The most devastating critique I’ve read of the current public option comes from Kip Sullivan. What makes it devastating is that although he’s a single payer advocate, instead of attacking it from the point of view of single payer, he takes it on on its own terms—comparing the House bill’s version of the public option to the one originally proposed by Hacker:
• The PO had to be pre-populated with tens of millions of people, that is, it had to begin like Medicare did representing a large pool of people the day it commenced operations (Hacker proposed shifting all or most uninsured people as well as Medicaid and SCHIP enrollees into his public program);
• Subsidies to individuals to buy insurance would be substantial, and only PO enrollees could get subsidies (people who chose to buy insurance from insurance companies could not get subsidies);
• The PO and its subsidies had to be available to all nonelderly Americans (not just the uninsured and employees of small employers);
• The PO had to be given authority to use Medicare’s provider reimbursement rates; and
• The insurance industry had to be required to offer the same minimum level of benefits the PO had to offer.
What would this mean in effect? 123 million people enrolled, the ability to set premiums substantially below those of private insurers and the ability pay hospitals and doctors less than private insurers, leading to massive cost savings.
But of the five conditions, only one is met in the new plan: requiring the insurance industry to offer the same plan. Not a single other requirement of the original public option plan is met. Not one. As Sullivan points out, the public plan starts without a single enrollee and has to hire sales staff, negotiate contracts and so on, all while being required to pay back its start up costs within 10 years.
What advantage do you have over the private insurers that means you will be able to out compete them? The only one I can think of is that you don’t have to make a profit, but that’s only half true, because of the requirement to pay back within 10 years, you effectively do have to turn a profit.
Go read the entire thing. Sullivans’ argument is, in my opinion, strong enough as to be devastating. I’ll be discussing this more next week, as promised, but Sullivan has said most of what I wanted to say and said it better than I would have. His argument about why the CBO scoring of only 9 million enrollees is either correct, or even overstates the case is of particular interest.
tjfxh
While single-payer is the no-brainer, and the initial PO second best, even a watered down PO is better than none. I suspect that a whole lot of people will choose a government bureaucrat to make decision about costs instead of an insurance company flunky paid to increase profits to save money.
There are essentially two views. 1) Sink any plan that isn’t single-payer of contain a correspondingly strong PO. 2) Pass a plan with any PO and figure on improving on it down the road.
I think that the second option is better simply because if the Dems don’t pass any plan, then they risk a repeat of 1994, which would scuttle the Obama presidency. So there will be a plan if the Dems want to remain in power, and I don’t think that the lesson of 1994 is lost on any of them. Let’s make sure there is a PO in it.
However, it’s seeming doubtful that an effective plan can pass in the Senate without a resolution for a simple majority. IMHO, that’s the way to go, since it is the only way to circumvent the huge amount of money being injected by into the political process and corrupting the outcome. Forget the bipartisanship and end run the blue dogs. Without an effective plan, cost control is impossible, and without health care cost control the economy is doomed going forward.
jacksmith
LEAD, FOLLOW, OR GET OUT OF THE WAY. (Thomas Paine)
We have the 37th worst quality of healthcare in the developed world. Conservative estimates are that over 120,000 of you dies each year in America from treatable illness that people in other developed countries don’t die from. Rich, middle class, and poor a like. Insured and uninsured. Men, women, children, and babies. This is what being 37th in quality of healthcare means.
I know that many of you are angry and frustrated that REPUBLICANS! In congress are dragging their feet and trying to block TRUE healthcare reform. What republicans want is just a taxpayer bailout of the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT health insurance industry, and the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT healthcare industry. A trillion dollar taxpayer funded private health insurance bailout is all you really get without a robust government-run public option available on day one.
YOU CANT HAVE AN INSURANCE MANDATE WITHOUT A ROBUST PUBLIC OPTION. MANDATEING PRIVATE FOR PROFIT HEALTH INSURANCE AS YOUR ONLY CHOICE WOULD BE UNETHICAL, CORRUPT, AND MORALLY REPUGNANT. AND PROBABLY UNCONSTITUTIONAL AS WELL.
These industries have been slaughtering you and your loved ones like cattle for decades for profit. Including members of congress and their families. These REPUBLICANS are FOOLS!
Republicans and their traitorous allies have been trying to make it look like it’s President Obama’s fault for the delays, and foot dragging. But I think you all know better than that. President Obama inherited one of the worst government catastrophes in American history from these REPUBLICANS! And President Obama has done a brilliant job of turning things around, and working his heart out for all of us.
But Republicans think you are just a bunch of stupid, idiot, cash cows with short memories. Just like they did under the Bush administration when they helped Bush and Cheney rape America and the rest of the World.
But you don’t have to put up with that. And this is what you can do. The Republicans below will be up for reelection on November 2, 2010. Just a little over 13 months from now. And many of you will be able to vote early. So pick some names and tell their voters that their representatives (by name) are obstructing TRUE healthcare reform. And are sellouts to the insurance and medical lobbyist.
Ask them to contact their representatives and tell them that they are going to work to throw them out of office on November 2, 2010, if not before by impeachment, or recall elections. Doing this will give you something more to do to make things better in America. And it will help you feel better too.
There are many resources on the internet that can help you find people to call and contact. For example, many social networking sites can be searched by state, city, or University. Be inventive and creative. I can think of many ways to do this. But be nice. These are your neighbors. And most will want to help.
I know there are a few democrats that have been trying to obstruct TRUE healthcare reform too. But the main problem is the Bush Republicans. Removing them is the best thing tactically to do. On the other hand. If you can easily replace a democrat obstructionist with a supportive democrat, DO IT!
You have been AMAZING!!! my people. Don’t loose heart. You knew it wasn’t going to be easy saving the World. 🙂
God Bless You
jacksmith — Working Class
Republican Senators up for re-election in 2010.
* Richard Shelby of Alabama
* Lisa Murkowski of Alaska
* John McCain of Arizona
* Mel Martinez of Florida
* Johnny Isakson of Georgia
* Mike Crapo of Idaho
* Chuck Grassley of Iowa
* Sam Brownback of Kansas
* Jim Bunning of Kentucky
* David Vitter of Louisiana
* Kit Bond of Missouri
* Judd Gregg of New Hampshire
* Richard Burr of North Carolina
* George Voinovich of Ohio
* Tom Coburn of Oklahoma
* Jim DeMint of South Carolina
* John Thune of South Dakota
* Kay Bailey Hutchison of Texas
* Bob Bennett of Utah
SocProf
Actually, the problem IS Obama and the Democrats. They are the ones who abdicate even before the battle. They are the ones who took single payer off the table BEFORE the discussions started and since then, they have been negotiating with themselves to water down the public option, with the complicity of some big “progressive” blogs. All the Republicans have to do is sit back and yelp “socialized medicine” to activate their base. Guess what? It’s what an opposition is supposed to do (read Ian’s post right below this one).
The problem is the lack of leadership and spinelessness of Congressional Democrats and the Obama administration. If they had the guts, they would make the case for single payer (it’s not hard to do) and fight for it and point out the insanity and lack of effectiveness of any alternatives (I thought Obama was supposed to be the pragmatic president).
selise
thanks ian, for your posts on this subject. there has been so much flack flying around — talking points, manipulation (instead of persuasion), propaganda and outright lies — that i’ve found it next to impossible to figure out what public plan was on offer or, now that the shape is becoming a bit clearer (via the committee bills), what they actually say policy-wise.
doesn’t help that the MA 2006 reform experience has got me in an even more skeptical state than usual.
selise
re kip sullivan’s article. i think there has definitely been a bait and switch. what i’m not sure of is the mouse model a step forward or back? what justifies accepting the individual mandates?
here in MA we had some laws to regulate insurance companies (no denial of coverage based on prior conditions, etc) BEFORE the 2006 reform. so insurance was available to all. of course, doesn’t control costs though. but if the mouse model public plan doesn’t control costs either what are we gaining by the mandate? prices are still going up.
btw, you can take a look at the MA exchange (called the connector) here:
http://www.mahealthconnector.org/portal/site/connector/
Mandos
I’m a little surprised that anyone would think that a major of reform of health care was ever in the offing, including in this presidency. To me, the biggest obstacle is that it’s still the case that at least half the population thinks (note: *thinks*) that it is adequately covered. So long as this is the case, and so long as this holds in most states and congressional districts, the less likely any health care reform of any value would occur. Regardless of how many single payer activists there were writing letters to Congress.
At present, the upper limit on health care reform is what it takes to make sure that that 50+% on Medicare, veterans benefits, big group plans, and so on remain sufficiently placated and emotionally invested in the system. If The Uninsured have not yet managed to stir the public’s sense of shame by now, relying on the breakdown of the system for the have-nots to spur reform eventually doesn’t make a lot of sense.
Ian Welsh
It won’t happen because of uninsureds, it will happen because of inadequate insureds. The polls are all over the place, more than half may be happy, but you can also find polls where 70% want government insurance.
Mandos
Yes, but do they want it enough to make it an issue for which they would take down their congresscritters? Many people still believe they have enough insurance even when they do not.
My prediction: the point at which real change becomes feasible is when the giant employer group plans start noticeably scaling back. I am on one of these giant employer group plans and on the face of it, all is mostly well.
But you know, pay no attention to the man behind the curtain. And we’re all dutifully obliging.