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Senator Chuck Schumer floated what he's calling a compromise on the public health insurance option, encompassing four points:

  • 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.


From a policy perspective, none of this is particularly controversial, actually.

Schumer is proposing a public health insurance plan, run by the government, that breaks the private insurance monopoly we have today. His policy prescriptions do not turn the public health insurance plan into a meaningless proposal. Here's why, point by point.

Should the public health insurance plan be self-sustaining? The concern here is that if the public health insurance plan has to be self-sustaining, than it will have to charge unaffordable premiums to stay afloat. This isn't how it will work.

Every implementation of the public health insurance option I've seen separates the public health insurance option from affordability provisions. (See Jacob Hacker for a liberal, and very good, proposal.) That means that as long as the insurance you choose conforms to certain insurance industry regulations and offers a comprehensive, standard set of benefits, you will get subsidized by the government so you can afford your premiums. It doesn't matter if you're on a private or public plan, you will get the subsidy as long as your plan conforms to certain benchmarks, or is part of the proposed insurance "exchange." (And, if sicker people enroll in a plan - public or private - the plan would be subsidizing more, eliminating self-selecting among private plans.)

So, your premiums wouldn't be affected by the self-sustaining idea. And, if we believe in the idea that a public health insurance option will be more efficient than private health insurance (no profits to deal with, no advertising, much less administrative overhead), self-sustaining isn't actually such a crazy idea.

Should doctors be forced to accept the new public health insurance plan? Doctors are not forced to accept Medicare now, so I'm not sure why we should go further with the public health insurance plan. While it's true that new Medicare enrollees can have trouble finding a doctor accepting new patients with Medicare, this is true for patients with private health insurance as well. In fact, it's harder for patients with private insurance to find doctors than it is for patients with Medicare [pdf]. In fact, 97% of doctors accept Medicare.

So, why is it hard to find care? We lack of doctors, especially primary care doctors, in this country. This is a problem that must also be solved, but it won't be solved by forcing doctors to accept the new public health insurance plan.

Should the public health insurance option pay Medicare rates? Not necessarily. Medicare and the VA are both government-run health care plans, and they pay different rates. And in fact, Medicare should pay higher rates for primary care and less for some specialists. By allowing the public health insurance plan to bargain for its own rates, as Schumer is doing, we can even out that balance. Schumer is only saying the public health insurance option will pay "more" than Medicare, but not saying how much more or more to which providers, and is still allowing the public health insurance option to bargain, something Medicare under Part D (a huge giveaway to the drug companies) can't do for drug prices. Schumer's plan is, in fact, a victory.

Should the public health insurance option be overseen by a separate board? Making a separate board to oversee the public health insurance plan makes sense. The administrators would still be government officials according to Schumer, but they wouldn't be the same people making the rules about the insurance market. I'm not sure how this is controversial.

Schumer is in fact proposing a real public health insurance plan - government run and a strong competitor with private insurance. And most importantly, Schumer's vision breaks the monopoly of private insurance, and this is the main standard on which a public health insurance plan proposal should be judged. None of his "compromises" are actually problematic from a policy perspective. We will still get something that's effective and affordable, and something that breaks the private monopoly.

What is really telling is the reaction of the insurance industry to this compromise:

Insurers also remain skeptical. Karen M. Ignagni, president of America's Health Insurance Plans, a trade group, said, "We are very, very grateful that members of Congress have been thoughtfully looking at our concerns." But she said she still saw no need for a public plan if you have much more aggressive regulation of insurance, which the industry has agreed to support.

Linda Douglass, a White House spokeswoman, said that Mr. Obama was for a public plan but that he realized it could be defined in different ways.

Mr. Schumer said his goal was a level playing field for competition between public and private insurers. But Ms. Ignagni said, "It's almost impossible to accomplish that objective."

The insurance industry has been continually lying, saying they're for reform. And yet, when a compromise comes around, they are dead set against it, and automatically reject the entire premise of a public health insurance plan, no matter how it's set up.

The insurance industry is not reasonable, and it does not want reform. That is beyond clear.

I would encourage you to contact Senator Schumer and all of your Representatives and tell them what you think about the public health insurance option. However, I would also encourage you to think about this compromise critically. We as progressives have become allergic to the word compromise, and for good reason. Over the last eight years, it usually means we're getting screwed. However, this just may be a new era, and some basic definitions are changing. This compromise might not be nearly as bad as you think.

(also posted at the NOW! blog)

I'm proud to work for Health Care for America Now

Originally posted to Jason Rosenbaum on Tue May 05, 2009 at 09:59 AM PDT.

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Comment Preferences

  •  Tips? Discussion? (193+ / 0-)
    Recommended by:
    Renee, fladem, JWC, PLS, decisivemoment, skyesNYC, ferg, DawnG, askew, Tuffy, sarac, The Crusader, ScientistMom in NY, existenz, kainah, kathyp, GayHillbilly, jdld, akeitz, John Campanelli, KevinBondelli, Duncan Idaho, gecko, lesliet, RubDMC, joynow, missLotus, Davidsfr, dianem, mmacdDE, anotherCt Dem, mkfarkus, buckhorn okie, Boston to Salem, Bronxist, superba, itskevin, bewert, dmsilev, Boris Godunov, Eddie C, Getreal1246, mrkvica, Eddie in ME, Chicago Lulu, NYFM, Penny Century, Catte Nappe, grrr, lcrp, Sophie Amrain, bwintx, ybruti, tomjones, d to the f, Alta Price, realalaskan, Julie Gulden, harlinchi, paige, bloomer 101, Bluesee, Simian, radarlady, salmo, denise b, el dorado gal, Elise, rweba, zeuspapa, wildcat6, majcmb1, where4art, LABobsterofAnaheim, ladybug53, HiBob, neroden, JanL, roubs, begone, elliott, Nance, Pinko Elephant, ej25, andydoubtless, fromer, nonnie9999, Bush Bites, imabluemerkin, happy camper, myrealname, soccergrandmom, Dinclusin, Something the Dog Said, Nulwee, DBunn, tegrat, dmh44, yoduuuh do or do not, FishOutofWater, HeartlandLiberal, mp, BasharH, roycej, TomP, MKinTN, Argyrios, brklyngrl, Youffraita, Fiona West, LI Mike, filby, lineatus, Happy Days, Jake Williams, pickandshovel, Populista, NogodsnomastersMary, Gemina13, joy sinha, nzanne, mary13L, dont think, briefer, fayea, ggwoman55, legendmn, prettygirlxoxoxo, Pris from LA, Jacob Bartle, ARS, litoralis, nextstep, Magick Maven, Skeptical Bastard, Dopeman, RandomActsOfReason, slaney black, zizi, csquared, obscuresportsquarterly, sanglug, allep10, The BBQ Chicken Madness, IDrankWhat, RadioGirl, adocarbog, RinaX, Its the Supreme Court Stupid, brentbent, jamtown, drache, TFinSF, blueingreen, PurpleMyst, Green Bean, MarkMarvin, CS in AZ, Crabby Abbey, your neighbor, polar bear, Eddie L, sullivanst, Benintn, Grumpy Young Man, pateTX, washunate, MsGrin, bushwhacked, Odeomi13, Enthalpy, stella0710, dmet, bottlerocketheart, coquiero, bluebuckaroo, Olon, Mr MadAsHell, Eclectablog, kevin k, princesspat, Lusty, dle2GA, FistJab, BarackStarObama, sjr1, MRA NY, illegal smile, sparkmaster, Andrew F Cockburn, wide eyed lib, Taunter, whitewash

    I realize folks may not agree with me, but let's have a real talk about the policy. It's complicated, so it deserves some real discussion.

  •  Why create yet another plan? (28+ / 0-)

    Medicare and the VA have worked well for many years.  There is no viable reason not to allow people to buy into an existing plan.  

    I don't trust Schumer, never have.  He is bought and paid for by corporate interests.  He may start out with something that sounds reasonable, but it will end up like Part D, a monument to corporate greed and excess.  

    •  Schumer (11+ / 0-)

      Yes, it's important we hold his feet to the fire, like everyone else. But we have to recognize that even though he's calling this a compromise, it isn't much of one from a policy perspective, and that's good.

      He's making this idea look reasonable and the opposition look unreasonable. Also a great thing.

      •  It's not a great thing Jason... (3+ / 0-)
        Recommended by:
        rsie, AmericanRiverCanyon, Uberbah

        apparently you don't know Mr. Schumer's history, do you?

        •  Again with the ad hominem attacks. eom (4+ / 0-)

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

          by sullivanst on Tue May 05, 2009 at 11:01:55 AM PDT

          [ Parent ]

          •  that word doesn't mean what you think it means (0+ / 0-)
            •  No, it means EXACTLY what I think it means (3+ / 0-)

              victoria2dc has at several points in this thread attacked not on the basis of what Schumer proposed, but on the basis that Schumer said it.

              That is precisely an ad hominem attack.

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

              by sullivanst on Tue May 05, 2009 at 01:55:09 PM PDT

              [ Parent ]

              •  it means have NO IDEA what you are talking about (0+ / 0-)

                 It's not a great thing Jason...

                apparently you don't know Mr. Schumer's history, do you?

                by victoria2dc

                No personal attack on Schumer in that post.  No attack, no ad hominem, no point for you.

                •  You have completely missed the point (0+ / 0-)

                  of what "ad hominem" means.

                  Literally translated from Latin, it means "to the person".

                  It means, that instead of debating what it said, you point at the source and ignore the argument.

                  That is exactly what victoria2dc has done.

                  And given his/her other posts make clear that [s]he considers Schumer's history to be strongly negative, it's clear that [s]he consideres pointing out his history to be an attack.

                  So I'm sorry, but you're the one lacking a clue.

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

                  by sullivanst on Wed May 06, 2009 at 06:09:46 AM PDT

                  [ Parent ]

        •  Something is only true... (7+ / 0-)

          ...until it is no longer true.

          judging everything PURELY on past actions is a way for your to avoid thinking about anything critically.

          Pretend it didn't even come from Shumer.  Pretend the whole thing fell from the sky and evaluate the warrants of the ideas, not the person who brings them forward.

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

          by DawnG on Tue May 05, 2009 at 12:17:27 PM PDT

          [ Parent ]

        •  Um, I know his history (2+ / 0-)
          Recommended by:
          askew, Jason Rosenbaum

          I'd prefer him over Feinstein, Reid, either Nelson, Specter, Lieberman, and in fact most of the Democratic Senate caucus any day.

          Wait 'till we hear the "Lieberman-Specter-Collins compromise".

          -5.63, -8.10. Learn about Duverger's Law.

          by neroden on Tue May 05, 2009 at 12:59:15 PM PDT

          [ Parent ]

          •  BFD (2+ / 0-)
            Recommended by:
            mrkvica, whaddaya

            He's better than Tom Coburn as well...but so what?  One of the bluest states in the nation can do better than Chuck Shumer.

            •  It may be deep blue for Presidential purposes (1+ / 0-)
              Recommended by:
              pstoller78

              but New York shouldn't be taken for granted by Democrats at any lower level.

              Just look at how long it took to finally wrest control of the state legislature.

              The state does not have a record of electing strong progressives. Schumer's seat was held for 42 years by the Republicans before he defeated D'Amato. In the Class 1 seat, Moynihan was hardly a lefty, nor was Clinton, and now we have Gillibrand. Moynihan won the seat from James Buckley ferchrissakes - William Buckley's brother. RFK sticks out like a sore thumb in New York's post-war electoral history, just three short years of progressive representation.

              Schumer's middle of the road for a Democratic senator, and that's absolutely the template for the politicians this state has a habit of sending to the US Senate.

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

              by sullivanst on Tue May 05, 2009 at 02:08:16 PM PDT

              [ Parent ]

              •  any blue state will have pockets of wingnuttia (1+ / 0-)
                Recommended by:
                sullivanst

                See: Minnesota and Michelle Bachman.  Same goes for red states, like Austin in Texas.  I'm talking about the statewide electorate for gubernatorial and senate races.

                The state does not have a record of electing strong progressives.

                Because some special interests (like Wall Street) have more money than God to throw into a race, intertwined with the fact that NY is a machine state.

                Federally finance elections, and hopefully we'd see fewer Pelosi's, Feinstien's and Shumer's.

                •  Sounds like we're mostly in agreement then (1+ / 0-)
                  Recommended by:
                  Uberbah

                  It's just down to the difference between how it is, and how we'd like it to be.

                  We'd need to do more than find a good progressive candidate to be able to replace Schumer with someone more than our taste - we'd have to overturn the political and money machines.

                  Not saying that's impossible or undesirable, just that it's a much bigger hill to climb.

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

                  by sullivanst on Wed May 06, 2009 at 06:15:06 AM PDT

                  [ Parent ]

    •  yes, why not tied to medicare rates? (7+ / 0-)

      I don't understand that part of Schumer's proposal:

      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 the Medicare rates are wrong, then Medicare should be changed.  I'd think having the public plan be exactly the same as Medicare would be beneficial to both plans, because any problems would be solved once.

      •  Medicare is wrong in a lot of ways (4+ / 0-)
        Recommended by:
        ferg, askew, zeuspapa, FistJab

        fee-for-service is a bad incentive anyway, so yes, it should be changed, but why tie the public option to Medicare. Those Medicare changes might actually be harder to accomplish, just because Medicare is so entrenched.

        •  so public option improves on medicare (2+ / 0-)
          Recommended by:
          neroden, fayea

          Just so I understand the logic.

          1. Medicare's fee structure is broken, so it's wiser to avoid that problem with the public option.
          1. If the public option has a better fee structure, it would be easier to fix Medicare to copy the public option, because there would be a successful model to copy.
          1. So long run, the public option and Medicare be the same; there's just a somewhat messy transition period.
        •  then why not more competition? (4+ / 0-)
          Recommended by:
          ferg, SarahLee, mrkvica, whaddaya

          even among the public options?

          first, open up medicare to everyone, so that uninsured people like me don't have to wait to get in a public plan.

          then you could also build the new public option to be better, faster, cheaper.  people (including seniors, presumably) would then be able to choose between private plans, medicare, or the new improved public option.

          heck, we could even allow people to buy into the VA system, for those of us who like fully socialized medicine.

          l'homme est né libre, et partout il est dans les fers

          by zeke L on Tue May 05, 2009 at 12:52:50 PM PDT

          [ Parent ]

    •  I agree, we have the technology there already (0+ / 0-)

      All that needs to happen is to increase the reimbursement rates a bit so more doctors would be incented to participate.  SINGLE-PAYOR

  •  The problem I see is offering a (36+ / 0-)

    compromise first. Why should we be the Party to throw open the negotiations? It is not like the Republicans are going to offer anything. There is a report that President Obama offered them caps on malpractice awards but when he asked what they would give in exchange for that the answer was nothing.

    It does not seem like a bad compromise, but if this becomes the place we negotiate down from, then what is enacted could be significantly worse. That is where the issue of compromise becomes a problem.

    Getting Dems together and keeping them that way is like trying to herd cats, hopped up on crank, through LA, during an earthquake, in the rain. -6.25, -6.10

    by Something the Dog Said on Tue May 05, 2009 at 10:06:22 AM PDT

  •  Something I don't understand about "self (18+ / 0-)

    sustaining."

    Insurance companies are not always "self sustaining" either.  They survive off of premiums, to be sure, but they also survive off of investments and "donations" from their parent/sibling companies (see: AIG).  

    Telling the government plan that it has to be "self sustaining" seems to be a way to ensure that it will not be competitive with the private plans, who will not have this limitation.

    www.legalwikipro.com Check it out.

    by briefer on Tue May 05, 2009 at 10:07:56 AM PDT

  •  Medicare should be the "public option". (19+ / 0-)

    Of course, the public option should not compete with Medicare, so why not make it the public option.  Private companies could make more than enough money providing supplemental insurance like they do with current Medicare recipients.

    •  It's kind of the do-no-harm principle (6+ / 0-)

      You talk about changing Medicare and suddenly seniors get very very nervous, no matter how much you reassure them. That's why the public option is separate, but it's likely to be based closely off Medicare.

    •  Medicare is only a partial answer (5+ / 0-)
      Recommended by:
      ferg, askew, zeuspapa, elliott, Jason Rosenbaum

      Medicare is fee-for-service, meaning that providers are payed for procedures performed. This model is a major driver of excessive health care costs, because the incentive for providers is to increase their revenues by performing more procedures.

      It should probably increase its administrative overhead somewhat, at least enough to be able to more effectively prevent fraudulent billing.

      It does not evaluate efficacy or cost/benefit of current or new drugs, technologies, and procedures.

      It does not limit over-concentration of health care services in certain markets (another driver of excessive costs), or encourage infrastructure development in under-served areas.

      We could certainly add or change all of the above, but then it wouldn't be Medicare any more, it would be something new.

      Medicare has been a great program, literaly a life saver for millions of seniors, but we should be clear about its limitations. It is not a complete model for what we need going forward.

    •  One of the problems with Medicare (4+ / 0-)
      Recommended by:
      ferg, askew, 3goldens, fool mee once

      is that for payments to hospitals, not infrequently the payment is actually less than the cost of the care (especially with fancier stuff like neurosurgery - and I don't mean unnecessary stuff unless you think walking is unnecessary).  Hospitals make up for it by being paid better for the same service by private insurers.  Currently the only hospital in my small town is barely surviving.  Payment schedules need to be examined very critically with the goal to keep hospitals from having to close, thus denying service to many.

      I was wise enough to never grow up while fooling most people into believing I had. - Margaret Mead

      by fayea on Tue May 05, 2009 at 01:03:19 PM PDT

      [ Parent ]

      •  only half true (0+ / 0-)

        The cost shifting argument is something of a myth. Efficient providers can get by on Medicare rates and provide higher quality care at the same time:

        http://www.medpac.gov/...

        {pdf warning!}

        •  I am on a committee in my (6+ / 0-)

          hospital that has to look at costs vs revenue on various surgical procedures.  Many of the neuro procedures cost way more than Medicare pays.  These are procedures with implants that cost lots.  One in particular costs $7000 per spinal level.  Medicare pays about $9000 for one level, and not a penny more even if a second or third level are necessary.   So for someone having 3 level surgery the OR toys alone cost $21,000, then there is the cost of staff, room, drugs, etc.  Again, most hospitals do okay because they have a good "payer mix".  The privates pay more for each level and so a profit is made.  
          My point is that if we go eventually to single payer, or effectively so, payment structures need to be adjusted so that there is not an actual loss when some poor soul needs an expensive but necessary surgery.  It is simply not sustainable.
          Now, doing something to rein in the costs that the implant companies charge - that would be a big help.  

          I was wise enough to never grow up while fooling most people into believing I had. - Margaret Mead

          by fayea on Tue May 05, 2009 at 01:26:28 PM PDT

          [ Parent ]

  •  The point I am concerned about (13+ / 0-)

    is this one

    Should the public health insurance option pay Medicare rates? Not necessarily.

    This is where the blue dogs and republicans can destroy universal health care from the inside.  Basically, imagine the presecription drug benefit.  By eliminating competitive bidding and government scalability, the whole plan is a giveaway to big pharma.  We cannot let it happen to health care.

    An open mind gets filled with crap.

    by Empty Vessel on Tue May 05, 2009 at 10:10:10 AM PDT

    •  Schumer (4+ / 0-)

      just defended bidding and government scale forcefully in the Senate. Ron Pollack of Families USA backed him up.

      I agree, we need these things, but Schumer agrees.

      •  Then why would it cost more than Medicare? (5+ / 0-)

        If medicare rates are lower, and the new health plan will likely have more (and younger) people in it, then, if anything, costs should be even less then medicare.  The only way to compromise on this is to artificially restrict the government's ability to bargain.  

        I don't want a level playing field between the government and private insurance.  I want the government to bankrupt private insurance with their better and cheaper plan.

        An open mind gets filled with crap.

        by Empty Vessel on Tue May 05, 2009 at 10:15:04 AM PDT

        [ Parent ]

        •  See above (5+ / 0-)
          Recommended by:
          ferg, askew, dmh44, LI Mike, Pris from LA

          Medicare actually underpays primary care providers and overpays some specialties, leading to our primary care provider shortage. Medicare should pay more for some things.

          •  But your comment is not what Schumer said (5+ / 0-)

            He said "pay more than medicare", not pay more or less depending on the specialty.  His comment, then, is that in aggregate, the new health plan will pay more than medicare, which leads to my above comment.  Why, given greater numbers and a lower age plan members would this plan cost more than medicare?

            An open mind gets filled with crap.

            by Empty Vessel on Tue May 05, 2009 at 10:19:39 AM PDT

            [ Parent ]

            •  He's not saying it would cost more (2+ / 0-)
              Recommended by:
              askew, Pris from LA

              Just pay more, and the wording is very very vague. He's leaving the door open to bargaining, something we didn't get with Part D, and that's pretty huge.

              •  If the government pays more (1+ / 0-)
                Recommended by:
                cloud9ine

                and it needs to be self-sustaining (as it should), then it will necessarily cost more.  Money out=money in.

                An open mind gets filled with crap.

                by Empty Vessel on Tue May 05, 2009 at 10:28:59 AM PDT

                [ Parent ]

                •  No (2+ / 0-)
                  Recommended by:
                  LI Mike, fayea

                  The subsidy portion is seperate, so the plan would get subsidies based on how much people can pay and if they take on sicker people. Those subsidies would be available to both private and public plans.

                  And, even if the plan pays more than Medicare, it would still be more efficient than private plans, which have to be self-sustaining by definition. No profit, no executives to pay, no advertising, less administrative overhead.

                  •  But you still haven't (3+ / 0-)
                    Recommended by:
                    slinkerwink, fool mee once, cloud9ine

                    explained why it would "cost more".  You're savings are all based on government efficiency, why not give that money to lower premiums rather than to the doctors or subsidies to private insurance companies?

                    An open mind gets filled with crap.

                    by Empty Vessel on Tue May 05, 2009 at 10:34:06 AM PDT

                    [ Parent ]

                    •  Ok, two issues (1+ / 0-)
                      Recommended by:
                      DBunn

                      Why not pay less to doctors and plow that extra savings back to help pay for the program? From a policy perspective, no reason. From a political perspective, the less you make an enemy of doctors in this, the better. Not that things shouldn't be changed, they should, but it might come a bit slower than we want. There is a big gap between what Medicare pays and what private insurance pays, and there is evidence that says efficient providers can get by on what Medicare pays. So, it means there is a lot of room in there to get good policy, as in paying rates that maybe are higher than Medicare, as a bone to doctors, but not much higher.

                      As for subsidies to private companies, that is coming from a separate program. All subsidies would be run through the "exchange," in which the public option would only be one player among other private companies. So saving money in the public option wouldn't go back to the exchange, as they're separate. See the Hacker report for a diagram that can probably explain it better.

                      •  OK (6+ / 0-)

                        Now we are finally at the heart of it.  You think doctors should be payed more than medicare currently does (at least for the medium term, as a pragmatic issue).  I don't.

                        The main way that the government can make their plan as close to universal as possible is to have a much cheaper, but better plan than the private insurance companies.  Everyone will sign up, and voila welcome to an effective single payer system by fiat.

                        To do that, it needs to be clearly better, and clearly cheaper.  Screw the doctors for now, medicare already pays plenty.  As a bonus, we can also start paying the same prices for prescription drugs as the European/Canadian systems.  

                        We have a majority, lets use it.

                        An open mind gets filled with crap.

                        by Empty Vessel on Tue May 05, 2009 at 10:43:05 AM PDT

                        [ Parent ]

                        •  well (2+ / 0-)
                          Recommended by:
                          zeuspapa, Pris from LA

                          we don't have to get there all in one day. The idea here is to bend the cost curve, so things aren't going up exponentially every year. So maybe that starts with efficiencies of scale and of administration, and eventually we get down to paying the docs less.

                        •  Apparently you are not a doctor. (1+ / 0-)
                          Recommended by:
                          askew

                          Thanks for volunteering that I will be among the screwees.  

                          Do you also mean to screw my employees in the same screw job?  How do you think their salaries are paid?  

                          Shall I also extend the screw to my patients by trying to see more faster giving each less time and care than they deserve because I can't make payroll anymore?  

                          Please, think before you screw.  

                          Medicare really does not pay plenty now.  We make up for it by getting more from private insurers.  It's a stupid system.  It's really weird that I get different payments for the same service from different sources.  I would prefer single payor.  Then everyone is equal.  The rules would be the same for all.  I could learn to jump thru one set of hoops.  

                          I was wise enough to never grow up while fooling most people into believing I had. - Margaret Mead

                          by fayea on Tue May 05, 2009 at 01:13:39 PM PDT

                          [ Parent ]

                          •  Sorry (2+ / 0-)
                            Recommended by:
                            mrkvica, fool mee once

                            But yeah, I am advocating you make less.  On the other side, it could be worse.  I am also trying to completely bankrupt the entire private health insurance system.  All the folks working for those companies will face far-worse than a pay cut.  

                            I support wealth redistribution from the richest to the poorest of our society.  That means those who make more than 100,000 need to make less, so that others have more.  

                            The pie is only so big--some peoples' slices will be smaller, while many others will get more.

                            An open mind gets filled with crap.

                            by Empty Vessel on Tue May 05, 2009 at 01:46:47 PM PDT

                            [ Parent ]

                          •  I have no problem with that concept. (5+ / 0-)

                            But I do expect a certain trade off.  I am only willing to accept such a high liability for the outcome of health care I provide if I am compensated pretty well for that really nerve-wracking stress.  Frankly, I would be quite pleased to make less than $100,000 if I knew I wasn't at risk of having everything I have ever made taken away for an outcome that isn't even my fault.  

                            I was wise enough to never grow up while fooling most people into believing I had. - Margaret Mead

                            by fayea on Tue May 05, 2009 at 02:33:09 PM PDT

                            [ Parent ]

                          •  Presumably you have malpractice insurance (0+ / 0-)

                            and that gets figured into the costs of running your practice.  If you have that insurance, you are not in danger of losing your home and your wealth, it only serves to limit your pay, again, presumably still over 100,000 if you are like most doctors.

                            An open mind gets filled with crap.

                            by Empty Vessel on Tue May 05, 2009 at 05:12:20 PM PDT

                            [ Parent ]

                          •  There is absolutely no protection (0+ / 0-)

                            against losing your home or "wealth" just because you have medmal insurance.  One can be sued for any amount and we are insured for a limited amount.  However, that is not really the worst of it.  Once you get sued, even if you win, your insurance premium skyrockets and if you get sued some undetermined number of times,  you are no longer insurable.  It's like a "pre-existing illness".  Then you are essentially out a career.  Suits don't only happen to "bad" doctors.  There is no real effective way to protect oneself.  What the hell am I doing this for anyway?  Maybe I should drive a truck - now that I've thought about the situation enough to write this comment, anyone doing this job must be insane.  Oh, yeah, mostly I love what I do and I am probably engaging in magical thinking in that "it won't happen to me".

                            I was wise enough to never grow up while fooling most people into believing I had. - Margaret Mead

                            by fayea on Tue May 05, 2009 at 07:25:37 PM PDT

                            [ Parent ]

                          •  My Mexican dentista (0+ / 0-)

                            has no employees.

                            If the employees don't justify their cost, get rid of them.

                            Medicare pays the same whether you have 0 or 10 employees.

          •  Headed the wrong direction (5+ / 0-)

            If you believe Medicare is not paying properly, fix Medicare's payment plans.  The problem of Medicare payments is hardly solved by creating a second Medicare with different administrators.

            If there were a MedicareOld and a MedicareYoung, you would expect MedicareYoung to pay less - there are more non-seniors, and their conditions are likely to be simpler (if nothing else, fewer things are happening in parallel).

            Deciding that MedicareYoung will be separate and pay more is a concession to doctors (who fear the bargaining power of the government) and private insurance companies (who cannot match Medicare pricing).  Maybe that concession needs to be made for some reason you have not articulated.  But denying that it exists does no one any favors.

  •  Screw this. (4+ / 0-)

    Why the fuck are we concerned about compromise? In case the honorable Shoe-meer forgot, WE HAVE A MAJORITY.

    This is our chance to build an NHS in the British model, except without the private doctors or private insurance. And we're going to waste it on this damned failed "free market" idea?

    WTF?

  •  Nice Analysis ... (27+ / 0-)

    CHOICE

    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 SINGLE PUBLIC OPTION (for all ages) and MULTIPLE 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 within the Budget 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 (cut from high executive compensation, advertising, etc).  

    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'.  

    The issue with Private Insurance is they only want the 'Well and Working' group they have no desire to cover the 'Old and Sick' nor anyone with 'Pre-existing Conditions'.  In addition, even their desired market of 'Well and Working' is charged substantial more than the Public Option will be able to offer - This is where the Private Insurance Companies are going to fight.

    Also, Orszag will kill the Private Care Groups and Private Insurance when  the final bill - deals with OUTCOMES.  

    Demographics do not equal destiny.

    by dr fatman on Tue May 05, 2009 at 10:12:33 AM PDT

    •  I really hope you're right about this (5+ / 0-)
      Recommended by:
      ferg, askew, paige, Naranjadia, Jason Rosenbaum

      Orszag strikes me as a brilliant budget tactician.

      "Ladies and gentlemen, I'm just a piano player, but tonight God is in the house." --Fats Waller, upon recognizing Art Tatum in the crowd

      by wildcat6 on Tue May 05, 2009 at 10:18:02 AM PDT

      [ Parent ]

      •  He knows health care backwards and forwards... (24+ / 0-)

        Obama had Rahm introduce Peter to the Senate Yahoos during the Stimulus Debate and Reid even acknowledged his skills during the closing of the debate.  It was only a warm-up ... I am not worried about what Baucus puts out of his Committee nor really what the Senate puts out - the House will have a very good bill with Obama's Public Option in it.  The 'bills' will go to Joint Committee and that is where the final bill will come to be and all we will need is 5O Senators + Biden and Peter will work the Senators over with 'numbers and logic' prior to the votes - we will get more than 50 votes.

        I would encourage everyone to support the Progressive Caucus especially in the HOUSE (77 members).  Dean said if we stand behind them they plan on not moving on the BILL unless it has a PUBLIC OPTION.  Dean says the Senate is the problem due to their completely sold out asses - so we should YELL YES but strongly encourage the HOUSE PROGRESSIVES.

        IT IS THE FIGHT OR OUR GENERATION - WE MUST WIN.

        Demographics do not equal destiny.

        by dr fatman on Tue May 05, 2009 at 10:24:48 AM PDT

        [ Parent ]

    •  Help me out with this part.. (0+ / 0-)

      As tragic as it is, Every long-term care episode eventually ends up with one outcome.  Transition.  By definition, every hospice case ends up with one outcome over time.  Transition.    

      Eventually everyone transitions.  How is that looked at now as "outcome"?  Heck, in a good deal of trauma cases there is a "negative outcome".  Eliminating the malpractice, accidents, et al., there are transitions..

  •  Not really. (8+ / 0-)

    From a policy perspective, none of this is particularly controversial, actually.

    If the plan is to provide quality health care to all Americans, your bullet points seem to be focused elsewhere.  No benefit comes to the American people by having a moribund inefficient politically interfering health insurance industry on its backs.  
    There are functioning single payer health systems in the world.  I don't know of any that are like the one you're supporting, and I can't think of any benefit to American people that comes from such a complex and, may I say, senseless hybrid.  
    Why not just do what works elsewhere?  Do you really think the American problem is so unique as to have not been faced by other nations?

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

    by Andhakari on Tue May 05, 2009 at 10:13:42 AM PDT

    •  'Self Sustaining' Means It Wont Be Affordable!!! (5+ / 0-)
      Recommended by:
      slinkerwink, jxg, wsexson, fool mee once, Losty

      The health insurance industry doesn't want a public plan that will be attractive to people who dont have health problems. The "revenue neutral" caveat will ENSURE that that old devil in the details, yes, adverse selection will ensure that the so called public option costs thousands of dollars a year, because nobody who doesn't HAVE to buy it, will. Google "adverse selection" for the math.

      They ALL knew this was the killer from the beginning but they want it to appear as if there is some kind of democratic process going on.

  •  "Mockery" "Don't freak out" (3+ / 0-)
    Recommended by:
    rweba, DBunn, Jason Rosenbaum

    All I can say at this point, is that yours will be the diary I will read.

    I need time to do it slowly, follow links, etc. though, so no conclusion yet. But I thank you - "make a mockery" diaries are turn-offs to me.

    The Medicare piece of it will be important - my parents survive on it.

  •  Pure Nonsense (13+ / 0-)

    They are deliberately setting up a handicapped, cost adverse mutation of the "public option" to guarantee that is it less attractive and less successful than the ripoff private insurance company options which are abusing us.

    Everyone knows that the whole point of the public option, was to have very low co-pays and premiums made possible by public financing.

    Chuck Schumer is a tool (of the crooked Insurance Industry and the Bankers).

    _________________
    "All tyranny needs to gain a foothold, is for
    people of good conscience to remain silent."
         --Thomas Jefferson

    by FreeSociety on Tue May 05, 2009 at 10:15:48 AM PDT

  •  Can someone explain to me... (8+ / 0-)

    ....why we'd be floating compromises when there's no effective opposition?

    Granted, I'm late to this discussion, so forgive me if this is a stupid question.

    "We are loaded today." - Rush Limbaugh

    by The Termite on Tue May 05, 2009 at 10:19:13 AM PDT

  •  this is my concern about the self-sustaining (23+ / 0-)

    principle.

    By demanding that the system be self-sustaining it requires that enough be raised from premiums to cover claims and administration costs.  If the insurance companies are allowed to continue to cherry pick their clients they will be able to provide much lower premiums because their claims liability will be much lower.  All of the "hard cases" will end up in the government plan.  Because the government plan cannot turn people away, only adjust for the additional costs, this will cause the public plan to be way more expensive than the insurance companies' plans and the only ones who will end up in the public plan will be those the insurance companies refuse to cover - making the public plan even more expensive per person.

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

    by slinkerwink on Tue May 05, 2009 at 10:22:14 AM PDT

  •  The problem I have (4+ / 0-)

    is the same problem I had with the stimulus...

    If, like you say, the industry isn't going to play ball regardless, why even compromise?  We aren't bettering our hand, we're only watering down the legislation.

    "Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that." - Martin Luther King, Jr.

    by burndtdan on Tue May 05, 2009 at 10:37:14 AM PDT

  •  All negotiations start the same way. (8+ / 0-)

    There is the asking price "make every American buy insurance from us and we will get the premiums down".

    There is the offering price " A public health care option for all that is at least as good as what Congress provides for them selves"

    There is no before we enter into negotiations give away phase.

    I really don't care what Senator Schumer's reasons are for this boneheaded move, He has hurt the cause of any public health care option for all of us.

    The apologetics you offer are misleading if not out right mendacious.  

    You are wrong for giving Senator Schumer air cover for this gaffe.

    You should be calling him out for giving away the store.

    •  What compromise? (1+ / 0-)
      Recommended by:
      askew

      Show me what he compromised? Cause I can't find it. Other than using the dreaded word...

      •  I never said the the word compromise, but you did (7+ / 0-)

        Since you brought it up, here are a few of the obvious compromises.

        From your Summary:

        • 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.
        If taken literally this means either that the government is sitting on the revenue from the premiums that have been paid to use as they please interest free, or that premiums will be very volatile to keep the plan solvent. That my friend is a rip off and a compromise

        • 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 again the public plan and Medicare should be identical. If Medicare is under paying then we need to fix Medicare. Furthermore there should only be one plan "Medicare" using the same infrastructure that Medicare has today, otherwise we are just increasing expenses without increasing the health care provided. This is a carve out compromise to allow Congress to mess with Medicare later on.

        • The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.
        Again sorry no. Doctors can choose to practice or not, allowing Doctors hospitals and Insurers to pick and choose what form of health care coverage and which patients to accept is what got us into this mess. At the risk of repeating myself this is a BIG compromise.

        • 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.
        Finally we agree on one thing. The same people that regulate Medicare should regulate a new and improved Medicare.

    •  If every American was required to buy (0+ / 0-)

      insurance tomorrow, the price might go down 10% because only 16% are uninsured and many would need to be subsidized.

      That 10% will be eaten up by one year of medical cost inflation.

  •  My suggestion to Schumer - (7+ / 0-)

    support changes to tax law that would tax  compensation of partners (Eg. "hedge fund managers") as ordinary income (instead of the beneficial CG treatment some of them get), then use those taxes to partially support a universal-type health care system.

    My Karma just ran over your Dogma

    by FoundingFatherDAR on Tue May 05, 2009 at 10:46:17 AM PDT

  •  I won't ever make you a profit. (9+ / 0-)

    If you want to know why this freaks me out, it is because I know that any for-profit plan will never have a reason to take me on. I have two chronic illnesses that need medication and will not get better. The only way to make a profit off of me is to charge full price for the medications, plus an insurance premium.

    I despair that our country's Health Care crisis has been framed as the Health Insurance crisis. The problem is Health Insurance itself is an unsustainable business, the asymmetrical information problem in insurmountable.

  •  You're Fighting a Losing Battle (7+ / 0-)

    You have to understand that the people who are doing the freaking out define ANYTHING but Single Payer Health care as "Murder by Spreadsheet."  There isn't anything Schumer could have proposed that wouldn't have prompted the exact same diary apart from, "I've seen the light.  Let's get Canadian!"

    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 11:00:05 AM PDT

  •  A Quality Diary (7+ / 0-)

    Note that the public plan has some significant economic advantages over private insurance companies, including:

    • Government does not pay local, state or federal income taxes or property taxes - while the private companies do.
    • Government has a lower cost of capital - issue bonds at Treasury interest rates and the interest is exempt from state and local income taxes.
    • Lower compensation for upper and middle managers - probably higher compensation for other employees

    The most important way to protect the environment is not to have more than one child.

    by nextstep on Tue May 05, 2009 at 11:30:09 AM PDT

  •  asdf (4+ / 0-)
    Recommended by:
    tmo, ybruti, Losty, Jason Rosenbaum

    That means that as long as the insurance you choose conforms to certain insurance industry regulations and offers a comprehensive, standard set of benefits, you will get subsidized by the government so you can afford your premiums.

    That sounds a lot like the Netherlands system I was reading about on NYTimes yesterday - although the subsidies were very large for private insurers, e.g. 70% or something. It also meant that no insurer could deny a patient coverage based on age or health.

    Let the circular firing begin!

    by Grass on Tue May 05, 2009 at 11:33:34 AM PDT

  •  Hope there is real choice in policies (3+ / 0-)
    Recommended by:
    tmo, jjohnjj, Jason Rosenbaum

    I hope the market that develops gives me some real choices.  I would want my insurance from a provider that:

    • Provides discounts to those with a healthy lifestyle (don't smoke, not overweight, no more than moderate use of alcohol, and other lifestyle items that can be measured.) These discounts would also encourage me and my family to live better.
    • Lower rates if I elect not to have heroic measures covered by my insurance (i.e., if I'm expected to die in a month or two, but can live one extra month in intensive care at a rate of $300,000/mo.)

    The most important way to protect the environment is not to have more than one child.

    by nextstep on Tue May 05, 2009 at 11:40:48 AM PDT

    •  How do you measure alcohol use? (0+ / 0-)

      Weight is easy to measure, but smoking and drinking? How many people would report that they were smokers and heavy drinkers if they knew it would cost them more money? Do you want your health company doing random drug tests? If not, then how many would simply not mention to their doctors that they drink a bit more than they should or smoke a bit? Even weight is a problem. What charts do you use? The bmi is not very reliable for tall or very active people, so you might end up charging tall athletes superpremiums even if they don't deserve it.

      •  Simple tests (0+ / 0-)

        Blood tests and other tests can detect tobacco use as well as long term alcohol abuse. If adjustments are needed for weight tables - adjust the tables.

        I would not require that people take these tests to get health insurance, but it would be required to get the discount.

        I would not charge anyone super-premiums but provide discounts for those who make sensible choices that lower health care costs.

        Do you object that people with a drunk driving record pay more for auto insurance?

        One of the major reasons the US has inferior health outcomes is due to our rates of drinking, smoking, being overweight, too much salt in our diet, too little exercise and other choice we make in how we live.  The most cost effective way to control healthcare costs is for people to live a healthy lifestyle.

        The most important way to protect the environment is not to have more than one child.

        by nextstep on Wed May 06, 2009 at 12:01:04 AM PDT

        [ Parent ]

  •  Just like mortgages private plans will hide... (6+ / 0-)

    the exclusions and coverage in the fine print. Now you want to force the public option to "compete" with that. How will it work out? Private insurers will deceive, cheat and outright lie to get the ill-informed consumer to "choose" their plan.

    Then when they get sick, they'll find out how crappy that is. Schumer's proposal will make the public plan more expensive.

  •  Devil is in the Details (11+ / 0-)

    Your explanation of the subsidy is especially welcome.  Also, you are absolutely correct about the need for PCPs.  But Schumer also needs to be a little more careful about how he presents this in public.  I think the freak out is eminently justified -- it's the only way to get people to listen.

    Also, to be a little more descriptive about Medicare:

    1.  Hospitals find it virtually impossible not to participate in Medicare.
    1.  Doctors don't have to participate in Medicare, but if they see Medicare patients they are limited in what they can charge the beneficiary (or Medicare) even if they don't participate.
    1.  One of the biggest problems with doctors (apart from the lack of PCPs) is cartel behavior, especially among hospital based physicians such as anesthesiologists, which leads to price gouging. That's why a little more consumer protection regarding what doctors can do would probably be necessary to really make either private or public insurance work.  But public insurance has the advantage because it's not trying to make a profit, unlike private insurers.  

    Complicated subject -- Schumer needs to signal a little better on what he really means if your explanation is correct.

  •  Find a plan that works and make it available (4+ / 0-)
    Recommended by:
    ferg, SarahLee, mrkvica, LI Mike

    for everyone.  As a state worker, I have their "group insurance" and it is great. I have not had any problems with it.  Why not just replicate this plan around the country for everyone.  What's wrong with that?

  •  I'm not freaking (12+ / 0-)

    just pissed off. I know a bamboozle when I see one. Compromise was the public option, this does not address affordable healthcare offers a new package for an old scam. no thanks.  

    "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 11:58:43 AM PDT

  •  I haven't had a chance to read all the comments (4+ / 0-)

    but The Hacker model, if implemented, would spell the death knell of private plans if, all other things being equal, this one assumption is correct: the public plan would have no incentive to delay or deny claims because of the profit motive. Private plans make their money on denying and delaying claims.  Private plans would need a new business model or fail.

  •  But freaking out is so fun! (5+ / 0-)
    Recommended by:
    askew, dianem, LordMike, RinaX, Jason Rosenbaum

    And it's almost certain that a "freak-out" diary will make the Rec list.

    Sometimes I can't help and think that maybe some of us could learn a lesson from our President (can you imagine saying that about the last guy?) and try to get all the information about something before making a decision on whether or not we like it....although that's decidedly less fun than freaking out

    •  People lives are hanging in the balance here. (2+ / 0-)
      Recommended by:
      SarahLee, mrkvica

      Good jobs are disappearing and they wont return unless technology stops working or we suddenly find the money to educate millions of people far more than we do now, in short, this is our last chance for an America that isn't a plutocracy.

      I knew this was coming but it still makes me sick.

  •  I'm curious... (6+ / 0-)

    ...will businesses be allowed to buy into the public plan?

    That is how you get it up and running, by allowing it to compete with private insurers in the business market.  If employers will get more for less with the public option, they should be allowed to buy into it.

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

    by DawnG on Tue May 05, 2009 at 12:10:51 PM PDT

    •  yes! (5+ / 0-)
      Recommended by:
      ferg, DawnG, askew, TooFolkGR, Populista

      Another bit of details that most folks don't know. Business could choose just like individuals. But, if a business chooses not to offer coverage, we hope they would have to pay a fee to share the responsibility and help finance coverage for everyone.

      •  that would be awesome. (n/t) (1+ / 0-)
        Recommended by:
        Jason Rosenbaum

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

        by DawnG on Tue May 05, 2009 at 12:37:37 PM PDT

        [ Parent ]

      •  i would let them off the hook completely (0+ / 0-)

        as part of a grand bargain to get them on board for the public option and eventually single-payer or socialized.

        however, the one chunk of money they should have to pony up is the amount they currently pay in to cover each employee.  that's the hidden cost that people don't see on their paycheck. we should have them list it on paystubs, and if they decide to opt out of providing a company plan, that money should go into the employees' pockets.  they'd still come out ahead as they would be free of the crazy premium escalations, not to mention the headache of dealing with sick and pissed-off employees.

        l'homme est né libre, et partout il est dans les fers

        by zeke L on Tue May 05, 2009 at 01:07:15 PM PDT

        [ Parent ]

  •  i'm too pissed (6+ / 0-)

    not to freak out.

    at this point, i do not trust anyone to come up with a plan that doesn't screw us, so i can't even sit still enough to analyze your claims.

    i want a single payer, public option and i do not think we should be talking about compromise before we even have a good plan on the table.

    what is wrong with everyone?  build the best and then propose it and then we can talk compromises from there.

    Geithner + Summers = EPIC FAIL

    by fernan47 on Tue May 05, 2009 at 12:15:34 PM PDT

  •  Your first point contradicts itself (6+ / 0-)
    Recommended by:
    eugene, jxg, mrkvica, Superpole, timba, jamesia

    Where do you think subsidies come from, some magic cornucopia of money from heavan? They come from taxpayers. They are by definition an appropriation from the government.

    So your entire thesis on this point at least holds no water at all. Schumer said no government money. Therefore under his model there can be no subsidies.

  •  Public option can't be a dump for the sickest (10+ / 0-)

    The insurance companies won't rest until they believe the "public option" will be an uncompetitive, unaffordable dumping ground for the very sickest Americans. They don't want those customers. They are the bane of for-profit health insurance; by definition, they get back more than they put in. Dumping those customers on the United States government would be a dream come true.

    In fact, there is no way to insure all Americans without forcing two key regulations on private insurers. First, they must insure everybody; second, they must charge everybody the same premiums, regardless of health.

    Without these changes, private insurers will continue to refuse insurance to sick people and refuse treatments to newly-sick customers. They will continue to rip off the healthy while kicking the sick in the ass. And they'll continue to burn 30% of their profits in "administration," trying to find every which way to get rid of sick customers and avoid paying claims.

    Any member of Congress who is worried about the "unfair advantages" of a public plan is simply not on our side. We want the public plan to have every advantage possible. We want it to be the best, most affordable, most comprehensive, most universal plan possible. Private industry is welcome to out-compete the government using the advantages of private industry. If they can't, good riddance to bad trash. I won't weep for jobs predicated upon the negligent murder of the sick.

    This is a once-in-a-lifetime opportunity. For-profit health insurance has destroyed our medical ethics and warped our whole helath-care system beyond belief, to the point where we pay twice as much as the rest of the world for third world care.

    A crippled public plan is not the answer and Schumer is nobody's friend at the moment. Without guaranteed insurability and community rating in every insurance plan in America, nobody wins anything and nothing changes. Here's hoping Obama does not intend to outsource his whole health care policy-making apparatus to the biggest blowhard in the Senate. I doubt he does. Schumer is probably just the good cop in this kabuki.

    We don't see things as they are, we see them as we are. - Anaïs Nin

    by Valentine on Tue May 05, 2009 at 12:28:26 PM PDT

    •  see above (2+ / 0-)
      Recommended by:
      neroden, chicago jeff

      Subsidies for those who take on the sick in effect even out the premiums, and accepting everyone would be the law. So yes, this is crucial, and it's taken into account.

    •  I still have mixed feelings on this (2+ / 0-)
      Recommended by:
      Losty, Taunter

      First, they must insure everybody; second, they must charge everybody the same premiums, regardless of health.

      As a type 1 diabetic, an illness that cannot be caused nor prevented in any way, by any action or lack of action, I am certainly sympathetic to this idea.  What I pay each month just to stay alive is staggering.  (I'm self-employed, so I have to rely on Blue Cross/Blue Shield of Michigan, the "insurer of last resort", which has such horrible coverage I sometimes think I'd be better off financially just paying for everything myself.)  

      But on the other hand... you're still saying that if you're a healthy guy who stays in great shape, eats well, doesn't smoke, exercises, and has zero health problems, you have to pay the same insurance rates as a heavy drinker, chain smoker, morbidly obese man who's unwilling to make any lifestyle changes, and has a whole host of illnesses?  That's a really, really tough sell, at least to those who are staying in shape, eating well, and don't have any health problems.  

      "Don't hope for a stronger America. Vote for one." - John McCain. And I did!

      by cartwrightdale on Tue May 05, 2009 at 12:47:31 PM PDT

      [ Parent ]

      •  good point but i disagree. (2+ / 0-)
        Recommended by:
        SarahLee, mrkvica

        being unhealthy is uncomfortable; and being sick is often a matter of luck.  health insurance premiums are a terribly ineffective way to modify behavior with a few exceptions.  

        under the current system, most people who take care of themselves are not doing it in response to economic incentives; that's unlikely to change.

        They tortured people to get false confessions to dupe us into invading Iraq.

        by chicago jeff on Tue May 05, 2009 at 01:28:01 PM PDT

        [ Parent ]

    •  25% of all jobs < 1 yr (7+ / 0-)

      You don;t have to worry about a candidate pool for the public health plan.  25% of all jobs last less than 1 year (NY Times, 2006).  Lots of uninsured working folks out there.

      •  Add in small businessmen (3+ / 0-)
        Recommended by:
        ferg, Losty, Jason Rosenbaum

        Every business which is currently stuck on a small-group plan, and the sole proprietors stuck in the individual insurance market, and the businesses currently offering no insurance -- small businesses are basically priced out of health insurance right now, and nearly every one in the country will jump into the public option.

        -5.63, -8.10. Learn about Duverger's Law.

        by neroden on Tue May 05, 2009 at 01:03:39 PM PDT

        [ Parent ]

    •  Health (0+ / 0-)

      Why would you assume:

      second, they must charge everybody the same premiums, regardless of health.

      That doesn't make a huge amount of sense.  People have different risk profiles.  The point of insurance is to save someone the lump-sum impact of a health problem by smoothing expenditures over his life and pooling his risks with others to avoid deviations from expected value, not have the healthy subsidize the unhealthy.  Otherwise you are assuming the healthy are dramatically more risk-averse than the unhealthy.

      Charging everyone the same health care premium is a bit like charging everyone the same flood insurance premium when some folks are on high ground and some are not.

      •  maybe not. (2+ / 0-)
        Recommended by:
        mrkvica, churchylafemme

        you describe why a relatively wealthy person might want insurance (cash flow management, hedge against inflation); that's completely irrelevant and useless for most people who's medical expenses -- if they're seriously ill -- will almost certainly outweigh their personal lifetime contribution.

        that's the "cancer care or transplant for a few but not for most" plan.

        alternatively,
        instead of smoothing out costs for an individual across time, health insurance for average people smooths out the expense across a population.  those with overwhelming need get the appropriate care; the majority who are lucky enough not to have a huge bill ... benefit from the knowledge that if their luck changes, they won't die or suffer needlessly for lack of money.

        in this model, many people don't get back what they put in, many get more, but either way, those who need it get what they need.

        They tortured people to get false confessions to dupe us into invading Iraq.

        by chicago jeff on Tue May 05, 2009 at 01:39:32 PM PDT

        [ Parent ]

        •  Expected value (1+ / 0-)
          Recommended by:
          chicago jeff

          At any point in time, you have a certain expected value of medical care going forward.  There is a probability you will get cancer, a probability you will need a transplant, a probability you will die peacefully in your sleep at 104 having never seen the inside of a hospital and surrounded by loved ones (the outcome I wish for you, me, and everyone else).

          Your actual expenses will differ from your expected value.

          Insurance charges you the expected value in regular installments, and the pool effect handles the deviation between your particular run of luck and what many people in similar circumstances will experience.

          It is absolutely untrue - indeed, it cannot be true - that most people's expenses outweigh their contributions, unless you assume that the few whose contributions do not outweigh their expenses massively, massively subsidize the system.  Think it through - if I consume more than I put in, and you consume more than you put in, how does the system ever balance?

          If a plan - government or otherwise - charges you dramatically more than your personal expected value, you should find a cheaper plan, and it would make sense for a private company to offer one to you and others with the same risk profile.  So making a system work requires some ability to segment insurance costs so a 22 year-old vegetarian athlete isn't paying the same as a 55 year-old chain smoking miner.

          •  i think you're missing the point. (2+ / 0-)
            Recommended by:
            mrkvica, churchylafemme

            "insurance" means different things to different people and, as a matter of choice/policy, can be designed to meet different objectives.  if, as a matter of choice/policy, your aim is to avoid ever shifting costs across individuals (really, in our current system it's a mix of individuals, families, and employers)... then your definition and model of "what insurance is and how it should work" makes sense.  that's not what most people want however and it's not what any of the reform plans are designed to do.

            for most people, insurance isn't intended to be a fancy savings plan that only returns your money (or most of it) under a byzantine set of rules.  it's intended to pool risk and access to health care among larger numbers of people so that it can be redistributed more efficiently.  (of course efficiency means different things to different people -- but for most people there's a desire to distribute health care (1) according to what they can pay for and (2) humanely according to what they really need -- and there's some tension there.)

            insurers and wealthy folks loooooooooooove your way of "defining" insurance because it opens up a lot of ways to extract profit and minimize what they might contribute to others "by mistake."  

            They tortured people to get false confessions to dupe us into invading Iraq.

            by chicago jeff on Tue May 05, 2009 at 02:15:22 PM PDT

            [ Parent ]

            •  Points missed and "most people" (1+ / 0-)
              Recommended by:
              chicago jeff

              I'm not sure "most people" ever give much thought to how insurance works.  But they see it every day.

              When middle-aged women with clean driving records get lower car insurance rates than seventeen year old boys with reckless driving convictions, they are seeing the definition I am using.

              When the guy who lives next to the fire station in a fancy neighborhood gets lower homeowner's insurance rates than the guy who lives twenty miles from town, he is seeing the definition I am using.

              People are risk averse.  Any risk that can be diversified makes for an insurance market (risks that cannot be diversified, such as California earthquakes, Mississippi floods, Florida hurricanes do not lend themselves to functioning insurance markets).

              As with any process of taking risk, there will be different outcomes for a given expected value (flipping a coin ten times will not necessarily lead to five heads and five tails).  However, I don't think "most people" would sign up for a system they expected to redistribute wealth away from them (beyond a small factor for their risk aversion) and call that "insurance"; they would call that a transfer payment or a tax.

              It stands to reason that a market would develop where similar risks would be pooled.  If you offer one national car insurance pool at charge A, I can offer B (a number less than A) only to middle-aged women; they will sign up, because it is cheaper for them, and I will make money, because my pool will have fewer claims than yours.  So in a mature market, we will each segment our pools to come up with the prices that most closely reflect the expected value of a given person.

              There is nothing wrong with doing this for health insurance.  What is wrong is a system that runs all health insurance through employers, so individuals cannot join the appropriate pool without a job and fall out of it upon unemployment.  A public plan would solve this problem, and its lower administrative costs and lack of a profit target would allow it to undercut the private option for any given pool..

              •  for most people, insurance doesn't pay... (0+ / 0-)

                not in your sense. yet they sign up for it.
                risk, for most people, isn't purely economic -- it's also about life/death.  Insurance isn't "rational" economically (do the math) for most people.  But they're afraid of dying.  

                Your model, that makes smaller pools in order to avoid the perception of redistribution, actually increases the risk of dying due to undercoverage as compared to a model with larger pools that redistribute based on need rather than chance (i.e. beating the actuarial odds).  

                You are right that people generally avoid giving away money; that's what mandates, regulation, and taxes take care of.  

                The reason insurance companies are despised right now is because they find it more profitable to cater to those who can pay more into the system and take less out.  Unfortunately, that really hurts people who have less market power.  

                It's a great business model but it doesn't really serve the interests of most people.  That's what we're seeking to change.

                They tortured people to get false confessions to dupe us into invading Iraq.

                by chicago jeff on Tue May 05, 2009 at 04:59:30 PM PDT

                [ Parent ]

                •  "Most people" (1+ / 0-)
                  Recommended by:
                  chicago jeff

                  I don't think we are seeing eye to eye on the math here.

                  People are risk averse.  So many would accept a guaranteed 49 cents versus a coin toss for a dollar (expected value: 50 cents).  That doesn't mean they are economically irrational; it means they value the certainty at greater than one cent.

                  I absolutely agree that people are very afraid of dying, which is why health care is not a true market and a la carte medical pricing makes such little sense.  But all the same, there is an aggregate amount of health care spending, and there needs to be some way to split that up.  You could split it evenly per person (a self-contained national plan with one price), split it in proportion to current income (no premium and all expenditures from tax revenue), or some combination of pricing by risk and government subsidies for people requiring assistance.

                  I go for the third, which I believe gives people a direct financial incentive in minimizing their risk, creates a viable public plan, and still provides open access.  It seems you think I am wrong, and I can understand having different preferences.  But I would hope we could agree that insurance pricing can be done very rationally.

              •  No (2+ / 0-)
                Recommended by:
                churchylafemme, chicago jeff

                What is also wrong is that sick people, older people and people deemed at risk cannot afford what the market offers.

                This past year I have been paying $876/mo just for myself. I consider myself very lucky in that I have been able to scrape it up and still be housed and fed; many, many people cannot.

                The whole point is that we want everyone to get health care, isn't it?

                "There -- it's -- you know, one of the hardest parts of my job is to connect Iraq to the war on terror." --GWB

                by denise b on Tue May 05, 2009 at 06:19:56 PM PDT

                [ Parent ]

                •  Sure (0+ / 0-)

                  Who do you want to pay for it?

                  Do you want it to be one-size-fits-all, or do you want people to pay differently based on their risk characteristics?

                  Doesn't mean we can't subsidize the plans for people who qualify for government assistance.

                  •  I want one-size-fits-all (0+ / 0-)

                    Isn't that the way the rest of the world does it?

                    "There -- it's -- you know, one of the hardest parts of my job is to connect Iraq to the war on terror." --GWB

                    by denise b on Tue May 05, 2009 at 08:42:08 PM PDT

                    [ Parent ]

                    •  No (0+ / 0-)

                      There is plenty of variation around the globe.  France has a one-size-fits-all basic plan plus private supplemental coverage.  The Netherlands has heavily regulated private coverage with government subsidies to consumers (there are several tiers of coverage) plus a government-provided catastrophic plan.  The UK has a state-run medical system with doctors as government employees, plus an entirely parallel system of private doctors not covered by the general funding process (I don't recommend this model).

                      I want some level of coverage to be available to all people.  I don't think it has to be the same for everyone, I don't think it has to be priced the same for all people, and I don't think it has to require people to give up private plans.  It is, however, probably necessary for everyone to purchase a basic plan.

          •  This is what we have now (1+ / 0-)
            Recommended by:
            churchylafemme

            Do you not have a problem with it?

            "There -- it's -- you know, one of the hardest parts of my job is to connect Iraq to the war on terror." --GWB

            by denise b on Tue May 05, 2009 at 06:12:42 PM PDT

            [ Parent ]

            •  Not exactly (0+ / 0-)

              We don't have a public option that offers a pool for everyone, is independent of job status, and uses its bargaining power to drive down costs.  We don't have a public option that allows us to provide an insurance subsidy/discount/rebate for poor people without getting gouged by a private company's overhead and rate of return.

              Apart from that, yeah, the current system is wonderful.

      •  The point of universal care (1+ / 0-)
        Recommended by:
        churchylafemme

        conflicts with the point of insurance. Which do you want?

        "There -- it's -- you know, one of the hardest parts of my job is to connect Iraq to the war on terror." --GWB

        by denise b on Tue May 05, 2009 at 06:10:39 PM PDT

        [ Parent ]

  •  Schumer's plan appears to be okay (2+ / 0-)
    Recommended by:
    Jason Rosenbaum, Taunter

    There doesn't seem to be anything wrong with it.  Yes, it helps subsidize private insurance, but that's okay if the Public insurance gets subsidized as well.  We can't be anti-business for the sake of being anti-business.  There are compromises that have to be made and therefore Schumer's ideas don't seem that bad in the grand scheme of things.  

    •  What kind of health insurance do YOU have? (4+ / 0-)
      Recommended by:
      wsexson, bigchin, jamesia, fool mee once

      I get the strong sense that the pro-Schumer posters here have not had direct dealings with the health insurers. Come to California and see what it's like in the trenches. Schumer is screwing us.

      •  i have personal experience with insurers and (0+ / 0-)

        i'd be happier with the Schumer model.
        the public plan is likely to be less expensive (govt. healthcare is more efficient) and it will be subsidized.

        i trust government more than i do insurers (i get the strong sense that anti-schumer posters have not had direct dealings with private health insurers. come to illinois and see what it's like in the trenches ... ).

        They tortured people to get false confessions to dupe us into invading Iraq.

        by chicago jeff on Tue May 05, 2009 at 01:45:16 PM PDT

        [ Parent ]

        •  what are you saying? (0+ / 0-)

          i trust government more than i do insurers

          check

          the public plan is likely to be less expensive (govt. healthcare is more efficient)

          check

          i'd be happier with the Schumer model.

          this does not compute

          read this one:

          http://www.dailykos.com/...

          •  i love slinkerwink but that (1+ / 0-)
            Recommended by:
            Jason Rosenbaum

            diary was short on logic/support.
            not saying she's wrong but her diary was more ventilation than argument.

            there are a number of places in her diary where she clearly misread her sources.

            ****

            there's absolutely nothing in the schumer model that's incompatible with the hybrid plans espoused by clinton, obama, edwards for the last two years.

            of course you can rig any plan to be good or bad (even single payer) but the problem wouldn't be what schumer actually said--it would be in the details, or not.

            They tortured people to get false confessions to dupe us into invading Iraq.

            by chicago jeff on Tue May 05, 2009 at 04:44:06 PM PDT

            [ Parent ]

            •  all right (0+ / 0-)

              I hope you're right, but Schumer is a dishonest bastard - that much fact proven time and again by contrasting his media-hog public statements followed by his contradictory backroom backstabbing.

              What makes you think this is any different from Alito, Mukasey, the US Attorney scandal and his various other disingenous treachery?

              Just as your cat mercilessly kills gophers, the health insurers, by their nature, are predisposed to cheat us, kill us, and wreck our economy. Allowing them control of something that every last citizen requires is insane. They're like a cancer - kill them or they kill you. Schumer has his health care plan taken care of (he has the plan Obama promised us and which Schumer seeks to withhold from us).

      •  Two things (1+ / 0-)
        Recommended by:
        stella0710

        I live in California and I have at this moment, no health insurance.  I'm just speaking from a non-emotional standpoint, which is how these things should be judged.

        •  that says it all (6+ / 0-)

          I live in California and I have at this moment, no health insurance.  

          I live in California and am paying $450 a month for COBRA which is running out. I can't get private health insurance although I have never had any serious disease, don't smoke, etc. etc.

          If they would give me insurance, it would be crappy insurance for more than $450 a month, but I can't even get that because I'm borderline anemic. The condition hasn't changed for 19 years and I have a letter from a hematologist stating that it's non-pathological.

          Still no insurance. And my story pales in comparison to the horror stories out there. If I had one cruise missile and the locations of Bin Laden and the Blue Cross boardroom ... it would be an easy choice.

    •  As a pie in the sky "We're going to Mars" idea (1+ / 0-)
      Recommended by:
      SarahLee

      sure it sounds great. But someone needs to show me the numbers for how this works. The devil, as always, is in the details, and without numbers, this idea is meaningless.

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

      by kovie on Tue May 05, 2009 at 01:23:04 PM PDT

      [ Parent ]

      •  here are numbers from the levin group (2+ / 0-)
        Recommended by:
        askew, kovie

        by way of ezra klein:

        9% is one estimate of how much lower a public plan's premiums can be without bargaining power.  tying it to medicare's rates lead to a 32% savings.

        link

        They tortured people to get false confessions to dupe us into invading Iraq.

        by chicago jeff on Tue May 05, 2009 at 01:57:26 PM PDT

        [ Parent ]

    •  Sorry, having providers and hospitals able to (1+ / 0-)
      Recommended by:
      churchylafemme

      opt out of a system is a showstopper for me.

      The HMOs would require hospitals to boycott the public plan if they wanted HMO participation.

      This has to be highly regulated.  If I buy a public plan option, I want to know that I can find providers in that system.

      Give every American a fair chance at the race of life - A. Lincoln and B. Obama

      by captainlaser on Tue May 05, 2009 at 06:05:21 PM PDT

      [ Parent ]

  •  Don't freak out... just bend over!!! (7+ / 0-)

    Schumer and his Healthcare Lobby buddies are coming for ya'!

    God told me he's never spoken to Miss California about hatin' teh gay... the bleach must've gotten to her opposite brain.

    by Dems 2008 on Tue May 05, 2009 at 12:39:18 PM PDT

  •  Why the hell are people paying premiums on this (11+ / 0-)

    proposed public plan?  It should be free for the user and paid for by taxes.  Anything else is a bullshit scam because it excludes the most vulnerable in our society: the people who can't afford to pay.  You know, the people that are in the most desperate need of health care reform.

    We don't need "public health insurance."

    We need public healthcare for everyone.  Especially for the people that can't afford to pay.

    Between excessive citizen activism and excessive trust or passivity, the former is far preferable to the latter. - Glenn Greenwald

    by An Affirming Flame on Tue May 05, 2009 at 12:41:57 PM PDT

    •  no (2+ / 0-)
      Recommended by:
      askew, TrueBlueDem

      People should pay what they can afford, with premiums set or subsidized on a sliding scale based on income. That means for some, it will indeed be free. But for most, we'll have to share the responsibility, too.

      •  Right (3+ / 0-)
        Recommended by:
        ferg, TrueBlueDem, Jason Rosenbaum

        I sell no reason that people making six figure salaries should also get a 100% free system.  We do have to be able to pay for it, after all.  :)  As long as it's a reasonable sliding scale, I think people will be okay with it.  The alternative would be to raise taxes on the same scale to cover the costs, but I think that will FEEL worse, even if dollar for dollar its the same.

        "Don't hope for a stronger America. Vote for one." - John McCain. And I did!

        by cartwrightdale on Tue May 05, 2009 at 12:49:21 PM PDT

        [ Parent ]

        •  What is the difference? (2+ / 0-)

          Everyone pays through taxes according to his income, THEN it's free.

          "There -- it's -- you know, one of the hardest parts of my job is to connect Iraq to the war on terror." --GWB

          by denise b on Tue May 05, 2009 at 06:26:13 PM PDT

          [ Parent ]

          •  Just the perception (0+ / 0-)

            You're right there's no practical difference.  We need to figure how much it would cost to have a public health care system, and then how to pay for it.  One way might be to have the 100k guy pay 10k more a year in taxes than the 20k guy.  Another way might be to have the 100k guy pay 10k more a year in premiums than the 20k guy.  At the end of the day, it's the same, so which way is going to SEEM better.

            "Don't hope for a stronger America. Vote for one." - John McCain. And I did!

            by cartwrightdale on Tue May 05, 2009 at 06:40:43 PM PDT

            [ Parent ]

      •  No, it's about taxes. (16+ / 0-)

        Those who can pay, share their responsibility through their taxes.  The richer pay more.  A lot more.

        And everyone gets health care for free, from the cradle to the grave.

        Between excessive citizen activism and excessive trust or passivity, the former is far preferable to the latter. - Glenn Greenwald

        by An Affirming Flame on Tue May 05, 2009 at 12:51:16 PM PDT

        [ Parent ]

        •  Blech. Reeks of abuse (0+ / 0-)

          Every idiot with the sniffles will be in the doctor's office 3 times a week. No thanks. People who can afford to contribute must pay a premium and co-pay that increases with income to share responsibility for the system. Below a certain income floor, yes, make it free.

          (-2.38, -3.28) Independent thinker

          by TrueBlueDem on Tue May 05, 2009 at 01:23:38 PM PDT

          [ Parent ]

          •  That is a feature of the system, not a bug. (9+ / 0-)

            When people actually go to the doctor when they feel sick, that helps with prevention of serious illness.  Or at least the early treatment of disease.

            That saves everyone more money in the long run as it leads to a healthier population with less far advanced diseases suddenly needing to be treated.

            Besides, if someone is really such a hypochondriac that they're wasting the doctor's time, the doctor will be able to refer them to a free therapist to work on the problem.  :-)

            Between excessive citizen activism and excessive trust or passivity, the former is far preferable to the latter. - Glenn Greenwald

            by An Affirming Flame on Tue May 05, 2009 at 01:37:18 PM PDT

            [ Parent ]

            •  P.S. We, as Americans with our broken system, (7+ / 0-)

              are so used to rationing our own health care, that we unfortunately do see more doctor visits as abuse.  At first, that is.

              The more we learn about and get used to the idea of single-payer, the less we will see more treatment as abuse.

              Between excessive citizen activism and excessive trust or passivity, the former is far preferable to the latter. - Glenn Greenwald

              by An Affirming Flame on Tue May 05, 2009 at 01:40:40 PM PDT

              [ Parent ]

            •  Nothing is free (0+ / 0-)

              All the doctor visits racked up by hypochondriacs, besides creating longer waits for patients who are actually sick (thus nullifying much of the supposed benefit) also mean more frivolous bills to the government and less money to education, energy, and every other initiative.

              Having worked in a hospital for 3 years, I can report the "fuck it, it's free" mentality is alive and well. Institute a small co-pay for people making more than $X a year and watch the chicken soup sales soar.

              There is a HUGE difference between free and cost-prohibitive. If patient fees are geared specifically to their particular income, the decision is no longer "doctor or food?" but "doctor or new jeans?", which is a deterrent only to the multitude of bullshit artists who know they're fine.  

              (-2.38, -3.28) Independent thinker

              by TrueBlueDem on Tue May 05, 2009 at 01:52:31 PM PDT

              [ Parent ]

          •  For every person (2+ / 0-)

            who goes to the doctor too often, there are probably 10 who don't go when they should. And people who go too often are anxious and looking for reassurance; they can be educated or perhaps their anxieties helped. People don't go to the doctor for fun unless they have a real problem.

            "There -- it's -- you know, one of the hardest parts of my job is to connect Iraq to the war on terror." --GWB

            by denise b on Tue May 05, 2009 at 06:29:41 PM PDT

            [ Parent ]

      •  That's what your taxes do. (3+ / 0-)

        You pay taxes proportionally to your income.  You should take the health care premiums out of taxes.  Then you don't have to set up a separate billing system with all the overhead involved.  Employers would pay a proportional amount from payroll taxes.

        Give every American a fair chance at the race of life - A. Lincoln and B. Obama

        by captainlaser on Tue May 05, 2009 at 06:07:53 PM PDT

        [ Parent ]

      •  What is the difference (3+ / 0-)

        between paying a premium and getting subsidized through tax money, and paying a tax? Six of one, except paying the tax is much simpler.

        "There -- it's -- you know, one of the hardest parts of my job is to connect Iraq to the war on terror." --GWB

        by denise b on Tue May 05, 2009 at 06:23:06 PM PDT

        [ Parent ]

      •  What part of (1+ / 0-)
        Recommended by:
        An Affirming Flame

        "no government subsidies" you don't understand... Schumer is fairly clear on that point.

        AAC: Support local arts

        by jamesia on Tue May 05, 2009 at 06:55:49 PM PDT

        [ Parent ]

  •  You can take single-payer off the table (8+ / 0-)

    But that doesn't fundamentally change peoples understanding of what reform means and their goals, benefits, and expectations of change.

    The public option will only have public support if it is something that is or can evolve into their measure of true authentic reform.  

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

    by kck on Tue May 05, 2009 at 12:46:07 PM PDT

  •  It should provide a doorway to single payer (2+ / 0-)
    Recommended by:
    lightfoot, RustyCannon

    as it drives the public options out of buisness.

    That's all I care about.

    ---
    Fight the stupid! Boycott BREAKING diaries!

    by VelvetElvis on Tue May 05, 2009 at 12:50:56 PM PDT

  •  stop drinking the kool-aid (7+ / 0-)

    Schumer is screwing us - just as he did on Mukasey, Alito, US Attorney, et al.

    The diarist and his supporters need to get come to California and try to get private health insurance. The bottom line is that if you work for a company that gives you health insurance then you have NO FREAKING IDEA how bad it is.

    Obama, Hillary and Kerry all ran on the same platform:

    "You will have access to the same public plan health insurance that members of congress have."

    Schumer and his sleazy pals are pulling the rug out from under us and you people are helping him. Get on the god damned phone and light a fire under the asses of Schumer and Obama before it's too late.

  •  The government should not compel doctors and (2+ / 0-)
    Recommended by:
    annrose, k9disc

    hospitals to participate.

    WEAK. this is a deal breaker.

    so what's the point of having this plan if only the bottom feeder doctors and hospitals are going to participate?

    forget it. just expand Medicare benefits for those who are uninsured- as many here have recommended. let's not pretend we're going to get a REAL national health care plan from our House of Lords.

    The bank bailouts are a failure. Robert Reich

    by Superpole on Tue May 05, 2009 at 12:53:13 PM PDT

  •  Pff (1+ / 0-)
    Recommended by:
    mrkvica

    So how are subsidies self sustaining? Sounds like double talk to me.

    Private small practices maybe should not be forced to accept public option patients but PUBLIC institutions like hospitals should, if not close any public funding/tax incentive they receive.

  •  Shumer's plan sounds like a Health Care Coop (1+ / 0-)
    Recommended by:
    neroden

    ... a non-profit, consumer-owned enterprise, along the lines of Seattle's GHC or Kaiser.

    This may the the most feasible option in the current political climate. I, for one, do not believe that a majority in Congress constitutes total political power. It's just one piece on the political chess board.

    The investors who own the private health care industry are wealthy and politically influential. If we threaten the value of their portfolios, by taking away their customers, they will fight ruthlessly to stop us.

    All it took last time was one "Harry and Louise" commercial.

    However, if we give them fair warning, demonstrate our determination to change the system and give them time to shift their wealth into other investments, many will choose to cut and run rather than fight.

    We can punish the corporate parasites, or we can provide health care to more of the people who need it. Trying to do both with be very very difficult.

    BushCheney Inc. - They lied to me, they lied to you, they lied to our troops.

    by jjohnjj on Tue May 05, 2009 at 01:04:59 PM PDT

  •  Only problem is #2 (4+ / 0-)
    Recommended by:
    Habitat Vic, ezdidit, RustyCannon, Losty

    There is no reason for the plan to be anything other than Medicare.  

    The argument set forth is that because someone thinks it is too difficult to explain an expansion of Medicare to seniors, the proper solution is to have two Medicares (MedicareOld and MedicareYoung) that operate completely independently.  And to assume, for no reason whatsoever, that MedicareYoung should pay higher reimbursement rates than MedicareOld.

    Run one Medicare and take advantage of the greater buying power to drive down reimbursement rates and overhead.

    •  to drive down reimbursement rates and overhead... (2+ / 0-)
      Recommended by:
      SarahLee, Losty

      amen, Taunter, but I go further.

      ...defund and unman the greed.

      One plan would suit everybody just fine!

      Medicare for all, and everybody get on line.

      Raise the tax rates on the wealthiest two per cent of Americans to pay for it! How much $$$ is in the pool from corporations already? They'll love this!

      If you have $$$ billions, or even just a few million $$$ and you want to pay for your own health care, fine. But I get dibs on line for knee replacements from your surgeon just like everybody else.

      And for God's sake, MAKE EVERY DOCTOR AND EVERY HOSPITAL JOIN. Private doctors are just like private cops or a private military: they serve one paymaster.

      Just don't have a Senator, my NY senator, piss on me and tell me it's raining. He has been a full of crap dollarDem just like his protege A. Weiner since he got into office.

      Anything for campaign contributions!

      First they ignore you. Then they laugh at you. Then they fight you. Then you win. -M.Gandhi (see also, Republican strategy)

      by ezdidit on Tue May 05, 2009 at 01:48:31 PM PDT

      [ Parent ]

      •  Why mandatory sign-up? (2+ / 0-)
        Recommended by:
        ezdidit, Jason Rosenbaum

        Medicare itself is not mandatory for doctors.  They are free to charge whatever prices they wish and accept whatever insurance they wish, or no insurance at all.

        If a doctor would like to withhold his services, I don't see why anyone should make him do anything.  I don't have to work for wages I don't like, and you probably don't either.  Why should doctors?

        Of course, most doctors do not have the pricing power or addressable market to stay out of the insurance system.  And for the folks who want to play ball, well, Medicare should drive a hard bargain.

        •  Don't be soft on crime. (0+ / 0-)

          Medicine is a license to steal practice just like any other certification. Make doctors accountable by making them Federal employees, just like any other vital service performed in 43 other nations that have national health care plans.

          This one's way too important to miss. (I warned you: I go further.)

          First they ignore you. Then they laugh at you. Then they fight you. Then you win. -M.Gandhi (see also, Republican strategy)

          by ezdidit on Tue May 05, 2009 at 02:04:03 PM PDT

          [ Parent ]

          •  Going further (0+ / 0-)

            You do go a lot further.  

            I think compulsory service goes against our bedrock principles, and I think the adverse selection we would face in the medical profession would be appalling.  I also happen to think the productivity loss that comes from moving to a wage model from a sole proprietorship/small partnership model would be horrendous and completely unneccessary.  

            A strong national health insurance system provides all the access and cost control we need.

            •  The total fallacy of our lost freedoms. (0+ / 0-)

              you said

              ...the productivity loss that comes from moving to a wage model from a sole proprietorship/small partnership model would be horrendous and completely unneccessary.

               

              The fallacy of the profit motive to counter what you warn as a productivity loss leads to all kinds of contradictions.

              If my doctor could earn a salary of $150,000 per year, he'd be much better off working an eight-hour day with two days off. If he was part of a small group of physicians with varied specialties, his patients, mostly in their fifties and sixties would get more expert service.

              For instance, he's under a great deal of pressure to see as many patients as he can, so his service to me has been questionable. (He prescribed Crestor that's linked to rabdomyolisis when Lipitor is safer for me & just as effective for my mildly elevated cholesterol, and he actually prescribed Celebrex for me - a drug linked to  cardiac risk - when all I needed was Advil, albeit a stronger dose.) He's an excellent gastro-enterologist, but he gladly changed both prescriptions after I did a little investigation and voiced objections of my own.

              That is just my take, and there are millions more to debunk the notion that the profit motive yields greater efficiency. I'd argue that the contrary is true as far as quality and efficiency of medical service is concerned.

              Plus, Federal employees would be insured against malpractice lawsuits. And the current sham medical boards would have to be re-certified as accrediting authorities accountable to Federal standards.

              First they ignore you. Then they laugh at you. Then they fight you. Then you win. -M.Gandhi (see also, Republican strategy)

              by ezdidit on Tue May 05, 2009 at 06:47:11 PM PDT

              [ Parent ]

              •  Reality (0+ / 0-)

                The fact remains that there have been plenty of attempts to organize doctors as employees over the past century - the HMO, for example - and doctors have consistently resisted it.  They prefer working for themselves, even at the cost of longer hours and the drudgery of managing a business.  It's a choice.  Let them make it.

          •  I never like compulsion (1+ / 0-)
            Recommended by:
            Taunter

            I favor expedited licensing of foreign doctors in areas with lower participation rates.

            •  Only one problem (0+ / 0-)

              We aren't China; we don't have internal migration controls.  We are reluctant to have separate visas for North Dakota and Florida.

              •  "we aren't China" and the "HMO" mention... (0+ / 0-)

                These are weak straw man arguments in the face of critical costs that threaten American lives. The gravity of the situation requires immediate, deliberate, and remedial action. - not straw man objections and half-loaf compromises that support leftover Reagan policies that are killing people.

                Consider how those who are yet to come will view excuses for the sake of profit and greed in the face of such mortal urgency.

                Have you lost your perspective? Why do we find it reasonable to debate what compromise legislation Congress will be 'able to pass' when the need is so great, the cost is so critical to the rest of the economy - and the solutions - are so obvious?

                First they ignore you. Then they laugh at you. Then they fight you. Then you win. -M.Gandhi (see also, Republican strategy)

                by ezdidit on Wed May 06, 2009 at 09:10:25 AM PDT

                [ Parent ]

    •  I don't see why creating another, (1+ / 0-)
      Recommended by:
      Taunter

      entirely new governmental organization is going to be cheaper than simply expanding something we already have in place, like Medicare...

      AAC: Support local arts

      by jamesia on Tue May 05, 2009 at 07:02:06 PM PDT

      [ Parent ]

  •  The diarist's PAC (10+ / 0-)

    Where are Bernie Sanders, Howard Dean, Russ Feingold,  Dennis Kucinich, etc. on their list of "Who's With Us"? Steny Hoyer's on that list though.

    http://blog.healthcareforamericanow....

    There's no mention of single payer that I can find anywhere on their site.

    Schumer has a long track record of backroom deals and back-stabbing. Anyone who's interested in bailing out the health insurance industry is thumbing his nose at the election results.

  •  NO !!! (11+ / 0-)

    single- payer ONLY.

    This is WHY we get screwed over and over. They know (being Dem's) we'll compromise and say "well okaaaay ... if that's the best they can do we'll just have to accept it"

    Enough! As Americans we deserve to have a free national healthcare plan.

    No more PROFIT on the back of the sick and dying in this country.

    I don't trust Chuck Schumer as far as I can throw him.

    When will our consciences grow so tender that we will act to prevent human misery rather than avenge it? Eleanor Roosevelt

    by IndyRobin on Tue May 05, 2009 at 01:13:02 PM PDT

    •  Where will you get the votes to pass single (4+ / 0-)

      payer? Who will sign on in the Senate, who will sign on in the House? What magical carrot or stick do you have for the Blue Dogs and ConservaDems?

      If we say "Single Payer Only!" and everyone knows we don't have the votes, that isn't a brave political stance, it's just saying what we want. And in fact it's important to keep saying what we want, where we want to end up, and keep defending that to the public to change people's thinking. But right now we're starting to look at what can actually be passed this year, in this Congress. And that means that we will have to negotiate (compromise) or get nothing.

      Moving this country to single payer is probably going to take a decade. We can't wait that long to deal with the worst of the crisis. We have to have a public option as a starting point.

      Then we have to keep pushing. We have to keep moving out the worst of the COnservadems and replacing them with progressives. People have to see that the public option works. Then we expand on that, and bring Medicare into line with its best practices. We can get to single payer. But we can't start there.

  •  Here's the problem (7+ / 0-)

    You're saying that this plan would:

    1 - Be fully self-funded from premiums and cost shares (not just co-pays, which are a form of cost shares along with coinsurance, deductibles, etc.).

    2 - Subsidize lower-income members (but not the very poor, who would be covered by Medicaid, nor disabled and those over 65, who would be covered by Medicare).

    3 - Be affordable and competitive for everyone else.

    4 - Offer decent benefits and coverage that would be comparable to a good private plan. and presumably have a decent network of PCP's and specialists (or else most people who had a choice wouldn't choose it).

    Eventually, this could be possible, with enough members of various income levels and health care needs, but I don't see how this could work without an initial large and ongoing investment, be in the form of long-term loans or outright grants, to get the plan going. Because initially, the majority of people opting for this plan would be those without insurance, who want or need insurance but either don't qualify because they're too sick or have preexisting conditions, or can't afford it--i.e. those who can pay the least into it and/or will be taking the most out of it. And there's no way that they'd be able to pay in enough to keep the plan self-funded. To get to self-funding status, higher-income and healthier people would have to join it, who'd pay in at 100% and/or utilize less than 100%, and most of them either already have decent employer-provider plans, or will choose to go without insurance, as they do now, to save money.

    I can't see how this gets off the ground without initial large subsidies, and preferably mandates that everyone have some form of health insurance. Has anyone come up with realistic projections for cost and membership numbers that show how this can be made to work without either? How does it reach critical mass?

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

    by kovie on Tue May 05, 2009 at 01:20:42 PM PDT

    •  Exactly (1+ / 0-)
      Recommended by:
      fool mee once

      Schumer's doing what he always does - trying to look as good as possible as he sets the stage for screwing us.

    •  I believe large upfront investment is the plan (1+ / 0-)
      Recommended by:
      Jason Rosenbaum

      Doesn't it only have to be "self sustaining" after 6 years?

      (-2.38, -3.28) Independent thinker

      by TrueBlueDem on Tue May 05, 2009 at 01:31:00 PM PDT

      [ Parent ]

      •  I doubt that 6 years would be enough (3+ / 0-)
        Recommended by:
        bigchin, jamesia, Jason Rosenbaum

        But if this allows for initial and ongoing subsidies to "prime the pump", then it might work and be eventually self-funding. But only either with mandates, or a plan that private insurers will absolutely hate and work furiously to defeat.

        The reality is that it's impossible to have a decent public plan that's self-funding in the long run that doesn't cut into private insurers' business, at least without mandates, because there simply not enough potential pay-in among the target group that such a plan would be most appealing to, to self-fund it.

        To work, such a plan would either have to be permanently subsidized, like Medicaid, or initially subsidized, and slowly leach away enough people from private insurers to eventually be self-funded. The former is economically untenable, and the latter appears to be politically untenable, due to the private insurance lobby.

        Something's got to give for this to work.

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

        by kovie on Tue May 05, 2009 at 01:45:21 PM PDT

        [ Parent ]

    •  Wouldn't sicker members lead to higher subsidies (0+ / 0-)

      for the public plan, relative to the private plans?

      I'm not an expert here - that's just my understanding from what I've been reading.

      "Patriotism is supporting your country all the time, and your government when it deserves it." Mark Twain, as quoted by Barack Obama 6/30/08 Independence, MO.

      by SunWolf78 on Tue May 05, 2009 at 01:46:25 PM PDT

      [ Parent ]

      •  But the requirement is that (3+ / 0-)
        Recommended by:
        slinkerwink, churchylafemme, jamesia

        there be NO subsidies (or, at least after 6 years, as someone noted above). Which can only work with enough healthier members who pay in at 100%. And the only way to make enough such people opt for this plan is to make it price-competitive with private plans. But that would be hard if not impossible to do in a self-funding plan with so many high-utililization, high cost members in it, which private insurers can and do currently screen out, to keep costs down.

        It's a catch-22: to be self-funding, you'd need LOTS of healthier members paying in at 100%, but to get that many members, you'd need to keep the price of premiums and cost shares low, which would be impossible to do up front given how many less healthy members there would be who'd cost such a plan much more than average. The only way around this would be initial subsidies, and perhaps mandates.

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

        by kovie on Tue May 05, 2009 at 01:52:45 PM PDT

        [ Parent ]

  •  But, but, but but... (3+ / 0-)
    Recommended by:
    ManhattanMan, churchylafemme, timba

    one of the great cost-savings is in eliminating paperwork and bureaucracy in health care. It seems here you're forcing the public option into the same sort of relationship that 1/3rd of all staffers in doctor's offices already have with insurance companies. In other words, where are the savings?

    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 01:23:26 PM PDT

  •  The insurance will be unaffordable (7+ / 0-)

    for those who are currently excluded from the private health insurance industry.  Even if this public insurance company could operate with 5% overhead costs (compared to 18-25% for private insurers), that wouldn't make it affordable for low income wage earners.  Add it the fact that higher risk individuals will be steered towards public insurance, and this "company" could be bankrupt within three years.

    What FDR giveth; GWB taketh away.

    by Marie on Tue May 05, 2009 at 01:28:18 PM PDT

  •  if you have to go through all this explaining (2+ / 0-)
    Recommended by:
    slinkerwink, mrkvica

    this his proposal is too weak and needs far more clarity. Thanks for making it clear, but I'm still scared and panicking.

    To the world sick with racism, poverty and greed...get well soon.

    by Cintimcmomma on Tue May 05, 2009 at 01:33:39 PM PDT

  •  Why compromise now? (8+ / 0-)

    Because Senator Ben Nelson (D-Nebraska) received over $600,000 in campaign contributions from the insurance lobby? Hey, there's good campaign money on the table!

    Jason, I said bullshit to HCAN proposals, and I mean it now--BULL SHIT!!

    Schumer should be ashamed of himself for this. This is not a public option at all. This is an option for the poor and people who go naked now. This is triage with bandaids, and you know it.

    The most profitable, most extravagantly funded scam in America is the unregulated health insurance industry and its adherents. Any proposal that does not impede the rapacious greed of the health insurance industry is just part of the same criminal conspiracy. Now, you!

    As much as 50 cents of every health care premium dollar is wasted! It goes to greedy, scheming management and luxury overhead. The only solution is socialized Christianized medicine for all.
    One program! Now!

    Schumer is just shilling for more of same. See Mukasey for specifics. HCAN sucks! And your essay doesn't even begin to address the social impacts of murder by spreadsheet.

    btw, don't freak out!

    First they ignore you. Then they laugh at you. Then they fight you. Then you win. -M.Gandhi (see also, Republican strategy)

    by ezdidit on Tue May 05, 2009 at 01:34:08 PM PDT

    •  Amen (2+ / 0-)
      Recommended by:
      AmericanRiverCanyon, ezdidit

      The most profitable, most extravagantly funded scam in America is the unregulated health insurance industry and its adherents. Any proposal that does not impede the rapacious greed of the health insurance industry is just part of the same criminal conspiracy.

      •  see -nyceve- for inspiration. (1+ / 0-)
        Recommended by:
        AmericanRiverCanyon

        We live in one of the most uncivilized nations in the world. The 'fastest gun in the West' is still hot stuff in DC. Wake them all the f**k up!

        First they ignore you. Then they laugh at you. Then they fight you. Then you win. -M.Gandhi (see also, Republican strategy)

        by ezdidit on Tue May 05, 2009 at 01:52:49 PM PDT

        [ Parent ]

    •  Tipped for... (1+ / 0-)
      Recommended by:
      ezdidit

      ..."Christianized Medicine"

    •  nice to see you refuting points (1+ / 0-)
      Recommended by:
      askew

      what exactly did schumer compromise, pray tell? I'd love to hear, because I can't find it myself.

      •  It would be too expensive & yield a second rate (0+ / 0-)

        service devoid of any of the quality amenities and services provided by most hospitals. Little more than a prison-type system and degrading comparison to the exclusive insurance-paid set-up.

        But that's exactly what you're trying to foist on the public, isn't it? A degraded system, so you can always say, "You get what you pay for."

        Sham bull shit. Scamming for dollardems. You ought to be ashamed of yourself.

        There is no way to pay for all of this compromise and create parity, no way, so the result will be a second rate (or third rate) system for the public - and that's for over 50 million Americans today!  That's fully 1/6th of our population, Jason.

        I say reform and restructure the Reagan-era ripoff health insurance companies out of existence, use their premium dollars for a world class medical system of hospitals, doctors, nurses and medical practitioners with salaries paid by a Federal system in place called MEDICARE - ANYTHING ELSE IS A CON JOB!

        There is no time to get this wrong through greasy guesswork put together by schemers strictly for the purpose of upholding greed and waste. Half of all insurance premiumn dollars is a waste!!

        Schumer's plan must be a con for campaign contributions from the health care industry. I do not understand why else he would be doing this. I won't vote for him under any circumstances now.

        After Mukasey, he was on short notice. Now, he's gone in my book. And don't think Weiner is any better. He's not. I asked him.

        Watch the Overton window here buddy. You're already out of sight and it's not 12 hours yet.

        First they ignore you. Then they laugh at you. Then they fight you. Then you win. -M.Gandhi (see also, Republican strategy)

        by ezdidit on Tue May 05, 2009 at 07:07:55 PM PDT

        [ Parent ]

  •  I would respectfully differ (7+ / 0-)

    You seem to be arguing that Medicare is a bad system, that something worse than Medicare-for-all would be an acceptable compromise. Am I reading that wrong? Would someone supporting Medicare use these as the four key points?

    The concern here is that if the public health insurance plan has to be self-sustaining, than it will have to charge unaffordable premiums to stay afloat. This isn't how it will work.

    One of the primary inefficiencies of our health insurance market is the time and effort wasted in finding a plan and paying the premiums, both for end consumers and for the employers that often act as middlemen (for the lucky employees that have coverage through work). The Medicare 'Modernization' and its related effects have created a system closer to this 'compromise'. I think we generally agree this has not been a positive development.

    The point isn't the affordability of premiums. The point is to eliminate premiums as the main funding source. The public plan shouldn't be 'subsidized' in the sense of a sliding scale for premiums. It should be subsidized in the sense that taxpayers, not consumers, pay directly for the bulk of the program. A plan funded by premiums rather than taxation is not much change; we might as well just directly subsidize the purchase of private insurance rather than creating yet another plan to market, evaluate, quote, etc. The barrier is not people believing in government insurance; people already desire this. Medicare doesn't have to run slick advertising campaigns and pay high salaries to attract people who turn 65. HR personnel at companies don't have to explain to workers the value of signing up; indeed, the biggest hassle medicare poses in the workplace is having to check the box on private insurance forms that a person is eligible.

    Doctors are not forced to accept Medicare now, so I'm not sure why we should go further with the public health insurance plan.

    I agree with you here. I'm not sure why this issue is getting mixed up with the debate about single payer. One key selling point of single payer is that it's not government-run healthcare. If individuals wish to seek separate insurance, and if providers wish to not accept the government plan (for non-emergencies, of course), I don't see any problem.

    Should the public health insurance option pay Medicare rates? Not necessarily.

    I don't know why they 'should' be higher. The rates that 'should' be are the rates as determined by the specific coverage we decide should be covered. So, the main question here is, why isn't this a three-point plan? What is the motivation for including this?

    Making a separate board to oversee the public health insurance plan makes sense. The administrators would still be government officials according to Schumer, but they wouldn't be the same people making the rules about the insurance market. I'm not sure how this is controversial.

    This is controversial to the extent that it's pointless. The pointlessness of a point suggests it's highly probable there's another motive behind the statement, or that at minimum it's a distraction. It's like saying the Social Security Administration should be separate from the people who regulate insurance or securities or debt issuance. Um, of course; it is.

    We want the government to be the player and the umpire when it comes specifically to health insurance. Government is always the umpire; that's its core function. But sometimes, being the player is also justified when it is more efficient and more equitable than private actors. The government plays to varying degrees from road construction to elections to court systems to the military. To Medicare itself, which is under the Department of Health and Human Services.

    The insurance industry has been continually lying, saying they're for reform. And yet, when a compromise comes around, they are dead set against it, and automatically reject the entire premise of a public health insurance plan, no matter how it's set up.

    I do agree with you that this doesn't appear simply to be a sellout. Obviously, the insurance industry thinks they can get a better deal than this. So, to that limited extent, it's not a bad thing.

    But it's clear that these four points were not floated by a panel of people representing public opinion. Single payer is the compromise. If the Senator thinks this is the best deal we can get politically, that's very sad. If the Senator thinks this is the best option, that's even sadder. If the Senator thinks this is what people want, he could use some new staff.

    So, in general, I'm a fan of not freaking out. It's hard to make good decisions when you're freaking out. But at the end of the day, this basically appears like another effort to distract from single payer. This is a good option if it leads to something better. Which begs the question, why not just jump to the something better?

    As far as picking four key points for an actual compromise, I'd suggest something more like this.

    1. Coverage should be universal.
    1. Most costs should be paid directly by taxpayers.
    1. People should be free to choose their own healthcare providers.
    1. Governance should function similarly to existing efforts like the Centers for Medicare and Medicaid Services or the Social Security Administration.
    •  medicare isn't bad (0+ / 0-)

      not perfect, so we should fix what we can in reform, though.

      •  I'm also wondering about (0+ / 0-)

        the ramp-up time that would be required to get a whole new public system going, compared to expanding Medicare. If we passed Schumer's plan tomorrow, how long do you think it would be before it went live?

        "There -- it's -- you know, one of the hardest parts of my job is to connect Iraq to the war on terror." --GWB

        by denise b on Tue May 05, 2009 at 07:11:32 PM PDT

        [ Parent ]

      •  so you agree Schumer isn't proposing Medicare? (0+ / 0-)

        You agree he's proposing something decidedly worse than Medicare for those under 65?

        We use tax dollars to fund the bulk of the insurance expenses at SSA and CMS. These systems work great, have low administrative costs, and enjoy widespread popularity. They are foundational to the counter-cyclical needs of volatility that exists in an economy. Beneficiaries receive their benefits regardless of whether unemployment goes up or down, whether GDP increases or decreases, whether mortgage rates are 5% or 15%. Indeed, the federal government has shown itself to be both the most efficient and the most popular insurance provider in the country.

        Schumer was explicitly clear in the NY Times piece that tax dollars should not be the main source of funding for healthcare for those under 65. It sure begs the question, why not eliminate Medicare and make this new public option apply to all ages, if it's better? If it's not better, why not have a single payer system for all ages?

        I just don't follow the defense of these principles. The last three are largely smoke screens to the core assault that is the first one. The heart of the debate is whether consumers or taxpayers should fun health insurance in this country. These principles run counter to the success of Medicare. Schumer not only opposes expanding single payer health insurance to all Americans, but he has very publicly articulated the conservative case for eliminating Medicare itself.

        That's not a middle ground, and it is worth pushing back against.

  •  OK for a compromise, not as a starting position. (4+ / 0-)
    Recommended by:
    ferg, mrkvica, polar bear, Jason Rosenbaum

    We best keep reminding Schumer that he called THIS the compromise.  Let's make sure it doesn't end up as just a starting point for a series of further capitulations.  

    It also leaves a lot of ambiguity about payment rates.  If medicare has payment-level problems, maybe those should be fixed, but I don't see a need for separate scales.  One transition-oriented proposal would be for the new public option to start at medicare +10% the first year, medicare + 9% the second year, and so on until payments are harmonized.  During that period medicare rates could also be re-examined, if necessary.

    "Patriotism is supporting your country all the time, and your government when it deserves it." Mark Twain, as quoted by Barack Obama 6/30/08 Independence, MO.

    by SunWolf78 on Tue May 05, 2009 at 01:43:45 PM PDT

    •  Starting position should be single-payer (2+ / 0-)
      Recommended by:
      ferg, polar bear

      Keep that pinned in our Representatives' and Senators' heads.  This is a suitable compromise -- but what we really want is single-payer.

      By the way, I agree with you about "Let's make sure it doesn't end up as just a starting point for a series of further capitulations."

      -5.63, -8.10. Learn about Duverger's Law.

      by neroden on Tue May 05, 2009 at 02:57:54 PM PDT

      [ Parent ]

  •  "self-sustaining" = ghetto for sick people? (5+ / 0-)

    The problem with self-sustaining is that while the public option is coexisting with private insurance it will be the health plan of last resort for those who cannot afford private or who are rejected by private.  This will increase its net costs b/c the privates can cherrypick healthy people and leave the sick ones to the public plan. If this leads to repeated needs for so-called "bailouts" of the public system it's going to create talking points for its eventual elimination.

    In short, there is a danger of ghettoizing the public plan in much the same way as Amtrak has been ghettoized by the same process.  A national public health plan, like a national passenger rail system, is a public good like roads and defense and should not be required to break even.

    Baz

  •  I don't get the rush to compromise (5+ / 0-)
    Recommended by:
    ferg, slinkerwink, Tanya, SunWolf78, slouchsock

    before any formal plan is the focus of debate.  It's as if we've already declared defeat.

    Or maybe this is mis-titled "compromise" and is instead the formal plan for general discussion.

    A government that manages your pregnancy is not limited.

    by thesunshinestateisdark on Tue May 05, 2009 at 01:43:55 PM PDT

  •  Here's the legitimate health care diary: (4+ / 1-)
    Recommended by:
    churchylafemme, ezdidit, leonard145b, HobbyWizard
    Hidden by:
    drache

    http://www.dailykos.com/...

    Enough of this HCAN doubletalk - let's hit the phones!

    •  there is plenty of room for more than one (5+ / 0-)

      opinion in the debate. They are both legitimate, as opposed to illegitimate?  what does that mean anyway. That this diary is wrong?  they are both interpretive as si the third won on the recc'd list by the nurses organisation.

      If you want to pimp a diary, fine, but it isn't any more informative than this one.

      Read them all, Compare them and read the NYT etc. articles, listen to the hearings if thet are to eb broadcast, or go to the govenment website and listen if you really want to have input instead of argument.

      Kearn to explore primary sources instead of arguing over secopnday opinion pieces.

      •  What kind of health care plan do YOU have? (0+ / 0-)

        I can tell from your tone that you - and this diarist - are insulated from the abuses of the health insurance industry. Congratulations.

        For the rest of us - it's a war here.

        •  Medicare, plus a supplemental catastrophic (2+ / 0-)
          Recommended by:
          schuylkill, drache

          AARP/United Heath policy, as does my ex husband in New York. Most of my family have New Mexico Blue Cross, I am not sure about my extended family, as one works for the State university so may be covered by a special plan. In addition my income is at the poverty level and I pretty much live on SS. Anthing else you'd like to know?

          I imagine we are all pretty much like the rest of America.  Not a question of whether or not can afford it, cannot afford not to have it. That is why I am rooting for as close to a European syle socialised national health system we can get to start with.

          I have many friends who don't have it because they either can't afford it or don't feel they need it because they are not sick!!! they are all much younger than I of course.  in other words we are a fairly typical American family.

          I am absolutly awed at your ability to know so much about me from my comments?

          Amazing, Obama could use your psychic powers on his advisory team!!!!  and that, in case anyone was not certain is pure sarcasm, not snark, sarcasm.

          Oh, and by the way since I have dual citizenship I do have the option of returning to the UK if i feel I need to.  My son is also taking our dual citizenship by virtue of descent in the event that some catatrophic medical event occurs in his family.  So I guess I am one of those 'insulated from the abuses of the health system' as you put it.  Those are the choices we have made to deal with possible catastrophe.

          But since I don't live in a Fuck you Jack, Im's alright world, i do care and I care deeply as you would know if you bothered to read my constant posting on the necessity for a socialised national health system.

          •  congratulations (0+ / 0-)

            I hope to live long enough to get Medicare too, and I wish I had UK dual citizenship too, and I hope your grandchild's team wins the world cup.

            And I mostly certainly hope that Chuck Fucking Schumer rots in hell.

            I am absolutely awed at your ability to know so much about me from my comment

            It didn't take a rocket scientist to be 100% certain that you were insulated from the violence of the US health insurance industry. I didn't give a shit about healthcare either when I could pay fifteen dollars to get my routine colonoscopy to make sure I wasn't going to die from an otherwise curable disease. Now, however, that I'm not protected by a massive company's group insurance plan, I'm in direct touch with Blue Cross of California and even for $500 a month they won't give me a policy and I have never spent a day in a hospital. I'm slightly anemic - don't worry - you won't catch it from reading my DKos comments.

            Until you have to deal with these bastards one on one, without some OTHER cut-throat corporation on your side, let the drache who is not without healthcare cast the first stone.

          •  "necessity for a socialised health system" (0+ / 0-)

            How does that stated position jive with your defense of Schumer and others who would sabotage the public option???

        •  your arrogance is astounding (0+ / 0-)

          and even stupefying.

          Of course anyone that does not agree with you just must be 'insulated' from the abuses of the health care industry.

          Do you no hear yourself?

          Jimmy fucking crickets you sound like some hyper partisan that can not take dissent. Just like the GOP in fact.

          You go fight your war, go fight it to the 'death' if you wish. See exactly how fair your hyperbole and inflexibility gets you.

          A song about life
          Why aren't you more like Gandhi? Why aren't I?

          by drache on Tue May 05, 2009 at 06:03:54 PM PDT

          [ Parent ]

          •  And your health care provider is ... ? (0+ / 0-)

            My massive company provided me with a good plan too - until they laid me off. Let's hear your story Mr. "Your Arrogance is Astounding".

            •  whose yours? (0+ / 0-)

              Tell me does it matter?

              Because I do not think you are going to believe anything I say because you have closed your mind down.

              In your world only those that agree with you have valid opinions and everyone else is just wrong.

              It's sad and closed minded of you.

              But in the spirit of cooperation, I have Cobra and I am praying it lasts me long enough to have a job. And before that I had to fight with the insurance industry when I was 15 to have surgery to correct a problem with both my knees because they considered it 'elective surgery' never mind I could not even walk without risk.

              So to hell with your pompous, sanctimonious attitude.  Unless you are actually being killed by the insurance industry I probably have more reason to be upset with them then you. You know what? Anger is not helpful and quite toxic; I can tell you that from personal experience.

              I am not going to let my horrible experiences blind me.

              You should remove your blinders too.

              A song about life
              Why aren't you more like Gandhi? Why aren't I?

              by drache on Wed May 06, 2009 at 09:13:16 AM PDT

              [ Parent ]

              •  let me get this straight (0+ / 0-)
                1. you have COBRA and it's running out
                1. if you don't soon get a job in the worst employment environment since the depression you will have to try to get private health insurance
                1. you appear to have sufficient pre-existing conditions to prevent you from getting private insurance as you'll soon discover(I speak from direct experience - I'm on COBRA too - because when I applied for private health insurance they wouldn't take me - my pre-existing condition was borderline non-pathological anemia and I have no other problems or risk factors).
                1. you're mad at ME for being mad at the health insurers and their democratic whores in the senate

                Well, I think you've succeeded at being "more like Gandhi". My goal is to have Chuck Shcumer be more like Howard Dean.

                •  I am well aware of my situation (0+ / 0-)

                  that is why I do not have time to let unrealistic demands and ideologues to shape the debate.

                  On either side

                  I accept that we are not going to change health care over night and that most likely we are going to have to do this incrementally.

                  The first step of which is to get a public option.

                  And really Schumer's proposal really is quite good as such a starting point.

                  A song about life
                  Why aren't you more like Gandhi? Why aren't I?

                  by drache on Wed May 06, 2009 at 11:56:31 AM PDT

                  [ Parent ]

  •  The main problem is calling it a "compromise" (0+ / 0-)

    IMO, but point #3 is a little puzzling - why shouldn't the public option be able to negotiate whatever rates it wants to regardless of Medicare reimbursement rates?
    But overall I would have to agree with you.  What eventually shakes out as the "public option" in reality will be interesting to see.  These are but the initial broad brush-strokes.

  •  Well written. (0+ / 0-)

    But if anybody thinks that adding still another set of rules, regulations, and forms is going to sit well with health care providers, they are wrong. This will just burden them even more.

    Single payer is the only way to make the system more efficient. I understand that's not on the table, but this plan is a loser from the start, no matter what they do to it.

    "It is often pleasant to stone a martyr, no matter how much we admire him"...John Barth

    by Giles Goat Boy on Tue May 05, 2009 at 02:04:36 PM PDT

  •  I hope the legislators and their staffs, not to (4+ / 0-)

    mention the producers and staff people of the 24/7 cable news channels who might read DK to see what the radical left is up to also read diaries like this one.

    Rational, reasonable, informative and educational.

    Why do I care?  because I hoinestly don't want to be associated with the Chicken Little, call them all rat bastards (I odn't know ehy but that one stung even me!!!!) crowd or mob.

    I enjoy Daily Kos because it allows me to challenge my own assumptions, check my own facts and learn to balance the can perfect with the good enough.

    I too want desperately some movement on a semi national health sustem passed this year and it can only happen if people accept some compromises.

    Yell louder bny all means, but calling the hardworking representative names and calling for them to lose their jobs isn't helpfyl at alla.

    But then I am a one lone small voice in the wilderness, and the loudmouths always get more attention initially because they instill fear and shame and turn people off.  In addition they are the voices the MSM  feed on.  We are plankton for the bottom feeders.

    •  There are a lot of us (2+ / 0-)
      Recommended by:
      askew, Jason Rosenbaum

      soccergrandmom. You've been here a long time. The diarist you refer to and her echoists do not speak for everybody here.

      I don't understand all the details about this issue. Does that diarist? Unless I believe she can help me come to an educated conclusion, I will ignore her efforts. Her track record is poor. Some of her supporters I never agree with. When time is limited, I make choices about who to click on here.

      Bottom line though. We won't be associated with "the Looney Left" unless we want to be. And as a poster said above, better to read the source material first. In this technological age, it's all out there.

    •  You are not alone. There are plenty of us (2+ / 0-)
      Recommended by:
      anotherCt Dem, Jason Rosenbaum

      who don't want the Chicken Little diaries to speak for us.

  •  The public plan is bullshit (1+ / 0-)
    Recommended by:
    whaddaya

    Single payer or there is no reform.

    Obama used to be for single payer before he came out against it.

    by formernadervoter on Tue May 05, 2009 at 02:17:02 PM PDT

  •  Public health care is just better. (5+ / 0-)

    If you can't grok that, then the plan will suck.

    It's better because it is more efficient. The "profit" in the private plans takes away from providing health care to other people. It is just a fact, and a weakness of any free market scheme when competing with a public scheme. Medicare is the proof.

    My view is the Obama health care plan will suck balls UNLESS Congress goes with the 50 vote option.

  •  About #2 (5+ / 0-)

    Should doctors be forced to accept the new public health insurance plan? Doctors are not forced to accept Medicare now, so I'm not sure why we should go further with the public health insurance plan.

    You are not addressing the main problem with this.  

    No, we shouldn't (and we can't) force any doctor to accept Medicare, and we shouldn't force them to accept Medicare.  But, if they want to take Medicare patients they should also have to take public plan patients.  It should all be part of the same big plan.  It makes absolutely no sense to create a separate public plan when we already have one.  Everyone knows that the bigger the risk pool, the better.  Everyone knows that the bigger the plan, the more bargaining power it has with all healthcare related companies.

    This part of Schumer's proposition is a scam for a hundred different reasons and you know them as well as I do.

    Please address this issue honestly.

    For the record, my doctor has told me that he wishes every one of his patients had Medicare.  It would allow him and his staff to focus on their real job of providing healthcare, not dealing with greedy, unreasonalbe insurance companies who are constantly throwing up hurdles and changing rules in the middle of the game.

    "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 02:39:21 PM PDT

    •  well (0+ / 0-)

      Medicare and the public option won't be part of the same plan, so I'm not sure why this holds.

      •  now, I am a bit confused. I thought that the (1+ / 0-)
        Recommended by:
        joanneleon

        public option plan basically IS expanded Medicare?

        If not, please explain what the HCFA means by public option plan?

        we seem all to be talking at cross purposes over the entire debate. Who means what by which definition that is being seriously discussed by the legislators, not just us.

        •  medicare has specific payment rules (1+ / 0-)
          Recommended by:
          soccergrandmom

          Payment rules like fee-for-service, which can be a problem because the penalize primary physicians.  (I'm pretty sure progressive health care wonks want those rules changed.)

          The idea, I think, is that the public option works similar to Medicare (from the non-expert position), but is free to have different payment rules than the current Medicare fee schedules.  So for most of us, the public plan would essentially be the same as Medicare, but it would be technically different for exact payment details.

        •  soccergrandmom (2+ / 0-)

          This is why people are "freaking out".

          This is a bait and switch.

          Plus, there have been so many different things thrown around between the '08 campaigns and now, that many people's heads are spinning and I don't know if any of us fully understand what's what.

          Last night, Howard Dean said that Pres. Obama's plan would include a public option that allows anyone to choose Medicare (and pay for it).  That was a great surprise to me.

          Now today, Schumer's "compromise" came out and we find out that it isn't Medicare after all.  It's a new "public plan" and it has all new rules.  We don't know who will run the program and we don't know if any insurance companies will be involved.

          Some people are saying that the reason Arlen Specter is valuable is that he "gets us healthcare".  But Arlen Specter, on Sunday, said unequivocally that he will not support a public option.

          The only thing I know for sure right now is that Pres. Obama's plan does not offer Medicare for everyone (for a price).  If it did, I'd be jumping for joy.

          "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 04:37:02 PM PDT

          [ Parent ]

          •  thanks for your explnation of why people (1+ / 0-)
            Recommended by:
            ferg

            are 'freaking out'.  If we are confused, if they are confused, if Dean and Obama and Schumer and Baucus and Kennedy and Harkin and everyone who speaks for whatever their favoriyte plan is, if everyone is confused then I guess noone knows what it all means.  Isn't that what negotiating, compromising, studying etc all means. trying to come to a consensus.

            Which is what I understand.  I believe they are all trying all the plans, the options, the perfects and the doable on for size until they can find a step that at least will be viable legislative wise.

            Which is why I am against freaking out on any level, it just dosesnt get anyone anywhere.  Medicare, an expanded Medicare, medicare by any other name under any other rules, a public option managed by whom under what rules?  What will energe is what can be agreed upon and it will NOT be a purebred progressive plan, it will not let be let the market decide, it will be a hybrid that will mutate over the years to come.

            All I say is research YOUIR own position, make sure everyone is on the same page with whatever label you put on it and take it to the table and argue your rationale reasonably and intelligently.

            Calling people names and insulting them gets no one anywhere.  But that is how I have found reaching consensus works best.

            There is no right way or wrong here, except doing nothing and that is not happening.

            •  I agree on the discussions (4+ / 0-)

              and negotiations, to some extent.  However, this isn't a new subject.  It's been discussed, and discussed again, and again, for fifteen years.  During the Democratic primary, it was studied and plans were formulated in detail, and put down on paper by several candidates.

              It's now a matter of looking at what the people want, choosing something from what has already been hashed over many times, and putting it together into a plan.  I wouldn't be surprised if this plan is already prepared and waiting to be introduced to the public for some months now.

              Frankly, if they are indeed floating things and looking for a response, then what they want is a reaction.  And they are getting their response.  Very few people are calling people names and insulting others, from what I've seen.  What I've seen is a spirited debate, and I have no problem at all with that.

              There is one more very important factor in all of this, IMHO.  Democratic senators have been incredibly dishonest with us over the last few years, and have made excuses about compromise legislation, like the latest FISA bill, and many others.  Being cautious and skeptical about what they bring forward is a natural and intelligent action.  

              "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 05:54:19 PM PDT

              [ Parent ]

      •  Please answer the question (2+ / 0-)

        I really should have kept my question simple in my previous comment instead of going into the issue of having one big plan.  So I'll ask my main question again:

        Why would we allow a provider to accept Medicare patients but reject public option patients?

        Why shouldn't it be a package deal?  If you take Medicare insurance you also take public option insurance?

        "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 04:25:46 PM PDT

        [ Parent ]

  •  why the hell should the insurance companies have (3+ / 0-)

    any say in this? did the buggy makers get a say in the design of the model t? if they don't like the compromise screw em. they'll get nothing and like it!

    "the christian in me says it's wrong, but the corrections officer in me says, 'i love to make a grown man piss himself.'" - cpl. charles graner

    by mindtrafficcontrol on Tue May 05, 2009 at 02:48:38 PM PDT

  •  Rec'd for having a discussion. nt (1+ / 0-)
    Recommended by:
    Jason Rosenbaum
  •  Jason, who will administer this public option (2+ / 0-)
    Recommended by:
    churchylafemme, timba

    program?

    Will there be any current insurance companies involved in managing this new plan or involved in any other way?

    "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 03:03:51 PM PDT

  •  Why is there a need for a separate plan? (2+ / 0-)
    Recommended by:
    crackpot, churchylafemme
    Why does the "public option" have to be a separate plan?  We've got a healthcare plan set up already == Medicare and Congress/fed employee healthcare plan.

    This is my biggest question.

    Why can't you simply allow people to pay premiums for Medicare?

    Wouldn't this be the simplest and best solution for everyone?  Wouldn't it make the risk pool larger?  Wouldn't it make the bargaining power better?

    Why doesn't every American have access to the same coverage that Congress and Fed. employees get and/or Medicare?

    Why not?  I have to hear a real explanation of this -- a straightforward and honest answer.

    "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 03:09:31 PM PDT

    •  very simply this appears to be exactly what is (2+ / 0-)
      Recommended by:
      schuylkill, AmericanRiverCanyon

      freaking out the insurance industry and the republicans.  The fear is that that simple option would prove so popular that millions would flock to it, not only the 45 million uninsured, but the underinsured and those who need cheaper insurance and that would drive private insurance out of business.

      Others say,  to the contrary it would be great for private insurance because everyone who could afford private insurance would keep it and the competition would be good for all.  Isn't that the American way?

      That is what I understand the talk of public/private or two tiered system is all about. The debate isn't happening because noone is being honest and open about the fact that any form of universal coverage would automatically mean some kind of 'rationing' or loss of choice.  Not all hospitals would be able to have the snazzy and expensive high tech equipment.  Hospitals beed beds, not just expensive equipment.

      But to say that the people don't want a faceless government bureaucrat standing between them and tier doctor is hogwash, because right now they already have a facelss health insurance bureacrat standing ebtween them and their doctor.

      You can't eat all you want and still get thin.

      So let's het real about the health debate folks abnd face the facts of cost and coverage and care.

    •  because (4+ / 0-)

      the real owners of this country don't want us to have it, (Medicare available to all) even though it's the most sane option

  •  didn't hear Howard Dean mention Schumer's ideas (4+ / 0-)
    Recommended by:
    ferg, timba, fool mee once, Losty

    last night during the moveon meeting about HC reform with a public option. so unless I hear Deans opinion on this I will wait and see. Unless someone wants to speak to this.

    Insulin in Ca public schools ruling STAYED during appeal. Great ruling for 15,000 diabetic students. http://preview.tinyurl.com/dxafql

    by foggycity on Tue May 05, 2009 at 03:10:34 PM PDT

  •  Interesting that this diary is from someone... (6+ / 0-)

    ...paid to advocate for this "compromise."

    Rosenbaum is Deputy Director and manager of internet communications for HCAN.

    Welcome to the NetroTurf.

    Self-styled progressives who call for balanced budgets are not merely parroting conservatives; they are parroting dead conservatives. - James Galbraith

    by GreenSooner on Tue May 05, 2009 at 03:33:13 PM PDT

  •  97% is way way WAY off (0+ / 0-)

    A recent study by the Texas medical Association says that:

    only 600,000 of 1.5 million total physicians are currently willing to treat Medicare patients

    I know that my parents and grandparents and most of their friends have had trouble finding doctors willing to take medicaid patients.

    I am for a public option, but bad numbers reduce the effectiveness of your augment.

    When you say numbers that are blatantly wrong, those with experience using the system assume that your other statements must also be wrong.

    The dwindling number of physicians accepting new medicaid patients is a problem. Ignoring this problem, hurts the cause and plays into the republican's hands.

  •  At this point they (2+ / 0-)
    Recommended by:
    SarahLee, kck

    are simply rearranging the deck chairs on the Titanic.

  •  asdf (0+ / 0-)

    1. 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.

    2. Medical treatment should not be funded.

    3. # 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.
    4. The wonders of the market don't apply to doctors.

    5. # The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.
    6. The government should not guarantee that people who deserve it get access to medicine.

    7. # 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.
    8. The people who know about and are responsible for quality healthcare should have nothing to do with it.

    Great stuff!

    When did markets become poor pathetic failures that couldn't compete with big powerful government?

    How about this:

    1. Market based medicine should not pay claims with investments. It should only pay claims with premiums and fees. Executive bonuses should be eliminated.
    2. # Market based medicine should not be forced to compete with government medicine.
    3. # Government should do it the same way the private sector does it. Deny access and refuse to cover illness.
    4. # To prevent abuse of power, Insurance companies should be banned from lobbying and contributing to political campaigns.

    Democracy - 1 person 1 vote. Free Markets - More dollars more power.

    by k9disc on Tue May 05, 2009 at 04:04:42 PM PDT

    •  Don't forget employer contributions (1+ / 0-)
      Recommended by:
      k9disc

      The one of many funding scenarios the diarist suggests as if it is fact, that Schumer means, means for the public option to be fashioned after is Individual Plans - no contributor but the patient - which are currently running >$700/month per person and rising quarterly. This is the standard subsidized highest risk pool for uninsureds rates - one of the problems reform is supposed to solve.

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

      by kck on Tue May 05, 2009 at 05:43:35 PM PDT

      [ Parent ]

  •  You're misreading Schumer's points (7+ / 0-)

    The public plan should pay doctors and hospitals more than what Medicare pays.

    Should the public health insurance option pay Medicare rates? Not necessarily. Medicare and the VA are both government-run health care plans, and they pay different rates. And in fact, Medicare should pay higher rates for primary care and less for some specialists. By allowing the public health insurance plan to bargain for its own rates, as Schumer is doing,

    Note that Schumer isn't saying it should be able to bargain on its own. He's saying it must pay more. Schumer wants to mandate that the public option take worse deals than Medicare even if it could negotiate better.

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

    Doctors are not forced to accept Medicare now, so I'm not sure why we should go further with the public health insurance plan.

    This isn't about mandating that all doctors accept the public option. It's about saying - if you accept Medicare then you must also accept the public option. Now, that's debatable ... but you've miscast the debate.

    Should the public health insurance plan be self-sustaining? The concern here is that if the public health insurance plan has to be self-sustaining, than it will have to charge unaffordable premiums to stay afloat. This isn't how it will work.

    Every implementation of the public health insurance option I've seen separates the public health insurance option from affordability provisions.

    What I'm reading into Schumer (and he's been vague here) is that he wants to do away with that separation. That would cripple and kill the public option. This is not debatable. Remember, for its first few years, the public option is going to heavily loaded with the most expensive patients. It will need extra government support until it gets a better share of the "profit" patients.

    Member, The Angry Left

    by nosleep4u on Tue May 05, 2009 at 04:11:32 PM PDT

  •  This diary is (0+ / 0-)

    Pragmatic progressivism at it's best. You support a progressive ideal (public option) but are using the facts to back up all your arguments.

    Between my shoulders is a genius. Between my legs is a penis. It seems I have to get both my minds right...

    by theone718 on Tue May 05, 2009 at 05:04:44 PM PDT

  •  What I would like: (3+ / 0-)

    Copy whatever France does.

    Is there any GOOD reason why not?

    "There -- it's -- you know, one of the hardest parts of my job is to connect Iraq to the war on terror." --GWB

    by denise b on Tue May 05, 2009 at 05:59:11 PM PDT

  •  Sorry, but #3 is a showstopper for me (4+ / 0-)
    I'm in a public plan.

    My local hospital does not want to participate in the public plan.

    How is this a good scenario?   Absolutely ridiculous.  The HMO's will gang up and offer incentives to providers and hospitals to not participate in public health care.  You will have to go to an inner city hospital to get health care.

    This is not an option.

    Give every American a fair chance at the race of life - A. Lincoln and B. Obama

    by captainlaser on Tue May 05, 2009 at 06:00:25 PM PDT

  •  good ol' Karen Ignagni says (2+ / 0-)
    Recommended by:
    slinkerwink, Jason Rosenbaum

    "But she said she still saw no need for a public plan if you have much more aggressive regulation of insurance, which the industry has agreed to support."
    sounds like how the banks regulated themselves. they were all for self regulation too. Save your breath Karen, that's old skool, and it doesn't play anymore.

    Yes we did. And we will keep doing...

    by pickandshovel on Tue May 05, 2009 at 06:03:50 PM PDT

  •  It's immoral (1+ / 0-)
    Recommended by:
    ebgill

    to profit off the sick and dying

    AAC: Support local arts

    by jamesia on Tue May 05, 2009 at 07:10:32 PM PDT

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