Framing the Public Option debate: It's oversight, baby!
By John Amato Thursday Jul 02, 2009 10:00amJacob Hacker is an exceptional mind and hits all the right notes when he discusses health care reform and the public option. This piece is a must-read, but he doesn't stop there.
Check out what he says in the TNR on page two of his article.
This is a not a radical idea. In many areas of American commerce, private and government programs comfortably co-exist. FHA insured loans and non-FHA loans, Social Security and private pensions, public and private universities--all have long thrived side by side. Each side of the divide has strengths and weaknesses, but in every case the public sector is providing something the private sector cannot: A backup that's there if and when you need it; a benchmark for private providers; and a backstop to make sure costs don't spin out of control. Just as it is comforting to have Social Security in case your 401(k) evaporates or an FHA loan in case your credit score tanks, a new public plan provides an added level of protection against the vicissitudes of an unaccountable insurance market.
A public plan is about competition as well as choice. Even on a level playing field, the public plan will create discipline for private insurers that regulations alone simply cannot. Regulations require extensive monitoring and vigilance--and, as we know from careful study and long experience, private insurers will try to get around these rules. Having a tough public-spirited competitor means that the regulations do not have to do more work than can be expected of even the most nimble and powerful regulator, much less real-world regulators constantly subject to industry pressure, ideological attacks, and budgetary constraints. So the public plan is about more than choice and competition.
It is also about regulatory realism and restraint of the kind that, in other contexts, conservatives generally espouse. The goal of the public plan isn't to eliminate private insurance, or put government in charge of American medicine, or any of the other frightening futures that critics have painted. The goal is to create accountability for the public and private sectors alike while ensuring all Americans have affordable quality care. Sure, there will be tensions and difficult questions to resolve. But the alternative, as we've seen, would be far worse.
The whole article is a must-read. Imagine that, the public option would also serve as a watchdog against the entire health-care industry. If the public option were worthless, there wouldn't be a hissy-fit going on among conservatives and groups like the AMA. Jacob uses the very smart framing that the public option provides a little "law and order," and I thought conservatives were into being tough guys, no?
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Until we get the media to accept (because they have no choice) the proper, logical framing of this issue, instead of the AMA/Luntz-provided framing, and until we get them to stop bringing on endless streams of Republican shills to lie about it...
...oh, who am I kidding? That's never going to happen.
Since good ol' boy B.Clinton passed the telecommunications act of 1996 the Media has become a small cluster of Corporate giants. The so called competition that was supposed to have been created never materialized as the major players all gobbled up the smaller players and made deals not to step on each others territories. The result is corporate America owns the media lock stock and barrel. Corporate America now controls everything you see, hear and read. The only exception being some of the Internet, and believe me they are working to end net neutrality as well.
The visible price we pay is out of control Cable, Satellite and phone bills. The invisible price we pay is being subjected to non stop corporate propaganda being disguised as "news" as they move their agendas forward.
everything was given away for free. what amounted to upwards of 70 BILLION dollars of the public's money was gifted to TimeWarner, GE, Viacom, etc.
We have this against us!
... and Americans not only pay over twice as much to get health care that is ranked in the bottom 5 of the world's top 40 industrialized nations, but we can't even cover every citizen... we have more uninsured Americans than many of those industrialized nations have citizens.
And the fact that we are still having a debate about health care, in which we are trying to figure out how to frame universal care... leds me to believe that Americans, at large, must be one of the largest collectives of dumb motherf*ckers in the history of the world.
if memory serves your wife is a surgeon, what is her take on the public option versus single payer, if i may?
Although we differ, I am against public option because it seems to be a compromise, and she sees it as getting the foot in the door to improve things in the future. She is an eternal optimist, and I am a pessimist.
... she went into medicine, because she actually cared about people (unlike a high percentage of her classmates). Plus we have lived overseas, so she has been exposed to other medical systems, she also had several rotations at the VA.
It seems the AMA is trying to frame this debate to convince doctors that public option leads to severely reduced wages for medical professionals. Even though they happily ignore things like the amount of income doctors have to spend on malpractice insurance (highest premiums in the world). And the insane hours Doctors have to put in due to increased pressure on the limited amount of doctors created by the artificial shortage (a shortage sponsored among others by the AMA themselves).
Believe it or not, some medical professionals want to practice medicine, and do not appreciate to be over ruled by some bean counter with no medical training whatsoever. She estimates that for each hour of medicine she practices there is almost an equal amount of time she has to spend dealing with over head completely unrelated to the procedures/medical practice.
People in the front lines get their hearts broken by the system rather quickly, you'd be astounded at the rates of alcoholism, divorce, etc. There are obviously selfish medical professionals who like the system the way it is. However, people who actually care want a change pronto. The current system makes no sense for patients or medical professionals, it is however the wet dream of any MBA.
i am always curious to hear input from the people that are a bit more knowledgeable about the issue than people like, well, me.
are knowledgeable about medicine, not the administrative aspects of it. They have probably more first hand experience with the system though.
However, the campaign of FUD (Fear Uncertainty Doubt) carried out by the AMA lately regarding universal health care is enough to have made me lose a big deal of respect for the medical profession's establishment.
Our current system does not only victimize consumers (I don't think of other country which thinks it is appropriate to refer patients like that) but also a big deal of medical professionals. For the most part, it only benefits the health management corporations, which themselves add very little value to the whole thing. So in other words we're perpetuating a system that only benefits those which add almost nothing to the health care part of the healthcare equation.
why does that not surprise me?
which is akin to financial "services" sector: nothing of value is added, just a pound of flesh taken.
"... and Americans not only pay over twice as much to get health care that is ranked in the bottom 5 of the world's top 40 industrialized nations, but we can't even cover every citizen... "
Uh huh. Also, why are so many people okay with paying sky-high prices for unreliable private insurance, but go postal over the idea of paying a little more in taxes for public health coverage that will actually be there when they need it? I don't get it.
Do people really believe the "extra" taxes will be more than what they're paying now for private health insurance?
The taxes won't go up that much, honest! I know because I live in Canada. Public health care is means less bureaucracy than the American system. Doctors don't have to spend half their time fighting with insurance companies to get coverage for treatment. The doctors and hospitals don't have to worry about getting paid.
Health care decisions are left to the patient and doctor. Contrary to the Repug talking points, we do not have government bureaucrats standing between us and our doctors. I'm 50 years old, I've lived in Canada all my life, and I've never had any government interference in my health care. As opposed to America's for-profit health care, where insurance company bureaucrats interfere in health care decisions, and get bonuses for finding creative excuses to deny you benefits.
And what about all those people who can't get private health care insurance because they have pre-existing conditions? Or the people who can't afford to pay insurance premiums, but aren't poor enough to be eligable for government assistance? Or all those stories about how the most common cause of personal bankruptcy is medical bills?
America is the land of Ralph Nader, and Americans are the most savvy consumers in the world. They've put up with those insurance companies long enough. Go kick some ass!
bankrolling the largest socialistic institution in the world: the US Armed Forces.
heckler's article is interesting and makes some good points(3r's). this is the real concern. the possible
UNfair advantage that a public option provides. the concerns by the private insurers are the concerns they use in their business model. they basically price fix and form a monopoly like structure so not to have any competition. the example has been mentioned in the state of iowa. the insurer WellPoint insurers i believe 71% of the state population. private insurers don't like competition. their actuaries want control and prediction for wallStreet. we need more competition and a public option may be our only way to get cost down drastically. otherwise it's estimated that healthCare ins. cost will double in less than 10 years. with cost going up and the good possibility of this (global) recession prolonging more people will fall into the uninsured/under insured demographic. the cost of that demographic will be a cost that that shifted unfairly. it will become a more noticeable hidden TAX.
HMOs are pretty much recognizing their industry is engaged in pervasive price fixing and collusion, this is the health care industry in this country is a cartel.
If Obama had any intention of changing the system, all he had to do is to instruct the DOJ to conduct an investigation on the HMOs' collusion. And you'll see how things quickly move along...
Alas, he is not interested in rocking the boat. After that farce of a "townhall meeting" made it abundantly clear, we're not getting single payer anytime soon, if ever (at least under his holiness guidance).
I worry about hospitals like our own (rural) community hospital. It's almost always teetering on the brink of financial viability and a big chunk of it's reimbursement comes from private insurance companies. Decrease that rate towards that provided by Medicare/Medicaid and the place could go under. What's unknown is whether the higher percentage of insured patients will cover that discrepancy.
Now if costs dropped across the board immediately, it wouldn't be a problem but the painful period of adjustment could put many hospitals out of business.
... else they would not make as much profit.
If anything single payer would guarantee less "profitable" institutions like the hospital in your area. If you feel like worrying, you should be terrified of the private option remaining, at some point a bean counter is going to notice that the little rural hospital near where you live is not cost effective, and they may advocate a "consolidation" at a more profitable urban centre... I hope you like traveling for your check ups.
Under the current system, insurers have no qualms about affecting your quality of care if it gets in the way of their profits. That is why it is fundamental to remove the profit portion of the health care equation. It is a basic human right, and we should deal with it...
I'm pretty sure private health insurance plans compensate significantly more than medicare. Why would doctors limit their number of medicare patients and/or not accept any new medicare patients in order to keep their practice financially viable if this were not the case?
... medicare may have lower compensation than some private carriers. Not all private carriers pay more than medicare, and the differential is not always "significantly" more.
At the end it all boils down to what perks a specific physician can negotiate with a specific carrier. Some private practices targeting the elderly can be quite financially viable and they mostly depend on medicare.
that insurance companies reimburse at a much higher rate than medicare. I agree with you on removing the profit from the equation but the question is how to get there. If we could wave the magic wand and immediately jump to single payer mode, that would solve 60% of the problem but that won't happen.
It's conceivable that the public option could do more damage than good and will delay or prevent single payer. That's why I'm against it.
Exactly waving a magic wand is the only realistic way to get single payer. It is simply too great a task to overhaul the entire industry, including the training of medical professionals, to institute a single payer option and its exactly why it's not being considered. My problem with the public option is what incentives will doctors have to take these patients? Since those with private insurance can keep it if they like, doctors will still have higher paying patients with private insurance. Also if the number of doctors does not increase, but the number of potential patients does by 40 million how can doctors possibly provide better patient care to all of these individuals?
A lot of these uninsured do show up at hospital ERs when they get sick - either they go broke trying to pay then or (more commonly) nobody gets paid. So I don't know that there will be a big surge in demand for services but I fear that there will be a drop in reimbursement to some if not many providers. Those already on the edge might just go belly up.
most hospitals have agreements with the state, in which they get to be compensated for the care of uninsured patients.
In fact they commonly "double dip" in the sense that they get the payment from the state, and they still go for the patient via collection agencies. They also get to charge higher rates to non-insured patients. If anything, some hospitals see uninsured patients as a cash cow, too bad about the added paperwork they require.... but that paperwork is almost the only thing that is keeping hospitals from literally preferring uninsured patients.
has to practice medicine is making lots and lots and lots of money.
Do not project your biases on other people, please.
Also, those 40 million people already exist, you think they are magically generated overnight? those people are still getting sick and clogging the ER infrastructure in our country.
Also, the only thing to overhaul is the dismantling of the private carriers and turn them into non-profit institutions. Hardly a hard task, it only affects the boards of those corporations, affecting a few thousand individuals tops. Hardly anything difficult, "lesser" countries have been able to do it without much fuss... frankly it is a trivial problem when you take into account we were able to send a man to the moon in less than a decade.
Incidentally, single payer may reduce some of the compensation doctors receive... but the differential is offset by the reduction in malpractice insurance doctors have to pay off their own pockets. The reduced overhead would be a welcome change by almost any physician...
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that series needs to be left to more creative sorts. The production qualities are really lower than the avg. wedding videographer these days. The script, set colors, lighting, and audio are all sub-par. But, I guess the crew was controlled by very specific demands by the producers. Shame. No money for this from me.
I find it interesting how John Amato is tauting that this article is a must read in the debate for a strong public option. Then he provides a link to the PNHP website which is a group of health care providers in favor of a single payer systems. In that article they question many of Jacob Hacker's conclusions about the public option. And at the end of Mr. Amato's post he asks for donations to the Blue America's Campaign For Health Care.
I guess he forgot to read the paragraph where PNHP states:
"We are opposed to a fragmented, dysfunctional health care financing system that is causing financial hardship, physical suffering, and, all too often, death. Adding a public option will have only a negligible impact on the fundamental flaws that are causing so much personal grief."
The public option will not be a stepping stone to single payer. It will only fail. We need to make real reform and support a single payer system. Don't support Blue America. Make real change and support PNHP or another group working for a single payer system.
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