Good Idea

JK, caution!

Watch yourself get flayed by commentators feverishly asserting that the idea of insuring people who are uninsured right now and introducing the exchanges mean nothing, NOTHING I TELL YOU, without a public option.

Of course, Barack Obama never wanted the public option at all, and devilishly manouevred to keep it in the bill until the very last minute so that he could throw a bone to the insurance companies whose pocket he’s in. Since he ran his campaign solely on the public option (don’t you remember his slogan “Change we can believe in….including the PUBLIC OPTION” – it was everywhere!) of course he is betraying everyone who thought that America might see a brighter day where politics as usual wasn’t played.

Plus, the fact that he reached a deal with big pharma – he should be ashamed that he is so close to passing healthcare reform.

Obviously, after ten months it is clear to all that Barack Obama hasn’t achieved anything, has betrayed all his principles and now he is going to send more troops to Afghanistan – how could he when he so clearly opposed the Iraw war!

I think that just about covers it all.

But all individuals would have to have access to the exchange whether their employer offers coverage or not. Ideally a public option would be offered on that very exchange. If not, there should be no mandate since the mandate would in fact be a subsidy.

One of the things missing completely is the benefits of personal medicine in the US, in which patients actually receive personal attention. Dr. Norman Makous (doctor for some 50-60 years) has written a book talking about just that, called “Time to Care.” It’s not about the current legislation, but about the changes that have happened in the care of patients and how that should be fixed. And the legislation fails to address the key issues in the book, which is HOW we provide medical services! His point of view is that having an independent primary care physician at the heart of the person’s medical care is a proven, effective and an ethical method of monitoring care, and it reduces unnecessary and expensive tests that drive up costs. Very thought-provoking — and the kind of medicine I want.

Medicare has the Advantage option. It offers lower deductibles and usually perscription coverage.
It is an option I’ve chosen. However, once a year I get a booklet that lists many insurance company plans. I am sure it is compares with an “exchange”.
Well, because there is no “public option” in competition, the costs for Medicare Advantage rises each year. In the 4 years I have belonged, my premium has risen from $30 to $119. Also, deductibles have risen and coverage weakened. I changed plans this year and my premium is still $95.
If you don’t think insurance companys collude, you are in a fantasy world.
I worked for 10 years at what was a wonderful plan to offer health insurance to small businesses in California. No preexisting limitations, no limits on life time coverage, and choice. The first couple years it was run by the state and then, by legislative mandate, privatized. At the end of the 10 years private insurance companies had destroyed the plan and pulled out.
What will guarantee that private insurance companys will be competitive with each other?

Hell, if politics wasn’t played, we would be a single payer country just like the rest of the world.
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That is all…

Klein misses the point. It isn’t that a public option is necessary to bring down (or simply slow the rate of increase) insurance premiums. The point is that there is a reason that the public option has been eviscerated. And that reason is the same reason that “a system of robust health care exchanges” will be just as strenuously opposed as the public option has been.

Contrary to the insinuation of homerhk, I can think of plenty of solutions to the problem that don’t include a public option. But none of those solutions have ever been on the table. The reason that robust public-option proponents have rallied in defense of that particular policy option isn’t because they are blinkered ideologues. It is because, of all the possibly-workable methods of bringing down costs (to consumers), only the public option has ever been on the table.

It is the Blue Dogs, the GOP, and their corporate masters who would oppose a system of genuinely robust health care exchanges. I find the suggestion that it is liberals who are standing in the way of serious consideration of policy alternatives to be laughably absurd.

“But I would much rather see health reform pass without a public option, and with a strong Exchange system, than have no reform at all.”
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If only progressives felt the way you do. But they don’t and will let Democrats go to hell before voting for them again after being shown that, even with 60 votes, it is the insurance industry who decides what sort of health care system the public is allowed and, to top it off, you will buy their grossly-overpriced product, like it or not.
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How long do you think it will be before your insurance “super-stores” bring the cost of a health plan down to the level of say, only twice what a Canadian or Japanese person pays? How ’bout a robust public plan (Medicare for all) available immediately? And what would be the respective political results in 2010 and 2012 for an exchange system that changes nothing in the near term vs. available, affordable government-administered heath care? Thought so.

That’s true but we don’t live in that world.

” … Once again, I have nothing against the public option. ”

Such may be a very powerful and well-considered statement on this on-going real-life-and-death debate from one who is starving, living in chronic pain and without access to health care.

Scenario:
Millions of Israelis have no access to health care.
The lawmakers in US congress are debating whether to give out billions of dollars for the Israelis to establish a health care system.
Can we expect that all that the neutral, free and fair JK will care to say about that debate is “I have nothing against” that idea but it should not hold up the passage of bills on other stuff?

Maybe not. Yet the number of Americans with no reliable access to health care is more than seven times the population of Israel (that denigrates us, the USA gentiles, who – according to their jewish-christianist myth – are unworthy and will be wiped out on the day of rapture.)

[Stated another way: Can our Congress explain why they seem to believe that according to our founders, the "right to exist" of the foreigners named Israelis - and to actualize their rights by laying claim on our resources - tramps the "right to exist" of each and all of the over 50 million (starving and diseased) Americans - securely and fully vested - in pursuit of the good old American happiness? ]

Why would any of the corporate wh*res opposed to the public option be open to an expanded exchange concept?

The only thing that will be expanding in the next few years is the number of progressives looking for a new party to support, if they give in to Lieberman and the other Bush dogs.

“That’s true but we don’t live in that world”

That’s fixable. Buses leave for Canada every hour

JK
I usually disagree with you on most subjects but you are right on this one. If we are to have healthcare reform than we must be honest and opened minded and not idealques.
Your approach plus allowing people to buy insurance over state lines and real Liability reform would allow for real healthcare reform and reduce the costs to a manageable level.

Wars kill mostly innocent people. It is estimated that over 90% of those killed in the current aggression in the Middle East are civilians.

So what is the nature of the current debates on HCR?
1) If we balk at providing HC to all Americans because of the cost, then

- it may be asked whether we have done all we can to come up with the funds.
Medical Insurance Battle Wastes $20 Billion a Year

- it may still be asked whether we have done all we can to come up with the funds. For instance, is it proper to spend exorbitant sums of American funds on providing cozy circumstances to foreigners in Israel, Egypt and Pakistan while millions of Americans – who have the overriding priority on such funds – wallow in poverty and disease?

- it may be stated that we would rather spend $10,000,000,000 A MONTH killing dirt-poor innocent kids and their mothers in far-away caves of Iraq, Afghanistan, Pakistan (per Israel’s and EU’s imperial strategic designs) than to provide HC for our citizens – the “we, the people”.
Would a sovereign USA kowtow to the whims of a foreign sovereign? If we don’t jump whenever Israel says so, then what will Israel do to us?

2) If congress people balk at at reducing the profits raked in the pharmaceutical and insurance companies that fund their/our political campaigns then we may wonder what could be more obscene to our founding fathers. Are the people we elect keeping the faith in our republic?
The devil within: Senators who raised millions of dollars in campaign donations from pharmaceutical interests secured industry-friendly changes to a landmark drug-safety bill, according to public records and interviews.
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Paul Starr of Princeton, one of the real wise men when it comes to health care reform..

Nope, he’s just reflecting whatever is currently passing for conventional wisdom, like:

…liberals imagine that it would radically alter the insurance market by providing better protection at lower cost.

Not this one. I see a public insurance option as a check on private insurers; they don’t comply with the regulation (if it hasn’t been weakened or ill-enforced), and those insurees can be moved to a public plan until another provider can be found or the faulty insurer is compliant. Then there’s stuff like this:

The government plan may well have to charge higher premiums because it is likely to attract more than its share of the chronically ill and other high-cost subscribers.

followed by this:

The bill would also ban pre-existing condition exclusions and require insurers to offer coverage to everyone in the exchange at the same rate regardless of health..

in which Starr contradicts himself; if insurers can’t dump their high-cost patients, then why would a public plan attract ‘more than it’s share’ of high-cost patients?

Yet many states have a poor record of regulating health insurance, and some would resist passing legislation to conform with the new federal law.

Then why on earth are we discussing state or regional control like it’s a good thing?

Accelerating the timetable of reform ought to be a priority.

Finally, something that I can agree with…but then there’s this:

The basic aim of reform is to create a more efficient and equitable system for health insurance and health care and to provide subsidies so everyone can afford coverage.

The basic aim of reform is to help sick Americans get better, not to provide afforable coverage. God forbid that we do something not because it’s profitable, but that it’s the right thing to do.

correction: ” ..isn’t it an act of betrayal by our American Congress to, eh, acquiesce to the expenditure of exorbitant sums of American funds on providing cozy circumstances to foreigners..”

The US is in a different world from… the rest of the world? We really are exceptional.

“- it may be stated that we would rather spend $10,000,000,000 A MONTH killing dirt-poor innocent kids and their mothers in far-away caves of Iraq, Afghanistan, Pakistan (per Israel’s and EU’s imperial strategic designs) than to provide HC for our citizens – the “we, the people”.”

You see, we’re tough, just like the ancient Spartans, if Sparta had had TV and Cheetos and giant foam fingers.

“God forbid that we do something not because it’s profitable, but that it’s the right thing to do.”
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At this point it is solely corporations who decide what’s doable and right to do in this country and their god is mammon.

The basic aim of reform is to help sick Americans get better, not to provide afforable coverage.
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I disagree. Universal coverage is a laudable goal, but it isn’t the driving force behind reform for me or millions of other Americans. I mainly want lower premiums.
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Right now, if you are “uninsured”, you can still get treatment: You can go to the E.R., you can pay out of pocket, or you can file for Medicaid.
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This Rube Goldberg health care system is far from perfect. Unlike the GOP, I think we can do far better. However, the health care crisis in America is not a crisis of coverage. It is a crisis of health care costs.
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If I had to choose between a “reform” bill that radically attacked costs (e.g. robust health care exchanges, open to all Americans; a public option that paid at Medicare rates; revocation of the anti-trust exemption) and a bill that guaranteed universal coverage without significant cost savings (i.e. the present bills under consideration), I would pick the former in a heartbeat.

How exactly will purchasing insurance across State lines lower costs in the long term? As I see it, it will only apply a slight downward pressure upon the rates of the local (in-state) insurers until an equilibrium is reached. If the difference in price is great, the price will eventually rise in the lower-priced health insurance pool as more and more people join it.
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Furthermore, without expanding the oversight role of the Federal Government, how do you solve the issue of a policyholder from State A buying a policy from an insurer in State B and subsequently having an issue with the insurer? Insurance is State regulated and the insurance commissioner in State A has no authority over the insurer in State B and the insurance commissioner in State B has no impetus to help said policyholder. How do you propose to solve this problem?
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How exactly do you contend that “liability reform”, better known as tort reform, will bring down health insurance costs when it has failed to do so in any number of states that have enacted such legislation? The current tort reform efforts have done little to nothing to lower insurance costs.

Just in case anyone is in danger of being misled: The Day of Rapture and all the other occurrences predicted in the Book of Revelation are strictly Christian in nature and origin. The Book of Revelation is part of the Christian scriptures (what Christians call the Old Testament). I do not mean to suggest that all Christians believe literally in all that is in Revelation, but NO authentic Jews believe any of it, and indeed Jews are specifically listed among the victims of the Rapture (although, unlike gentiles, they are given the option to convert and escape).
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It’s not easy fact-checking blog comments.

Universal coverage is a laudable goal..
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Agreed. And I know that we’re not going to get it…It just seems that, with all the focus on financial aspects of health care reform, we’ve lost focus on the reasons why we are reforming in the first place; we are not being served well, and we want something better for ourselves.

What, exactly, would the exchanges do for us?

The problem is the for-profit insurance business model. Giving us more options in that area is helpful, but won’t solve the problem. It. just. won’t.

Example: what was your last experience with cellphone company technical or customer support?

That’s what I thought. that’s a competitive market, isn’t it?

Now if Joe was suggesting exchanges and re-conversion back to non profit status for all the former Blue Cross blue shields, maybe we’d have something.

But a wide selection of cigarette companies is not beneficial. A wide selection of Indian casinos is not beneficial. A wide selection of for profit companies motivated to make money by denying me health care is simply not in my best interest.

It is worth noting that theoretical legislation always sounds better than actual legislation. Klein’s complaint about the public option is that it isn’t that important. But that is only because Klein is talking about the public option as defined in actual, pending legislation and not a theoretically optimal public option.

If liberals had capitulated on the public option and focused on “robust health care exchanges,” only to have the White House, Blue Dogs and GOP slowly destroy the effectiveness of the exchanges, then right now Joe Klein would be writing:

Once again, I have nothing against the health care exchanges. They might increase competition and reduce costs, if drawn differently from the current Senate plan. But I would much rather see health reform pass without exchanges, and with a strong public option, than have no reform at all.

Sassamassin’ rassafrass! “What Christians call the NEW Testament.” It’s not easy fact-checking oneself.

“authentic Jews”

Is that like, say, a pure-bred one?
How can we tell the real one from the fake ones?
And why do we need to?

diecash1
Liability insurance currently costs doctors between $100,000 to $300,000 per year. With common sense liability reform tens of billions of dollars could be saved ever year.
Buying insurance across state lines would add competition in many states that are currently under served by insurance companies which would drive down costs.
These are facts that any sane person can understand but I’m sure you will disagree with them. If you cannot understand these facts than there is no use talking to you. You are too far gone.

The fact that you can neither articulate or substantiate your position is telling. I simply asked for some facts. As I pointed out, tort reform has done nothing to lower costs for health insurance in Texas, often held as the model for tort reform, or anywhere else. I see that you feel that your “common sense” is proper support for your position; I assure you it is not.

You also failed to address the problems I pointed out with selling insurance across State lines. Perhaps you believe that the problems will just magically disappear? Not likely.

Where exactly will these tens of billions of dollars of savings come from and why have they not yet materialized in Texas, Florida or California? Regardless, no savings have materialized for consumers in any of those states either.

I find it comical that you make statements such as this:

“These are facts that any sane person can understand…”

without actually providing any facts or evidence to substantiate your position. Perhaps you google “substantiate.” This may assist you in formulating an actual response.