Health care: Most wouldn't have public option

[celeb_2006]

Health care: Most wouldn't have public option

Senate Majority Leader Harry Reid's gambit to include a government-run insurance option in health care legislation has given a fresh tailwind to the idea despite opposition from conservatives.
But lost amid the ideological battle for or against a public option is a key overlooked fact: The vast majority of Americans would have no access to a public option even under its most expansive versions.
House and Senate bills limit the option to the smallest businesses and to individuals who cannot get insurance, or whose health care costs exceed 12.5 percent of their income. Even seven years into an overhaul, an estimated 90 percent of Americans, including nearly everyone who has employer-based coverage now, would be shut out of a public option.
Those currently in other government programs, such as Medicare and the Veterans Administration, also would be excluded.
The public option under all bills would be offered through insurance exchanges, a Web-based market for health plans. But most people who are unhappy with the insurance they have now would be locked out of these exchanges, leaving many Americans who are watching the debate in for a big surprise.
Only a handful of senators, such as Ron Wyden, D-Ore., and Mary Landrieu, D-La., have focused on widening the exchanges where a public option might be available. Wyden wants everyone who now has employer-based coverage to have access to the exchange if they don't like their insurance companies, but his efforts have been lost amid the narrower fixation on the public option itself.
"When you ask people in a poll, 'Are you in favor of a public option that would be available to everybody,' they say, 'Yes,' " Wyden said. "I don't think they're going to feel the same way about a public option available to only 10 percent of the population."
Wyden, an iconoclastic liberal, questioned the basic assumption by his fellow Democrats that such a limited public option will provide adequate competition to private insurers.
"People are going to want choices, public choices and private choices, available to everybody, because that's how you're going to hold the insurance companies accountable," he said. "You can't expect that having 10 percent of the American people getting the public option will force major changes with the other 90 percent who aren't subjected to choices, public or private."
He pointed to another surprise that awaits the public: Even those who would have access to a public option may not be able to afford it.
Citing estimates that a family of four earning $66,000 could pay an estimated 19 percent of its income on health care under some bill versions, Wyden said, "I can tell you, Americans are not going to consider 19 percent of their income affordable coverage."
Many health care experts agree. "I'm afraid rude surprises could be around a lot of different corners in this debate," said Marian Mulkey, senior program officer for the California Health Care Foundation, an independent philanthropy group based in Oakland.
Mulkey said the public option has been "dominating the discussion to an extreme extent" and that its importance as a principle to liberals and conservatives may outweigh its actual effect, at least in the short run.
A public program might face the difficulties private insurers have in holding down costs. "It's not entirely clear that just because it's a public program, it will be able to negotiate lower payments to providers or somehow develop more efficient benefits in a way that will yield a more affordable plan," she said.
Health care consultant Robert Laszewski, head of Health Policy and Strategy Associates in Washington, said that even if a public option is 25 percent cheaper than a private plan, which averages $13,000 a year for a family of four, it still will cost $10,000 a year.
Under subsidies in the House bill, a family earning $55,000 would pay the first $5,500 of any premium, public or private, he said.
"How many families earning $55,000 a year do you know that have an extra $5,000 in their checking account?" he asked.
Sen. Sheldon Whitehouse, D-R.I., a big advocate of the public option, acknowledged that most people won't have access to it. The exchanges were kept very narrow, he said, because of the way the Congressional Budget Office analyzes budget costs.
"We have to live with CBO's numbers and that creates some constraints," Whitehouse said. "I hope that quickly the public option will begin to demonstrate that those concerns were not justified and those constraints can be lifted and we can extend the option to everybody, because that's what makes sense."
Ironically, the power of the exchanges to dismantle the current system of employer-based health care, which many economists cite as the root source of exploding costs, could raise budget costs if more people move onto the exchanges and possibly into a public option.
But whatever effect a public option may have on the government's costs, there is little disagreement that giving individuals more choices - public or private - through the exchanges would inject powerful competitive forces into the system that could lower costs for everyone.

House to reveal overhaul today

After months of tense negotiations and setbacks, House Speaker Nancy Pelosi, D-San Francisco, will unveil a sweeping health care overhaul plan today, with a vote possible in the House as early as next week.
Pelosi is in an all-out push to move the legislation, which will have a government-sponsored insurance plan available to some people but not the "robust" version tied to Medicare rates that Pelosi and liberals favored.
Instead, it will have rates negotiated by the secretary of Health and Human Services, as swing-state "Blue Dog" Democrats preferred. Leaders are also working furiously to assure moderate Democrats that no public funds would be used for abortion.
House and Senate leaders have cleared the calendar for a possible weekend session Nov. 7 and another possible House session just before Thanksgiving, and canceled a planned Veterans Day break.
House Democrats said Senate Majority Leader Harry Reid's move to include a public option in the Senate bill Monday made it easier for moderate House Democrats to vote for a public option.

[Grimmlok]

big surprise, a shit bill that does nothing.

[RevellingInSane]

This isn't an overhaul. It is a a mere repackaging of the same shit!

Why fear socialized medicine unless you are an insurance company?

[celeb_2006]

After all the fuss, public health plan covers few - Yahoo! News

WASHINGTON – What's all the fuss about? After all the noise over Democrats' push for a government insurance plan to compete with private carriers, coverage numbers are finally in: Two percent.
That's the estimated share of Americans younger than 65 who'd sign up for the public option plan under the health care bill that Speaker Nancy Pelosi, D-Calif., is steering toward House approval.
The underwhelming statistic is raising questions about whether the government plan will be the iron-fisted competitor that private insurers warn will shut them down or a niche operator that becomes a haven for patients with health insurance horror stories.
Some experts are wondering if lawmakers have wasted too much time arguing about the public plan, giving short shrift to basics such as ensuring that new coverage will be affordable.
"The public option is a significant issue, but its place in the debate is completely out of proportion to its actual importance to consumers," said Drew Altman, president of the nonpartisan Kaiser Family Foundation. "It has sucked all the oxygen out of the room and diverted attention from bread-and-butter consumer issues, such as affordable coverage and comprehensive benefits."
The Democratic health care bills would extend coverage to the uninsured by providing government help with premiums and prohibiting insurers from excluding people in poor health or charging them more. But to keep from piling more on the federal deficit, most of the uninsured will have to wait until 2013 for help. Even then, many will have to pay a significant share of their own health care costs.
The latest look at the public option comes from the Congressional Budget Office, the nonpartisan economic analysts for lawmakers.
It found that the scaled back government plan in the House bill wouldn't overtake private health insurance. To the contrary, it might help the insurers a little.
The budget office estimated that about 6 million people would sign up for the public option in 2019, when the House bill is fully phased in. That represents about 2 percent of a total of 282 million Americans under age 65. (Older people are covered through Medicare.)
The overwhelming majority of the population would remain in private health insurance plans sponsored by employers. Others, mainly low-income people, would be covered through an expanded Medicaid program.
To be fair, most people would not have access to the new public plan. Under the House bill, it would be offered through new insurance exchanges open only to those who buy coverage on their own or work for small companies. Yet even within that pool of 30 million people, only 1-in-5 would take the public option.
Who's likely to sign up?
The budget office said "a less healthy pool of enrollees" would probably be attracted to the public option, drawn by the prospect of looser rules on access to specialists and medical services.
As a result, premiums in the public plan would be higher than the average for private plans. That could nudge healthy middle-class workers and their families to sign up for private plans.
"The concern was that the public option would destabilize the bulk of private insurance, but in fact what Congress has fashioned is very targeted," said economist Karen Davis, president of the Commonwealth Fund. "It's not going to be taking away the insurance industry's core business."
It's unclear whether there are enough votes in the Senate for a public plan. The version that Majority Leader Harry Reid, D-Nev., has offered would let states opt out, probably leaving a smaller plan that the House would want.
Insurers aren't buying the budget office analysis. Asked if it might soften that opposition, industry spokesman Robert Zirkelbach of America's Health Insurance Plans responded with a curt "No."

While a government plan might start out modestly, insurers fear that Congress could change the rules later, opening it up to all people and setting take-it-or-leave payments for hospitals and medical providers, instead of negotiating, as the House bill calls for.
For the same reason, employer groups also remain wary. Big companies don't want to lose control of their health care budgets and instead have the government send them a tax bill.
"That cost is going to come back to you one way or another ... and it's coming back in the way of taxes and liabilities," said Eastman Kodak's chief executive, Antonio M. Perez, speaking for the Business Roundtable. "We just don't believe that there are miracles out there." If Congress passes a public plan that's not much of a sensation, Democrats might have reason to regret all the time and energy they invested in it.

[Rayvin400]

F-this. I'm moving to Canada.

[Mr. Authority]

Just expand Medicare for everybody! That's the only way I can think of with healthcare being overhauled. Fuck the companies and fuck the people that are pushing this 'same shit as always' public option.

[Grimmlok]

So they made a public option, but made it so powerless, toothless and useless that nobody will use it.

Way to go, Dems. The illusion of doing something, but really not, is complete.

Looks like the insurance industry sharks win.

[visitor42]

Just saying "Fuck it" only helps the Republicans. This bill, warts and all, is still better than the current system... moreover, it can be improved.

[travelbug]

Another option would be to force health insurance companies to operate as not-for-profits. Either that or regulate them like they do utilities.

The regulation might be the simplest option. In our state we have an insurance commissioner and auto insurance rates are regulated and set by the state. We also have ways to insure uninsurable motorists...of course we all pay a surcharge for that on our policy, but NC has some of the lowest rates in the country vs. other states that are free market only.

[qwerty]

How about some serious tort reform instead so prices wouldn't be so high in the first place? Too bad most of Washington and their cronies are lawyers. Frustrating.

[Grimmlok]

tort reform is a red herring, the cost of suits is infinitesimal compared to how much the prices are jacked up for pure profit.

HMO's and health industries are run FOR PROFIT. They are owned by shareholders. Tort reform will do jack shit. It's just something the GOP likes to throw out as an excuse for the industry raping people.

[ManxMouse]

Originally Posted by qwerty

How about some serious tort reform instead so prices wouldn't be so high in the first place? Too bad most of Washington and their cronies are lawyers. Frustrating.

Tort reform passed in Texas, and it did exactly zero to lower the cost of malpractice insurance or doctor shortages. So, it didn't do jack to overall costs either.

[visitor42]

Tort reform isn't going to do anything.

What's wrong with the insurance companies isn't just that are for profit, but also that they are wasteful and bureaucratic.

[Jexxifer]

Originally Posted by Mr. Authority

Just expand Medicare for everybody! That's the only way I can think of with healthcare being overhauled. Fuck the companies and fuck the people that are pushing this 'same shit as always' public option.

Doctors and other providers have already opted out of the Medicare system in droves. There are potential access/bottleneck issues until more providers who accept Medicare/Medicaid are graduating.

[kingcap72]

Originally Posted by Jexxifer

Doctors and other providers have already opted out of the Medicare system in droves. There are potential access/bottleneck issues until more providers who accept Medicare/Medicaid are graduating.

Exactly. And with some of the other issues surrounding Medicare/Medicaid it may take another generation before we see a possible expansion of Medicare to everyone. But the biggest obstacle is the for-profit health industry.