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I was pretty incensed when I read this article in the New York Times this morning about the "so-called middle ground" for the public option to appease the murder-by-spreadsheet insurance industry. Here's Senator Schumer's ridiculous compromise outlined below:

The chairman of the Senate Finance Committee, Max Baucus, Democrat of Montana, asked Mr. Schumer to seek a solution. In his response, Mr. Schumer set forth these principles:

¶The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

¶The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

¶To prevent the government from serving as both "player and umpire," the officials who manage a public plan should be different from those who regulate the insurance market.

In addition, Mr. Schumer said, the public plan should be required to establish a reserve fund, just as private insurers must maintain reserves for the payment of anticipated claims. And he said the public plan should be required to provide the same minimum benefits as private insurers.

I don't think the public plan should be self-sustaining, because if it's wholly reliant on money raised from premiums and co-payments, that means that the premiums and co-payments will be higher than those of the premiums and co-payments offered by private health plans.

And yes, the government should compel doctors and hospitals to participate in a public plan, otherwise the doctors and hospitals will refuse to take the patients in the public plan just like they refuse to take on any new Medicare patients. In order for the public plan to work, it has to have widespread participation by medical professionals which translate to universal access for Americans. In any city, town, or state, they should be able to go to a doctor who can't refuse to take them on. In a small town, a doctor might be enticed by private plan insurers to refuse patients from the public option. That's why I'm against the second bullet point in Senator Schumer's cockamamie proposal.

And there should be NO private officials to manage a public plan. It MUST be managed by the government to promote efficiency and to reduce administrative overhead in the public plan. There can be NO appointment of officials from the private health insurance industry to manage the public plan.

This sort of "middle ground" is unacceptable for me.

Please call Senator Schumer's office today and let him KNOW that his middle-ground proposals are unacceptable for you too.

Here's his damn phone number:

(202) 224-6542

If you can't get through to Schumer's office on that main line, go to this CONTACT page on his website, scroll all the way DOWN to the bottom and call the phone numbers of his local offices.

Oh, and don't forget to call that turncoat traitor Senator Nelson as well! Tell him that he MUST support the a Medicare-like public option in health care reform.

(202) 224-6551

UPDATE:

President Obama will be meeting with House Democrats on the Energy and Commerce Committes to talk about health care reform and the climate change crisis in about an hour.

Please call these House Democrats below and tell them to stand up for US on the public option in health care reform and to oppose the Schumer so-called compromise!

House Committee on Energy and Commerce
(202) 225-2927

And use this phone number (202) 224-3121 to be connected to the Member of Congress below on this list:

Henry A. Waxman, CA, Chair  
John D. Dingell, MI, Chair Emeritus  
Edward J. Markey, MA  
Rick Boucher, VA  
Frank Pallone, Jr., NJ  
Bart Gordon, TN  
Bobby L. Rush, IL  
Anna G. Eshoo, CA  
Bart Stupak, MI  
Eliot L. Engel, NY  
Gene Green, TX  
Diana DeGette, CO  
Lois Capps, CA  
Mike Doyle, PA  
Jane Harman, CA  
Jan Schakowsky, IL  
Charles A. Gonzalez, TX  
Jay Inslee, WA  
Tammy Baldwin, WI  
Mike Ross, AR  
Anthony D. Weiner, NY  
Jim Matheson, UT  
G.K. Butterfield, NC  
Charlie Melancon, LA  
John Barrow, GA  
Baron P. Hill, IN  
Doris O. Matsui, CA  
Donna M. Christensen, VI  
Kathy Castor, FL  
John P. Sarbanes, MD  
Christopher S. Murphy, CT  
Zachary T. Space, OH  
Jerry McNerney, CA  
Betty Sutton, OH  
Bruce L. Braley, IA  
Peter Welch, VT

COMMENT IF YOU'VE CALLED SCHUMER'S OFFICE AND THE HOUSE ENERGY AND COMMERCE COMMITTEE!

UPDATE TWO:

Kossack ovals49 just got hung up on by Schumer's health care aide. Here's his report from the phone conversation:

It may have been predictable (0+ / 0-)

but what may surprise them is the level of public outrage this bullshit "compromise" will engender.

I just got off the phone with an aide to Senator Schumer and made the point that this was a complete kowtow to the for profit insurance industry.  When the aide interrupted to defend the compromise points with the 60 vote argument, I reminded him that this once in a lifetime opportunity for health care reform should not be squandered on a public option doomed to fail.  When I reminded the aide that elected representatives should be serving the interests of the people, not the insurance interest and that there would be consequences at the ballot box.....he hung up on me.

Originally posted to slinkerwink on Tue May 05, 2009 at 04:59 AM PDT.

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  •  give me a damn break (393+ / 0-)
    Recommended by:
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    with this middle-ground crap!

    They tortured people to get false confessions to fraudulently justify our invading Iraq.

    by slinkerwink on Tue May 05, 2009 at 05:00:12 AM PDT

  •  and rec this up if you think Schumer's (30+ / 0-)

    compromise is cockamamie too.

    They tortured people to get false confessions to fraudulently justify our invading Iraq.

    by slinkerwink on Tue May 05, 2009 at 05:02:01 AM PDT

  •  POS plan (and I don't mean point of service) (30+ / 0-)

    is going to be like a defibrillator for the goposaurus.

    Chuckles is getting a call from me this AM.

    Sic gorgiamus allos subjectatos nunc -7.25 -8.15

    by mydailydrunk on Tue May 05, 2009 at 05:04:43 AM PDT

  •  I Wonder If It's Actually That Unrealistic (13+ / 0-)

    Isn't the far-and-away most expensive client pool already covered in Medicare? Meaning the elderly. So I'm not sure that the public client pool is necessarily too much more costly to insure than those who'll go to private plans.

    And I'm not sure why the public option has to charge more than private insurance because private insurance also has to survive on premiums & copays, but the public option doesn't need to collect for profits.

    I'll be looking for more discussion.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Tue May 05, 2009 at 05:07:13 AM PDT

    •  The public option has to charge more (34+ / 0-)

      otherwise why would people choose private options?

      If there is a genuinely good public option, people will flock to it and private profits will shrink.

      Lobbyists would HATE that.

      Therefore, smart lobbyists would seek to sabotage the public option so it remains unattractive to most consumers.

      "Seeing our planet as a whole, enables one to see our planet as a whole" - Tad Daley

      by Bill White on Tue May 05, 2009 at 05:12:06 AM PDT

      [ Parent ]

      •  Oh Yeah I Understand the POLITICAL Reason (9+ / 0-)

        that saboteurs would require the public option to charge more.

        But apart from a political reason for high premiums, the diarist said that premiums plus copays wouldn't be enough to sustain it without tax revenues to boot, and that's what I was having trouble understanding since there's no need to support profits whereas private plans do have to make profit from those same premiums and copays, and the costliest clients are mostly already in Medicare.

        We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

        by Gooserock on Tue May 05, 2009 at 05:25:17 AM PDT

        [ Parent ]

        •  I disagree with this diary. (10+ / 0-)

          What is required is a level playing field.  

          Public should not be subsidized, why does it need to be subsidized, it don't have to make a profit.

          On the other hand Private should not be allowed to "cherry pick" customers in any way shape or form.

          I believe that the public option is better and cheaper.

          The public option is to keep the private option honest.  If the private option can be honest and do a better job, well great.  I just don't think so.

          So go ahead and put the public option on a level playing field.

          - Strength does not come from stupidity.

          by NCJim on Tue May 05, 2009 at 06:28:20 AM PDT

          [ Parent ]

          •  Needs to be subsidized because sick people cost (7+ / 0-)

            a lot of money to treat. Its not a gamble, they are a known risk.

            Health insurance companies make money by insuring healthy people at a profit. They only take sick people when there are lots of well people to dilte the pain.

            The high risk pools (i.e. "public option") cost big bucks because they only attract sick people. Google "adverse selection" and you'll see why. basically, they know more about their own health than insurers do (although Obama is trying to change that)

            They seek insurance because they know they are sick.

            Their only other option is self pay or no care.

            Get the picture? This is what Obama knew would happen from the beginning, Everybody did.

            •  I was just tryin to formulate an answer... (5+ / 0-)

              you beat me to it.

              That's the crucial problem:

              They seek insurance because they know they are sick.

              Their only other option is self pay or no care.

              Right now, many people are too poor or too sick or both to get private insurance.

              In order to attract these people, public option would have to have considerably lower premiums - which means it probably has to be subsidized - which in turn would attract many healthy individuals who figure they could save a lot with the public plan - which in turn would endanger the profitability of the private insurance industry (for the healthy ones are their cash cows) - and this can never happen!

              "Labor is prior to, and independent of, capital. (...) Labor is superior to capital, and deserves much the higher consideration." Abraham Lincoln

              by aufklaerer on Tue May 05, 2009 at 06:48:11 AM PDT

              [ Parent ]

          •  Uninsured (4+ / 0-)

            There needs to be a level of subsidy in a tax scale or something. I know some uninsured just don't wanna pay but most can't just afford it, there needs to be a really affordable option for them and for that you need to subsidize it some how.

          •  Real issue: What are the ground rules? (5+ / 0-)

            If the ground rules for public and private are traditional public rules -- no underwriting (that means no screening for sickness), no price differentiation, must accept all comers, etc., a lot of private insurers will simply fall out of the market because they have no f'ing clue how to make money in that kind of environment.  Most private insurers survive based on their underwriting department, which will be completely neutralized.  

            A few insurers are different, large and sophisticated enough to survive, but probably not profit greatly.

            I don't think regulators are tough enough to regulate insurers in a way that will ensure universal access.  I think the utility of a public option is that insurers really will have to match the "good" that a public option offers if they want to compete.  

            •  Thank you. (0+ / 0-)

              That was the point I was trying to make.

              Be meticulous about a level playing field and then let them fail.

              - Strength does not come from stupidity.

              by NCJim on Tue May 05, 2009 at 10:09:33 AM PDT

              [ Parent ]

              •  Define "a level playing field" (2+ / 0-)
                Recommended by:
                Brooke In Seattle, polar bear

                I would assert that the current playing field is tilted in favor of insurer profits at the expense of affordable medical care for all Americans.

                Unless we significantly change the current playing field, adding a public option player won't accomplish much.

                A greater percentage of every dollar spent on health care needs to go to actual caregivers and a lower percentage of every dollar spent on health care should go to the financial and managerial functions.

                "Seeing our planet as a whole, enables one to see our planet as a whole" - Tad Daley

                by Bill White on Tue May 05, 2009 at 10:39:45 AM PDT

                [ Parent ]

      •  The public option doesn't have to charge more (24+ / 0-)

        That's a misreading of the conditions.  The public option has to pay more than Medicare, which every private insurer already does because Medicare rates are set very low by the government.  Many providers do not take Medicare for precisely this reason.  Not allowing the public option to pay more than Medicare would make it very unpopular with providers from the start.

        What the public option pays and what they charge subscribers are two totally different questions.  We need to be clear about what's being proposed here.

        Godwin is dead. Glenn Beck killed him.

        by Dallasdoc on Tue May 05, 2009 at 05:47:24 AM PDT

        [ Parent ]

        •  Bingo. n/t (0+ / 0-)

          "History is a tragedy, not a melodrama." - I.F.Stone

          by bigchin on Tue May 05, 2009 at 06:30:56 AM PDT

          [ Parent ]

        •  "Medicare rates" are not necessarily low (0+ / 0-)

          It depends greatly on the service.  Medicare rates are much higher than market for a broad range of services.  Anyway, Medicare reimbursement is a complicated subject and people who don't work in it often don't understand the issues and incentives involved.  

        •  Are you then disagreeing with... (2+ / 0-)
          Recommended by:
          Dallasdoc, churchylafemme

          the following comment from the diarist:

          I don't think the public plan should be self-sustaining, because if it's wholly reliant on money raised from premiums and co-payments, that means that the premiums and co-payments will be higher than those of the premiums and co-payments offered by private health plans.

          I ask not in a challenging tone but more in a confused one. I think what you are discussing is orthogonal to the claim above from the diarist. My expectation is that you do NOT agree with the claim above. If so, then ok. If not, then I am indeed confused. Thanks!

          Time lost is always a disadvantage that is bound in some way to weaken him who loses it. -Clausewitz

          by Malachite on Tue May 05, 2009 at 09:32:50 AM PDT

          [ Parent ]

          •  I disagree with the diarist's claim (4+ / 0-)

            ... but also think that's a relatively unimportant question.  If a public option plan attracts a population comparable to private insurers it will likely outcompete them, which private insurers and their political protectors have not been shy about admitting.  

            The problem, I feel, is that the public option is likely to be hobbled by restrictions which make it less attractive to younger, healthier customers and their employers.  Private insurers will lobby very hard to make this happen, which will allow them -- implicitly or explicitly -- to cherry-pick the healthy.  At that point all bets are off.

            Private insurers know they can't win a fair competition with a publicly sponsored competitor.  Therefore they will spare no effort either to eliminate that competitor or to sabotage it in Congress.  That's essentially my criticism and my fear of a public-private hybrid reformed system.

            Godwin is dead. Glenn Beck killed him.

            by Dallasdoc on Tue May 05, 2009 at 11:06:54 AM PDT

            [ Parent ]

        •  We need to be clear about what's being proposed (3+ / 0-)

          Absolutely yes.

          But if a public option isn't subsidized by general tax revenue how can it compete with private insurance?

          If it is subsidized by general tax revenue how can we avoid "socializing the losses" and "privatizing the profits" through the cherry picking of healthy people by private insurers?

          Finally, unless the insurance companies stop getting their cut from every health insurance dollar spent (or at least a reduced cut) how will we possibly pay for universal coverage?

          "Seeing our planet as a whole, enables one to see our planet as a whole" - Tad Daley

          by Bill White on Tue May 05, 2009 at 09:46:14 AM PDT

          [ Parent ]

          •  If it can't be self-sustaining and cost less than (2+ / 0-)
            Recommended by:
            slinkerwink, churchylafemme

            private insurance, what's the point of the public option again?  If it can't pay for itself and be competitive with private insurance, then it's hard to see what having it improves.  Health care wonks, what am I missing?

            •  Well, kinda sorta exactly . . . (2+ / 0-)
              Recommended by:
              churchylafemme, polar bear

              The real point is that unless a greater percentage of every dollar spent on health care starts going to actual care-givers (doctors, nurses, imaging & lab technicians and so forth) with a smaller percentage of every dollar spent on health care going to managers and insurance company financial wizard types, then it won't matter much what we do.

              Reducing middle-person revenue is what needs to happen if universal health care is to be affordable.

              In other words, less overhead.

              In theory (the devil is in the details) a well run single payer system can reduce overhead and middle management costs.

              "Seeing our planet as a whole, enables one to see our planet as a whole" - Tad Daley

              by Bill White on Tue May 05, 2009 at 10:33:44 AM PDT

              [ Parent ]

              •  Right... (3+ / 0-)

                ... so, shouldn't the public option be able to do that because it doesn't need to make a profit? If the problem is, as we've been told, the profit motive, then the public option should be able to have lower-than-private-premiums and still pay for itself.

                Right?

                •  Provided the public option is given a truly (6+ / 0-)

                  level playing field, yes it should.

                  However there are many many ways to sabotage this such as imposing different rules concerning the acceptance of patients with pre-existing conditions and possible collaboration between private insurers and health care providers to decline to accept public option coverage.

                  The challenge will be to guide a genuine public option through Congress and past the lobbyists to make sure trap doors aren't inserted that will undermine the effort.

                  "Seeing our planet as a whole, enables one to see our planet as a whole" - Tad Daley

                  by Bill White on Tue May 05, 2009 at 11:18:36 AM PDT

                  [ Parent ]

            •  Put differently, perhaps the private insurance (3+ / 0-)

              model needs to be abolished. Not competed with, but abolished.

              And some argue that would be "un-American"

              "Seeing our planet as a whole, enables one to see our planet as a whole" - Tad Daley

              by Bill White on Tue May 05, 2009 at 10:35:36 AM PDT

              [ Parent ]

    •  Agree with your point (1+ / 0-)
      Recommended by:
      ScientistMom in NY

      about it doesn't have to be more expensive than private. Private companies are making a profit. Public policy should be not for profit. Those "profit" dollars should go to keeping costs down and paying doctors the same as for profit insurance, and keeping premiums lower..

      Today's problems are yesterday's solutions. Don Beck

      by Sherri in TX on Tue May 05, 2009 at 05:14:45 AM PDT

      [ Parent ]

    •  The whole thing is unrealistic (13+ / 0-)

      allowing health-insurance companies to continue bleeding massive profits out of the health care system while providing no health care is not going to reduce health care costs IMO.

      I have yet to see any plan that's going to reduce the enormous paperwork costs engendered by private health insurance corporations either.

      "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

      by Edgewater on Tue May 05, 2009 at 05:18:15 AM PDT

      [ Parent ]

    •  Is medicare self-sustaining? (4+ / 0-)
      Recommended by:
      NCJim, Dallasdoc, PsychoSavannah, MPociask

      Clearly we all chip in for medicare...at a small rate/month compared to private insurance.
      With smaller admin costs due to no profit required,I wonder what the numbers would look like on paper.
      Lets face it, if the program is not self-sustaining, it becomes full single payer a la medicare.I would like that but do people really expect to get what basically will become full single payer in the first reform of our healthcare system in forever? I have a hard time figuring out how a full single payer option that does not reflect true costs does not totally wipe out healthcare insurance companies..why would anyone ever go private again? So, I am not surprised that some compromising will occur...Congress is not going to agree with basically wiping out the insurance industry in one fell swoop. Would I be ok if they did, sure, but I did not expect it. Do we push for better? Sure. But this is not going to happen in one dramatic gesture by Congress...and anyone expecting that was destined to be disapointed.

      •  At a 'small' rate?? (0+ / 0-)

        The wages of every American times 2.9% (1.45% from you, 1.45% from your employer) is massive.  Medicare is highly expensive, precisely because it covers those who need the most expensive care.  

        [Note that unlike Social Security, there's no cap on medicare tax.]

  •  This is why I oppose mandates (28+ / 0-)

    to buy health insurance. Both now and back during the primaries.

    Combine the mandated purchase of health insurance with a crappy "public option" and its a reverse Robin Hood scenario. Collect from everyone and pay to health insurance lobbyists and financial wizards.

    "Seeing our planet as a whole, enables one to see our planet as a whole" - Tad Daley

    by Bill White on Tue May 05, 2009 at 05:08:42 AM PDT

    •  I don't personally see what's wrong (1+ / 0-)
      Recommended by:
      polar bear

      with asking the President to uphold his campaign promise...

      AAC: Support local arts

      by jamesia on Tue May 05, 2009 at 10:39:42 AM PDT

      [ Parent ]

      •  President promised no Tax Inc on Income < 250K (0+ / 0-)

        That was his promise.

        And when McCain suggested taxing health care insurance benefits, President Obama called it the largest tax increase on the middle class, ever.

        I support health care reform.

        But not on the backs of the middle-class, defines as HHs earning less than US$ 250K, according to President Obama.

        Learn about Centrist Economics, learn about Robert Rubin's Hamilton Project. http://www1.hamiltonproject.org/es/hamilton/hamilton_hp.htm

        by PatriciaVa on Tue May 05, 2009 at 10:45:55 AM PDT

        [ Parent ]

  •  those "plans" are insane (57+ / 0-)

    What they're doing is designing a new private insurance company and calling it a "public option".  They're also planting a time bomb inside it to make sure that it self destructs.  Then, the public option will forever be off the table because they will say "well, buddy, we tried that already and it failed".

    Bastards.

    Bush repealed Godwin's Law with a Signing Statement.

    by Mad Kossack on Tue May 05, 2009 at 05:09:10 AM PDT

  •  Oh come on, give Chuck a break (4+ / 0-)

    in what must be these oh-so-trying times for him, with Wall Street in its current funk and all.

  •  By the time all is said and done... (7+ / 0-)

    Change is going to be changed to no change, so save your change, you'll need it for the medical bills.

    St. Ronnie was an asshole.

    by manwithnoname on Tue May 05, 2009 at 05:10:11 AM PDT

  •  "Uniquely American" is buzzword... (25+ / 0-)

    for not doing a God Damned thing.  Democrats are almost as bad as GOPers when it comes to selling Americans out.  

    "You cannot have a strong middle class without a strong labor movement." President Barack Obama

    by Jack Dublin on Tue May 05, 2009 at 05:11:14 AM PDT

  •  The public option will have to support itself. (6+ / 0-)

    What it will do is run efficiently and there will be no lining of the shareholders pockets.  It will be a public good just like a park.  It will be less expensive and better quality than the private insurers and guess what...it will force the private insurers to really compete instead of getting together to monopolize the system.  It will be the insurance company trust-buster.!!

    •  Profit is needed so it will cost 31% more than si (10+ / 0-)

      with that 31% of all healthcare spending, we could INSURE EVERYONE WHO IS UNINSURED NOW throw away the paperwork, and ALL BE MUCH HEALTHIER!

      But, insurance wouldn't be tied to people's jobs, meaning that the poor could get medical care just like the rich, and so wages might go up. There would be more job mobility, and many people might start their own businesses, competing with big contributors

      (they dont want that!)

      •  I read the article and didn't see (1+ / 0-)
        Recommended by:
        polar bear

        that he was proposing that this new "public" insurance agency or company was the only means of insuring the uninsured.  I think that public subsidy for the low income to buy coverage is a seperate issue.  They may buy the "public option" or the private option.  I don't think the public plan needs to make a profit.

        •  You don't understand that sick people cost money (2+ / 0-)
          Recommended by:
          happymisanthropy, MPociask

          on some months, more than others.. but its a lot of money. More than they make. More than they could possibly pay.

          Companies are not welfare agencies, they are in business to make money. Not lose it.

          The Obama campaign has gotten where they are by perpetrating some ridiculous misassumptions that show how mathematically challenged Americans are very depressingly.

          First, if one sick person is very unprofitable, how is adding MORE sick people going to lower costs?

          Its going to raise costs, quite a bit. Maybe they might be cheaper, but NOT THAT MUCH CHEAPER TO STOP THE OUTFLOW OF MONEY THEY WAY THAT OBAMA IMPLIES..  No way..

          That economics of scale concept may apply to mass production, but it doesn't apply to sick people who have finite costs for care and drugs.

          You can't turn $1500 a month into $200 a month by adding more of them!

          The things people believe because they want to believe them are amazing.

          •  We have to regulate private insurance. (1+ / 0-)
            Recommended by:
            happymisanthropy

            That includes rules like "You can't turn away sick people.  You can't jack up sick people's premiums.  You must accept and charge sick people exactly the same premiums as healthy people."  It would also mandate that insurance companies can only take in so much revenue more than it pays out - enough to make a moderate profit, but if it makes more than that, it has to refund it or invest in more health care.

            I would also suggest a .gov subsidy of the insanely expensive illnesses and medical procedures - transplants, cancer treatment - the stuff that runs up five, six, seven figure bills.  Also subsidize preventative care - that will pay for itself.

            Waster of electrons, unlawful enemy combatant. http://meldroc.com/

            by meldroc on Tue May 05, 2009 at 07:27:58 AM PDT

            [ Parent ]

            •  While we're at it, regulate hospitals. (4+ / 0-)

              And regulate care providers.  Why the fuck are people being charged $10 for a bag of ice and $50 for a single Tylenol pill?

              Oh yeah, because the care providers play this game where the provider sends a bill for 5-10 times the actual cost to the insurance company, then the insurance haggles it down to 2-3 times the actual cost, and everybody profits except the little guy - the insurance companies benefit because we're force to go through them - that runs in more than enough profit to justify continuing to overpay the hospitals and providers.

              Regulate the fuck out of them, audit the fuck out of them, find the places where we're getting gouged and put a stop to it!

              Waster of electrons, unlawful enemy combatant. http://meldroc.com/

              by meldroc on Tue May 05, 2009 at 07:31:44 AM PDT

              [ Parent ]

            •  That is exactly what the high risk pools do.. (0+ / 0-)

              You are describing the high risk pools. Most states already have them. If you can pay their outrageously high remiums, you cannot be turned away (after a waiting period or time on a waiting list of years, because they still operate at a loss)

              In Oregon, they have a lottery.

              >That includes rules like "You can't turn away sick people.  You can't jack up sick people's premiums.  You must accept and charge sick people exactly the same premiums as healthy people."

              BTW, Obama supports rescission of sick people's benefits if it turns out that they lied on their applications to get a lower premium. "Its inherent to contract law"

              Obama is first a foremost, a lawyer.

  •  Well I Was Saying Before We Had a Nominee (3+ / 0-)
    Recommended by:
    wu ming, Woody, pamelabrown

    that health care reform would be "significant" in the scientific sense.

    Meaning, detectable.

    To my eye there's no logistical way for 500+ elected officials to put us on the path to any kind of universal health care.

    That said, I haven't had enough morning tea to see why the specifics of this plan meet my failure expectations without a little more explanation.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Tue May 05, 2009 at 05:15:18 AM PDT

  •  Thank you for posting. (13+ / 0-)

    Diary recommended.

    I will call Schumer on my break from work. This is going to be a challenge, but we must end murder by spreadshet!

    Here in America, our destiny is not written for us - it's written by us. Barack Obama 9/28/08

    by quadmom on Tue May 05, 2009 at 05:18:29 AM PDT

  •  I'm starting to think (28+ / 0-)

    it will be easier to get a federal gay marriage bill, legalization of drugs and prostitution, and a mandatory 5 week paid vacation for every worker in America than it would be to pass basic health reform.

    It's just unreal how our country refuses to take care of this most basic issue.

    Durbin was wrong, the real owners of Congress are the HMOs. We will never get universal health care, even with 95 Democratic senators.

    "People place their hand on the Bible and swear to uphold the Constitution. They don't put their hand on the Constitution and swear to uphold the Bible." --J.R.

    by michael1104 on Tue May 05, 2009 at 05:19:05 AM PDT

    •  Careful, You've Bumped Into the Fence on a Couple (8+ / 0-)

      The fence around government by and for the people is built and maintained by the global economy and the global superpower.

      The superpower must have eternally increasing budgets. The economy must keep its top owners getting richer faster than the rest society.

      That's what sets the boundaries.

      You can't end the war on drugs because it's a global growth industry and it's interwoven with the War on the USSR.

      The 5 week paid vacation costs the global economy.

      So those two are out.

      Now, you could withdraw from Iraq and possibly even Afghanistan, if you can come up with comparably lucrative missions to compensate.

      Which is why I'm truly seriously proposing that the military complex be assigned the mission of climate change. Sure they don't have almost any expertise at it, but what they do have expertise at is maintaining their perpetual funding increases by selling us on threats that aren't at all obvious to anyone if they even exist (like the USSR), and this is a threat we genuinely need to be sold on.

      Given that we must continue to fund them, wouldn't it be better to have them fumbling around with climate change than expertly conquering more 3rd world nations expanding the terrorist pool?

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Tue May 05, 2009 at 05:33:18 AM PDT

      [ Parent ]

      •  i'd rather see them doing disaster relief (1+ / 0-)
        Recommended by:
        hillgiant

        it's closer to their current skills in terms of logistics and mobilization on short notice, and they get to play the beloved hero role without the accompanying problems of PSTD and lost limbs from the current imperial role. given the projected changes in weather patterns with global warming, there should be a growth industry for dealing with floods, hurricanes, tornadoes, wildfires and blizzards.

        surf putah, your friendly neighborhood central valley samizdat

        by wu ming on Tue May 05, 2009 at 07:50:30 AM PDT

        [ Parent ]

    •  Don't say "never"... (0+ / 0-)

      Let's keep fighting!!!

  •  This is such an insult (15+ / 0-)

    ¶The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

    This isn't public, it's private contracted by the government? or something... call it BS

    ¶The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

    We're reminded: Don't forget to kill medicare

    ¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

    Kill medicare

    ¶To prevent the government from serving as both "player and umpire," the officials who manage a public plan should be different from those who regulate the insurance market.

    Leave room for gaming the system

    Free University and Health Care for all, now. -8.88, -7.13

    by SoCalHobbit on Tue May 05, 2009 at 05:26:50 AM PDT

    •  Privatize the public option (6+ / 0-)

      Yeah, that's the ticket /snark

    •  Pffft (4+ / 0-)

      ¶The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

      All fine and dandy until you realize that many poor families cannot afford health insurance. This why we need single payer health insurance. Healthcare should not allocated to the more wealthy people. There will be public contributions of some form. I think they will be far less than what the public pays now.

      ¶The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

      Wrong. Medicare and all private insurance negotiate for costs. If the government is the largest insurer, it should be able to negotiate the lowest prices.

      ¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

      Point is moot. If public option is the largest insurer, or is very large, most will want to take it. If they participate in Medicare, I can pretty much guarantee they will participate in the public option. Doctors and hospitals want to treat people and collect payment.

      Medicare is actually pretty good to doctors. They bill and get paid. Everybody knows what Medicare is going to cover. It is private insurers that doctors have a hard time with because they frequently won't cover stuff, change what they will, and fight on payments and treatments.

      ¶To prevent the government from serving as both "player and umpire," the officials who manage a public plan should be different from those who regulate the insurance market.

      Medicare does not have this problem, why would public option? Medicare pays exactly what it defines. Medicare Supplement is available to pay what they do not- and it is highly regulated by the states, not the federal government.

      In addition, Mr. Schumer said, the public plan should be required to establish a reserve fund, just as private insurers must maintain reserves for the payment of anticipated claims.

      #1 I am scared of any reserve fund just because the government always raids it. If there is one, it needs tobe in a "lockbox."

      #2 Schumer really does not understand health insurance very well. Health insurance basically distributes risks and costs on an annual basis to the pool of insured. You establish expected losses, devise a premium to meet those costs and expenses, collect premiums and pay out claims. It is very predictable. Reserves are actually fairly low compared to life insurance and property casualty insurance. (Life insurance, on the other hand, distributes risk over generations for a pool and so holds very high reserves.) Holding reserves really would not be a problem. The majority of health reserves are Incurred But Not Reported or In Course of Settlement. These are for claims not yet received or settled for a time period for which premiums have already been received- you have the money already- you have the money but have not distributed it yet. As long as private insurers are not given an unfair advantage and allowed to cherry pick the healthy population leaving only the very sick to the public option, this won't be an issue.

      Signature Impaired.

      by gttim on Tue May 05, 2009 at 08:27:49 AM PDT

      [ Parent ]

  •  thank you for this. (9+ / 0-)

    Schumer is another Specter.  Principles always fold under pressure and his personal goals(stay in office) come first.  He is my Senator and he is gonna hear from me.

    Manhattan straight up please

    by el vasco on Tue May 05, 2009 at 05:28:10 AM PDT

  •  The solution is simple (17+ / 0-)

    too simple, and that is why they don't like it.  Allow people to buy into medicare.  The reason they don't like this idea is that it would immediately be cheaper than every private health plan in the US due to how well it is run and the limited overhead.

    Anyone who proposes anything else is just admitting that the private health care industry in the US is just a massive jobs program.  And every insured person is paying a premium (tax to corporations) to keep health care welfare queens in their limos.

    http://en.wikipedia.org/wiki/Jesusland_map is shrinking

    by AppleP on Tue May 05, 2009 at 05:29:23 AM PDT

    •  Well It's Like Everything Imporant About America (5+ / 0-)

      Many fools know what's better policy in almost any area you can name.

      The issue is that nobody knows how to get a nation to do it when it has this system of government.

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Tue May 05, 2009 at 05:35:19 AM PDT

      [ Parent ]

    •  See mine below ("Here's the thing"). -nt- (2+ / 0-)
      Recommended by:
      quotemstr, Words In Action

      "Unseen, in the background, Fate was quietly slipping the lead into the boxing-glove." -- P.G. Wodehouse (via Bertie Wooster)

      by BenGoshi on Tue May 05, 2009 at 05:51:59 AM PDT

      [ Parent ]

    •  Not so simple....need public subsidy. (6+ / 0-)

      I agree all around. However, the problem with taking Medicare countrywide is that the rates they pay doctors are low. So doctors will only accept a certain number of Medicare patients. If you have been with a doctor, then they will usually keep you when you turn 65. But if you are new, it is a crap shoot whether or not they will accept you. (I know from first hand experience!).  

      My brother lives 100 miles from Sacramento in a small town and he cannot find doctors who will take him so has to drive 100 miles to find one who will. What's the solution? The doctor's have to be forced to take Medicare payments (as low as $25 a visit), there needs to be some public subsidy to cover everyone, or the premiums have to be raised high enough to attract more doctors into the system.

      The point I am making here is that it is not quite as simple as shifting people to Medicare - a lot of details have to be figured out before that can happen. Unfortunately, our health care industry lackeys in the Senate will not let it come to this as slinkerwink shows us.

    •  Speaking of massive jobs programs..... (0+ / 0-)

      where do you propose the millions of people working in the insurance industry (including the people at doctor's offices and clinics) find a job once theirs is gone?

      The finance workers in NYC could tell you a thing or two about losing a job that paid the bills.....they will never have a job like that to go back to.

      There are so many complicated issues that need to be addressed before any health insurance issues can be resolved.  That is just one of them.

      •  HUMAN SACRIFICE (2+ / 0-)
        Recommended by:
        mideedah, farbuska

        So their dysfunctional industry is SO important

        that we will have a huge HUMAN SACRIFICE of America on their altar?

      •  When the insurance industry collapses (3+ / 0-)

        because no-one can afford their product, where will they get a job then?

        http://en.wikipedia.org/wiki/Jesusland_map is shrinking

        by AppleP on Tue May 05, 2009 at 07:27:52 AM PDT

        [ Parent ]

      •  They start treating actual patients instead of (3+ / 0-)
        Recommended by:
        wu ming, Brooke In Seattle, hillgiant

        ... just being a person who continually loses claims and pretends that the claim was never filed.

        There needs to be a shift away from bean counters and paper shufflers to actual medical technicians, physician's assistants, nurses, etc.

        not to mention we need more doctors and nurses, so the govt. needs to get off its sorry ass and figure out quickly how to get them educated and in the workplace.

        The jobs are there.  They're getting paid to do the wrong thing. The govt is currently letting them get away with it. Because we have this half subsidized system that is NOT free market and not "government run" all the way.

        "Toads of Glory, slugs of joy... as he trotted down the path before a dragon ate him"-Alex Hall/ Stop McClintock

        by AmericanRiverCanyon on Tue May 05, 2009 at 07:30:32 AM PDT

        [ Parent ]

      •  the calculus is still a net positive (3+ / 0-)

        when you factor in all the jobs not lost and families not driven to bankruptcy by insurance corp. parasites. hell, it'll make it a lot easier for people to open businesses too, if they don't have to pay into the crap for profit system when they hire new employees.

        surf putah, your friendly neighborhood central valley samizdat

        by wu ming on Tue May 05, 2009 at 07:53:27 AM PDT

        [ Parent ]

      •  Even in this economy, healthcare is expected (1+ / 0-)
        Recommended by:
        Brooke In Seattle

        to grow.

        I think you will have a very difficult time finding someone who think that these millions of people should continue to provide a non-value-added service when they could be transitioned into a role that actually facilitates care.

      •  Maybe they could learn to DO something... (1+ / 0-)
        Recommended by:
        Brooke In Seattle

        ...besides suck blood and push papers around just like former Wall St. types had to learn a skill other than buying and selling money.

        In any event, there will always be a market for private, boutique insurance that goes far above and beyond what the public system provides. Some people want to be able to be evacuated by jet from their vacation in South America if they get sick, for example, or pay for cosmetic reconstruction should they be tragically disfigured. There are people with plenty of money who will gladly fork it over to some insurance company.

        No need to feel sorry for the corporate desk jockeys...they got their actuarial education just like I got my degree in religion. Nobody guarantees US a job.

      •  But they'll have great health insurance! (0+ / 0-)

        With Single-Payer, as H.R.676, losing your job will no longer be such a gobstopper.

  •  Schumer is up for re-election next year. (7+ / 0-)

    We need to primary him.

    I don't understand these RINO Senators from states that went for Obama 2-1. (Schumer, Feinstein)

  •  We need public option hyrid cars too! (6+ / 0-)

    They should all:

    1 - Achieve at least 150mpg
    2 - Seat 12 comfortably, with 47 cup holders
    3 - Go 1200 miles per tank
    4 - Cost $250 a piece

    Yeah, that should about do it...

    "Reagan's dead, and he was a lousy president!" -- Keith Olbermann 4/22/09

    by kovie on Tue May 05, 2009 at 05:38:50 AM PDT

  •  What I want from health care reform: (5+ / 0-)
    Recommended by:
    askew, phild1976, wishingwell, Iberian, FistJab

    I want to be able to choose an option of health care.  I am a physician and I have Kaiser health care in California.  I really like my Kaiser insurance so I am not an advocate of the single payer option because I want that choice.

    In terms of public option being part of health care reform.  What I want is health care costs to go down.  What ever way that can be achieved where there is less cost, continued option, and more people are covered than I am for that health care reform proposal whether it is with or without public option.

    "Because we won...we have to win." Obama - 6/6/08. WELL WE DID IT!!! 11/4/08

    by Drdemocrat on Tue May 05, 2009 at 05:41:29 AM PDT

    •  Bringing costs down is only part of the solution (7+ / 0-)

      Managing existing costs, even as they hopefully come down, can only be done by spreading them over the entire population, even if that means that better-off and healthier people subsidize less well-off and healthy people. That doesn't have to mean single payer right away, but from a fiscal perspective, that's clearly the most cost-effective way to do this. And it doesn't have to result in diminished health care for all but the wealthiest. Between cost-cutting, cost-sharing, and improving health care, this can be done. But ultimately, that's likely to mean single payer.

      "Reagan's dead, and he was a lousy president!" -- Keith Olbermann 4/22/09

      by kovie on Tue May 05, 2009 at 05:50:03 AM PDT

      [ Parent ]

    •  What I Want (11+ / 0-)

      I want my 84 year old mother, bedridden because of a stroke and severe depression to get all the care she needs. She is covered by Medicare and GHI (part of her pension) and neither of those cover a damned thing.

      I want a doctor to get up off of his ass and see my mother in her home because she can't come to them. I know it's a hardship to not make a tee time but we all have to make sacrifices.

      I want prescription drugs to be affordable to the general public. If that means buying them through the mail from Canada or Lesotho then so be it. Having Big Pharma behave as if they are going to go out of business because of this is so ridiculous that I want to laugh so hard that it makes me walk up to a CEO and kick the shit out of them

      I want to be able to see a therapist because of all my stress for more than 8 weeks because that's all my insurance will pay for (I suppose I better be cured in 8 weeks).

      I want my elected representatives to give a fuck about the public rather than their campaign contributors and lobbyists. As a matter of fact, I want lobbyists to be put on a ship and that ship sunk in the middle of the Pacific Ocean.

      The system we have now is completely and utterly broken because it is all about shareholders and profit. The insurance companies are not about shared risk but about having the public subsidize their stock price by paying into an insurance policy that they will, in the end, be told they can't use for whatever bogus reason.

      The Road to 2010: More Democrats. Better Democrats.

      by Splicer on Tue May 05, 2009 at 05:53:26 AM PDT

      [ Parent ]

      •  you realize that that's completely unrealistic (0+ / 0-)

        It may sound a bit heartless -- I agree with you that medicare should pay more, but there absolutely should be a lifetime maximum amount through medicare.  The problem is we just cannot afford as a country to provide full coverage for those over a particular cut-off age or monetary amount.

        I agree about shareholders and profit; but the bigger problem is that once someone hits 80, they are effectively uninsurable.  They will with very high probability, within 5 years or less, hit major/costly expenses to "stay alive".   Insurance is there to cover unlikely events... not to cover things that are a given.

        Some core level of public health care sounds fine (routine doctor visits, etc.).   But I'd hardly call that insurance, less the definition of insurance streached beyond all bounds.   This is why it's "medicare", it's really not insurance as much as it is a bunch of co-pays with a lifetime maximum.

        •  we "cannot afford" not to put people on ice floes (3+ / 0-)

          and send them out to sea. but we can afford to do all sorts of other stuff like bomb the crap out of countries all around the world. gotcha.

          surf putah, your friendly neighborhood central valley samizdat

          by wu ming on Tue May 05, 2009 at 07:55:37 AM PDT

          [ Parent ]

        •  Death By Spreadsheet (2+ / 0-)
          Recommended by:
          Brooke In Seattle, mideedah

          And laws written of, by and for the wealthy who are only interested in maximizing profit. Billions for wasteful Pentagon programs, nothing for those above the cutoff because some accountant deems them surplus. Dickens could not have written it better than it is.

          The Road to 2010: More Democrats. Better Democrats.

          by Splicer on Tue May 05, 2009 at 07:56:48 AM PDT

          [ Parent ]

        •  Government should subsidize the expensive stuff. (1+ / 0-)
          Recommended by:
          Splicer

          Regardless of whether we go with private industry regulation or a public option, there definitely should be a government subsidy to handle the transplants, chemotherapy, experimental treatments, big surgeries and other stuff with a six or seven figure price tag.

          That's not just too much for individuals to be expected to pay for, and even hard for insurance companies and the employers that pay the premiums to be expected to handle.  It's too expensive for just about anyone to handle, and government should be stepping in for these cases.

          If you ask me, government should pay for the expensive stuff, and should also subsidize the preventative stuff - that pays for itself.

          Maybe that would do something for making the more routine health care and the lower-level surgeries more affordable.

          Waster of electrons, unlawful enemy combatant. http://meldroc.com/

          by meldroc on Tue May 05, 2009 at 08:10:39 AM PDT

          [ Parent ]

        •  That is heartless and not correct (2+ / 0-)
          Recommended by:
          Brooke In Seattle, Splicer

          How is it that 29 other industrialized countries can provide for people over 80? The purpose of universal care is precisely to help ANY people in need of this basic right no matter their age. You want to ask people to crawl out of their beds and take a hike if they are 80+?  Forget it.  

          You have a bit of a right wing radio bent to your comment.  

    •  you want the status quo. n/t (1+ / 0-)
      Recommended by:
      Big River Bandido

      "History is a tragedy, not a melodrama." - I.F.Stone

      by bigchin on Tue May 05, 2009 at 06:34:38 AM PDT

      [ Parent ]

      •  Status quo means no change in cost (0+ / 0-)

        and no more coverage for people who don't have health insureance so if you had read what I posted than you would never had posted your "comment".

        "Because we won...we have to win." Obama - 6/6/08. WELL WE DID IT!!! 11/4/08

        by Drdemocrat on Tue May 05, 2009 at 11:36:13 AM PDT

        [ Parent ]

  •  The public option is ALREADY a compromise (25+ / 0-)

    Don't let them forget that what we want is single payer, and that we are giving up a LOT settling for just a viable public option.

    We can't let them compromise our compromise.

    "I think a basic principle of our Constitution is nobody above the law" -Obama

    by heart of a quince on Tue May 05, 2009 at 05:44:07 AM PDT

  •  Public plan my ass..... (10+ / 0-)

    This is a "The Public Gets Screwed Again Plan".

    We deserve what we get if we let them get away with this again.  Credit card rates, EFCA, cram down, now this.....

    Any party that would lie to start a war would also steal an election.

    by landrew on Tue May 05, 2009 at 05:48:23 AM PDT

  •  "self-sustaining" (7+ / 0-)

    That's my senator! Hey Chuck, are the banks self-sustaining? Where was that proviso in TARP? All four of those bullets are non-starters and he'll get a call from me this morning.

  •  Here's the thing. (12+ / 0-)

    .
     Herein demonstrates part of my argument that the Hannities, Limbaughs, McConnells, Steeles, Cantors, Scarboroughs, O'Reillys, Cornyns, et mal of this country are really, really sick sociopaths:


     What's it to them!?  They'll always get Gold-plated health care.  A public option (or even single-payer that one may certainly opt-out of) won't in any way substantively impinge on their wallets.  The efficiencies in opening-up Medicare-type treatment to those who can't afford private health insurance will take a great cost burden off hospitals that get stuck with bills/treatment costs that destitute (read:  the poor and a growing number of the middle class) can't afford to pay.  Their friends in the health insurance industry will still make billion$ per annum.

    .

     Of course, the answer is that they just can't stand the notion that someone who's not as "hard working" (there's their delusional narcissism coming into focus) as they are getting something "for free".  Bastards.

     bg
    _________________

    "Unseen, in the background, Fate was quietly slipping the lead into the boxing-glove." -- P.G. Wodehouse (via Bertie Wooster)

    by BenGoshi on Tue May 05, 2009 at 05:50:48 AM PDT

    •  You summed up the opposition (8+ / 0-)

      especially by "conservatives", perfectly.

      "I worked hard for what I have.  Everyone else should have to too! Wah!"

      I hear it daily and it drives me nuts.  I try to explain that you too can take advantage of this program and save a few bucks, making your oh-so-hard-earned dollars go even further.

      "It will squash the competition for good doctors!  If everyone is getting paid the same, no one will try harder!"

      I try to explain that docs pretty much get paid the same from ALL insurance companies, so this will be no different.

      It is a daily battle and I'm getting so tired of fighting it.  

    •  Their whole world order is built upon... (1+ / 0-)
      Recommended by:
      BenGoshi

      ...the one beneficent self-reliant patriarch. If someone needs charity they get taken in by the nearest patriarch. Anything that threatens the dependencies upon the patriarchy threatens all of society. That is the fundamental rule in their jungle.

      Btw, we share this belief with most of the world except Europe...

      HR 676 - Health care reform we can believe in - national single-payer NOW.

      by kck on Tue May 05, 2009 at 09:04:47 AM PDT

      [ Parent ]

  •  "players and umpires"? (4+ / 0-)

    Our health is not a frigging baseball game.

    •  To them it's a giant con game (3+ / 0-)
      Recommended by:
      emmasnacker, luvmovies2000, mkor7

      Let us buy into what we think is a great plan, when it's really just junk insurance. This is a game we need to win or (some of us will) die. Literally.

      The only thing that helps me maintain my slender grip on reality is the friendship I share with my collection of singing potatoes. -5.75, -7.18

      by Rogneid on Tue May 05, 2009 at 06:06:20 AM PDT

      [ Parent ]

  •  AHIP's Overton Window (21+ / 0-)

    This is what single payer folks predicted all along:

    Step 1: Take single payer off the table from the beginning. Even many on the left chose to do this, starting a couple of years ago.

    Step 2: Present a range of left-over public option from HCAN and Hacker-care as the acceptable left.

    Step 3: Have mainstream Democratic option (Baucus, Obama) to the right of the #2.

    Step 4: Allow right wing corporate Democrats, negotiating with themselves and Repugs and AHIP, to set the agenda.

    Step 5: Consider #2 to be considered extremist.

    Step 6: Split the difference between 3 and 4.

    Step 7: After Republicans and AHIP and right wing Dems (Nelson) complain more anyway, compromise further to the right from 6.

    Step 8: Call it moderate.

    •  brilliant DrSteveB! (1+ / 0-)
      Recommended by:
      churchylafemme

      This sign should be in every Democratic congressperson's office.
      "It's the Overton window stupid"

      "Whenever I get the urge, I lie down 'til it passes." - Mark Twain on exercise.

      by mkor7 on Tue May 05, 2009 at 07:12:02 AM PDT

      [ Parent ]

    •  This is exactly what happened when Edwards... (1+ / 0-)
      Recommended by:
      elwior

      ...released his vaunted health care reform plan during the primary. He pre-compromised and opened the gate. He shifted the goal-posts from SP to this PO notion.  

      HR 676 - Health care reform we can believe in - national single-payer NOW.

      by kck on Tue May 05, 2009 at 09:07:59 AM PDT

      [ Parent ]

  •  Make those calls!! (6+ / 0-)

    Why the action diaries get the least responses and in many occasions don't make it to the recommended diaries?

    We can't get health reform without a little effort from ALL of you. Email, make some calls, fax, write letters for Public option to all your State representatives, even if they are Rs, particularly those int he Senate.

    About this middle ground:

    The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

    Then what we do with all the uninsured? There needs to be some form of public funding. Maybe we can allocate directly some of our taxes, marking a box in your tax form for those of us that want to have a Public plan. If there is no money from the government at all it will just not work.

    ¶The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

    I'm OK with this as long as they don't tie their hands and force them to have the same price as the private plans or as they did with medicines force the agencies to buy them at the price the pharma companies want to sell them. Come on, that is one of the only real possibilities of reducing the cost of the whole nation Health Care. If we go through some private plan system it better be like the Dutch or Japanese plans that are HEAVILY regulated and price controlled.

    ¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

    BS, at least on Hospital level. You want to perform a public service and then win some money then tend to all the public. If they let the Hospitals and clinics out of the loop the plan is done.

    ¶To prevent the government from serving as both "player and umpire," the officials who manage a public plan should be different from those who regulate the insurance market.

    Fine with that

  •  Public health care should be a default (5+ / 0-)

    if you lose your job or choose it or are unable to pay for private health insurance.

    And for those who do have jobs, administering it should be done like FICA and with a simple W-4 entry (paycheck withholding).

    I am unsure of the first "compromise" but sure as hell dead set against the others!

    And as far as "reserves" that should be an initial government input of funds.  They should at least get the public health option up and running before worrying about stocking it with "reserves" from participant funding -- that in itself seems to be a guaranteed killer of the idea to begin with.

    Because my life doesn't need to be an educational experience for someone else. (-6.62, -6.26)

    by AndyS In Colorado on Tue May 05, 2009 at 05:58:30 AM PDT

    •  and require all private plans (3+ / 0-)

      cover exactly what the public plan has, and then some.  Then, make private insurers accept the re-imbursement forms that the public plan has.  This way doctors will have a 'minium care' that they can count on, and those that want to provide this 'minimum care' will have a consistent set of rules and dramatically reduced paperwork.

      Re-imbursement above and beyond what the public plan offers can then be between the private individual and their insurance.

  •  hmm... (2+ / 0-)
    Recommended by:
    rainmanjr, dditt

    "It MUST be managed by the government to promote efficiency"

    not so sure about that...

  •  It is all relevant to the bottom line. (9+ / 0-)

    It has nothing to do with "patriotism" or "American" or "socialist". It has everything to do with money and profit and gambling.
    In a nation of over 300 million, some people are going to die no matter what the insurance companies do and they are betting that the numbers will be small enough so that it really won't affect their bottom line negatively. People will always "bet" on buying insurance to help out if a need arises. And Insurance Companies will bet that the need won't arise or if it does it can be denied to some extant if not entirely. Once everyone realizes that the insurance companies are suckering you to take your money, then a nationwide Health Care plan will become acceptable. Right now there are too many in denial to see the light and the Insurance Companies are busy trying to prevent people from realizing that they've been playing a shell game.
    And, yes, I have insurance, and yes I want a Universal Health Care system. I think it is the "right" of every human being to be able to get decent care without profiting some third party who has no interest in whether you live or die.

  •  This is completely stupid. (14+ / 0-)

    Essentially they want the government to set up a fucked up health insurance company. What the fuck would be the purpose of that? Why build a completely new beuracracy for the fuck of it?

    Makes no sense.

    The whole point of the public plan is that it be substantially cheaper because of the governments power to tax EVERYONE. That is the entire point.

  •  Schumer's is not a "public option" (14+ / 0-)

    It's another private insurance plan.

    A public option would be people could opt in for Medicare as their basic health insurance. This would be Medicare Plus as higher payroll deduction and higher employer contribution...but not much higher. Average total premium on behalf of employee would be $6,600 per year (that's the 60% of current per capita health care cost which is the cost for higher quality European plans.

    As far as Schumer's items.

    1. No tax revenue. That's OK as long as we don't consider Medicare payments by employee and employer as "tax revenue".
    1. Paying more than Medicare is good as GOP has cut Medicare to make it a burden for doctors to drive people and health care providers to private insurance companies.
    1. Health care providers must take Medicare Plus participants. It is totally crazy that they could refuse people in the public health care plan. Medicare benefits need to be raised but that's another issue.
    1. Medicare should manage the plan since Medicare is the most efficient health insurance provider in the game. We don't need another bureacracy or another private insurance company.
    •  Stop tying it to employment! (2+ / 0-)
      Recommended by:
      Bouwerie Boy, elwior

      What are the 12 million (and counting) of us who are unemployed supposed to do?

      Or people whose companies don't provide health care?

      Just stop tying it to employment at all.

      Otherwise, I agree with what you said.

      "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

      by Brooke In Seattle on Tue May 05, 2009 at 09:14:37 AM PDT

      [ Parent ]

      •  Payroll Tax is how we finance public health. (0+ / 0-)

        The Medicare tax, 14% tax on income split between employee and employer is how we pay for a $1.34T health care system.   Add a tax for people who file income tax but are not subject to payroll taxes so everyone pays fair share.

        Keep in mind that is $800B less than the current health care system which costs of $2.2T.

        How do you propose to pay for health care?

  •  Has anyone done a survey on exactly how many (2+ / 0-)
    Recommended by:
    luvmovies2000, elwior

    Senators support a public option of any kind?  Also, didn't the private insurers balk at the Medicare advantage program until the government bankrolled it? Now that that gravy train has left the station, these plans will wither and die

    "Lean to the left, lean to the right. Sit down, stand up, fight! fight! fight! Stand by our President" -Lazlo Toth

    by dditt on Tue May 05, 2009 at 06:07:03 AM PDT

  •  When this issue (3+ / 0-)
    Recommended by:
    annrose, luvmovies2000, elwior

    is discusssed,part of the equation is always that in America,even now, no one gets turned away who needs healthcare,ie. at emergency rooms. And the theory is that emergency room care for the uninsured 47 million ends up costing taxpayers a whole lot more than having an insurance plan for these folks.

    Does anyone know exactly how emergency room costs for uninsured work there way thru the system?; how much that tab is?

    Can a case be made based on that expense that we still can justify a public option that is not self-sustaining that still saves tax dollars overall?

    We need numbers to make a good case for the public option.

  •  There is no middle ground, or (8+ / 0-)

    any way to success at all, unless exclusions for preexisting conditions are taekn care of.

    Otherwise, any public option becomes a ghetto for uninsurables with second-rate care.

    "To be afraid is to behave as if the truth were not true." -- Bayard Rustin

    by Joelarama on Tue May 05, 2009 at 06:08:39 AM PDT

  •  So Damned Simple (16+ / 0-)

    We are already paying for excellent health Care.
    Too bad the money NEVER reaches the Doctor, the Nurse
    or the Hospital. Thanks to the PARASITES in the insurance companies.
    Every dollar they make in profit is a dollar that never reaches the providers.
    Last year, that amount was over 6 Billion.
    Still think we Can't Afford Health Care?
    What we can't afford are the THIEVES
    that have HIJACKED our healthcare system.

    Healthcare REFORM means getting RID of the Private Insurance Companies.
    Period. Anything else is nothing but smoke and mirrors.

    On Giving Advice: Smart People Don't Need It and Stupid People Don't Listen

    by Brian76239 on Tue May 05, 2009 at 06:10:54 AM PDT

  •  Health care reform requires public option (4+ / 0-)

    There is simply NO WAY to achieve benefits associated with quality improvement and cost efficiency by continuing the fragmented private insurance based health care financing we have now.  

    MEDICARE FOR ALL!!!!!

  •  The insurance industry should be forced (5+ / 0-)

    to comport like the public plan.

    •  that's what fair competition is supposed to be (7+ / 0-)

      about. We're not supposed to gut the public option to make the private insurance companies feel better. That's corporate welfare, basically.

      They tortured people to get false confessions to fraudulently justify our invading Iraq.

      by slinkerwink on Tue May 05, 2009 at 06:18:23 AM PDT

      [ Parent ]

      •  They can't force a COMPANY to LOSE MONEY (3+ / 0-)

        This is AMERICA.

        Thats why Obama's public option will be SO EXPENSIVE THAT IT WONT COMPETE WITH PRIVATE INSURANCE.. Only the sickest people will buy it.

        Just like in New York's public option..

           Premium Rates for Standard Individual Health Plans

           April 2009

           New York County

           Monthly family premium rates for Point of Service Plans (POS)

           $4450 - Aetna Health. Inc.
           $3776 - Atlantis Health Plan, Inc.
           $4066 - Empire BlueCross BlueShield HMO
           $6824 - GHI HMO Select, Inc.
           $4187 - Health Insurance Plan of Greater New York, Inc.
           $3816 - Health Net of New York, Inc.
           $3500 - Managed Health, Inc.
           $4208 - Oxford Health Plans (NY), Inc.

           HMO family rates for these same insurers range from $2266 to $5686 per month.

           http://www.ins.state.ny.us/...

        If you read the requirements being laid out, they will SERIOUSLY kill any hope for its affordability..

        http://www.nytimes.com/...

      •  Conservatives are supposed to oppose Welfare (0+ / 0-)

         If these "health care industry" guys are not really needed, shouldn't the market weed them out?

        "We the People of the United States...." -U.S. Constitution

        by elwior on Tue May 05, 2009 at 03:47:30 PM PDT

        [ Parent ]

  •  First they fucked up FISA... (22+ / 0-)

    and I kept my powder dry...
    Then they fucked up the Bankster bailouts, and I kept my powder dry...
    Then they fucked up the stimulus (WAY too small), and I kept my powder dry...
    Then they fucked up holding torturers accountable, and I kept my powder dry...
    Then they fucked up cramdowns, and I kept my powder dry...

    So now they're gonna fuck up health care?

    WHAT THE FUCK DID WE ELECT THESE DEMOCRATS FOR???????

    I despair of this system of ours ever being capable of producing just results.

    Dear Mr. President, There are too many states nowadays. Please eliminate three.
    P.S. I am not a crackpot.
    -Abe Simpson

    by fromer on Tue May 05, 2009 at 06:17:49 AM PDT

  •  Schumer turns "reform" into "delay" (8+ / 0-)

    All this is is a stalling action. If the Schumer plan passes, it means reform of the health care industry has been delayed until a majority of its supporters can be replaced with real progressives.

    Make no mistake, the American people want REAL health care reform. If we can't get it with this Congress, we'll get it with the representatives that we replace these guys with.

    Real economic recovery depends on health care reform. American industry will never be able to compete on a level playing field with the rest of the world until we take the burden of health care off of employers and put it in the public realm where it belongs -- where it is for every other industrialized nation in the world.

    Protecting the insurance industry is as damaging to our economy as giving Wall Street a blank check has been over the past decade.

    The health-care mafia is doing us as much harm as the derivatives mobsters did under Bush.

    We need real health care reform NOW, and if we can't get it now, then a lot of Congress people, even Democrats, have to go.

  •  I mostly agree but I don't understand (1+ / 0-)
    Recommended by:
    rainmanjr

    why you believe that premiums and co-payments would be higher. What is your evidence for that? Private insurance uses the exact same model. Furthermore, because there is no need to turn a profit, a public plan under this scenario should be 15-30% cheaper than a private plan.

    •  A public plan will accept all risks, (13+ / 0-)

      I assume. Preexisting conditions, family histories, etc. would not be grounds for excluding under a public plan, would it?
      Insurance companies make money by denying coverage.  How would a public plan compete with that?  Why should it be expected to?
      I thought the whole point of this program was to was provide health care, not to guarantee profits for insurance companies.

      Why can't I free your doubtful mind and melt your cold cold heart. ~ H. Williams

      by Andhakari on Tue May 05, 2009 at 06:54:29 AM PDT

      [ Parent ]

      •  As I understand it (6+ / 0-)

        part of Obama's plan would be to force private insurance to take all comers, thereby leveling the playing field as well as spreading the risk to a much wider group. That's how a public plan could compete.

        Additionally, when all Americans are covered, then nobody shows up at the emergency room without insurance. So hospitals don't have to jack up the rates for everybody else to compensate for it.

        I'll give you an example, last year my wife had emergency gall bladder surgery. The hospital bill was $33,000. After my insurance company finished negotiating, the total bill was adjusted down to about $6500, of which I ended up paying about half in co-pays and deductibles, etc.

        Clearly, the actual cost of the procedures was a tiny fraction of what they tried to bill us. But it didn't stop them from trying to gouge us anyway. If everyone was covered, these games would no longer be necessary for hospitals to recoup their costs.

        •  If someone can pay the premium of $5000/month (5+ / 0-)

          they will be accepted,

          The high risk pools/public options do that now, after a waiting period of up to a year.

          (This is because they are supposed to not take patients away from private insurers, which they dont do anyway because private insurers wont insure sick people.)

          Thats why the whole idea of them self supporting is so wrong..

          That will make them SO unaffordable.. worse than the existing high risk pools.. worse..

          •  I think you have to look at this holistically (0+ / 0-)

            That premium of $5000, first of all seems like a massive exagguration, but that aside, it's as high as it is right now primarily because so many hospital fees go unpaid, so they jack up the fees for those who can pay to compensate. When everyone is insured, the risk pool is spread much wider and premiums can be reduced for everyone. That's how insurance works.

            •  I live in Norway (14+ / 0-)

              and participate in the national system here.  All this crap about finding a way to keep the bloodsucking insurance companies in gravy just sounds like silly horse hockey to me.
              It's like employing firemen on diesel trains: it's just a throwback to the past.

              Why can't I free your doubtful mind and melt your cold cold heart. ~ H. Williams

              by Andhakari on Tue May 05, 2009 at 07:31:06 AM PDT

              [ Parent ]

              •  Oh I DO agree with that (2+ / 0-)
                Recommended by:
                luvmovies2000, rainmanjr

                It is a throwback to the past, and obsolete system that has proven ineffective in it's current form. But it's the system we're stuck with for now. A full scale national healthcare system is politically impossible right now and probably will be for several more years.

                You are not the only person from overseas here. I used to live in Colombia, where there is a reasonably functioning public-private system. This kind of system is imperfect to be sure, but it can be made to work much better than what we have here right now. If a poor, war torn, third world country like Colombia can make it work, there is no reason why we can't do it here too.

                By the way, that is also the kind of system that Germany has as well, it works pretty well for them too.

      •  True, unless there's a mandate (0+ / 0-)

        and then you don't have to do medical underwriting, since there's a uniform risk pool.

        The Enemy ('08): McCain/Palin........The Enemy ('09): Geithner/Summers

        by slaney black on Tue May 05, 2009 at 07:08:21 AM PDT

        [ Parent ]

  •  "Public Plan".... "government money" (7+ / 0-)

    I understand that this is a massive plan, and it's more complicated to set up than we'd like to believe, but treating us like morons is not helping.

    I'm getting really tired og this "government money" stuff. What's the difference between the public and the government? Whose government is it? Who finances it? When the government borrows money from China, who is supposed to pay it back? Whose money does the government use to bail out Wall Street? Whose money does Schumer take home as salary? Who pays for his retirement and his health care?

    These morons have to stop talking about the government as if it's an entity that has no relation to the public.

    Deal with the facts: Every western country, with the sole exception of the US of A  has health care for it's citizens. Americans cannot afford health care and need something that every other developed nation takes for granted. Period.

    If the government cannot run healthcare, and the government is made up of Americans, elected to office by Americans, that means they are saying Americans cannot run healthcare. That is unacceptable.

    •  not just western (0+ / 0-)

      most developed asian ones as well, and more than a few developing ones. we're way behind the ball here.

      surf putah, your friendly neighborhood central valley samizdat

      by wu ming on Tue May 05, 2009 at 08:11:05 AM PDT

      [ Parent ]

    •  Maybe if we stopped spending "government money" (0+ / 0-)

      in Iraq and Afghanistan, we would have enough government money to make sure every American gets good quality health care that doesn't bankrupt them.
       That would give us some real security.

      "We the People of the United States...." -U.S. Constitution

      by elwior on Tue May 05, 2009 at 03:56:58 PM PDT

      [ Parent ]

  •  You don't explain your positions (5+ / 0-)

    so please don't expect me to support them.

    Slinkerwink, you state:

    I don't think the public plan should be self-sustaining, because if it's wholly reliant on money raised from premiums and co-payments, that means that the premiums and co-payments will be higher than those of the premiums and co-payments offered by private health plans.

    Frankly, that makes no sense to me.  Why would this be the case?  The basic premises upon which we heap our wrath towards the health insurance industry are:  1) They extract huge profits at the expense of patient health, 2) Because it is not universally available, and prior conditions are excluded, millions of people are left uncovered, which is less efficient overall and frankly, unconscionable.  If everyone is covered and no one is extracting huge profits, why couldn't the thing be self sustaining?  What is the harm if it is?

    And yes, the government should compel doctors and hospitals to participate in a public plan, otherwise the doctors and hospitals will refuse to take the patients in the public plan just like they refuse to take on any new Medicare patients. In order for the public plan to work, it has to have widespread participation by medical professionals which translate to universal access for Americans. In any city, town, or state, they should be able to go to a doctor who can't refuse to take them on. In a small town, a doctor might be enticed by private plan insurers to refuse patients from the public option. That's why I'm against the second bullet point in Senator Schumer's cockamamie proposal.

    So, here you are ignoring the fact that doctors refuse to take additional medicare patients because they lose money on every single one.  That is addressed by a bullet you seem to ignore.  It seems to be one of the key premises of any system that the workers involved in it should be able to receive reasonable wages.  In this case the workers are the health professionals - the doctors and nurses and others involved.  However, rather than forcing them in as conscripts, the idea here seems to be that we would attract them in by the balance of the benefits of the system.  To me, that seems to be a key benefit to the system, not a flaw.  It also subverts your assertion that a private plan could entice the doctors away.  One would ask, why would they and how could they?  In a small town I suggest it is even less likely to happen.

    I assume I will get slammed and that is okay.  I'm playing devil's advocate here because while your position may or may not be valid, your explanation is really lacking.  Consider this a request to back it up more than anything else.  If you think anything to date has required thorough and rigorous thinking, I expect you will be surprised.  The insurance industry would pick your argument apart and leave it in tatters.

    "What the cynics fail to understand is that the ground has shifted beneath them..." Amen.

    by nsfbr on Tue May 05, 2009 at 06:22:46 AM PDT

    •  I think you are right on point one, but (5+ / 0-)

      not necessarily on point two. Doctors in this country are massively overpaid. A medical degree should not be an automatic winning lottery ticket.

      Doctors in Brittain for example live quite comfortably, driving fancy cars and living in million dollar houses all for a fraction of what doctors in the US are paid.

      So the notion that  doctors would somehow not be paid reasonable wages is absurd, as is the notion that doctors "lose" money on medicare patients. They don't lose money, they just don't earn the same exhorbitant gouging fees that they do for other patients.

      •  So What Percentage of Health Care Spending (0+ / 0-)

        Ends up as "Net salary for doctors?"

        If spittle & tooth=vigor & youth Bill-O & Savage won't grow any older If wishes & dreams=bitches & beams We'll all live in skyscrapers bu

        by TooFolkGR on Tue May 05, 2009 at 07:16:53 AM PDT

        [ Parent ]

        •  There was a study done in the early 90s..... (0+ / 0-)

          AT the Urban Institute showing that health care inflation was on account of the technologies used, tests, etc. and administrative costs, and not increases in doctor's compensation. Just one slightly dated data point.

          The doctor's share is not huge. Someone might be in ICU for 5 days and it costs $200,000 and the doctors' takes might be $10,000 - $30,000 depending on the problem.  

      •  I wholeheartedly disagree with generalizations (0+ / 0-)

        There are doctors who are in it for the money, and have figured out how to milk the system.  However, there are also doctors who choose to serve their patients as their profession was intended.  I know of the difficulty of paying off med school from friends who had a debt load more than my first and second homes combined.  

        The problem I have here is that we actually are a capitalistic society.  I like that.  I believe the government has a role in regulating commerce to protect the less powerful and providing for the common good.  However, I don't believe it is in the long term interests to force a particular profession to a particular business model that includes receiving their paycheck from the government.  That just <and now I'm not supporting my perspective with facts and I'm calling myself on it, but so be it> doesn't sit right with me.

        The point of my comment was that this is a very complex issue.  One on which there are companies who are "loaded for bear" as we say.  We can not afford to have dire pronouncements of doom with the absolute best fact and reason based argument backing things up at every step of the way.  I know we can do better.  And I know (from previous experience) that the diarist can do better.

        "What the cynics fail to understand is that the ground has shifted beneath them..." Amen.

        by nsfbr on Tue May 05, 2009 at 08:22:00 AM PDT

        [ Parent ]

        •  And just like that... (2+ / 0-)
          Recommended by:
          Brooke In Seattle, nsfbr

          I know of the difficulty of paying off med school from friends who had a debt load more than my first and second homes combined.  

          ...the problem spins back to something more closely resembling an original problem.

          If the cost of getting an education weren't out of reach for most people, the cost of paying it back wouldn't need to be borne by the same people.

          Once we cut out the corporate middle-men, things get a lot cheaper when we just pay for things up-front.

          •  If you are going to argue that we need to (0+ / 0-)

            first fix the funding of higher education in this country before we address the crisis in paying for health care, I would suggest that we are going to have to wait for an intolerably long time to see either.  The education funding system we have does work for a large number of people fairly well.  It has serious problems, but its state of health (forgive the pun) is nothing like that of health care.  At its core, the university system we have is very sound.  That, while making it relatively straightforward to fix, also means that the groundswell of support just isn't there.  We aren't bankrupting (literally) our manufacturing companies and forcing tens of millions of people to put their lives at risk due to the issues in higher education financing.  That is the case with health care however.  

            From my perspective, health care is the single biggest social issue there is.  In terms of overall threat to our future it is second only to the destabilizing effect of climate disruption due to fossil fuel consumption.  That is why I believe we must have arguments that can withstand attack.

            "What the cynics fail to understand is that the ground has shifted beneath them..." Amen.

            by nsfbr on Tue May 05, 2009 at 10:09:43 AM PDT

            [ Parent ]

    •  asdf (0+ / 0-)

      I think I get what Slinkerwink meant by the first one:

      Public plan can't say no to anyone, I don't think.  Private for-profit insurers (and even non-profit ones like Kaiser) say no all the time if they think someone will cost too much.

      How much is enough? $500K/year?

      by billlaurelMD on Tue May 05, 2009 at 08:44:56 AM PDT

      [ Parent ]

  •  We are so fucked (10+ / 0-)

    I hate to be a negative person, but honestly we switch parties in control and it is still the same corporate masters.

    This country has become a subsidiary of the global multi-nationals at this point and does whatever the parent company tells them.

    •  It's called "Plutcracy" (1+ / 0-)
      Recommended by:
      LaFajita

      and it's what we labor under. We are slaves in all but name.

      "Much law, but little justice": Proverb

      by Dave925 on Tue May 05, 2009 at 07:45:01 AM PDT

      [ Parent ]

    •  And yet... (0+ / 0-)

      ...when election time rolls around, and some of us start screaming for a truly populist progressive candidate to support, we're all shown the door early, because, you know, we have to win before we can make policy.

      We haven't won yet. Sure, the man we elected looks different and says most of the right things, but we're still playing by the same corporate rule book they wrote to keep themselves rolling in our money.

      Until that changes, we're still digging our hole.

      •  You are so dead-on it is scary (1+ / 0-)
        Recommended by:
        slinkerwink

        We are told we have to appeal to the middle to win. We win and we are told we have to appeal to the middle-right to get things to pass. We have the majority and they have no excuses - so now we are told nothing.

        What's next? They tell us to shut the fuck up and enjoy serfdom?

  •  Are there 50 Senators that would be for (2+ / 0-)
    Recommended by:
    LordMike, PeggyD

    a public health care plan?

    If there is than there needs to be a coalition that will make up to options for Senators to vote on which include one option being a public health care plan.

    "Because we won...we have to win." Obama - 6/6/08. WELL WE DID IT!!! 11/4/08

    by Drdemocrat on Tue May 05, 2009 at 06:24:20 AM PDT

  •  I'm on now, we live in Westchester (6+ / 0-)

    They put me on hold!

    I apologize for being Republican spawn

    by cama2008 on Tue May 05, 2009 at 06:27:48 AM PDT

  •  It's a travesty. It's a travesty of a mockery of (4+ / 0-)

    a sham ofa mockery of a travesty of two mockeries of a sham.

    This is just to say Forgive us victory tastes delicious so sweet and so cold

    by Dave the Wave on Tue May 05, 2009 at 06:28:34 AM PDT

  •  The fewer the payers, the more purchasing power (5+ / 0-)

    The most expensive components of healthcare are hospitals and physicians (70-80% of spend).  

    With a fragmented payer landscape, regardless of how much they bitch and moan, empirically doctors and hospitals ("providers") win -- physicians are much better paid in the US than anywhere else, and hospital care here is much costlier.

    Single payer offers the prospect of significantly lowering healthcare costs through exercise of monopsony power.  The public plan (if it reaches scale to achieve purchasing power) would be the next best thing - fragmented insurers, with limited purchasing power and absurd administrative costs (they need to pay all those people looking for reasons to deny claims, as well as the million dollar executive bonuses) would never be able to compete.

    Don't we believe in using market forces for public good, Chuck?

    We must pick ourselves up, dust ourselves off, and begin again the work of remaking America.

    by Minerva on Tue May 05, 2009 at 06:32:29 AM PDT

  •  called (my) senator Nelson's office, (19+ / 0-)

    told them that anything but the medicare-style public option is unacceptable, that I was concerned he was conspiring with the health care industry to undermine the reforms the American people, in the current crisis, desperately need.

    Added that it was my opinion that THIS--to me--was what what patriotism means, serving Americans and not corporations, and that the time was coming when serving one's corporate masters instead of the people would come to be seen as traitorous. Also said I was emailing 20 friends this a.m. to encourage them to become active on getting us some g.d. universal healthcare!

    That's my story and I am sticking to it.  

    Why are we on this side so much like the other side when it comes to tribe loyalty? Nada Lemming

    by Matthew Detroit on Tue May 05, 2009 at 06:32:43 AM PDT

  •  OK, done (8+ / 0-)

    I spoke to the gal, she was so nice and thanked me for my comments.

    Thanks for posting this.

    I apologize for being Republican spawn

    by cama2008 on Tue May 05, 2009 at 06:32:57 AM PDT

  •  Last night, Howard Dean (12+ / 0-)

    told us that Pres. Obama's plan would include a public option.

    This was news to me as I had always thought that his plan, during the campaign, did not consider either a public option or a single payer plan.  Advocates of single payer health insurance were not even invited to the president's summit until this fact was exposed and there was outrage.

    Last night, on one of the MSNBC shows, a group of pundits concluded that Arlen Specter "gets us healthcare."

    This was also news to me, since on Sunday morning, Specter unequivocally declared that "No" he would not support a public option.

    So what's the deal?  I'm thoroughly confused.  And I feel very much like we're being lied to.

    "The true measure of a man is how he treats someone who can do him absolutely no good." --Samuel Johnson

    by joanneleon on Tue May 05, 2009 at 06:33:26 AM PDT

  •  Schumer is an embarrassment (12+ / 0-)

    He stands for nothing except the big money players on any issue. And as we witnessed with the Mukasey nomination, there is no limit to the depths he will stoop to "compromise."  Shut up Chuck.

    An end to the Bush nightmare is only the first step in rebuilding America.

    by DWG on Tue May 05, 2009 at 06:33:44 AM PDT

  •  Isn't Schumer the one who sank Indymac? (2+ / 0-)
    Recommended by:
    elwior, oaktownadam
    He's good (sic) like that.

    The Victorian novel is right. Possessiveness, controlling others and not listening to your own heart always goes badly. - MKKendrick

    by cskendrick on Tue May 05, 2009 at 06:37:46 AM PDT

  •  Fuck Chuck. n/t (3+ / 0-)
    Recommended by:
    Dave925, rainmanjr, elwior

    "History is a tragedy, not a melodrama." - I.F.Stone

    by bigchin on Tue May 05, 2009 at 06:41:17 AM PDT

  •  They refuse to take new medicare patients... (4+ / 0-)

    ...because they operate at losses when they do. At least, that's the case for my future mother who is a nurse-specialist in a certain medical field. Then again she also spends half her time getting free samples to give her patients so they don't die from being too poor.

    There's something attractive about invincible ignorance... for the first 5 seconds.

    by MNPundit on Tue May 05, 2009 at 06:42:36 AM PDT

    •  Sorry, you need to look behind this (0+ / 0-)

      There is no question that reimbursement reform is truly necessary for Medicare, but when anyone says they operate at a loss for Medicare patients just remember that they have rarely tried to adopt any kind of innovation that would make them more efficient, and are including in their calculus whether Medicare subsidizes its fair share of the uninsured.  

      One of the reasons why we need to reduce fragmentation and not build another god damned bureaucracy is so that we can actually figure out how much it actually costs to care for a patient,  instead of doing paperwork, subsidizing the uninsured, etc.  Eliminating Medicaid and folding all public options into the existing Medicare infrastructure would make it very difficult for either health care providers or insurers to hide behind their self-interested arguments about where the money goes and what it is spent for.

      •  Future mother-in-law, whoops. (1+ / 0-)
        Recommended by:
        elwior

        Who's "they?"

        What can a single RN-specialist do to adopt any kind of innovation that would make the system more efficient?

        Interestingly there is a lot computerized stuff in the Iowa health system which I approve of mostly.

        There's something attractive about invincible ignorance... for the first 5 seconds.

        by MNPundit on Tue May 05, 2009 at 10:36:43 AM PDT

        [ Parent ]

    •  Your future mother? (0+ / 0-)

      I've never heard that one before.

      "We the People of the United States...." -U.S. Constitution

      by elwior on Tue May 05, 2009 at 05:38:43 PM PDT

      [ Parent ]

  •  I don't know that this is a mockery. (3+ / 0-)
    Recommended by:
    slinkerwink, Dave925, luvmovies2000

    Whatever they do to "moderate" a public option the simiple fact of the matter is that private for profit insurance with 30-some% overhead can't compete with a public option with overhead in the single digits.

    So what if a public option has to pay comparable to private insurance?  Have you seen what private insurance pays for services?  It's incredible.  I got an MRI, and my statement from the insurance company (BC/BS) outlined what was charged, what was paid, and what I am responsible for paying.  They paid less than $300 for a $3000 dollar test.  I wasn't charged the remainder, the imaging center ate the difference because that is what it negotiated with my insurance company.

    As long as a public option has the power of negotiation, there is no way in hell the private insurance industry can compete.  

    However, seeing what happened to medicare part D, the power of negotiation is not a foregone conclusion.  But THAT is what we need to fight for most.

    You are entitled to express your opinion. But you are NOT entitled to agreement.

    by DawnG on Tue May 05, 2009 at 06:47:55 AM PDT

    •  But are you aware hospitals grossly inflate (2+ / 0-)
      Recommended by:
      slinkerwink, luvmovies2000

      their prices?  Your insurance company paid a reasonable price for your test... possibly after months of paperwork and negotiation that is a large part of that 30% overhead.  And the hospital has to employ a huge crew with all the associated infrastructure... buildings, computers, etc. as well, greatly increasing their overhead as well and increasing your costs.
        The people who cannot negotiate to lower prices are the un-insured, or self insured, or who pay out-of-pocket.  Then it's a win-win for the hospitals.  If they pay, the hospital makes enormous profits on them.  If they don't, they can write off a much larger bill and reap a huge tax break.
        What we need from a public healthcare plan is to create something truly competetive to the corporate model that will begin balancing patients' financial needs with the real financial needs of health institutions.  What Schumer is doing is ensuring that won't happen.
       

      •  Yes that has occured to me. (5+ / 0-)

        And something should be done about those "grossly inflated" prices for uninsured.  I have no doubt it's to discourage the uninsured from seeking medical help from them and I'm surprised no one's filed a lawsuit over it.  Some exclusionary thing.

        But everything I've ever read from people who actually work in the healthcare field is they hate dealing with private insurance companies.  Too much paperwork, too many "codes" and they'll deny charges at the slightest mistake.

        That is intentional on the insurance companies part and I would think that doctors and hopsitals would enjoy something a bit less strenuous and tedious.  As long as they were getting a fair price for their services.

        You are entitled to express your opinion. But you are NOT entitled to agreement.

        by DawnG on Tue May 05, 2009 at 07:28:50 AM PDT

        [ Parent ]

        •  There are two areas where Schumer could make (0+ / 0-)

          "a mockery" of a public insurance plan if his statements are followed.  The first is  with high rates.  The "ideal" form of insurance (in a maket-based system) is a big financial pool created so people can chip a manageable amount into, so they can withdraw a larger unmanageable amount from it if an unavoidable financial hardship strikes them.  The collected money has to be sufficient to first cover the expenses of the participants, second pay for the overhead of running the insurance, and third, generate a profit for its administrators and investors who helped create and run it.
           The process of creating public insurance needs to avoid creating an uneven playing field where private companies could not compete.  There should be transparency and separation from insurance company oversight functionaries. The huge negotiating power of the government and lowered costs due to lowered profit motive are large advantages in the marketplace that need to be addressed.  The private sector model is deeply flawed, however, so we also have to avoid protecting its excesses, such as routine delay and denial of care or excluding valid health problems from financial coverage.  Personally, I believe the government as single-payer health insurer is an excellent alternative to the stinking mess we have now, and if we're going to leave for-profit insurers a place, they should have to work hard for their money.  (If Reagan could fire every single air traffic controller in the country because they wouldn't control air traffic, why can't President Obama fire the health insurance industry for denial of health care?)  We must also refuse to create a system with intentional weaknesses such as following existing overpriced health costs or the ability of medical facilities to "opt out" of providing health care to people with certain coverages... especially following the private consolidation of a lot of health care facilities in recent years. Large areas of the country could end up with no healthcare providers for people with public coverage, truly making it a joke.
            Premium payments are a huge issue because many lucky people still get coverage through their employers, and who would choose to pay for a benefit they already have?   So the costs have to be kept in line, especially at the outset, and the government has to be the investor to absorb early losses until the mathematics are worked out.

    •  Umm, who decided that test was worth $3000? (5+ / 0-)

      Your hospital did!!! Welcome to the "free market" of health care pricing!  

      Imagine giving your employer or client a bill for $1 million and then, when they dispute it, say, "but that's my charge!"

      Everyone wants a free market -- for the other guy.

      Hospitals want insurers to pay their charges but they don't want to tell consumers what those charges are.  

      Don't demonize the insurers here to the exclusion of providers -- there's a lot of greed to go around.

  •  the real middle ground is the -compromise- (4+ / 0-)

    crappy laws politicians make as they attempt to look like they're doing the people's business but are really making their real employers, the business interests and lobbyists the have to keep happy and contributing to stay competetive in high-dollar election cycles, satisfied.
      If we take the big money out of hiring our government officials, we'll all be better off.

    •  That's the fix for everything (2+ / 0-)
      Recommended by:
      luvmovies2000, Actbriniel

      and as such, can never be implemented. Those who own the government want to keep it working for them, not us.

      "Much law, but little justice": Proverb

      by Dave925 on Tue May 05, 2009 at 07:32:35 AM PDT

      [ Parent ]

      •  It is the underlying element of corruption (1+ / 0-)
        Recommended by:
        Dave925

        that stinks up the whole joint.
          It can happen in Obama's second term, if the Democrats continue to grow their majorities, and if the political power of the netroots/grassroots movements in this Nation continue to grow.
          Getting the dirty, stinkin' money out of the political process is by far in the best long-term interests of the Democrats because political contests would become about intelligent political debate and who represents the best interests of the People.

        "We the People of the United States...." -U.S. Constitution

        by elwior on Tue May 05, 2009 at 05:55:35 PM PDT

        [ Parent ]

  •  called nelson (15+ / 0-)

    asked if he was up yet, or if he was still in bed with the insurance industry. they remember quips like that, anger shows weakness - be cool, like you're conning another con. disturbs them.

    "The due administration of justice is the firmest pillar of good government." George Washington

    by bob zimway on Tue May 05, 2009 at 06:53:31 AM PDT

  •  Public opinion had not heated up on this (9+ / 0-)

    Right now, Democrats in Congress are running from the "socialized medicine" arguments the Republicans, Fox, and a good portion of the corporate media are peddling.

    Under the terms that Schumer describes, it is impossible to provide healthcare to all Americans.  It flunks the universal healthcare test.

    There needs to be some noise made about healthcare, and Howard Dean is on the case with DfA.

    Make those phones ring.

    •  He wants this done for free? (0+ / 0-)

      I think he wants a Public option which is both crappy and expensive for those who use it.
      In this way most people will prefer private (HMO) plans.

      "We the People of the United States...." -U.S. Constitution

      by elwior on Tue May 05, 2009 at 06:05:53 PM PDT

      [ Parent ]

  •  Poison pills, courtesy Schumer, Sen.(Wall Street) (8+ / 0-)
  •  OFFSHORING THE CARE OF THE SICK COMING (2+ / 0-)
    Recommended by:
    luvmovies2000, smkngman

    Many of us don't see where this is going, I will tell you. Its going to come down to sending the sick and unemployed to other countries, on a cash and carry basis.

    Preferably countries with a low ground level effected by global warming.

    Out of sight, out of mind.

    "Arbeit Macht Frei"

  •  CHOICE... (5+ / 0-)

    From the conference last night with Howard Dean, MoveOn, and Democracy for America - the talking point going forward is the Health Care Debate should be hinged on one word: CHOICE.  We need to be able to choose between a PUBLIC OPTION and PRIVATE OPTIONS - it is that simple.  

    Also, doctors today have the option if they accept certain private insurance and/or Medicare - so we should not get in the weeds and force any doctor to do anything it is their CHOICE.  From my experience MEDICARE is the surest bet of getting paid - Private Insurance takes a great deal more man hours to collect the same dollars for the same treatment.

    As far as being 'self sustaining' - President Obama and Orzsag are already setting forth the perspective of 'PayGo' and that is where the set aside of $640 Billion or so and more set aside will be released this week per Orszag's Blog... So yes the Public Option will be 'self sustaining' and also produce an overall savings of at least 30% to the Health Care System as currently measured.  

    In the end, Peter Orszag will or has found the money to get the Public Plan off the ground somewhere in the range of $1.2T - $1.5T over 10 years .... in addition once it becomes available on the market - many, many, many people will join and their monthly or quarterly premium payments will begin the process of making it 'self sustaining'.

    Demographics do not equal destiny.

    by dr fatman on Tue May 05, 2009 at 07:00:37 AM PDT

  •  We need to have a self sustaining public option (4+ / 0-)
    Recommended by:
    cwech, frandor55, stella0710, dr fatman

    plan.
    Otherwise it will always be suspect to criticism and repeal once republicans at some point take over.
    What we are looking at here is the establishment of a large non-for profit plan. I am fine with that. I would prefer that plan to my current private plan just I prefer my credit union compared to for profit bank.

    •  Agree and disagree... (1+ / 0-)
      Recommended by:
      denise b

      ...recommended because of the agree part.  I think the end part, comparing it to a credit union is a good argument.  I'm not sure I buy the institutional argument.  The way "self-sustaining" is used in this context suggests that it won't have any tax base at all, social security as a counter example is self-sustaining because of its tax base.  I think at least some sort of a tax base is important, and institutionally speaking a self-supporting one does shield it from hostile future administrations.  I think however that more accurately, public support for the program rather than whether it is self sustaining will shield it.  Republicans are not exactly big supporters of medicaid, but it has survived 4 decades in which at least one Republican has been President, four years of complete Republican control of everything, and one decade with no Democratic Presidents.  The reason is that the public likes it, at the end of the day I think public support for SS saved it from Bushes privatization proposal a lot more than the fact that it is self sustaining (particularly since most people don't seem to understand that it is self sustaining).

      What bothers me in this "compromise" proposal is the part that says the public option will pay doctors more than medicare rates, and the part that says doctors and hospitals won't be compelled to participate.

      I do not accept the premise that the only way the public plan is cheaper than the private plan is if it has a tax base, I would love to see an analysis of how much lower the premiums will be than private plans.  Medicare has far lower administrative costs than private plans, its largely those administrative costs that drive up the cost of health care in general, and private insurance premiums specifically.  What I think would be a workable compromise in this regard would be making it semi-self-sustaining (in the context its used above) give the program some kind of a tax base, then charge individuals premiums whose value is based on the individuals income level, that way wealthier people are more likely to stick with private insurance, and people who barely exceed eligibility for medicaid will pay next to nothing, subsidized by taxes and the overhead from the premiums of wealthier people who choose to participate in the public plan.

      In any event, I would really like to see someone with some expertise in this field explain exactly what is lost by making the program entirely funded by premiums and copays.  Something has to be lost by definition, but I think the diarist overstates it pretty badly.

      "You can only protect your liberties in this world by protecting the other man's freedom. You can only be free if I am free."-Clarence Darrow

      by cwech on Tue May 05, 2009 at 10:44:34 AM PDT

      [ Parent ]

  •  The same minimum benefits as private insurers?? (3+ / 0-)

    This is where the real madness sets in.  We all know that private insurers make their profits by promising a level of service then reneging on it.

    The public plan will be at a disadvantage because it will be required to actually keep its promises.

    •  Almost all of the state plans are administered by (0+ / 0-)

      private insurers, and they are expensive partially for that reason.

      For example, from http://www.pnhp.org/...

         Premium Rates for Standard Individual Health Plans

         April 2009

         New York County

         Monthly family premium rates for Point of Service Plans (POS)

         $4450 - Aetna Health. Inc.
         $3776 - Atlantis Health Plan, Inc.
         $4066 - Empire BlueCross BlueShield HMO
         $6824 - GHI HMO Select, Inc.
         $4187 - Health Insurance Plan of Greater New York, Inc.
         $3816 - Health Net of New York, Inc.
         $3500 - Managed Health, Inc.
         $4208 - Oxford Health Plans (NY), Inc.

         HMO family rates for these same insurers range from $2266 to $5686

         http://www.ins.state.ny.us/...

  •  It sound like a universal Blue Cross/ (5+ / 0-)

    Blue Shield plan. Which is actually great and fairly affordable med insurance, at least in Michigan.

    But Shumer is missing one point, they supplement premiums and co-pays to keep their rates relatively reasonable by investing in the private sector. Which would be necessary and inescapable if the government option were to be competative viable and self sustaining.

    This is Bush's 'privatised social security plan' applied to medical care. Compulsory transitory investment in the stock market through 'independent management'. It's the corporatist convergence of right and left extremity, casting it's dollar green shadow over the middle.

    Shumer left out that necessary caviat for the investment option, on purpose I'm sure, but it's necessity is plain as day.

    Moving on, finally.

    by fisheye on Tue May 05, 2009 at 07:06:48 AM PDT

  •  Strategy: Make sure we have a public option first (1+ / 0-)
    Recommended by:
    frandor55

    Yes, the attempted nerfing of the public option sucks.

    But how do reforms frequently happen?  One tiny piece at a time.

    We're trying to take a big bite out of the health care problem, and we damned well need it, so may I suggest a strategy:

    First, get the public option in place.  Get it in there at all costs.  Yes, it will be nerfed.

    Once it's signed into law, we immediately start working on the unnerfing.  We can say that people's hands are tied, there's too many nonsensical restrictions on the public plan, that they can't do enough to control costs, and so on, and we can work on turning a nerfed public option into a working public option.

    But before we can do that, we need a public option.  It does have the virtue of providing a cost ceiling for health care - if the public option can drive down costs, the CEOs of the private plans will be forced to lower the costs of their plans to keep up.  Of course, the insurance lobbyists will want the ceiling as high as possible.

    It's up to us as to where the ceiling will be set.

    Waster of electrons, unlawful enemy combatant. http://meldroc.com/

    by meldroc on Tue May 05, 2009 at 07:07:09 AM PDT

  •  This will not change anything (7+ / 0-)

    What happened to Obama's promise? Making health care affordable for every American who wants it.

    My biggest problem with this compromise?

    ¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

    That kills it in that one sentence. If there is no requirement to participate, nearly none will. Private insurers will surely threaten to drop them, killing their practices and businesses. People already have a hard enough time because doctors or hospitals don't participate in their plans. A public option will only be worse as far as availability is concerned.

    ¶The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

    If payments to providers are not lowered there can be no real savings. If public payments are the same as private insurers, payments will be roughly the same.

    ¶The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

    For those who argue the non-profit status will make enough of a dent, you're wrong. I pay $26,000.00 a year for a "premium" plan. If prices drop an optimistic 30% I'll save $7800.00. This still leaves me with an $18,200.00 bill. How is this affordable to an average American who needs substantial coverage?

    I am one of those who require substantial coverage. I have several health problems, and I need coverage for my family. Two of my three children have conditions that will require care and medications for the rest of their lives. I have the same condition and thus, the same need. Additionally, I have a degenerative spine disorder. Four of the seven bones in my neck are affected. You'd be stunned what a "premium" plan doesn't cover. However, discontinuing treatment is unimaginable to me. I am in chronic pain that is often unbearable. Four times this past week alone I have been brought to tears. I cannot use my left arm at this point. I will need to undergo three minor procedures (requiring general anesthesia) to even have a shot at temporary relief. The minor procedures combined only last for several months. Short term relief is not really appealing. I will most likely need surgery as this has been going on for five years now, with my condition only worsening. The best surgeons do not take insurance as it is. Do I want a lesser surgeon to operate on my spine? No thank you.

    Now for the final provision.

    ¶To prevent the government from serving as both "player and umpire," the officials who manage a public plan should be different from those who regulate the insurance market.

    If the manager and regulator do not work in tandem the system is open to large gaping loopholes. If regulators are not wholly involved with the managers, there will be no successful and meaningful regulation. If managers are not working side by side with regulators enforcement will be weak. Only managers are in a position to propose regulation that will have an impact. Only regulators can ensure that impact. In other words, regulation will be about as successful as it has been on Wall Street the last two decades. We all know how well that worked out.

    These provisions are all aimed at limiting any and all impact on private insurers.

    Private insurers are scared to death of health care reform. They will stop at nothing to kill it. If that is unsuccessful they will lobby to weaken it to the point of insignificance.

    Health care costs and problems are so great that reform is necessary. This type of reform will change virtually nothing.

    It this is the best "reform" that we can hope to pass it will be nothing more than a shell game.
     

    We either make ourselves miserable, or we make ourselves happy. The amount of work is the same." Carlos Castaneda

    by BP in NJ on Tue May 05, 2009 at 07:08:06 AM PDT

    •  Good lord (5+ / 0-)

      I have the same spinal condition, I suspect, as you do. C-4 through T-1? Severe stenosis, spinal cord compression and degeneration? Luckily mine was diagnosed years after I had secured private insurance, I am single and self-employed.

      When I was going through the process of early treatment and diagnosis (MRI and meds), I kept most off the insurance, out of pocket the expense was not bad. They still bumped my premiums 33%.

      So what was an affordable PPO is approaching unafforadbility and I have opted for surgery, the pain is just too much (epidurals are ineffective) as well as the increasing dysfunction as you describe. Fortunately there are great surgeons here that do take my insurance. Paying for it all out of pocket is not an option- it would have been but the banks truncated drastically (or eliminated entirely) all my credit lines, despite a perfect record of payment and re-payment.

      But guess what? After this, I won't be able to afford the increase in the premiums. If surgery is unsuccessful, I am doubly screwed. And I am doubly screwed on all fronts because my government sides with big insurance and big banks over me.

      What the fuck kind of country do we have that sides with these huge companies over a guy who tries to play by the rules and works his ass off? Am I such a threat that the government has to even it up for the big boys? I mean, jesus, wtf? What kind of country is this?

      Don't answer, I know what kind of country it is. It is a fucked up country built by the conservatives and designed to destroy what middle class that can't just be kept broke and in perpetual fear of catastrophe and thus politically impotent.

      That's what kind of counrty it is. It sucks.

      "Much law, but little justice": Proverb

      by Dave925 on Tue May 05, 2009 at 07:24:05 AM PDT

      [ Parent ]

      •  Nearly the same condition. (2+ / 0-)
        Recommended by:
        luvmovies2000, Brooke In Seattle

        I have central canal stenosis (spinal cord compression) as well as left neural foraminal stenosis (compression of the nerve roots emanating from left side of the spinal cord) C2 though C5. I also have three bulging discs and arthritis in the area, not all of which affect the same vertebrae. Consequently all of these things together affect six discs and vertebrae out of seven.

        There is no cure. There is no treatment. Further degeneration is inevitable.

        I'm only 44 and the arthritis as well as the other conditions, I'm told, are not normally seen in one so young. Usually they are not evident until one is in their 60's. Furthermore, there is no obvious reason for my condition. I have not been in a car accident and no work experience could have caused it.

        The epidurals have successfully stopped the chronic migraines for now. More epidurals may or may not help the neck, shoulder, left arm, back, and left leg pain I currently experience. I have never been afraid of general anesthesia complications, but the prospect of having it several times a year for next 30 to 40 years frightens the hell out of me. Besides, even these treatments, if successful, may not be enough to treat the current pain, let alone when the inevitable further degeneration occurs.

        I have always had private insurance, so my costs are not due to being added to the roles with a pre-existing condition. Costs are unbelievably high where I live. An MRI (I've had two so far) costs about two thousand, so out of pocket is prohibitive. Insurance covered the majority of the cost. Considering the already high premiums I pay I felt it was only right to have filed it through my insurance. I thought this was the kind of thing I was paying so much for anyway.

        Just one epidural cost me five thousand out of pocket. But that's only due to a deceptive practice by my specialist. To get around the lower private insurance payments he has essentially set up a bait and switch operation. The doctor is on the plan, but the ambulatory surgery center, which is a wholly owned subsidiary, is not. The anesthesiologist cost me $900.00, the surgical center cost $3300.00, the rest is the doctor's fee. I am currently in the process of getting a new pain management specialist. I know now to be more pointed in my questions regarding coverage of all aspects of my required treatment. Even with participating providers my out of pocket expense will be roughly 1200.00 per epidural. Though I've not been able to ascertain a good estimate. It may be more, it may be less.

        My insurance just a few years ago was far less than twenty thousand. Due to all the claims it now stands at twenty six thousand. We too are self employed and thankfully the success of our business has made this manageable for us. I shudder to think what this would do to the average working family's budget. It would surely add to the roles of the uninsured.

        The surgery has an 85% success rate. Some of the remaining 15% see no improvement. The possibility of surgery making it worse is high enough to have kept me from choosing it until this point. Now my quality of life is so bad that 85% is not so unappealing. Though I am loathe to think of it getting worse, which is why I want a surgeon with experience and expertise in this delicate procedure. If my spine in my neck is damaged there goes my heart and lung function as well as everything else from the neck down. Fortunately I have a brother who is a neuro-radiologist. I spoke to him only two nights ago and he is in the process of finding a surgeon he feels comfortable in recommending for me.

        For all these reasons and more, meaningful and widespread health care reform is absolutely necessary.

        p.s. I'm sorry to have rambled on about all the details. It's been somewhat cathartic to get it all out though.

        We either make ourselves miserable, or we make ourselves happy. The amount of work is the same." Carlos Castaneda

        by BP in NJ on Tue May 05, 2009 at 08:40:11 AM PDT

        [ Parent ]

        •  Feel free (0+ / 0-)

          I dispensed with the technical stuff but yeah very similar but I have more of the neurofromina stenosis, it's all through there.

          You know you have at least one other here who knows how you suffer.

          If you should feel the need to discuss things, my email is dme 925 at e a r t h l i n k dot n e t.

          Good luck!

          "Much law, but little justice": Proverb

          by Dave925 on Tue May 05, 2009 at 09:41:56 AM PDT

          [ Parent ]

  •  Well there is going to be some compromise (0+ / 0-)

    The health insurance company is too powerful and is not going to let Congress put it out of business. Whatever final solution emerges it will include the insurance companies.

  •  There are health care systems that work (8+ / 0-)

    around the world.  What these corrupt nimrods in the Senate are proposing doesn't exist anywhere and won't work -- which of course is precisely what they intend.
    I'm an American citizen with residency in Norway, and I get fabulous health-care for a very reasonable cost: maybe 40 bucks for a visit to the doctor, major surgeries FREE.  A stay in the hospital is FREE.
    Doctors make a good living, but nothing extravagant.  Nurses, and all health-care workers, do quite well, relative to America.
    Access to health-care doesn't benefit from competition.  It benefits from recognizing that you are all in it together.

    Why can't I free your doubtful mind and melt your cold cold heart. ~ H. Williams

    by Andhakari on Tue May 05, 2009 at 07:13:25 AM PDT

  •  Contacted my congressman on this (3+ / 0-)
    Recommended by:
    Iberian, luvmovies2000, frandor55

    Chris Murphy of CT.

    "I'm not a member of an organized political party - I'm a Democrat." Will Rogers

    by newjeffct on Tue May 05, 2009 at 07:14:29 AM PDT

  •  Called NYC office, DC never answered (8+ / 0-)

    NYC office picked up after a couple of rings, pleasant young-sounding woman took my info and thanked me quickly.

    I ran thru all 4 points - and mentioned that I don't have health insurance because it is too expensive.

  •  And we're surprised? (1+ / 0-)
    Recommended by:
    Words In Action
  •  Medicare For All (6+ / 0-)

    They want to screw with us and call this crap a "public option"? then let's change it's name. Start calling it, Medicare For All

    ¶The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

    I'm on Medicare - it isn't a free ride. there are co-pays, $100 per month is deducted from your social security, and not all doctors want your business. I had to get a new doctor - but I like her even better than the last family doc. Tetanus shot is still 50 bucks. Flu' shot, $20. It isn't a free ride. Still, I would be totally screwed without it.

    Law is security; lawlessness invites terror. -Joe Margulies

    by mrobinson on Tue May 05, 2009 at 07:20:00 AM PDT

  •  The only decision is which universal approach? (4+ / 0-)

    Fixing our FUBAR health care system requires changing to universal health care. Everything else is bullshit.

    We need to analyze all the different universal health plans such as in Great Britain, France and Germany; and then we simply decide which approach we are going to go with.

    All truths are easy to understand once they are discovered; The point is to discover them. -Galileo

    by phild1976 on Tue May 05, 2009 at 07:21:04 AM PDT

  •  Why not kill the insurance companies? (6+ / 0-)

    They're not on your side.  Why should anyone be on their side?
    They're in the business on denying coverage.  Who wants a public plan that's designed to compete with that?

    Why can't I free your doubtful mind and melt your cold cold heart. ~ H. Williams

    by Andhakari on Tue May 05, 2009 at 07:24:42 AM PDT

    •  Over time, that's what will happen (0+ / 0-)

      Seriously, one reason why I support a "Medicare for all" option alongside rigorously regulated insurance companies is that it will allow people to achieve a consensus about what insurance really brings to the table.  Many people are more or less satisfied with insurance -- these people often don't have any significant health problems, but they are a kind of silent majority who can be easily scared into not supporting reform efforts.  

      Also, the form that insurance regulation should take would be to mimic Medigap -- where a number of options (fewer than 20) are standardized and the insurer is prohibited from deviating or underwriting upon initial enrollment (this would have to be tweaked a little bit, but I could write the legislation to do it effectively :))

      Balance billing by health care providers would also have to be limited to provide them with an incentive to participate.

    •  They should die, but we need to deal with .... (0+ / 0-)

      ... the consequences of another 800,000 people out of work.

      Many could be re-employed in the National Health Program, but we are trying to remove as much of the 30+% overhead of the private insurance industry as possible.

      Most is profit, but some is the labor expense of all those employee's.

      I think the economists can make the case for the improvements to the economy and business overall by surgically removing healthcare costs from business and employment will open up enough new business and free up enough capital that the rest of the economy will grow to hire all the displaced and more.

      That our increased competitiveness by taking the healthcare cost burden off of business will generate growth and jobs to more than offset the jobs lost by eliminating most of the private health insurance industry.

  •  Dr. Dean/Gov. Spitzer - We need PIs (1+ / 0-)
    Recommended by:
    luvmovies2000

    We need them funded and engaged in front of every mic and reelections visibly at stake.

    Obama campaigned on being above the perception of control of lobbyists.  If hc reform is to be his signature accomplishment then he needs to start getting involved in more than kick-off speeches. The fix is in. They already titled the blank page "HC Reform Act of 2009" and are about to stuff it into a box, wrap it up and hand it to him with a bow.

    What has he planned for his next move?

    HR 676 - Health care reform we can believe in - national single-payer NOW.

    by kck on Tue May 05, 2009 at 07:25:12 AM PDT

    •  Dean was on the Ed Show MSNBC last night (3+ / 0-)
      Recommended by:
      slinkerwink, Iberian, Ann T Bush

      and was perfect, pithy, strong, asked for everyone to go to MoveOn.org to sign the letter, make the phone call, he has a plan.

      Law is security; lawlessness invites terror. -Joe Margulies

      by mrobinson on Tue May 05, 2009 at 07:27:57 AM PDT

      [ Parent ]

      •  Yes, I saw him. (3+ / 0-)

        I sent him (DfA) $100 last month and have signed everything he's asked. I'll sign the MoveOn letter also. But we need much more.  

        He needs to get from the starting gate into the pack and we're not there yet.

        We can do this. The only way we can though is to make a presidential-election-sized effort and force the President, Congress, and the press to be confident as much is at stake.

        And while we're doing that, we need the courts engaged now with legal actions to strengthen our case or cripple theirs, whether it's personally based or otherwise. Anti-rust, monopolistic activities, fraud, investment irregularities, for God's sake, jay-walking. It's time for the kitchen sink.

        HR 676 - Health care reform we can believe in - national single-payer NOW.

        by kck on Tue May 05, 2009 at 07:47:14 AM PDT

        [ Parent ]

  •  Need to slow down the process (4+ / 0-)

    Need to slow down Baucus. We have allies in the House. Need to slow down the process because the people are on our side, single payer, not pay-go.

    Law is security; lawlessness invites terror. -Joe Margulies

    by mrobinson on Tue May 05, 2009 at 07:26:19 AM PDT

  •  The Public Option is a compromise. (1+ / 0-)
    Recommended by:
    k9disc

    We aren't getting Universal Health Care.  Remember?

    Compromising on the Public Option means putting the insurance companies first.

    Nothing new here.  Same as with the banks and the financial bail out.  The banks are winning hand over fist.  The insurance companies will, too.  The public loses.

    Cannot WAIT to hear Rahm Emanuel say we have to be politically pragmatic.  This is just another way of saying that the American people just aren't important.

    •  PO will be too expensive for those that need it (2+ / 0-)
      Recommended by:
      Brooke In Seattle, sweeper

      The Public Option will end up being a disaster for working people because it will be designed to fail. Literally designed to fail. The revenue neutral constraing DOOMS IT.

      They know this and anybody who doesn't admit this is lying.

      Nobody will buy it because it will be too expensive.

      This is all a play-act and thats why it stinks.

      They are betraying the people who voted for them.

      Look at the high risk pools in the states - they cost so much money that they are only for the desperate. When you only have catastrophic health care you avoid seeing doctors and for the chronically ill that literally kills people.

      Study after study has shown that this is the absolute worst approach.

      THATS WHY OTHER COUNTRIES HAVE UHC, NOT "PRIVATE OPTIONS".

  •  Dean said public option was Obama's plan (5+ / 0-)

    said is often. Ed Schultz is on our side - has been hammering single payer. They want to ruin our "public option" label? fine - we'll talk about Single Payer.

    Law is security; lawlessness invites terror. -Joe Margulies

    by mrobinson on Tue May 05, 2009 at 07:30:19 AM PDT

  •  If you want universal healthcare (5+ / 0-)

    make this a household name: William W. McGuire

    William W. McGuire M.D. was the CEO of UnitedHealth Group Inc. from 1992 until 2006.

    McGuire's exit compensation from UnitedHealth, was around $1.1 billion, the largest golden parachute in the history of corporate America. On 6 December 2007, the SEC announced a settlement under which McGuire will repay $468 million, as a partial settlement of the backdating prosecution.

    This was the first time in which the little-used "clawback" provision under the Sarbanes-Oxley Act was used against an individual by SEC. Wiki

    This man exemplifies THE REASON WE NEED PRIVATE FOR-PROFIT HEALTH INSURANCE COMPANIES OUT OF THE PICTURE. They are in business to make as much profit as possible. That means rejecting payment and treatment for their insured.

  •  No - that isn't what it means. (8+ / 0-)

    I don't think the public plan should be self-sustaining, because if it's wholly reliant on money raised from premiums and co-payments, that means that the premiums and co-payments will be higher than those of the premiums and co-payments offered by private health plans.

    It doesn't mean that AT ALL.

    Of course, if you knew anything at all about how insurance works, you'd know that isn't what it means.

    AND nothing that you quoted above at all indicates that private officials will be managing a public plan - which you state at the end of your diary.

    This is simply not true. What Schumer SAID was

    To prevent the government from serving as both "player and umpire," the officials who manage a public plan should be different from those who regulate the insurance market.

    Your interpretation of that is not correct. Schumer is simply saying that those who regulate the insurance market shouldn't be the same people who are managing the public plan.

    The Dept of Health and Human Services would undoubtedly "manage" any public plan. What Schumer is saying is that those who are regulating the insurance industry need to be seen as independent of HHS.

    This isn't a problem because at the moment individual states regulate the insurance industry in each state - that's why SOME states have better insurance options for their residents than others.

    •  I believe they're trying to seperate the PO & CMS (3+ / 0-)
      Recommended by:
      slinkerwink, luvmovies2000, Elise

      One of the key financial enablers of the public option is that existing infrastructure (e.g., people, IT, facilities) and processes can be reused from Medicare. All budget additions will be added to the liabilities and costs.

      HR 676 - Health care reform we can believe in - national single-payer NOW.

      by kck on Tue May 05, 2009 at 07:56:57 AM PDT

      [ Parent ]

      •  Exactly. (2+ / 0-)
        Recommended by:
        luvmovies2000, stella0710

        And honestly, they SHOULD be doing that. I can tell you right now all the people who claim they want a "Medicare for all" option have no idea what Medicare costs. The 47 million who are uninsured - half of them wouldn't be able to afford Medicare. I'd prefer to see a public option that's actually affordable.

        •  Ah, yes, you bring up affordabiity (1+ / 0-)
          Recommended by:
          slinkerwink

          In all of the CSPAN'd sessions I have seen none have addressed solutions for affordability for existing insureds. I hope to be corrected here...

          We need to get to the regulatory plans before the best PO design is revealed since the obvious options (e.g., part of Medicare, not part of Medicare) can all be gamed.

          Whatever we have in the end, no matter what it is called, will have to be something all of us prefer, including those over 65 - essentially a new and improved, expanded Medicare. Do we want to do all of this for a PO less attractive than Medicare? Of course not. So why won't the Medicare members join? Of course they will want to.

          I have never been a fan of the phrase "Medicare for All" because it comes with Medicare's bugs. But, it is the most popular way to look at a PO that is an expanded and improved form of Medicare.

          Beyond just syntax though, since the operational infrastructure is reusable, as well as changeable, and we know it's scalable, why not integrate the back-ends? I think the discussion around separation is premature so I think it's a an attempt to hamper the PO. For now, a more honest approach would be to establish the goals they want to achieve with separate support and settle on the "hows" later.

          HR 676 - Health care reform we can believe in - national single-payer NOW.

          by kck on Tue May 05, 2009 at 08:32:45 AM PDT

          [ Parent ]

          •  Medicare beneficiaries would likely not be (1+ / 0-)
            Recommended by:
            luvmovies2000

            allowed to join a public option. Typically, once a person turns 65, their private insurance company requires them to go on Medicare. If they're still working, some are still required and some are able to keep their private plan until retirement. It just depends on the job/insurer.

            Basically, as soon as someone is 65 or 2 years after they start getting disability, they are eligible for Medicare and I'm guessing any public option would also require those people who are eligible for Medicare to join it.

            And honestly, we wouldn't want those Medicare-aged folks to be part of the public plan because they would drive up the cost.

            The 2 groups that are most costly to insure are those over 65 & those who are disabled (those who are eligible for Medicare) AND women of childbearing age. The public option should be available as a individual or family option (Medicare is based on individual eligibility). If the 47 million currently uninsured and another 20 million underinsured (with junk plans at the moment) joined this public health insurance option, it could be financially independent and still be cost-effective for people because the only real "risky" people who would be covered by the plan are women of child-bearing age.

            •  But if everyone is in the same pool (1+ / 0-)
              Recommended by:
              CJnyc

              the costs are spread more evenly.

              What you described seems like it would be easy to game as well.  Private companies could encourage their women of childbearing age to join the public option so that the OB services were thrown onto the public plan.

              And what I don't get, is why people think that most of the 47 million uninsured (and that number is probably much higher if you add in all those who have lost their jobs and health care since that number was released) don't just go BUY insurance. If you have no money now, what makes anyone think that suddenly passing all these plans will give us money to buy into them?

              Even if the greatest health care plan in the world were unveiled tomorrow, if I have to pay into it, I'm still not going to get any care. I'm unemployed and have no savings -- and I know I'm not alone. We don't have insurance because we can't afford it at any price.

              And the idea that anyone, even if they DO have a job, would pay some of the ridiculous premiums that people have quoted here ($50K per year? How many people even have $50K per year salaries?), just makes my stomach hurt.

              Medicare for all. Call it something else if people can't handle the negative connotations of the Medicare name (maybe American Care), but geez, give us something that we can actually use, just because we deserve health care because we are human beings.

              "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

              by Brooke In Seattle on Tue May 05, 2009 at 10:00:41 AM PDT

              [ Parent ]

              •  The ridiculous premium costs (1+ / 0-)
                Recommended by:
                stella0710

                people have quoted here? The ones they pulled out of their asses and made up?

                That's why I hate diaries like this. They're full of misinformation and inaccuracies.

                Here's the thing - Medicare for all - Medicare isn't cheap. Part A (usually paid by tax $) costs roughly $450/month. Part B costs $96.40/month for most people - but it's income based so those making more pay more. That doesn't cover any of the prescription coverage - typically between $25-50/month for the premium. Then there's the copayments...and the deductibles - for each part of Medicare.

                When you add up all the costs, Medicare - for an individual - costs approximately several thousand dollars PER YEAR. Medicare isn't a family plan. If you want Medicare for all, fine, but most people who are currently uninsured couldn't afford Medicare.

                If we can get a public option that families can buy into - and if we can get a pool of tens of millions of people on that plan - we can keep the costs relatively low and we have Medicaid for those who who need extra help with the costs.

                What Schumer is suggesting would create a plan that is more affordable. The plan will be more affordable because of the sheer number of people involved and because those tens of millions of people buy negotiating power when it comes to costs.

                There isn't going to be a free option - free is for people who qualify for Medicaid. That's something else. And yes, there are problems with that system and we need to work to fix them, but that's a separate topic from the creation of a public option.

                •  Medicare covers the sickest people in the pool (0+ / 0-)

                  ESRD, Disabled and Elderly.  That's why it costs so much more.  It's also a mostly straight FFS payment outside of hospital and some other institutional services, which adds to costs through rewarding excessive services. But nothing you have said suggests a public option would be any different. You seem wedded to them being separate without explaining how there would be meaningful differences that would make the PO more affordable.

                  •  The public option Schumer (1+ / 0-)
                    Recommended by:
                    stella0710

                    is suggesting would be completely different from Medicare. It would operate like a hybrid public/private plan. It would negotiate its own prices and operate like a private plan, but it would be available to the public and it would be more affordable.

                    I have explained repeatedly how this is possible - it's not my problem if you cannot read.

                    The point is the numbers. If you have 60 million people insured on a public plan - most of the highest risk patients covered by Medicare, some covered by Medicaid because of cost, then you're left with a segment of the population that is relatively cheap to insure because they are relatively healthy. This makes it cheaper. The other thing that makes it cheaper is the fact that you can negotiate your prices for 60 million people - if the public plan negotiates one price and has one cost other insurance companies will either have to get on board to be competetive, or they will lose business to those who want to join the public plan - which again only increases that plan's power.

                    Eventually - that public plan is the most cost effective option for most Americans and everyone wants to join and you have a single payer health care system, the very thing people are demanding.

                    •  The point is . . . (0+ / 0-)

                      I can read just fine, but if you fold those same 60 million people into the Medicare plan it would have the same dilutive effect on Medicare costs because the new risks would be much lower.  It's  just robbing Peter to pay Paul, but with the significant difference being that the "new" public plan will not have the same bargaining power as the old Medicare plan.  

                      Medicare needs serious changing, there is no doubt, but there are a lot of unspoken assumptions in your post, along with some clear omissions.  If Medicare is expanded then it will be Medicare for life.  What's your plan? To replace Medicare with the private/public options so as to reduce government bargaining power altogether?  

                      Let me be clear: no one deserves the benefit of the doubt here.

                      •  Doctors and hospitals cover Medicare (0+ / 0-)

                        patients at the low costs they do now because they divert the costs onto everyone else. The fact is, they cannot function on so little in payments. So no, it isn't a good idea to add those people to Medicare. That's a BAD idea.

                        Medicare stays where it is...it clearly needs fixing, but it stays.

                        Medicaid stays

                        SCHIP stays.

                        All of these plans stay - they may need some changes along the way, but they're fixable.

                        In addition to what we already have - we have a public option available to all Americans under 65 and not disabled.

                •  I don't mean Medicare as it currently exists. (1+ / 0-)
                  Recommended by:
                  kck

                  It will have to be drastically upgraded, the reimbursements to doctors raised, and other administrative procedures changed too -- including a big PR push so people stop recoiling in horror when we talk about Medicare for All.

                  But why isn't there going to be a free option? And by free, I mean paid for with taxes, so that it is free at point of service, like other civilized countries have?

                  If the poor are going to be shunted off yet again to some sub-standard plan, then they need to redefine what is "poor" in this country. It's too hard to qualify for disability when you have to hire a lawyer and have your claim automatically denied the first time you apply. Which is bullshit as well, but that's another story. There are crazy arbitrary rules and unrealistic income and asset limits on those plans that the truly needy can't access because they make one dollar too much or some other bureaucratic nonsense. When my kids were small, ONE of them qualified for Medicaid, but not the other. They had the same parents, lived in the same house, attended schools in the same district, but my son qualified and not my daughter who was four years older. Why? They would never tell us. Arbitrary BULLSHIT rules.

                  I thought Medicare, as it currently exists, was free once you reach 65. And if it isn't, it should be. It shows me how much we actually value the elderly in this country.

                  And it lets me know how very screwed I'm going to be.

                  "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

                  by Brooke In Seattle on Tue May 05, 2009 at 12:46:41 PM PDT

                  [ Parent ]

                  •  What you're describing - (1+ / 0-)
                    Recommended by:
                    Brooke In Seattle

                    an updated Medicare - is what Schumer is putting forward.

                    Medicare is so far from free it isn't even funny. Everyone pays Medicare taxes and that money goes into two pots - Part A and Part B. I wrote a diary about how much Medicare costs because people kept saying they wanted Medicare for all - Medicare is expensive...so I wanted people to know exactly what they were advocating.

                    Here's a link.

                    Here's the rundown of the costs that you can find in the diary in a blockquote:

                    Here's a rundown:

                    Part A premiums - over $400/month unless you qualify to get it for free because you've worked over 40 quarters in your lifetime (equivalent of 10 years).

                    Part B premiums - $96.40/month (unless you qualify for the highest level of Medicaid and then Medicaid pays for you - although California no longer pays this for people because they're broke).

                    Part D premiums and copays - average premium is $28/month. Copays vary, but the donut hole is HUGE and most don't qualify for extra help. You have to make less than $16,000/yr individually or $22,000/yr if married to qualify for extra help.

                    Yearly deductible for Part B - $135.00
                    Yearly deductible for Part D - varies, but the standard is $295.00
                    Deductible for Part A - $1069 per benefit period. Benefit period is defined as starting the day you enter the hospital and ending 60 days after you have been discharged from the hospital. So, you could technically have up to 5 benefit periods each year.

                    Copayments -

                    Part B is 80%-20% of the Medicare approved amount. Every visit to the doctor costs SOME money. It may not be a ton of money, but it adds up.

                    Durable Medical Equipment is 80%-20% - anyone need a motorized wheelchair? Have a few hundred bucks to pay for it? And there's a lot of equipment that isn't covered by Medicare at all, or has limits on it (diabetic testing strips, for instance) - those are out of pocket costs you have to add in.

                    Most beneficiaries buy Medigap policies which pick up these extra costs, but then they are paying 3 premiums per month -
                    Part B - $96.40
                    Part D - avg. $28
                    Medigap - can vary in cost from $80-$500 per month - depending on when you sign up for the policy and how much extra coverage you are buying.

                    •  Heh. Thanks. I guess. (1+ / 0-)
                      Recommended by:
                      churchylafemme

                      Like I said, it lets me know how very screwed I'm going to be.

                      I can qualify for part A no problem. I've been working full time since 1979, so that's not an issue.

                      It's all those deductibles and co-pays and out-of-pocket costs.

                      I just don't see how anyone thinks that we as individuals can afford all this better than the country as a whole can. Discussions like this bring out the worst in people it seems.

                      How is some widowed grandma who doesn't qualify for any program but is still bravely getting by on $1 more than the limits for a program any less deserving of care than one whose husband had a golden parachute and a big inheritance to leave her to pay for her care for the rest of her life?

                      I feel like I'm just shouting into a hurricane-force wind, and no one hears me. There are too many people in need that are being ignored in this whole equation. And all the people who keep saying the economy is going to recover by the end of the year are going to be unpleasantly surprised. The Dow may go up and corporate profits may rise, but there are still homeless unemployed people by the thousands out there, and we haven't even reached critical mass yet.

                      I despair for our future as humans. There are far too many homo sapiens out there who have absolutely no capacity for humanity. Witness all the uproar about Obama's call for someone on the Supreme Court who has "empathy," as if that equates to communism or something. Sad.

                      "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

                      by Brooke In Seattle on Tue May 05, 2009 at 01:15:26 PM PDT

                      [ Parent ]

                    •  These are GOOD prices! (1+ / 0-)
                      Recommended by:
                      churchylafemme

                      I am very familiar with Medicare, HMOs, and private insurance. Medicare has problems but also has very high satisfaction as do not for profit HMOs.

                      As Brooke says, none of the pricing scenarios is fashioned after Medicare as it is. Reform means reform universally - universal affordability.

                       

                      HR 676 - Health care reform we can believe in - national single-payer NOW.

                      by kck on Tue May 05, 2009 at 05:58:27 PM PDT

                      [ Parent ]

                      •  These are affordable prices for an individual. (1+ / 0-)
                        Recommended by:
                        kck

                        They aren't for a family of four - multiply everything times four. Medicare is an individual benefit - that's the key here.

                        I think we can actually do better if we have a larger bargaining pool.

                    •  BTW, Schumer has been dragged into hc... (0+ / 0-)

                      ...with his heels dug in the sand. He tried to quash it for 2009 before the election and we have Obama to thank for over-riding the reluctant Senate.

                      HR 676 - Health care reform we can believe in - national single-payer NOW.

                      by kck on Tue May 05, 2009 at 05:59:52 PM PDT

                      [ Parent ]

        •  And yet, remarkably, (1+ / 0-)
          Recommended by:
          slinkerwink

          the new public plan should be forced to cost more than Medicare.  How would that be more affordable?

          Through the magic of financial alchemy?

          I've read most of your posts and you seem to be in the realm of wishful thinking.

          •  I've read yours and you seem to be (0+ / 0-)

            in the realm of stamp your feet and clap and you'll magically get everyone free health care!

            That's not reality.

          •  Once again - (1+ / 0-)
            Recommended by:
            Brooke In Seattle

            the more people you're covering that are healthy - the cheaper the plan can be.

            The plan could very well cost less than Medicare - the pool of beneficiaries would be healthier than those of Medicare age and would therefore cost less.

            See, if I pay $100/month in premiums and a $15 copay every time I go to the doctor and I only go to the doctor 2 times a year, I'm not costing the plan more than I'm paying in...my money goes to cover someone who is costing more than they're paying in.

            We don't know what the cost will be to individuals or families, but the more people who join, the cheaper it will be. And if we can get small businesses to help contribute to the public health plan and help provide insurance to their employees at a lower cost than a private plan would cost them, then we're in an even better position as far as cost goes. And if we can get big businesses to join in and help pay for the costs for people, we're in an even better position as far as cost goes...

            Perhaps now you understand?

            I'm guessing no.

            •  Show me once where I used the word free (1+ / 0-)
              Recommended by:
              churchylafemme

              That's right: not once.  

              Those 60 million new people will not vaporize the pool of Medicare people, who will still be drawing from the treasury.  I mean, those people who are paying for the new public option will still be paying Medicare SS tax -- so their so-called premium will still incorporate paying for Medicare.  Medicare ISN'T free -- someone (taxpayers) will still be paying for it.  But under your scenario there will be two separate federal bureaucracies, two separate sets of rules and a lot less chance to rationalize the existing fragmentation.

              •  Yes, I'm talking about two different plans. (0+ / 0-)

                Actually, I'm talking about SEVERAL different plans. We have Medicare and Medicaid. We're not getting rid of those. We can modify them and correct the problems. That's not hard.

                A public plan has to be different. It can't include Medicare beneficiaries because the cost will be too high because of the risk pool. If the public plan we create doesn't include Medicare beneficiaries or Medicaid recipients, then we have a relatively low risk and VERY large pool. We negotiate prices for services and set up the cost structure.

                It really isn't difficult. The lower the risk and the larger the pool, the lower the costs.

                And by the way - we WANT this plan to be self-sufficient precisely so that the coverage can be the best. If the plan is subject to tax dollars, we'll spend the next 100 years flip flopping between cuts in coverage and increases in coverage depending on who wins majorities in the Congress and White House. If the plan is self sufficient, Republicans can NEVER destroy it.

                •  Sorry, I disagree with you (2+ / 0-)
                  Recommended by:
                  slinkerwink, churchylafemme

                  There is no reason to keep Medicaid: Not a single reason.  Medicaid people are often working, they are usually young and healthy (save for nursing homes, which is indeed a serious issue, but that's not a reason to keep children and poor people out of a public option plan that is more generally available).  What you are talking about would be continuing ghettoization of care for the poor, and that is unacceptable. "Fixing" Medicaid would be impossible.  It's 50 separate usually dysfunctional bureaucracies.

                  You still didn't answer my questions.  It's clear that you are trying to keep atomization and fragmentation within the system, and wherever you work within health care, obviously that must be an advantage, but I can't think of a single way in which it is an advantage to the common good.

    •  What about the rest (0+ / 0-)

      That's the least contentious of all his proposals:

      "The public plan," Mr. Schumer said Monday, "must be subject to the same regulations and requirements as all other plans" in the insurance market.

      The chairman of the Senate Finance Committee, Max Baucus, Democrat of Montana, asked Mr. Schumer to seek a solution. In his response, Mr. Schumer set forth these principles:

      ¶The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

      ¶The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

      ¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

      ¶To prevent the government from serving as both "player and umpire," the officials who manage a public plan should be different from those who regulate the insurance market.

      In addition, Mr. Schumer said, the public plan should be required to establish a reserve fund, just as private insurers must maintain reserves for the payment of anticipated claims. And he said the public plan should be required to provide the same minimum benefits as private insurers.

      •  Why not make it subject to the same rules (3+ / 0-)
        Recommended by:
        Chi, drache, stella0710

        and regulations. It's insurance. Every state has laws regulating the insurance industry and they should be able to have any plan comply with those rules. Medicare complies with them.

        And sure, doctors and hospitals should have the "option" to participate in a public plan. There's nothing wrong with providing them that option.

        Honestly - they'd be utterly stupid to not participate. Part of the reason some doctors don't want to participate in Medicare is because Medicare doesn't pay as much as Medicare Advantage plans. They can accept the private MA plans and still help Medicare patients and make more money. If the public health insurance option pays more than Medicare does then doctors and hospitals will be glad to join - not only that, but can you imagine? You're talking about a public health insurance plan that will insure tens of millions of Americans. They will benefit from participating in that. AND private insurance companies will be forced to compete with that or lose customers.

        This is the only thing I disagree with - and the disagreement is partial:

        The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

        I think the public plan should be self-sustaining. I do think that initially it needs to receive appropriations from the government. I also think it needs to be run by HHS. The overhead will be much lower if it's run by a Federal office. It can even be contracted out, or parts of it can - just like parts of Medicare and Medicaid are contracted out, but it needs to be managed by HHS.

        •  Naive (3+ / 0-)

          That is basically proposing a Medical Apartheid were Hospitals and Doctors deny access to those from a government run program because if not Insurances will cut them or rise their bills.

          The public plan will never be able to be 100% self sustaining: Were do you put all the people that can't afford Health Insurance? Are Medicare and Medicaid self sustained?

          And it needs to be mostly federally regulated or people living in red states will never have the chance to get it.

          •  shimata (0+ / 0-)

            I really and truly am fucking sick of the melodrama and hyperbole from you and those that agree with you.

            Medical Apartheid?!?!?!?!

            Give me a fucking broke, not only does that really not make sense but you have no clue what you are talking about.

            Stop overreacting.

            A song about life
            Why aren't you more like Gandhi? Why aren't I?

            by drache on Tue May 05, 2009 at 08:21:42 AM PDT

            [ Parent ]

            •  No clue? (5+ / 0-)

              I work in health care I see the fucking Medical Apartheid every fucking single day you condescending shimata my ass.

              You probably are privilege enough to have never suffered from the awful third worthless Medical System many Americans have to go through.

              If we let the Hospitals and clinics say no to those with public heath insurance we will have solidified a caste Medical Health system a God damn Medical Apartheid!!

              Stop telling me to not overreact about my family and friends Health. You work for Bluecross and Blue shield or something?

              •  lol (0+ / 0-)

                now now, shimata my ass is bad for you and you should not mix lanuages.

                It's still hyperbole and I really do not care where you work.

                Besides who said anything about letting hospitals and clinics do anything of the sort?

                If you can actually back that claim up I will at least start to take you more seriously.

                A song about life
                Why aren't you more like Gandhi? Why aren't I?

                by drache on Tue May 05, 2009 at 08:55:53 AM PDT

                [ Parent ]

                •  Ookiosewada (0+ / 0-)

                  ¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

                  Urusai!!

                  •  Sie sind ein verdammt idiot (0+ / 0-)

                    That in no way shape or form means what you are saying it does.

                    Note the words just because? The argument being made is that they shouldn't be forced to participate just because the participate in Medicare. That is not the same as what you are claiming.

                    aho!

                    A song about life
                    Why aren't you more like Gandhi? Why aren't I?

                    by drache on Tue May 05, 2009 at 09:13:05 AM PDT

                    [ Parent ]

          •  You have no fucking clue how insurance works. (0+ / 0-)

            None.

            Medicare and Medicaid are for the most part self-sustaining plans. Parts of them are federally funded, but the claims are paid from the payments people make to whichever part of Medicare they are using - Part A or Part B. There are two money pots there. Hospital claims come out of Part A. Medical claims come out of Part B.

            Every beneficiary pays at least $96.40 per month for Part B. Part A is paid for out of taxes for most people - IF you worked 10 years of your life. IF you didn't work 10 years of your life in the US, you pay monthly for Part A - based on how many years you're either paying $250 or $450 per month for Part A.

            That money pays claims. Part A money comes from taxes, so that is basically not entirely self-sustaining. That's coming from the Govt. What Schumer is saying is that he does not want a plan that works like this. That makes a lot of sense.

            •  Sure (0+ / 0-)

              I just work in the Health system.

              Medicare and Medicaid are for the most part self-sustaining plans.

               are you sure about that?

              •  I work in the health care system (0+ / 0-)

                and yeah, I'm sure about that. The beneficiaries pay into one pot, the tax money goes into the other. The interest builds. The claims get paid.

                What Schumer is suggesting is that we use the Medicare Part B funding model, but for the entire public option. That's not a bad idea - and since the people ON the plan will have less risk and lower costs than Medicare beneficiaries, the cost won't even be that much different.

                •  Right (1+ / 0-)
                  Recommended by:
                  slinkerwink

                  That's why there is no deficit in either program, because they are self sufficient.

                  •  The funds for Part A are running a deficit (0+ / 0-)

                    that's because there are more people using Part A (boomers) than the tax can cover costs for. This can be corrected.

                    The funds for Part B - some are federal and some are based on the money collected from beneficiaries. Part B is mostly not in trouble, but some hospital claims are paid out of the Part B pot and as a result, there could be an increasing deficit - AGAIN, due to the fact that there are more people using the funds and that the taxes were not enough to cover the increase. A big part of this problem will start to go away when Medicare stops paying for Medicare Advantage plans to cover beneficiaries - something Obama already has in the works.

                    The increase isn't just in people though, it's also in cost of services. Some of the money is also gone due to fraud. Durable Medical Equipment companies have been defrauding Medicare of millions per year. I expect Obama will put new regulations in place that will curb some of this - and in some states those regulations are already starting to work.

                    •  Eventually (2+ / 0-)
                      Recommended by:
                      slinkerwink, churchylafemme

                      Medicaid is even in worse position and as you as explain Medicare is clearly not self sufficient. Now imaging adding all the uninsured, many of them unable to pay the cost of Medicare.

                      It is just a fallacy to say that we can enact a Public option that will be self sustained, without costing a fortune to join in. There is a need for public funding.

                      •  No one is adding them. (0+ / 0-)

                        That's precisely the goddamned point! We do not want to add the people who can't pay to Medicare.

                        It's a numbers game - the more people join your public option, the more negotiating power that plan has, the cheaper it is.

                        We can fix Medicare and Medicaid, but those are two entirely different systems.

                        We may be able to create an extra help program FOR this public option, but I would guess those who need that help would already qualify for Medicaid.

                        You can't just put every person on Medicaid. There has to be a cost associated with the coverage.

            •  Insurance for the wealthy (2+ / 0-)
              Recommended by:
              slinkerwink, churchylafemme

              Without government subsidies how will poor people manage to get coverage?  

              Medicare Part A is totally and definitely not "self-sustaining" and neither is Part B or Part D or Part C, for that matter, which is grossly over subsidized.

              Your understanding is incredibly superficial.  If they were self-sustaining Peter Orszag and every other health care economist wouldn't be wringing their hands about health care costs.

              Do you have any idea what you are talking about?  

        •  You need to deal with the poor (1+ / 0-)
          Recommended by:
          churchylafemme

          Your use of the word self-sustaining is misleading and non-descriptive otherwise.  You aren't dealing with the real issue.

    •  So what does "self-sustaining" mean? (3+ / 0-)
      Recommended by:
      Chi, Iberian, luvmovies2000

      Could you explain it to those of us who are not in the parasite insurance industry?

      "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

      by Subterranean on Tue May 05, 2009 at 08:44:35 AM PDT

      [ Parent ]

      •  Basically, the plan would have costs (3+ / 0-)
        Recommended by:
        barath, luvmovies2000, stella0710

        and those costs would cover all the claims made each year.

        The plan would likely have a premium cost each month. The plan would also likely have a deductible for certain services. There might be co-payments required for some services.

        All of the money collected will cover the claims submitted - It wouldn't be a for-profit plan, but the plan would have costs and those costs would cover what the plan has to pay out each year to doctors and hospitals, etc.

        My health plan at work - for instance - costs $109/mo for myself and my husband. Our yearly deductible is $200. I have a $15 copay for a primary doctor and a $35 copay for specialists. My plan is with Aetna, so clearly they're making a profit each year off the amount people are paying in vs what they're paying out. Some people will cost more than others. Some years the costs will vary.

        Schumer is suggesting that the plan be self-sustaining - in the sense that unlike Medicare, we won't have a tax deduction for the plan and federal tax dollars being directed towards the public plan. In his vision, the plan will be able to pay out the claims on the money it's bringing in. This is where the risk pool comes in. Most people will end up paying in more than they use each year. Some people will end up costing more than they pay in each year. Those people balance one another out in cost.

        I do disagree with Schumer on some of this - I think it would be necessary to have some federal funds to start off this program. I also think it should be managed by HHS - similar to how Medicare is.

        •  So who pays for the poor? (2+ / 0-)

          Or are they shut out from insurance just like they are now?

          I  mean, your explanation doesn't even pass the first threshold of common sense.  

          •  As I stated before (1+ / 0-)
            Recommended by:
            stella0710

            we can create a program that helps cover their costs. There are a variety of ways we can handle these costs. First of all, Medicaid is there for the poor. We can reform Medicaid to help those who currently do not qualify.

            The 47 million without current insurance aren't all poor...some of them make enough to pay for some insurance, they just don't make enough to pay for the private insurance plans that are junk. This public option will help cover a large part of our currently uninsured population and then we move from there to help those who still can't afford insurance.

            Are you demanding a free plan for all? That would be what lacks common sense.

            •  You keep saying Medicaid is there for the poor. (1+ / 0-)
              Recommended by:
              churchylafemme

              No, it's not.

              It may be there for SOME of the poor, but when we were so poor we qualified for foodstamps in a family of four, only ONE person in the house was accepted into the Medicaid program, my son.

              The rest of us were just screwed. They wouldn't cover us at all. And we were the much-vaunted "family." What are single people with no kids supposed to do?

              And that 47 million number is much larger now, but no one seems to be admitting that. When that data point was first given, we hadn't hit the huge numbers of layoffs we have now. The number of uninsured is more likely closer to 100 million now.

              "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

              by Brooke In Seattle on Tue May 05, 2009 at 02:39:22 PM PDT

              [ Parent ]

              •  Medicaid is there for the poor. (0+ / 0-)

                And yeah, you're right - it's failing for many. Some of the reason for that is that it needs fixing and their funding is fucked. That's all fixable.

                I'm sure there will be people who don't qualify for Medicaid and who still can't quite afford the public option - those people can get subsidies which will help them join the public option. Corporations can help us subsidize those costs and in return, the public option provides cheaper insurance coverage for their employees. Problem solved.

                Massachusetts has a public plan - they subsidize cost for those who fall between the cracks in funding.

            •  Medicaid!!!!!! Oh, please. (1+ / 0-)
              Recommended by:
              churchylafemme

              Medicaid should be the first program to go.  What you are suggesting is simply a continuation of the massively inefficient and fragmented system we still have.  Medicaid is 50 separate crazy bureaucracies that barely serves the Medicaid population.

            •  You sure are obssessed with the idea of free care (0+ / 0-)

              Oh no! No one here is suggesting that and it is the silliest of strawmen to suggest otherwise.  

  •  I'm not sure this is true (4+ / 0-)
    Recommended by:
    Cedwyn, Elise, Brooke In Seattle, drache

    because if it's wholly reliant on money raised from premiums and co-payments, that means that the premiums and co-payments will be higher than those of the premiums and co-payments offered by private health plans.

    Private plans have something like 30% overhead; that's advertising, the whole apparatus of claim denial and litigation, executive pay, and shareholder profit.

    A public option would lack all of these. One can be reasonably certain that public option that offered the same benefits as private option could be at least 25% cheaper.

  •  I called his NYC (6+ / 0-)

    office. The woman I talked too was very polite and when she asked what county I lived in she was surprised. Said 'I've had a lot of calls today but this is the first from Oregon. Hope it's not the last.' She said she'd write my opinion down. I said that it is a national concern and I want public affordable healthcare no more private insurance control of our system. It's a disgrace that we are held hostage to a for profit system, that cares nothing about heath for people. I also pointed out that if they can bail out the too big banks because they are essential tp the economy , why can't they provide a public plan for the crisis that insurance company's are causing for millions of people.  

    "And if my thought-dreams could be seen They'd probably put my head in a guillotine" Bob Dylan

    by shaharazade on Tue May 05, 2009 at 07:37:29 AM PDT

  •  We've got to get to the language, labels first (2+ / 0-)
    Recommended by:
    slinkerwink, luvmovies2000

    knife>gun [They come with a knife...]
    public option>single payer
    compromise talk>patriotism talk [single payer is what the people want]

    When our opponents offer this stupid compromise, call it bad names like the Republicans used to. Call what the people want Medicare for all, Healthcare for all, Equality Helathcare. Single Payer.

    Talking points.

    Why can't the people have what the people want? Haven't they suffered enough? The people want single payer. The insurance company executives can retire on the billions they sucked out of the system. The people need change now. Obama wants the public option as a choice available to the people - he is on the side of the people who need care.

    Law is security; lawlessness invites terror. -Joe Margulies

    by mrobinson on Tue May 05, 2009 at 07:39:15 AM PDT

  •  HOW MANY OF YOU ARE PHHYSICALLY IN NYC??? (9+ / 0-)

    my sister is..

    EVE???

    enough with this bullshit..we need to start occupying
    their offices and shaming them...I will be in NYC
    Thurs and would be willing to show up with a camera at Schumers office

  •  You have to make it simple for people. (3+ / 0-)
    Recommended by:
    slinkerwink, luvmovies2000, LaFajita

    That is why using William McGuire to illustrate where people's insurance money goes will work.

    Plus, it outrages people when they know that is how much these CEOs of insurance companies are making.

    Please believe me, this is the kind of example that anyone can grasp for why the insurance companies need to be killed off.

  •  Phone line (3+ / 0-)
    Recommended by:
    Ann T Bush, polar bear, Loose Fur

    Schumer's office phone number: (202) 224-6542
    Is permanently busy call his offices and the
    House Committee on Energy and Commerce
    (202) 225-2927

    District Offices:
        15 Henry Street, Room M103
    Binghamton, NY 13901 Voice: 607-772-6792
    FAX: 607-772-8124

        Leo W. O'Brien Federal Office Building, Room 420
    1 Clinton Square
    Albany, NY 12207 Voice: 518-431-4070
    FAX: 518-431-4076

        100 State Street, Room 3040
    Rochester, NY 14614 Voice: 585-263-5866
    FAX: 585-263-3173

        145 Pine Lawn Road, # 300
    Melville, NY 11747 Voice: 631-753-0978
    FAX: 631-753-0997

        100 South Clinton Street, Room 841
    Syracuse, NY 13261-7318 Voice: 315-423-5471
    FAX: 315-423-5185

        757 Third Avenue, Suite 17-02
    New York, NY 10017 Voice: 212-486-4430
    FAX: 212-486-7693

        1 Park Place, Suite 100
    Peekskill, NY 10566 Voice: 914-734-1532
    FAX: 914-734-1673
    s
        130 South Elmwood Avenue, #660
    Buffalo, NY 14202 Voice: 716-846-4111
    FAX: 716-846-4113

  •  A means test will make this unworkable. (15+ / 0-)
    1. The public option is only an "option" if it is available to everyone, regardless of income (or provable lack of income.)
    1. Without a real public option, available to all,  cherry-picking by for-profit insurance companies must be totally prohibited. "Pre-existing condition" should disappear from the insurance vocabulary and setting rates by age should be prohibited.
    1. Another major reason we need a real public option, is that insurance companies cheat by denying coverage. People like those brought to our attention by nyceve, as well as other people like me and you and my children and your children and many of our friends and neighbors (who are, with good reason, afraid that something similar will happen to them) cannot afford the risk that comes with being insured by a for-profit company.
  •  i just called (4+ / 0-)

    as was surprised to actually get to talk to a person. I said that I really wanted him to support the public option.

  •  Ed Schultz hammers single payer on radio &TV (6+ / 0-)

    He asks, why can't we talk about single payer? It's what the majority of Americans want. Why no one from single payer at the table?

    He would love to hear from us about the "Schumer Compromise."

    Law is security; lawlessness invites terror. -Joe Margulies

    by mrobinson on Tue May 05, 2009 at 08:01:35 AM PDT

  •  For those making calls: (6+ / 0-)

    Toll free number to capital switchboard: 1-800-826-3688. You can make alot more calls when they're free!

    Abolish the Homeland Scrutiny Department.

    by hoplite9 on Tue May 05, 2009 at 08:02:42 AM PDT

  •  When we stop talking (8+ / 0-)

    about universal health care and start talking about universal health insurance, we lose. Universal health INSURANCE is a scam and a con, and keeps the insurance companies in business. We need universal health CARE. PERIOD. Bottom line. End of story.

    Every time the debate has come up in the past, the conversation has always switched from health care to health insurance, like there's no difference. And we've got what we've got: Crap. We need to force the conversation back to universal health care. If the for-profit insurance industry can find a niche in that conversation, fine.

    "You can't get something for nothing...It's time to stop being stupid." Bob Herbert

    by Orinoco on Tue May 05, 2009 at 08:04:31 AM PDT

  •  Me smash. (2+ / 0-)
    Recommended by:
    churchylafemme, polar bear

    If this is coffee, please bring me some tea. But if this is tea, please bring me some coffee.

    by Muskegon Critic on Tue May 05, 2009 at 08:04:48 AM PDT

  •  Here's mine, to Bart Gordon (7+ / 0-)

    Who is, apparently, the the fastest member of Congress! (Check the end of the Bio section...)

    I realize that I'm not a constituent, but as a fellow Tennessean, I'm concerned about the direction that the public option for health care reform is taking.  I fear that a watered-down version of the public option, as outlined by Sen. Schumer, will squander a rare opportunity for health care reform.  

    I have no problem with Schumer's call for separate management and oversight, so long as neither come from people beholden to private insurers.  But I am concerned that without some sort of compulsion (or perhaps incentive--a tax break perhaps?  Those seem popular these days.), doctors will refuse people on the public plan just as they refuse Medicare or Tenncare patients.  I also worry that without some assistance from the government, particularly in the early years of the plan, it will not be able to provide a low-cost alternative to private insurance.  Many uninsured people are in that state because they can't afford coverage: if the cost is exactly the same as a private plan, how can the public option solve the problem it's supposed to address?  

    I'm from Blount County--my exchanges with Rep. Duncan have indicated to me that there's no hope my views will have any sort of representation on that front--you and Rep. Davis are the closest Democrats I've got.  I ask  you to consider these factors as you attend the meetings and upcoming votes on health care reform that's so crucial to our country's continued physical, emotional, and economic health.  Thank you for your time.

    Because for Zen surrealism, you can't beat living in the Bible Belt...

    by salvador dalai llama on Tue May 05, 2009 at 08:06:56 AM PDT

  •  Listen to these people testifying on CSPAN (4+ / 0-)

    They know how to talk the talk this time around.

    They are not going to inflame the public.

    They will be writing the bill behind the scenes to get what they want.

  •  Done. (6+ / 0-)

    I write a letter, CCed to Roland Burris, Dick Durbin, Charles Schumer and Jan Schakowsky.

    -7.75 -4.67

    "Freedom's just another word for nothing left to lose."

    There are no Christians in foxholes.

    by Odysseus on Tue May 05, 2009 at 08:12:45 AM PDT

  •  Howard Dean MSNBC (5+ / 0-)

    Dean: a public health insurance plan that is essentially single payer.

    Law is security; lawlessness invites terror. -Joe Margulies

    by mrobinson on Tue May 05, 2009 at 08:18:03 AM PDT

  •  Called Schumer, busy. Slin, please explain: (2+ / 0-)
    Recommended by:
    polar bear, Loose Fur

    "because if it's wholly reliant on money raised from premiums and co-payments, that means that the premiums and co-payments will be higher than those of the premiums and co-payments offered by private health plans."

    Give me a "why" because I want to use it when I call Schumer again.

    Do you have a child? Will you send her to the war?... anon

    by andreww on Tue May 05, 2009 at 08:35:25 AM PDT

  •  Obama has to pull out the big guns (5+ / 0-)

    on this one, and completely annihilate whoever doesn't fall in line.

    Look at these people! They suck each other! They eat each other's saliva and dirt! -- Tsonga people of southern Africa on Europeans kissing.

    by upstate NY on Tue May 05, 2009 at 08:39:09 AM PDT

  •  Call in Ed Schultz - program from NYC today (3+ / 0-)
    Recommended by:
    slinkerwink, polar bear, princesspat

    Radio call in: 1-877-934-6833 Monday - Friday 12:00 to 3:00 PM Eastern No calls are screened - this is real talk radio.

    email screen
    http://www.bigeddieradio.com/...

    This is the quickest way to contact Ed outside of calling his show. We do our best to answer all questions submitted through e-mail.

    I suggest the title: The Schumer Compromise
    Tell him what it is, what you think. Keep it pithy!

    Law is security; lawlessness invites terror. -Joe Margulies

    by mrobinson on Tue May 05, 2009 at 08:39:36 AM PDT

  •  Breaking this down piece by piece (7+ / 0-)
    ¶The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

    I have no issue with a self-sustaining program. That is, I do not wish to see a solution that is unsustainable. I don't beleive anyone else does either (except, perhaps the propenent's of an unsustainable compromise like that Shumer has framed here).

    How it is funded is a different matter entirely.

    Calling the funding premiums, a health insurance tax or whatever you like it makes no difference to me as a name. But, why assume it must be done per the current private insurers? Why assume similar (level) cost transfers through co-payments? These arose because of the inefficiencies of private health care plans - not because of any real need.

    ¶The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

    This presumes that Medicare reimbursements are inadequate - which they may be in the context of for-profit hospitals. Think outside the box Charlie!
    Yes Medicare may pay less than rates commonly "enjoyed" by privately insured patients and doctors. That isn't bad - it may mean, in fact, that a not-for-profit model yields greater efficiency. Private insurers can compete or get out of the way. Your job Mr. Shumer is to protect the interests of your consttituents, not those of the health insurance companies.


    ¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

    Head scratcher, illogical.
    If the doctor or facility already participates in Medicare then
    A -- The rates issue goes away, and;
    B -- They would leap at the chance to see those patients who presently have no insurance at all arrive on their doorstep with coverage.


    ¶To prevent the government from serving as both "player and umpire," the officials who manage a public plan should be different from those who regulate the insurance market.

    On the one hand, this could be played to the advantage of the Federal Government - make the DHS the agency responsible. On the other hand it is clear what the insurers have in mind - another opportunity to influence and lobby for the benefit of private insurers.

    Don't let the private insurers have any part of this other than the first phrase in the first broad principle - that the plan be one which is sustainable.

    The private insurers all have told us for many years that their market based efficiency made them a better modle for health care, less costly to the economy. Now, when it is clear that their claim will actually be put firmly to the test, they wail about unfair competition from a public option.

    Let them wail. Be do not give in to them just because they cry like babies.

    •  Schumer not Shumer (1+ / 0-)
      Recommended by:
      polar bear
    •  Medicare reimbursements ARE inadequate... (1+ / 0-)
      Recommended by:
      luvmovies2000

      And not just private hospitals... community hosptials are the ones who bear the burden the most, and they will come right out and tell you that if they didn't have private pay patients, they would be sunk.

      Do you know what medicare paid for my mom's b-12 shot?  $0.32  That's right, thirty two cents.  That's not a typo.  They had to add extra columns to her bill to show the hundredths of dollars that the doctor and nurse and pharmacy got paid.

      $0.32

      One of the reasons why private health care costs so much, is that hospitals have to make up for the shortfalls of Medicare, Medicaid, and the uninsured...

      DARTH SPECTER: I am altering the deal! Pray I don't alter it any further!
      LANDO REID: This deal keeps getting worse all the time!

      by LordMike on Tue May 05, 2009 at 10:33:03 AM PDT

      [ Parent ]

      •  And if they were all in the same pool (0+ / 0-)

        It would be a lot easier to see this, as well as to suggest an alternative to deal with it.  Right now, the system is so fragmented that it is often impossible even to know what a provider's costs are -- for one thing, they include all kinds of bad debt and cost shifting among programs, not to mention providing health insurance to their own employees.  Medicare got "serious" about holding the line with hospitals when it becamse clear that hospitals were essentially charging the Medicare program for all uncompensated care.  Now, Medicare does not carry its load -- but for the first 20  years of the program, Medicare was picked clean.  

  •  I called both! (6+ / 0-)

    I got through to Nelson.  Yaaah!  This makes me crazy with rage!  I pay about $6K a year for my litttle family of four, and we each have a $5K deductible!!!

    I feel so BETRAYED by these Dems who are watering this down or trying to put the kibosh on it out and out.

    I couldn't get through to Schumer's office, though I hit redial 20 times in five minutes.

    KEEP THE CALLS COMING KOSSACKS!!

  •  I've been thinking a lot about (4+ / 0-)
    Recommended by:
    slinkerwink, annrose, ShadowSD, sethtriggs

    how Obama undoes decades of entrenchment by insurance and health care corporations who not only came into existence because of for-profit interests but now also can pressure many elected officials with contributions.

    The entire industry depends on the status quo. If Obama were to suddenly do a rip up and re-layout what will that do to our economy? It would seem to me that literally millions of people will lose their jobs as their companies who depend on the current condition suddenly go out of business.

    I haven't come up with much that provides for a smoother transition.

    Obama seems to be trying to turn a mighty big ship but this middle-ground approach seems a much smaller  turn of the wheel than is needed.

    As always I'm a bit impatient. I want the change now. People I know and know of are suffering because of our totally inadequate health care system. Some of them will die unnecessarily soon because this is so messed up.

    I'm Ron Shepston and I'm not done yet. There's much left to accomplish.

    by CanYouBeAngryAndStillDream on Tue May 05, 2009 at 08:47:41 AM PDT

    •  the problem with "turning a big ship" metaphor (0+ / 0-)

      As I always understood it, the issue in turning a big ship is slow response time, so you have to turn the wheel hard and far but EARLY.

      People in govt try to use the slow moving ship metaphor as an excuse for doing less and more slowly or over time. That may be valid in some way but it's not actually what's needed in turning (literally) a big ship. And I'd wager not what's needed in turning a big mess like this one.

      Nautical types--feel free to correct me.

      •  Agreed. (0+ / 0-)

        That's why I said

        this middle-ground approach seems a much smaller  turn of the wheel than is needed.

        However, I think the big-ship metaphor falls apart because in the health care industry there are consequences to killing an industry dependent on the status quo.

        There are no consequences that I know of to turning the rudder of a big ship full-turn immediately.

        I'm Ron Shepston and I'm not done yet. There's much left to accomplish.

        by CanYouBeAngryAndStillDream on Tue May 05, 2009 at 10:01:51 AM PDT

        [ Parent ]

    •  Unlikely that they will go out of business (0+ / 0-)

      Yes, there will be a retraction, but the companies will still be selling insurance for anything not on the single-payer plan, extended travel insurance, hospital room upgrades, cosmetic and elective surgery, and other types of non-health related insurance.  Plus there will still need to be administrative jobs in the new system (not as many, to be sure).  Canada has plenty of private insurers.  Also, the single-payer bills incorporate money for retraining of displaced personnel.  All in all, that is really not a big deal breaker.

  •  more call in (2+ / 0-)
    Recommended by:
    slinkerwink, princesspat

    Thom Hartmann show

    Toll-free number to call into the show: 1-866-987-THOM (8466)
    This is the only reliable way to actually talk with Thom if you’re a listener and want to discuss politics.

    Law is security; lawlessness invites terror. -Joe Margulies

    by mrobinson on Tue May 05, 2009 at 08:53:47 AM PDT

  •  video, petition, stand with dr dean (4+ / 0-)

    http://standwithdrdean.com/

    Choice. Public Option Like Medicare. Not insurance reform, but healthcare reform. Healthcare For All.

    Give America a choice. We support healthcare reform that allows individual Americans to choose either a universally available public healthcare option like Medicare or for-profit private insurance. A public option is the only way to guarantee healthcare for all Americans and its inclusion is non- negotiable.

    Any legislation without the choice of a public option is only insurance reform and not the healthcare reform America needs.

    Law is security; lawlessness invites terror. -Joe Margulies

    by mrobinson on Tue May 05, 2009 at 08:58:50 AM PDT

  •  What about the plan Congress has? (2+ / 0-)
    Recommended by:
    annrose, Brooke In Seattle

    It might be worth asking Schumer et al how much their own premiums are and whether the Congressional plan is "self-sustaining."  No doubt a torrent of weasel words will follow, but it seems reasonable to ask why "public servants" should receive an excellent, government subsidized health plan while those whom they purportedly serve should not.

    It might also be worth asking why government subsidized health plans in Canada and Europe yield a lower cost per capita for health care than what is observed in the United States.

    I can't tell you how happy I am that I immigrated to Canada after Bush was re-elected.  Health care certainly isn't perfect here, but it's infinitely better than all of the propaganda in the U.S. would have you believe, and it's definitely preferable to wondering how I could pay for insurance or a doctor if I lose my job.

    Schumer, Nelson, Baucus and Feinstein are all tools.  They can go to hell and room with the Republicans as far as I'm concerned.

    •  THAT'S the option Obama PROMISED. nt (2+ / 0-)
      Recommended by:
      Free Spirit, jamesia

      They tortured people to get false confessions to fraudulently justify their fraudulent invasion of Iraq.

      by Words In Action on Tue May 05, 2009 at 09:06:19 AM PDT

      [ Parent ]

      •  Obama wont get re-elected if he pulls this stunt (0+ / 0-)

        The people who were in essence coerced into voting for him with his dysfunctional health plan, WONT do it again.

        we will sit out the election or something.

        If Obama and friends dont FIGHT for UHC, its over.

    •  Please tell me (1+ / 0-)
      Recommended by:
      LordMike

      was it hard to emigrate? I have heard that Canada doesn't really want Americans since they compete with Canadians for jobs? Do I have any chance at all if I am not wealthy or not desperately poor?

      •  Immigrating to Canada (3+ / 0-)
        Recommended by:
        churchylafemme, polar bear, Wisewood

        No, it's not easy to immigrate to Canada, and it takes 2-3 years to complete the process.  If you're seriously interested, you can find out more and take a quick test here:

        http://www.cic.gc.ca/...

        The test gives you a finger in the breeze assessment of your chances.  Things that work in your favor are your age (the younger the better), your employability (and whether your skills are sought after), whether you have enough money to live in while you look for a job (about six months worth), whether you have relatives in Canada, whether you speak English and/or French, and whether you can pass a medical exam that you have to pay for.  All told, it can cost a few thousand dollars just to get to the point where they send you an immigration visa. But your quickest ticket to Canada would be to persuade some company up here to hire you and bring you in on a work visa.  Then you can go through the immigration process while working here, and I've heard that definitely greases the chute.  Basically they want people working and paying taxes and not breaking the law.  It's not easy to do, which probably explains why so many people talk about it but never do it.  But I can tell you from experience that it's been worth it.  As long as I behave myself and avoid committing felonies, I can stay for the rest of my life and have all the rights of Canadian citizens except the right to vote.  But I can still vote in the U.S.  After three years, you can also apply for Canadian citizenship.

        Good luck.

    •  VERY expensive to offer the federal plans (0+ / 0-)

      Premiums (on these private insurance plans offered by the government) are subsidized by you know who's taxes at around 80%.  Offering such a plan to everyone would just cost a lot of money while still lining the pockets of the private insurers.

      •  My point exactly (0+ / 0-)

        Yes, Congressional health care benefits are subsidized by tax payers.  Does this meet Schumer's definition of a "self-sustaining" health care plan? My guess is that it does not.  So I return to my original question.  Since supposedly they work for us, why must our health insurance be "self-sustaining" while theirs doesn't have to be?  Why should a working parent who doesn't receive health care benefits with his or her job have to subsidize the health care of Congressional parasites who pull down six figure salaries?  Is it that we're trying to attract the best to serve in Congress?  If so, I direct your attention to Joe Barton or James Inhofe. Or Chuckie Schumer.  How are those hiring incentives working out in practice?  And how often are members of Congress turned down by their insurance company when they file a claim?  Something tells me Arlen Specter received zero grief from any insurance company bureaucrats when he was getting his cancer treatment.

        And of course part of the reason why their private health care plans are so expensive is that the insurance industry takes a large cut off the top, which is more to the point, I suppose, but it lacks the entertainment value of needling the assholes in Congress about their hypocrisy.

        And since their plan is too expensive to offer to the general public, why did President McChange promise it in the first place?  That's a rhetorical question, obviously.

        I'll be astonished if whatever gets excreted by this process produces anything of value for working poor people, or does anything that in any way inconveniences the sacks of ambulatory dog waste who run the health insurance industry.  I would love to be proven wrong.

  •  Some thoughts: (1+ / 0-)
    Recommended by:
    tegrat

    The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

    That actually makes sense.  With a large number of covered lives, they could bargain for lower fees from physicians and offer truely affordable premiums and co-pays, much like GE does.

    ¶The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

    All this depends on the CPT codes you are talking about.  Preferred Provider Organizations ("PPOs"), starting about 10 or 11 years ago, were able to bargain physicians and institutional providers out of steep discounts, not only as to their Usual Customary and Reasonable ("UCR") fees but often the Medicare fee schedule.  This defeats the purpose of even offering this as an alternative.        

    ¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

    Really kind of meaningless.  Volume is everything, for a PCP 6-10 patient encounters per hour at an RBRVS Level 3 or greater.  People will par to get the census and because the USG is a prompt payor.

    ¶To prevent the government from serving as both "player and umpire," the officials who manage a public plan should be different from those who regulate the insurance market.

    This makes a lot of sense.

    •  Don't play on their field (5+ / 0-)
      Recommend