The Trigger
In case anybody cares, and you shouldn’t, I am now officially agnostic on just how important if at all the “public option” is in supporting the eventual health care bill. I have just heard too many good arguments on all sides of the question to be able to persuasively argue one or the other.
I remain convinced that, in a perfect world, a sweeping single-payer system — free, universal health care paid for by progressive taxation — is the best way to go. But as Ghandi said when asked his view of Western Civilization: It would be a good idea.
Back to reality. There are those I respect who suggest a bill without a public option might not be worth supporting. Others argue it’s not THAT big of a deal in practice. There are those who just love the opt-out approach, which sounds reasonable enough to me.
What I had not heard, up till now, is a good reason to support the so-called “trigger” option. But now Matt Miller makes what I think is solid argument in its favor. Good reading.
Beyond the details of the eventual bill, or better said, precisely because of the way they are evolving, my META view of this whole thing is finally gelling.
I think the best way to look at health care reform is through the lens of absolute, hardscrabble political reality. Passage of the Obama bill, whatever its provisions, will be similar to the Civil Rights Act of 45 years ago. It didn’t abolish racism or end segregation or inequality. But it did lay down the moral marker and the political foundation upon which further gains were conquered. It became unacceptable to condone any official racism. The fight began, it didn’t end.
With the passage of Obamacare, we will not have universal, affordable health care. But it will no longer be politically acceptable to officially tolerate any significant number of Americans denied affordable access. The real fight will begin.
That’s the good news and the bad news. But it’s the reality. It will have taken us 50 years, or arguably nearly a hundred, to have won the political principle of national health care. It will take a number of decades to make it all a reality.
Nothing in that formula makes me happy. Or, at least, not very much.
Our Neon Tommy piece of the day come again from out First Draft news blog. Our news editor, Richie Duchon, adds more info to this debate on the trigger.
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October 26th, 2009 at 6:54 am
I think you may be a bit overly pessimistic, but on balance your perspective is the only one that makes any sense. The main reason is because the bill isn’t a simplified universal reform like single payer or opening Medicare for all it tries to balance a jillion vested interests, including some that simply don’t even deserve to be at the table, like the private insurers. “In fairness”, this is a huge and complex issue with enormous economic impacts over the long term. Some questions – like “rationing” extreme measures in terminal cases – will not go away. Given this reality and the attendant lobbying and demagogy, there’s no way a fully plausible and effective bill can emerge from the current process. But it lays out principles that will take hold – it’s the beginning, not the end, of universal health care reform. And this bill, itself, changes some fundamental practices within the system that have become totally unacceptable to the majority of Americans. The fight has also (again) revealed the GOP to be the party of Nothing and Namecallers. The mendacity and irrelevance of the right to anything resembling reasoned discourse on the issue has been truly stunning.
October 26th, 2009 at 7:20 am
I think if the extremely rich wanted to pay for our healthcare they wouldn’t be dropping us like flies whenever we have a preexisting condition, like rape or spousal abuse. Sorry, but it’s just wrong to do anything with taxes that insurance CEOs don’t agree with.
October 26th, 2009 at 9:55 am
BTW can’t get the Matt Miller piece to load from the Beast address by clicking on your link, Marc. Googled to try to get at it–no luck. Only got what I thought must have been a truncated version. Seemed awfully short. That was through another site that posted his blog.
Anyway…HBO happened to run a doc called Schmatta from Rags to Riches to Rags this weekend. Once the ILGU made huge strides and 95% of clothing consumed in US was manufactured here if not directly in the garment district. Hundreds of thousands of people were employed. It was New York’s (or just NYC’s) largest employer.
We all know what happened. This country has the most venal record of exploitation and union busting on the planet. The McCarthy era was not about commies but about UNION power in the workplace. Anything that would rock the bottom line was literally targeted like a foreign enemy and the full force of law enforcement etc brought to bear.
Re read that Taibbi article I posted in the other thread. The one about the peasant mentality the permeates the sensibility here. He makes a great point about people being kept subservient by giving them as little in the way of benefits as possible. Universal healthcare would become a weapon in the citizen arsenal that would give us more bargaining power in the work place. If we don’t fear loosing our healthcare we can be more bold in demanding a better work environment and treatment.
By rationalizing the benefit of accepting crumbs is going against the historic precedents.
I don’t think comparing civil rights to health care is a good analogy.
Unions became corrupted because of our peasant mentality. Certain industries created virtual communities of serfs where everything was operated as a satellite of that industry.
We have a huge hurdle to overcome in this country: passiveness.
Liberals rationalizing a crap bill that will suck money and cause all kinds of stupid administrative fuck ups and upheaval and still do next to nothing is not a “moral marker” a line in the sand.
What we need is another keeping our eyes on the prize moment like when they kept crossing that bridge in Alabama.
In that respect the civil rights analogy is apt. But not as you describe it, Marc, as a compromise.
The civil rights battle went form 0 to 100. They had nothing to start with, it was not a victory of incremental compromises.
We have the incremental solutions…the way stations with Social Security and Medicaid and Medicare. Now we need to cut the bullshit.
We need to get EVERYBODY”S eyes on the prize.
October 26th, 2009 at 10:36 am
PS: Roger and Me a hair raising document of the serf population.
October 26th, 2009 at 12:18 pm
Anna C’s synopsis of the civil rights movement is stunningly inapposite as well as wrong. First, when “they kept crossing that bridge in Alabama,” leaders like John Lewis were getting their heads beat in. He was nearly killed. I’m not sure we should be looking for such a moment in the battle over health care. If we were, I suppose the Sarkisians’ loss of their daughter could be such a moment.
It is absurd to say that the “civil rights battle went from 0 to 100.” If nothing else, note that the Civil Rights Act passed in 1964, but the Voting Rights Act was held back until after the election, in 1965. And the reach of those two bills was very limited. And to say “they had nothing to start with” is silly as well. Recent court decisions had struck down segregated housing (Shelley v Kraemer); segregated education (Brown v Topeka Board of Education); segregated marriage (Loving v Virginia). Schools had been opened up in Arkansas, Alabama and Mississippi, all before the 1964 passage of the Civil Rights Act. Truman issued an executive order desegregating the military long before any of that.
Most importantly, the battle was not won in 64 and 65. In many ways it is still being fought today. But we are much further along thanks to the series of incremental steps along the way.
Look, I wish we could legislate a health care program that took health care out of the market economy altogether. There is no good reason that we cannot, except that most Senators and Representatives, and a very large group of their constituents, believe this is too radical a change. I don’t think we should wait around for their minds to change before we deal with the critical unavailability of health care to many hard-pressed Americans of ill-health and modest means.
October 26th, 2009 at 12:24 pm
Most importantly, the battle was not won in 64 and 65. In many ways it is still being fought today. But we are much further along thanks to the series of incremental steps along the way.
Indeed. Boston became Birmingham in 1975.
October 26th, 2009 at 1:08 pm
Michael, those “hard pressed” Americans aren’t going to get squat if any of the various assessments of what is on the table now are correct. Plus there is also the thought that what exists now in terms of Medicaid will get stripped.
And my analogy of those daring demonstrations of we won’t take NO for answer enacted by the civil rights marchers not to mention Gandhi’s tactics are what we need. Health care is a life and death issue and thousands die because of the lack of willingness for people in this country to understand the sinister cabal of greed heads that should be on trial for premeditated murder.
This is a situation that demands an uprising. Not to mention the bailouts and Katrina and hundreds of other outrages.
The whole point of this bend we supposedly went round by electing an Obama was to stop accepting bullshit and being blackmailed into accepting “incremental” change when there is no longer an excuse for anything less than a sane, civilized solution.
October 26th, 2009 at 1:13 pm
PS and the racism issue is still allowed to fester because boldness was not demanded in the first instance and legislative rollbacks occurred under all those fucking Republican years.
We have a constitution and because of an attitude like yours, Michael, accepting anything less than the full measure of that document is what causes the ongoing problems.
October 26th, 2009 at 1:14 pm
Michael, what you advocate is what keeps Americans peasants.
October 26th, 2009 at 1:51 pm
61 yeas is long enough:
“…As he readied for the approaching 1948 election, Truman made clear his identity as a Democrat in the New Deal tradition, advocating national health insurance,[74] the repeal of the anti-union Taft-Hartley Act, and an aggressive civil rights program. Taken together, it all constituted a broad legislative agenda that came to be called the “Fair Deal”.
Truman’s proposals made for potent campaign rhetoric, but were not well received by Congress, even after Democratic gains in the 1948 election. Only one of the major Fair Deal bills, the Housing Act of 1949, was ever enacted.[75][76]“
October 26th, 2009 at 2:05 pm
My point, Michael, is that it took Rosa Parks and the march to get anything done. Just “incremental” attempts at legislation failed.
It took civil disobedience to catch the thing on fire.
October 26th, 2009 at 2:14 pm
Anna, explain to someone who cannot get treatment for cancer because it is a pre-existing condition that they aren’t getting squat from a bill making it unlawful to exclude payment for pre-existing conditions. The Baucus bill does that.
This is the best opportunity to achieve a meaningful leap forward toward a coherent national health care system since 1965. We must get as full a cup of reform as we can. If we opt for “all or nothing” in order to prove we are not serfs, and get nothing, our children and grandchildren will look upon us, rightly, as foolish ideologues.
As for your 1:13 post, Anna, I cannot respond to such clear, well-documented commentary.
October 26th, 2009 at 2:42 pm
OK, at 2:05 you published something coherent. If you are proposing engagement in civil disobedience in order to dramatize the need for comprehensive, single-payer health care reform, do it. Don’t think, however, that the civil rights activists in SNCC or SCLC or SDS for that matter got everything they wanted by passage of the 1964 Civil Rights Act. Their pressure contributed significantly to the sense in the nation that we needed to move on civil rights legislation, so that the 14th amendment’s promise of equal protection of life, liberty and property might really mean something to all Americans. It really did little, though, to achieve economic justice, which was a critical aspect of the 1963 March on Washington and most civil rights work.
October 26th, 2009 at 3:06 pm
“explain to someone who cannot get treatment for cancer because it is a pre-existing condition that they aren’t getting squat from a bill making it unlawful to exclude payment for pre-existing conditions. The Baucus bill does that.”
The Baucus bill says it does that, but so did the Kennedy-Kassebaum that was passed back in the 90′s and signed into law by Bill Clinton. Written by then-Senators Nancy Kassebaum and Ted Kennedy, it was supposed to once and for all do away with pre-existing conditions abuses in the insurance industry.
Guess what? It turns out that the insurance companies have lawyers (!) who can make irrelevant any such legislation dealing with insurance reform. Who knew? In fact, believe it or not, that might be why Kennedy/Kassebaum back then, and Baucus now, had the insurance company help write the bill….unbelievable, I know. Who knew that the insurance company was out to make huge massive profits at the expense of letting people croak?
.And then later, the much-ballyhooed “Patients Bill of Rights”. Another law that D.O.A.ed thanks to those clever lawyers. As lightweight health care bills go that turned out to be nothing but a waste of paper, I could go on for hours here.
This is why I agree with Anna here. Nothing short of a single payer health care system is what is truly needed in this country.
October 26th, 2009 at 3:18 pm
Anna’s position seems to be accurately summed as follows: no change can be good change unless it is my change (and right now dammit).
I always marvel at the size of the magic wand the true believers think they wield.
We actually live in a country with competing interests, and genuine people with genuinely differing opinions–some of whom are not in fact captives of the insurance lobby, for example.
The system we have, as flawed as it is, relies on compromise, and pork barrel, and incremental change. It’s frustrating as hell at times, and it drives the radicals positively nutso (I’m looking at you Sergio), but there it is.
And while there are clear and compelling moral issues at play here, I would rather see something happen as opposed to pissing in the sandbox if I don’t get single payer. You can demand 100% or nothing ™ or you can face reality and fight for the best 50% you can get, and fight on for more another day. One way is likely to get you 50% and the other way is (I submit) guaranteed to get you nothing.
October 26th, 2009 at 3:31 pm
OK, David. Let’s assume that you are right that single payer health care is what is truly needed in this country. Now let’s assume that its supporters in Congress cannot muster anything like a majority in favor of a bill implementing single payer.
So what do you, Mr. Congressman, when faced with a bill that contains wide-ranging reforms, but no provision for single payer? Do you finally see the question–as Dan O puts it–”100% or nothing” [honoring his trademark claim]? Do you vote “no”?
This is the question for progressives, because this is the choice they will be facing in a few weeks.
October 26th, 2009 at 7:24 pm
I think David helped me rest my case.
Those of you whose point of view deems compromise a necessary evil would have a point if each modest piece of legislation actually was a small victory. The reason I advocate all or nothing is because when someone like Potter–who should bloody well know–says these stepping stone pieces of legislation have the paw prints of the insurance industry all over them and that they will, in fact, make things worse; strip existing programs; raise premiums and in short screw people…. I tend to believe him as opposed to wishful thinking that its an improvement.
I think my civil rights analogy still stands. Without the anger and energy and organization we would not have THE LAWS. Laws and taboos are what mold civilized behavior. Doesn’t mean they eradicate human nature.
I also think the point made in the Taibbi piece on Americans as peasants is one of the best analogies. Especially the point made about that refusal to capitulate to universal coverage is a huge stick that continues to beat us into submission.
All other western countries understand the need to not grind their citizens to a pulp and feel pride in civic infrastructure. Here the “dream” bullshit discounts the need for a certain percentage of profit to be returned to help keep up a quality of life.
Workers have continually been paid less, benefits stripped while share holders earn more and false evaluation of the economy’s health are given.
Result is thousands of businesses fail and so does everything else including the institutions like schools that depend on a tax base.
It has to stop. A bloody good first step to making the idiots in this country understand that health is key to the psychic and economic health of a country is key.
If people don’t feel blackmailed into not protesting for fear of loosing health care we might actually see some changes.
The cause for demanding nothing less than what every other first world country has managed to provide for its citizens is a first step in redressing our greed based problems.
We need to take the same attitude as was done towards demanding civil rights. It should become a movement about moral outrage.
October 26th, 2009 at 7:48 pm
CNN news bite:
“…Reid, a Nevada Democrat, has been melding legislation from the more conservative Senate Finance Committee and the more liberal Senate Health, Education, Labor, and Pensions Committee. The Health Committee included a form of the public option in its bill; the Finance Committee did not.
House Speaker Nancy Pelosi has insisted that the House of Representatives will pass a health care reform bill including a public option.
President Obama is “pleased that the Senate has decided to include a public option for health coverage,” White House Press Secretary Robert Gibbs said in a written statement.
“He supports the public option because it has the potential to play an essential role in holding insurance companies accountable through choice and competition,” Gibbs said.”
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This type of report makes me gnash my teeth. Supposedly every poll for weeks has been showing at least 60 percent of the public wants a public option.
The fact that this might be acknowledged by the fuckers elected to represent the majority is what makes giving one penny to any political party a joke.
Despite all the batshit Fox and talk radio and paid for town hall agitators could throw at the issue (and trying to elect Palin to national office) there was defection of historical proportions.
So how come these “blue dog” Dems (wolves in Rethug clothing) aren’t being held acccountable?
It is a suspicious mystery about how and when social networking and the internet are used by progressives.
October 26th, 2009 at 7:59 pm
Well, just in the hours of today things heated up. Public Option back on the table. Huffpo headlines screaming progressive activism forced their hand…
Interesting.
October 26th, 2009 at 8:06 pm
As I was huffing and puffing about the need to stand firm…
“Democratic leaders were forced to include a national public health insurance option as part of health care reform by progressive Democratic senators who refused to support anything less, Senate Majority Whip Dick Durbin (D-Ill.) said on Monday.
Durbin’s assessment was made to a handful of reporters following the announcement by Senate Majority Leader Harry Reid (D-Nev.) that after weeks of talks with his colleagues he had determined that including a public option that states could opt out of was the best way to go.
For many years, it’s been centrist and conservative-leaning senators who have been scoring legislative victories by digging in their heels, so this represented a quite dramatic turnabout. It is difficult to remember the last time that progressives won a legislative victory by laying down firm demands and sticking to them. In the House, the Congressional Progressive Caucus has found its feet, too, and is locked in a final battle with conservative Democrats over the shape of a public option.”
October 27th, 2009 at 1:21 am
The civil rights movement existed in rudimentary form as early as the Constitutional convention, continued throughout the nineteenth century both pre and post-Civil War, and continued to develop, enjoying and suffering its ups and downs for another century and more. That’s why all this flamboyant rhetoric about accepting nothing less than single payer isn’t consistent with how progress actually happens here.
I’ve been on this topic for at least a couple of decades already, and I agree that redefining our national attitude about the right to buy into the system is a first start. More to the point, it is the first first-start we have had in a very long time, and we can’t afford to blow it. So all the perfectionists who can’t accept anything less than single payer can put that plaque on the wall right next to the autographed photo from Ralph Nader’s inauguration.
Assuming that a half decent bill is passed and signed, the way this is going to work is that people will demand improvements bit by bit, and over the course of time they will occur. The ultimate result is that for-profit health insurance will dwindle away (why should anyone opt for paying that extra 25% overhead?), employers will ultimately figure out that they can just pay a certain amount of tax to the government (or the co-op) rather than deal with an insurer directly, and the system will eventually turn into either a single payer governmental system or some amalgam of cooperatives and non-profit companies. In other words, it will look more like one of the European systems, but it isn’t clear which one as yet. The important point, unrecognized by most people, is that creating such a system will not replace the current system — it will replace the current absence of a system.
October 27th, 2009 at 8:02 am
“every poll for weeks has been showing at least 60 percent of the public wants a public option.
“The fact that this might be acknowledged by the fuckers elected to represent the majority is what makes giving one penny to any political party a joke.”
The reality is that we live in a representative democracy that isn’t terribly democratic in that it privileges a handful of rural and tiny states with representation in the Senate equal to the very largest population centers. We’re also saddled with parliamentary rules that mean 41 Senators can block a vote on a bill. Polls mean very little. Political representation that’s effective does. Which is why participation in the process, via $$ donations and activism, is crucial for progressives. We’ve got to be twice as tough and tenacious, look at the long game, celebrate even small victories and not be cry-babies because we can’t get our way and it’s not easy.
October 27th, 2009 at 8:04 am
Bob G,
In earlier blogs on the this issue I concurred with your view…initially when I first heard the term “public option’ I thought it would be the wedge in the door and because no sane person would want to pay for a middle man to make profit the for profit vampire would shrivel and die from lack of usefulness.
The problem is… will the public option even be “half decent”. As this debate has escalated and the revelations of the still heavy footprints of the insurance industry are still to be seen on the backsides of those drafting the bills it seems dubious there will even be an incremental step.
The French system is based kinda like you envisioned…our Medicaid system is pretty awkward and isn’t anything like a universal coverage.
I am still trying to figure out what this P.O. means. How will it be paid for. In England a deduction is simply taken from your pay check. So does this PO mean that those who are at least getting a pay check will have full coverage? What will the deduction be?
And those that aren’t getting a pay check ??? Is there provision for expansion of Medicaid?
What will happen with this messy inbetween bullshit is it will be a mess causing everyone to sour on the idea of any governmental intervention and the arguments will start all over.
Its not like we don’t plenty of functioning universal systems to draw on for inspiration from which a think tank can’t come up with a solution. Oh. They did. And the numbers show its the most viable option.
This inbetween step on this issue is not sound and its only being considered because the health care industry lobby still has everyone by the balls.
October 27th, 2009 at 8:10 am
PS…we are forgetting that the Pub Op has an opt out clause for various states. Gee, think thats to leave a big wedge in the door for the health insurance interests? That little clause makes the whole Pub Op a joke. Will still leave millions in the lurch and costly battles to be fought at the state level.
Ideally it should actually BE the states that create plans…like some were starting to do or some cities like SF. (whatever happened to the SF plan– did it get stalled with the budget crisis? I lost track of that one)
October 27th, 2009 at 8:14 am
Is anyone else aware of the fact that most of what happens in the terrain of politics is bullshit, corrupted by lust for money and power ? It’s true. I have links to Bill Moyers’ shows to prove it. I’m fed up with this crap. If people listened more to what I have to say the world would be a much, much better place. I’m very angry that this is the way things work. I’m considering putting the rest of the fucked up world on notice and holding my breath until this sorry state of affairs turns around.
October 27th, 2009 at 9:12 am
“Those of you whose point of view deems compromise a necessary evil would have a point if each modest piece of legislation actually was a small victory.”
Yeah. That’s why we have a point. IT IS A PARTIAL VICTORY. That you can’t see that is beyond myopic – it’s total blindness.
Preventing insurance companies from issuing recisions will help people. Preventing insurance companies from denying coverage to those with pre-existing conditions will help people. Instituting out-of-pocket spending caps will help people. Those who couldn’t afford care but will now receive assistance in buying care will be far better off. There are problems with the proposed bill, but there are real provisions that help real people (including me!). Additionally, many experts expect this bill to help with long term costs. Anna can continue to side with the Republicans by falsely claiming that the bill won’t help anybody or she can honestly acknowledge the benefits of this bill and then make a (frankly insane) tactical decision to oppose it.
October 27th, 2009 at 9:43 am
David Says: “…Guess what? It turns out that the insurance companies have lawyers (!) who can make irrelevant any such legislation dealing with insurance reform…”
You’re right. I was thinking the other day when seeing these bills with 900 to a 1000 pages how many loop holes were intentionally put in there for pre-existing conditions, cancellations of insurance, denial of converge and god knows else. Then you have this from KOS:
http://www.cbpp.org/cms/index.cfm?fa=view&id=2962
And these people would be required to buy insurance, with the IRS acting as the enforcement agent? Could one believe the horror stories arising out of IRS enforcement action against them- garnishing their wages, seizing bank accounts? Obamacare could become Frankenstein’s monster. Obama and the Democrats would be blamed for it and rightfully so.
October 27th, 2009 at 9:45 am
Mavis, if a bill gets passed that actually implements the incremental improvements you outline…bravo.
And, Mavis, I am hardly siding with Republicans. I am siding with progressives. The ones who pushed and refused to get on board until this latest Public Option option was reinstated– tho it still allows states to not allow it. But it was stubbornness that even put the Pub Op back into the mix.
October 27th, 2009 at 9:46 am
….THAT was a victory.
October 27th, 2009 at 12:07 pm
Matt,
Excellent observations. A bill like the Baucus one mandating that every American find a way to get themselves covered [only in the private insurance sector] without (1) controlling health care costs and (2) providing some competition and choice for Americans is worse than no bill at all.
October 27th, 2009 at 12:28 pm
Yezzzzzzzzzzzzzzzzzzzzzzzzzzzzzz.
Its what I have been trying warn about. Thank you, Matt for digging for the dirt.
October 27th, 2009 at 12:43 pm
That link from KOS to that public policy site won’t stick.
The page comes up for a few seconds (the one going over the healthcare bill warning of its threat to low income famillites) then goes to error no matter how you link to it.
October 27th, 2009 at 1:06 pm
The budget link is interesting. I don’t think that the fact that some people will have to pay more money under the “Reid” bill compared to the “Baucus” bill means that the Reid bill is necessarily worse. It certainly does not mean that the bill as a whole is unworthy of support. What this illustrates is that no matter how you cut it, until we find a way to cut health care costs, the cost of insuring against them will be high.
I hope that something can be done to lessen the burden on those within 125%-150% of the poverty line. Still, even if the burden remains as it is, and the other reforms we have been discussing are in the bill that is ultimately presented for passage in the Senate, I would urge a vote for it.
This process is extremely complex and painful. That fact does not weigh against the necessity for fundamental reform of the way we deliver and pay for health care. Rather, it underscores it.
October 27th, 2009 at 1:11 pm
The enforcement problem that Matt describes is I think the reason the Republicans have taken such a total rejectionist position with respect to the health care reform legislation in both houses. They want it known that this is a Democratic (or, as they would have it, “Democrat”) plan, and any problems arising from it (and there will be plenty) they will blame on the Democrats. Of course that is the position the Republicans took on Social Security and Medicare, I believe, and the Democratic Party has survived the blowback from those reforms.
October 27th, 2009 at 1:14 pm
Anna Churchill Says: “That link from KOS to that public policy site won’t stick.”
On KOS, scroll down to
“Health Care Tuesday
by DemFromCT
Tue Oct 27, 2009 at 07:00:03 AM PDT” and it should work. The link here works fine using Firefox.
Also, this idea about 60% or more Americans supporting a public option is rather ambiguous to me, mainly because what do these people consider a “public option?” I’m not sure, but most would imagine it as some form of Medicare program for all. But from what I understand, these bills would exclude 90% of Americans from the public option. I’m not sure if most Americans are aware of that, though I haven’t read or seen all the polls. For me, what these bills do, call them what you want, is creating just another means-tested welfare program of some sort.
October 27th, 2009 at 1:39 pm
Michael Crosby Says: “Of course that is the position the Republicans took on Social Security and Medicare, I believe, and the Democratic Party has survived the blowback from those reforms.”
That’s true, but Social Security and Medicare were/are open to all Americans and to many, it’s mandatory. The public option is only open to around 10%. I wonder how many Americans would support this public option if it wasn’t available to them. I think the Democratic Party is skating on very thin ice with such convoluted reforms.
October 27th, 2009 at 2:09 pm
Krugman answered a lot of these concerns the other day with his column on the Massachusetts bill – which tends to suck in even worse ways than the Reid-Pelosi likely plan. The devil is indeed in the details, but the citizenry supports the Mass reform on principle, along with efforts to make it work better. The Dems may be skating on ice, but the thinnest ice of all is no reform.
October 27th, 2009 at 2:38 pm
I thought a Pub Op meant rather than one’s expensive health care plan one can opt to choose an equal plan at less cost because of not having a for profit insurer in the mix.
According to my very confused understanding now is the Pub Op now something akin to Medicaid that is meant to cover those that have no cover and aren’t eligible for Medicaid and too young for Medicare??????
I grilled my retired school teacher sister on her health care cover under Medicare plus her AARP $100 a month supplemental. She has had some serious health issues and got to choose her doctors and had terrific care. Once on Medicare you have x amount deducted each month from So Sec check–still don’t know what that is.
Now what is goofy is all those years of having the great coverage teachers got as part of their benefits/salary package could have been going towards a single payer plan. Its all mad.
I admit I absolutely don’t know what the hell they mean now by a Pub Op.
From what Potter said the ins ind was smacking its lips with the idea that people HAD to get some sort of cover because it means now they are going to get millions of more customers at mostly the government’s expense because all these bills so far keep them in the mix just leveling their fees a bit, but they will get many more premium payments to fuck around with in risky investments.
October 27th, 2009 at 4:43 pm
Anna, I think you have pretty accurately described what passes for the public option at this point. From what I’ve heard Potter’s issue mostly grew out of the mandated coverage, which is a different issue from the public option “insurance policy.” Though all these issues are interrelated. Last night Rachel Maddow went thru about 8 iterations of the “public option,” starting with the UK system and heading rightward. The version in the “Reid” bill is something a little right-of-center on the government-involvement spectrum.
The goal would be to make the “premiums” for the public option sufficient to cover the claims plus overhead. One of the problems is that it is difficult–basically impossible–to set the premiums on an actuarially sound basis because no one has more than a foggy idea who will be signing up for it, whether the eligible population would be “good health risks” or “bad health risks”, etc.
My guess would be that they will be somewhat better risks than most because the uninsured–the eligible class–are generally younger adults. Age is the single most significant morbidity factor an insurer can identify w/o requiring exams for coverage.
October 27th, 2009 at 6:31 pm
So how will one PAY for it. Deductions??? Or one signs up and pays like a bill????
Any idea of what the monthly cost would be?
Will it function better than Medicaid? Will it be like having real coverage or still put one as a second class citizen and constantly having to renew one’s eligibility like for Medicaid????
This is insane. I stick with my notion that its gotta be all or nuthin’.
October 27th, 2009 at 9:27 pm
“its gotta be all or nuthin”
A common attitude that develops from a habit of gettin’ something for nuttin’. It develops into a right.
Your right.
October 29th, 2009 at 12:09 pm
Sorry, out for a day or so…Anna, most of the questions you pose would arise in your “all” scenario. Many of these questions will be resolved in the reg-writing at HHS. Insurer lawyers, as well as consumer/health group lawyers, will be all over that process, but in that case, Obama will have the last word.
I would say this, the cost will probably be at least partly age-rated, so that younger people will get a lesser rate than us feeble oldsters.
My guess is that the class of people eligible for the public plan, in this iteration, would be a relatively healthy group. Sen. Wyden, who knows a lot about group health coverage, says just the opposite, based on his view that this group has received inferior health care to date, probably lives an unhealthy lifestyle, etc. I think he is probably mostly wrong, but if we wait til all the variables are constants, the time for reform will have passed.
October 29th, 2009 at 1:30 pm
Thanks, Michael.