so stop treating him emotionally with diaries like "Imagine" that feature a laundry list of promises he never really made.
Yesterday I wrote a diary that was intended to point how Obama has put the GOP into full disarray and retreat on the debt ceiling issue, how he's shown the backbone many people have said he didn't have - however I made two technical mistakes. I briefly included a link that referred to the public option replacement, that was unfortunately broken - and I included the video just before the one I really wanted which was this one.
Normally those would have fixed almost immediately and the clusterfunk that ensued would have been largely avoided - but I had to leave my computer. So I take the blame for orphaning the diary that way and not testing my link and video. Mea culpa.
On the other hand what was displayed is something that really does need to be addressed. There is a massive feeling of betrayal and resentment out there. A lot of people apparently feel that they've been Hippy Punched more than a few times already, and that yet again they caught Obama cheating on them with that GOP Sl*t from across the aisle once too many times - and while I can sympathies with it that feeling, and understand it - there comes a point where it become self-defeating and self-destructive.
Obama's not your boyfriend, but more importantly he hasn't been "cheating" either. He's trying to get some shit done, against overwhelming odds and opposition.
The first and still most raw item of betrayal that is shown and cited is the Lack of a Public Option in Health Reform. Now, I've talked about this a ton of times, so much so that I figured one little link as a reminder should have been sufficient because I've always felt that redundancy is a flaw of those who have little new to say and/or think what they have to say is way more important than it really is.
But this is neither of those, it really is important.
As I wrote almost a year ago before the 2010 Election in a diary I then called "Revealing the Stealth Public Option" the simple truth is that the Original Public Option wasn't simply dropped and removed during negotiations in the Senate. It was REPLACED with another Option.
My point was just that CBO Scored the impact of the replacement as being basically the same, and just as good as the Public Option at controlling costs. The difference between the two plans was only $2 Billion (although some other changes were involved as shown below)
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.
Let me repeat: According to the CBO the Public Option was Replaced, not removed or deleted, Replaced with a different idea that almost no one, except maybe me, has even bothered to talk about. And they scored it as almost the same in deficit reduction as the PO.
Now this wasn't the main point of yesterday's diary. I only mentioned it in one sentence, but the fact it got such an argument going proves that it's worth mentioning again and going over in detail.
The Public Option was a fairly simple idea, but this isn't so bear with me.
The original Public Option was a plan run by HHS using public employees similar to the way that Medicare is run. There was a brief moment where Congress flirted with the idea of simply opening up Medicare for younger citizens to buy into which would have been good, but not great as it's to not clear how that would effect the long term stability of the Medicare Trust Fund. Would those premiums have to be inflated to help close Medicare's long term viability gap? I don't know.
Instead ot National Single Payer, or Medicare-for-All, or a Public Option what we actually have is this Multi-State Non-Profit Option.
Maybe if it had simple catchy name, people would get it - and maybe not.
There are only two differences between this Option and the Public Option. 1) Instead of being run by HHS, it's run by the Office of Personnel Management (who also currently handle the Federal Employee Benefit System that the Exchanges are modeled on) and 2) Instead of government employees handing the plan, it will be government contractors, some of whom will have to be Not-For-Profit.
Now the goal of the PO was to allow an alternative to For-Profit Private Insurance that would apply downward pressure on the costs that isn't otherwise available. The best we could hope for is that it would be as financially efficient as Medicare with only 4% overhead and run about 28% cheaper than private insurance the way that Medicare Part-A and B are 28% cheaper than Medicare-Advantage which is farmed out to private insurers.
The PO replacement accomplishes that goal.
The point here is that we've never tried to implement anything like this in the past, and the assumptions that the Public Option would perform as well as Medicare are just that - assumptions. They were never proven, only projected when the CBO said that adding the PO to the Kennedy HELP Bill would save $389 Billion compared to the previous version of the bill.
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."
Again, the final bill with the PO replacement, according to the CBO, saved as much as that one did, so where's the problem exactly?
Well apparently it's the idea that "only a government managed plan will give people a way to escape the greed and malfeasance of the private system".
Except that this plan is management by the government. The Director of OPM has a massive amount of power to control these plan including the following:
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).
The Director can negotiate the Premiums these plans charge, as well as their Medical Loss Ratio (over and above 85%), and their Profit Margin.
Some have dismissed this in my previous discussions of it, but let me just say one thing about that. The reason that people have argued that Medicare should be able to negotiate for prescription drugs is the fact that the VA can negotiate and saves 40%6 on them compared to Medicare. So the fact that the Director of OPM can Negotiate these Premiums is just a big, and just as powerful a tool.
Some I've argued with have said this would be just like the "Co-ops", but that is incorrect. Those are private plans that would be owned by their members, not Non-Profits with a profit-margin and premium level set by the government. Not the same thing at all.
Some have stated what they want is to be able to buy insurance through the government, well you can do that now if you have a pre-existing condition under the PCIP plans that the ACA created and will be in place until 2014. Premiums for those plans have just been cut by 40% in many states, but unfortunately not all.
Exactly what Non-Profits would be eligible to become part of this plan remains unclear, because it's entirely up to the Director of OPM to decide, and they don't have to do that until 2014 when the exchanges come online. (Incidentally, the PO wouldn't have become available until then either.) Could a fake Non-Profit like California's Blue Cross/Blue Shield manage to slip in and continue gouging customers with 59% rate hikes the way they have been for years?
My initial thoughts when I wrote about this were "No", because a company like that couldn't possibly even get into the Exchanges because of their 85% Medical Loss Ratio requirement. The Exchanges have the ability to ban any insurer who exceeds that MLR. They also have the ability to force any insurer to pay rebates retroactively to their customers for exceeding that MLR going all the way back to the start of the ACA in 2010. This is something I pointed out when listing all the ways the Ryan Plan impacts people NOW, rather than in 10 years.
[The Ryan Plan] would repeal the 85% Medical Loss Ratio Limit for Insurers in the Exchange, and repeal the leverage State Insurance Regulators currently have to block insurers who are currently gouging their beneficiaries with costs above the 85% MLR level by denying them access to the exchange and requiring that they pay REBATES to their customers for any premium charges above the 85% MLR. This impacts us NOW, because if there aren't going to be Exchanges in 2014, there isn't any leverage to push for lower premiums with insurers today.
Interestingly, Blue Cross of California just recently decided to Cut their premiums and offer Rebates back to 2010, exactly like what the ACA requires for them to be able to join the Exchange. They just did it a couple years early.
Health insurer Blue Shield of California, under fire for a series of recent rate hikes and the pay of its chief executive, plans to cut this year's premiums by 2.5% for many of its 3.3 million policyholders as part of a new initiative to hold down costs.
The nonprofit insurer, with about 10% of the California market, said the rate reduction would be applied to bills in October, resulting in $167 million in savings for nearly 2 million customers.
Now they might be able to join the Exchanges and could possibly be part of the "Multi-State" option if they keep their premiums low enough to satisfy the Director of OPM. As long as they behave, they might get in, we'll have to just wait and see.
Even if they don't HHS has just recently announced guidelines for all Health Insurers requirement them to justify any premium increases of 10%, they've also provided over $200 Million in grants to the states to help them implement this and pass laws like California AB52 which grants the State Insurance Commissioner with the same power the Director of OPM has for multi-state plans - the power to control insurance premiums. AB52 has already passed the State Assembly and the Senate Health Committee - after passing the Appropriations Committee and full Senate it's headed for Governor Brown's desk and he's likely to sign it.
Lastly, thanks to the "Waivers for State Innovation" included in the ACA, Vermont now has Single Payer.
All of this isn't neat, it's not simple - it's not as easy to comprehend and digest as "We have a Public Option". But neither is it a total betrayal of progressives by the two-timing Bastard Obama that people have been treating it as.
And hey guess what, Medicare is already means tested.
Higher-income seniors will pay monthly Part B premiums that are double or triple the amount of the standard Part B premium. The means-testing provisions in the MMA were phased-in over a three year period. As of 2009, the phase-in period is complete, and higher-income beneficiaries will pay the full disproportionate share of Part B per beneficiary costs through higher premiums.
As Lawrence points out in the video, the Social Security Age is already slated to increase to 67.
Years ago, lawmakers decided to gradually increase the Social Security retirement age to 67 for people born in 1960 or later. But they left the Medicare eligibility age unchanged. Now some policymakers are saying the qualifying ages for the two programs should be yoked together - at 67 or even higher.
Read more: http://azstarnet.com/...
Let me address some of the other "Imagine" wish-list items.
Imagine that Wall Street firms shown to have engaged in misconduct were heavily fined and otherwise subjected to the legal consequences of their actions.
I can understand being frustrated about that, but just like the reality vs the fantasy of the Public Option - the truth is that the DOJ are doing just that.
NEW YORK – The United States has filed a civil mortgage fraud lawsuit against Deutsche Bank AG and its wholly owned subsidiary, MortgageIT Inc. The government’s complaint seeks damages and civil penalties under the False Claims Act for repeated false certifications made to the U.S. Department of Housing and Urban Development (HUD) in connection with the residential mortgage origination and sponsorship practices of MortgageIT. To date, the Federal Housing Administration (FHA) has paid insurance claims on more than 3,100 mortgages, totaling $386 million, for mortgages endorsed by MortgageIT.
Outside the DOJ Well Fargo was successfully sued and paid $125 Million. Countrywide was sued for $624 Million.
Is it as fast, clear and simple as we might like? Probably not, but it is happening. The DOJ (and others) are going after these thieves.
Imagine that climate change, renewable energy, ocean acidification, rainforest depletion, chemical pollution and the solving of other looming problems were made first level priorities.
As I pointed out in this diary, even Al Gore Admits that Obama has done more for Climate Change and Renewable Energy than any President in History.
In spite of these obstacles, President Obama included significant climate-friendly initiatives in the economic stimulus package he presented to Congress during his first month in office. With the skillful leadership of House Speaker Nancy Pelosi and committee chairmen Henry Waxman and Ed Markey, he helped secure passage of a cap-and-trade measure in the House a few months later. He implemented historic improvements in fuel-efficiency standards for automobiles, and instructed the Environmental Protection Agency to move forward on the regulation of global-warming pollution under the Clean Air Act. He appointed many excellent men and women to key positions, and they, in turn, have made hundreds of changes in environmental and energy policy that have helped move the country forward slightly on the climate issue. During his first six months, he clearly articulated the link between environmental security, economic security and national security — making the case that a national commitment to renewable energy could simultaneously reduce unemployment, dependence on foreign oil and vulnerability to the disruption of oil markets dominated by the Persian Gulf reserves. And more recently, as the issue of long-term debt has forced discussion of new revenue, he proposed the elimination of unnecessary and expensive subsidies for oil and gas.
It may not be as neat and clean as we might like, but we don't have to IMAGINE THIS - it's actually occurring.
Or this..
Imagine that the USA quit torturing people and running secret prisons, and instead became a force for good in the world.
People have to realize that the President has done what he can on this - he implemented an order banning civilians in the CIA from deviating from the Army Field Manual - but that the real problem is Congress who need to repeal the Military Commissions Act to truly ban torture.
Under current law with the MCA in place what used to be torture isn't torture anymore. The MCA made the Bybee Standard (only pain equal to death is toture) into the Law. The DOJ can't prosecute anyone for waterboarding because Bush and the 2006 Congress actually made it legal. However they can prosecute when someone dies from torture... and they are.
Obama tried to close Gitmo, but Congress has blocked him and defunded it. The DOJ wanted to try KSM in New York, but Congress blocked it.
I think Constructive Criticism is generally a good thing, I think wanting things to be better is at the core of what progressives stand for, but I really haven't seen a lot of that in last few months. As Lawrence points out, being criticized from his Left actually strengthens Obama's hand in negotiations by making his seem far more reasonable than the screaming hordes of the Professional Left. He's playing Reasonable Cop to our Flaming Liberal Cop. Fine, I get that and I can see how it works.
However, what I've also seen, is more than a people acting like a jealous pissed off petulant girlfriend.
And I can understand that too, because it comes from passion - it's really just the lashing out of the broken-hearted. When people lose Hope, it easily turns to Anger.
But the facts are that most of what we generally as progressives have wanted, though not all - Obama has either already accomplished, has made significant strides toward or continuing to work on while being blocked by Congress... and that's includes Congressional Democrats, as much as Republicans.
Now, is when he needs us most. Yes, to criticize and push him - but to do so fairly and honestly. For those who desperately wanted the Public Option, you basically have it. It's a little different, but you can't find a CBO assessment that says the fully government run PO is better and more cost effective than the current law with it's replacement.
As far as I can tell there isn't one.
If you wanted prosecutions for torture - that's happening.
If you wanted someone to go after Wall Street - that's happening too.
If you wanted significant movement on Climate Change - also happening.
Could they all be better? Could they be more aggressive?
Sure. But you don't have to Imagine It - it's real. All of it.
So keep screaming, keep shouting. I want this President and the country to do better and to be better too - I simply suggestion we try to do it over the things he really hasn't done yet - rather than ignoring and whining about what he has.
Vyan
8:08 PM PT: Ok, now that I'm home from work I can see I certainly got a reaction.
I will first say that I didn't intend to demean OPOL's diary or anyone personally, I was simply trying to use some snark and Democratic self-depreciation to make a broader point about people getting ragingly bent out of shape, then refusing to accept a pretty good result because it's not pretty good enough, fast enough.
It started a hornet's nest, but then the same thing happened when I dared to say the Robert Gibb's wasn't our Enemy..
I'm not saying people should "Shut Up and Clap Louder". I think they should scream their heads off, but maybe direct that screaming a little bit better to actually achievable goals that move us forward rather than sap our strength, until we fall back into frustration and cynicism.
We need to protect and expand the ACA. pushing more states to implement Single Payer like Vermont and expanding better coverage at better prices where that isn't yet possible. We need to get the Military Commissions Act Absolutely Repealed. We need to push to keep Dodd-Frank from being defanged. We have a ton of work still ahead of us. This isn't really about Obama, it's about our getting serious and channeling our passion for the long haul, the long fight. Change was never going to happen in two or even four years.
Change is generational.
And there's likely to be a lot more hurt feelings, spit milk, bad snark and blood and guts churned along the way.
I'm in this for the long haul. I believe and hope most of you are too.
Wed Jul 20, 2011 at 12:39 PM PT: On the issue of the PO Replacement, we've had a productive if contentious debate of it in this portion of the thread.
The argument has been made that I'm mistaken, lying, talking about the wrong version of the legislation, or misunderstanding the difference between the bill's impact on the deficit and it's impact on premiums.
Despite all that one commenter who initially and angrily doubted my claim about the PO Replacement found confirmation that I was right. when Heritage Called the OPM Replacement a "Public Option"
Under the Patient Protection and Affordable Care Act (PPACA),[1] the federal government, through the Office of Personnel Management (OPM), is legally required to sponsor at least two national health insurance plans beginning in 2014.[2] These OPM-sponsored plans would automatically be eligible to compete against private health insurance offered in the new health insurance exchanges to be established in every state.[3]
It Creates an Uneven Playing Field. Former OPM Director Kay Cole James notes that “OPM would not merely serve as the umpire overseeing competition among private health plans. It would also become a health-plan sponsor, fielding its own team of players to compete against the existing private plans in every state.”[9]
OPM-sponsored plans would thus have an exclusive franchise: They would be perfectly poised to compete nationwide; they would be subject to OPM-negotiated determinations for medical loss ratios, profit margins, and premiums; they would have their own standards for state certification and solvency requirements. This clearly gives the OPM-sponsored plans special advantages.
It Creates the Foundation for a “Robust Public Option.” In their authoritative taxonomy of PPACA, Kaiser Family Foundation analysts categorize the OPM-sponsored health plans as “the Public Option.”[10] Original proponents of a “robust public option”—a government plan that would base provider payments on Medicare rates—viewed it as an ideal vehicle to undercut private health plans and ensure a rapid evolution toward a single-payer system. With the creation of this “OPM alternative,” advocates of a “robust public option” have a second chance to crowd out private health insurance and secure their original policy goals.[11]
Some discredited this because it comes from Heritage which is a dubious source, a point I would agree with except that Heritage was just repeated what the Kaiser Foundation had already said about the Impact of the Law and also referred to it as a Public Plan Option (pdf).
The primary benefit of the Public Option was it's ability to drive down overall costs via competition - however, I can't really say this was guarateed in any particular version of the ACA. There are many reports that indicate that premiums for the Public Option would have been higher than that of private care.
From TPM.
Health care reformers have a number of arguments for the public option, but the main one is this: that by injecting fairness and competition into the market the public option will lower premiums for everybody, including those paying for private plans. Unfortunately, a new CBO study finds that it may not have that effect at all.
in an analysis of House health care legislation, the CBO concluded that the six million people expected to enroll in the public option by 2019 will be paying, on average, higher premiums than will people buying private plans.
"[A] plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges," wrote CBO chief Doug Elmendorf.
Now admittedly this was an analysis of the House version of the bill which didn't enter the final legislation with it's "Robust Public Option" in the end.
Ironically the "weaker" PO from the Senate HELP Bill actually did more to bring down costs.
The CBO recently published a new letter on health care reform. They were asked to evaluate the impact of the weak (level playing field) public option in the Senate HELP committee's bill. Their conclusion was that the competitive pressure from the public option “would probably lower private premiums in the insurance exchanges to a small degree,” and with a public plan in the exchange “the costs and premiums of competing private plans would, on average, be slightly lower than if no public plan was available” By reduc[ing] the cost of buying private insurance on the exchange, a public plan, “would tend to lower federal subsidy payments through the exchanges.”
So this was the Holy Grail right here. The "Betrayal" I spoke of stems from the feeling that passing a Health Reform Bill without the impact predicted here - is nothing more than a big giveaway to Big Insurance the same way that the Medicare Prescription Drug Bill without the ability to negotiate for better prices was.
The core of my counter claim hinges on whether the OPM Replacement also manages to provide the same kind of downward pressure, and so far I haven't seen any specific documentation indicating that it wouldn't.
Until now.
Via The Hill.
A feature of Senate Democrats' healthcare bill that would allow the federal government to negotiate national insurance plans with private providers may not produce the savings its proponents anticipate.
That plan -- the costs of which will depend wholly on future years' budgets -- is unlikely to "substantially change" most Americans' monthly premium costs over the long term, the Congressional Budget Office revealed last week.
Democrats decided to write the new mandate for the Office of Personnel Management into their healthcare bill after talks over the public option collapsed.
Their substitute plan would require OPM to solicit bids for multi-state insurance packages, in the hope that the bidding process would prove competitive enough to lower healthcare costs across the country.
This would seem to essentially end the matter - there is an Replacement "Public" Option, but it's too weak to do what was expected - except that the Robust Public Option from the House didn't do that either and me being the "Show Me" person that I am, I wanted to read what the CBO said about this directly rather than what someone claims said.
And unfortunately, I can't find this report. The article didn't link to it and it was published in December of 2009, months before the final bill was signed. What I do have from the CBO Premiums comes from my original CBO source on the Manager's Amendment which originally introduced the OPM Option.
This analysis also reviews the main changes included in the manager’s amendment,examines the longer-term effects of the legislation on the federal budget, and assesses the effects of the manager’s amendment on health insurance premiums
Effects on Health Insurance Premiums
On November 30, CBO released an analysis prepared by CBO and JCT of the expected impact on average premiums for health insurance in different markets of the legislation as originally proposed.10 Although CBO and JCT have not updated the estimates provided in that letter, the effects on premiums of the legislation incorporating the manager’s amendment would probably be quite similar. Replacing the provisions for a public plan run by HHS with provisions for a multi-state plan under contract with OPM is unlikely to have much effect on average insurance premiums because the existence of that public plan would not substantially change the average premiums that would be paid in the exchanges.11 The provisions contained in the manager’s amendment to regulate the share of premiums devoted to administrative costs would tend to lower premiums slightly, and the provisions prohibiting the imposition of annual limits on coverage would tend to raise premiums slightly.
I've been saying this essentially from the beginning because this was my original source. The question is did the CBO change it's assessment later or not?
The CBO Report on the Managers Amendment was Dated December 19, 2009 and the Hill Report was December 23. So did the CBO change it's view in just 4 days, or is it possible the Hill Report is just wrong?
So I looked again, and decided to focus on the CBO Final Analysis of the ACA as it was signed into law
Effects on Health Insurance Premiums. Under PPACA and the Reconciliation Act,premiums for health insurance in the individual market will be somewhat higher than they would otherwise be, CBO and JCT estimate, mostly because the average insurance policy in that market will cover a larger share of enrollees’ costs for health care and provide a slightly wider range of benefits.8 The effects of those differences will be offset in part by other factors that will tend to reduce premiums in the individual market; for example, purchasers in that market will tend to be healthier than they would have been under prior law, leading to lower average costs for their health care. Although premiums in the individual market will be higher on average, many people will end up paying less for health insurance—because the majority of enrollees purchasing coverage in that market will receive subsidies via the insurance exchanges.
Premiums for employment-based coverage obtained through large employers will be slightly lower than they would otherwise be; premiums for employment-based coverage obtained through small employers may be slightly higher or slightly lower.
Overall, this really IMO isn't that much different from what CBO had previously said about the House and or Senate PO's. Premiums in the exchange would be slightly higher because of it's greater coverage, while premiums outside the exchange would be slightly lower due to the competition of the Exchange themselves.
Is this final result because of the OPM Option or not? Well, I frankly don't know because the final CBO report doesn't even bring it up.
It's not even discussed.
So I went back again and found this Selection of Publications on the Health Care Legislation 2009-2010.
Members have also requested information about the effect of the legislation on health insurance premiums. On November 30, 2009, CBO released an analysis prepared by CBO and JCT of the expected impact on average premiums for health insurance in different markets of PPACA as originally proposed.11 Although CBO and JCT have not updated the estimates provided in that letter, the effects on premiums of the legislation as passed by the Senate and modified by the reconciliation proposal would probably be quite similar.
This shows that there wasn't an update after November 30th and the Hill Report is probably either bogus or simply wrong and that the impact on premiums with the original PPACA which included the Public Option and the Final PPACA that has the OPM Replacement Didn't Change That Much.
Which is exactly what I said originally. On the whole CBO confirms what I said, Kaiser Confirms what I said,even Heritage confirms it - on the Hill Report says what many progressive critics of the ACA claim and it seem to simply be wrong.
Now, if someone can confirm and verify that Hill Report and explain why Kaiser, multiple CBO reports and even the Heritage Foundation continue to claim that the OPM Replacement did NOT remove the downward premium pressure that the Public Option was slated to have - then I'm more than willing to admit I was wrong all along and will drop this issue for good.
Until then, I'm sticking with it.
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