The First thing I'd like to say, is I'd like to thank Sen. Rockefeller for standing up and telling the truth about Max Baucus' garbage health care bill. He should be commended for standing up for the principle of a Public option, and pointing out just how much of a sell-out the Baucus plan is. I can't claim to know if his amendment is garbage on purpose or whether it just came out that way.
Now, I know he's only doing this to increase his progressive gravitas, to soften the blow for when he stabs us in the back utterly and completely on climate change. Don't worry, we know it's coming, Sen. Rockefeller. It won't be a surprise, at all. I probably shouldn't even characterize it as back-stabbing, as that would imply some degree of surprise or prior record of progressiveness on Climate Change issues.
Nobody expects a senator from West Virginia to support real climate change legislation. We expect the opposite. We know that when you talk about protecting healthcare for coal miners, Sen. Rockefeller, you're going to keep defending those same miners against those who want to put a stop to their pollution. But here's what I didn't expect:
Sen Rockefeller's "public" "option" is a poison pill. It's worse than nothing. Like most (all?) of the "public" "option" ideas floating through congress, It's an insult. Here's the text:
http://www.finance.senate.gov/... (on page 13)
Short Title: Establishment and administration of a public health insurance option as an exchange-qualified health benefits plan (Sections 221, 222, 223, 224, 225, and 226 of H.R. 3200, America‘s Affordable Health Choices Act of 2009)
Description of Amendment: Sec. 221. Establishment and administration of a public health insurance option as an Exchange-qualified health benefits plan. Requires the Secretary of Health and Human Services to develop a public health insurance option to be offered starting in 2013 as a plan choice within the Health Insurance Exchange. It participates on a level playing field with private plan choices. Like private plans, it must offer the same benefits, abide by the same insurance market reforms, and follow provider network requirements and other consumer protections.
Sec. 222. Premiums and financing. Premiums for the public option are geographically-adjusted and are required to be set so as to fully cover the cost of coverage as well as administrative costs of the plan. This includes a requirement that the public option, like private plans, include a contingency margin in its premium to cover unexpected cost variations. In order to establish the public option, there is an initial appropriation of $2 billion for administrative costs and in order to provide for initial claims reserves before the collection of premiums such sums as necessary to cover 90 days worth of claims reserves based on projected enrollment. These start up funds are amortized into the premiums for the public option to be recouped over the first 10 years of operation. The plan must be self-sustaining after that initial funding.
Sec. 223. Payment rates for items and services. The Secretary of HHS establishes geographically-adjusted provider payment rates for the public option. For the first three years, those rates are based on Medicare rates with a 5% add-on for practitioners who also participate in the Medicare program. This increase also applies to practitioners, like pediatricians, who do not typically participate in Medicare. After the first three years, the Secretary is granted greater flexibility in setting rates, but the general rule is that overall spending should remain consistent with the initial levels. Flexibility is provided to the Secretary to create payment rates for services not covered by Medicare, pursue delivery system reforms, make adjustments to offset geographic variations and adjust rates as necessary to assure competitiveness with Exchange-participating plans or for excessive or deficient payments. Medicare providers are presumed to also be participating in the public option unless they opt out. There are no penalties for opting out. The Secretary also has authority to negotiate prescription drug prices for the public option.
Sec. 224. Modernized payment initiatives and delivery system reform. The Secretary is empowered to move forward with delivery system reforms to change the way the public option pays for medical services to promote better quality and more efficient use of medical care. Such payment changes must seek to reduce cost for enrollees, improve health outcomes, reduce health disparities, address geographic variation in the provision of medical services, prevent or manage chronic illnesses, and r promote integrated patient-centered care.
Sec. 225. Provider participation. Provides the Secretary of HHS with the authority to develop conditions of participation for the public health insurance option. Providers must be licensed in the state in which they do business. Physician participation comes in two types: preferred physicians are those physicians who agree to accept the public option‘s payment rate (without regard to cost-sharing) as payment in full; participating non-preferred physicians are those who agree not to impose charges in excess of the balance billing limitations in Medicare. Providers must be excluded from participating in the public option if they are excluded from other federal health programs.
Sec. 226. Application of fraud and abuse provisions. Applies Medicare‘s anti-fraud and abuse protections to the public health insurance option.
There's a lot of fail in this amendment.
The first, most serious problem, is that the public option expires if it runs out of money after burning through it's initial 2 billion.
The whole problem with insurance companies-- non-profit, and for-profit alike--is that they have to make end's meet, so they have to worry about the bottom line first, and your care second. If the public option is not subsidized past the initial 2 billion and is capable of expiring, then it's administrators will have to sell you out in the same way private insurance companies do, or it won't be able to compete. Nothing in this bill really says what public option premiums will be based on, but presumably they'll be based on demographics and medical history, the same as private insurance. How it's funded would be determined by whoever happens to be secretary of HHS in 2013 (!) when it goes into effect... more on 2013 later...
Because of the above, there's no reason to believe that the public option's administrative overhead will be lower than a private insurance company's. Medicare has low administrative costs for the reason that it doesn't have to set premium rates, and it doesn't have to make money so it doesn't have to hire people to screw you over cut the bottom line. The public option could have the same overhead benefits as medicare, if only it was funded by premiums based only on % of income, and would be subsidized if it loses money. But those options seem to be off the table.
Rockefeller's "Public" "Option" has to make money (or at least break even) or it's done. Although not explicitly mentioned in the bill, most likely whoever is secretary of HHS in 2013 will outsource the administration of the bill to the private sector (since he's required to establish it, this would be the path of least resistance for doing that). Best case scenario, it's just as bad as an insurance company, and maybe provides a little competition for the existing insurance companies. Worst case, and most likely scenario, it gets run into the ground by whoever manages it and it goes bankrupt and expires.
But that alone isn't enough to make this bill a poison pill.
The reason this is a poison pill is the date, as mentioned before:
Goes into effect 2013.
Aside from this being an absurdly long wait, as bad as these stupid triggers everyone talks about, this means no public option until AFTER the next presidential election.
In otherwords, if this bill passes, insurance companies will be forced to do everything in their power to elect a republican in 2012. Democrats shouldn't vote for it unless they want all of that money flowing into the republican coffers in 2012.
Since so much power is vested into the HHS secretary, if they succeed in unseating Obama, the BASIC OUTLINE for how the public option is FIRST implemented will be determined by a REPUBLICAN secretary of HHS. If we get the public option now, yes they can still retroactively kill it in 2013 if they win congress and the white house, but that would be politically difficult because by 2013 it would already be a popular program with large membership, and could very well become a "third-rail" similar to social security, politically impossible to destroy. But with the 2013 implementation date, Republicans will be in a position to destroy it before it even starts, and all they have to do is beat Obama in 2012. That's assuming whoever Obama appoints as secretary of HHS will even implement it properly
With the new supreme court ruling, soon allowing corporations to directly campaign, you can bet that the big insurance co's will do everything in their power to elect a republican in 2012. Of course the insurance companies are fighting it, they don't want to spend all that money, but democrats should fight it too because we don't need all that corporate help going to the republican candidate in 2012.
We need a public option NOW not one where the basic implementation of the plan won't even be set until 2013 by the HHS secretary. Why can't the democrats take leadership on this issue now rather than passing the buck, passing all of the important questions about implementation, to a future HHS secretary who hasn't even been appointed yet? Do you think that in 2013, whoever is HHS secretary is going to be a take-charge guy who will be gung-ho to make this work? Maybe? No? Then this amendment is totally useless.
And this is supposedly t he "strong" version of the public option in finance. I haven't even read the "weak" version of the public option.
We should not stop fighting for a public option, if implemented properly it can work. But please, before jumping onto any public option, please make sure it isn't a piece of crap, a public option in name only.
edited to add:
Also, we need to get the damn bill out of finance with or without this "public" "option" and maybe something stronger can be added later once max baucus has his grimy hands off of it. but things are looking pretty grim right now.
update: It's been pointed out to me that i should probably mention that all of these problems are also in the house bill, H.R. 3200.
We need to lobby the house progressive caucus to vote down any bill that doesn't include a Strong public option