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It's been awhile since I said goodbye and wrote my GBCW.  Back then I wrote that I didn't think DKos was a productive place anymore, and that the blogosphere didn't know how to have a Democratic president in power, since they're only defined by raging against a machine.   Nothing since then has changed my mind, but the degree to which I think the "left" has gone off-course in this health debate brought me back to start expressing a minority view in comments.  

Today, a front-page post from Hunter pushed me over the edge and I've decided to write my first diary in a long, long time.   Here's what I think: the progressive left is now crossing the line from being a productive, "make him do it" force to a counter-productive force that is departing the reality-based community.

The post from Hunter made it all too clear: you have assigned the public options magical powers that it does not have, never will have, and never had to begin with.  You have lost even basic knowledge of how the health reform is going to work, and gotten so whipped into a frenzy over the public option that you're in danger of preventing millions of people from improving their lives.

This is what Hunter wrote today, referring to the notion of a public option "trigger."

Nothing in such a plan would solve the problem of actually getting health care -- if you have junk insurance, you won't go to the doctor anyway, unless it's an emergency. And it won't solve the problem of people going bankrupt when they get sick.

Sigh.  As has been the case here for weeks and months, Hunter is conflating two completely different issues, misleading the readers, and just making shit up. I'll explain.

Let me first be clear: I absolutely support the notion of a public option.  I think it's important to forcefully advocate for one.  It would be a far better bill if a public option were included.  The public option would contribute substantially towards containing costs in the health system as a whole.  But the public option would only be available as an option, on an exchange, to those who don't currently have health insurance.  

How on God's green earth, the public option is now going to transmit consumer protections to the 90% of people who wouldn't be on it is beyond me.  How can it prevent others from going bankrupt?  How can it prevent other insurance from denying coverage for pre-existing condition?  How can it eliminate caps on lifetime benefits?

It can't.  That's in the rest of the bill.   The bill which most people here have now convinced themselves is completely useless without a public option.  Guess what guys?  There are other parts to the bill.  

What I support is a bill with a public option.  What I DON'T support, is the notion that a bill without it can't be meaningful progress that tangibly helps millions of people.  So fight for it now, but don't lose sight of the bigger picture.

This is where the DKos community is most disheartening.  There are countless, countless people who have no insurance now.  They don't have it because they can't afford it.  They have pre-existing conditions.  They've lost their jobs, etc.  And this bill would give them subsidies to buy insurance, prevent them from being denied coverage, etc.  

People like my brother-in-law, who suffered one of the most horrendous possible cancers while unemployed, only covered through COBRA (or what you'd attack as a subsidy to the junk insurance companies).  Well, guess what?  He got excellent care, and he's on the path to recovery now.  Thank God for COBRA.  His insurance has a time limit on it, and we all know no one else will cover him because of his cancer.  Unless this bill passes.

To the millions of people without health insurance, you've convinced yourselves that without the public option, they might not as well have insurance.  What a load of crap.  $100 isn't a lot of money either, but it is when you have $0.  

The public option is just that, an option that has to pay for itself through premiums, that would be available on an exchange with other insurance options and would help keep costs down in the overall system.  IF IT DOESN'T pass now, cost control will still be dealt with in the future.  It'll have to be.   This bill doesn't have to be the end-all-be-all.  

What the bill DOES have to be is something that:

  1. Meaningfully improves the lives of people
  1. Changes the terms of the debate and sets the stage for further reforms
  1. Moves us tangibly in the right direction.

It's simply a fact, the public option doesn't have all the powers you are ascribing to it.  In fact, most of the things you want it to do occur in other parts of the bill.  Yes, it sucks that insurance companies will get money, but hey, life isn't fair.  But if coupled with the kinds of consumer protections that help out the millions of people who need it, I'll take that over nothing any day of the week.

And nothing is exactly what will happen if some sort of reform doesn't pass now.  So fight for the public option all day long.  Fight for it now, but support reform in the end if it moves us in the right direction.

But when you convince yourselves that without the public option, everything else is meaningless, and give it powers it doesn't have, you have lost touch with basic reality.  

Your President isn't perfect, but he's put his presidency on the line to advocate for positive health care reform.  Instead of positive bolstering and reinforcement, it's been a lot of whining, freak-outs, and petulant behavior over every signal one way or another. Get out in the streets, follow the lead of people like Kath and Casperr.  

I'm ready for it: call me a tool of insurance companies.  The old "you think Obama is perfect" meme.  All the same crap you'll throw at me.  I don't care at all.  I've said my piece.  I'm back.

Originally posted to dansac on Fri Sep 04, 2009 at 08:35 AM PDT.

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Comment Preferences

    •  welcome back!!!! (8+ / 0-)

      "I have confidence that the American people are more interested in doing what is right to protect this country than in political posturing."

      by fhamme on Fri Sep 04, 2009 at 08:38:02 AM PDT

      [ Parent ]

      •  Thanks :) we'll see how welcome it is, lol (6+ / 0-)

        I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

        by dansac on Fri Sep 04, 2009 at 08:38:28 AM PDT

        [ Parent ]

        •  :)...hold on! it's gonna be a bumpy ride!!! (4+ / 0-)
          Recommended by:
          dansac, Christin, cotterperson, buddabelly

          "I have confidence that the American people are more interested in doing what is right to protect this country than in political posturing."

          by fhamme on Fri Sep 04, 2009 at 08:47:32 AM PDT

          [ Parent ]

        •  I would be interested to see (2+ / 0-)
          Recommended by:
          cotterperson, Mother of Zeus

          your take on what other reforms specifically could be had for ditching the public option.  

          At this point, the public option is about political power as much as it is about policy.  Abandoning it would command a very high price, I would think.

          "The future will not belong to the cynics. The future will not belong to those who stand on the sidelines"-Paul Wellstone

          by Sauceman on Fri Sep 04, 2009 at 09:08:56 AM PDT

          [ Parent ]

          •  Phrased in a better way, (8+ / 0-)

            has anyone tried buying off progressives with alternatives to the PO?

            Not that I've seen- usually it's just a matter of getting rid of it and getting nothing in return all for "bipartisanship."  

            Everything has a price, what is the price for the public option?  Harsher regulation?  No more antitrust exemptions for insurance?  Drug price caps?

            What are they willing to give to get everyone to shut up about the PO?  

            Thus far, I don't even see an offer being made by conservative democrats.  Which, to me, is no deal at all.  They want the take, but aren't willing to give.

            "The future will not belong to the cynics. The future will not belong to those who stand on the sidelines"-Paul Wellstone

            by Sauceman on Fri Sep 04, 2009 at 09:14:33 AM PDT

            [ Parent ]

          •  Good point - I don't think I'm qualified to say (3+ / 0-)
            Recommended by:
            Sauceman, GOTV, Mother of Zeus

            I only know enough to know that powers were being assigned to the P.O. that didn't exist.

            I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

            by dansac on Fri Sep 04, 2009 at 09:14:54 AM PDT

            [ Parent ]

            •  I generally agree, (3+ / 0-)

              but the next logical step from this diary is asking what should happen next.  The progressive caucus in the house has staked their reputation on this, and will need to be appeased in some fashion for a bill to get through.  Thus, something they see as equivalent in value to the public option, but which is perhaps less objectionable to conservative democrats, would need to be put on the table.  

              Co-ops ain't gonna do that.  The Conrads and Liebermans of the world are going for the whole hog, just for watering down the bill with next to zero compensation.  In my uninformed opinion, that's a significant factor behind the progressive communities drawing a line in the sand around the public option.  

              I guess it's just a question worth asking in the community, especially for those whose support for the president hinges on the public option.  I don't especially think the policy options involved have to be necessarily a single-payer/public option dichotomy- but what else out there buys progressive support?  What's plan B for getting everyone covered and keeping costs down?

              "The future will not belong to the cynics. The future will not belong to those who stand on the sidelines"-Paul Wellstone

              by Sauceman on Fri Sep 04, 2009 at 09:22:22 AM PDT

              [ Parent ]

        •  i ♥ you dansac. (2+ / 0-)
          Recommended by:
          Kitty, anotherCt Dem

          you and a few others on here just have my ♥

          "Oh no...you changed your hair color? It's just so dark. You like it? And with your skin tone?" My Beloved Mom, December 25 2007, once again on notice.

          by Christin on Fri Sep 04, 2009 at 08:24:48 PM PDT

          [ Parent ]

          •  I saw him first! (1+ / 0-)
            Recommended by:
            Christin

            And we took OUR relationship to email - HAH! Who's the ACD? Who's the ACD? Picture middle aged lady doing that arms go round thing.

            Ceee when our SO's dump the both of us, you can move out to CT and hang with me. I think I said this last week - you make me smile after a tough day/week.

            Much thanks and sweet dreams!

            •  yeah i found this diary and by reading your (1+ / 0-)
              Recommended by:
              anotherCt Dem

              comments gee.
              i am going to get dumped.
              today for sure.

              i only moving in wif you if you promise me good weather in CT.
              oh - and you have to do the cooking too.
              me no cook.
              me only sit here with two computers open working with the left side of brain and playing with right side.

               i know it's been a rough week for you.
              be good to yourself and give yourself hugs from me and the others that care or you.

              ♥ to you and dream of sunlight and butterflies.

              "Oh no...you changed your hair color? It's just so dark. You like it? And with your skin tone?" My Beloved Mom, December 25 2007, once again on notice.

              by Christin on Fri Sep 04, 2009 at 09:21:27 PM PDT

              [ Parent ]

    •  Okay, even if no public option and no mandates (5+ / 0-)

      There are other incremental reforms we can do.

      But it will only be a nibbling at the edges sort of bill which will kick the can down the road on the necessary heavy lifting.

      Just say "No!" to premature capitulation

      by Bill White on Fri Sep 04, 2009 at 08:45:38 AM PDT

      [ Parent ]

    •  Fabulous. Love the diary. (9+ / 0-)

      Ablington is a scab at the bending factory. Relentless!

      by ablington on Fri Sep 04, 2009 at 09:13:38 AM PDT

      [ Parent ]

    •  Welcome back. And thanks for the reality-check. (3+ / 0-)
      Recommended by:
      Aexia, GOTV, Elise

      Unfortunately, as you already know, Daily Kos gave up reality a long time ago. It is all rage, all the time now.

    •  It's a fine diary, dansac (0+ / 0-)

      Thanks for coming back to post it.  I, too, hope that we can finish this with a bill that has a strong public option, one that moves to quality, accessible, affordable health care, but you're right, it's only part of the picture, and need to address the entire paackage.

      Nice work.

      Plus vini, plus veri.

      by GOTV on Fri Sep 04, 2009 at 04:34:26 PM PDT

      [ Parent ]

  •  Sorry. (13+ / 0-)

    The most disturbing thing for me has been the Dems willingness to give up the narrative, leaving for the month to hand the discussion and media coverage over to the wingnuts.

    Their inability to CONTROL THE NARRATIVE is disturbing looking ahead.

    Oh, and WB.

    Yes We DID!!!!!!! Now back to work!

    by InquisitiveRaven on Fri Sep 04, 2009 at 08:39:52 AM PDT

  •  You should have stayed away (4+ / 0-)

    if you're just going to cheerlead while the public option circles the drain.

    This the line in the sand.  Deal with it.

  •  right (14+ / 0-)

    Your President isn't perfect, but he's put his presidency on the line to advocate for positive health care reform.

    he's put his presidency on the line by not advocating for real reform. people voted for transformational change, and they're not seeing it. being better than mccain would have been isn't much.

  •  Sorry, dansac, but without the PO, the mandates (18+ / 0-)

    are unacceptable and a massive gift to the health insurance industry.

    You are absolutely right that many of the (potential) reforms could be beneficial, and that we have to start somewhere.

    But the PO was part of the compromise, and it is the cost control.

    It's also the main reason I voted for President Obama.

    Good to see you again, though!

    No more money for non-progressive Democrats from me, ever.

    by iconoclastic cat on Fri Sep 04, 2009 at 08:40:17 AM PDT

    •  Unacceptable (1+ / 0-)
      Recommended by:
      jim bow

      Why?  Most of those would go to private insurance anyway.

      I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

      by dansac on Fri Sep 04, 2009 at 08:41:10 AM PDT

      [ Parent ]

      •  Most of who/what would go to priv. ins? (4+ / 0-)

        Sorry, I don't understand what you're asking.

        No more money for non-progressive Democrats from me, ever.

        by iconoclastic cat on Fri Sep 04, 2009 at 08:42:52 AM PDT

        [ Parent ]

        •  He's not asking you (5+ / 0-)

          he's telling you.  The public option is currently designed to herd uninsured Americans into purchasing private insurance products.  And that's a fact.  While people rail against President Obama and join irrational rages against the wrong target, this crap is going on beneath our noses.

          We're not focused on the details and a Public Option In Name Only is coming down the pike: a program so weak, so restricted, so kneecapped, that coupled with individual mandates, the insurance industry gets what it wants in a backdoor fashion: millions of new involuntary consumers.

      •  why? here's why (3+ / 0-)
        Recommended by:
        slinkerwink, alkalinesky, NoVa Boy

        how are those 50 million people, now to be fined if they don't buy this insurance they can't afford now going to be able to buy this mandated insurance tomorrow?

        Government is just going to pay for that?  

        By the way, check out how Cobra is funded.

        "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

        by SteveP on Fri Sep 04, 2009 at 08:59:23 AM PDT

        [ Parent ]

        •  Subsidies (3+ / 0-)
          Recommended by:
          slinkerwink, alkalinesky, SteveP

          Private insurance will be subsidized.  While the public option won't be available to most of the country, and will have funding restrictions.

          Gift to the private insurance industry.  And an obvious one.  2010 is going to be a bloodbath.

          •  what they'll get is Mass care (3+ / 0-)
            Recommended by:
            ablington, GN1927, alkalinesky

            which will end up being more expensive than expanding the free care program that had already been in existence, leave 10% uninsured as is now predicted (current uninsured figures in MA are running 5-6% and expected to rise, some say probably double to around the uninsured rate before romneycare, despite the fines and co-pays that drive even the insured away from actually getting healthcare in MA.

            "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

            by SteveP on Fri Sep 04, 2009 at 09:08:19 AM PDT

            [ Parent ]

            •  All because congress (1+ / 0-)
              Recommended by:
              SteveP

              is choosing to prioritize the "needs" of an inefficient, unpopular industry over the needs of the rest of the country.  This is literally no more than, "well, they still want your money and we're going to give it to them, in fact, we're going to give more of it to them and now simply force you to pay it, and in exchange, these companies promise to stop abusing you."

              This is madness.  2010 will be an ABSOLUTE bloodbath.

            •  Where's that data? (0+ / 0-)

              Kerry said we were around 2 or 3% uninsured the other night.  

              Earns no money here for blogging, commenting, or driving traffic to any web site.

              by mem from somerville on Fri Sep 04, 2009 at 09:27:30 AM PDT

              [ Parent ]

              •  I found one source (4+ / 0-)
                Recommended by:
                slinkerwink, GN1927, Elise, SteveP

                that says 2.6%: http://www.rollcall.com/...

                With these building blocks of reform firmly in place, Massachusetts has the lowest rate of uninsured in the country, 2.6 percent. As of May 2009, more than 428,000 people are newly enrolled in insurance plans; about 190,000 (or 45 percent) of them are enrolled in commercial plans.

                Earns no money here for blogging, commenting, or driving traffic to any web site.

                by mem from somerville on Fri Sep 04, 2009 at 09:30:48 AM PDT

                [ Parent ]

                •  SteveP says that's a phone land-line poll (1+ / 0-)
                  Recommended by:
                  SteveP

                  that only targeted English-speaking househoulds, and that a census showed a higher number of uninsured.

                  Also, the landline poll showing 2.5% of uninsured was done by private insurers.

                  I work full-time with the FDL team on health reform thanks to your donations.

                  by slinkerwink on Fri Sep 04, 2009 at 09:42:47 AM PDT

                  [ Parent ]

                  •  just look at the link (0+ / 0-)

                    which found only 2.6% of respondents to be uninsured in mid-2008. However,despite considerable efforts, this survey reached few non-English speaking households and few households lacking landline phones---two demographic groups with high rates of un-insurance.

                    "the U.S. Census Bureau conducted its annual door-to-door survey using a group of interviewers representing every major language group. Households were asked about their insurance coverage in the previous year --- 5.4% of people
                    said they were uninsured."

                    the Massachusetts Department of Revenue (DOR), which administers the tax penalties on those who fail to obtain the mandated coverage, reports that 5% of income tax filers were uninsured as of December 2007. However, persons who fail to file a tax return1 are believed to be at high risk of being uninsured, so even these DOR figures may underestimate the number of uninsured residents.

                    Perhaps the most compelling evidence that the number of uninsured persons exceeds the 2.6% figure comes from the safety-net providers who continue to provide free care to the uninsured.
                    According to the Massachusetts Department of Health Care Policy and Finance (which partially reimburses safety-net providers for such care), the number of patients receiving free care has fallen by just over a third (36%), not the 75% that would be expected if the state’s uninsured had fallen from 10.4 % of the populations (its pre-reform level according to the Census Bureau) to the 2.6% rate that the reform’s proponents claim.

                    Meanwhile, the state has begun dis-enrolling about 5,000 people per month from its subsidized Commonwealth Care insurance program following eligibility reviews resulting in a small drop in enrollment between mid-2008 and early 20093.

                    Moreover, the situation is likely to worsen. For fiscal year 2009 the Connector went through protracted negotiations with the four non-profit insurers participating in Commonwealth Care (the subsidized insurance program). In order to bring the state’s cost increases down from 15.4% to 9.4%, the plans boosted co-payments and enrollee contributions, making services even less affordable for the near-poor families enrolled in Commonwealth Care. Several safety-net providers are now demanding (for the first time) that patients whose condition is not immediately life-threatening make up-front co-payments before seeing a doctor.

                    "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                    by SteveP on Fri Sep 04, 2009 at 09:53:53 AM PDT

                    [ Parent ]

                    •  Yeah, I was still reading (2+ / 0-)
                      Recommended by:
                      Elise, SteveP

                      to see if there was more recent data than then census and the 2007 taxes, because those would reflect the first year of implementation, and it wasn't a whole year.

                      So if the census question asked something like: were you uninsured for any part of the previous year that could be a yes, but not the final result.

                      Shouldn't there be 2008 tax data by now?

                      Earns no money here for blogging, commenting, or driving traffic to any web site.

                      by mem from somerville on Fri Sep 04, 2009 at 10:05:34 AM PDT

                      [ Parent ]

                      •  It's the same time frame (0+ / 0-)

                        as the phone poll - the tax info comes from April 15 2008 filed returns, obviously referring to end of year 2007, but still  the same as a may phone poll for all intents and purposes.

                        I haven't seen the 2008 stuff - but no one is saying this stuff is going to improve, if you read the .pdf you'll see it already has plateaued and has started down.

                        And remember also that the co-pays and deductibles are going UP, which will not only push more insured people into a place where they can't afford care.

                        "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                        by SteveP on Fri Sep 04, 2009 at 10:11:13 AM PDT

                        [ Parent ]

                •  take a look at this link (2+ / 0-)
                  Recommended by:
                  slinkerwink, GN1927

                  that discusses this. here.

                  h/t tocassiodorus on this one.

                  It's a great read.  As you can see, in addition to the unisured - there's a large swath of people who were are now insured who have no health care because of the withdrawal of the free care regime, they must choose whether to pay for the insurance (even subsidized) or the fine, and if they pay for the insurance they no longer can afford the co-pays and deductibles that are on even the subsidized plans.  Plus many of the free care clinics that used to provide primary care no longer do because of the withdrawal of funding.

                  "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                  by SteveP on Fri Sep 04, 2009 at 09:44:44 AM PDT

                  [ Parent ]

              •  The insurance co figures (2+ / 0-)
                Recommended by:
                slinkerwink, GN1927

                did a phone poll that was landline only and only english speakers that came up with 2.5%  A census poll that didn't have this problem showed over 5% currently.

                Here's the info. WARNING .pdf

                "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                by SteveP on Fri Sep 04, 2009 at 09:40:08 AM PDT

                [ Parent ]

    •  Absolutely (3+ / 0-)

      But I'm very happy that dansac (inadvertantly) articulated a crucial point: the weak public option, as currently contemplated, would have availability and funding restraints.  Chuck Schumer made sure of that.

      The currently contemplated public option design, coupled with individual mandates, would herd the vast majority people into purchasing private insurance products, while mandates with no public option would simply force most people to purchase private insurance products.  And so what's the difference if you just toss the weak public option out altogether?  

      Nothing being contemplated seriously now is not a private insurance company giveaway.  What is being contemplated is Americans forced to keep this inefficient industry afloat, with Americans NOT being offered completely universal access to a cheap, subsidized basic publicly-run nonprofit insurance program.  What's being contemplated is whether we're merely going to be herded (via a weak Schumer-ish public option) or forced to buy private insurance.

      This is the miracle of a Dem one-party state.

      Dems are on a precipice, and stand to lose seats should they get this wrong.

      RomneyCare isn't popular in MA, and will be even less popular if its equivalent is implemented nationwide.

      •  So, the question is, will dansac support (2+ / 0-)
        Recommended by:
        GN1927, alkalinesky

        the RomneyCare plan on a national scale?

        I work full-time with the FDL team on health reform thanks to your donations.

        by slinkerwink on Fri Sep 04, 2009 at 09:08:14 AM PDT

        [ Parent ]

        •  From my reading (1+ / 0-)
          Recommended by:
          paintitblue

          he's saying he sees little difference between the weak public option currently contemplated and no public option, because both, coupled with individual mandates, will generate materially the same result: most of the uninsured forced to buy private insurance products, which is the result which the private insurance industry wanted in the first place.

          I really am not all that invested in the conflicts back and forth here, because I'm so happy that this point has been made; people need to pay attention.

          I do hope that dansac hopes to lead the way towards a productive means of advocating for real healthcare reform, because I really think this situation is urgent and we can lose seats if this is done wrong.  No need for us to fight each other and divide into teams at this 11th hour.

        •  My question is... (1+ / 0-)
          Recommended by:
          askew

          will slinkerwink ever realize how to be effective in her activism?

    •  The mandates are acceptable if exclusions (0+ / 0-)

      for pre-existing conditions and rescissions due to illness (canceling someone who is able to pay but refuses to would have to be treated like income tax evasion) become illegal.

      IF we're going to have to continue dealing with private insurance - and it seems as though we might - then we have to make sure that rescission and pre-existing condition clauses are eliminated. Insurance companies cannot pick and choose only the healthiest to insure. And individuals cannot wait until they get sick to enroll in coverage.

      I hate this barbaric system. And I'm one of the lucky ones who gets good benefits from my employer! But my SiL pays beaucoups bucks for Kaiser because of her age and her partner has no coverage at all.

      The line between generalization and stereotype is as fine as the line between stereotype and bigotry.

      by 1BQ on Fri Sep 04, 2009 at 10:34:27 AM PDT

      [ Parent ]

  •  Regulations. Yeah. (5+ / 0-)

    Sure. That worked great for Wall Street. No corporate work-arounds there. Swiss cheese "regulations" sure do make the politicians feel good about themselves. And, while we're at it, transfer a mass amount of middle class wealth into health insurance company pockets through "mandates" that will piss EVERYONE off. Great bill!

    Affordable? 15% of my annual income for a family of 4, somewhere around $10,000, is affordable? And who the fuck can afford COBRA? You are speaking to a different income bracket, my friend.

    This bill is a joke! You have got to be kidding me. The only thing it will do is give more money to corporations to fuck us over. I can't believe how short-sighted some people are on this.

    No moral nation lets people die because they don't have money.

    by alkalinesky on Fri Sep 04, 2009 at 08:41:07 AM PDT

    •  Regulations are only as good as the party (4+ / 0-)

      that enforces them.

      I work full-time with the FDL team on health reform thanks to your donations.

      by slinkerwink on Fri Sep 04, 2009 at 08:45:57 AM PDT

      [ Parent ]

    •  Regulations worked while they actually (3+ / 0-)
      Recommended by:
      askew, Gooserock, cotterperson

      existed, the '40's through the '70's, so I'd say there's plenty of proof that regulation does work. Swiss cheese ones, as set up during the last 30 years, don't.

      And by the way. You'd be surprised just how many people already pay 15%, counting employer contributions already. Like most people you don't seem to understand just how much it costs you now.

      •  We Had 90% to 70% Top Income Tax Rates Then (3+ / 0-)

        ANYBODY could regulate an industry in that environment. With no ability to carry home a jackpot, there was no incentive to set up a casino in any industry.

        We even had REPUBLICANS running economies less destructive than this one, with proper taxation.

        That's why both parties adopted Reaganocracy, to liberate the rich and get the economic roulette wheel spinning again.

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

        by Gooserock on Fri Sep 04, 2009 at 09:42:31 AM PDT

        [ Parent ]

      •  I know exactly (1+ / 0-)
        Recommended by:
        slinkerwink

        how much my health insurance costs. I know it is UNAFFORDABLE. And unsustainable. I had to purchase a plan for my daughter out of pocket because I couldn't AFFORD to put her on my employer plan. She has a high deductible on a plan that I pay for every month. If she were to actually NEED the insurance, I would be bankrupt. I take home $2,100 a month after taxes and my health care costs. Her deductible is $2,500, and even at that it's only 80/20 coverage. There is no way I could pay for her to actually use that insurance. I would go bankrupt. I do the math every day, when I pay her daycare costs and go to the grocery store and try to figure out rent. Only in this fucked up country do I have to worry about this shit. I take exception to the notion that I don't know how much I put in, and how much my employer puts in, for our piece of shit junk insurance. I know all too well. Which is why mandating that people buy this crap is a fucking bad idea.

        No moral nation lets people die because they don't have money.

        by alkalinesky on Fri Sep 04, 2009 at 10:05:04 AM PDT

        [ Parent ]

        •  If the trigger in your state is 15% (0+ / 0-)

          it sounds like there's a lot in your boots. So either the rates go down, or the trigger goes into effect. Even a 3 year trigger would put you on the same footing as a PO.

          By the way, that policy wouldn't be acceptable as a qualifying policy, period.

      •  And I also know (1+ / 0-)
        Recommended by:
        slinkerwink

        There is absolutely nothing at all in this bill that would do anything for me, as far as "affordability". According to their math, I am just fine.

        So they can talk their talk and blah blah blah. Nothing is changing for us here on the ground.

        Nothing.

        No moral nation lets people die because they don't have money.

        by alkalinesky on Fri Sep 04, 2009 at 10:08:19 AM PDT

        [ Parent ]

  •  For 47 million people . . . (17+ / 0-)

    including myself the public option issue isn't academic.

    After being hosed in the individual market, I have no interest in being compelled to purchase insurance from another private health insurer -- with or without a subsidy.

    Plus, who's to say that the consumer protections will survive this administration?  

    It seems entirely plausible that the next GOP administration will simply keep the mandates, and fail to enforce consumer protection measures -- as was the case with the last GOP administration.  

    The public option at least has the ability to keep the private insurers and future GOP administrations somewhat honest (in part because it will deprive them of an not insignificant revenue stream).  

    For those in the individual market, this is an issue that matters.

    •  I support the P.O. (9+ / 0-)

      For all the reasons you said.  

      But that's not the argument of my piece.  

      I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

      by dansac on Fri Sep 04, 2009 at 08:42:56 AM PDT

      [ Parent ]

      •  Oh Sure (11+ / 0-)

        So in order to disagree with you, we have to disagree with stuff you actually SAID?  What kind of standard is that?  Have you NEVER read a rec list diary here?

        ---- Don't mind me, I'm just here trolling for James Inhofe. [Note to Complete Idiots: I'm Not Really Trolling for James Inhofe]

        by TooFolkGR on Fri Sep 04, 2009 at 08:45:52 AM PDT

        [ Parent ]

      •  Your argument . . . (1+ / 0-)
        Recommended by:
        slinkerwink

        assumes that costs will be dealt with in the future and that the bill has merit beyond the public option, correct?

        The problem as I see it is that a bill without a public option reduces the likelihood that we will have future cost reduction measures.  I see it as more of a Pyrrhic victory.

        If the circumsribed public option limited to 10 mill. is inconsequential why is the industry pushing back against even this measure?

        You seem to trust that the short-term benefit of a badly compromised piece of legislation will necessarily be remedied for the better in the future.  

        I'm a lot more cynical about the current process.  If even a badly circumscribed public option can make it through this bill what does that say about the prospect for future revisions?  It's a pretty sad statement.

        There are few ways that we could actually make the current system even worse -- however, that doesn't mean that the status quo is the worst of all possible worlds.    

        •  They're pushing back because of the mandate (0+ / 0-)

          and the other stuff that sticks the nose of the feds in regulating medical care for other than the indigent and elderly. You may be focused on the public option, but they're looking at the regulations.

          •  Mandates apply to consumers, not the insurers . (1+ / 0-)
            Recommended by:
            slinkerwink

            The insurers will have new regs put into effect (e.g. no recission, no cherry-picking -- although they will undoubtedly try to craft legislation that makes this happen).

            The insurers though aren't opposed to the Feds requiring the uninsured to buy their product (that's what mandates are).  Especially if the Feds are also planning to provide subsidies to cover the cost.

            You'll note that no Senators are saying "cherry picking must be allowed!"

            No, they're saying "No public option."  Who is it that's prompting them to say that?  It's the insurers who would be in direct competition with the public insurance program.  The private insurers don't want to share the market with the public option; they want the new captive, federally subsidized 47 mill. market to themselves!

            •  The insurance companies do not want (0+ / 0-)

              the feds to start regulating them. That's what keeps them up at night. Their nightmare is a swiss system, a heavily regulated private market. That's so much more feasible in the US than any expansion of a small PO into single payer.

              Don't forget, of those 47million only 10 or so are expected to be on the PO. That's still 37 million new customers for them. They're still gonna make out like bandits, without serious regulation.

  •  Obama needn't go to the trouble (5+ / 0-)

    of "putting his presidency on the line" if this is the best he can come up with. Smoke and mirrors. You can call it "reform" but most of us are not buying it.

    "At least the war on the environment is going well."

    by spider webs unite on Fri Sep 04, 2009 at 08:41:52 AM PDT

  •  Without the PO, the bill simply won't pass (10+ / 0-)

    And we'll be stuck with the status quo.

    With the public option, the bill can pass, and it will also have other goodies that will reduce the number of medical bankruptcies:

    - Elimination of lifetime caps

    - Elimination of recission

    - Caps on yearly out-of-pocket expenses

    - Elimination of denials for pre-existing conditions

    I don't view the PO as a panacea for cost reduction, but it's the best watered-down first step we can hope for at this point.

    How long did it take the right to go from: "if you criticize the President you are a traitor" to "School children should not trust the President."

    by MKinTN on Fri Sep 04, 2009 at 08:41:57 AM PDT

  •  Yup. (14+ / 0-)

    kos should ban kos and Hunter and Meter Blades and mcjoan, and David Waldman and DarkSyde because they are insufficiently supportive of Obama.

    Good luck with that.

  •  Predictions are that in 10 years (10+ / 0-)

    3% of Americans will be on the public plan. Let's fight and give up all insurance reforms for that.

    I want a public option and I think it would be crazy for Dems to drop it, but if they do drop it, it should be at the last minute, not in September.

    There is so much in this bill that will make millions of Americans lives better, including people like me with pre-existing conditions that can't even get coverage.

    •  Not if you read this place (5+ / 0-)
      Recommended by:
      askew, jim bow, Elise, Mother of Zeus, nickrud

      They REFUSE to believe anything in the bill helps lives without a public option. REFUSE!

      I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

      by dansac on Fri Sep 04, 2009 at 08:44:40 AM PDT

      [ Parent ]

    •  Where does cost containment (4+ / 0-)

      come from if not the PO?  It doesn't matter how many Americans will actually select the PO.  What matters is the honest competition.  Wihtout that the insurance comanies will continue to do business as usual.  What is so hard to understand about that?  The only people who should even consider dropping a strong PO are those who own stock in the health insurance industry.

      •  And besides, the insurance companies (2+ / 0-)
        Recommended by:
        alkalinesky, NotGeorgeWill

        will just game the system within the exchange if there's no public option. With no antitrust protection, there's nothing keeping private insurance companies from buying up smaller insurance companies within the exchange, and it becomes the situation where there are 6 major insurance companies dominating much of the national exchange.

        I work full-time with the FDL team on health reform thanks to your donations.

        by slinkerwink on Fri Sep 04, 2009 at 08:56:18 AM PDT

        [ Parent ]

      •  Two separate issues (4+ / 0-)
        Recommended by:
        askew, jim bow, Elise, Mother of Zeus

        I agree that the public option is crucially important for cost containment for the system as a whole.  HOWEVER, I do disagree that it's the only tool (e.g. now, medicare reimbursement rates set the market).

        My argument is that it's a separate issue from consumer protections and that assigning the consumer protection power to the P.O. as Hunter did today is dishonest and untrue.

        I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

        by dansac on Fri Sep 04, 2009 at 08:57:53 AM PDT

        [ Parent ]

        •  How are you defining consumer protections (1+ / 0-)
          Recommended by:
          NotGeorgeWill

          I see reference to them made but no examples of how it will be accomplished without the PO.

          If I just missed it, apologies.

          Slap happy is a platform.

          by averageyoungman on Fri Sep 04, 2009 at 09:05:31 AM PDT

          [ Parent ]

          •  How will it be accomplished WITH P.O.? (3+ / 0-)
            Recommended by:
            askew, jim bow, Mother of Zeus

            Hunter said, for example, that people will still go bankrupt because of private insurance without the P.O.  

            First of all, the bill will have protections against that, but I don't doubt there will still be problems.

            What I do doubt is how the P.O. changes that?  90% of people will still be on private insurance?

            I have asked multiple times and still haven't received one single clear answer for how the P.O. prevents bankruptcies for people who don't have it?

            I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

            by dansac on Fri Sep 04, 2009 at 09:08:20 AM PDT

            [ Parent ]

            •  Medical bankruptcies still exist in MA with the (1+ / 0-)
              Recommended by:
              NotGeorgeWill

              exact same legislation that's being proposed in the Senate Finance Bill. For instance, private insurers in the Senate Finance Bill are required to pay only 65% of the cost of a claim. Right now, they pay 75% to 90% of a claim's cost.

              I work full-time with the FDL team on health reform thanks to your donations.

              by slinkerwink on Fri Sep 04, 2009 at 09:10:42 AM PDT

              [ Parent ]

            •  What I asked was... (1+ / 0-)
              Recommended by:
              NotGeorgeWill

              What consumer protections, other than the PO, are you referring to?

              Slap happy is a platform.

              by averageyoungman on Fri Sep 04, 2009 at 09:24:15 AM PDT

              [ Parent ]

              •  Many, including prevention of denying care (3+ / 0-)

                based on pre-existing condition, banning lifetime caps on benefits (one of the main causes of bankruptcies), etc.

                I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

                by dansac on Fri Sep 04, 2009 at 09:25:20 AM PDT

                [ Parent ]

              •  No recisssion; no denial for pre-existing . . . (3+ / 0-)

                conditions for starters; no cherry-picking customers.

                Whether the laws are written with gaping loopholes, and whether the DHS actually enforces those protections remain open questions.  

                •  Operative passage IMO... (1+ / 0-)
                  Recommended by:
                  NoVa Boy

                  Whether the laws are written with gaping loopholes, and whether the DHS actually enforces those protections remain open questions.

                  The only actual consumer protection I can see above is the banning on lifetime caps, which shouldn't be a concession we have to make. And you could mean multiple things by "cherry picking customers." So please explain that if you have a second :) The PO only must implement the rest to force the same from private insurers.

                  Not to mention the fact that you will be forced - forced - to buy potential junk insurance. One need only look at the current state of affairs across numerous government entities to predict how regulation will go. The loopholes will simply change, as may the representatives being paid off to write them.

                  IMO - none of that will do fuck all to control cost, especially for people who fall in between the numerous cracks that will - and already - exist, governed by such things as the definition of "affordability." There's a reason they fight the PO so adamantly, and that's because it's the one and only equalizing component of potential reform. Instead of denying care, they will simply raise costs  because no competition exists to stop them, and their consumer base will be legally captive. This proposition is so ripe for corruption. There's no possible way it won't end up a complete distortion of any positive intent.

                  The only way I could even begrudgingly accept a bill absent a PO would be if the mandate were dropped. Of course, other worthwhile parts of the bill would then be stripped.  

                  Slap happy is a platform.

                  by averageyoungman on Fri Sep 04, 2009 at 10:06:28 AM PDT

                  [ Parent ]

            •  Consumer protections only matter if they are . . (3+ / 0-)
              Recommended by:
              slinkerwink, Mother of Zeus, NoVa Boy

              enforced.

              And frankly if the industry has such extreme influence with a Democratic Congress and administration that it's able to dictate the existence of a limited public option -- even in a bill that substantially increases its revenue (with the public option) -- it's not hard to envision how the industry will dictate how future administrations enforce those laws.

          •  Well, what I asked was... (1+ / 0-)
            Recommended by:
            NotGeorgeWill

            What consumer protections, other than the PO, are you referring to?

            Slap happy is a platform.

            by averageyoungman on Fri Sep 04, 2009 at 09:18:13 AM PDT

            [ Parent ]

        •  Medicare reimbursement rates (0+ / 0-)

          are "off the table" right?  So where does cost containment come from?  And if there is no costs containment, where is the reform?

          •  Sorry, what are you talking about? (1+ / 0-)
            Recommended by:
            Mother of Zeus

            Medicare reimbursement rates as they currently exist are on the table?

            Where is the reform?  

            If there were a bill that said one thing only in it: "Insurances companies are banned from denying coverage based on pre-existing condition," that would be reform.

            NOTE: not what I'm advocated for alone, just using that to prove a point.  That point being we've lost the definition of reform because people are no longer being accurate about what accomplishes what in this bill

            I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

            by dansac on Fri Sep 04, 2009 at 09:13:30 AM PDT

            [ Parent ]

            •  Wrong again (0+ / 0-)

              "Medicare reimbursement rates as they currently exist are on the table?"  Uh, no, no they aren't.  It was watered down to the PO had to negotiate rather than just using Medicare rates.

              "If there were a bill that said one thing only in it: "Insurances companies are banned from denying coverage based on pre-existing condition," that would be reform."  Uh, no, no it wouldn't be real reform because the premiums that the health insurers would charge those with pre-existing conditions would mean that none of those people woud be able to afford the alleged insurance.

              There can be no real reform without cost containment.

              •  You totally misunderstood me (2+ / 0-)
                Recommended by:
                Elise, Mother of Zeus

                I'm talking about Medicare itself now - nothing to do with the bill being written.

                Medicare rates set the standard for private insurers - NOW.  Separate from any legislation.

                I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

                by dansac on Fri Sep 04, 2009 at 09:47:39 AM PDT

                [ Parent ]

              •  2 of the House bills use medicare rates for (1+ / 0-)
                Recommended by:
                Elise

                the public option right now. They aren't off the table, but they are going to have to build in some kind of factor for rural areas. Medicare rates are too low in rural areas.

          •  Public option in HR 3200 . . . (2+ / 0-)
            Recommended by:
            dansac, Mother of Zeus

            is Medicare rates plus 5%.

            In theory cost containment could happen if there is genuine competition between the insurers.

            Unfortunately, mandates and subsidies introduce distortions into the market, so you'd have to regulate the hell out of them like we do with most utility companies.

      •  yeah, 3%, 10%, 99%... (1+ / 0-)
        Recommended by:
        NoVa Boy

        Doesn't matter. In fact it could be argued that it's effectiveness would be higher the lower the percentage of Americans using the PO, because the implication would be that private insurers were being forced to provide a product worth buying.

        I am still scratching my head regarding what excuse will be provided for a mandate if it is scrapped.

        ???

        Slap happy is a platform.

        by averageyoungman on Fri Sep 04, 2009 at 09:01:04 AM PDT

        [ Parent ]

      •  Cost containment won't come primarily (4+ / 0-)
        Recommended by:
        jim bow, Elise, Mother of Zeus, NoVa Boy

        from the public option. It will come from the following:

        1. The insurance exchange. Increased competition in markets that have seen insurance monopolies for years. Look at what competition has done to lower costs of cell phone plans.
        1. The elimination of pricing based on prior claims and pre-existing conditions. That is where the price gouging really happens. Under this bill, they will only be able to use community rating and age to determine premium.
        1. The pricing on age for the oldest policyholders is 2x the premium of the youngest policyholders. That percentage is much higher now.
        •  Thanks for a cogent and detailed answer (0+ / 0-)

          Let's see . . . first, without a strong public option the exchange will not introduce any serious competition on pricing as long as the health insurers enjoy antitrust exemptions.  The final bill would have to have a strong trust-buster provision and enforcement.  Second, community rating is nice, but won't do much as long as markets are highly concentrated and/or there is no real competition (IOW, without competition community rating will likely lower premium for a few and raise premiums for many).  Third, similarly, capping age-based ratios is a nice idea that will do alot but only if there is real competition.

          In theory a final bill without a public option could be designed to accomplish the same goal, but I am strongly skeptical that it would work out in practice.  Such a bill would rely entirely on the government enforcing a strict regulatory regime on a private industry will millions upon millions of dollars available to spend on lobbyists and PAC's.  That didn't work out so well for the financial services industry, now did it?  I do not trust the Obama administration to police big business.  Just like we ended up with Goldman Sachs in charge of our economy, we'll get Pharma in charge of health care.  

          So there, dansac, I guess I'm "reality based" enough to see what could happen in a perfect world where government agencies take their duties to protect the public seriosuly, but show me where that world exists.

          We need a strong, independent public option that, once it's up and running, no Congress and no President can screw with without political ramifications.

          •  Actually, you are wrong about needing a public (2+ / 0-)
            Recommended by:
            Mother of Zeus, NoVa Boy

            option in order to have competition in the exchange. The exchange is based on the Federal Employee Insurance Plan which has an exchange of only private insurers. It does provide competition without a public option.

            •  Because the federal plan does not allow the (1+ / 0-)
              Recommended by:
              Mother of Zeus

              insurance companies to divvy up the country into concentrated markets.  If the public exchange that is created does not do anything about anti-trust exemption then the competition in the exchange will be an illusion.

              I want to see what the final bill creates, (I hate the way the Dem leadership forced us into this prolonged period of wait-and-see), but I have strong doubts that a reform bill without a public option will do anything except be a billion dollar giveaway to the insurance industry.

              •  I agree that the anti-trust exemption needs to go (2+ / 0-)
                Recommended by:
                buddabelly, Mother of Zeus

                However, before that happens we need to make sure there are tight enough regulations at the federal level on insurers. Some states have very tight regulations on insurers. We would want to incorporate those into the federal regulations before we allow the anti-trust exemption to be reversed. Otherwise, all of the insurers would just set-up shop in whatever state has the most lax regulations (similar to what credit card companies do).

    •  If you think they won't find loopholes... (2+ / 0-)
      Recommended by:
      alkalinesky, NoVa Boy

      To deny you coverage, or that they are going to stop denying care on a line-item basis whenever and wherever they can, you're delusional.

      And, what predictions? If it's 3%, and it is because a PO is forcing private insurers to provide a product worth an affordable cost, wouldn't it have accomplished its purpose?

      Can you tell me what the need for a mandate is if all we'd be doing is to force insurance companies to play by a meager set of rules?

      Slap happy is a platform.

      by averageyoungman on Fri Sep 04, 2009 at 08:57:19 AM PDT

      [ Parent ]

    •  If that's the case . . . (0+ / 0-)

      regarding the public option then why is there ANY industry push-back?  

      If the measure is so incredibly inconsequential and meaningless in the big picture, then why the investment on the part of the industry to keep it from happening.  It makes no sense.

      I think the industry realizes, as many of us do, that the public option is a major structural feature -- even if its availability is limited on the front-end.

      It's also not clear to me how we make reforms easier in the future by settling at this stage.  The pressures for real reform are likely to increase, not decrease with the direction that things are currently going (and yes, I realize that's asking an awful lot of a lot of people -- including the uninsured like myself who are running significant financial and health risks by holding out for what we believe would be a more reasonable compromise).  

      •  The 'public option' is sexy and distills what (0+ / 0-)

        is objectionable to both sides in the bills under discussion.

        For the left, it's profit by insurance companies, murder by spreadsheet.

        For the right, it's government mandates over what they spend their money on, or, to them, creeping socialism.

        Easy to stir emotional rather than rational discussion and thereby whip up their base.

        •  That might explain the GOP push-back . . . (1+ / 0-)
          Recommended by:
          Larsstephens

          it doesn't explain push-back by the industry.  

          Dem Senators aren't running scared on the public option just because of demagoging by the GOP.  People like Evan Bayh, whose wife sits on the board of Well-Point, a major player in the individual market, stand to lose market share and revenue long-term if they are put into direct competition with a genuine national public option.  That's their fear.

          For the Dem Senators health insurance money is a huge source of campaign money.  If we had Medicare for All, you remove one major source of funding from future election cycles.

          That's part of the reason for the push-back within the party.

          •  I don't think the election money is (0+ / 0-)

            the defining issue for the blue dogs; most  ideologically don't like the public option.

            Our side is all to ready to put venal motives on actions that truly are alternative views of how government should function, just as the other is far too often putting ulterior anti-american motives on us..

          •  Oh, and for all the talk about how the (1+ / 0-)
            Recommended by:
            buddabelly

            insurance co's are all for mandates the regulations that come with them are more frightening than the PO. Have you ever seen a corporation that didn't fight tooth and nail any bill that had regulation in it?

      •  First, the PO (0+ / 0-)

        would cut into industry profits, and they don't like that.  Second, I think there is a genuine concern that it would be a trojan horse for single payer.   In other words, the PO might not actually be the most important reform to protect consumers in the short run relative to other reforms being proposed (rescissions, pre-existings, caps, community ratings, etc.)  However, it might ultimately soften resistance to a public insurance plan as payor and prove more attractive to the public.  

        The GNOP: We take the bi out of bipartisanship

        by Mother of Zeus on Fri Sep 04, 2009 at 08:53:23 PM PDT

        [ Parent ]

  •  Thanks for this diary, but (7+ / 0-)

    its easier to blame the President, 'cause he's not "tough" enough.

    Uh huh.

  •  Recced for the quality of argument (31+ / 0-)

    Instead of calling people names, you supported your position with solid arguments. My two cents is that the legislation will do little to curb the health and insurance industries' greed and almost nothing to make the system more efficient; and that a public option would act as a check on insurance companies (much the same way as labor unions in some companies within an industry force non-union employers to offer better pay and working conditions). But those are for another debate to be held at another time. You've provided plenty of fodder for a good, substantive discussion.

    "You can never guarantee victory, but you can guarantee defeat."--Hall of Fame baseball writer Leonard Koppett.

    by Dump Terry McAuliffe on Fri Sep 04, 2009 at 08:44:43 AM PDT

    •  Thank you sir - I'd add (8+ / 0-)

      I want all those things to happen.  I think that one important criteria is whether this bill lays the groundwork for future improvement.  

      What I reject is the notion that this bill has to be the end-all-be-all.  

      There IS no healthcare reform without a bill giving us some momentum.

      I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

      by dansac on Fri Sep 04, 2009 at 08:46:05 AM PDT

      [ Parent ]

    •  Agreed. (6+ / 0-)

      I'm willing to walk away from a trigger bill, or any non-PO bill.

      But that's partly because I'm in MA and I'll still have insurance.  It's not a perfect solution either, but it's better than I used to have.

      I think it's a fair argument though.

      Earns no money here for blogging, commenting, or driving traffic to any web site.

      by mem from somerville on Fri Sep 04, 2009 at 08:54:08 AM PDT

      [ Parent ]

      •  I have insurance too. (0+ / 0-)

        Private insurance.  A Cadillac PPO plan that covers  me, my wife and two kids.  And it costs me an arm and a fucking leg.  I could use that money in my pocket, not lining the pocket of some insurance company executive who makes millions under the staus quo.

        So, no public option?  No way!

        •  I do hope you realize you won't be eligible for (0+ / 0-)

          the PO? That nothing in your cadillac policy will change under this legislation except for no caps on payouts (checked your policy for that, it's the most common out insurance companies use) and other useful regulations on current policies.

          •  **palm slaps forehead** (1+ / 0-)
            Recommended by:
            slinkerwink

            Will my f-ing premiums go down if the public option is competing with my health insurer?  Yes?  Thank you.

            BTW, I would not qualify for subsidies to purchase the PO.  I would be able to drop my current plan and buy the PO (that is, if Obama does not sell us out).

            •  How would you be eligible? I'm using HR3200 (0+ / 0-)

              Section 202, EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS.

              One of the requirements to be eligible for the exchange (the only way you can get the PO is:

              (B) is not enrolled in coverage as a full-time employee (or as a dependent of such an employee) under a group health plan if the coverage and an employer contribution under the plan meet the requirements of section 312.

              The insurance company won't be competing with the PO for your policy.

              •  And I will be eligible (1+ / 0-)
                Recommended by:
                slinkerwink

                If I stop my enrollment in the employer offered plan.  It's not mandatory for me now.  That's called competition.  If my insurer does not meet the standards set by the exchange then I bail on them.

                •  Hm. I do believe I read a provision that (1+ / 0-)
                  Recommended by:
                  NoVa Boy

                  regulates that. But even if I'm wrong you're going to drop that cadillac program for your family for the minimal benefits the PO will offer? You really expect it to be better?

                  •  Well I would need to see the terms. (0+ / 0-)

                    My Cadillac plan covers lots of stuff, and is really neato with flashy debit cards and such, but it costs a ton of money.  If I can get good, fairly comprehensive coverage for less money through the exchange, then yeah I'll dump BC/BS in a heartbeat.  I have no faith that will even be a possibility without the public option.

                    As far as any provision that limits an individual's eligibility to use the exchange, there isn't any in HR3200 (that I have found) except for the employer enrollment limitation.  There is a 3 years phase in for employers, to soften the blow against insurers and give them time to work out ways to compete.

                    •  Assuming the administrator (2+ / 0-)
                      Recommended by:
                      buddabelly, NoVa Boy

                      (I don't have it open at the moment, forget the legal term) allows in that employer. But based on the CBO, with a 10-15 million enrollment in the PO by 2019 I don't expect many to be approved.

                      Anyway, this isn't the key issue for me. I've worked with homeless, low income, disabled, mentally ill people for decades now and for me the major stuff is the medicaid and subsidies so that people at the low end pay 3-4% of income for health care That they even have access other than the emergency room, period. PO or not their lives would be incredibly improved by the regulatory and subsidy changes.

                      •  Fair enough (1+ / 0-)
                        Recommended by:
                        nickrud

                        and I want to see all of that reform enacted.  But looking at the delivery of health care as a unified issue, reform without cost containment is not advisable, hell it's not sustainable.  We cannot afford to keep doing business as usual.  Tinkering with the margins will not solve the problem.  If we do not get cost containment now, we will never get it.  Between the health insurers and the defense industry this country will be bleed to death.

  •  FWIW, for me it isn't really even about (3+ / 0-)

    the public option itself.  It's that it doesn't appear that Obama is willing to fight for it.  Where's the fire we saw during the campaign?  While there's a difference between being candidate and president I guess I thought I'd see some of that passion from a politician for us not special interests.  I'm tired of those with the money winning out over the rest of us.

    We're calling and writing and going to town halls but we're still being ignored/taken for granted.  My last bit of hope will either gather strength or be depleted depending on what he says Monday and Wednesday.  I'll either work with him or around him.

    The GOP is right: there is a "death panel." It's called the Senate Finance Comittee where good reform was allowed to die.

    by My mom is my hero on Fri Sep 04, 2009 at 08:45:38 AM PDT

  •  Wow (13+ / 0-)

    This is thick, THICK, with errors.

    Lets start here:

    But the public option would only be available as an option, on an exchange, to those who don't currently have health insurance.  

    Only partially correct. It is also available to small employers.

    The public option is just that, an option that has to pay for itself through premiums, that would be available on an exchange with other insurance options and would help keep costs down in the overall system.  IF IT DOESN'T pass now, cost control will still be dealt with in the future.

    We've been trying to pass reform for what, 60 years now? Insanity to think we can just revisit it easily and add it later. We will NOT have the seat advantages we have now. If not now, then when? WHEN do you think this will actually be revisited?

    There are countless, countless people who have no insurance now.  They don't have it because they can't afford it.  They have pre-existing conditions.  They've lost their jobs, etc.  And this bill would give them subsidies to buy insurance, prevent them from being denied coverage, etc.  

    And these people will be mandated to buy that insurance. And the rates will rise without the public option faster than the subsidies can keep up. This will cost us a fortune, both in terms of personal costs and tax cost for subsidies.

    How on God's green earth, the public option is now going to transmit consumer protections to the 90% of people who wouldn't be on it is beyond me.  How can it prevent others from going bankrupt?  How can it prevent other insurance from denying coverage for pre-existing condition?  How can it eliminate caps on lifetime benefits?

    Lots of straw there. None of those was ever the point of the public option. The point of the public option was to provide an affordable choice that wasn't junk insurance to the people we are about to slam with a mandate.

    This is a really, really unconvincing diary.

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

    by heart of a quince on Fri Sep 04, 2009 at 08:46:19 AM PDT

  •  In the middle of a fight (8+ / 0-)

    It isn't the best time to start looking for a compromise fall-back position.

    Single payer is long gone.

    Public option is looking like a long-shot but it is still possible.

    So maximum pressure must be brought to bear from all constituencies to make this happen.

    Every day's another chance to stick it to The Man. - dls.

    by The Raven on Fri Sep 04, 2009 at 08:46:56 AM PDT

    •  I agree actually (9+ / 0-)

      I'm not advocating a compromise - I'm advocating everyone take a deep breath.  This place is rife with eagerness to be disillusioned and I fear a decision to actually fight a bill without a P.O.

      I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

      by dansac on Fri Sep 04, 2009 at 08:49:19 AM PDT

      [ Parent ]

      •  This is DKos (4+ / 0-)
        Recommended by:
        dansac, Elise, buddabelly, nickrud

        This place is rife with eagerness to be disillusioned

        Did you really think that would ever have changed around here? Welcome back, btw.

        Every day's another chance to stick it to The Man. - dls.

        by The Raven on Fri Sep 04, 2009 at 08:52:37 AM PDT

        [ Parent ]

      •  That's not what you said in the diary (0+ / 0-)

        asdf

        •  Sure is: (2+ / 0-)
          Recommended by:
          askew, Elise

          Let me first be clear: I absolutely support the notion of a public option.  I think it's important to forcefully advocate for one.  It would be a far better bill if a public option were included.

          I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

          by dansac on Fri Sep 04, 2009 at 09:01:06 AM PDT

          [ Parent ]

          •  Nope (1+ / 0-)
            Recommended by:
            slinkerwink

            Here:

            I'm not advocating a compromise - I'm advocating everyone take a deep breath.

            Diary:

            It's simply a fact, the public option doesn't have all the powers you are ascribing to it.  In fact, most of the things you want it to do occur in other parts of the bill.  Yes, it sucks that insurance companies will get money, but hey, life isn't fair.  But if coupled with the kinds of consumer protections that help out the millions of people who need it, I'll take that over nothing any day of the week.

            And nothing is exactly what will happen if some sort of reform doesn't pass now.  So fight for the public option all day long.  Fight for it now, but support reform in the end if it moves us in the right direction

            Compromise (i.e., throwing the public option under the bus) is exactly what your diary is about.  Just admit it.  You "support" the public option as long as it is useful as a negotiating point.

      •  If no mandates, there will be less opposition to (1+ / 0-)
        Recommended by:
        GN1927

        a bill w/o public option.

        If nibbling at the edges is the best we can do - because of the Blue Dogs - well then nibble at the edges. More money for Medicaid, expand SCHIP etc . . .

        But don't blow smoke and call it comprehensive reform.

        Just say "No!" to premature capitulation

        by Bill White on Fri Sep 04, 2009 at 09:04:50 AM PDT

        [ Parent ]

        •  Fair enough - let's see what the final bill is (2+ / 0-)
          Recommended by:
          Bill White, buddabelly

          my only argument was the elevation of powers to the P.O. that don't exist.  Not that we should have a worthless bill.

          I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

          by dansac on Fri Sep 04, 2009 at 09:06:02 AM PDT

          [ Parent ]

          •  Public option is not a panacea (3+ / 0-)
            Recommended by:
            dansac, buddabelly, Larsstephens

            However it has become the insignificant crossroads where two armies are now colliding.

            Perhaps Gettysburg? As an analogy?

            Was that crossroads worth fighting over? Probably not. But once the battle was joined, backing down becomes very difficult.

            Just say "No!" to premature capitulation

            by Bill White on Fri Sep 04, 2009 at 09:11:05 AM PDT

            [ Parent ]

            •  Agreed - I regret it has come to this (3+ / 0-)
              Recommended by:
              Elise, Bill White, buddabelly

              Because I think there's a lot of forest being lost through the trees

              I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

              by dansac on Fri Sep 04, 2009 at 09:11:59 AM PDT

              [ Parent ]

              •  Years and years of DLC versus outsiders (5+ / 0-)

                has built up tensions.

                World War One happened because some obscure royal dude got shot in Serbia.

                Anyway, if Olympia Snowe refuses to openly advocate triggers as sufficient to break with the GOP, Obama will have room to maneuver. Triggers are a trap for the GOP as well as for us.

                If they (GOP) say "No" to everything and Obama can do the framing right, he can pivot hard and crush them.

                If they (GOP) say "Yes" to something then he can negotiate a deal.

                But some GOP-er has to say "Yes" first. Otherwise there is no reason to surrender ANY point.

                Just say "No!" to premature capitulation

                by Bill White on Fri Sep 04, 2009 at 09:16:17 AM PDT

                [ Parent ]

  •  The public option is the cop in the corner (7+ / 0-)

    It keeps the insurance companies honest.  If they get too cute, they lose customers to the public option or suppliers refuse to accept them as insurance and the public option wins again.

    Provide better coverage and you'll survive as an insurance company.  Otherwise, you'll get out of the business.

    In many ways the public option has the potential to be better than single payer - it provides a floor but not a ceiling.  No one wil have worse health coverage than this level.  If you want and can afford better coverage - go for it.

    OK, so we're up by 21, there's 34 seconds left in the 4th and we have the ball. I say we forfeit. - Coach Baucus

    by nightsweat on Fri Sep 04, 2009 at 08:47:02 AM PDT

    •  All reasons I support it (6+ / 0-)

      My argument isn't against public option.  It's against the elevation of public option as the only meaningful reform.

      I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

      by dansac on Fri Sep 04, 2009 at 08:54:07 AM PDT

      [ Parent ]

      •  Which is exactly what (1+ / 0-)
        Recommended by:
        slinkerwink

        no one is arguing for.  Nice strawman there, but the argument is that the public option is the lynchpin of real reform.  Without it the rest of the reforms will not work.

        •  That's just not true on multiple levels (3+ / 0-)
          Recommended by:
          askew, Elise, buddabelly

          Countless people here argue that without the P.O. there isn't meanginful reform.

          In fact, you just said it.  And your argument for the P.O. isn't true either - the rest of the reforms are not dependent on the P.O.  They would be helped by it, but they aren't dependent on it.

          I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

          by dansac on Fri Sep 04, 2009 at 09:03:16 AM PDT

          [ Parent ]

        •  I'm Not Sure There's a Meaningful Difference (2+ / 0-)
          Recommended by:
          askew, Elise

          Between something being the "lynchpin" without which everything else is meaningless and something being "the only meaningfull" part.

          ---- Don't mind me, I'm just here trolling for James Inhofe. [Note to Complete Idiots: I'm Not Really Trolling for James Inhofe]

          by TooFolkGR on Fri Sep 04, 2009 at 09:05:06 AM PDT

          [ Parent ]

          •  Well then I'll put it in real simply terms (2+ / 0-)
            Recommended by:
            slinkerwink, GN1927
            1. HCR equals public optin plus "lot's of other stuff".  
            1. The "lot's of other stuff" is great and necessary and has to be included, but
            1. without the cost containment of the public option none of it will be worth anything.  

            The health insurers will still have no competition without the public option, and real competition is the only thing that will make them change the way they do business.  Regulation?  Yeah right.  That'll work, 'cause the Blue Dogs and the Rethug's and the sellouts won't find any way to water down the regulations.

            So, to make my point explicit: no one is arguing that the "public option is the only meaningful reform" but plenty of people are arguing -- correctly -- that without the public option the other reforms will not be meaningful.

  •  Hey, Dansac (12+ / 0-)

    Welcome back. I actually sort of agree with you. The PO has wrongly become a silver bullet in the minds of many progressives, but that's because of three related reasons.

    - most progressives support some version of single-payer, and the PO allows us to swallow the bitter pill of keeping the Insurance Company regime in place.

    - It's a crack in the regime that (we hope) that might lead to its downfall, to be replaced by single payer. Without that crack there is little hope of eventual fundamental change.

    - A PO is the one thing in the bill that scares Big Insurance, so that's reason alone to fight for it.

    All that said, a poorly designed PO, one that tips scales against it, might actually undermine the case for single-payer, as would the Insurance Companies gaming the system, beating the laws against dumping the unhealthy. Then there would be two systems, a government one for the expensive to cover and a private one for the cheap to cover. Another reason why it's strange that a PO has become THE cause for progressives.

    Don't get me wrong, I basically support the fight, but it contains ironies on top of ironies.

  •  the PO shouldn't be sacrificed for nothing (2+ / 0-)
    Recommended by:
    slinkerwink, NoVa Boy

    how many people would sign onto the bill if obama abandons the PO?  Has anyone gone on record and said, "I'd support the bill if we had a trigger"?  Maybe Snowe?  Other than that, crickets.  I'm tired of the democratic leadership offering concessions and hoping that others will sign on.  What crap.  Soon we'll have nothing.

  •  See What You're Saying Is (8+ / 0-)
    1.  You want a Public Option
    1.  The public option is good, and is important
    1.  The public option alone isn't meaningful reform

    I don't think there's ANYBODY here who would disagree with ANY of those.

    What you AREN'T saying is:

    1.  Obama is a Blue Dog who sold us up the river.

    You're getting a lot of negative feedback.  Since there's nobody here who disagrees with what you ARE saying, what is there left for them to disagree with?  I wonder.

    ---- Don't mind me, I'm just here trolling for James Inhofe. [Note to Complete Idiots: I'm Not Really Trolling for James Inhofe]

    by TooFolkGR on Fri Sep 04, 2009 at 08:52:47 AM PDT

  •  Welcome back dansac (3+ / 0-)
    Recommended by:
    dansac, cotterperson, GN1927

    although I may not agree with your views on this subject I'm glad you came here to express them.

  •  OK -- I will Say It (3+ / 0-)
    Recommended by:
    slinkerwink, Bill White, NoVa Boy

    You are a tool of insurance companies and you think Obama is perfect.

    That aside, I will say what I said when Paul Begala made this same argument.  Passing a bill without a public option is an enormous missed opportunity.  It would be like having the #1 pick in the 1995 NBA draft and selecting Joe Smith instead of Kevin Garnett; or having Jennifer Aniston hit on you at a bar all night and at the end of the night deciding to make a late night White Castle run with your sister.

    You could have done something great, but you just didn't.

    You have big Dem majorities in both chambers and you still get something really mediocre.  Congrats.  Way to show you can lead, Democratic Party!

  •  Here's another Hunter idiocy. (4+ / 0-)
    Recommended by:
    askew, Elise, Mother of Zeus, TFinSF

    Or at least it shows how frighteningly unknowledgeable he is about health care:

    More to the point, if our metrics are "affordable and competitive", that means next to nothing, and all parties involved know it. All the insurance industry has to do in order to dodge the affordable trigger entirely is to offer up more of the current "junk" plans that are relatively inexpensive, but don't cover anything when you actually need them: plans with $20k, $50k deductables and the like. That's exactly what they're doing now, since they've priced more effective insurance entirely out of the hands of millions of people. As long as it's "affordable" -- and a plan that covers nothing can be pretty affordable, compared to plans that actually provide healthcare coverage when you need it -- and "competitive" -- within the industry itself, with no outside public pressures on containing costs -- they're home free.

    Maybe he should read the damn bill -- particularly Section 122 of H.R. 3200, particularly subsection c, paragraphs 2 and 3.  Here's we go:

    (2) ANNUAL LIMITATION-

    (A) ANNUAL LIMITATION- The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).

    (B) APPLICABLE LEVEL- The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.

    (C) USE OF COPAYMENTS- In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.

    (3) MINIMUM ACTUARIAL VALUE-

    (A) IN GENERAL- The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).

    (B) REFERENCE BENEFITS PACKAGE DESCRIBED- The reference benefits package described in this subparagraph is the essential benefits package if there were no cost-sharing imposed.

    In other words, a plan must have an out-of-pocket cap of $5,000 for an individual and $10,000 for a family, and it must have an actuarial value, which measures a plan's generosity, of at least 70 percent.  The cheapest plans on the Massachusetts Connector's Silver tier have an actuarial value of 67 percent, and those plans have at most a $2,000/$4,000 individual/family deductible and a $5,000/$10,000 out-of-pocket.  So there's no way a family can get saddled with a $10K, $20K, $50K deductible in the legislation.

    jim bow, ASA, MAAA

    by jim bow on Fri Sep 04, 2009 at 09:00:27 AM PDT

    •  and our resident health Insurance company shill (2+ / 0-)
      Recommended by:
      slinkerwink, AmericanRiverCanyon

      makes his appearance right on time.

      "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

      by SteveP on Fri Sep 04, 2009 at 09:01:52 AM PDT

      [ Parent ]

      •  The one who thinks it's affordable to have (2+ / 0-)
        Recommended by:
        AmericanRiverCanyon, SteveP

        13% or 15% of your income guaranteed to go to private insurers.

        I work full-time with the FDL team on health reform thanks to your donations.

        by slinkerwink on Fri Sep 04, 2009 at 09:06:05 AM PDT

        [ Parent ]

        •  I love how you distort people's words. (7+ / 0-)

          I don't care if I get troll-rated on this because it's not often I do.  slink, your diaries and your comments are embarrassing this blog.  Everyone on this blog is being made dumber on health care by your comments.  May G-d have mercy on your soul.

          jim bow, ASA, MAAA

          by jim bow on Fri Sep 04, 2009 at 09:13:13 AM PDT

          [ Parent ]

          •  Tipped not just for being sane about Slink, but (4+ / 0-)
            Recommended by:
            askew, jim bow, Elise, Mother of Zeus

            for quoting Billy Madison.

            I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

            by dansac on Fri Sep 04, 2009 at 09:16:46 AM PDT

            [ Parent ]

          •  I Like The "Action" Part of the Diaries (6+ / 0-)

            At least as it relates to the contact your congresspeople.  They've gone off the rails recently with this whole, "Let's prove that progresive congresspeople are secretly corporate shills" crusade.

            But this whole, "Anyone who disagrees with anything I say is some kind of corporate tool or must be using strawmen because I'm right about everything," is somewhat childish.  

            And I know childish when I see it, I come from the "Takes One to Know One" school.

            ---- Don't mind me, I'm just here trolling for James Inhofe. [Note to Complete Idiots: I'm Not Really Trolling for James Inhofe]

            by TooFolkGR on Fri Sep 04, 2009 at 09:19:56 AM PDT

            [ Parent ]

          •  Wow, thanks for this. (3+ / 0-)
            Recommended by:
            dansac, jim bow, Elise

            I don't agree with everything you argue on health care reform, but at least you understand the bill. slinkerwink clearly doesn't have a clue what she is talking about.

            •  I realize we don't see eye-to-eye on everything. (4+ / 0-)
              Recommended by:
              dansac, askew, Elise, Prince Nekhlyudov

              But I do like having people like you, dansac, Kitty, Actuary4Change (who hasn't been on this blog for a while) and others like you guys on this blog to keep the discussions high-level information-based.

              Of course, I realize this blog is more about activism than policy debates.  I'm, of course, more comfortable with the policy than the politics.  Which is why the health care debate has been so uncomfortable and depressing for me.

              jim bow, ASA, MAAA

              by jim bow on Fri Sep 04, 2009 at 11:08:02 AM PDT

              [ Parent ]

              •  Second Comment Above (4+ / 0-)
                Recommended by:
                dansac, askew, jim bow, Elise

                I disagreed with you in the past, but more over tactics than policy.  I respect your expertise.  Some people have either lost sight of what the goals are, or they are not being honest about what their goals are.

                •  Thank you for the compliments, Prince N. (2+ / 0-)
                  Recommended by:
                  dansac, Elise

                  Another reality-based guy.  I know there are more out there.

                  jim bow, ASA, MAAA

                  by jim bow on Fri Sep 04, 2009 at 11:13:45 AM PDT

                  [ Parent ]

                  •  Re Tactics (1+ / 0-)
                    Recommended by:
                    buddabelly

                    I know you like policy more than tactics, but in a negotiation it is sometimes useful to have somebody taking an extreme, crazy position, so that you can bring the other side closer to where you want to get.  Here, I define the "other side" with whom we are negotiating as the centrist Democrats and possibly Snowe, not he Republicans, who are obviously only intent upon destroying Obama.  Remember one of Nixon's tapes where he talked about how he liked for the Soviets to think that he was a crazy man who might actually drop the bomb, because it helped on arms control negotiations.  So I see some of the progressive extremists as being helpful in the negotiation of a better bill - Obama can tell people like Baucus, etc., that they have to come around on at least some kind of public option because otherwise the crazies are going to go nuts and burn down the house.  However, what bothers me is the increasing level of venom directed against Democrats in general and Obama in particular.  This is not helpful.  Indeed, it may well be one of the main reasons for Obama's drop in the polls, which the media is spinning as lack of public support for healthcare reform.  Again, these people are either losing sight of what's important, or they have an agenda that is quite a bit different from what I would like to see.

        •  in fact I do...do you? n/t (2+ / 0-)
          Recommended by:
          slinkerwink, AmericanRiverCanyon

          "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

          by SteveP on Fri Sep 04, 2009 at 09:17:37 AM PDT

          [ Parent ]

          •  Yes (0+ / 0-)

            Loss ratio, or benefit ratio, deals with the ratio of losses incurred to premiums earned.  Actuarial value measures the generosity of the benefits.   Actuarial value has no relationship to premiums paid, and has everything to do with cost-sharing.

            Your response to my comment I linked showed you thought otherwise.

            jim bow, ASA, MAAA

            by jim bow on Fri Sep 04, 2009 at 09:20:28 AM PDT

            [ Parent ]

            •  not exactly (3+ / 0-)

              do me the courtesy of acknowledging we were talking in several parts of the same thread and across pollinating our answers.

              In fact actuarial value has little to do with benefit generosity because benefits generosity is not reflected in costs of care, you as an actuary know that benefit generosity is a combination of the actuarial value (how much the policy owners have to pay for what is covered) and what is not covered at all. One way, THE way, to increase actuarial value, while lowering benefit generosity, is to cut benefits. Insurance companies do this all the time.  Funny you didn't mention this when you were calling Actuarial value "the" metric for benefit generosity.

              Or did they not teach you that inn actuarial school?  Or did the school the insurance company send you to tell you not to mention that?

              Oh and is the problem with crossing state lines cherry picking healthy people still?  Or did you get that part about insurance companies cherry picking favourable insurance laws?

              "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

              by SteveP on Fri Sep 04, 2009 at 09:35:23 AM PDT

              [ Parent ]

              •  I'm sorry (0+ / 0-)

                Actuarial value measures a plan's generosity.  I didn't use the right words.  Picky, picky.

                jim bow, ASA, MAAA

                by jim bow on Fri Sep 04, 2009 at 09:45:28 AM PDT

                [ Parent ]

                •  It's an important distinction (0+ / 0-)

                  Because the term is thrown around as if it was benefit generosity (and 70% is a piss poor number anyway).

                  "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                  by SteveP on Fri Sep 04, 2009 at 10:02:46 AM PDT

                  [ Parent ]

                  •  I do agree 70 percent isn't good. (0+ / 0-)

                    That's what H.R. 3200 is.  I diaried about this, and wrote that I thought the minimum actuarial value should be 80 percent.  The most generous plans on the Connector's Silver tier have an 81 percent actuarial value.

                    jim bow, ASA, MAAA

                    by jim bow on Fri Sep 04, 2009 at 10:21:08 AM PDT

                    [ Parent ]

                    •  And that's the "silver" tier (1+ / 0-)
                      Recommended by:
                      jim bow

                      Of a choice plan. With the accompanying premiums and the additional "bonus" overhead of the connector.

                      The poor saps on the Rbonze level are getting anywhere from 56% to 67% actuarial values. And those are the actuarial values. Granted there are mandated policy cores so they can't play the secondary game of acheiving mandated actuarial levels by cutting benefit coverage.

                      In fact 85% ought to be the absolute minimum for any plan (we don't have to guess, it works here in various government plans) and it ought to be for a comprehensive set of benefits including primary care.

                      Kind of like a public option.  Put that in and I bet the insurance companies find a way to stay in business and pay their shareholders anyway. And your little 10%  (which would be trillions of dollars) would be a drop in that bucket.

                      "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                      by SteveP on Fri Sep 04, 2009 at 10:32:31 AM PDT

                      [ Parent ]

                      •  I think 85% is probably too generous. (0+ / 0-)

                        I could be wrong.  No way are the taxpayers going to support that level of subsidies.  I also think 85% would probably cause too much moral hazard.  I think 80-83% is better.

                        I also think the group I cite overestimates BC/BS Standard Option's actuarial value (87%) since they don't include out-of-network whereas my dad and others' study, which estimates BC/BS Standard Option at 82.8%, does.

                        jim bow, ASA, MAAA

                        by jim bow on Fri Sep 04, 2009 at 10:44:46 AM PDT

                        [ Parent ]

                        •  Moral hazard? (1+ / 0-)
                          Recommended by:
                          Larsstephens

                          OK...umm..what would that be?

                          "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                          by SteveP on Fri Sep 04, 2009 at 10:56:37 AM PDT

                          [ Parent ]

                          •  Americans getting gold-plated plans ... (0+ / 0-)

                            ... and overutilizing the free surgery, free X-rays, free CT Scans, etc. ... when these treatments are unnecessary.  I agree that lower-income Americans should have the kind of items I mentioned, although they should have to pay much more if they would like a wider network of providers.  But at some income level, people should have higher cost-sharing in order to prevent overutilization of services and to help subsidize lower-income Americans.

                            jim bow, ASA, MAAA

                            by jim bow on Fri Sep 04, 2009 at 11:03:36 AM PDT

                            [ Parent ]

                          •  That's a "moral" hazard? LOLOLOLOL (2+ / 0-)
                            Recommended by:
                            slinkerwink, Larsstephens

                            oh please.

                            And we don't have to guess about these things - all kinds of single payer and universal health plans are in use around the world and this stuff doesn't happen. WE DON'T HAVE TO GUESS.

                            "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                            by SteveP on Fri Sep 04, 2009 at 11:06:17 AM PDT

                            [ Parent ]

                          •  Huh? (0+ / 0-)

                            You're honestly telling me there are no waiting lines in Canada and Great Britain?

                            Look, I favor single-payor, but I acknowledge there are tradeoffs when you ration solely by need (no premiums and cost-sharing) rather than mostly by need.

                            jim bow, ASA, MAAA

                            by jim bow on Fri Sep 04, 2009 at 11:11:53 AM PDT

                            [ Parent ]

                          •  oh please. (1+ / 0-)
                            Recommended by:
                            Larsstephens

                            This is the weakest argument going.  Yes, you have to wait for elective procedures, but there's almost no waiting for medically necessary procedures, more often less waiting than here.  

                            this is just the for-the-lowest-common-denominator argument you have to maintain the status quo.  Think of what you are trying to say here.  That somehow we have to have people put some "skin" into the system so they don't overuse the system, and when I mention that we don't have to guess whether this will happen or not as we have examples of single payer and it doesn't not.  The best you can come up with is lines and rationing for single payer - you're hiding your shill-dom less well than usual.  let me make a couple of modest proposals.

                            1. We not drop an entire health care plan/approach that we agree is better than the status quo because single payer doesn't accommodate one tiny slice as well as subsidize-rich-folks-care (multi-payer insurance based care) does.  Even if it weren't elective surgery, let's say on side A we have 50 million uninsured and then on side B we have everyone insured but say Cataract surgery had to wait an extra three months or so.  Which plan would you choose?
                            1. From a healthcare outcome standpoint you WANT there to be lines for elective surgery, you want your resources going predominantly to medically necessary matters. Having people put some 'skin' into it doesn't lower the incidence of elective surgery, it restricts it to the more affluent.  It doesn't keep people from getting unnecessary X-rays (stopping fee per service does that), it prevents poor people from getting medically necessary care.  And ABOVE ALL it prevents people from accessing primary care - which is absolutely the worst and most expensive health care choice you can make if you are worried about health outcomes.

                            You, as an actuary, know this.  So why the hell are you bringing up "moral" and "rationing" and "queues?"

                            "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                            by SteveP on Fri Sep 04, 2009 at 11:28:31 AM PDT

                            [ Parent ]

                          •  You asked about moral hazard. (0+ / 0-)

                            It's not like other contries don't struggle to prevent moral hazard and don't have problems with their own health care systems.

                            There is no perfect system.  Someone is going to have their health care rationed in some form in every country.  It's just in the U.S. we do it by ability to pay, and I find it unjust that we do so.

                            jim bow, ASA, MAAA

                            by jim bow on Fri Sep 04, 2009 at 11:33:01 AM PDT

                            [ Parent ]

                          •  There's no "moral" hazard (1+ / 0-)
                            Recommended by:
                            Larsstephens

                            at all, not even with people overusing their insurance.  That's not a "moral" hazard.

                            And you as an actuary KNOW that putting some "skin" in the game does NOT lower elective procedures nor unnecessary tests.  Stopping fee per service does that.

                            "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                            by SteveP on Fri Sep 04, 2009 at 12:01:40 PM PDT

                            [ Parent ]

                          •  And I'm in favor of eliminating FFS. (0+ / 0-)

                            Alas, we agree on something, so let's end on a good note there. -:)

                            jim bow, ASA, MAAA

                            by jim bow on Fri Sep 04, 2009 at 12:08:31 PM PDT

                            [ Parent ]

              •  And, no, they didn't teach me this in ... (0+ / 0-)

                ... actuarial school.  I'm in the life insurance industry.  My father is a health economist, so that's where I learned the term actuarial value.

                Look, we're on the same side and the same page.  We're fighting for the same cause -- to prevent Americans from having to file for  bankruptcy because of medical expenses.  Let's quit playing games with each other.

                jim bow, ASA, MAAA

                by jim bow on Fri Sep 04, 2009 at 09:51:12 AM PDT

                [ Parent ]

                •  Oh, please, talk to me in "economist" talk (4+ / 0-)

                  ..... so I can translate for the great unwashed that you are full of cheapa$$ Republican talking points  trying to kill reform, masquerading as knowing anything.

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

                  by AmericanRiverCanyon on Fri Sep 04, 2009 at 10:02:56 AM PDT

                  [ Parent ]

                  •  What's offensive to me here (3+ / 0-)

                    is this idea that Hunter is lying/uninformed about a 20K deductible when he's clearly showing the kinds of policies that will happen as a natural outcome of this kind f an approach, particularly a trigger.  We create a carrot for one particular outcome - number of names on policy papers, and they will find a way to do it, and the way to do it is to create extraordinarily cheap "insurance" with no benefits at all.  Any cap on contribution is going to be pencil whipped into tomorrow the instant the lights are off.

                    It's the same dishonesty that pervades the insurance side of this discussion.  People would be able to cross state lines - this is Extraordinary Insurance Rendition. but it's represented that the 'problem' is cherry picking healthy people, as opposed to gutting tough state insurance laws by allowing companies to go off shore (maybe the next step). It's using actuarial value as a measure of benefit generosity (and Jim Bow is not the only one who does), when all it means is that you take the denial of healthcare out of the 'generosity' equation. They would have you believe this is nothing, afterall they would get x percent of whatever services were covered.  But in fact what they are working is actuarial tables of risk and the less risk they take, the better for them.  So if they can take cancer off their books and leave flu shots - well, that 30% is a fine percentage to make in THAT business....

                    "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                    by SteveP on Fri Sep 04, 2009 at 10:26:21 AM PDT

                    [ Parent ]

                    •  A 70 percent minimum actuarial value ... (0+ / 0-)

                      ... would prohibit a $20K deductible policy from being allowed to be offered.  You know that.

                      I thought Hunter deserved to be called on that.

                      jim bow, ASA, MAAA

                      by jim bow on Fri Sep 04, 2009 at 10:37:35 AM PDT

                      [ Parent ]

                      •  You, as an actuary (3+ / 0-)

                        know that isn't true.  You could put the deductible anywhere you wanted on a certain percentage of your policies.

                        It's not the 70% that would make 20K impossible, it would be if Hunter were talking about a scenario where a 10K cap on personal contribution existed, but he/she is not.

                        "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                        by SteveP on Fri Sep 04, 2009 at 11:04:14 AM PDT

                        [ Parent ]

                        •  I have no idea how you can get ... (0+ / 0-)

                          ... 70 percent actuarial value with a $20K deductible.  I don't believe if it was a $20K deductible and out-of-pocket cap, you could get to a 70 percent actuarial value.  You might be able to do it with $10K -- maybe even $15K -- but not $20K.  Roland McDevitt ran some simulations, and I don't think it's possible to get 70 percent with a $20K deductible/out-of-pocket cap.

                          jim bow, ASA, MAAA

                          by jim bow on Fri Sep 04, 2009 at 11:23:50 AM PDT

                          [ Parent ]

                          •  you, an actuary really don't know? (3+ / 0-)

                            you merely run $0 deductibles side by side with your 20K deductibles. or enough $500 deductibles, or enough $1000 deductibles.  And remember they don't even have to HIT 70% or near to it, they just have to actuarially project it.  Anyone can do that, I can do that.  They just add a 20K deductible policy that costs nothing and project no one will buy it.  Bingo, 70% achieved.  Then the following year when every single employer who feels forced to offer insurance and doesn't really care what it is has purchased that insurance - then the insurance company goes back to the leg. (if asked) and says "no one could have foretold - but our insured rate is up, so isn't it worthwhile to fudge the actuarial value?"  The politicians instantly latch onto the higher insured rate, declare victory and go home to hold town halls on how they saved us from Socialized healthcare.  Meanwhile another 50 millions people slide from underinsured into a new category, functionally uninsured.

                            Doh!  Remember they just have to keep actuarial value across the pool, not for each individual policy offered.

                            "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                            by SteveP on Fri Sep 04, 2009 at 11:38:00 AM PDT

                            [ Parent ]

                          •  No state insurance commisioner ... (0+ / 0-)

                            ... would approve of what you're discussing.

                            jim bow, ASA, MAAA

                            by jim bow on Fri Sep 04, 2009 at 11:48:18 AM PDT

                            [ Parent ]

                          •  State insurance commissioners ALREADY do (2+ / 0-)

                            In mass. for instance.  Check Commonwealth choice - they meet more or less 70% with Bronze levels down to 56% and gold levels I presume up to 0%.

                            the total 70% does NOT prevent the total pool from INCLUDING deductibles of almost any size if the pool on average can be projected within the 70% figure.  The 20K deductible plan itself does NOT have to be 70%.

                            "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                            by SteveP on Fri Sep 04, 2009 at 11:59:23 AM PDT

                            [ Parent ]

                          •  Except ... (0+ / 0-)

                            ... Hunter was talking about a $20K deductible -- not a $20K out-of-pocket cap, although I do think that figure is way, way too high for in-network.  Out-of-network I might be willing to live with a $20K out-of-pocket cap.

                            jim bow, ASA, MAAA

                            by jim bow on Fri Sep 04, 2009 at 12:06:57 PM PDT

                            [ Parent ]

                •  And the way to do that is to eliminate (3+ / 0-)

                  insurance. Period.  No more bankruptcy. No more serious illness resulting from lack of primary care.  We'll spend half the money on twice the care.  It'll be fun.

                  Let's put in a public option so that every kind of accounting and, forgive me, actuarial abuse has the potnetial to be an election year issue.  You;re cutting WHAT?  wait, we, as a PLAN are paying 30% of every dollar on health care?  And our Commonwealth Care INCREASED overhead by 4-5%?

                  "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                  by SteveP on Fri Sep 04, 2009 at 10:06:04 AM PDT

                  [ Parent ]

                  •  I do agree that single-payer is preferable. (0+ / 0-)

                    It's just not politically feasible.  I acknowledge this.  I question whether some insurance company practices that hold down costs, i.e., basing payments on comparative effectiveness research, can survive the political process.  That said, single-payer is preferable, but it's only preferable if all the unpopular cost-control measures can survive the political process.

                    jim bow, ASA, MAAA

                    by jim bow on Fri Sep 04, 2009 at 10:35:04 AM PDT

                    [ Parent ]

                    •  I think it would be preferable without those (2+ / 0-)

                      as well.  But it's important to understand that the resistance to cost control measures is largely done now by the insurance companies and their enablers.  There would be little will to resist sensible cost controls once the insurance companies were sliced out of the equation.  For example many of the doctor fee questions aren't affected by such cost controls, ergo the largest remaining special interest wouldn't be trying to pollute the political discourse.

                      The main practical (not political) problem is how to tailor a single payer to the infrastructure that has been established based on for-profit multi-payer. We'll know when the insurance companies start to get scared of single payer when they start to tout Germany as a model. (note they conspicuously leave them out already, instead demonizing UK, Canada - because they have English speaking people wo can be used in ads, and Frane becasue they seem to think Republicans are still in charge).

                      "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

                      by SteveP on Fri Sep 04, 2009 at 10:54:24 AM PDT

                      [ Parent ]

        •  I'll sum up (3+ / 0-)

          as I aid before, prior to reading your posting history I was willing to give more or less the benefit of the doubt, but looking at the posting history and your misrepresenation of basic data and obvious non-mentions of the important stff.  I perhaps didn't go trough all the steps.

          Actuarial value is basically how much of the actual medical costs are paid by the plan.  i.e. over the whole group for all of everyone's costs are pooled, what percentge does the program pay - n this case you;re pointing to the "around" 70% figure, leaving 30% to be paid for by the pool as a whole on heir own.

          Benefit premum ratios are...well the ratio of benefits paid to premiums collected.

          See, sinple.

          "you have the right to your own opinion. You do not have the right to your own facts" -Daniel Patrick Moynihan

          by SteveP on Fri Sep 04, 2009 at 09:26:15 AM PDT

          [ Parent ]

    •  Dude, it seems you are seeking to escalate (2+ / 0-)
      Recommended by:
      GN1927, Larsstephens

      a blue on blue firefight. Why?

      Public option is the insignificant crossroads where two armies (DLC & Progressive) have collided.

      We can escalate or we can collaborate. But collaboration requires that progressive concerns be respected, not shouted down.

      Agree that there shall be "no mandates w/o public option" and public option ceases to be a panacea line in the sand.

      I would be willing to take public option off the table in mandates come off the table.

      Then we can nibble at the edges with more SCHIP, increased Medicaid funding, etc. . .

      However if (as in WW1 or when Lancelot's army faced Arthur's army) you desire total war with the progressives then I predict many will die at this insignificant cross-roads.

      Your call, mate.

      Just say "No!" to premature capitulation

      by Bill White on Fri Sep 04, 2009 at 09:32:25 AM PDT

      [ Parent ]

      •  shouting down (1+ / 0-)
        Recommended by:
        Elise

        We can escalate or we can collaborate. But collaboration requires that progressive concerns be respected, not shouted down

        I haven't seen a whole lot of shouting down of progressive voices on this site. I also wonder how it has become accepted that if you aren't totally wedded to the PO you are no longer a progressive. I'm not saying that this is your attitude, but it certainly is for some folks here.  As for the country in general, it depends where you are looking.  The MSM is ignoring the progressives.  But that should be no surprise to anyone.  It's what they have been doing for over 20 years.

        Waitress bring me some garlic bread, and a baked potato 'cause its good for my head

        by Borg Warner on Fri Sep 04, 2009 at 09:42:17 AM PDT

        [ Parent ]

        •  Its not "public option" it's "no mandates w/o PO" (2+ / 0-)
          Recommended by:
          Elise, Larsstephens

          And if mandates w/o public option passes and is signed by Obama, I predict the "on the ground" reality that will play out from that will tear apart the Democratic party.

          Yes, too many progressives express themselves poorly and are too quick to label Obama a "sell out" however those same people are the demographic that got him elected; and

          If a few Blue Dog Senators can block health care, the same number of Senators can oppose mandates and vote "No" and nothing will pass.

          Just say "No!" to premature capitulation

          by Bill White on Fri Sep 04, 2009 at 10:07:31 AM PDT

          [ Parent ]

  •  Wait...you were gone? (1+ / 0-)
    Recommended by:
    randallt

    What did you say your name was?

    "Troll-be-gone...apply directly to the asshole. Troll-be-gone...apply directly to the asshole."

    by homogenius on Fri Sep 04, 2009 at 09:11:38 AM PDT

  •  I'm glad your brother-in-law (6+ / 0-)

    made it through, dansac. My best friend didn't get diagnosed until she was stage four because she didn't go uninsured to the doctor. When the VA slow-walked my lover, he didn't seek outside care either, so he's dead, too. Being uninsured myself, I'm certainly for a public option -- something like Medicare for all.

    I have every right to be hysterical like some others here. Instead, I've adjusted to the deaths and contacted my congress critters -- DINOs all.

    OTOH, I am sick to death of listening to the personal vitriol here when we don't even have a bill yet. We've been through these hysterical arguments before, and I generally just ignore them.

    Maybe this is what the push-back Obama wanted looks like. The corporate media is certainly doing its best to paint gloom and doom, and it appalling to see so many buying into their meme, which keeps us from standing together when we most need it.

    Thank you for being a voice of reason in this ghastly atmosphere.

    "Jesus didn't come to take sides. He came to take over." -- Mark Pryor, DINO (Ark.)

    by cotterperson on Fri Sep 04, 2009 at 09:12:50 AM PDT

  •  If there isn't a competitive option (3+ / 0-)

    It will cause the increases in coverage to increase the cost of coverage.  

    An insurance company will simply say that they can't deny you healthcare based on a pre-existing condition, but it will cost you 3 times what others are paying.  

    "Jesus was like an unpaid babysitter." Ricky Gervais

    by otto on Fri Sep 04, 2009 at 09:15:26 AM PDT

    •  Sigh. You clearly haven't read the bill. (4+ / 0-)

      Either have any of the posters who recommended your comment. Figures slinkerwink is one of them.

      In the bill, it clearly states that insurance companies will not be able to rate on medical conditions. It is simply on community rating and age and there is max. differential between the youngest policyholders and the oldest policy holders of 1:2.  

      This is one of the key elements to holding down costs on policies. It will actually do more to hold down costs than a public option would.

      •  Sigh. (0+ / 0-)

        Thanks for the information.  

        That's good to hear.

        Which bill is it in?

        "Jesus was like an unpaid babysitter." Ricky Gervais

        by otto on Fri Sep 04, 2009 at 01:52:07 PM PDT

        [ Parent ]

      •  I do want to make a quick addendum (0+ / 0-)

        After I made that post, Bernie Sanders said the exact same thing about cost containment.  He said that he's in favor of single payer (obviously), but that if there isn't a public option in a bill, there won't be any way to contain the costs for pre-existing conditions.

        "Jesus was like an unpaid babysitter." Ricky Gervais

        by otto on Fri Sep 04, 2009 at 01:53:46 PM PDT

        [ Parent ]

        •  Not sure if Sanders means costs (1+ / 0-)
          Recommended by:
          otto
          for insureds, in other words, premium costs and out-of-pocket expenses or costs that that the system generates overall. I am assuming he means premium and out-of-pocket expenses, since the public option has no effect on the other types of costs.

          The premium cost containment will come from 3 areas:

             1.  The insurance exchange. Increased competition in markets that have seen insurance monopolies for years. Look at what competition has done to lower costs of cell phone plans.

             2. The elimination of pricing based on prior claims and pre-existing conditions. That is where the price gouging really happens. Under this bill, they will only be able to use community rating and age to determine premium.

             3. The pricing on age for the oldest policyholders is 2x the premium of the youngest policyholders. That percentage is much higher now.

          The public option's cost containments will not be more effective than the three I listed above. The best cost containment would be maximum premium amounts that insurers can charge and a maximum out-of-pocket expenses that can be incurred annually. That would do more than a public option by far. However, that is not being discussed at all.

          •  I don't agree on your assessment (1+ / 0-)
            Recommended by:
            askew

            Personally, I favor a single payer plan- just to get that out of the way.

            Medicare is a single payer plan with the highest risk patients- seniors and the disabled.  It is able to insure those high risk individuals at a decent rate.  If Medicare is any example, then an option which is similar to Medicare may indeed help to bring competition to the costs.

            "Jesus was like an unpaid babysitter." Ricky Gervais

            by otto on Fri Sep 04, 2009 at 02:57:34 PM PDT

            [ Parent ]

  •  You raise a fair point (5+ / 0-)

    so please allow me to debate with you objectively.  Are there a lot of other good things in the bill as we expect to see it?  Of course.  But ultimately, none of that matters if all that happens is that the medical cost juggernaut just gets slowed down for a while.  We need to see costs go down permanently.

    There is significant support for a public option.  The problem with your analysis is that you assume that there is a political cost for going after the public option.  Maybe there's an "inside baseball" noise quotient cost in DC, but the public option, properly explained as a device to keep the private insurance companies honest, is a public winner.

    And frankly, if we don't install a mechanism which forces the insurance companies to become more responsive and cost-effective, then ultimately the American people lose.  At which point, they will (wrongly) blame liberals and progressives for getting them into the mess.

    I understand the logic of incremental change.  I heard it from the Clintonites in the '90s.  And the problem with incremental change is that it is too easily reversed.  

    What happens with a public option?  Folks will see the benefit very quickly.  And once they do, just as was the case with Social Security and Medicare, which were also very contraversial in their day, it will become part of the public third rail that politicians can't erode or erase.  That's how you make sure universal health care endures.

    I know you don't like to talk about politics, but let me mention it anyway.  Politics in DC is a zero-sum game, plain and simple.  You have winners and you have losers; nothing in between.  That's how that town works.  And a bill which results from the progressives in Congress, whom we have worked so hard to empower, getting steamrolled, keeps progressive values in the closet for years to come.  So the question becomes who do we wish to control the debate in Washington going forward?

    As to the idea that progressives, by focussing on the public option are harming average citizens, that's bunk.  The Republicans, by insisting on no reform, and the Blue Dogs, by insisting on fake expensive reform, are doing that.  We're just standing up for average citizens.

    Ancora Impara--Michelangelo

    by aravir on Fri Sep 04, 2009 at 09:17:10 AM PDT

  •  Welcome back!!!! (3+ / 0-)
    Recommended by:
    askew, Elise, chicago minx

    The ranks of reasonable voices here have missed you!

  •  a mandate w/o a public option (12+ / 0-)

    with require people to buy insurance they cannot afford when they are already struggling.  

    But the bigger issue is that you've set up a false opposition, here.  The issue is not "this bill or nobody gets helped."  The issue is what will happen--both good and bad--if this bill passes without a public option as it was described initially?  That's the question.  And the response is multi-sided.

    Sure, some people will get helped by the regulations.  Absolutely.  But the bill would also create a condition that would crush struggling families: a requirement to purchase coverage through the exchange that would come in at premiums roughly equivalent to COBRA.  But it wouldn't be optional.  We don't know how many people would face that problem, but as it stands:  many.

    Next, without a public option, the industry would absorb the regulations then slowly get back to doing what they do: maintaining forward momentum in their business model (e.g. increasing premiums), this time with the imprimatur of having been heroic leaders in the movement for "reform."  A few years later, they would dump billions into junk ideas like "tort reform"--which is the low fat fried chicken of health care reform (e.g., total bs).  These are massive corporations who depend in increasing revenue to survive, regulations or not.  After five years, when we all expect to be building on the reforms of this compromise no-PO bill, the industry would actually be well underway undoing them and blocking any possibility of a public option (why would anyone want it when they never had a chance to experience it).  Eventually, under a Republican administration returns, they would push to undue the original regulations on the argument that they increased costs and are causing coverage to be denied.

    So this is not just about one bill.  It's about how to craft a kind of political push to get us started down a true path of reform and not some junk food version that looks good from one perspective, but in the long run will completely undo itself.

    •  Great points Jeffrey - I'd like to see what the (3+ / 0-)
      Recommended by:
      jim bow, buddabelly, Mother of Zeus

      final bill says.

      My only argument is against the notion of the public option as being elevated to the sole meaningful reform - and also being ascribed powers that don't exist

      But I'd like to see how the parts work together in the final bill AND I still totally support a public option.  I just won't vow to oppose a bill solely on the grounds that it doesn't have one.

      I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

      by dansac on Fri Sep 04, 2009 at 09:22:28 AM PDT

      [ Parent ]

    •  You Slipped In A Few Words (1+ / 0-)
      Recommended by:
      Mother of Zeus

      You said, "the public option as it was described initially".  I'm not sure what that means.  Are you referring to the original Jacob Hacker proposal?  If so, you are surely going to be disappointed because nothing in any proposed legislation is the equivalent of that.  In fact, the "public options" as they appear in the HELP bill and in HR 3200 are quite different.  Which one are you referring to?  According to the letter Rep. Woolsey sent to the White House yesterday, the HELP bill would be "unacceptable" to the House progressive caucus, under their definition of an acceptable public option.  Would you want to kill healthcare reform if the HELP bill was what came out of conference?
      As Gibbs once commented, the position of the Obama Administration on this issue has been "boringly consistent."  He says he wants a public option to keep the insurance companies honest, but he is willing to consider several different approaches in order to accomplish that objective.  My hunch is that is exactly what you will hear in his speech to Congress on Wednesday, albeit with more specificity as to the kinds of approaches he is talking about.  "No Drama Obama" is not going to undertake a major speech so he can announce that he is selling out; nor is he likely to do so when he appears at the AFL-CIO Labor Day picnic.
      My basic problem with some of the absolutists on this issue is that I don't think they are being completely honest.  I think they remain committed to single payer and the end of private health insurance.  They support a "robust public option" because they believe it will inevitably drive private insurance companies out of business and will lead to single payer.  In fact, if the public option is "robust" enough, i.e., if it is effectively "Medicare for All", then that is likely to be exactly what would happen.  A reform that merely creates competition and makes health insurance universal and more affordable, but essentially leaves the private health insurance industry intact but more regulated, is simply unacceptable to these absolutists.  As such, they are never going to be satisfied with what Obama does, because he does not share their goal of ending private health insurance.

      •  Here's why I'm puzzled (2+ / 0-)
        Recommended by:
        slinkerwink, Pithy Cherub

        if the public option is "robust" enough, i.e., if it is effectively "Medicare for All", then that is likely to be exactly what would happen.

        And this would be a problem for...whom?  The only rationale for kneecaping the public option would be corporate welfare in its purest form, if voluntary enrollment in the public option grabbed enough of the basic insurance market to make private insurers nonviable and defunct.

        •  One Point Obama Has Consistently Made (1+ / 0-)
          Recommended by:
          Mother of Zeus

          If you have private health insurance, and are satisfied with what you have, you can keep it.  However, if your private health insurance company goes out of business, you will obviously not be able to keep the insurance you have.  This is more complicated politically than many on this blog, including you I suspect, are willing to admit.  Obama is starting with the fact that a majority of Americans do have health insurance, and while polling is not always consistent on this, probably a majority of those who do have health insurance are satisfied with it.  Now, while polls also say that a majority of Americans favor a "public option" (rarely defined), I strongly suspect that if asked the question, "would you be in favor of establishing a public option recognizing that it is likely to result in your having to be covered by it rather than the insurance you currently have", the answer would be strongly negative.  Obama is trying to thread a difficult needle by doing 4 things: 1) universal coverage, 2) reduce costs, 3) increase competition, and 4) don't disturb people who are happy with their coverage.  Not so easy.

          •  No one is forcing anyone into a thing (2+ / 0-)
            Recommended by:
            slinkerwink, Mother of Zeus

            As you say, if most Americans have and are satisfied with private insurance products, what does any fiscal conservative have to fear?  

            Because clearly this private industry product will remain the far superior choice, no?  

            Unless the true and unarticulated fear is that once exposed to the prospect of a well-run, Medicare-like public option, a significant percentage of Americans just might find that while they're satisfied with private insurance products, they'd  prefer the public one.  At which circumstance, what precisely would be the problem?  A too-popular program?

            What I see taking place is that people like Schumer are making sure that the public option is kneecapped with restricted availability coupled with funding and negotiation restrictions to artificially bolster the attractiveness of private insurance products.  And this is not out of any concern for average people.

            •  In That Form, It's Not Really Competition (1+ / 0-)
              Recommended by:
              Mother of Zeus

              Medicare is not an insurance company.  Medicare is the federal government.  It can be funded by taxes, effectively without limit.  It can set reimbursement rates by operation of law, not by negotiation with service providers.  No private insurance company can compete with that.  That is why there is currently very little market for private insurance for seniors - not because Medicare is "better", but because it has economic power that no private company has.  That is why I say, a "robust public option", assuming that means "Medicare for All", is in reality the equivalent of single payer.  Also note that the choice will not be made by individual consumers, it will be made by employers who will cease to provide private insurance to employees, since the cost of private insurance will become prohibitive.  You may argue that single payer is the best system, and you may be right, although there is by no means universal agreement on that among people who have studied other countries that provide universal coverage without a public plan.  In any event, Obama has made it clear that he does not want to go in the direction of single payer, wisely IMO.

              •  And insurers don't receive (2+ / 0-)
                Recommended by:
                slinkerwink, Mother of Zeus

                any government funds or subsidies now?  Aren't anticipating a windfall courtesy of individual mandates subsidized by the government?

                Free market arguments don't work in the context of this particular industry.

              •  And to add (0+ / 0-)

                That is why there is currently very little market for private insurance for seniors - not because Medicare is "better", but because it has economic power that no private company has.

                IIRC, Medicare has a higher satisfaction rate than private insurers as well.  Popular program.  Delivers services in a more efficient manner than does the private insurance industry.  Yet we're supposed to make sure that the equivalent isn't available to the remainder of the population solely because such would cut into private insurers' market share and profits.  Is this why people donated until we bled---for this?

      •  if this is your concern, then (2+ / 0-)
        Recommended by:
        slinkerwink, Pithy Cherub

        go back and listen to Barney Frank when he addressed it.

        To say that it's "dishonest" to fight for the public option when the public option is what the fight is about--that is nonsensical.  This isn't a bill with single payer in nit. nor is it a bill with fairy dust in it.  It's a bill with a public option. So we're fighting for it.

        (And as for the rest of that self-righteous crap about "you will be disappointed" etc.  you know what you can do with that particular brand of condescension...)

        •  Thank You For Your Trenchant Answer (0+ / 0-)

          I still don't know what you are talking about.  Do you?

        •  A Civil Response, (1+ / 0-)
          Recommended by:
          buddabelly

          Would have been nice.  I have spent some time trying to find the Rep. Frank statement you are referring to, so far unsuccessfully.  I would have been interested, since he is probably one of the top 5 people in Congress, IMO.
          In any event, I assume by your reference to "a bill with a public option" you are referring to HR 3200 (you could have just said that).  However, it is important to emphasize that the public option established by HR 3200 is a far cry from Medicare-For-All, and fails to satisfy many of the criteria that the House Progressive Caucus "initially" set for a "robust public option."  In fact, Rep. Woolsey has not committed (to my knowledge) to support HR 3200, and has said that she intends to offer amendments when it reaches the floor to strengthen the public option.  It also bears emphasis that the public option does not even go into effect until 2013 under HR 3200, so I am having trouble understanding exactly why people who seem to be OK with HR 3200 get apoplectic at the mention of a trigger.  Seems to me that a case can be made that a trigger that goes into effect in a shorter time frame and which is tied to very specific cost reduction points might even be preferable.  I don't think that uttering those blasphemous words makes me a corporate hack (although I may well be one anyway).
          Here is a critique of the HR 3200 public option from the left.  http://pnhp.org/...
          I don't agree with it - HR 3200 would be fine with me - but it is illustrative of the fact that the public option in HR 3200 is a long way from what liberals initially defined to be the criteria for a "robust public option".
          As I noted in my comment above, HR 3200 is also a lot different from the HELP bill.  Specifically, HR 3200 provides for reimbursement at Medicare rates +5%, while the HELP bill provides for negotiated rates.  Rep. Woolsey's letter yesterday said that a public option that would have negotiated rates is "unacceptable."  Personally, I think that negotiated rates make a lot more sense than do Medicare rates and that the HELP bill is preferable on this point, but whether you agree or not, this strikes me as an utterly absurd place to draw a line in the sand.
          My point in all of this, is that there is nothing wrong with having flexibility going into negotiations to produce a conference bill as to exactly what kind of public option we wind up with.  People seem to be very eager to call Obama a "sellout" and they are drawing lines in the sand that don't make a lot of sense.  And just saying "Well having a public option has to be the line in the sand" doesn't really answer the question, because there is an enormous variation, both in existing bills and in proposals that are floating around, as to what exactly having a "public option" means.  The process seems to be getting unnecessarily divisive and counterproductive to what ought to be goals that most Democrats can agree on.
          BTW, a commenter above (david mizner) is pretty candid in saying that he supports a public option only because he thinks it will lead to single payer, as I suggested.  I think a lot of people think that way (I haven't made any accusation against you), but don't admit it.

    •  But Jeffrey, (4+ / 0-)

      there are in fact people here - very vocal ones - who have said this:

      The issue is not "this bill or nobody gets helped."

      They've worded it a bit differently - it shows up more like this:

      "Without a public option, NO bill should pass."

      "There is no reform without a public option."

      "Obama should veto any bill without a public option."

      It's these folks who have set up a false dichotomy. We are not in an either/or situation, but they wanted to create one, so they did. There are now dozens of commenters (maybe more than that, I only have so much time to read) who believe that we should vote against any health care reform bill that comes up if it doesn't have the words "public option" in it.

      The problem with this is that a public option isn't the only way to insert cost controls into the legislation. There are many other options for cost controls. None of them will be acceptable to these folks because they aren't called "public option".

  •  And welcome back! (4+ / 0-)

    Glad you came back, although I don't agree with your point of view here, I'm happy to see your username.

  •  My issue with dropping the PO (7+ / 0-)

    dansac, I recognize that there's a lot of good in the bill, and that the PO by itself won't effectuate consumer protection. But it is a crucial part of price control, which you recognize.

    Your argument is rational. Pass the consumer protection now, because it's good. Price control is necessary, and can be passed later. That's a fine, rational argument.

    The issue is that we aren't always dealing with rational people. It takes the same form as Krugman's argument for bigger stimulus. Compromise weakened the stimulus. If it hadn't worked, it wouldn't have been seen as evidence that more stimulus was needed, but that the idea of stimulus was flawed.

    Similarly, if a health bill passes and costs continue to rise, will the Republicans and Blue Dogs say "Gee, we were wrong, I guess we do need the President's original proposals."? No, they'll say "See, we told you you couldn't trust him on health care!" It will not matter that this bill was about consumer protection. The continually rising costs because of the delay of cost controls (an important component of which is the public option) will be taken as an argument for dismantling what President Obama managed to get in place.

    It's not about what the public option will do, it's what it's absence will do.

  •  The real power of the public option: (3+ / 0-)
    Recommended by:
    slinkerwink, GN1927, Mother of Zeus

    It's harder to kill a specific program with real, live enrollees who will end up on the news if some future GOP Congress decides to smite liberal nannyism & farm people out to the big insurers.  Everything else proposed can be-- and certainly will be-- weakened quietly & without fanfare.

    Plus, what others said about this basically being our only real opportunity to establish a good foundation on HCR.

    "Conservative principles" are marketing props used by the Conservative Movement to achieve political power, not actual beliefs. -Glenn Greenwald

    by latts on Fri Sep 04, 2009 at 09:23:19 AM PDT

  •  Finally! A voice of reason. Please stay (5+ / 0-)

    and fight the single issue activists who r hijackng the debate.

  •  Single issue acivists destroyed the GOP. (0+ / 0-)

    Is it our turn now?

    •  Take A Lesson From Women's Groups (1+ / 0-)
      Recommended by:
      askew

      It is noteworthy that women's groups have not been pushing to have coverage for abortion included as part of healthcare reform.  While there unquestionably ought to be coverage for abortion so that the right to choose does not turn on ability to pay, these groups have been sensible enough to recognize that it just isn't going to happen, and that insisting on it would just kill desperately needed reform.

      •  Its the blind rage that is destroying the debate. (1+ / 0-)
        Recommended by:
        askew

        Not able to see the rest of reality; only what happens with PO.

      •  Oh, there will be coverage for abortion... (3+ / 0-)
        Recommended by:
        askew, buddabelly, Mother of Zeus

        it just won't be paid for by public money. So far the media hasn't really been specific on that because they don't really understand it. The GOP keeps saying "there's public funding for abortion!!!" and the response is, "no, there is no public money being spent on abortion."

        That's not because there's no coverage for it. It's that private funds will pay for that coverage because the Hyde Amendment prevents public money being spent on it.

        I'm glad that the GOP hasn't quite figured out how to frame that issue yet to make it a part of the overall discussion - without it being considered one of their lies, as it has been so far.

  •  No, I'm glad you're back (5+ / 0-)
    Recommended by:
    dansac, askew, GN1927, Elise, buddabelly
  •  I Am Really Pretty Certain (2+ / 0-)
    Recommended by:
    askew, Elise

    That there will be a public option included in the bill that Obama ultimately signs.  I am also pretty certain that it won't be exactly what the purity-left wants.  It will probably be some combination of coops, non-profit insurance, and a government corporation with a trigger.  BTW, I don't really understand why there is so much uproar here about the "trigger" - under HR 3200 the public option doesn't exist until 2013 anyway, while as I understand it, the so-called "trigger" proposal would make a public option available on a state-by-state basis almost immediately.  What I don't get is the veritable enthusiasm that there seems to be for labeling Obama a "sell-out".  I can guarantee that no matter what happens, there will be plenty of people here attacking Obama as a shill for "corporate America."  The Right has its "birthers", we seem to have our "biters".

  •  Thank you!!!! (5+ / 0-)

    I expect the crazy to populate the rec list around here, but the extent to which the FP has totally lost touch with reality this past week or two has been truly disheartening.

    FWIW, the President could care less about the whining and freak-outs here, and I'm pretty sure the administration pays no attention to it.  nor does he need a lot of positive bolstering and reinforcement.  He has an agenda and he is already strongly motivated to succeed with the most effective bill possible.  Why anybody would assume anything to the contrary or that they have some special insight into the legislative process that absolutely no one in the administration has is just absurd.  So absurd that the only way people can sustain their paranoia is to conclude that Obama is just in bed with AHIP.  It's absurd, really, since if that were the case he would hardly have cut a deal with PhARMA to get them to advocate against AHIP's interest.  

    There are a lot of people here with too much time and bandwidth on their hands, and little going on in their skulls, and that's the truth.

    I took a very long break from this place after the election and somehow got sucked back in during the last month, but things have not only not improved but, if anything, have gone downhill.

    Marcos built a great site here, but you know everything has its season and all that . . .

    It was really nice to read this post, and I'm glad you came back to write it.  It's too bad that reasoned and reality-based thoughts such as these gain so little traction here now.

    The GNOP: "We take the bi out of bi-partisanship"

    by Mother of Zeus on Fri Sep 04, 2009 at 09:42:09 AM PDT

  •  Serious Health Care Reform proposals (2+ / 0-)
    Recommended by:
    GN1927, AmericanRiverCanyon

    began in 1950 when the U.S. had around
    150,000,000 people. Today we have double
    that with only Medicare to show in the last
    60 yrs. In this period insurance companies
    have completely taken over Medicine and have
    dug their claws deeply into congress. Health Care
    is not a commodity, and the Public Option is the
    only type of legislation that will put a damper on the Corporate-Congressional love affair. The People are out of the loop, and we have a government that is supposed to be FOR the people. Without the Public Option, changes will be small technical tinkering, and the People will still be shut out of the debate. Medicare has improved the health and happiness of tens of millions of people, given them security and hope and protected their life long earnings. We need the same for everybody else! It's way past time!!!!!!

  •  Meta: We had an episode with Alegre (4+ / 0-)
    Recommended by:
    dansac, askew, Elise, buddabelly

    who had her band of supporters. She also manipulated the Rec List the way slinkerwink does now. And could not handle dissenting opinions. Ended up with her retreating into her own corner with her acolytes. At least she wasn't a paid lobbyist.

  •  There is more to this fight them HC reform... (3+ / 0-)
    Recommended by:
    slinkerwink, GN1927, bigsurtree

    it is also going to war against the undue influence of huge money on our legislature.  Our congress is broken and it will take some real fights to fix it.  This is the first battle of many.

    I do not want, and I will actively work against, an industry friendly ($$$) health care bill.  A significant piece of every dollar we give the health care corporations will be used against us and against our democracy.

    It is time to dig in and stop this corruption.

    There are two kinds of people, those who finish what they start and so on.

    by rubine on Fri Sep 04, 2009 at 09:54:10 AM PDT

  •  I am damn glad to have you back. (3+ / 0-)
    Recommended by:
    askew, buddabelly, Mother of Zeus

    Thanks for the realism :-)

  •  List of important reforms in the health care bill (3+ / 0-)
    Recommended by:
    Elise, buddabelly, Mother of Zeus
    1. Ban on rejecting insurance applicants for pre-existing conditions.
    1. Ban on excluding coverage for pre-existing conditions.
    1. Ban on rating for medical conditions. Insurance companies are only allowed to use community rating and age to determine premium.
    1. Maximum premium difference for the oldest policyholders of 2x the premium for the youngest policyholders.
    1. Ban on rescission unless fraud can be proven and an appeals process for policyholders to appeal any rescission.
    1. Premium subsidies up to 400% of FPL in the House bill for the poor and lower income.
    1. Increase in eligibility of Medicaid up to 133% of poverty line.
    1. Partial closure of the donut hole in Medicare Part D.

    All of the above items will help more people than a public option will. All of these are progressive items worth fighting for. I want a public option, but I am much more excited about the items I listed above. These will lower premiums, provide assistance to those who need it and allow more people access to insurance.  

    Unfortunately, the loudest advocate for health care on DK doesn't understand the bill and can only scream "PUBLIC OPTION NOW!!!".

  •  Damn you! (7+ / 0-)

    I had to go log in again to thank you!

    I agree with everything you said. And the progressives are sabotaging the efforts at HCR. I'd like to have them take their "line..."

    Get a bill out and tinker and finesse and add and subtract and see what you get.

    I told Slink I'd cool it with my criticism of her because she was helpful to me in understanding the politics of cochlear implants. But her lack of professionalism is ludicrous. And the worshipping of her here because people need a savior as they damn others for supporting Obama is hypocritical. It's OK if you're a Prog. Pelosi is evil/heroic, Russ is hero/goat. Lemmings. Nobody who supports the President has ever said to support him blindly. That is a crock. A lie. but IOKIYAP. Hornbeck was decrying "bullies." That one speaks for itself.

    I got HRed the other day in retaliation. I was called pictorally a straw-brained Kool-Aid drinker. I hred it. Got my next comment HRed by that schmuck. And that comment was mild. But I shouldn't complain. I wanted to accrue them, so I COULDN'T be tempted to log on here again. "LOL."

    The Reps are brilliant because they are unethical. Obama's numbers ARE tanking. They COULD take over again. And the Progs, whose values I believe in, but nothing else, can look back on this debacle and wonder..."Perhaps if we had tried to be a bit more suportive."

    This once fine site is a pathetic winging hot mess.

    Thank you Dan, from the bottom of my heart.

    Please email me sometime, as maybe I finally HAVE managed to commit blogicide.

    G

  •  Trollope Novels (2+ / 0-)
    Recommended by:
    dansac, Mother of Zeus

    He does these great portraits of "journalists" - Quintus Slide of The People's Banner and Tom Towers of the Jupiter - who relish attacking people in authority positions, claiming to have a monopoly on virtue, but really being largely interested in asserting their own power.  I'm detecting a lot of that in the postings on this blog.
    Great diary.  I had many of the same reactions during the financial crisis last fall.  Basically, TARP has proven to be a phenomenally successful government program, but you'd never know it from what you read here.  Shut up you corporate hack - OK, I said it, so nobody else has to.

    •  Funny you mention, was thinking about TARP (2+ / 0-)

      I think there were issues on the margins, but the essential theory behind it was an unfortunate necessity.

      I'm shocked to learn that 1 in 12 Americans do not know that the bird, is in fact, that word.

      by dansac on Fri Sep 04, 2009 at 12:34:55 PM PDT

      [ Parent ]

      •  Not a Coincidence (1+ / 0-)
        Recommended by:
        dansac

        I read your GBCW diary.

      •  Exactly. It's a damned bitter brew to swallow, (0+ / 0-)

        but yeah, a necessity.  However, the future of financial industry regulation is another matter.  That is where might end up with cause for legitimate complaint.  That's going to probably be even harder to pass than health care.  It might be harder to demagogue with the public (although if anyone could find a way to get retired machinists to come out and protest in favor of punk-assed MBAs earning 50 million dollar bonuses . . . it would our modern-day GOP), but the lobby and industry influence is unbelievable.

        The GNOP: We take the bi out of bipartisanship

        by Mother of Zeus on Fri Sep 04, 2009 at 09:04:37 PM PDT

        [ Parent ]

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