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View Diary: Obama to Propose Federal Oversight of Rate Increases (153 comments)

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  •  The point is that saying they will (3+ / 0-)
    Recommended by:
    hester, poxonyou, output

    regulate insurers means little because it depends on how well they regulate.  The insurers have been playing the regulation game a long time and quite successfully.  Why would this commission be any different than those in states who continually fail to reign in premium increases?

    We'll see if Obama's plan includes a public option.  Without one, there is no benchmark for premiums and with premiums relative to what only the insurers set them to be, the insurers remain in the cat bird seat.  In this case, the bird is the word on premiums.

    The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

    by accumbens on Mon Feb 22, 2010 at 06:42:17 AM PST

    [ Parent ]

    •  Well, wouldn't you agree that having the power (6+ / 0-)
      Recommended by:
      dansac, Fabienne, Seeds, TomP, zizi, jtown

      to regulate the prices is better than not having it?

      •  I'm saying it makes such little difference (0+ / 0-)

        it essentially doesn't matter.  A strong public option would create a benchmark for rates.  Without it, it's all up to the insurers to define the playing field.  Would you rather have rates determined by insurers with some nibbling at the edges or by a strong public option?  A short time will tell if the public option is in Obama's plan.

        The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

        by accumbens on Mon Feb 22, 2010 at 06:49:36 AM PST

        [ Parent ]

        •  The CBO says the public option (4+ / 0-)
          Recommended by:
          Fabienne, Bush Bites, TomP, MariaWr

          will actually be more expensive than private insurance because it will likely have a large pool of very sick people, while private insurers will get most if not all of the healthy uninsured because of the mandate. So...there's that.

          I'm in full support of the public option. Always have been. Not only because of its price benchmark, but because of its base package of benefits benchmark. Still, that won't happen overnight. Rate control is a heavy hand of government, but it will most certainly work if applied. It will actually control prices better than the public option that is currently in the House bill.

          •  the cbo was talking about the overly restrictive (0+ / 0-)

            "public option" in the (Senate?) that appears to have been designed as a dumping-ground for the sick, before it was trashed in favor of some other bad idea. We're talking about a robust public option that provides meaningful competition to the private plans.

            " unfortunately, insurers compete mainly by trying to excel in the art of denying coverage to those who need it most" - Paul Krugman

            by output on Mon Feb 22, 2010 at 06:58:22 AM PST

            [ Parent ]

          •  Not sure how everybody fell in love with the PO. (0+ / 0-)

            It was always just a means of lowering costs that would hopefully buy over the blue dogs; there are other, more direct, means.

            Bush Bites is a subsidiary of Bush Bites Inc., a registered corporate personhood.

            by Bush Bites on Mon Feb 22, 2010 at 07:33:36 AM PST

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            •  the only people who loved the cbo-scored (1+ / 0-)
              Recommended by:
              Bush Bites

              PO (the one in the House Bill) were the insurance companies who would have benefitted from a back-door subsidy once the six million sickest people in America were shunted off to said plan. That so-callled "public option" was a boon to the insurance industry that was bound to fail the CBO test because it was not designed to save taxpayer mone.

              " unfortunately, insurers compete mainly by trying to excel in the art of denying coverage to those who need it most" - Paul Krugman

              by output on Mon Feb 22, 2010 at 07:42:05 AM PST

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      •  I would; given the lackluster HCR proposals (2+ / 0-)
        Recommended by:
        Pescadero Bill, accumbens

        I've seen coming out of the Senate. However, Bush's Blue Skies Initiative served to turn over the EPA to corporate interests. The devil is in the details and I have little doubt the insurers will game the system as this goes forward - maybe, not today but give it time.

        If they can regulate insurers via reconciliation, then I want to see a straight up or down vote on Medicare expansion even if they limit it to those 55 and over - which I don't agree with the limitation.

        Personally, anything less than a Medicare buy-in for all who want it is merely business as usual in DC. Corporate giveaways without really constraining costs or lowering the GDP expenditure. I don't want the mirage - I want the water.

      •  false dichotomy. please. nt (0+ / 0-)

        " unfortunately, insurers compete mainly by trying to excel in the art of denying coverage to those who need it most" - Paul Krugman

        by output on Mon Feb 22, 2010 at 06:55:52 AM PST

        [ Parent ]

        •  As of today, (1+ / 0-)
          Recommended by:
          J M F

          the federal government has no power whatsoever to regulate the prices of private insurers. If this provision is enacted, it will. The choice isn't false. It's clear.

          •  let's get real: the point of these (0+ / 0-)

            comments is that this plan is, at best, an ineffective and inefficient way to lower premiums; and at worst, an intelligence-insulting political stunt. i say that it's a false dichotomy because even if it were a halfway sincere effort, the power to regulate comes in many shades of gray that cannot be reduced to "the power to regulate" (already residing, by the way, in the states) or not.

            " unfortunately, insurers compete mainly by trying to excel in the art of denying coverage to those who need it most" - Paul Krugman

            by output on Mon Feb 22, 2010 at 07:06:11 AM PST

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            •  You're flailing... (0+ / 0-)

              I understand the instinct to oppose the President on just about everything. I've been opposed to this healthcare bill for some time. But a good idea is a good idea. You either want to give the federal government the power to regulate health insurance prices or you don't. It doesn't affect any other issues on which I probably agree with you. Even if we had a Medicare for all bill, i'd be in favor of giving the Federal government the power to regulate prices.

              •  flailing? can't you address the substance (0+ / 0-)

                of my comment? are we down to me not being sufficiently hopeful?

                " unfortunately, insurers compete mainly by trying to excel in the art of denying coverage to those who need it most" - Paul Krugman

                by output on Mon Feb 22, 2010 at 07:11:56 AM PST

                [ Parent ]

                •  Here's your quote: (0+ / 0-)

                  this plan is, at best, an ineffective and inefficient way to lower premiums; and at worst, an intelligence-insulting political stunt.

                  You rest that conclusion on this premise:

                  The insurers have been playing the regulation game a long time and quite successfully.  Why would this commission be any different than those in states who continually fail to reign in premium increases?

                  This is called the fallacy of inductive generalization or statistical generalization. It's a common argumentative error for the untrained.

                  The argument for the policy rests on different premisis, rather than such fallicies.

                  1. Federal regulation is, both generally and specifically, more effective than state regulation.
                  1. Some states do not have the power to regulate insurance rates. Federal review will solve this problem.

                  If you agree with #1 and #2, it isn't difficult to conclude that federal regulation of prices is a better scenario that not having it.

                  Now, as you say, it all depends on how vigorously one regulates. Well, you can't regulate at all if you don't have the authority. So that is the discussion one should have after said power is granted, correct?

                  •  you're MISQUOTING now? you guys do play dirty! (0+ / 0-)

                    The insurers have been playing the regulation game a long time and quite successfully.  Why would this commission be any different than those in states who continually fail to reign in premium increases?

                    I didn't say that.

                    " unfortunately, insurers compete mainly by trying to excel in the art of denying coverage to those who need it most" - Paul Krugman

                    by output on Mon Feb 22, 2010 at 07:26:34 AM PST

                    [ Parent ]

          •  yep.. cherry picking and lemon dropping ends now! (0+ / 0-)

            standardizing the benefit packages, so everybody knows what they're paying for, will force companies to compete with the voluntary Public Option.  Once people understand that they can get the SAME benfits, with fewer administrative hassles and without contributing to shareholders' profits, then "we the people" can vote with our pocketbooks on which plan we choose.

      •  Question...do states currently have this (0+ / 0-)

        power?

        "I know, I know.  I could google it.  But I figured someone here would know."

        "Just today, Senator McCain offered up the oldest Washington stunt in the book - you pass the buck to a commission to study the problem." Sen. Barack Obama

        by justmy2 on Mon Feb 22, 2010 at 07:20:07 AM PST

        [ Parent ]

        •  Some do, some don't. (0+ / 0-)

          Problem is, the states are less immune to the power of the insurance lobby than the Federal government. FAR less. Most state ethics and lobbying regulations are in the dark ages. Add in a monopoly player to a place where there is lax ethics and lobbying regulations and you've got the current situation: lax regulation of insurance prices.

          •  Thanks, that is what I thought but I wasn't sure (0+ / 0-)

            Although states are far less immune to lobbyists (and this was one of the key rationales against the opt-in proposal), I don't think that it is unreasonable to state the federal government is sufficiently immune to eliminate concern here.  Our experience the last nine months gives us some insight.

            If states are 80% influenced by their lobbies, the federal government could be 50%.  That is far less, but it still presents an issue.

            "Just today, Senator McCain offered up the oldest Washington stunt in the book - you pass the buck to a commission to study the problem." Sen. Barack Obama

            by justmy2 on Mon Feb 22, 2010 at 07:37:05 AM PST

            [ Parent ]

          •  industry would much rather a weak *federal* (0+ / 0-)

            regulator to fifty varied state systems. it makes for far more efficient bribing lobbying - fewer rules to master and oppose, and fewer checks to write.

            " unfortunately, insurers compete mainly by trying to excel in the art of denying coverage to those who need it most" - Paul Krugman

            by output on Mon Feb 22, 2010 at 07:47:35 AM PST

            [ Parent ]

            •  Quite true. The industry would much prefer (0+ / 0-)

              a federal regulator. But this is a double eged sword. Politics in Washington are volatile...much moreso than state legislature. Would was probably cheap before could prove far more expensive when you add in the fact that a Washington campaign requires not only contributions, but paid media. Not so in state legislatures.

      •  Also, I think one of the issues raised (1+ / 0-)
        Recommended by:
        output

        when this part of the bill was first reported was that it would be dependent on the Administration.

        If Evan Bayh, Mitt Romney, or John McCain were elected, it seems like this would have limited teeth.  In the same way EPA regulations move and shift as Administrations come in and out.  I believe the point people were making was the facade of regulation could give explicit permission to insurers to hike rates.  "The Government okayed it".  Similar to the line energy lobbies use.

        The question is will the people hold the Administration in power accountable for not regulating effectively, and our current financial industry experience doesn't lead to optimism.

        Just another side of the coin.

        I think people are asking for something that has teeth, clearly provides competition, and doesn't rely on the whims of the electorate.  I would submit health care regulation should not be managed or influenced by politics, which this almost certainly assures.

        Thoughts?

        "Just today, Senator McCain offered up the oldest Washington stunt in the book - you pass the buck to a commission to study the problem." Sen. Barack Obama

        by justmy2 on Mon Feb 22, 2010 at 07:24:59 AM PST

        [ Parent ]

    •  If government cost controls via regulation are (1+ / 0-)
      Recommended by:
      J M F

      hard wired to fail, what makes you think that the same won't be true of the public option?

      all of these idea work in theory. whether they work in practice will always depend on whether we can get real committed people into the right positions an shelter them from manipulation from the indsutry and their allies in congress.

      that is always what this is about.

      as for the tactical value of this proposal, clearly is has some political benefit to our cause because of what it forces the GOP and conservadems to do in response. let's not be so quick to declare it a giveaway.

      •  So far, there's little indication that the (1+ / 0-)
        Recommended by:
        J M F

        Republicans can be forced into anything.  If they just keep saying "no" they will be seen to stand by their principles.  If they go along with Obama (how likely does that sound?), they would be failing on their own and right-wing base's terms and they are not likely to let that happen.

        The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

        by accumbens on Mon Feb 22, 2010 at 06:52:10 AM PST

        [ Parent ]

        •  The PO (1+ / 0-)
          Recommended by:
          J M F

          The public option, if it's still alive, is something that would be managed by the HHS.  

          If regulation of the system doesn't mean anything because insurers can rig the game, then how in the world could we be expected to think that the PO would do any better under the direction of the HHS?  

          It's a pretty legitimate question, if you ask me.

          People don't get up in the morning and ask, Do I want single-payer or managed competition? Wellstone

          by otto on Mon Feb 22, 2010 at 06:55:46 AM PST

          [ Parent ]

          •  Because they would be creating a benchmark (0+ / 0-)

            for rates not trying to regulate the numbers proposed by insurers.  They would take the lead instead of playing catch up.

            The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

            by accumbens on Mon Feb 22, 2010 at 07:02:25 AM PST

            [ Parent ]

            •  They do that with medicare rates now. (2+ / 0-)
              Recommended by:
              Seeds, output

              There's no benchmark; they just get together and decide on a fair rate.

              (it's too low, most health professionals will tell you. But the point remains, it can be done.)

              Bush Bites is a subsidiary of Bush Bites Inc., a registered corporate personhood.

              by Bush Bites on Mon Feb 22, 2010 at 07:04:30 AM PST

              [ Parent ]

              •  the dirty little secret about the relatively low (0+ / 0-)

                rates paid by Medicare is that provider still come out ahead because they don't have to spend hours fighting with insurance company bureaucrats - before and after services are rendered - every time they see a patient.

                " unfortunately, insurers compete mainly by trying to excel in the art of denying coverage to those who need it most" - Paul Krugman

                by output on Mon Feb 22, 2010 at 08:01:48 AM PST

                [ Parent ]

          •  that was my point (0+ / 0-)

            all it would take is a GOP election somewhere down the road, and they would stick in a Brownie type to run the PO into the ground, and then trumpet it as an example of how  the government can't do anytying.

            they ideas, all of  them, work so long as they are sheltered from this kind of politics. Medicare works (for now)because its enemies have not found a politically safe way to destroy it. so they are trying to starve it.

            •  I see that (0+ / 0-)

              I'm trying to understand how someone could be cynical about this legislation, but still be supportive of a public option.  

              That's not saying that I am against a public option, that's me trying to square some opinions that appear to contain conflicts.  

              People don't get up in the morning and ask, Do I want single-payer or managed competition? Wellstone

              by otto on Mon Feb 22, 2010 at 07:10:05 AM PST

              [ Parent ]

              •  I think it is based on the assumption (0+ / 0-)

                that it would be politically unpalatable to mess with the public option in the same way it is a third rail to mess with Medicare.

                One off regulation doesn't appear to have the same public impact if changes are made (EPA, SEC).  

                At least I believe that is the thought...

                "Just today, Senator McCain offered up the oldest Washington stunt in the book - you pass the buck to a commission to study the problem." Sen. Barack Obama

                by justmy2 on Mon Feb 22, 2010 at 07:39:40 AM PST

                [ Parent ]

          •  your conclusion does not follow from your premise (0+ / 0-)

            As it happens, DHHS now runs the largest insurance plan in the country, Medicare, with the highest "medical loss" ratio and customer satisfaction in the land. This is the administratively successful, fiscally responsible reality. There's nothing at all theoretical about it.

            " unfortunately, insurers compete mainly by trying to excel in the art of denying coverage to those who need it most" - Paul Krugman

            by output on Mon Feb 22, 2010 at 07:55:59 AM PST

            [ Parent ]

            •  It does (0+ / 0-)

              My question was in response to the notion that a PO managed by HHS would be a good idea, but insurance price regulations under HHS would be a bad idea because they could be manipulated.

              There's a dissonance that needs to be addressed.  

              People don't get up in the morning and ask, Do I want single-payer or managed competition? Wellstone

              by otto on Mon Feb 22, 2010 at 08:13:11 AM PST

              [ Parent ]

              •  you said, (0+ / 0-)

                If regulation of the system doesn't mean anything because insurers can rig the game, then how in the world could we be expected to think that the PO would do any better under the direction of the HHS?

                in essence, what i understand you to ask is how a board convened under the auspices of HHS is too weak to regulate private premiums, how can HHS, in providing insurance, avoid the corrupting influence of the industry.

                no one said that regulatory boards are inherently manipulable. they are saying that this particular one is. what i said was that DHHS has a track record of successfully administering an insurance plan (a PO, really), and that it does not follow that creation of a sham regulator would alter that plan, or upset the effects of competition and supply and demand.  

                " unfortunately, insurers compete mainly by trying to excel in the art of denying coverage to those who need it most" - Paul Krugman

                by output on Mon Feb 22, 2010 at 08:39:12 AM PST

                [ Parent ]

        •  the point is not to get their votes (0+ / 0-)

          the point is to use their united opposition to everything  obama says against them, in this case forcing them to stand in favor of rate increases. of course they will still be opposed to it, but if you make them take the unpopular road while they are doing it, you give cover to democrats who will need to go it alone.

      •  no one is saying that *all* regulatory (0+ / 0-)

        schemes are hard-wired to fail; only that this one seems to be. in fact, it sounds to me rather like an advisory body, not  (even) a (toothless) regulatory one.

        " unfortunately, insurers compete mainly by trying to excel in the art of denying coverage to those who need it most" - Paul Krugman

        by output on Mon Feb 22, 2010 at 07:51:48 AM PST

        [ Parent ]

        •  i know no one is saying itq (0+ / 0-)

          but the question is still unanswered. if commissions can't control costs their designed to control becuase industry or their allies are set up as the oversears, what makes anyone think that the PO won't be vulnerable to the same problems? I can easily see the PO set up to fail once industry allies get themselves into position to appoint its managers.

          •  not sure what kind of public option (0+ / 0-)

            I can easily see the PO set up to fail once industry allies get themselves into position to appoint its managers

            you're proposing here. the most obvious means of establishing a PO is medicare. and the notion that a sham commission will have no effect on premium prices has nothing to do with whether DHHS can manage a health plan -  they already do.

            " unfortunately, insurers compete mainly by trying to excel in the art of denying coverage to those who need it most" - Paul Krugman

            by output on Mon Feb 22, 2010 at 09:34:18 AM PST

            [ Parent ]

    •  well why not wait and see (0+ / 0-)

      before declaring it a gift?

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