States and to upgrade coverage for the tens of millions with inadequate plans.

Public option proposals come in three main varieties:

§ A simple buy-in. Some proposals, including those by Joe Biden and Pete Buttigieg, would offer a Medicare-like public plan for sale alongside private plans on the insurance exchanges now available under the Affordable Care Act. These buy-in reforms would minimize the need for new taxes, since most enrollees would be charged premiums. But tens of millions would remain uninsured or with coverage so skimpy, they still couldn’t afford care.

§ Pay or play. This variant (similar to the plan advanced by the Center for American Progress and endorsed by Beto O’Rourke) would offer employers a choice between purchasing private insurance or paying a steep payroll tax (about 8 percent). Anyone lacking employer-paid private coverage would be automatically enrolled in the public plan. The public option would be a good deal for employers who would otherwise have to pay more than 8 percent of their payroll for private coverage—for example, employers with older or mostly female workers (who tend to use more care and incur high premiums) or with lots of low-wage workers (for whom 8 percent of payroll is a relatively small sum). But many firms employing mostly young, male, or highly paid workers (e.g., finance and tech) would likely stay with a private insurer.

§ Medicare Advantage for All. The public option approach favored by Kamala Harris would mimic the current Medicare Advantage program. Medicare Advantage plans are commercial managed care products currently offered by private insurers to seniors. The Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare, collects the taxes that pay for the program and passes the funds ($233 billion in 2018) along to the insurance companies. Under this approach, the public option would operate alongside the private Medicare Advantage plans and compete with them, as the traditional fully public Medicare program currently does.

No working models of the buy-in or pay-or-play public option variants currently exist in the United States or elsewhere. But decades of experience with Medicare Advantage offer lessons about that program and how private insurers capture profits for themselves and push losses onto their public rival—strategies that allow them to win the competition while driving up everyone’s costs.

In US Health Insurance, Good Guys Finish Last

A public option plan that facilitates enrollees’ genuine access to health care can’t compete with private insurers that avoid the expensively ill and obstruct access to care. Despite having overhead costs almost seven times that of traditional Medicare (13.7 versus 2 percent), Medicare Advantage plans have grown rapidly. They now cover more than one-third of Medicare beneficiaries, up from 13 percent in 2005. Greed has trumped efficiency, and the efforts of regulators to level the playing field have been overwhelmed by insurers’ profit-driven schemes to tilt it.

Private insurers employ a dizzying array of profit-​enhancing schemes that would be out of bounds for a public plan. These schemes, which continually evolve in response to regulators’ efforts to counter them, boil down to four strategies that are legal, in addition to occasional outright fraud.

§ Obstructing expensive care. Plans try to attract profitable, low-needs enrollees by assuring convenient and affordable access to routine care for minor problems. Simultaneously, they erect barriers to expensive services that threaten profits—for example, prior authorization requirements, high co-payments, narrow networks, and drug formulary restrictions that penalize the unprofitably ill. While the fully public Medicare program contracts with any willing provider, many private insurers exclude (for example) cystic fibrosis specialists, and few Medicare Advantage plans cover care at cancer centers like Memorial Sloan Kettering. Moreover, private insurers’ drug formularies often put all of the drugs—even cheap generics—needed by those with diabetes, schizophrenia, or HIV in a high co-payment tier.

Insurers whose first reaction to a big bill is “claim denied” discourage many patients from pursuing their claims. And as discussed below, if hassling over claims drives some enrollees away, even better: The sickest will be the most hassled and therefore the most likely to switch to a competitor.

§ Cherry-picking and lemon-dropping, or selectively enrolling people who need little care and disenrolling the unprofitably ill. A relatively small number of very sick patients account for the vast majority of medical costs each year. A plan that dodges even a few of these high-needs patients wins, while a competing plan that welcomes all comers loses.

https://www.thenation.com/article/insurance-health-care-medicare/

Sanders and Warren put big donors on notice with massive hauls



By DAVID SIDERS

10/05/2019 06:33 AM EDT

The latest batch of fundraising reports released this week confirmed a new reality of presidential politics: the traditional, big-dollar model of funding a presidential campaign is going the way of landlines and the VCR.

With Elizabeth Warren’s announcement Friday that she had raised nearly $25 million in the last three months — slightly less than Bernie Sanders reported Tuesday — two candidates who didn’t hold traditional donor events became the top two fundraisers in Democratic primary.

And they both blew past the ones who did.

excerpt: (“The fact that progressives combined to raise $50 million without one fundraiser is mind-boggling,” said Rebecca Katz, a progressive consultant who advised Cynthia Nixon in her primary campaign against New York Gov. Andrew Cuomo last year. “And really exciting, because they showed there’s a better way to do this.”)

https://www.politico.com/news/2019/10/05/bernie-sanders-elizabeth-warren-donors-fundraising-029053


Paul Krugman: This sort of confirms Warren's whole worldview, doesn't? Big Finance, given the choice

between treason and a wealth tax, chooses treason.

https://twitter.com/paulkrugman/status/1177267983120551937

Warren 2020!

( Trump ) In an election mainly about pocketbook issues, he is vulnerable. Warren 2020!!

Their policies will win us back the White House, imho.


Excerpt_____If the election is about drastic economic change to benefit working people generally, it will bridge differences and not default to an election about identity. Trump talked a good game about making America great for working families, but he delivered little. In an election mainly about pocketbook issues, he is vulnerable.

Opinion: There’s a reason populists like Elizabeth Warren and Bernie Sanders are gaining on Joe Biden

https://www.latimes.com/opinion/story/2019-09-09/democrats-strategy-race-warren-biden-populism-pocketbook-issues

Sanders And Warren Just Released the Most Decarceral Criminal Justice Platforms Ever

( Warren 2020 )


The 2020 presidential candidates recently unveiled national criminal justice agendas that reimagine public safety and punishment.

Within a few days of each other, Democratic presidential candidates Bernie Sanders and Elizabeth Warren released sweeping criminal justice platforms that rethink public safety and punishment after decades of harmful mass incarceration policy.

The Appeal talked to a number of experts and advocates who say the plans are the most decarceral criminal justice platforms to enter presidential politics. There’s concern these far-reaching progressive proposals could carry political costs for Sanders or Warren in the general election. Still, many feel that their plans represent a historic moment in more than 30 years of the reform movement.

In a plan released Tuesday, Warren pledged to repeal the Violent Crime Control and Law Enforcement Act of 1994, “tough on crime” legislation that catalyzed mass incarceration in America. Released just days before Warren’s, the Sanders plan strikes a similar tone in its pledge to cut the prison population in half by ending mandatory minimum sentencing and “three strikes laws” at the federal level, as well as expanding the use of presidential clemency.

Both plans also call for the legalization of marijuana, and an end to cash bail and the death penalty.

https://theappeal.org/sanders-and-warren-just-released-the-most-decarceral-criminal-justice-platforms-ever/

Elizabeth Warren: Cherith is an Okie educator who teaches AP English Lit

https://twitter.com/ewarren/status/1161350145893703681










WARREN 2020!!!!!!!!!!!!!!!

Elizabeth Warren's New Plan On Guns Has A Goal: Reduce Gun Deaths By 80%

Massachusetts Sen. Elizabeth Warren introduced a sweeping gun control plan Saturday with the goal of reducing gun deaths by 80% through executive action and legislation.

"You've got to start with a goal. I haven't heard anybody else talk about a goal," Warren said in an interview with The NPR Politics Podcast. "What I've heard them talk about is here's one thing we'll do, and one thing we'll do, and one thing we'll do and then we'll quit."

Announcing her plan, Warren said the first step toward meeting her goal is immediate administrative action, which includes a range of ideas, such as requiring background checks, investigating the NRA, and revoking licenses for gun dealers who break the law.

https://www.npr.org/2019/08/10/749946102/elizabeth-warrens-new-plan-on-guns-has-a-goal-reduce-gun-deaths-by-80

Warren 2020!!!!!!!!!!!!!!!!!!!!

Warren speaks for me: Why Would Anybody Run For President Just To "Talk About What We Can't Do?"

WARREN 2020!

She was amazing last night!!!!!!!!!

I LOVE how she fights: #StopWallStreetLooting Act

https://twitter.com/SenWarren/status/1152637778653581314










Warren 2020

( Warren 2020! ) Peter Thiel says Elizabeth Warren is 'dangerous;' Warren responds: 'Good'



Senator Elizabeth Warren doesn’t seem too unhappy about being labeled “dangerous” by investor Peter Thiel .

Thiel, who co-founded PayPal, Palantir and Founders Fund, made the comments in an interview on Fox News with Tucker Carlson, where he described most of the Democratic presidential field as “equally unimpressive” and called Warren “the dangerous one.”

“I’m most scared by Elizabeth Warren,” he said. “I think she’s the one who’s actually talking about the economy, which is the only thing — the thing that I think matters by far the most.”

Warren tweeted a link to a Bloomberg story about Thiel’s remarks with a succinct response of her own: “Good.”

https://techcrunch.com/2019/07/16/peter-thiel-vs-elizabeth-warren/


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