Thursday, June 04, 2009

Rose Ann DeMoro is God


Steve Bates said...

Could we list Sanders as at least an archangel? :)

hipparchia said...

yes, we can!

furthermore, i have.

Mahakal / महाकाल said...

What's your objection to the open enrollment public plan option, leaving people free to keep their current coverage if they have it?

Steve Bates said...

Mahakal, my explanation may differ from how hipparchia would frame it, but here's the short version: as long as private insurers exist in the marketplace in competition with one or more publicly funded plans, they (the private insurers) will do everything possible to privatize their profits and socialize their losses... in other words, they will attempt to select people (or have them self-select) who are healthier and therefore less expensive (more profitable) to insure. This will burden the public plans with a great majority of people who need a lot of medical care, which in turn will remove the strongest motivation for having public plans in the first place. As I see it, it's pretty much single-payer all the way, or no advantage at all. YMMV.

Mahakal / महाकाल said...

Steve, I understand this point but it is the current state of affairs except that right now the unprofitable patients lose coverage and cannot get it, unless they qualify for Medicaid. Having the public plan option means nobody has to go without health care. Obviously it's a half of a loaf from the single payer perspective, but it's not nothing.

As a political matter I don't see people being willing to lose current coverage that they are satisfied with (and some people are), for a government run system that may or may not provide them with the coverage they are used to. Even if the care is as good or better it will be easy to stir up fear and confusion.

Plus if we have the public plan we can let the private insurers cover only things the public plan doesn't, and pass through the rest. That would seem to be a win-win, but I'd be interested in hearing objections.

hipparchia said...

Plus if we have the public plan we can let the private insurers cover only things the public plan doesn't

that's how canada does it, and how hr 676 is written.

under a national health insurance plan, everybody would have the same coverage for whatever is medically necessary, paid for with taxes, and would be free to buy extra coverage in the marketplace, but buying or selling private insurance for whatever the govt insurance covers is illegal.

in canada, employers often offer this supplemental coverage as a benefit to attract employees, but in general, since so much is already covered under the govt plan, the cost of supplemental insurance is affordable even if your employer doesn't pay for it. it's my understanding that this happens in france too, with employers sometimes footing the bill for extra insurance to attract and keep employees.

to answer your first question, steve is correct. plus, if congress basically designs a bad bill [example: romneycare in massachusetts], i don't trust obama to veto it. i think he'd sign it anyway, because like managed care in the 90s [and the above-referenced mass plan], it would work ok for the first couple of years or so, but then the bloodsucking leeches would ratchet up costs, or deny care, or whatever, to keep their profits flowing.

i would go along with having a public option and letting people keep their present insurance if two things happen:

- we start collecting enough taxes from day one to pay for medicare for everybody [yes, you would have to pay the full taxes even if you elected to keep your private insurance], and

- we set a time limit on how long that would go on, say two years [maybe up to five], before it becomes illegal to buy or sell private insurance for anything that the govt insurance covers.

i've got some other objections, too.

one: everybody is proposing putting as many poor people into medicaid as possible, where the care can be pretty stingy, depending on the state you live in, first off, but it would still be a boondoggle for private insurance. check out the growth of managed care [private ins] in medicaid over the years.

amerigroup is just one of them. they spend about 84% of premiums on patients' health care, which sounds pretty good until you learn that regular medicaid spends about 93% of premiums on patients and regular medicare spends about 97% of its money on patients [the rest goes to overhead, mostly administrative costs for medicae and medicaid, but for private insurance the 'rest' includes payments to shareholders, big ceo salaries, profits, etc].

nor will people necessarily tell you [or congress] any of this. and reinhardt is one of the good guys. sigh...

Mahakal / महाकाल said...

i would go along with having a public option and letting people keep their present insurance if two things happen:

I don't think that those two things are politically realistic in the current environment. Does this mean you would oppose the public option plan?

It seems to me we can get everyone covered and make temporary compromises with the expectation that we will be able to come back and improve it in the future, as long as there is an open enrollment public option now.

Mahakal / महाकाल said...

Oh, by the way so you don't think I'm ytrying to pick an argument, I think it's good that people are advocating the single payer model, and it deserves a seat at the table even if it won't pass, because it improves our ability to get the public plan by showing that this is in fact a compromise position.

Without the public plan, I would personally oppose health care reform that tried to tinker around the edges of regulating the present insurance system, as being pointless and incapable of solving the problems we face even in the short run.

hipparchia said...

Does this mean you would oppose the public option plan?

yes, right now i am actively opposing the public plan option. i call, write, fax, email senators and congresscritters, to tell them i want hr 676 and nothing less. i talk to friends and neighbors. i go to the ofa meetings if i can and talk to them about single payer. i comment on blogs, even the right wing blogs. i write letters to the editors of various publications.

the politicians are basically asking me to support something they haven't even come up with yet, even with all their secret meetings. even the best options that observers have suggested so far that might come out of all this are crappy.

i don't like it, but i'd go along with bernie sanders' idea that we spend the money on expanding free clinics now and wait till next year, or the next congress, or if we have to, the next president and go for single payer.

Mike Goldman said...

Oh that idea of just expanding free clinics and punting is terrible. HR676 has almost no chance of passage, you must know. Still, it's fine to advocate for what you want.

I am now using my given name.

hipparchia said...

oh yes, spending all the money on giving free care to actual people would be just terrible. far better we give it to fatcat ceos of insurance companies and hospital conglomerates and drug and device manufacturers so that they then turn around and give it to fatcat lobbyists to give to fatcat politicians.

yes, it's an uphill climb. once upon a time, though, people actually resisted when the govt tried to impose crappy policies on them.

names. you've got more courage than i do. good on ya.

Mike Goldman said...

I didn't say it would be bad to give more money to free clinics, but that isn't a sufficient solution to our health care crisis. Punting isn't a sufficient solution. You don't think a public option is a sufficient solution. You may be right, but a public option is not what the "fatcat ceos of insurance companies" want.

I respect you won't give an inch from what you want, and it helps us get a better plan because we have people willing to stand up for stronger measures.