Congress ready to cave on public health insurance?

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Dominus Atheos
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Congress ready to cave on public health insurance?

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The Hill
Some of the biggest names in the Democratic Party have lined up to take the lead on healthcare reform, but the key to a bipartisan compromise may be the lesser-known Sen. Ron Wyden.

The Oregon Democrat doesn’t chair a committee in the upper chamber and represents one of the most liberal states. Yet Wyden has emerged as a potential game-changer by insisting the legislation have strong support across the aisle and forging a partnership with a GOP senator who has the Senate minority leader’s ear.

Republicans are so impressed with Wyden’s bill that some are convinced he represents President Obama’s best chance for getting major healthcare reform signed into law this Congress.

And while Democratic Sens. Edward Kennedy (Mass.) and Max Baucus (Mont.) may chair the committees charged with shepherding the bill through the Senate, Wyden, a 6-foot-4 former college basketball player, has his own advantage: a standing invitation to play hoops with the president at the White House, which may come in handy when hashing out the final details behind the scenes.

For Wyden, the key to passing lasting healthcare reform is finding a legislative solution that can win at least 70 votes in the Senate — and he’s not shy about letting Democrats know that means dropping thoughts of a government-run public plan for the entire nation.

To make his case, he has met individually with more than 80 Senate colleagues to discuss his proposals. He has envisioned his role as neutral broker so vividly that during the height of the Democratic presidential primary, Wyden refused to back either Obama or then-Sen. Hillary Rodham Clinton (D-N.Y.).

Wyden counts among his closest friends Sens. Bob Bennett (R-Utah), who is a confidant of Republican Leader Mitch McConnell (Ky.), and Dianne Feinstein (D-Calif.), who is widely respected and has a knack for persuading colleagues to support compromises.

Bennett has signed on as the chief GOP co-sponsor of Wyden’s bill and has persuaded two other members of the Senate Republican leadership to join him: Senate Republican Conference Chairman Lamar Alexander (Tenn.) and Sen. Judd Gregg (N.H.).

“The history of bringing about enduring change, change that is going to last, change that people are going to rally behind — that history is predicated on bringing people together,” Wyden said during an interview in his Senate office. “There’s a real path of getting an upwards of 70 votes for historic health reform, where the country can say, after all these years of bickering and fighting and polarizing contentious debate, people really came together.”

Wyden’s support among Republicans is surprising because he is far from the far-right of his own party. He is the son of a muckraking journalist who smoked cigars with Fidel Castro. After college, Wyden founded the Oregon chapter of the Gray Panthers, a liberal advocacy group for senior citizens that borrowed its name from the radical black-power activists of the 1960s, albeit with some humor. One of the group’s first victories was passage of a referendum reducing the price of dentures.

“Sen. Wyden, by virtue of spending a lot of time on the issue and having attracted a lot of Republicans and Democrats, is a strong force,” said Alexander. “Senators that know an issue earn the respect of other senators, and we listen to them.”

Wyden’s standing with the left may be essential if he is to persuade the majority to strike a compromise over the principal sticking point in the debate: the availability of a government-run health insurance option.

However, he has already come under fire from unions for proposing to cut a tax exclusion for health benefits to pay for his plan.

And liberals are demanding that all Americans have access to a government-run healthcare plan. Republicans say that making a government-run health insurance option available to all Americans would be a march to “single-payer health insurance” and “socialized medicine,” and would drive private insurance companies out of business.

Wyden’s chief innovation is to be one of the first Democrats to call for universal coverage and for the private sector to serve as the principal provider.

Wyden said Republicans recognize everyone needs to be covered, and that the current system is not cost-effective because the insured are already paying the bills of the uninsured.

Democrats, he said, know the private sector must play “a significant role” to preserve innovation and cannot be saddled with price controls.

“I think the first thing our group has tried to bring to this discussion is a recognition there is philosophical truce almost within the Senate’s grasp and the country’s grasp,” Wyden said.

Wyden has sought a middle ground by proposing that the government offer a public plan option only in underserved areas, such as regions where consumers have only two private plans to choose from.

Alexander said he decided to support Wyden’s bill because it embodied two principles: “everybody insured” and “private sector.”

Gregg, who has participated regularly in negotiations over the healthcare proposal that Democratic leaders will soon bring to the floor, said Wyden has “shown you can develop a large coalition around an approach to solving this by using the private sector as the essence of a healthcare reform initiative.”

Sen. Chuck Grassley (Iowa), the ranking Republican on the Finance Committee, said that he, Finance Committee Chairman Baucus and other negotiators are borrowing from Wyden’s plan to assemble a package that lawmakers will soon consider on the Senate floor.

“I agree with a lot of things in the Wyden plan and I believe a lot of those will be included,” Grassley said. “A good share of it could be a model.”
This is the most recent news about this issue, but there have been concerns about it for almost a month.

WaPo, April 21:
As Congress returns to begin an intense debate over reshaping the nation's $2.2 trillion health-care system, prominent left-leaning organizations and liberal House members are issuing a warning to their Democratic allies: Don't cave on us.

...

More than 70 House Democrats recently warned party leaders that they will not support a broad health reform bill that does not offer consumers a government-sponsored policy, and two unions withdrew from a high-profile health coalition because it would not endorse a public plan.

"It's way too early" to abandon what it considers a central plank in health reform, said Andy Stern, president of the Service Employees International Union. He said the organization pulled out of the bipartisan Health Reform Dialogue because it feared its friends in the coalition were sacrificing core principles too soon. "You don't make compromises with your allies."

...

Many Republicans and industry executives say that any program modeled after Medicare -- with its power to set prices -- would have an unfair advantage over private-sector competitors and eventually force some companies out of business.

"The sacred cow on the left and the right is the public plan," said former senator Thomas A. Daschle, who was Obama's first choice to oversee the reform effort.

In comments last week, Nancy-Ann DeParle, head of the White House Office of Health Reform, said the ultimate solution may rest in how a public plan is defined.

"There are different breeds of public plans that could be part of this," she said, explaining that the Medicare model is not the only approach.

...

The formal legislative process will start today, when Baucus convenes the first meeting of the Senate Finance Committee.

But in a letter to Kennedy, Court chastised the longtime lawmaker for compromising on health legislation in the past and warned Kennedy against succumbing again to the "for-profit, waste-enhancing" private insurance industry.

"Don't let the institution of the United States Senate use your name and credibility for something that goes against the principles you fought for your entire life," it said.

Kennedy spokesman Anthony Coley said the senator "believes that Americans should have the option of buying a public insurance plan if they believe that's the best choice for their families."
Several senators sent a much weaker letter to their own leaders :
A new public insurance plan is an essential part of reforming the U.S. healthcare system, 16 Democratic senators declared in a letter to two powerful committee chairmen Wednesday.

The letter was addressed to the two senators expected to shape healthcare reform legislation; Senate Health, Education, Labor and Pensions Committee Chairman Edward Kennedy (D-Mass.) and Senate Finance Committee Chairman Max Baucus (D-Mont.).

“As members of key committees and leaders on health care issues, we write to support a public plan option as a core component of this reform,” the letter said. “There is no reason to believe that private insurers alone will meet the public purpose of ensuring coverage for all Americans at affordable prices for taxpayers.”

A public plan option “would provide competition to the sometimes dysfunctional private insurance market,” Sen. Sherrod Brown (D-Ohio), who originated the letter, said on a conference call with reporters Wednesday.

The public plan option, as it's called, emerged early on as one of the most controversial elements of the Democratic health reform plan. Though President Obama endorsed it on the campaign trail and Kennedy and Baucus have also offered their support, liberal Democratic lawmakers have expressed uneasiness about whether the proposal will survive the negotiating process.

More than 100 liberal House Democrats, represented by the Progressive Caucus, the Congressional Black Caucus, the Congressional Hispanic Caucus and the Congressional Asian-Pacific American Caucus, sent a similar letter to House leaders Tuesday.

“The support for a public plan is very broad,” said Brown, who noted he will add more senators to the letter over time. But, Brown acknowledged: “We don't have everybody in the Democratic caucus convinced.”

Brown emphasized that the senators who signed the letter are not threatening to reject a health reform bill that excludes a public plan option.

“We are not saying we will not support this without a public option,” he said. “This is not a condition to kill healthcare reform.”

In addition to Brown, the letter is signed by Senate Majority Whip Dick Durbin (D-Ill.) and Democratic Sens. Bob Casey Jr. (Pa.), Kirsten GillIbrand (N.Y.), Tom Harkin (Iowa), Daniel Inouye (Hawaii), Ted Kaufman (Del.), Carl Levin (Mich.), Jeff Merkley (Ore.), Jack Reed (R.I.), Jay Rockefeller (W.Va.), Charles Schumer (N.Y.), Debbie Stabenow (Mich.), Sheldon Whitehouse (R.I.) and Jim Webb (Va.), as well as independent Sen. Bernie Sanders (Vt.), who caucuses with the Democrats.

Proponents contend that the public plan must exist to serve as a bulwark against unfair insurance industry practices and as a means to drive changes to the delivery of healthcare services to make them more efficient and less costly.

To liberals, many of whom strongly support replacing the current healthcare market with a single-payer, government-run plan that insures everyone, the public plan option would represent a vital nod to their interests. Obama and senior congressional leaders have rejected a single-payer healthcare system on the grounds that they could not generate enough public support for the program because most people who have insurance get private coverage through their employers.

Brown said that even with strong insurance market reforms designed to prevent health plans from denying coverage or charging sky-high premiums to people with preexisting conditions, a public plan remains necessary. “Insurance companies have a reputation of staying one step ahead of the sheriff,” he said.

Republicans, along with healthcare and business interests, oppose the public plan option. The contend that the plan will muscle out private insurers by cutting payment rates to medical providers in order to charge lower premiums, and will lead to the federal government dominating the insurance market.
So to sum up: The current president was elected on a platform of providing universal healthcare access to all Americans, and almost certainly wouldn't be president if he hadn't promised that (Hillary Clinton would be). But now that the debate is starting in Congress, quite a few Democrats want to cave on that point and just make private health insurance mandatory.
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Re: Congress ready to cave on public health insurance?

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Dominus Atheos wrote:
So to sum up: The current president was elected on a platform of providing universal healthcare access to all Americans, and almost certainly wouldn't be president if he hadn't promised that (Hillary Clinton would be). But now that the debate is starting in Congress, quite a few Democrats want to cave on that point and just make private health insurance mandatory.
I think that's overly simplistic, private insurance doesn't negate the idea of universal health care, it's just a different method, to wit:

I thought the Republicans were offering as an alternative to single-payer, subsidizing the insurance premiums of those that couldn't afford to pay. I've seen a few op-eds recently referring to this as the Dutch or alternatively the Swiss model. One of the major Republican concerns is that the government health-care system will use its monopsony power to force lower prices. Some Republicans are concerned this may hurt profits and thereby discourage innovation, others are just concerned that it will hurt profits.

What I've seen from Democrats is either, arguments that innovation (new drugs, medical devices, surgical techniques,etc) will continue due to some grant system for new stuff (most credible method I've seen to keep research going), or some sort variation of a malthusian argument that really expensive treatments aren't worth the resources thrown at them.
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Re: Congress ready to cave on public health insurance?

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What I've seen from Democrats is either, arguments that innovation (new drugs, medical devices, surgical techniques,etc) will continue due to some grant system for new stuff (most credible method I've seen to keep research going), or some sort variation of a malthusian argument that really expensive treatments aren't worth the resources thrown at them.
Are you saying that in a situation where there is one major payer (either a single-payer or a payer so huge that it has gigantic market power) is one where innovation is going to be discouraged on the "supply" side of medicine?

To be honest, I don't see how that follows. It's not as if the single-payer system wouldn't be under strong political pressure to cover the best treatments available, or the best available drugs within reason, particularly since it doesn't have actual control over the supply side of things.
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Re: Congress ready to cave on public health insurance?

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Gerald Tarrant wrote:What I've seen from Democrats is either, arguments that innovation (new drugs, medical devices, surgical techniques,etc) will continue due to some grant system for new stuff (most credible method I've seen to keep research going), or some sort variation of a malthusian argument that really expensive treatments aren't worth the resources thrown at them.
If you want super expensive and advanced treatments, you can always just pay for them out-of-pocket, or (presumably) take out additional insurance on top of the basic public insurance. Certainly that's how it works in the UK and Germany.
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Re: Congress ready to cave on public health insurance?

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Guardsman Bass wrote:
Gerald Tarrant wrote:What I've seen from Democrats is either, arguments that innovation (new drugs, medical devices, surgical techniques,etc) will continue due to some grant system for new stuff (most credible method I've seen to keep research going), or some sort variation of a malthusian argument that really expensive treatments aren't worth the resources thrown at them.
Are you saying that in a situation where there is one major payer (either a single-payer or a payer so huge that it has gigantic market power) is one where innovation is going to be discouraged on the "supply" side of medicine?
So the government must create extra grants to "keep research going" compared to the current system of multiple private insurers? How much medical research do insurance companies pay for at present? Are there examples of insurance company research grants that we can look at for comparison? Or is Gerald simply assuming that the mere fact of private insurance just magically makes innovation happen?
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Re: Congress ready to cave on public health insurance?

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If we're going to have a hybrid system, why, exactly, should the public health insurance be available to the rich?

One imagines that the simplest solution is just to provide coverage on a sliding scale of 20 - 100 dollars a month for everyone above the poverty line but below $65,000 USD in income, say (for a single person), with those below the poverty line receiving it free.

Unfortunately part of the problem is that price controls are extremely necessary in this sort of system...

...What is bound to happen is that a hybrid system is implemented which fails miserably because it's a massive compromise and lurching clunker that simply cannot function well, but paves the way for universal health insurance in America.
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Re: Congress ready to cave on public health insurance?

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The Duchess of Zeon wrote:If we're going to have a hybrid system, why, exactly, should the public health insurance be available to the rich?
So that they will not use their exceptional influence to gut it at every turn. Also on principle: universal health care should be considered an inalienable public service, not a form of graduated welfare.
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Re: Congress ready to cave on public health insurance?

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Guardsman Bass wrote:
What I've seen from Democrats is either, arguments that innovation (new drugs, medical devices, surgical techniques,etc) will continue due to some grant system for new stuff (most credible method I've seen to keep research going), or some sort variation of a malthusian argument that really expensive treatments aren't worth the resources thrown at them.
Are you saying that in a situation where there is one major payer (either a single-payer or a payer so huge that it has gigantic market power) is one where innovation is going to be discouraged on the "supply" side of medicine?

To be honest, I don't see how that follows. It's not as if the single-payer system wouldn't be under strong political pressure to cover the best treatments available, or the best available drugs within reason, particularly since it doesn't have actual control over the supply side of things.
The issue is that a single-payer can negotiate lower prices because it's the only game in town. This is occasionally referred to as "cost control". From Krugman (who, although his bailiwick is Trade Econ, not policy, is the only nobel-prize winning Democratic economic columnist I know of)

Krugman OP-ED
Is this the end for Harry and Louise?

Harry and Louise were the fictional couple who appeared in advertisements run by the insurance industry in 1993, fretting about what would happen if “government bureaucrats” started making health care decisions. The ads helped kill the Clinton health care plan, and have stood, ever since, as a symbol of the ability of powerful special interests to block health care reform.

But on Saturday, excited administration officials called me to say that this time the medical-industrial complex (their term, not mine) is offering to be helpful.

Six major industry players — including America’s Health Insurance Plans (AHIP), a descendant of the lobbying group that spawned Harry and Louise — have sent a letter to President Obama sketching out a plan to control health care costs. What’s more, the letter implicitly endorses much of what administration officials have been saying about health economics.

Are there reasons to be suspicious about this gift? You bet — and I’ll get to that in a bit. But first things first: on the face of it, this is tremendously good news.

The signatories of the letter say that they’re developing proposals to help the administration achieve its goal of shaving 1.5 percentage points off the growth rate of health care spending. That may not sound like much, but it’s actually huge: achieving that goal would save $2 trillion over the next decade.

How are costs to be contained? There are few details, but the industry has clearly been reading Peter Orszag, the budget director.

In his previous job, as the director of the Congressional Budget Office, Mr. Orszag argued that America spends far too much on some types of health care with little or no medical benefit, even as it spends too little on other types of care, like prevention and treatment of chronic conditions. Putting these together, he concluded that “substantial opportunities exist to reduce costs without harming health over all.”

Sure enough, the health industry letter talks of “reducing over-use and under-use of health care by aligning quality and efficiency incentives.” It also picks up a related favorite Orszag theme, calling for “adherence to evidence-based best practices and therapies.” All in all, it’s just what the doctor, er, budget director ordered.

Before we start celebrating, however, we have to ask the obvious question. Is this gift a Trojan horse? After all, several of the organizations that sent that letter have in the past been major villains when it comes to health care policy.

I’ve already mentioned AHIP. There’s also the Pharmaceutical Research and Manufacturers of America (PhRMA), the lobbying group that helped push through the Medicare Modernization Act of 2003 — a bill that both prevented Medicare from bargaining over drug prices and locked in huge overpayments to private insurers. Indeed, one of the new letter’s signatories is former Representative Billy Tauzin, who shepherded that bill through Congress then immediately left public office to become PhRMA’s lavishly paid president.

The point is that there’s every reason to be cynical about these players’ motives. Remember that what the rest of us call health care costs, they call income.

What’s presumably going on here is that key interest groups have realized that health care reform is going to happen no matter what they do, and that aligning themselves with the Party of No will just deny them a seat at the table. (Republicans, after all, still denounce research into which medical procedures are effective and which are not as a dastardly plot to deprive Americans of their freedom to choose.)

I would strongly urge the Obama administration to hang tough in the bargaining ahead. In particular, AHIP will surely try to use the good will created by its stance on cost control to kill an important part of health reform: giving Americans the choice of buying into a public insurance plan as an alternative to private insurers. The administration should not give in on this point.

But let me not be too negative. The fact that the medical-industrial complex is trying to shape health care reform rather than block it is a tremendously good omen. It looks as if America may finally get what every other advanced country already has: a system that guarantees essential health care to all its citizens.

And serious cost control would change everything, not just for health care, but for America’s fiscal future. As Mr. Orszag has emphasized, rising health care costs are the main reason long-run budget projections look so grim. Slow the rate at which those costs rise, and the future will look far brighter.

I still won’t count my health care chickens until they’re hatched. But this is some of the best policy news I’ve heard in a long time.
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Remember that what the rest of us call health care costs, they call income.


The Republican concern is that controlling costs will include bargaining for lower drug and equipment prices; and the thinking runs that given a single-payer system the government would get its lower prices. Maybe I'm mistaken about this, but I thought the above was generally accepted among economists.

How to respond to the above generally breaks down into two camps: 1) prevent the erosion of prices (usually just drug prices, but new devices fit here too) to protect profits and innovation. 2) allow the erosion in prices but... 2a) Provide alternate incentives to innovation, like tax breaks and grants. 2b) Sometimes those expensive new things aren't worth it; for example a $1 million leukemia cure is 100,000 anti-mosquito nets, or closer to home 10's of full paid treatments for premies and other at risk infants.
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Re: Congress ready to cave on public health insurance?

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Gerald Tarrant wrote:How to respond to the above generally breaks down into two camps: 1) prevent the erosion of prices (usually just drug prices, but new devices fit here too) to protect profits and innovation. 2) allow the erosion in prices but... 2a) Provide alternate incentives to innovation, like tax breaks and grants. 2b) Sometimes those expensive new things aren't worth it; for example a $1 million leukemia cure is 100,000 anti-mosquito nets, or closer to home 10's of full paid treatments for premies and other at risk infants.
1) is somewhat stupid, not using the colossal economy of scale you just created... 2) and 2x) are both very legitimate. In fact 2a) might sound "wrong" at first but it's morally valid. What's the point on busting billions to save a single (rich enough to pay for the obscenely expensive drug!) person from a rare disease, when thousands could be saved from more common diseases using the same funds? Many lives trump 1 life.
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Re: Congress ready to cave on public health insurance?

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Stas Bush wrote:
Gerald Tarrant wrote:How to respond to the above generally breaks down into two camps: 1) prevent the erosion of prices (usually just drug prices, but new devices fit here too) to protect profits and innovation. 2) allow the erosion in prices but... 2a) Provide alternate incentives to innovation, like tax breaks and grants. 2b) Sometimes those expensive new things aren't worth it; for example a $1 million leukemia cure is 100,000 anti-mosquito nets, or closer to home 10's of full paid treatments for premies and other at risk infants.
1) is somewhat stupid, not using the colossal economy of scale you just created... 2) and 2x) are both very legitimate. In fact 2a) might sound "wrong" at first but it's morally valid. What's the point on busting billions to save a single (rich enough to pay for the obscenely expensive drug!) person from a rare disease, when thousands could be saved from more common diseases using the same funds? Many lives trump 1 life.
I disagree about 1, since patents lapse, and then the drugs or equipment can legally be made by someone else, meaning that after well to do patients have finished paying for the privilege of being guinea-pigs (and under-writing a decent chunk of the research costs of the drug), other patients will get a crack at a generic version of the same thing. It would be different if the government could devise adequate offsets for the firms doing the research, but I'm not as convinced that that would happen in the US, given current budgetary pressures.

Or maybe I'm misinterpreting you, what do you mean by
1) is somewhat stupid, not using the colossal economy of scale you just created...
The bolded section.
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Re: Congress ready to cave on public health insurance?

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Health care is ridiculously overpriced in America. Why is bringing down prices a bad thing? Europe, Australia, Japan, etc. all have universal health care systems and churn out shitloads of medical research and new drugs every year.

Much of the cost of health care in America goes to overhead and bureaucracy rather than "innovation".
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Re: Congress ready to cave on public health insurance?

Post by Dominus Atheos »

bobalot wrote:Health care is ridiculously overpriced in America. Why is bringing down prices a bad thing? Europe, Australia, Japan, etc. all have universal health care systems and churn out shitloads of medical research and new drugs every year.

Much of the cost of health care in America goes to overhead and bureaucracy rather than "innovation".
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Re: Congress ready to cave on public health insurance?

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And liberals are demanding that all Americans have access to a government-run healthcare plan. Republicans say that making a government-run health insurance option available to all Americans would be a march to “single-payer health insurance” and “socialized medicine,” and would drive private insurance companies out of business.
Wait, wait, wait - if the free market and capitalism are soooooo superior, how could a government run health insurance option put private insurance companies out of business??? And if private insurance is that obviously inferior how can you justify having it?
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Re: Congress ready to cave on public health insurance?

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Darth Wong wrote:How much medical research do insurance companies pay for at present? Are there examples of insurance company research grants that we can look at for comparison?
Very little to none - I know my former employer employed a small group of people (actually, co-funded with Kaiser Permanente) to sift through medical research to find the decently constructed and actually meaningful research. There have been a few cost-effectiveness studies funded by insurers over the years. By and large, though, the health insurance companies do no medical research.
Or is Gerald simply assuming that the mere fact of private insurance just magically makes innovation happen?
I believe there's an element of magic here.

Private health insurance does jackshit to promote medical research. Most medical research in the US is funded by the pharmaceutical industry, which is and under any foreseeable plan will remain very much for-profit. A small slice of research is funded by other organizations such as the patient-advocacy groups and another slice by the US government.
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Re: Congress ready to cave on public health insurance?

Post by Edi »

Fuck the private healthcare industry. If they were to be in any way a viable option, they would all need to use the same, centralized patient records database and develop common, compatible practices to reduce the bureaucratic overhead to manageable levels.

If they can't do that, then they deserve to go right the fuck out of business. For an example, all private insurance companies in Finland use a centralized claims database where all accident notifications and claims go, so that they can be cross-referenced, eliminating the possibility of claiming insurance from several companies for the same event.

Given that healthcare is a public good, the profits of private health insurance companies in the current model are meaningless for the purposes of making decisions on designing an actually working system.
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Re: Congress ready to cave on public health insurance?

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Broomstick wrote:Wait, wait, wait - if the free market and capitalism are soooooo superior, how could a government run health insurance option put private insurance companies out of business??? And if private insurance is that obviously inferior how can you justify having it?
Because the government is evil and exists only to abort your babies and take your money while stomping on your face, so it'll force the insurance companies out of business. And not wash their hands. Because they're evil.

I'm pretty sure that's how the actual thought processes go, assuming people actually think about it. Which they probably don't.
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Unless the plan is to create a lurching failure of a clunker so the opposition can say, "See, it doesn't work at all!" and thus kill the idea of universal health coverage in the U.S. for another couple decades.
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Re: Congress ready to cave on public health insurance?

Post by Master of Ossus »

Broomstick wrote:Wait, wait, wait - if the free market and capitalism are soooooo superior, how could a government run health insurance option put private insurance companies out of business??? And if private insurance is that obviously inferior how can you justify having it?
Because the government's not answerable to all types of things that private health insurers must respond to. Moreover, the government can freely cross-subsidize since it has a diversified series of interests from which it takes funding (like, say, taxpayers), whereas the private insurer has only the resources it can generate through sales of its services.
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Re: Congress ready to cave on public health insurance?

Post by Darth Wong »

Master of Ossus wrote:
Broomstick wrote:Wait, wait, wait - if the free market and capitalism are soooooo superior, how could a government run health insurance option put private insurance companies out of business??? And if private insurance is that obviously inferior how can you justify having it?
Because the government's not answerable to all types of things that private health insurers must respond to. Moreover, the government can freely cross-subsidize since it has a diversified series of interests from which it takes funding (like, say, taxpayers), whereas the private insurer has only the resources it can generate through sales of its services.
Yeah, I'm sure the possibility of the private insurer stamping "DENIED" on your claim in order to increase its profit margin has nothing to do with it, right?
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Re: Congress ready to cave on public health insurance?

Post by Master of Ossus »

Darth Wong wrote:Yeah, I'm sure the possibility of the private insurer stamping "DENIED" on your claim has nothing to do with it, right?
Probably it does, but even if a hypothetical private insurer were legitimately able to offer the same (or better) service for the same or a lower price than government healthcare, they would still be at risk of being driven out of the industry by a competing government service.
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Re: Congress ready to cave on public health insurance?

Post by Pablo Sanchez »

For me the strangest thing about these congressional machinations is how far from the national consensus it comes down. Polls have shown that firm majorities of Americans support universal healthcare, yet it's an idea that somehow has no traction in Congress. It's really appalling to see an elected government swimming upstream against policies that are demonstrated to be efficacious in other countries and are supported by a majority of Americans.
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Re: Congress ready to cave on public health insurance?

Post by Patrick Degan »

The Duchess of Zeon wrote:If we're going to have a hybrid system, why, exactly, should the public health insurance be available to the rich?
For the same reason Social Security is also available to the rich: a truly universal system is a lot harder to argue against, much less cut, than one which is aimed only at partial coverage of the poorer segments of society: hence why Medicare and Medicaid is always in much bigger bugetary danger than Social Security is.
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Re: Congress ready to cave on public health insurance?

Post by The Duchess of Zeon »

Mayabird wrote:
The Duchess of Zeon wrote: ...What is bound to happen is that a hybrid system is implemented which fails miserably because it's a massive compromise and lurching clunker that simply cannot function well, but paves the way for universal health insurance in America.
Unless the plan is to create a lurching failure of a clunker so the opposition can say, "See, it doesn't work at all!" and thus kill the idea of universal health coverage in the U.S. for another couple decades.

Eh, the main thing is that it would be impossible to kill because so many people would be dependent on it by then, just like social security. That said, actually reforming it would probably have to wait until the federal budget was falling apart at the seams and someone stood up and told the knuckleheads: "Alright, we either go to universal healthcare or eliminate our aircraft carriers." Because if Medicare/Medicaid is any indication, any compromise "hybrid" system we create will end up costing so much more than universal healthcare that it will cripple the US government in a couple decades. This is basically fundamental to how Congress does business at present.

When this system is implemented, I expect healthcare costs to rise and become even more unaffordable; if this system is killed and we revert to private health insurance, they will also continue to rise and become even more unaffordable. The entire system has become an unsustainable morass, and essentially all the current proposals do end up retaining at unsustainable morass. The total elimination of the entire existing system is the only way to bring costs down, and it would bring costs down dramatically, but because everyone is in a race to be less "socialist", the end result will be a bloated monster which consumes more resources, not less, instead.
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Re: Congress ready to cave on public health insurance?

Post by Psychic_Sandwich »

Probably it does, but even if a hypothetical private insurer were legitimately able to offer the same (or better) service for the same or a lower price than government healthcare, they would still be at risk of being driven out of the industry by a competing government service.
They manage to survive perfectly well over here in Britain. Granted, they're pretty much 'luxury goods' for those people lucky enough to be able to afford them, but companies like BUPA show no signs of going out of buisness. People who can afford to do so will always pay for better healthcare, because the demand for it is, pretty much, a giant vertical line. Very few people are going to say 'yes,this level of care is perfectly adequate for my needs'. They're going to get the best they possibly can. For most people, this would be the NHS, so, yes, the health insurance industry would shrink, but it would still be there.

Anyway, since the private industry in the US is offering a sub-par service, it should probably go. When you have fewer beds, doctors and nurses per 10,000 people than the UK NHS, a system which is notorious for being ill managed, then you have a problem.
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