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Editorial: Consequences of the 'public option'

Abstract:
At the heart of the proposed "American Health Choices Act" is the "public option." This gives every American the option of buying into a health care plan run by the federal government. Ostensibly, this would provide competition and choice that would put downward pressure on the price of health care and improve quality of care....

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Dave

posted 6/17/09 @ 11:59 PM CST

"According to a study by the Lewin Group, the consequences of this plan would force 120 million Americans off their employer-provided health plans and into a government plan."

This is very misleading. The Lewin Group evaluated six variations of government funded health care proposals and the 120 million figure (which, I believe is actually 119.1 million in the actual study)refers to the most extreme welfare-like plan which has little support from Democrats or Republicans. It is also a plan that Obama has not voiced support for to my knowledge.

http://www.factcheck.org/politics/more_health_care_scare.html

Matt Zimmerman

posted 6/18/09 @ 11:36 AM CST

The 120 million figure comes from a plan that proposes that the government pays the rates they pay for Medicare and which does not prevent employers from dumping their employees into a government run plan. This is essentially the plans that have been introduced into the House and Senate, including the American Health Choices Act, which Obama and most Democrats support.

Also, I just have to say that there are plenty of Democrats who have signaled support for single-payer health insurance, including President Obama, so this is nothing.

The exact compensation levels will be determined (and will be changed later-Just like Medicare's payment levels have been lowered over the years) In any scenario, the rates the government pays will be significantly lower than market value. In any scenario, their has to be the possibility of employers NOT buying private health insurance. It has to be, or there is none of the vaunted competition.

The other details concerning hundred of billions in tax hikes and regulation are yet to be determined and will also make a difference in how competitive this plan really is.

If you wanted to be fair, you would have to mention that each of the six proposals analyzed by the Lewin Group, millions of uninsured will remain uninsured, while millions of people who are already insured are dumped into some type of public plan, including the one where enrollment is limited to individuals and which would pay market value.

And as, Senator Chris Dodd said, "This bill is [going to affect] 100 percent of the population of our country, every consumer, every provider, every business."

Considering that the federal government has screwed up nearly 100% of everything it has ever done, this is not comforting.

student

posted 7/05/09 @ 9:14 AM CST

Originally posted by

Matt Zimmerman

The 120 million figure comes from a plan that proposes that the government pays the rates they pay for Medicare and which does not prevent employers from dumping their employees into a government run plan. This is essentially the plans that have been introduced into the House and Senate, including the American Health Choices Act, which Obama and most Democrats support.

Also, I just have to say that there are plenty of Democrats who have signaled support for single-payer health insurance, including President Obama, so this is nothing.

The exact compensation levels will be determined (and will be changed later-Just like Medicare's payment levels have been lowered over the years) In any scenario, the rates the government pays will be significantly lower than market value. In any scenario, their has to be the possibility of employers NOT buying private health insurance. It has to be, or there is none of the vaunted competition.

The other details concerning hundred of billions in tax hikes and regulation are yet to be determined and will also make a difference in how competitive this plan really is.

If you wanted to be fair, you would have to mention that each of the six proposals analyzed by the Lewin Group, millions of uninsured will remain uninsured, while millions of people who are already insured are dumped into some type of public plan, including the one where enrollment is limited to individuals and which would pay market value.

And as, Senator Chris Dodd said, "This bill is [going to affect] 100 percent of the population of our country, every consumer, every provider, every business."

Considering that the federal government has screwed up nearly 100% of everything it has ever done, this is not comforting.


Why do you continue to lie even after you've been called out on it? President Obama has never supported single-payer health insurance. In fact, that is the reason I supported Kucinich way back in January 2008.

But whether he has ever "signaled" support for it or not is beside the point, since you claimed in the column that the plan currently being forwarded would force 120 million people off of private insurance according to the Lewin Group's findings, which is absolutely false.

Dave

posted 6/19/09 @ 8:28 AM CST

I don't think that the rates in the American Health Choices Act are the same as Medicare. The rates that have been proposed, according to factcheck.org, would be 10% higher than Medicare. You can argue that rates will likely fall over time (as they have with Medicare) and that it may ultimately be a slippery slope to some kind of single payer system. But, as far as I can tell, the bill put forth by Ted Kennedy that Obama and Dems are currently supporting is not the plan that the Lewin Group estimated would cause 120 million to switch off of their private insurance plan. This is copied directly from the factcheck.org article:

Sen. Ted Kennedy, meanwhile, has drafted a health care proposal with a public plan that would pay providers at Medicare rates plus 10 percent. The Lewin Group study didn't specifically look at that option, but it did analyze the effects of a plan paying rates midway between Medicare and private coverage. That would be close to Kennedy's idea. (The Lewin Group study notes that Medicare payments to hospitals are 30 percent less than what private insurers pay and payments to doctors are 20 percent less.) Under the midpoint scenario, the number with private insurance would drop by between 21.5 million and 67.5 million, depending on who would be allowed to buy into the public plan.

hsr0601

posted 6/20/09 @ 11:31 AM CST

I suppose some common sense and cool head can solve this cost problem.
As we know, the public option currently being discussed is modeled after Massachusetts Plan, under which about 97% of all Massachusetts residents are now covered.
According to the approach of CBO, its rate of the uninsured in Massachusetts should be far greater than the present one at the moment.
Moreover, in case the strong public option, medical IT, increased efforts in prevention, and a broader array of cost-saving plans and beyond add to the Massachusetts Plan, the cost containment does not matter at all. And most importantly, the promising stem cell research is making its way.
To date, private insurers have coexisted profitably with Medicare and Medicaid for many years.
Basically, healthy society leads to better productivity and better performance.

ok

posted 7/05/09 @ 12:35 PM CST

The difference between this plan Massachusetts plan is that there was a MANDATE to buy health insurance in Mass. Of course the number of insured will be higher if the government is threatening higher taxes.

That the CBO got it wrong is also a weak argument for implementing a massive new government program.

I don't really understand what you mean by your third paragraph, but I will say that it is not the federal governments job to stick their hands into every part of our lives in order to increase productivity. That's what the Chinese do.

Mike Leon

posted 7/07/09 @ 5:46 PM CST

There is NO reason why Americans cannot have 100% free health. Taxes pay for libraries, schools, fire fighters, policemen, and military forces in Iraq. Yet the government doesn't regulate what time I can report a crime, or what kind of books I can check out, or whether or not 6th graders can learn long division.

The propaganda that the government is going to regulate what medicine or care your receive is used so the health insurance companies can continue to make money by denying coverage from those with serious preexisting conditions and collecting money from those who are well off and rarely need to visit a doctor.

We're a free country, so why should I have to fill out a stack of papers and pay thousands when I need to go to the hospital?

all right

posted 7/07/09 @ 6:41 PM CST

Mike,
The government already regulates medicine. What do you think Medicare does when they say they will not pay for X medicine or Y procedure?

What do you think Obama means when he says he wants the government to make sure that doctors provide the best care not the most care? What do you think when Kathleen Sebelius say she wants to bring all doctors under federal standards?

It means they want the federal government to be inserted into the doctor-patient relationship in order to save money.

Why would we want to bring 250 million people that are happy with their health care under a system run by the federal government? Might I remind you that Medicare is INSOLVENT. The VA medical system is a joke. Medicaid is destroying states' budgets.

Maybe the Federal Government should fix what is on its plate before destroying everyone else's care and spending trillions of dollars doing it.

Even if we could deal with single-payer health care system (we can't) there is NO REASON to do so. It does not make any sense to stick your hands in everyone else's health care to deal with people with pre-existing conditions. If you want to deal with that, fine. Don't act like you need to root around in other peoples' care to do it.

Likewise, because a few million people don't have health insurance isn't a good reason to make everyone in the country be on an inefficient government plan.

Again, paperwork is a different problem that has nothing to do with implementing a single-payer system.

If you trust the people (the 535 members of Congress, the President, and the federal bureaucracy) who have caused the current recession, gave us the Iraq War, bankrupted Medicare and Social Security, failed the War on Poverty, and failed in improving education, then I guess you might think it makes sense to give the same people the control over your relationship with your doctor...

Mike Leon

posted 7/07/09 @ 8:07 PM CST

Anonymous poster,
Few million? Try almost 50 million. All those people pay out of pocket at the hospital, sometimes thousands of dollars. But hey, if you have full coverage you "love" that shouldn't be your problem, right? This is America and we supposedly look out for one another. But do we?
Your argument that the government is going to screw up medicine just like everything else it ever did is typical of everyone who favors big business. The government ensures us it can handle two "terrorist" wars and find the solution to an economic crisis, but doctors? Oh no, THEN they can't be trusted, they'll just screw it up. Best to leave that to the CEO's and not the 535 congress persons America voted to give the power of legislation to.
I'm suggesting every pill, procedure, and x-ray is funded by taxes. It's not that hard, we provided free healthcare to the detainees at Guantanamo Bay. I think Americans should get the same healthcare given to the "Axis of Evil."
Let's get real, many nations have 100% free healthcare, and as a result, most have longer life expectancies and lower infant mortality rates than the U.S. (look it up, right after you revise your "few million statistic")
America needs to stop the "it's my money, my insurance, and I deserve it more than any other bum without a job" attitude and start helping one another.
If we can find trillions of dollars to kill in Iraq, we can fork up some money so a single mother can get antibiotics for her child and keep America healthy.

Anonymous Poster

posted 7/07/09 @ 9:39 PM CST

25% of the uninsured are already eligible for public assistance and choose not to take advantage of it
20% have family incomes of over $75,000 a year. They can afford it.
40% are young and choose not to get health insurance
A significant portion of the number are illegal immigrants. A significant portion are unemployed temporarily and the actual people in the category is constantly changing so it is disingenuous to suggest that they are left out of the system.

America did not vote to give Congresspeople the power of legislation. The Constitution gave them that power, and incidentely, did not give them the power not delegated to them by said document.

Many nations have "free" health care, sure. Their taxes are astronomical, countries like England have huge waits for health care, life-saving procedures are rationed in order to save money, their mortlity rates for cancers are higher. They do not have better health care. And there are other factors to take into account. The Swedish people may have "free" health care, but they also have completely different cultures and lifestyles that Barack Obama can't dictate no matter how much he raises taxes on soda.

The fact is, that you deflected by trying to say that I am a shill of big business, is that the government ALREADY HAS significant control over health care in American and they have FAILED. If you want to help the few who do not have health insurance, fine. Don't screw up the rest of it for a reason you haven't explained yet.

ts

posted 8/05/09 @ 9:46 AM CST

The Lewin report said a nonprofit/public insurance option would be MORE COST EFFECTIVE than forprofit/private insurance because it could negotiate discount rates for members (like medicare does) and admin costs would only be 13.2% (vs. 31.7% to cover profit and advertising in forprofit/private insurance). NOT BECAUSE OF GOVT SUBSIDIES

A family would pay $761 per month in a nonprofit/public plan instead of $970 in private insurance. As a result 120 million people would VOTE WITH THEIR FEET and dump the overpriced forprofit/private inurance.

The report is at

http://www.lewin.com/content/publications/LewinCostandCoverageImpactsofPublicPlan-Alternative%20DesignOptions.pdf

What

posted 8/05/09 @ 11:44 AM CST

Where in the report does it say that the public option would be cheaper because of negotiation?

It would be cheaper, but like Medicare, it would be because Congress sets a price ceiling, and like Medicare, it will ration services, and like Medicare, it will be increasingly difficult to find a doctor who accepts Medicare patients.

I don't really see how destroying competition and giving people no choice is letting people vote with their feet.

Maybe the government should tear down barriers to competition rather than fixing the tax code so that 200 million people are forced to go to an HMO and don't have the option of a tax credit to purchase private health insurance and aren't allowed to buy insurance from other states.

Also, what is wrong with making a profit on health care?

moop

posted 8/07/09 @ 4:10 PM CST

Ah, Matt Zimmerman, glad to see you took some time off of your summer break to be a tool for the right wing. I never knew you were a millionaire with guaranteed health care for life! I mean you have to be if you are not concerned about the cost of healthcare. Some of us, who no longer have mommy or daddy to pay for our cuts and scrapes, either already have huge healthcare bills, (I payed 6k for a sleep study myself) or have to pay outrageous premiums (I now have insurance through my federal government job and I pay almost 200 bucks a month, not including co-pays, and I am single). The problem is most of your talking points are derived from a memo form the Levin Group, an Insurance company think tank supported by Republican interests. President Obama has stated over and over again that Americans can keep their insurance and will have more competition which will keep costs down. It also seems like you really like medicare, excellent! So do I! So why can't we extend medicare to all citizens? I mean, you seem like what government is already doing for people so what is wrong with expanding it? The way I see it if you want healthcare reform you have 2 choices, you can advocate for single payer or at the very least a public option, or you can join with Matt and the other teabaggers who have no plan of there own and storm town hall meetings, comparing Obama to Hitler.

Moop

posted 8/07/09 @ 4:44 PM CST

Oh and to the person who was insulting the VA. I work for the VA and I get care there. It took me a week to schedule a checkup and two weeks to schedule an ultrasound. I called my local hospital, a hospital that has been rated as one of the best in the country, and they couldn't schedule me for three months. I got all my labs and procedures done at the VA hospital faster and for free. As an ER administrator, I have seen a patient get in and out with all their labs and prescriptions including triage and actually seeing a doctor, in about 3 hours. Tell me the last private hospital you went to that got you in and out of the ER in less than 3 hours. The VA also rates similar or higher in patient satisfaction than many area private hospitals and they do it with a about a quarter of the budget. Also if "socialist" health programs are so bad, then why aernt there a plethora of Canadians clamoring to live in the US? I mean if the government program is "killing" people, then why do Canadians live longer and rate their healthcare system higher than Americans? Every issue you have with government run insurance is already effecting private insurance ten fold. Try getting insurance with a pre-existing condition, or calling you HMO and telling them you want to chose your own doctor. It kills me that people think healthcare should make a profit. SHould the fire department and police department make a profit? Can we not at least agree that certain basic services should be provided for all citizens?

Matt

posted 8/07/09 @ 5:30 PM CST

Moop, you need to think about what you type before you type it.

You say that I am a tool for the right wing, yet you rattle off the talking points of the left and you insult me and other Republicans who dare to disagree with you.

And what have you proved? Not a whole lot.

Even if you refuse to actually read the Lewin Group Report (without giving a reason why), look at the estimates of the Democrat-appointed Congressional Budget Office-The public option would kick 23 million off private health insurance, leave 30 million uninsured, and would cost 1 trillion dollars.

This prediction by this non-partisan office contradicts your blind-faith in Obama's promise that you can keep your health insurance if you want. You see, Obama doesn't HAVE to take away your insurance outright.

All you have to do is create another option -NOT a competitive one, rather, a government-mandated monopoly - that takes taxpayer money to subsidize it, and then uses its legislative power to decree that health care costs 30% less than the market price. Just like they do with Medicare.

Business cannot compete with this. You can stay on your health care if you want, but there is nothing stopping private insurance companies from going out of business.

Medicare is bankrupt. There are tens of trillions in unfunded liabilities. Why? Because Congress stole the money out of the fund. Exactly the reason why they should have as little to do with health care as possible.

No one says that we don't need to do anything to make things a little better. However, it is ridiculous to say that we only have two extreme choices or that Republicans haven't proposed anything.

Now, feel free to actually read and address what I am saying. Don't bother trying to insult me and pretending like you proved something.
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