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Heading into the midterm elections, the level of vitriol and energy on the right continues to rise while those and the left feel demoralized, betrayed, and dispirited despite numerous legislative accomplishments by the Democratic Congress and President Obama.

Chief among those disappointments is the lack of single payer plan, or at the very least - a public option within the plan to allow people to avoid having to choose exclusively from health insurance agencies motivated entirely by profit, not patient satisfaction.

What many of us apparently don't know is the final version of the PPACA as passed actually does include something that functions as a public option, and in some ways may even be slightly better as scored by the CBO.

Here's one recent diary which wistfully pines for better non-profit options.

Where we should be talking about the future reforms we need -  i.e.,  opening up Medicare to more Americans on an opt-in basis,  creating a  more powerful nonprofit option (whether it's negotiated on  Medicare  rates or not, putting patients ahead of profits), and reining  in  insurance company abuses and rate increases - instead, we're too  busy  attacking and ceding political turf to the Republicans, who did  NOTHING  to support reform and even lied about it to scare voters.
My point here is  this nonprofit option already exists.

The final Health Care bill included the "Non-For-Profit Option" as overseen  by the Office of Personnel Management which scored just as well as the Public  Option for Budget Reduction and Cost Savings according to CBO - so for those who desired downward pressure on costs, that's exactly what we have.  

The Original Kennedy-Dodd Senate Bill did not include a Public Option  and Scored at about $1 Trillion, but after the PO it was re-scored at $389 billion cheaper initially - but also that it's long term projection of over ten years would have increased the deficit by over half a billion

 

Indeed, according to CBO's July 2 score of the HELP bill, under the  legislation, 21 million fewer Americans would be uninsured in 2019 than  under current law. In a July 1 letter to members of the HELP committee,  publicly released the following day, Kennedy and Dodd wrote that the  "Congressional Budget Office has carefully reviewed our complete bill,  and we are pleased to report that the CBO has scored it at $611.4 billion over 10 years,  with the new coverage provisions scored at $597 billion" -- a cost they  noted was a "significant reduction from earlier estimates." The  preliminary score of the complete bill that the committee released  stated that Title I of the bill would increase the deficit by $597  billion over 10 years.

See that?  The Kennedy Bill with the PO included increased the deficit.

The final bill came in with a higher initial costs due to increased subsidies for low income insurance seekers, but long term deficit reductions were an almost $1.5 Trillion improvement over 20 years.

 

Comprehensive health care reform will cost the federal government  $940 billion over a ten-year period, but will increase revenue and cut  other costs by a greater amount, leading to a reduction of $138 billion  in the federal deficit over the same period, according to an analysis by  the Congressional Budget Office, a Democratic source tells HuffPost. It will cut the deficit by $1.2 trillion over the second ten year period.

 

The source said it also extends Medicare's solvency by at least nine  years and reduces the rate of its growth by 1.4 percent, while closing  the doughnut hole for seniors, meaning there will no longer be a gap in  coverage of medication. The CBO also estimated it would extend coverage  to 32 million additional people.

The Public Option was removed during negotiations with Sen. Joe Leiberman in the "Manager's Amendment". That amendment was scored by CBO here, where it showed that this option saves just as much of a cost savings as the Public Option did, in fact it came out $2 billion cheaper.  

 This estimate incorporates the effects of the manager’s amendment,   which would make a number of changes to the Patient Protection and   Affordable Care Act as originally proposed. The changes with the largest   budgetary effects include: expanding eligibility for a small business   tax credit; increasing penalties on certain uninsured people; replacing   a "public plan" that would be run by the Department of Health and  Human  Services (HHS) with "multi-state" plans that would be offered  under  contract with the Office of Personnel Management (OPM);   deleting provisions that would increase payment rates for physicians   under Medicare; and increasing the payroll tax on higher-income   individuals and families. Of the total deficit reduction of $132 billion   projected to result from the legislation, the manager’s amendment   accounts for about $2 billion, and the act as originally proposed   accounts for the remaining $130 billion.

...

The proposal would call on OPM to contract for two national or multi-state health insurance plans—one of which would have to be nonprofit—that would be offered through the insurance exchanges.

 

Considering the intensity of the opposition against the public option, the Stealth Option was able to slip in under the wire without being noticed by the press, and largely without being noticed by the legislators themselves.  As a result they haven't been able to respond back to their own constituents on the Left who loudly complain that they caved when the rubber met the road.

In the end, we got 90-95%% of what we wanted and needed.

One of the few Democrats I've even seen bring this provision up was Sen. Mary Landrieu (at 11:58) as she was being attacked and criticized by Howard Dean.  (Some of Dean's long list of criticisms here especially the ability to charge older people at 300% higher rate was removed, along with the "Louisiana Purchase" and "Cornhusker Kick-back" via Reconciliation after the House passed the Senate version of the bill with the Manager's Amendment)


Landrieu: In the Bill that the Governor now says he's not for, there is a national non-profit option that gives the same choices that members of Congress and Federal Employees have...

In all the twists and turns of the legislation - this point was completely lost.  We have something that is just as good as what most of us wanted, and maybe having it going through in the background was best, because otherwise if it had gotten more focus and more press - just like Single Payer or the PO - it might have been stripped out too, but it wasn't. It slipped in under the radar, but now we need to drag out into the light.

Other issues criticizing the bill, which I've seen are arguments that it doesn't contain "cost controls" - this has especially been brought up by NYCEVE. in What happened to the promise to "control skyrocketing premiums"?!

However, the PPACA does have cost controls, it requires an 85%  Medical Loss Ratio, which means that at least 85% of the money paid in  as part of premiums has to go to actual care, not advertising, not  overhead, not stock value.

NYCeve's next major complaint is that their aren't any limits on deductibles in "junk insurance" - but there will be for people buying employer based insurance outside of the Exchange through their employer.

 

   (2) ANNUAL LIMITATION ON DEDUCTIBLES FOR EMPLOYER SPONSORED PLANS.—
  (A) IN GENERAL.—In the case of a health plan offered
  in the small group market, the deductible under the plan shall not exceed—
  (i) $2,000 in the case of a plan covering a single
  individual; and
  (ii) $4,000 in the case of any other plan.
  The amounts under clauses (i) and (ii) may be increased by the  maximum amount of reimbursement which is reasonably available to a  participant under a flexible spending arrangement described in section  106(c)(2) of the Internal Revenue Code of 1986 (determined without  regard to any salary reduction arrangement).

 

Prior to the actual implementation of the full plan in 2014, it's not  that surprising that some insurers would try to price gouge before they  get hit with the ban on life time limits, the 85% medical loss ratio,  and the limit on out-of-pocket cost, however they  do so at their own risk of being punished for it because there are penalties for Insurers who issue exorbitant rate hikes.

 

   The law allows states that have, or plan to implement, measures  that require insurance companies to justify their premium increases to be eligible for $250 million in new grants. Insurance companies with excessive or unjustified premium increases may not be able to participate in the new health insurance Exchanges in 2014.

If the companies try to jack up prices now before the Exchanges come online, as some appear to be doing - although these may be outliers according to the Kaiser Report which says that overall 2010 insurance rates have only increased between 3%-5% - they either have to justify it or not get any access to the new customers available in the exchanges.

Lastly on this point, if an insurer takes the risk of gouging anyway though the exchange, they can be forced to pay back their customers via rebates.

From the CBO

 

   Several provisions regulating insurers were added, including a requirement for an insurer to provide rebates if its share of premiums going to administrative costs exceeds specified levels and a general prohibition on imposing annual limits on the amount of benefits that would be covered.

If insurers charge more than the 85% limit they  have to GIVE THE DIFFERENCE BACK as a rebate.  That would be what's  called a Price Control.

 

Nyceve's issue with the junk insurance would not apply to the  insurance offered through the Exchanges in 2014 which require that  preventative care be offered for free (not with a high deductible), and  that a fairly comprehensive minimum set of coverage - for the bronze  plans - which haven't even been established by the Secretary of HHS yet  be made available at a reasonably affordable price, with subsidies  available for those who still can't afford them.

Beyond Health Care the second major criticism of the Obama Administration has been their failure to address the War Crimes of the previous Administration and their overall handing of the "Rule of Law".

The problem isn't just with the Administration, it's with the Law itself and Congress failure to correct that law, although the SCOTUS has been gradually correcting much of this on their own.  

After losing the Hamdan case the Bush  Administration pushed through the Military Commissions Act which stripped Foreign Enemy Combatants of Habaeus protection, some of which  was restored  by Boumediene  in regards to Gitmo, but as yet has not been restored for Bagram A.F.B.  which is were the current detention sore festers. Thus Far the Courts have ruled against Bagram Habeas petitions in accordance with the MCA, but this issue has yet to reach SCOTUS.

On two levels, both via executive order and via both Hamdan & Boumediene at the SCOTUS Habeaus has been restored for Enemy Combatants - but not yet for those held in Bagram, and that is where Congress needs to act.

Don't like Warrantless Searches?  Congress essentially Ratified them with the FISA Fix, so Congress needs to "Unfix" it.  Unlike the Bush Administration, the Obama Administration's Justice Dept has been implementing the law as written even if it's a lousy law. The problem is the law itself, not the Administration who has pledged to uphold the law - even when that law sucks.

The investigation of Torture & Bush War Crimes has been handed off to a Special Prosecutor,  and although there is no guarantee exactly what that prosecutor will  do, or how far they will or won't take the case - it is clearly NOT fair  to argue that the Administration has ignored the issue, they've done  what they should have done which is let a prosecutor handle this outside of the political process, but under the law.  The problem is with the law itself, specifically the MCA which effectively immunized many of these activities retroactively by re-writing the War Crimes Act to match the Bybee Standard (Torture equals Likely Death Only) during the lame-duck session of 2006 right after the Hamdan decision came down.  Obama wasn't even in the Senate when that happened.

Admittedly Obama hasn't addressed this  since campaigning but he has made it known that he realizes the MCA needs  to be repealed and Habeaus restored, the Detainee Treatment Act needs  an update to include civilians under Geneva and the AFM, the War Crimes  Act needs an update which includes providing legal advice designed to  deliberately circumvent the law, and Obama needs to get both Gitmo and  Bagram closed down - but those are all works in progress (many of which  were delayed by Health Care, The Stimulus and Financial Reform) as the  Iraq and Afghanistan Wars wind down, not failures.  Not yet.

 

Even though Bush is gone, he left behind a pile of bad laws that Congress needs to fix, not just Obama - and as a result we need the best possible Congress we can get if we're going to have any hope at all of addressing all of these continuing issues.

Right now Barbara Boxer is in Trouble.  Russ Feingold - the only U.S. Senator to vote against the original Patriot Act - is threatened.  We may have our issues with Blue Dogs like Mary Landrieu, but we can't let that frustration be taken out actual progressives like Boxer or Feingold. They need our help, and they need it NOW!

I'm not arguing for anyone to just "clap louder", but to admit these are complex and difficult issues - it will take years to clean up this mess and all the while we're doing it we'll have to fight hard to keep the Conservatives and the out-and-out Wingnuts from rebuilding the mess as fast as they can.

The facts are on our side, we don't have to feel bad or down about anything.  This legislation is far from perfect and still has many fixes and changes need, but we're not likely to get any of that done with even fewer Democrats in Congress than we currently have.  It's not time to give up, give in, or sit at home grumbling - it's time to Grab a Mop, double-down - and to ActBlue.

We all may our issues with how things went down, but one thing we can't do is let the Know Less-Than-Nothing Party steal the day and benefit from their own strategy of obstruction and obfuscation.  We have to keep Congress in Democratic hands, at all costs.

Vyan

Update Thanks for the Rescue: to save time let me quickly recap some of discussion that's occurred so far in the comments.  Besides what I mention above there are several immediate or nearly immediate benefits of the PPACA that often goes under discussed amid all the teeth-gnashing over the public option/single-payer failure.

To address the problem of people not having access to health care due to pre-existing conditions until the Exchanges come online and ban them in 2014 - 34 States have implemented High-Risk Insurance Pools.

To address the problem of increasing premiums in the employer insurance market in the short term, there are Employer Tax Credits of up to 35% available to companies with 25 Employees or less, effective Jan 1, 2010.  This could completely nullify premium rate hikes which seem to have been occurring as Nyceye describes.

In California alone over 400,000 Business are eligible for this credit.

Garnering little to no press attention when released in July, a report undertaken by Families USA and the Small Business Majority  found that 80 percent of California’s small businesses with 25 or fewer employees will qualify for federal tax credits under the Patient Protection and Affordable Care Act starting this year. This means  that of the state’s 571,200 small businesses, 465,500 are eligible for the tax credits in 2010. Of those, 30 percent – or 135,900 – qualify for the maximum tax credit amount.

Substantial funds have provided for the expansion of Medicaid for those who can not currently afford to buy care on the open market.

Effective April 1, 2010

States will be able to receive federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available. This will make it easier for states that choose to do so to cover more of their residents.

Preventative Care as of September 23rd must be provided without co-pays or deductibles.

Effective for health plan years beginning on or after September 23, 2010

All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance.

The Non-Profit Option actually has another potential advantage over the Public Option because the Director of OPM has independent authority to negotiate their Medical Loss Ratio, Premiums and Profit Margin separate from the 85% MLR currently setup in the Exchanges.

   SEC 1332 (3) NON-PROFIT ENTITIES.—In entering into contracts under paragraph (1), the Director shall ensure that at least one contract is entered into with a non-profit entity.
    (4) ADMINISTRATION.—The Director shall implement this subsection in a manner similar to the manner in which the Director implements the contracting provisions with respect to carriers under the Federal employees health benefit program under chapter 89 of title 5, United States Code, including
    (through negotiating with each multi-state plan)—
    (A) a medical loss ratio;
    (B) a profit margin;
    (C) the premiums to be charged; and

    (D) such other terms and conditions of coverage as are
    in the interests of enrollees in such plans.
    (5) AUTHORITY TO PROTECT CONSUMERS.—The Director may prohibit the offering of any multi-State health plan that does not meet the terms and conditions defined by the Director with respect to the elements described in subparagraphs (A)
    through (D) of paragraph (4).

    (b) ELIGIBILITY.—A health insurance issuer shall be eligible to enter into a contract under subsection (a)(1) if such issuer—
    (1) agrees to offer a multi-State qualified health plan that meets the requirements of subsection (c) in each Exchange in each State;

It's fair to say than an MLR much higher than 85% could be negotiated, and that by requiring this contract to be established only for mult-state entities (just like the Holy "Purchase Care Across State-Lines" Grail that the GOP was clamoring for) better bulk pricing should be possible due to the larger economy of scale that the Federal Employee's Health Benefits Program, already administered by OPM, currently enjoys.

That potential price break wouldn't have been available to a public option that was being run and administered state by state.

All of these features are not going to completely pacify anyone who continues to want out-and-out Single Payer.  There are two paths to achieving this, one is to raise of eliminate the means testing on Medicaid (in 2014 this actually happens and the eligibility restrictions are loosened), the other is to eliminate or lower the age requirement for Medicare and allow people to purchase it if they want (an option that was briefly considered as a compromise in the Senate, but not adpted.).

If we're going to continue to fight for something closer to full-on single payer, I think we should do it by continuing to close the gap between Medicaid and Medicare bit by bit which this bill at least partially does for those people who need it most.  There's a lot of good stuff in this bill, and between now and 2014 we need to be fighting to make it even better - not let ourselves get rolled by the GOP.

Vyan

Originally posted to Vyan on Mon Sep 06, 2010 at 11:51 AM PDT.

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Comment Preferences

    •  great diary (1+ / 0-)
      Recommended by:
      radarlady

      This surely deserves to be on the rec list. I had no idea a special prosecutor had been hired to go after torturers.  I'll bet most Kossacks didn't know either.  I had absolutely no idea about this:

      In the Bill that the Governor now says he's not for, there is a national non-profit option that gives the same choices that members of Congress and Federal Employees have...

      Can you tell me any more?  Like when is this due to start? 2014?  Thanks!

      Scientific Materialism debunked here

      by wilderness voice on Mon Sep 06, 2010 at 12:48:38 PM PDT

      [ Parent ]

      •  It'll start with the Exchanges in 2014 (2+ / 0-)
        Recommended by:
        radarlady, reddbierd

        as a replacement for the long lamented Public Option.

        We haven't heard much yet from the Special Prosecutor, but then that's normal until (or if) he puts together a grand jury and starts hearing testimony.  The big problem he faces is really the noddle-roney that Congress made out of the War Crimes act with the Detainee Treatment & Military Commissions Acts.  A lot of what would have been a slam-dunk is now fairly muddy water legally since coerced testimony is now admissible, and Habeaus is still a bit fukaktda!  

        His best path, is come at them through the Conspiracy clause in 18 USC 2460 (The Torture Statute) which was clearly violated, even under Bybee Craxy ("It's-Not-Torture-Unless-You-Die!") rules, because as many as 25-100 Detainees actually DID DIE in custody as a result of their treatment and interrogations. It's just being able to find the forensic data and witnesses  willing to come forward that causes the problem with that one, not legal hamstrings.

        Vyan

  •  Blue Cross Blue Shield is a good example. (3+ / 0-)
    Recommended by:
    Shockwave, neroden, JesseCW

    They make more in revenue than they spend in healthcare, they overpay their CEOs by the tens of millions of dollars, they suppress competition and cancel policies when customers get sick, and they escape laws relating to the amount they must spend on healthcare by passing off trips to Bermuda as 'health fairs'.

    But officially, they are not for profit.

    "To pass these defendants a poisoned chalice is to put it to our own lips as well." Justice Robert Jackson, Chief Prosecutor, Nuremberg.

    by Wayward Son on Mon Sep 06, 2010 at 11:57:30 AM PDT

    •  That's been true, but won't be (0+ / 0-)

      allowed for insurers involved in the Exchange, which is where this option will exist.

      Vyan

      •   BC BS in California was given permission (2+ / 0-)
        Recommended by:
        neroden, JesseCW

        to raise rates -- what will happen?

        •  That rate approval (5+ / 0-)

          according to the article you linked was based on 70% MLR, the new rule will require a 85% MLR so I think - at a quick glance - things are likely to get better, rather than worse as time goes on.

          These agencies are going to raise their rates, that's a given - but while they're doing that the states are setting up low-risk insurance pools (now available in 34 states) and expanding access to Medicaid. Even now, before the Exchanges come online, people are gradually gaining more options.  I agree this doesn't solve every problem yet, for example employee-based insurance - which Obama promised not to significantly change, contrary to claims this was a "government takeover" - is likely to get hosed, but then again they were ALREADY getting hosed.

          Rather than just throw their hands up in frustration, I think employers need seriously to look at the tax-credits that are available to help them right now.

          Effective Jan. 1, 2010

          Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35% of the employer’s contribution to the employees’ health insurance. Small non-profit organizations may receive up to a 25% credit.

          A 35% tax credit would more than offset the proposed 14%-20% Blue Cross rate hike for eligible businesses.

          Vyan

    •  BCBS is a for-profit insurance company just (0+ / 0-)

      like most others.

      •  It didn't used to be.. (1+ / 0-)
        Recommended by:
        FG

        they were bought out.

      •  Wrong. (1+ / 0-)
        Recommended by:
        neroden

        Our Company
        Blue Cross and Blue Shield of North Carolina (BCBSNC) is a not-for-profit, fully taxed company with headquarters in Chapel Hill and major operations centers in Durham and Winston-Salem.

        But thanks for the... help?

        "To pass these defendants a poisoned chalice is to put it to our own lips as well." Justice Robert Jackson, Chief Prosecutor, Nuremberg.

        by Wayward Son on Mon Sep 06, 2010 at 06:15:35 PM PDT

        [ Parent ]

        •  You're lucky in NC that it's still non-profit. (1+ / 0-)
          Recommended by:
          SoCalSal

          In most states it's not the case. Btw, about the NC company:
          'BCBSNC has also come under fire for a failed attempt to convert to for-profit status in 2003, a year in which they posted a record profit of $196 million and most customers saw their rates rise by more than 10%.' (from wikipedia)

          •  I've noticed.. (1+ / 0-)
            Recommended by:
            neroden

            ..that when people offer uninvited and incorrect commentary, and are then corrected, they rarely act as a person would if they had done the same thing face-to-face.  You know.. apologize, realize how they could have said it better, be slightly embarrassed.  Things like that.

            No, they usually bluster through with some sort of partial justification and attempt to make it seem like the person who was right was only correct due to luck.

            Happens over and over, almost like clockwork.

            "To pass these defendants a poisoned chalice is to put it to our own lips as well." Justice Robert Jackson, Chief Prosecutor, Nuremberg.

            by Wayward Son on Mon Sep 06, 2010 at 06:47:16 PM PDT

            [ Parent ]

            •  Ok, so you only accept invited commentary. (0+ / 0-)

              Got it.

              •  It can be uninvited and correct. (0+ / 0-)

                That's always fine, too.

                "To pass these defendants a poisoned chalice is to put it to our own lips as well." Justice Robert Jackson, Chief Prosecutor, Nuremberg.

                by Wayward Son on Mon Sep 06, 2010 at 07:19:03 PM PDT

                [ Parent ]

                •  Blue Shied definately (2+ / 0-)
                  Recommended by:
                  neroden, SoCalSal

                  used to be not-for-profit everywhere (actually, I mis-read and thought that what he said originally "not-for-profit" - so I said "It's been bought out" because I know that in some places at least, it's now operates exactly like a "for-profit" company)

                  This for-profit/non-profit argument is fair to have, especially since the Director of OPM will have to internally create rules to make this distinction, including negotiating their premiums, profit margin and medical loss ratio independent of other plans available in the exchange and without going back to Congress for authority.  It's likely that these companies will be held to a much higher MLR than 85%.

                  The only thing different with the Public Option would be to have the government handle all the administration (the way they do Medicare or Medicaid) themselves rather than have several different (at least two) companies compete and negotiate.

                  SEC 1332 (3) NON-PROFIT ENTITIES.—In entering into contracts under paragraph (1), the Director shall ensure that at least one contract is entered into with a non-profit entity.
                  (4) ADMINISTRATION.—The Director shall implement this subsection in a manner similar to the manner in which the Director implements the contracting provisions with respect to carriers under the Federal employees health benefit program under chapter 89 of title 5, United States Code, including
                  (through negotiating with each multi-state plan)—
                  (A) a medical loss ratio;
                  (B) a profit margin;
                  (C) the premiums to be charged; and

                  (D) such other terms and conditions of coverage as are
                  in the interests of enrollees in such plans.
                  (5) AUTHORITY TO PROTECT CONSUMERS.—The Director may prohibit the offering of any multi-State health plan that does not meet the terms and conditions defined by the Director with respect to the elements described in subparagraphs (A)
                  through (D) of paragraph (4).

                  (b) ELIGIBILITY.—A health insurance issuer shall be eligible to enter into a contract under subsection (a)(1) if such issuer—
                  (1) agrees to offer a multi-State qualified health plan that meets the requirements of subsection (c) in each Exchange in each State;

                  The multi-state aspect of this also torpedo's yet another right-wing talking point that their wanted the option to offer plans "across state lines", but this provision does exactly that.

                  You're point about people responding to comments is also fair, clearly my perspective what it was when I posted the original diary as a result of following the debate and reviewing healthcare.gov.  As comments have come in I've been going back to healthcare.gov to check it out, or reading the actually legislation and checking for specifics (like I did just above).

                  so far I haven't quoted "opinions" - I've either read or quoted the actual legislation or CBO analysis of the legislation - and people, many without any citation or quotes, are bickering with me.  Not that I'm surprised.

                  Vyan

                  •  Thanks. What I should have said is that in most (2+ / 0-)
                    Recommended by:
                    Wayward Son, SoCalSal

                    states BCBS converted to for-profit status. I thought it happened in all states but I was wrong, should have checked.

                    •  Even in the states where it didn't (0+ / 0-)

                      it's generally being run by greedy executives who are doing their best to loot the affiliates.  :-P  Which is the real potential issue with the new non-profit plan.

                      Much, much better to have it run by civil service employees at standard salaries.  That would be the public option which we had taken away from us.

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

                      by neroden on Tue Sep 07, 2010 at 11:10:03 AM PDT

                      [ Parent ]

  •  Meh. (0+ / 0-)

    The healthcare bill was a terrible move no matter how you look at it, because it was entirely misdirected.  There is a way to lower healthcare costs, within the market framework, that would have been OK with almost everyone - take steps to increase the supply of healthcare available (more doctors, more equipment, etc.)  Greater supply for approximately constant demand means lower prices.

    But we basically totally ignored that.  Instead, we're apparently trying to help people pay for healthcare.  But since healthcare providers don't have a lot of idle time anyways, all this really amounts to is a redistribution of care - some people will get better care, but only because other people are getting worse.  So it should be no surprise that a lot of people are antagonistic towards the law.  There was a much better way.

  •  Single Payer is the ultimate Public Option (6+ / 0-)

    We need to put it back on the table.

    http://www.californiaonecare.org

    Dailykos.com; an oasis of truth. Truth that leads to action -1.75 -7.23

    by Shockwave on Mon Sep 06, 2010 at 12:06:25 PM PDT

    •  The easiest way to do that (5+ / 0-)

      is to allow and option to voluntarily buy-in to Medicare - which is a single-payer system which is proven to work. One thing the Repubs are good at is branding, we can get exactly what we want, all we have to do is learn better terms and branding for it.  

      We will effectively Have the "Public Option" via the OPM in 2014.  Want single-payer?  Push to let people buy-in to Medicare.

      Vyan

      •  No, it's not. "Allowing" people to buy into an (1+ / 0-)
        Recommended by:
        Shockwave

        option most of them will not be able to afford to buy into does them no good.

        Only in the mind of a person who thinks the entire population of Tacoma, WA lying needlessly dead in 4 years is "95% of what we need" do Not-For-Profits = a Public Option.

        Politicians are Puppets / Let's get Geppeto ~ Boots

        by JesseCW on Mon Sep 06, 2010 at 12:49:47 PM PDT

        [ Parent ]

        •  You're ignoring the low-income subsidies (3+ / 0-)
          Recommended by:
          allep10, eyesonly, SoCalSal

          the free preventative care, the investment in Community Health Centers, the 50% RX discount for seniors, the Medicaid expansion and the High-Risk Polls that are going into effect RIGHT NOW that are in the bill to address exactly that problem.

          http://www.healthcare.gov/...

          Effective April 1, 2010

          States will be able to receive federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available. This will make it easier for states that choose to do so to cover more of their residents.

          -----

          Effective for health plan years beginning on or after September 23, 2010

          All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance.

          I know how many people are suffering from lack of health care they can't afford to pay for - I'm one of those people - so spare me that particular lecture, as if I'm someone who doesn't care.  I know how many of them die from lack of that care, and that the number is increasing  every year to absolutely obscene levels, but there are logistical and infrastructure issues here.  The 4 years is about the states, giving them time legislatively to establish the Exchanges - which are State based.

          My counter suggestion, to open up Medicare to the full population (something that was only briefly flirted with in the Senate) could be immediate and fairly simple to implement with the existing infrastructure, and done while the states are putting up the Exchanges - I'm not suggesting we sit on our hands in the meanwhile. If you want to get single-payer as an improvement on the current bill, extending Medicare to everyone is that fastest way to do it, but you also inherit Medicare's long-term funding problem with doing that.

          •  The low income subsidies that start in 2014? (1+ / 0-)
            Recommended by:
            neroden

            Jesus.

            No honesty in you, and not the slightest willingness to take responsibility for the hundreds of thousands who are going to die as the price for the sell-out you supported.

            The delay was entirely about massaging budget numbers, which was widely admited even by the bills backers at the time.

            I love the Fruedian slip though -

            High risk polls

            Really demonstrates what the prime issue here is.

            You threw away the chance to open Medicare to everyone when you promised AHIP another 400 billion in funds to buy Senators with every year.

            It's hard to believe you're unaware of that.

            Politicians are Puppets / Let's get Geppeto ~ Boots

            by JesseCW on Mon Sep 06, 2010 at 02:12:09 PM PDT

            [ Parent ]

            •  Not just that.. (0+ / 0-)

              I listed several things besides that which are already in effect.

              Also I still support opening up Medicare - I brought it up in another in another one of the threads. I don't disagree that a ton of ugly horse-trading and budget slight-of-hand went on, but here's my problem - even doing what we both like - opening up Medicare - wouldn't address the problem your complaining about which is getting immediate relief to people who need it now.  As the other poster who I brought up the Medicaid expansion with pointed out, "What about the people who can't afford to buy-in to Medicare?"  

              Someone has to pay for it.

              If we just opened it up to everyone and pay for it with taxes, you either blow a massive hole in the deficit or else create a giant tax increase. A bill like that was not going to fly for anyone and you know it. Would there be competitive pressure for providers to lower costs if people could opt-out of the private market into Medicare?  Maybe, probably, but then they technically can do that right now with Medicaid - which has already been expanded - and that leads you right back to where we are now.

              The main reason people don't have coverage are costs and pre-existing conditions.  In the short term expanding Medicaid (which they have) and creating High-Risk Pools (which they have) addresses both these problems right now.  I don't yet see a proposal coming from anyone that would do it faster.  The PO wasn't going to be available until 2014 either.

              And that's not a "freudian slip" - that's what they're being called under the law, I didn't make it up.

              Vyan

            •  I got two different discussions (0+ / 0-)

              a little confused, now realize you're the same person in both.

            •  I notice that Vyan hasn't resorted to personal (0+ / 0-)

              attacks at least.

              Solidarity Now. (We can continue the fighting later). See you in Washington 10-02-10.

              by reddbierd on Tue Sep 07, 2010 at 06:53:16 AM PDT

              [ Parent ]

          •  I'm on Medicare, and it can still break the bank (2+ / 0-)
            Recommended by:
            mataliandy, ybruti

            Currently Medicare pays 80% of procedures.  Unless one can afford an obscenely priced Medigap policy, that 20% can, given one hospital stay of oh, say, one week, can leave the 'covered' individual with $50,000 worth of debt.  That's enough to force many, many families into bankruptcy.  It happened to me.

            I agree that opening Medicare up would begin to solve the problem, but what happens after that?  Until we have Single Payer and are taxed across the board, exactly as we are for FICA, et al, we are still putting band aids on open wounds.

            •  They made some improvements to Mediare (0+ / 0-)

              such as 50% discount on drugs and free preventative care, but you're right - for catastrophic or long term cases, there can still be a significant personal financial hit.  We have to keep closing these gaps, even though right now Medicare is the closest thing we have to single payer, it's not enough on it's own.

  •  There is no stealth PO (6+ / 0-)

    I already have one of the nation's leading not-for-profit HMO, Kaiser Permanente, which reports a 95% MLR, practices fine medicine with high customer satisfaction, good outcomes, state-of-the-art electronic medical records, and a staff model that pays physicians salaries eliminating the burdensome fee-for-service model that drives cost up so much.

    I pay $1000/month for one healthy 55 year old and the 2010-2011 increase has not been announced yet.

    All revenue above and beyond cost is given to the autonomous dedicated for profit physician partnership which is sunk into the Medical part of MLR.

    MLR is a useful tool but is fundamentally and essentially an accounting trick.

    Kaiser Permanente is a key model for your "steath PO" and it's not even close.

    Elements in the PPCA exist that will individually cost less however, the national budget for health care is rising every year, by a lot, and is projected to continue to rise. There are no reputable health science or economics sources that will say the PPCA "bends the cost curve" with any measurable significance and there are no rollbacks planned for an already unaffordable situation.  

    "People need dramatic examples to shake them out of apathy," Bruce Wayne in Batman Begins.

    by kck on Mon Sep 06, 2010 at 12:27:57 PM PDT

    •  Well, that's not what CBO said... (4+ / 0-)
      Recommended by:
      Aexia, ybruti, kck, allep10

      on multiple run-thrus with and without the PO.

      Point of disclosure : I used to work as a Contractor for KPM in their physician compensation dept helping to write a program to allow the various Chiefs of each department to set pay levels for their staff.

      I don't necessarily know that KPM will be one of the Non-profits that OPM ends up contracting with, it might be Blue-Cross/Blue-Shield or some new agency that is completely different.  That is yet to be determined - but one thing I can tell you is that whoever is ultimately selected with have to compete for one of those two contracts - and things then may be very different than they are now (which is what CBO realized).

      •  Competition is a funny thing (3+ / 0-)
        Recommended by:
        mataliandy, neroden, enhydra lutris

        Point of disclosure (as I've given many time before) : I used to work for KP.

        There was a time when KP did not have to compete for business in California and the rates were much lower. Competition itself drove up rates as being the least expensive insurance in town is not always the most sustainable position in heath care. I suspect that as more insurers and HMOs compete they will be increasing service and cost to meet KP's caliber rather than create an affordable option.

        CBO scores are only in reference to the federal budget and as such are also funny things. The federal budget can be reduced yet the national health care dollars increase as expected. You and I can be spending more and more every year simply by the federal budget being reduced.

        As for just the CBO scoring itself, it's not a static thing. For instance, a necessary element for deficit neutrality was the 21% Medicare physician fee reduction which, of course, as predicted, did not happen.  

        "People need dramatic examples to shake them out of apathy," Bruce Wayne in Batman Begins.

        by kck on Mon Sep 06, 2010 at 12:52:26 PM PDT

        [ Parent ]

        •  I agree with most that in general (3+ / 0-)
          Recommended by:
          citizen k, neroden, kck

          that's all true.  Exactly how agencies like KPM or BC/BS react to this over the next couple of years remains to be seen.  The key factor here is whether the PO as it was written prior to the Manager's Amendment would provide more downward pressure on overall health care inflation - which is reflected in the budget through Medicare/Medicaid costs - than this option does.

          They honestly admitted having a difficult time predicting that, but their result was either the same or better than the projections for the PO.  We can speculate back and forth for some time, and maybe with our collective direct experience with KPM either one of us may be more or less likely to end up correct as time goes on, but the professional and recognized predictors came up with the answer they came up with.

          CBO said this option is about as good as that option, they said it several times - we either accept that, or we don't.

  •  It takes my breath away to read this (2+ / 0-)
    Recommended by:
    neroden, geraldlaslo

    from someone trying to pass themself off as a progressive.

    In the end, we got 90-95%% of what we wanted and needed.

    The four year implimentation delay alone will cost the lives of more than 200,000 people.

    20 million people will still have insurance at all in 2020, under this bill.

    If you think that's "90-95% of what we needed", than either or definition of "we" or your definition of "need" are so far off as to render your opinions utterly without value.

    Politicians are Puppets / Let's get Geppeto ~ Boots

    by JesseCW on Mon Sep 06, 2010 at 12:46:53 PM PDT

    •  That assumes that in the meanwhile.... (0+ / 0-)

      we have effectively Nothing to address those issues, and that's frankly not true - as I outline here.

      •  Only a million people will gain insurance (2+ / 0-)
        Recommended by:
        neroden, enhydra lutris

        prior to 2014 and full subsidies kicking in.

        Some people just don't care about anything but a "message", and how the facts can be spun.

        Those of us who have lost loved ones due to a lack of afordable health care don't agree with you that 20 million people uncovered in 2020 is "95% of what we want".

        Politicians are Puppets / Let's get Geppeto ~ Boots

        by JesseCW on Mon Sep 06, 2010 at 01:59:57 PM PDT

        [ Parent ]

        •  I'm not sure about those numbers (0+ / 0-)

          although I could be wrong of course.

          4 Million Small Business, many of whom couldn't previously afford to offer insurance now how tax credits available to offset up to 35% of their costs.  (There have to be at least 1/4 ratio out of that I would hope!)

          Medicaid has been significantly expanded for the States to allow more people access to that program.

          The federal government will bear virtually the entire cost of expanding Medicaid under the new health-care law, according to a comprehensive new study by the Kaiser Family Foundation that directly rebuts the loud protests of governors warning about its impact on their strapped state budgets. About half of the increase in health insurance coverage under the new law is expected to come from expanding Medicaid in 2014 to a new nationwide eligibility threshold of 133 percent of the poverty level -- $14,400 for a single adult or $29,300 for a family of four." The Post notes that a "disproportionate share" of the people likely to enroll in the expanded Medicaid will come from the South and West. Many of these states currently have "stringent eligibility rules" for childless low-income adults.  

          The money for this expansion has already been released and is in the pipeline as of April 1st.

          States are also creating High-Risk Insurance Pools for those blocked by Pre-existing Conditions. 34 States have them now and that covers just about 180,000 people so far, presumably more when (and if) it reaches the remaining states.

          •  Yep, less than a million. (0+ / 0-)

            Small businesses are still dropping health insurance left and right, because premium increases are going up fast enough that the tax credits simply don't make up for it.

            The high-risk pools are a bit of a joke, though they do help those with pre-existing conditions who have lots of money and can therefore afford these ferociously expensive beasts.

            The Medicaid expansion reduces Medicaid from "only for destitute homeless people" to "only for destitute people".  Great.

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

            by neroden on Tue Sep 07, 2010 at 11:17:59 AM PDT

            [ Parent ]

        •  Only a Million? (1+ / 0-)
          Recommended by:
          ybruti

          I highly doubt it.

          Garnering little to no press attention when released in July, a report undertaken by Families USA and the Small Business Majority  found that 80 percent of California’s small businesses with 25 or fewer employees will qualify for federal tax credits under the Patient Protection and Affordable Care Act starting this year. This means  that of the state’s 571,200 small businesses, 465,500 are eligible for the tax credits in 2010. Of those, 30 percent – or 135,900 – qualify for the maximum tax credit amount.

          And that's just California.

      •  In the meantime we have effectively nothing. (0+ / 0-)

        "the free preventative care,"

        Actually not significant.  :-P  Doesn't include most of the preventive services which people currently can't get and need (dental checkups?)

        "the investment in Community Health Centers,"

        Not really present yet, though it does show up before 2014.  OK, I'll give you this one -- in regions which have such centers.

        "the 50% RX discount for seniors,"
        Not significant, sorry.  Seniors weren't the ones with the serious problems.

        "the Medicaid expansion"
        Great for the bankrupt.  It's going to take even more people out of the workforce and/or reduce their wages as they struggle to stay under Medicaid's draconian limits, which even with the expansion are still draconian.

        "and the High-Risk Pools that are going into effect RIGHT NOW that are"
        a total failure, unfortunately, due to being completely unaffordable.  :-P

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

        by neroden on Tue Sep 07, 2010 at 11:15:27 AM PDT

        [ Parent ]

    •  Who made you pope of Progressives? (0+ / 0-)

      This is a bill endorsed by Barbara Lee, Lloyd Doggett, Sherrod Brown and others.

  •  Two questions (0+ / 0-)
    1. how do I sign up for this stealth public option?
    1. Regarding:

    However, the PPACA does have cost controls, it requires an 85%  Medical Loss Ratio, which means that at least 85% of the money paid in  as part of premiums has to go to actual care, not advertising, not  overhead, not stock value.

    what, exactly, is the definition of "Medical Loss Ratio" and exactly how much stuff that's really overhead will the insurance companies be allowed to reclassify as "actual care?"  Note that this game is already being played.

    Tropical weather info and discussion at Storm2k.org

    by jrooth on Mon Sep 06, 2010 at 12:57:19 PM PDT

    •  The Option (1+ / 0-)
      Recommended by:
      allep10

      will be available through the Exchanges, just like the Original Public Option was going to be.  It's a direct replacement.

      what, exactly, is the definition of "Medical Loss Ratio" and exactly how much stuff that's really overhead will the insurance companies be allowed to reclassify as "actual care?"  Note that this game is already being played

      There is the potential for shell games to be played - there always are - but also for regulations to be written under HHS allowing which insurers can and can't be included in the Exchange to help clamp down on tricky accounting.

      The crooks are always going to try and outwit the coppers, doesn't mean that they will.

      Vyan

      •  OK ... well I hope it's worth something ... (4+ / 0-)

        although I also note that the CBO (in your linked document) are pretty equivocal about it:

        The proposal would call on OPM to contract for two national or multi-state health insurance plans—one of which would have to be nonprofit—that would be offered through the insurance exchanges. Whether insurers would be interested in offering such plans is unclear, and establishing a nationwide plan comprising only nonprofit insurers might be particularly difficult. Even if such plans were arranged, the insurers offering them would probably have participated in the insurance exchanges anyway, so the inclusion of this provision did not have a significant effect on the estimates of federal costs or enrollment in the exchanges.

        And meanwhile, my premium has been jacked up again, and I don't have the $137 for my copay for 6 Relpax pills, so I'm left hoping I don't have another migraine episode for a couple of weeks until I do.

        Tropical weather info and discussion at Storm2k.org

        by jrooth on Mon Sep 06, 2010 at 01:47:04 PM PDT

        [ Parent ]

        •  That's absolute true (2+ / 0-)
          Recommended by:
          neroden, SoCalSal

          and that's why I included so much of the quote, they weren't absolutely sure - but they didn't see this option being significantly worse than the PO from a budgetary perspective.  

          Yes, I do think based on anecdotal reports that the insurance agencies are likely price gouging us - something they've been doing for quite some time - but that we now have more tools and options than we used to.  If you're a business owner, I highly suggest you look into the tax-credits I mention in this reply.  They could IMO easily offset some or all of the price hikes and then some, if you're eligible.

  •  Reforming Health Insurance is like (2+ / 0-)
    Recommended by:
    ybruti, neroden

    trying to stop a stampede. You don't just stand in front of the herd, fire your pistol in the air shout "whoa!"

    The reform bill built some fences and threw up some obstacles in an initial attempt to "turn" the stampede. But the industry is still out of control and it's still going to do some damage.

    Eventually, with a lot more work, they're going be "turned, circled, and slowed", until they're finally "settled" and maybe even guided into some kind of a corral.

    It looks to me like the first phase of reform was a simple attempt to force the InsurCo's to start squeezing the providers instead of squeezing the patients.

    We may end up with single payer, and we may end up with a health care provided by regulated public utilities.

    I suspect it will be the latter. As we place more limits on profitability, the greediest investors will take their money elsewhere. Those who remain will be happy to convert to a "utility" model that earns a fixed return in exchange for charging fixed rates.

    Public utilities... they're as American as apple pie.

    Politicians who promise LESS government only deliver BAD government.

    by jjohnjj on Mon Sep 06, 2010 at 01:26:51 PM PDT

  •  asdf (0+ / 0-)
    1. 100% - 85% = 15%
    1. if A > B. then 15% of A > 15% of B

    In and of themselves, MLRs are not cost controls.

    That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt -

    by enhydra lutris on Mon Sep 06, 2010 at 08:57:19 PM PDT

  •  Excellent, Vyan. (0+ / 0-)

    Thanks for putting in the time and effort to put out such comprehensive information. I'm glad the diary got rescued, or I'd have missed it. Now I have it bookmarked.

    Slavery is the legal fiction that a person is property. Corporate personhood is the legal fiction that property is a person. -Jan Edwards

    by SoCalSal on Tue Sep 07, 2010 at 03:15:11 AM PDT

  •  Tipped and recced. (1+ / 0-)
    Recommended by:
    ybruti

       I'm hoping this all becomes a moot point when Medicare is opened up for everyone.

    Solidarity Now. (We can continue the fighting later). See you in Washington 10-02-10.

    by reddbierd on Tue Sep 07, 2010 at 06:56:24 AM PDT

  •  We'll see if it's a REAL non-profit. (1+ / 0-)
    Recommended by:
    ybruti

    Most of the so-called non-profit health insurers in this country have been taken over by very highly paid managers, and are run for the personal profit of those executives.  :-P  Look at most BCBS affiliates.

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

    by neroden on Tue Sep 07, 2010 at 11:07:38 AM PDT

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