Public Plan
Public Option Popularity in Limbo
Published October 22, 2009 @ 06:00AM PT
Consider this a watch list update. Things are looking rosy for a public option right now. The majority of Americans support it, up to 57% from 52% two months ago. Bipartisanship is no longer in vogue, with 51% preferring a public option to a bipartisan one. Nancy Pelosi is rumored to be inserting a strong public option in the House bill, one that may be cheaper and cover more people than the combined Senate bill. Even Harry Reid is considering including “public option lite” in the Senate bill, with a state opt-out clause. So why all the talk about the public option being in limbo, of looking for alternative ways to try and keep private insurers in check?
Health Reform Lite or Value Meal?
Published October 21, 2009 @ 06:00AM PT
For anyone fazed by healthcare reform histrionics, take heart. We’ve been here many times before. The real question is, for all the political, capitalistic, and social angst, what’s changed? According to medical economist J.D. Kleinke, who first arrived on the scene in 1989, only one big thing: now everybody gets to whine about the status quo on Facebook. He goes so far as to call the healthcare bills moving forward today “a violent endorsement of the status quo.” I can’t say I disagree with his logic, but two women just gave me hope for this go-round.
Kleinke points out that in 1989 we had a dysfunctional third-party payer insurance system based on fee-for-service. Some insurers, hospitals, doctors, drug companies, and even employers figured out how to game the system and make out like bandits. Medicare was forecasted to become insolvent, Medicaid programs were underfunded, and malpractice costs were supposedly bankrupting healthcare. Costs were skyrocketing along with the number of uninsured. Does all this sound familiar?
Yet in 20 years, he says, all we can come up with is to fit more insured patients into our current mess and make it harder for insurers to kick them out. Each time the smallest of reforms is proposed (like adding prescription benefits to Medicare) entrenched US stakeholders rally mass hysteria, and the result is government funding of more corporate services. That’s true, J.D., but times have changed; about that Facebook phenomenon …
5 Moves to Watch in Healthcare Reform
Published October 19, 2009 @ 06:00AM PT
With the frenetic activity of the last few months, you may be wondering what’s going to happen next in the healthcare reform carnival. First there was the breathless buildup to bill … after bill … after bill. Then the ensuing media circus took over. Tea partyers continue to spout hyperbolic nonsense we hope bears no resemblance to 18th century history, and many members of Congress regularly emit scaremongering tripe that has nothing to do with campaign contributions from the insurance industry. Really. Meanwhile private insurers progressively expose their ugly underbellies. What’s next?
Take a deep breath and take heart: there is an actual semi-logical legislative process. And you can follow it, in between sideshows. In fact, here is a simplified outline of the complexities, adapted from the National Health Council (you can also download the entire Health Reform Legislation: Potential Impact on Patients PDF):
Big Insurance Promotes a Public Option
Published October 13, 2009 @ 06:00AM PT
Big Insurance just made the most convincing argument yet for a public insurance option. In a memo explaining a highly questionable study that AHIP commissioned from PriceWaterhouseCoopers, Karen Ignani explicitly promised that private insurance prices would rise dramatically under proposed healthcare reforms (I didn’t think they would confirm my wallet-stealing point so quickly.) Now we have it straight from the horse’s mouth – thanks, AHIP!
Actually, private insurance prices have already risen dramatically with NO healthcare reform. We can rest assured they will continue to rise. But it’s nice to have a scapegoat, isn’t it? Obviously the point of this study is to disrupt the passage of Max Baucus’ bill. AHIP isn’t satisfied with the millions of new enrollees it will reap, or the no-strings-attached government handouts (otherwise known as subsidies) to pay for those enrollees’ inflated premiums. Nope, they want more for all their lobbying millions.
First, they want a stronger individual mandate to lock in the maximum number of captive customers. Second, they want the excise tax on high-cost plans to go away. Third, they assume reflexive higher provider private insurance reimbursement rates due to Medicare cuts (though a Milliman, Inc. study already debunked the myth of cost-shifting.) Fourth, they promise to pass any industry taxes straight on to consumers – yep, we told you that was a lame idea. Is there any better combined argument for a public option to remove the private insurance choke-hold on our outlandish healthcare costs?
Faulty Math in CBO Senate Healthcare Bill Analysis
Published October 08, 2009 @ 06:00AM PT
Well, the CBO definitely got one thing right in its financial analysis of the Senate Finance Committee’s health bill. In commenting on Kent Conrad’s nonprofit co-op idea, it wrote that they "seem unlikely to establish a significant medical presence in many areas of the country." I already shared my opinion on co-ops as destined-to-fail recycling attempts.
Other than that, though, here is their 10 year breakdown of the bill:
- Cost: $829 billion
- Benefit: $81 billion in reduced federal deficits
- Coverage: Increase from 83% to 94% of Americans
- Uninsured Reduction: 29 million
- Missing: $200 billion in Medicare physician payment increases
- Risk: 15% low-income subsidy cuts to abide by Obama’s budget-neutral failsafe mechanism
The SFC bill’s lower cost sent House Democrats scrambling to reduce HR 3200’s cost under the $900 billion limit set by the president, even though their plan would cover 8 million more people than the SFC’s. Part of their strategy may be to move 7 million low-income individuals onto Medicaid instead of providing subsidies for private insurance.
Which brings me to my point. They realized something most of us haven’t. Much of the budgeting exercise has been based on faulty math because the largest cost factor is an unknown – private insurance costs. Higher education provides a useful, though painfully similar, example.
3 Recycling Blunders in Failed Healthcare Policy
Published October 05, 2009 @ 06:00AM PT
Washington, D.C. denizens have done it again. Under the guise of innovative compromise, they have recycled Bush Jr.’s failed “Great Healthcare Bailout of 2002.” Never heard of it? Well, bailouts weren’t the Hollywood stars then that they are today. They called them strategies instead. This one went straight into the failed policy bucket.
Observe: In 2002, Bush tried giving away $40 million in grants to high-risk pools "as part of the Bush Administration's broad strategy for expanding access to health care for the more than 40 million Americans without health insurance." Um, the plan was to spend $1 per person? Really? But I digress.
When Healthcare Polls Go Bipolar
Published October 03, 2009 @ 06:00AM PT
Color me confused. First I encounter the headline “Poll: Support for Government Health Insurance Declines a Bit”, released just in time to justify the Senate Finance Committee voting down the public option. Then I discover another headline, “Public Support for Reform Legislation Shows Small Rise”.
So which is it? Are we climbing the hill or sliding back down?
