guy44

You're right on target. Throwing crap at a wall. Two mutually exclusive arguments against the public option.

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aceventura3

How about different people with different points of view are making different arguments or that they are simply two different issues.

On one hand we know that Medicare/Medicaid at current costs and projected cost increases that these programs can not be sustained unless there are some significant changes. We also know that private sector health care insurers, like them or not, are mostly profitable. Some very reasonable people agree that private sector companies are too restrictive and need to be forced to address things like pre-existing conditions. Even people like me see a need for some change. There are also some very reasonable people who agree that Medicare/Medicaid are generally good programs but because of out of control costs have concerns regarding increases in taxes or reduction in benefits, or both. Even people like me see a need for some change.

A totally different issue is the "public option". Some very reasonable people agree that there needs to be increased competition and increased consumer choice. Different solutions have been proposed contrary to statements from the President - Republican have presented alternative solutions. Some of us believe it is unlikely that the government can enter the health insurance market and act like a private insurance company. Given this belief, if government enters the market and creates a competitive advantage, private insurance companies will not be able to compete. If the government has "hidden" subsidies (i.e. - like Medicare/Medicaid that will eventually have to make major changes), the period where these subsidies exist will put private insurers out of business or turn them into niche players.

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Derwood

A government option will not put private insurers out of business, just like: the USPS hasn't put FedEx or UPS out of business, government funded state universities haven't put private universities out of business, etc.

aceventura3

FedEx is a niche player in the market. The founding of the company is based on exploiting a need not being served by the Postal Service. FedEx will never be able to go head to head with the post office. I am not even sure they should.

Private universities and public universities operate in a pretty unique business and I don't see similarities to health insurance. the most obvious difference is that people see insurance as more of a commodity than a university education. People will pay a premium for a Harvard education because of the perceived value compared to an education at a state school. Also, a school like Harvard only accepts a small percentage of those who apply. Most people would not care if their insurance card says, Blue Cross, Aetna, Cigna, Big Government or ABC, they care about the contract, they care about their doctor, they care about the hospital they would go to, etc.

Also,most people who attend private universities get a subsidy (scholarships, aid, discount loans, etc.) in some cases the out of pocket costs are not that different for those who qualify. The "rich" don't care about the cost.

__________________
"Democracy is two wolves and a sheep voting on lunch."
"It is useless for the sheep to pass resolutions on vegetarianism while the wolf is of a different opinion."
"If you live among wolves you have to act like one."
"A lady screams at the mouse but smiles at the wolf. A gentleman is a wolf who sends flowers."

flstf

I also believe that there are probably ways to cut waste and fraud out of Medicare. Any health care program for old people is bound to be very expensive, perhaps the program should be open to younger people as well.

In regards to the "public option", it seems as though the Republicans and Democrats agree on the majority of insurance reforms such as covering pre-conditions and eliminating caps. In my opinion the main difference is the Republicans want to give people money to only buy private insurance and the Democrats want to include a government run alternative. Either way, or if we do nothing, health care insurance/costs are probably going to continue to go up.

Since the government is going to pick up the majority of costs anyway, it seems that some money could be saved by eliminating the costs for insurance company profits. If we are going to put so much control on insurance companies we may as well eliminate the middle man.

Halx

Would you trust a judge's ability to make a ruling on your court case if he was paid 5% of the final settlement? Of course not! That would be a conflict of interest. So, why do we allow other conflicts of interest to shape our world? Bankers advise us on loans that they get kickbacks from. Politicians vote for bills in exchange for lobbyist money. Insurance companies manipulate coverage and premiums based on what allows them to turn a profit or not.

The question isn't how much these companies are making, it is their method of doing business that is corrupt. They could be in the red and it would still be corrupt. It needs to be regulated.

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guy44

I'm glad that you agree that Medicare (and, to a much lesser degree, Medicaid) need to change. Although most of the coverage of the health care debate has focused on the public option and universal coverage, the fact is that the vast bulk of the reform consists of hundreds of smaller measures which collectively improve our health care system a great deal. For example, Obama's MedPAC recommendations would do a great deal to save gigantic sums of money by essentially creating an independent, non-partisan group of experts to evaluate the effectiveness of medical procedures and drugs and set Medicare reimbursement rates. The former task is important because thanks to health care industry lobbying, right now no one independent actually studies the effectiveness of different medical procedures - many are eventually shown to be highly expensive and basically useless. The latter task is just as crucial, because Medicare almost acts like a monopsony in setting reimbursement rates and right now those rates are decided in the most inefficient conceivable place - Congress.

Of course, there are other thousands of other ideas being thrown around. Nevertheless, I fully agree (as does every expert on the subject) that the reforms will do wonders for improving our health care system but will ultimately do far too little to bend the cost curve. Essentially, there's way too much money floating around in the system, and sometime in the next decade or two we're going to have to find a way to reduce it. Personally, I'd institute single payer, but instead we're going to have to have a fight with the insurance companies, doctors, Big Pharma, etc. in order to get them to take less profits. But that's for the future.

As for the public option, I've never seen a serious economic analysis showing how the public option will destroy private insurers. With the caveat that we don't know if the public option will be included in the bill, let alone what form it will take, or who has access to it, there's almost no way for it to severely outcompete private insurers. In fact, if it is included, it looks like it won't be able to negotiate bulk discounts on pharmaceuticals like Medicare or use Medicare reimbursement rates. All it will do is provide competition to the private insurance companies.

Furthermore, I can see a serious public option resulting in two outcomes. One, the public option is competitive and private insurers reduce costs and offer better plans. This is what all the experts think will happen. Two, it handily outcompetes the private insurers and shows that the government can provide better health care more cheaply than private insurers can. I fail to see how this is a bad thing - it proves once and for all that single payer will work, plus it destroys private insurers, who are universally horrid.

Nope. The Republicans barely have a plan, but what anyone can decipher from it is that they want to give people money (that otherwise would have been spent by their employers on health care) to spend themselves on health care. This is a terrible, horrible, miserable idea. There are tremendous advantages to size - large employers negotiate huge discounts on health care, while the government does even better - and forcing people to negotiate individually would be a tremendous disaster. This would mean an end to the employer-based health care system entirely.

The Democratic plan keeps things mostly in place. You will still probably get your insurance through your employer. There will be new rules (no rescission, no preexisting conditions, community rating), new competition (the health care exchange, maybe regulation about the number of insurers offering health care within a state), and maybe a public option that is exactly like a private health insurance plan except run by the government.

These are very different ideas, and I don't think there are 5 health care experts anywhere who think the GOP plan (to the extent it exists) is tolerable.

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flstf

Are there any laws to prevent a state from grouping all their residences together to negotiate lower health care insurance costs, or for that matter how about all the states getting together to negotiate a super low rate? I ask this almost as a joke, but I wonder.

guy44

Are you asking if states can create their own public insurance agencies, and then bargain via those for lower health insurance costs? I'm honestly not sure, although you'd need a large number of people enrolled in the plan. I'm not sure exactly how many, but I'm talking many millions. Probably only a few states (CA, TX, IL, NY, PA, FL, probably some others) have enough, especially since we can't expect 100% of residents to sign up.

Also, all the states getting together to negotiate a super low rate is basically a federally administered public option.

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Derwood

pretty amusing:

National Journal Magazine - If Air Travel Worked Like Health Care