let me get to the point: Since the beginning of the Obama campaign, and his initial health care drafts, created to respond to Hillary Clinton's health care plan, I have had many very serious concerns about "public option". (and some of Obama's and public option's online supporters)
And they NEVER seem to get addressed.. When they are asked the hard questions, they change the subject.
Ive had these concerns about ALL of the "public option" drafts that I have seen to date, Ive verified these concerns legitimacy (you can do this yourself, ask any people that you know who are familiar with game theory or insurance math) and I've been asking the public option supporters here to answer those questions, BUT THEY CAN'T OR WON'T.
I find this to be extremely curious. Why won't they answer the simplest questions about public option? Why do they keep rehashing the same logical fallacies - rather than addressing the questions put to them?
So, after having these deficits rubbed in my face again and again, I came to the conclusion that at least some of the people supporting public option are probably being paid, (perhaps by the post, or by the word?) and that they may have a hidden, rigid set of rules that determine how they are allowed to promote public option. I would like to solicit the help of the DailyKos readership in developing a sort of "Turing test" for public option supporters to determine if they are supporting it as humans with free will, or as "machines" who follow a hidden "playbook" "ruleset" "algorithm" or whatever you want to call it.
Maybe we can also put forward some theories about the structure of this ruleset?
In computer science, a Turing test is defined as so:
"a human judge engages in a natural language conversation with one human and one machine, each of which tries to appear human. All participants are placed in isolated locations. If the judge cannot reliably tell the machine from the human, the machine is said to have passed the test. In order to test the machine's intelligence rather than its ability to render words into audio, the conversation is limited to a text-only channel such as a computer keyboard and screen."
Lets compile a list of the questions that the public option supporters refuse to answer online..
Here are some candidate questions..and explanations of why they are important. If they ENGAGE, they are normal advocates of a position. They can argue it's merits like intelligent adults.
If they avoid the question, their motives, in my view of this, are very suspect. They may be working for interests funded by insurance companies, who are secretly backing public option as a 'brer rabbit' sort of strategy against single payer. Despite what anybody tells you,(and this is the area that they are trying to hammer into our heads) public option preserves the insurance company stranglehold on America. THAT IS THE ASPECT OF IT THAT WILL PROVE TO BE NON-OPTIONAL.
I am not looking to get into arguments with unquestioning supporters of public option here, so if you are one, please, address please leave the propaganda elsewhere.
Candidate questions
(There are lots more.. please add your suggestions in comments)
1.) ADVERSE SELECTION/DEATH SPIRAL - HOW can any "self-sustaining" Public Option avoid the Death Spiral effect caused by adverse selection?
A "death spiral" (in insurance lingo) comes "when a health plan starts attracting sicker patients, which causes the price of premiums to go up, which causes more healthy people (who have other options) to leave the plan, which causes the remaining pool to be proportionately sicker, which causes the price of premiums to increase even more, eventually resulting in the company going bankrupt-in other words, dying."
A google on the words "death spiral" and insurance brings up many descriptions..
This is an effect of adverse selection and its a very serious concern!
IMO, if somebody attempts to address that question, they are a legitimate searcher for affordable health care reform. If not, they
may not be.
2.) COST CONTROL.. Example of a question that addresses this: Why "Medicare-like" and not Medicare itself?
For many reasons, any "option" can't reduce costs because of its weak competitive position, compared to self pay or private insurance. A mandate would address this somewhat, but them we might run into the problem of...
This interesting related question.. Putative inability of any public option to do real cost control because of "takings" clauses in state, Federal laws, and international treaties- any "taking" by the government quite possibly MUST BE COMPENSATED FOR. This "taking" is defined as the difference between a product or service's real cost (as determined by its FREE MARKET VALUE) and the controlled cost.. This is another reason why any "option" might well run into problems with cost control if a provider could make a credible argument that they were being undercompensated for a service. (This kind of potential lawsuit I think is also why the insurance industry is lying by saying that a "public option" has an "unfair advantage" when they really have an "fairness disadvantage" in that they are required to act in the public interest- more on that later!)
3.) AFFORDABILITY for the Middle Class.. the large segment of the population who make more than, say (arbitrary) 3 times the Federal Poverty Line... Since (see #2) any public option that addresses the needs of a sicker risk pool is unable to do cost control.. they may well soon need to charge more than a commercial insurer with a far healthier risk pool, even if they are completely nonprofit. How can we save THEM money, as they may well be the group that in the end, is asked to pay for the whole program.. They don't have the political clout to stop this. They also are too trusting, they don't have the time to analyze the proposals, until they impact them.
4.) NO LIMIT WHATSOEVER ON UNCOVERED COSTS for anyone. bankruptcies would continue.
5.) NO TRIGGER TO SINGLE PAYER UPON FAILURE In truth, single payer should be the default, as its got a proven track record, and public option should have the burden of proof upon IT.
What the hell is wrong with a picture where we are asked to swallow an unproven and risky experimental procedure, risking an entire country, and most probably wasting years and tens or hundreds of thousands of lives, when we have a path that we know would work.
What happens if the economy implodes next year, as many predict?
Discussion:
Its pretty clear that single payer would save us a very large ampunt, its been done in many other countries, single payer is a well trod path.
"public option" is a blank slate- Whatever it turns out to be, it is an experimental procedure Especially they still have not laid out specifics that acceptably define what benefits will be offered and putative subsidy levels at all, so its IMPOSSIBLE to guess the amount a public option could save sick people over a completely profit driven plan priced based solely on their risk.
However, it is clear that the combination of private insurance and public option could easily end up being as a whole, less efficient than what we have now. The comparison to Medicare is NOT an honest one at all. Public option is NOT single payer.
SO money available for actual patient care in America as a whole, could well decline and the total amount of money spent on paperwork could well increase. That's what happened in Massachusetts. Drug prices also went up.
Community rating would save the sick a lot, but it also would increase the price for the healthy well beyond their expectations of what affordable could be..
Single payer avoids this completely by using TAXES to fund single payer, and as the "premium tax" would end, it ends up being a very substantial win, a BIG improvement for everybody except employers who currently don't offer insurance of any kind to employees. (and of course, to health insurance companies)
Seems to me that those are the two groups who deserve to see changes.
How we can easily pay for health care for all!
Important: We would pay FAR LESS than we are paying now
This is from:
http://www.pnhp.org/...
"Won’t this raise my taxes?
Currently, about 60% of our health care system is financed by public money: federal and state taxes, property taxes and tax subsidies. These funds pay for Medicare, Medicaid, the VA, coverage for public employees (including police and teachers), elected officials, military personnel, etc. There are also hefty tax subsidies to employers to help pay for their employees’ health insurance. About 20% of health care is financed by all of us individually through out-of-pocket payments, such as co-pays, deductibles, the uninsured paying directly for care, people paying privately for premiums, etc. Private employers only pay 21% of health care costs. In all, it is a very "regressive" way to finance health care, in that the poor pay a much higher percentage of their income for health care than higher income individuals do.
A universal public system would be financed in the following way: The public funds already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees’ health care, which would be eliminated. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and other out-of-pocket payments. For the vast majority of people, a 2% income tax is less than what they now pay for insurance premiums and out-of-pocket payments such as co-pays and deductibles, particularly if a family member has a serious illness. It is also a fair and sustainable contribution.
Currently, 47 million people have no insurance and hundreds of thousands of people with insurance are bankrupted when they have an accident or illness. Employers who currently offer no health insurance would pay more, but those who currently offer coverage would, on average, pay less. For most large employers, a payroll tax in the 7% range would mean they would pay slightly less than they currently do (about 8.5%). No employer, moreover, would gain a competitive advantage because he had scrimped on employee health benefits. And health insurance would disappear from the bargaining table between employers and employees.
Of course, the biggest change would be that everyone would have the same comprehensive health coverage, including all medical, hospital, eye care, dental care, long-term care, and mental health services. Currently, many people and businesses are paying huge premiums for insurance so full of gaps like co-payments, deductibles and uncovered services that it would be almost worthless if they were to have a serious illness."
In America today, most sick people who lose coverage, can't then buy any insurance at all, so they would be extremely happy to be able to buy ANY decent, affordable plan. (But obviously, most can't afford an expensive plan. Even if its a great deal for them, considering their illnesses, and priced fairly, with a "level playing field" they WON'T be able to afford it. I suspect that this is what the insurers are counting on to kill public option eventually.)
How do we know this? We've already seen it happen. Many states do already have these "public options"- in the form of high risk insurance pools. They are typically very expensive. They offer excellent insurance, often far better than almost any other plan available in that state (after all, they are designed for sick people) but they are very expensive. SO, they don't put that sizeable dent in the uninusured population that we would hope.
AND THEY OFTEN STILL DO LOSE MONEY!
If public option doesn't have a mandate that makes the risk pool a healthy one (the insurance companies seem to be vetoing this!) or large subsidies available to it, THAT IS WHAT WILL HAPPEN TO IT, and IT WILL EVENTUALLY FAIL, because not only will it be unpopular because of its failed promise, again, unless it receives subsidies that are not pegged at some low, arbitrary amount -its inherently limited by the amount of losses it is allowed to have before it is discontinued.
All of this is avoidable - with single payer, because single payer - the only game in town, can be much more effective in controlling costs.. Just look at Medicare..which is single payer.
Expanding Medicare to cover all Americans is the simplest, fastest solution. Not a "Medicare-like public OPTION" alongside private insurers - Medicare!
This might also make Medicare itself solvent, remember- the healthier the overall risk pool, the better a chance that any insurance plan, especially "public option" or medicare - both "public" with "pubic"'s fairness disadvantage- has for success.
If the public option is an "option" which means no mandate, its threatened by adverse selection.
So, it MAY WELL NOT BE ABLE TO GET THE HEALTHIER RISK POOL IT NEEDS TO AVOID THE DEATH SPIRAL CAUSED BY HIGH PREMIUMS DRIVING ALL BUT THE SICKEST CUSTOMERS AWAY.
Sorry to keep harping on this, but its THE crucial question that going to determine the affordability and long term sustainability of ANY new plan.
If Senators and Congresspeople appear to be giving up on public option, ITS BECAUSE THEY CAN'T ADDRESS THESE ISSUES, having backed themselves into a corner by OBVIOUSLY over-optimistic LIES.
Lets try again with Single Payer which addresses all these questions WELL, and IS SUSTAINABLE.
So, do any of you have any ideas for other important questions to ask the public option supporters to determine if they are legitimately seekin change, or merely trying to protect the insurance company stranglehold on Americans futures and savings.
If public option supporters, Senators, Congresspeople, etc, address these questions, and refuse to bow down to the scammers who want to force a craptacular of shame on Americans instead of a health care solution for all of us, they are legitimate in their desire for change. Its better to wait for a viable plan than force a phony false "solution" on us that wont make health care and prescription drugs affordable for all of us.
If they evade the important questions, as many do, and as Obama and many Senators and Congresspeople have done in the election campaign, and in their scripted "town hall meetings" etc, then, maybe its time to replace THEM with new legislators and chief executives who will bring about affordable health care for all like "civilized nations" have.
The "Public Option" vs. Single Payer Compared |
| Single-Payer | "Public Option" |
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Number Insured | Universal Coverage | Millions remain uninsured or underinsured |
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Coverage | Coverage for all medically necessary services. | Insurers continue to strip-down policies and increase patients' co-payments and deductibles. |
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Cost | Redirect $350 billion in administrative waste to care; no net increase in health spending. | Increase health spending more than $1 trillion over 10 years. |
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Savings | $350 billion in administrative waste. Further systemic savings achieved through negotiated fee schedule with physicians, global budgeting of hospitals, bulk purchasing of pharmaceuticals, rational planning of capital expenditures, etc. | Add further layers of administrative bloat to our health system through the introduction of a regulator / broker "exchange." |
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Sustainability | Large scale cost controls (global budgeting, capital planning, etc.) ensure that benefits are sustainable over the long term. | Uncontrolled costs ensure that any gains in coverage are quickly erased as government is forced to hike spending or slash benefits. |
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