I've been making this point for a couple of weeks. If you're going to argue that the free market knows best, and that government can't do anything right; then you can't turn around and claim that a public option would amount to a monopoly. It's one or the other.

Maybe we can call back those insurance CEO's and ask them again if they will agree to end recission policies.

Here's hoping the "centrists" in the Senate Democratic caucus were listening.

I wouldn't want to bet the ranch on that.

I believe it was David Jackson, from USA Today,

Now, this is the question I would have argued might have been a plant. But even so, it was the kind of question journalists are supposed to ask. The fact that Obama handled it well says far more about the substance of the debate than Obama's improv skills.

I think President Obama must watch The Daily Show; Jon Stewart has made this same point many times, and in a similar way. It really makes sense, and the public "gets it" sp why doesn't Congress? After all, they work for us, so must have our best interests at heart. Oh, wait...

This was perhaps my favorite part. He spelled it out so clearly and tactfully--what do they have to fear if they're doing such a bang up job and govt. can't do anything right? (Answer: a lot, because they're doing a lousy job and charging outrageous prices for the same).

Finally, he exposed the real question that must be asked in this debate.

Pay no attention to the man behind the curtain..

It's illogical to think the reactionaries will argue logically when their self-interest is at stake.

Almost as illogical as Conrad's "Clinton-Like" plan would do anything but go down in flames. And then we'll have to wait another 20 years before anyone really tries to fix the system

Canada has had experience with public entities competing against private- we call them "crown corporations" they are run like a business and are somewhat insulated from politics: for about 60 years Canadian National Railway (crown corporation) competed against Canadian Pacific, as far as I can make out it worked OK.

Nice to see him push back - intelligently - against the stupid 'there are two credible sides to every position' meme.

I thoroughly enjoyed the Obama's response.

Now that's funny.

He also mentioned the medicare advantage program where private insurers charge the government more money to do the same job as medicare (something like 12% more as I recall). It is actually even a bit worse than than that because the private insurers tailor their plans to do some cherry picking of healthier seniors (I think they cannot actually reject people, but they can set up co-pays, etc to attract the healthy and discourage the unhealthy).

Private insurers are quite confident they can't compete with government insurance because even with a subsidy and some ability to cherry pick they have only achieved 20% market share in medicare. Before the subsidy (which started soon after the republicans took over completely 8 years ago) private insurers had less than 5% market share for the ten or more years medicare advantage had existed.

Actually, I think that a public plan option wouldn't necessarily be such an obvious choice... private insurors COULD compete. The reason: let's assume, for a moment, that a public plan would have to be revenue nuetral, at least in the sense that it couldn't (and certainly shouldn't) cost the taxpayers any more than they are currently paying for indigent care via Medicaid. Furthermore, a public plan would, by definition, have to accept anyone regardless of pre-existing conditions, and would not have 'recission' power (i.e., the ability to shed customers with expensive illnesses by claiming that pre-existing conditions were not revealed at the time of the contract; an example of this is the woman being treated for breast cancer whose insuror dropped her because she failed to report a previous visit with a dermatologist for acne treatment).

With those constraints, private insurors would still have a possible leg up... and the fee for the public plan would have to reflect those extra costs (due to pre-existing condition coverage, and no recission power).

I STILL think the public plan option is a no-brainer... but let's face it, the opposition isn't concerned with health care quality or efficiency, they're concerned with profits. A new health care policy that requires everyone to obtain health insurance represents a 46 million person untapped pool of revenue... the health insurors want that business... but they certainly DON'T want to compete for it.

This highlights what I've been saying for months: Obama gets it. He's on our side. He's not stupid, and wants to push what we want pushed; not because he wants our support but because we're right. Liberalism works and if he wants to succeed, he needs to push liberal policies, because they work. But he can't do that alone. It has never been about forcing him to do the right thing, but about forcing Congressional Dems to give him the political cover he needs to do it.

And that's where we fit in. Bitching on messageboards about Obama not winning every battle singlehandedly is stupid and pointless. Our job is to make Congressional Dems understand that it's dangerous for them to cowardly sit on the sidelines. Obama's political fortunes rest on his ability to succeed and he knows it. But the fortunes of Congressional Dems rest on their ability to play it safe. Our job is to tie their fate into supporting Obama, making it dangerous for them to not give him the political cover he needs to push policies that work. We either hang together or we hang separately. Our job is to make Congress understand that.

exactly the point Paul Begala was making on Real Time on Fri. nite. totally contradictory arguments against health care reform, but the media are consistently too dumb to notice. and the Republicans are certainly too dumb to notice.

The is get this message amplified. Time and again I've seen Obama and his people make excellent arguments only to watch them die as the media does not report them and congressional democrats fail to pick them up and run with them.

Norm:
"With those constraints, private insurors would still have a possible leg up..."

Obama did specify that the pool, of which the public option would be a part, would have to have more regulation so that private plans could not so easily cherry pick.

However it seems unavoidable that they would be able to do some less explicit cherry picking, as they have under medicare advantage.

The Republicans (and to a lesser extent, the "centrist" Dems) supposedly believe that the free market can do anything better than the government can.

But the argument against the public plan has been, fundamentally, an argument against that position. I'd been waiting for someone to point out that fundamental tension. Instead, Obama very adroitly exploited it here.

Damn, he's good.

The best health care insurance I've ever had began when I turned 65, seven years ago, and went on Medicare. I choose my own docs, show my Medicare card to them, and it works like a charm. I also have a supplemental plan to cover the gaps which, added to what I pay for Medicare is still a bargain compared to an individual policy through private insurance companies.

Isn't Medkcare a single payer, public option system?

The insurance companies know this. Good for Obama calling them out today.

I was listening to NPR on my way home this afternoon and the discussion was healthcare.

According to NPR, the "battle" is between "the left" and Republicans. No mention of the public.

What do you bet Obama's defense of the public option is shit canned by the traditional media?

His argument is persuasive. In fact it is overwhelmingly persuasive. It leaves the insurance industry fuming. The corporate media can't allow the public to actually hear Obama's message, so his answer will be cut completely or at least heavily edited.

By the way 72% of Americans get the public option part of Obama's plan. Only the media monkeys and the Senate Blue Dogs pretend not to understand why the public option is necessary.

The best health care insurance I've ever had began when I turned 65, seven years ago, and went on Medicare. I choose my own docs, show my Medicare card to them, and it works like a charm. I also have a supplemental plan to cover the gaps which, added to what I pay for Medicare is still a bargain compared to an individual policy through private insurance companies.

Isn't Medicare a single payer, public option system?

The insurance companies know this. Good for Obama calling them out today.

A very quick response to any of the whiners who bemoan the public option: UPS/DHL/Fedex vs the postal service.

Not exactly the same parallels of course, but just a very quick example of how private and government-run operations can coexist.

Here's hoping the "centrists" in the Senate Democratic caucus were listening.

Unfortunately I think Nate Silver has shown who the "centrists" are listening to.

THANK YOU MR. PRESIDENT! For saying, loud and clear, what everying sensible person knows. If the government sucks so bad, the insurance companies have nothing to fear. In fact, they should welcome the public option, since it would prove once and for all that a public plan doesn't work.
Of course, watching Obama make fools of the rightwing corporate media hacks is just a bonus.

Indeed, it's been the underlying point all along that usually goes overlooked in media coverage.

The nonsensical nature of the Fear, Uncertainty and Doubt campaign in defense of the insurance industry in general has gone overlooked in media coverage. Obama didn't call their bluff, he called bullshit -- which, of course, hardly anyone in the so-called "liberal media" will do. But now they can't avoid talking about it.

Score one for Obama. Good for him.

If the private insurance companies would not hit people with pre existing conditions with riders and everything else they do to prevent coverage they would have nothing to fear from a public plan. If they would be happy with very good profits rather than the obscene ones they presently make they would not need to pull out all the stops to prevent the average citizen from getting GOOD coverage from a public plan. And if public plans were so bad why has Medicare worked so well for our seniors for the past 40 years?

In the UK, where we have national healthcare, there is also the ability to have a private healthcare policy, but not many people want it, the difference my friend who used private healthcare found was a fancier room, more choices of food, but same doctors, same care etc. Here in North Carolina, we have a senator who is going to try to block a public option - Kay Hagen, I hope people will call her office or email her, I am doing both, they keep telling me she has not made a decision, but she has, she has more interest in the health insurance/medical industries than you could shake a stick at, I am pestering her, please do it too. 4 or 5 buses are leaving NC tomorrow for Washington to state support for a public option!

The public option will also make it possible for the government to negotiate more reasonable prices for drugs. The push back against the public option is not just coming from private insurers but by the pharmaceutical industry as well. They represent a big chunk of the donations senators depend on. I believe that is why the anti-public option arguments are so incoherent. The senators know that they do not have an honest leg to stand on but need to defend the golden goose anyway.

How can you compete against a plan that doesn't have to make a profit, isn't required to have proven reserves like insurance companies do by state laws and if it gets in trouble can just tell the doctors and hospitals that we aren't going to pay. That's why you won't see any insurance companies in health insurance if a public option becomes available.

The issue is that political forces will intervene on the public plan. Voters will ask politicians to lower premiums and they will, via increased subsidies. It won't start that way, but it will end that way, because voters will demand it. Giving voters something expensive for no charge (i.e. expanding the deficit) is a guarenteed vote winner.

And that will be the death of the insurance industry.

What no one on this site seems to understand is that private insurers need to make profits; a public plan does not. President Obama seems to think that all private sector workers are in unions that collectively bargain their benefit plans, and thus the employer cannot make unilateral changes. Of course, the vast majority of American workers work in non-union enterprises; and if a public plan offers insurance without needing to make a profit you will see your employer choose the public, necesarily cheaper, option. It is just economics, but the President's argument is being swallowed because he is using poll-tested lingo.
Don't be fooled. The public option means you will likely lose the plan your employer provides. You may like this or not, but most Americans who have insurance like the insurance they have, as the polls show.

Here is an article, written in two parts, that needs wider exposure:

Myth-busting Canadian Health Care

Part 1

Part 2

Insurance companies have to raise their own capital and sell their own stock and turn a profit. I think that is a great model for the "public option." Let the government sell it's own stock for the "Public Option" and absolutely forbid the spending of one penny or public tax revenue and you get my unqualified support for a "public option." It is when you start tapping into tax dollars that everything goes crazy.

As to the gentleman who said the best health care of his life when he turned 65 and went on Medicare, you better watch out. President Obama has stated a number of times that Medicare, Medicade, Social Security, and VA benefits are bankrupting future and need to be overhauled.

Maybe the rallying cry needs to be to make Medicare, Social Security, Medicade, and VA benefits fully self supporting. If he does that first he will achieve my conservative support for other programs. I want to see at least one program fixed before we add more.

The issue is that political forces will intervene on the public plan.

You mean the way political forces have intervened on behalf of our lousy status quo since at least the 1990s?

Voters will ask politicians to lower premiums and they will, via increased subsidies. It won't start that way, but it will end that way, because voters will demand it.

Yet another successful Democratic program, popular with voters, proving the Democratic governing philosophy works and the Republicans', well, doesn't. Yup.

Giving voters something expensive for no charge (i.e. expanding the deficit) is a guarenteed vote winner.

Is that the new GOP blast-fax? Because I thought the word was "tax-and-spend liberal." We Democrats are perfectly fine with raising taxes -- which is, of course, what all this is about -- to pay for programs. Democrats weren't the ones trying to finance the Iraq War with a tax cut.

And that will be the death of the insurance industry.

Unlamented, I might add. Yet another bonus!

Bottom line: The only real risk here is another round of Grover Norquist-style tax cut jihad to run up the deficits. Again, P.J. O'Rourke identified the GOP back in the '80s as the party that insists government doesn't work, then gets elected and proves it.

Health care reform may well mean highter taxes -- which loyal Americans poll as willing to pay -- and yet another indictment of the failure of faith-based Republican ideology. Small wonder they're dead-set against it, but they might as well try to hold the tide back with a broom.

A Moron wrote: What no one on this site seems to understand is that private insurers need to make profits; a public plan does not.

To the contrary, we all know this: insurers' profit motive leads them to not deliver the services we pay them so much for.

President Obama seems to think that all private sector workers are in unions that collectively bargain their benefit plans, and thus the employer cannot make unilateral changes.

No, he doesn't. As he pointed out today, many employers will condinue to reduce benefits or drop health care althogether even -- or especially -- if no reform is passed.

Of course, the vast majority of American workers work in non-union enterprises; and if a public plan offers insurance without needing to make a profit you will see your employer choose the public, necesarily cheaper, option.

Good! Employers not needing to pay for cripplingly expensive health care will make American industries more competitive in the global marketplace, where other companies don't bear that burden.

It is just economics, but the President's argument is being swallowed because he is using poll-tested lingo.

Becuase the Republicans would never, say, have Frank Luntz issue a poll-tested guide to their Fear, Uncertainty and doubt campaign.

Don't be fooled.

We aren't fooled by Republican bullshit; but then, that's because we have any critical thinking facilities at all.

The public option means you will likely lose the plan your employer provides.

Again, many Americans are likely to lose that anyway. The public plan means we'd get something in return -- and as a commenter above noted, voters would demand it be at least as good.

You may like this or not, but most Americans who have insurance like the insurance they have, as the polls show.

Of course, that doesn't stop employers and insurance companies from changing those plans the minute it means saving a buck. So the real question, again, is whether the public optuion is as good or better than privatep lans. From the reaction of the status quo apologists, there seems to be a tacit assumption it will be -- that's just what Obama pointed out!

And that will be the death of the insurance industry. And your point is?

No industry has a right to exist if it can't provide a better service at a lower cost. No industry should be too important to fail.

The problem is there is nothing the health insurance industry does that can't be done better by the government, cheaper.

"Insurance companies have to raise their own capital and sell their own stock and turn a profit. I think that is a great model for the "public option.""

You do, do you? Have you been paying attention to the stock market lately? And, for that matter, have you even noticed that health care being a for-profit industry is precisely the problem?

"Let the government sell it's own stock for the "Public Option" and absolutely forbid the spending of one penny or public tax revenue and you get my unqualified support for a "public option." It is when you start tapping into tax dollars that everything goes crazy."

You're right. That's when it actually starts working, and that really is crazy here in the US. We're used to a system that is broken, and you conservatives are quite desperate to defend that inhuman status quo.

"As to the gentleman who said the best health care of his life when he turned 65 and went on Medicare, you better watch out. President Obama has stated a number of times that Medicare, Medicade, Social Security, and VA benefits are bankrupting future and need to be overhauled."

Of course, what Obama has always *actually* said is that the general cost of health care itself is what is leading the US to bankruptcy, but don't let context get in the way of your fear-mongering.

"Maybe the rallying cry needs to be to make Medicare, Social Security, Medicade, and VA benefits fully self supporting. If he does that first he will achieve my conservative support for other programs. I want to see at least one program fixed before we add more."

Your conservative support is irrelevant and unwanted. you conservatives are trying to defend a broken system and therefore deserve to be ignored. I do agree with your final sentence; these disparate medical care programs need to be fixed by taking them all and folding them into a larger single-payer system. It is unfortunate that the democrats don't have the spine to do this and are, instead, playing around with this public option idea which will only delay the inevitable. But, at least, it is a start.

The best thing, is that Obama came right out and said the explicit point about the contradiction. Lots of leaders wouldn't do that, and a certain crowd (not just the direct opposition, but Villagers etc. who want dancers and glad-handlers) despise Obama for it.

Curt says: How can you compete against a plan that doesn't have to make a profit, isn't required to have proven reserves like insurance companies do by state laws

Well, that's the point. Either the efficiencies of the free market can overcome the combination of these inherent governmental advantages and allegedly inherent governmental bureaucratic inefficiency, or they can't.

If they can, then the free-market believers are right, and the insurance companies will continue to prosper.

But if they can't, then you're demanding that citizens pay extra out of their own pockets to line the pockets of insurance industry execs and stockholders. That's rather outrageous, don't you think?

and if it gets in trouble can just tell the doctors and hospitals that we aren't going to pay.

And then doctors and hospitals wouldn't serve patients on the public plan, except under the same emergency circumstances that they'd serve uninsured patients today.

And everyone would want out of the public plan, and private insurers would prosper. The End.

That's why you won't see any insurance companies in health insurance if a public option becomes available.

Thanks for playing.

Why do I get the feeling that Curt, Real Real American, D Moran, and Mark G all have the same IP address?

[I thought so to, and checked, but no. One is a lackey for big pharma and the others work for insurance companies.]

You may like this or not, but most Americans who have insurance like the insurance they have, as the polls show.

You might not like this, but most Americans who have insurance don't really know how much it costs and since the don't use it all that frequently they don't start to hate it until they find out just how bad and tenuous their plan really is.

As an small business employer who has to "negotiate" with insurance people every year, I would love a plan that I could count on not to go up double digits every year. You know, it is funny, but right now, in the middle of the worst recession since the great depression, and during the fight for universal health care my plan went up about 4%. I have had to change providers to keep my costs under control.

D Moran is the only one on this site that gets it. If the public option passes, employers all over the country will pull out of private insurance plans and take the cheaper government option, whether we employees like it or not.

That's why Obama is lying when he says "if you're satisfied with your plan, you won't have to give it up." Most people get health insurance through their employer, who decides our insurance provider. The end result is putting the entire country on Medicare, which already cuts what doctors get paid by private insurance carriers.

So it's simple economics. You pay less for health care, you get less service and longer wait to see a physician. This has failed everywhere it's been tried, from old Europe to Canada.

The reason that it will drive out private insurance is that the government, via the taxpayer, can subsidize the cost for this "public insurance" and therefore make such insurance much cheaper than private insurance.

So public insurance may cost a person $100 per month but the actual cost is really $200 per month (see college tuition). That doesn't mean the public option is better or cheaper. It just means that taxpayers have to subsidize someone else's insurance.

In short, it's disingenous to argue that private insurance companies should be competing with a subsidized public insurance company. The taxpayers aren't subsidizing the private insurance company.

Oh to be a naive Liberal!

The president pointed out a supposed contradiction in the anti public option position and you all start orgasming. What private companies currently compete with Medicare or Medicaide? Are Medicare and Medicaide being run efficiently or are they expensive, bankrupting, and inefficient? Tell me there is a vibrant, non-monopoly, in the parts of the health care industry that are already government controlled and I will think about supporting a public option.

This public option will be the death of private insurance and anyone can see it. The government will simply take more tax dollars as the public insurance costs grow and grow like they do with Medicare already. A real private company has to balance their books, produce revenue, profit, and good quality service. An insurance option that has unlimited bank roll at the expense of American tax payers will win out in the not too distant future.

When the government is in control of the public health, its going to be ugly.

Could someone who knows him send Jake Tapper a note and tell him that health insurance is NOT required to be for profit? Huh?

What a stupid asshat.

Most people get health insurance through their employer, who decides our insurance provider. -Bear

Why should my employer be tasked with determining the best insurance option for ME to begin with? Why should I feel tethered to a job because of concerns about consistent health insurance for my children?

Think of how stupid that sounds for a minute. What if the brand of car insurance you used was dictated by your employer? Or home insurance? It sounds absurd and unacceptable.

Additionally, just because you're employer choose not to have a health insurance plan doesn't mean you can't still purchase health insurance from that provider.

You're the one who is lying by implying that. No, cutting the employer strings to health insurance will only improve the health insurance market by making it more competitive. The insurance companies would have to go after YOUR business, not your bosses, or some CEO, more realistically, who is heavily invested in them.

As someone above said, cutting this cord also makes our companies more competitive in the world economy.

If the public option passes, employers all over the country will pull out of private insurance plans and take the cheaper government option, whether we employees like it or not.

And then we get single player health care, which makes more sense anyway. Plus, as I said, employers won't have to compete on the global marketplace with the anvil of heatlth costs on their back. And, again, if the public option succeeds in competition it'll be because it provides equal service cheaper (and why not; government financed health care already has a lower overhead than privately funded).

I know the ominious implication of this FUD is that the public option will be worse, but there's no reason to believe that's true, and every reason not to. Seriously, what's not to like?

Why do I get the feeling that Curt, Real Real American, D Moran, and Mark G all have the same IP address?

Why do I get the feeling it'd be an insurance industry lobbyist's ?

Everyone is missing the point here. If a private insurance company looses money, they go out of business. If the government institutes a public plan, it needs to be paid for. That means a predetermined amount of money from tax revenues is necessary to keep its solvent. If the government miscalculates numbers, as they have done with Iraq war, unemployment, stimulus package, ect, then the program will be underfunded, and more money will need to be pumped in, taxes raised, ect. The real problem though is that this program CAN'T be shut down. The plug cannot be pulled on this if it doesnt go as planned. Or lets just say it WON'T. Not by any politican in our lifetime. There could be 100 million people on this plan. Then what? It will just continue to bleed money, and its unfunded liabilites will grow in the trillions. Hummmmm, this is sounding a bit like something else...i think its called medicare. Unfunded liability of 70 TRILLION dollars. A program that if not reformed will bankrupt our entire nation.

In short, it's disingenous to argue that private insurance companies should be competing with a subsidized public insurance company. The taxpayers aren't subsidizing the private insurance company.

Sure they are -- by treating, at public expense, those who don't have insurance, in many cases because private insurance companies won't take them.

I'll remind the forum, by the way, that spreading the risk around in a bigger pool is a cost-saving advantage of the public plan that wouldn't need taxes to subsidize.

Are Medicare and Medicaide being run efficiently

Yup -- much less overhead than private insurance, in fact. Thanks for asking.

You pay less for health care, you get less service and longer wait to see a physician. This has failed everywhere it's been tried, from old Europe to Canada.

No, it hasn't. That argument wasn't true in the '90s -- though it was repeated a lot -- and it isn't true now. And, of course, it completely fails to address the millions of people in this country with no health insurance at all.

Seriously, all you status quo shills, you're only proving our point -- insisting that private insurance can't compete is an argument in facor of the private plan. The fact that it won't need to make a profit is an argument in favor of the private plan.

And if your point is basically that you don't want to pay taxes for it, well, who needs you? The anti-tax jihadist party is about as popular as syphillis right now, and standing in the way of fixing our health care system will only make it more so.

A real private company has to balance their books, produce revenue, profit, and good quality service.

On the contrary -- insurance companies make their profit by not providing services.

The absence of a profit motive -- of not having health care denied by a corporate bureaucrat who has a financial incentive to deny it -- is a feature of the public option, not a bug, you blithering idiots.

"Yup -- much less overhead than private insurance, in fact. Thanks for asking. "

True. But 30% of medicare's budget is lost to fraud and waste. If you don't care about waste and have no bottom line to be accountable to, its amazing how little overhead you need! Accounting department? Why bother?!

The taxpayers aren't subsidizing the private insurance company.

No, we're subsidizing the entire healthcare industry, from federal loans to train medical professionals to funding rural clinics (and bribing debt-ridden new doctors to work in them) to attaching tax breaks to insurance premiums to funding cancer research to making sure those expensive-ass drugs are safe... as well as, yes, Medicare, Medicaid, SCHIP, the VHA, and the vast private-insurance rolls of government workers. All this so for-profit middlemen can get into the game and engineer ways to make massive profits by providing as little actual healthcare as possible.

By the way- in what Orwellian world is a government entity that has no limit on its budget, and no requirement to make a profit legitimate 'competition'?

How about this stipulation- the "public option" has to be solvent and can't draw on federal funding to keep printing money for them as they hemorrhage. They have to live or die on their premiums and their payouts, just like their real competition does. Any takers?

Moronic comments are coming in. These idiots justify the profits of the insurance companies. Why do these companies need to make money? Mostly to pay MILLIONS and MILLIONS and MILLIONS of dollars to FAT PIGS who run them. The FAT INSURANCE PIGS could slim down, and pay the workers, but they seem to want to WHINE, WHINE, WHINE.

I say let's cut the profits of these PIG CORPORATIONS, and see what happens. Well, the FAT PIG EXECUTIVES may try to keep their FAT PIG salaries, but then they will lose customers. Good.

Many of these corporations have already offshored, anyway. Why the hell should any of us care if a bunch of wetback Indian scabs loose their jobs?

But 30% of medicare's budget is lost to fraud and waste.

Which only says that Medicare and Medicaid should have more resources devoted to administration. It could easily do so and still be more efficient than private insurance.

And again, of course, the fact that private insurance has a predisposition not to pay claims is hardly an argument in its favor.

"Which only says that Medicare and Medicaid should have more resources devoted to administration"

Of course, nothing says 'desperately in need of a huger budget' like '30% waste and fraud'. Not to mention that the entire 'allure' of medicare being pointed to as an example is its LACK Of overhead. You take the 30% and apply it to administration and you lose that argument, and thats NOT more efficient than the private companies. If they are spending 30% on administration they are out of business (much less fraud and waste, has anyone heard of ANY private company that is a third fraud and waste? The pentagon would blush).

The government will simply take more tax dollars...

Because lord knows, our current healthcare 'system' is very stable, cost-wise.

No, I guess we should 'fess up and admit that we liberals want more than anything to make all Americans-- especially affluent white men with names like Bryan or Mark or Eric-- suffer horribly under a soulless, inefficient, nation-bankrupting healthcare bureaucracy. Truly, I can't think of any higher achievement than destroying this beautiful, efficient, fair healthcare system they've built out of the goodness of their angel-pure hearts.

------------------

Y'know, some days there's just not enough acid in the world to fuel the necessary sarcasm.

in what Orwellian world is a government entity that has no limit on its budget, and no requirement to make a profit legitimate 'competition'?

Because if the public plan produces an inferior product, as many of you status quo shills keep predicting, no one will use it.

Like Obama said -- the problem here is deep down y'all don't really believe your free-market rhetoric.

They have to live or die on their premiums and their payouts, just like their real competition does.

Bullshit. Private insurance profit isn't derived just from premiums and payouts, but also from investment of surplus capital in the stock market. How's that working out for them now?

And in what Orwellian world does the Federal government have no limit on its budget? Oh, wait, I know -- when Republicans are in charge. Tax and spend Democrats, remember?

Don't worry, though -- when the Democrats pass a successful public health plan, the GOP likely won't be in charge again for quite a long time.

Here's the thing, conservatives -- no one belives you're arguing in good faith, and we don't need your support. We'll just go about proving you wrong, like we usually do. And the fact that you may have to give up your sweet, sweet Republican tax cuts is just icing on the cake.

Of course, nothing says 'desperately in need of a huger budget' like '30% waste and fraud'.

Who said anything about a bigger budget? You can accomplish the task simply by shifting the allocation of existing resources, and still be more efficient than private insurance.

Of course, I already said that. Do try to keep up, will you?

Great piece. One of the more compelling defenses of the public option out there. For those interested, there is excellent opinion coverage from the other side at www.thedcwriteup.com. They've also got reporting from every senate hearing.

Car insurance and home insurance are cheaper than health insurance and life insurance. That's why you shop individually for the former, and let your employer shop for the latter. The system that's in place exists because it works. Most of the 47 million uninsured either choose not to be covered or are illegal aliens. The rest have an option and it's called Medicaid. If you don't like it, then the solution should be an individual tax credit to purchase coverage from a private carrier. That should be the end of it.

If you don't care about waste and have no bottom line to be accountable to, its amazing how little overhead you need! Accounting department? Why bother?!

We're talking about Halliburton here and cost-plus contracts, right? KBR and million-dollar toilet seats? AIG creating worthless derivatives to the tunes of trillions? Oh, Morgan Stanley and a dozen other banks that needed taxpayer money to regain solvency and then paid themselves historically large bonuses with it?

All of these private companies are fraught with waste and fraud equal to and worse than anything a government-run entity could produce. I can't decide if it's naive or cynical to try and pretend that corporations are run better than the government, particularly when they routinely screw taxpayers out of hundreds of billions.

"Because if the public plan produces an inferior product, as many of you status quo shills keep predicting, no one will use it."

They will have no choice when government skews the rules so most businesses are economically enticed into dumping coverage. I thought everyone gets to keep their coverage if they want? Apparently not.

"Like Obama said -- the problem here is deep down y'all don't really believe your free-market rhetoric."

What does free market and fake public 'company' that runs on infinite red ink have to do with each other?! Make the public option pay for itself or its nothing more giving away a product that other people are trying to sell... ie- impossible.

"Who said anything about a bigger budget? You can accomplish the task simply by shifting the allocation of existing resources, and still be more efficient than private insurance."
GREAT!!!

WHY HASNT ANYBODY DONE THAT IN 50 YEARS?!!!!

Fundamental misunderstanding of HC economics:

1. The reason why seniors in the Medicare program have the ability to see whom they wish, where they wish is b/c of private insurance. When a government program pays 70 cents on the dollar, it is up to the private sector to subsidize the government. If anyone on this board claims otherwise, you are mistaken. Senate Finance testimony, armed with data from the CBO, suggests the private sector subsidizes Medicare and Medicaid to the tune of $89B/yr.

2. HC Reform is comprised of two main provisions: cost reduction and expansion of coverage.

a. With respect to cost reduction, the issue in the US HC system resides with the gov't programs, namely Medicare & Medicaid. By 2017, liabilities will be greater than assets, and by 2034, the Medicare program will be bankrupt. Managed care controls 11M of the 44M Medicare beneficiaries. So tell me, what in any of these bills slows the cost curve in the Medicare and Medicaid programs? And let it be known, Medicare HMOs have shown a slower cost trend than traditional FFS Medicare over the past 10 years. If the $ allotted to private insurance declines, the rate of subsidization will decline as well. The private sector can not continue to subsidize these gov't programs.

b. With respect to the uninsured, the census bureau states that of the 46-47M people that are uninsured in this country, roughly 23% are truly uninsured; i.e., they can't afford the insurance. As such, even using an FEHBP rate, the cost of insuring these individuals would run $250-300B over 10 years; then why the $1T score card?

In conclusion, the proposals submitted thus far do little to nothing to affect the cost curve in the Medicare and Medicaid programs. Moreover, the math of insuring the uninsured simply does not add up. As such, we must ask ourselves, what else is in these bills? I suggest people take a look at what was discussed today at the HELP market-up - $8B for running trails, walking trails, community centers, playgrounds?

OPH, how dare you inject fact and reason? I mean... Haliburton? Morgan Stanley?!! Duh?!! THOSE are strong arguments. Just say Karl Rove and you win!

D Moran: What no one on this site seems to understand is that private insurers need to make profits; a public plan does not.

I, for one, don't think that health insurance should be for profit. Or even a business. An insurance company basically hopes to convince you that you will be sick and that it will cost a fortune. Then when you are sick they do everything they can to make sure you've given them more money than they are willing to pay for your care.

It's just like Vegas. The odds are always in favor of the house. It is always about profits. It is NEVER about healthcare.

The private insurer model provides great coverage to people who can afford it. Unfortunately illness, catastrophic or otherwise, have no prejudice.

Neither should our healthcare system.

They will have no choice when government skews the rules so most businesses are economically enticed into dumping coverage. I thought everyone gets to keep their coverage if they want?

But again, the government doesn't need to do anything at all; that's already happening under the free-market, private-insurance scheme.

And again, I pointed this fact out upthread. Do pay attention.

What does free market and fake public 'company' that runs on infinite red ink have to do with each other?!

They're both figments of your imagination? Health care isn't a free market in the first place.

It's clear by now that you're less about a good-faith argument than you are about venting faith-based free-market-conservative paranoia.

You and your Republican buddies can go right ahead. The rest of us have health care reform to pass.

This public option will be the death of private insurance and anyone can see it.

And that would be bad because ... ?

I mean, yes, it would throw claims adjusters out of work, but other than that, it's hard for me to see the health insurance companies going out of business as a bad thing. If auto insurance ran the same way we run health insurance, not only would your company fight tooth and nail not to pay your claim when you get into an accident, your auto insurance company would drop you entirely after the accident because you didn't tell them you got an oil change from Jiffy Lube and not your car's dealer.

Why is anyone worried about the insurance companies? They've been screwing us for decades. Private health insurance is offered in the UK, where the National health plan is already paid by taxes. I presume insurance companies are writing, and making profits on those policies. Our insurance companies will find a way to compete, or move on to insure something else. The terrible reality is that every American who is not independently wealthy is one accident, one serious disease, one lay-off away from financial ruin.

Interesting point: the four or five flooders arguing for the preservation of the non-free-market insurance monopoly work for big pharma or health insurance companies. Check out this comment up-thread:

http://www.washingtonmonthly.com/archives/individual/2009_06/018739.php#1524451

I think I'll leave this board b/c it is the rhetoric and heresy that leads to bad decisions; support your assertions with data and I'll listen.

FYI: The US HC system is roughly a $2.4T industry. The profit of the ~1,300 healthcare insurance companies is roughly 60 basis points of the pie; 60 basis points is less than 1%.

Not quite sure if anyone is involved in a business, but last time I checked, eliminating 60 basis points or $15B from a $2.4T marketplace does not get one much; in fact, $15B does not even buy one year of insuring the uninsured.

OPH, how dare you inject fact and reason? I mean... Haliburton? Morgan Stanley?!! Duh?!! THOSE are strong arguments. Just say Karl Rove and you win!

No, I win because you are making the very specific claim that corporations necessarily run better than government organizations and I am providing counterrexamples to show the largest corporations don't necessarily run any better, and rely on screwing the taxpayer to survive themselves.

You are leaping sideways and trying to grab onto the coattails of OPH because unlike your handwaving and mythmaking, OPH actually posted data, albeit without citations, and you thought that would strengthen your weak claim, upon which the core of your argument apparently rests.

The U.S. already spends a significantly higher portion of its GNP on health care than any country with a public run program. Efficient, it is not.

Of course, Obama metioned that a public plan funded by the taxpayer WOULD be unfair competition. Also, to those who love Medicare - paying below the rates doctors need to charge for medical services, like medicare does, would create just such a public plan that lives of the taxpayer. Forceful defence? I think not.

"$15B does not even buy one year of insuring the uninsured."

This discussion hasn't even broached the issue of government debt

WHY HASNT ANYBODY DONE THAT IN 50 YEARS?!!!!

Three letters...one is a vowel, and it repeats. AMA.

I spent my career in healthcare, and you don't want to know what I think. I know my ideas aren't going to happen because they are too fucking radical. Not this time anyway. But what I would do tomorrow is the sort of emergency action that will be taken in ten or twenty years when the system we have now collapses under it's own weight if we fuck it up this time.

Reform now or federalize later. Those are your fucking choices, whether you like it or not.

Of course the insurance fluffers are checking actuarial tables and saying "Maybe I'll be dead by then..."

I appreciate some of the pro-status quo commenters making some reasonable assertions, but here's the one for which none have an answer:
Why do single payer countries (France especially) have higher quality healthcare at a fraction of what the U.S. pays?

Anyone who has been denied their healthcare benefits from a for-profit corporation knows the answer to that.

And I believe that Pres. Obama has some experience with a situation like that.

This argument is falsely premised since the playing field would be far from level. Any company in any enterprise would be hard pressed to overcome a 20% or more "cost of goods sold" disparity. That's the minimum disparity that insurers would face with a public option. And that excludes any taxpayer subsidies. The disparity comes from the government paying below market rates to doctors and hospitals. Presently, Medicare & Medicaid pay 83% of what insurers pay - and few doctors and almost no hospitals can afford to not participate in those programs. Once the public plan starts paying these reimbursement rates, doctors and hospitals will need to make up their growing revenue shortfall from private insurers. This "cost of goods sold" disparity will be reflected in premium rates. Now add in other items that private but not public insurers incur (such as premium taxes, federal and state income taxes and the cost of capital) and the public plan will have an almost insurmountable price advantage. Most consumers will vote with their wallet and choose the public plan even if the private insurers provide better service. And that would set in motion a downward spiral for private insurers: the public reimbursement shortfall they will need to make up will increase, driving their premiums up and more people to the public plan. It won't be long before the health insurers will just drop out. Obama and other public plan advocates know this and are counting on the endgame to get them to full socialization of the largest sector of the economy.

There is no credible reason to deny a public option.
Only bought and bribed senators stand in the way for they have no other reason to justify denying a public option except for ...it will drive down the profits of private ins....which is exactly the reform needed.
Think how much more effective Medicare would be if Part-d were able to be negotiated with big pharm rather than subsidized by tax payers.

If the public option were so bad then why would HC ins. lobbyists pay so much and fight so hard to prevent it. It's the "not for profit" part they can't tolerate yet that is exactly what is needed. No real reform without it. I'll get the same treatment and wit time and choices if I'm covered by Blue cross or Medicare or the so called "public option"...it's all Ins.

"The U.S. already spends a significantly higher portion of its GNP on health care than any country with a public run program. Efficient, it is not."

Liberals can't grasp that Medicare is the reason we have dysfunctional and expensive health care. Washington floods the market with health care dollars at triple the rate of inflation yearly in Medicare benefits. Yet it shortchanges physicians what the market pays. On what planet does such an economic system work?

Health care outlays are crippling the ability of the market to function properly and putting us into mountains of debt at the same time. Whatever the solution to everyone's affordable cost and coverage is, the answer is less government intervention. Not more.

"Make the public option pay for itself or its nothing more giving away a product that other people are trying to sell... ie- impossible."

Uh, no, and you'd know this if you actually got out of your cubicle and did some research. My software company competes with many, many software authors out there that provide free, open-source equivalents to what we sell. Yet, somehow we're still in business and doing quite well. How ? We provide better service, better support, better quality, and better value. You insurance industry shills should check out these attributes some time, and you might learn how to run a business without jacking your customers with rate increases every year.

You jackasses are too stupid to see the writing on the wall: namely, screwing your customers over year after year doesn't engender a lot of good will. In fact, it tends to make your customers hate your guts. I know, because last year we had to drop full coverage for our company and go with only major medical coverage. The interesting part is the major medical coverage costs the same as the full coverage did 5 YEARS AGO, yet requires us to spend $2000 per person per year before *any* coverage kicks in. So, we're paying $600 a month for "just in case" insurance, i.e. one of us gets a very serious illness. Ever check out cancer insurance ? It's not $600 a month. So, where is all of the extra money going ? So far this year we've paid about $700 out of pocket for our health expenses. So, please tell me how all of this equates to the best possible deal for my business and my family ? I'm all ears.

Robert, who the hell knows what rates doctors really charge for services? I mean that in all seriousness. They are paid one thing by Medicaid, another by Medicare, a third by insurance company 1, a fourth by insurance company z ect....and they try to charge the uninsured a totally different and much greater amount all for the same services. Seriously, there is nothing particularly competitive about rates paid to doctors. It is more like the luck of the draw. I guess if doctors don't like Medicare rates they can decline Medicare patients. Some do, but most don't.

Anyway, the insurance industry is regulated by state governments already. There is nothing particularly free about the insurance market.

I love the trolls (troll) who has been working this thread. Good luck to you in the future. I sure hope you don't come down with cancer and are left to the tender mercies of some insurance company who rewards it employees who screw their "customers."

The insurance industry had 20 years to prove just how superior it is to the government. It has failed and failed miserably.

This is an absurd argument. Government doesn't have the same cost structure so they will be able to undercut private companies until they are the only ones standing. Once they achieve monopoly status, they will raise premiums and/or reduce service. If you don't believe me, just look at public education.

Tim,

How can you cite to public education given the rather large, rather successful number of private schools at all levels of education?

Whatever the solution to everyone's affordable cost and coverage is, the answer is less government intervention. Not more.

Because, again, the private sector has done such a bang-up job of providing affordable health care to all since 1993.

No sale.

If you don't believe me, just look at public education.

Which is run by 50 different states -- hardly a monopoly, even leaving aside Mike Lamb's point about successful private education.

Seriously, is this the best the status quo side can do? Get a bunch of insurance and pharma employees to spam the thread with taling points that were bullshit back in the '90s? Check it out, people: if Obama's plan winds up the end of private insurance, that's a feature, not a bug.

And given your piss-poor performance in this thread, I'd say throwing your lame asses out of work would be a nice bonus besides.

Jackasses.

"I sure hope you don't come down with cancer and are left to the tender mercies of some insurance company who rewards it employees who screw their "customers."

That's precisely why I don't want the federal government to be my insurance company.

Like Obama, the liberal bloggers love to denigrate the insurance companies for not covering people with pre-existing conditions and for denying claims. On the first point, if pre-ex were eliminated while coverage was voluntary, why would you buy coverage when you were healthy? Just wait until you are diagnosed with heart disease, cancer, etc. before buying your coverage. Imagine if homeowners coverage did that? The only buyers would be those whose house was burning. Pre-ex goes hand in hand with a voluntary market. If you make the coverage mandatory - and enforce it - then pre-ex can be eliminated. But stop calling insurers bad guys for doing what' right in a voluntary market.

As for claim denials, aren't you aware that Medicare and Medicaid deny claims? And that they get sued for their decisions? For example, denying continued home health care coverage for a patient who needs the support but who Medicare says is not improving sufficiently? Don't you think that a public option will deny claims - sometimes wrongly? And please don't tell me that the lack of a profit motive will protect the consumers. Consider the cases of abusive prosecution in our non-profit judicial system. The point is that claim decisions must be made and some percentage of them will be deemed to be unfair - whether rendered by a public or private insurer.

Private insurers take, on average, 13% of premium dollars for overhead and profit. Overhead/profits are even higher, about 30%, in big managed care plans like U.S. Healthcare. In contrast, overhead consumes less than 2% of funds in the fee-for-service Medicare program, and less than 1% in Canada’s program.

Blue Cross in Massachusetts employs more people to administer coverage for about 2.5 million New Englanders than are employed in all of Canada to administer single payer coverage for 27 million Canadians. In Massachusetts, hospitals spend 25.5% of their revenues on billing and administration.The average Canadian hospital spends less than half as much, because the single payer system obviates the need to determine patient eligibility for services, obtain prior approval, attribute costs and charges to individual patients, and battle with insurers over care and payment.

Physicians in the U.S. face massive bureaucratic costs. The average office-based American doctor employs 1.5 clerical and managerial staff, spends 44% of gross income on overhead, and devotes 134 hours of his/her own time annually to billing2. Canadian physicians employ 0.7 clerical/administrative staff, spend 34% of their gross income for overhead, and trivial amounts of time on billing2 (there’s a single half page form for all patients, or a simple electronic system).

According to U.S. Congress’ General Accounting Office, administrative savings from a single payer reform would total about 10% of overall health spending. These administrative savings, about $100 billion annually, are enough to cover all of the uninsured, and virtually eliminate co-payments, deductibles and exclusions for those who now have inadequate plans - without any increase in total health spending.

Source: Physicians for a National Health Program

Mmmm, tasty free-market efficiency. And we haven't even gotten to the topic of how for-profit managed care systems are becoming wildly more expensive while at the same time denying more and more care and delisting physicians who provide "too much" care.

"I sure hope you don't come down with cancer and are left to the tender mercies of some insurance company who rewards it employees who screw their "customers."

That's precisely why I don't want the federal government to be my insurance company.
Posted by: Bear on June 23, 2009 at 9:12 PM

Let me see if I understand, the government rewards it's employees with bonuses for denying coverage to a constituent or for figuring out bullshit ways to shed itself of responsibility to pay for an illness. And exactly what elected politician would condone screwing a constituent?

Protecting constituents is exactly why we have a democracy.

Insurance companies have a built in incentive to screw their customers. Except for making state regulators happy they have ho reason to take care of someone they can dump.

Medicare is not a revenue neutral program. This new public plan will also never be revenue nuetral. Could either of these programs have success if the could only operate on the monthly fees? Medicare faces an unfunded mandate of nearly 80 trillion dollars.

How many Americans will still support this plan when they find out their private doctor is not taking patients in the public plan as many are now doing with Medicare and most already are doing with Medicade?

I agree that there should be an effort to cover all Americans with serious desease, accident, or illness. But the approach to offering a public plan looks more like forcing a soup kitchen to provide 12 course gourmet meals. Why does every medical plan have to include full coverage of everything from Viagra pills to Breast implants?

noc, to keep my costs down my business has just had to change networks for the third time in 4 years. Just exactly how should my employees feel about changing docs year after year. Please make arguments that are more difficult to counter.

By the way the reason this argument isn't working this time is most people have had to face a network change several times since the Clinton era. People are wising up to the bullshit propaganda. The industry should have done a lot of things over the last 17 years to make this trip unnecessary. Why didn't they?

Oh, I know. They were obligated to increase their profit margins year after year which meant they had no money to fund actual changes that might lead to real efficiency. Anyway the current "system" is designed to be inefficient. More inefficiency, more employees, more employees, more big ticket insurance executives.

noc, as to your last argument, I don't know what the public option plan is going to look like. Neither do you. Right now the industry is fighting tooth and nail to deny 50 million people any coverage at all.

Ron, So where then is the great cost savings in the Medicare program? Why are doctors leaving or not taking more patients in Medicare? What makes you think that the new public plan will not follow the same exact course we have already witnessed in Medicare?

"And exactly what elected politician would condone screwing a constituent? Protecting constituents is exactly why we have a democracy."

Are you really that clueless about the gulf between what politicians promise and what they deliver?

noc, I am the decision maker in my company. I buy the best insurance I can afford for my employees, but unlike Congressmen and Insurance Executives I use the same plan I provide for all of my employees. Personally, I am counting the days until I am 65 because Medicare combined with a little optional insurance will provide me with the best insurance I have been able to buy since the 1990s.

I have an older workforce. I guess you might argue that I really should replace all those older workers with cheaper youngsters, but like a lot of small businessmen I am not going to lay them off unless I have absolutely no choice. I will go out with them. They are my friends, they have stood by me all these years, and I intend to stand by them. Anyway. they work harder than most young people I know.

As to the Medicare cost savings, there is a program called Medicare Plus that is run by the insurance industry. It is supposed to be the proof of concept for the idea that private industry is able to do the job cheaper than government. It charges something between 20% and 30% more than regular Medicare for the same benefits. It has turned into an insurance industry welfare program--a real Republican sacred cow. If the insurance industry was actually able to compete head to head with Medicare the industry wouldn't be begging for Medicare Plus subsidies year after year.

Are you really that clueless about the gulf between what politicians promise and what they deliver?
Posted by: Bear on June 23, 2009 at 10:01 PM

Obviously not nearly as clueless as you are about what unelected insurance executives promise customers and what they deliver. Friend if you have a problem with democracy, get involved. Otherwise move to Iran. I understand they aren't burdened with a democracy there right now.

I agree with the notion of having a public plan to compete with the private plans. Given a level playing field, the public plan will experience shortages of doctors, nurses, medical equipment, drugs and other resources. The public plan needs to be subject to the same legal actions as private plans. Also, the $1.6 trillion that it will cost over the 10 years should be paid for by those who use the public options. After all, we are talking about a public plan to compete with the public option. So it is simple. For those 50,000,000 people without insurance, they need to pay $3200 to get the plan moving and then they will need to pay for the treatment options that the public plan will allow.

George, I like the sarcastic approach but what is your alternative for those 50,000,000 people. The industry will tell you that they elect not to have insurance, but that is bullshit. Most of them would love to have insurance they just can't afford or qualify for a private plan.

As to legal liability, if you understand anything about ERISA you know that is a giant red herring. Of course Obama has offered to look at it.

This time son, just saying no isn't going to get the job done.

By the way, where do you come up with your numbers? The CATO Institute or some other right wing propaganda tank?

Sorry guy(s), but I have to move on. Got to work tomorrow. You might try another website until the end of your shift.

ERISA= Every Rotten Idea Since Adam

maybe it's been raised already, but having gone on a recent series of trips to various parts of the health care system to accompany my gf (who btw has a good plan and is a doctor) i couldnt help but notice that there are currently long lines and waiting lists. the whole meme of long lines and waiting lists if there was govt health care is a joke. govt health care will be no worse then the current system (the doctors arent being changed just the middlemen) but could be cheaper.

furthermore, how can anyone argue both in favor of a free market system and the employer based model? the employer based model is what makes the market not work since the average consumer is removed from the full cost of their coverage and is not personally involved with the choice of insurers.

Ron,

I was not being sarcastic. If you truly want a public option to compete with the private option, then people using the public option have to pay for the public option. Now, my numbers come from no place other than the Congressional Budget office, $1.6 trillion. The 50,000,000 is the number of uninsured today. Hence, the cost if getting the system in place is $3,200 each and I will add over the next ten years. That per person cost could actually be higher. It could be lowered by additional people buying into the system

And since you brought up ERISA, you make my point. Plans by government entities are not subject to ERISA regulations. To truly compete, they do need to be subject to these regulations.

"George, I like the sarcastic approach but what is your alternative for those 50,000,000 people. The industry will tell you that they elect not to have insurance, but that is bullshit"

Is it? Why then is the current proposal to offer subsidies for those earning 4-5 times the poverty rate? That is $80-100k a year. For those who can't afford we have Medicaid. The simple solution is to expand that slightly and use a mandate for the rest. Require the insurance companies remove pre-existing conditions as a trade-off for universal coverage. In other words something much closer to the 2008 HRC plan. I would love to see a CBO estimate of how much that would save compared to the current $1.6 trillion price tag.

The House bill has a public option which is entirely funded by premiums and NO federal monies.

The House bill also expands Medicaid and apparently that complicates things a bit for states. They might not be able to afford their part.

The bill also might require language which would guarantee that the gov't public option is limited so as to NOT compete too much with private insurers.

Of course, funding is going to have to be worked out and that takes some time.

I think that in the end it's a sound foundation for the Senate to work with. It's pretty complete, which the Senate version isn't, it hits all the right issues (except funding) and with the employer mandate shouldn't scare away pro-insurance senators.

Some changes the Senate will want to make could be classified as tweaks, but there are a couple which should take a bit more time to get right.

If the Senate takes up the House bill I would expect they could get it done in 3 to 4 weeks, certainly before the August recess.

The quicker they get to it the sooner they could finish. The House members who wrote it should also be available to Senate members who want help with the bill's details without having to scour the bill themselves.

Beauregard said: "furthermore, how can anyone argue both in favor of a free market system and the employer based model? the employer based model is what makes the market not work since the average consumer is removed from the full cost of their coverage and is not personally involved with the choice of insurers."

Actually, that is a good point. My employer offers a couple of plans. One is a typical HMO plan. That is very costly. The other is a high-deductible plan which has zero-cost to me. Also, they contribute to an HSA and the employee can contribute too. I have selected the second options. I have more control over my health care spending than I would otherwise have with the HMO plan. Also, dollars accumulate in the HSA. I wish I had such an option 30 years ago when I started working

trex: I would check the source data on the assertions made by the physicians. Note the clear majority of the "big insurance companies" are all publically-traded, with net margins of roughly 4-6%. Not quite sure how they get to 30%+?

With respect to the public plan, I only ask a few questions: Anyone run a business here? Anyone understand the concept of cost of capital? If company X has a cost of capital of 10%, while its competitor has a cost of capital approaching 0%, who wins? Enough said.

Lastly, one must contemplate the unintended consequences of a mix shift from private insurance to public insurance on the provider community, including docs, hospitals, SNFs, etc. If a large % of the US population moves into a public plan, the provider community will be decimated. On average, hospitals generate 40% of their revenues from private insurance, which pay 30% higher than a gov't program. As such, if 50% of the 40% goes the way of a public plan at a rate that is 30% less (although the costs to the provider are the same), we are talking about a 15% reimbursement cut. Ever think about those consequences?

Lastly, unlike many on this Board, I will offer my solutions:

1. Take HC out of the employers' hands, and put into the hands of the employee. Continue with the tax deduction, but phase it out over 10 yrs, such that at yr 10, only plans costing more than $12,500 for a family of four, or $3,500/individual will be taxed on the overage. Advantage is employees now have skin in the game, which will engender greater price transparency throughout the supply chain and less HC consumption.

2. Put all insurance bidding online. Eliminate the brokers. Instant 2-3% savings to the industry. Similar to buying stocks online vs. through a broker; those that want a broker will have to pay up.

3. Means test for Medicare. Those wealthy enough should not rely on the gov't for their HC. Since these individuals paid into Medicare, lower their tax bill each yr by their annual Medicare contribution.

4. Manage Medicare + Medicaid, eliminating the FFS system. Create economies of scale through network-based plans. Design plans that force care into lower cost settings; no one should use the ER for an ear ache.

5. Reward good behavior via lower premiums. Those that engage in risky behavior (smoking, alcohol, obesity) should pay more. Why do bad drivers have to pay more for car insurance but not health insurance?

6. Trim Medicaid and Medicare benefits on the pharmaceutical side - mandate a generics first program. Step therapy in each therapeutic class.

MarkH: The House bill has not been scored by CBO last time I checked. The Senate HELP bill while scored did not include the public option b/c the cmte did not provide CBO with enough data. In fact, the CBO sent a letter to the Senate cmte members asking a whole host of questions; it is online at the CBO site.

Once again, the public option debate comes down to 2 things: cost of capital and reimbursement rates. None of us know the cost of capital b/c politicians have thus far not given us enough information to make that determination. With respect to reimbursement rates, anything that pays rates on par with Medicare simply compounds the subsidization problem. See my prior posts. Pay market rates, and operate on a level playing field (similar cost of capital) makes you wonder, what is 1,301 vs. 1,300 insurance companies going to accomplish?

Lastly, I suggest readers take a look at the Wyden (D) / Bennett (R) bill, as well as the Coburn bill. Both bills are much, much better than anything we've seen debated in the House Tri-Cmte or the Senate HELP cmte and yet since they are not far, far left they receive no consideration from liberal democrats - despite being a bi-partisan bill.

"I think there can be some legitimate concerns on the part of private insurers that if any public plan is simply being subsidized by taxpayers endlessly that over time they can't compete with the government just printing money."

This is exactly the problem with the public option. Student loans are a much less politically charged issue than health care, but after the recent college affordability act, graduates are guaranteed to never pay more than 15% of their income towards student loans and to never pay on their student loans for more than 25 years (the IBR option). In essence, the government is subsidizing student loans. Does anyone seriously doubt the government will do the same with health care?

Wow how naive are the bulk of the comments.

Does anyone think that a public plan would compete equally with a private company.

It will be subsidized, and If Obama sticks to his word and somehow manages to control the spending now, the next joker will unleash it .

The public option will absolutely crowd out private plans over time.

It's amazing how disingenuous Obama's line of reasoning, is. As if the government would ever compete on a fair basis. It never has.

If the governments plan has low subscription they will claim it is not affordable and lower the rates. Government is not bound by costs, or market forces. Any high schooler with a semester of economics would see past this charade.

Are we going to get the same level of spectacular service that is provide by the VA, or if Medicare is so wonderful why are most private doctors moving to not accept Medicare and Medicaid patients.

The real danger in what Obama and gang are proposing is not the added cost to the taxpayers but the potential of crippling the medical innovation that takes place in this market precisely because Americans are willing to pay for it.
Once that profit motive is gone, our healthcare will truly suffer and unfortunately for us there are no other attractive markets for medical companies in the world. Right now the U.S. is carrying the world in medical innovation particularly in Bio technology, pharmaceuticals, and cancer research.

"The public option will absolutely crowd out private plans over time."

As others have said above, that is a feature and not a bug. Private insurance industries are leaches that are letting people die for the sake of their bottom line. Crowding them out is a good thing.

"Are we going to get the same level of spectacular service that is provide by the VA"

One would hope so, as the VA is widely regarded as the best health care program in all the US.

"if Medicare is so wonderful why are most private doctors moving to not accept Medicare and Medicaid patients."

Blatant lie. There is no shortage of doctors who are perfectly happy to take Medic* patients.

"The real danger in what Obama and gang are proposing is not the added cost to the taxpayers but the potential of crippling the medical innovation that takes place in this market precisely because Americans are willing to pay for it."

Another blatant lie. Medical innovation is all coming from publicly funded university programs, mainly in Canada and Europe. Private companies, particularly in the US and particularly big pharma, are merely working on the next iteration of whatever they sell now, not on anything innovative.

Right now the U.S. is carrying the world in medical innovation particularly in Bio technology, pharmaceuticals, and cancer research.

False. According to the Council for American Medical Innovation -- who should know, as they advocate for more innovation -- the U.S. is currently outranked by Singapore, Luxembourg,
Denmark, South Korea, and Sweden, who ranks first in the world. These countries have aggressive GOVERNMENT funded programs.

The VA, by the way, has among the best quality of care of any health care provider.

When all of your objections are twenty years old, your analysis and solutions are going to be just as stale.

This whole debate is an exercise in futility for both sides. As long as there is a fundamental disagreement over whether health care is a right or a privelege, then public option will ALWAYS lead to intense debates like this because it strikes at the core of people's belief on this right vs. privelige issue, no matter which side you're on.

Therefore, we have the ballot box, and the latest round in that fight certainly belongs to the Left.

Having said that, I'll plant myself on the neanderthal side of things for a couple of reasons:

1) I find it ironic that the "greed" that produced many innovations in medical practice, surgical procedures, and pharmaceuticals has (despite its flaws) impacted so many lives all over the globe that we can take it for granted that everyone should now get it for "free," and many countries have moved in that direction.

2) I don't quite understand the comparisons using other Government / Private marketplaces. For example, while the Post Office is in the same industry (package delivery) as FedEx & UPS, there really isn't that much overlap. I don't kow the ins & outs, but my perception is that UPS still "owns" the large package delivery market, while FedEx owns the overnight market. I don't sense that the USPS really competes much in those two segments, which is probably why I see FedEx & UPS drop boxes in post offices. I'm sure this "peaceful coexistence" would change if the government started using Air Force airlifters to help the Post Office offer a "Public Option" to assist those who simply can't afford FedEx.

Bedtime.

"False. According to the Council for American Medical Innovation -- who should know, as they advocate for more innovation -- the U.S. is currently outranked by Singapore, Luxembourg,
Denmark, South Korea, and Sweden, who ranks first in the world. These countries have aggressive GOVERNMENT funded programs"

I enjoyed their website, especially the following:

"Policies that incentivize private sector R&D risk-taking"

"Foster a legal and regulatory environment that protects intellectual property." (such as drugs)

"Expand appropriate tax policies to ensure that medical innovation industries continue to innovate in America."

"Ensure the strength of strong capital markets which are crucial for small companies to gain access to financing for continued innovation."

"Support regulatory reforms that can improve the process of developing and approving of safe and effective drugs, biologics, medical devices and diagnostics."

Also, I like the snippets from the "Committed Council Partners":

"National Venture Capital Association"

"Pharmaceutical Research & Manufacturers of America (PhRMA)"

The problem seems to be that no one, including Dear Leader Obama, is defining what 'compete' means. As far as quality goes, i don't think there's much doubt that the private sector delivers. As far as how much coverage can be provided, the government, with the ability to make laws and tax people, will always win. it isn't a matter of people choosing govt health care because it is better, but because employers will be forced to do so, a la pay-or-play.

Well it's nice to know that the POTUS is NOT an "advocate of the free market." Anyway, the fact of the matter is that in the beginning the federal option will be generous with benefits and low on costs. That's how government programs always start out. Then, over time, as more employers dump their employees' coverage so they can avail themselves of the cheap government plan, the costs will explode and rationing will occur. It is inevitable. And the socialist lefties will start complaining but, by then, it will be too late...

In response to some of our new found conservative friends:

1. The main issue in regards to health care right now is cost. The numbers on comparative health care spending to health care outcomes are obscene. An individual making a decent amount of money ($50k) cannot afford coverage on their own. This has led to a high percentage of people without coverage. Furthermore the traditional model we have of employer based health care when combined with the high cost of health care has put our businesses at a major financial disadvantage vis a vis international competitors and limits small business formation.

2. The primary cause of the high costs is a lack of competition. with a secondary cause being a reverse free rider problem in which we are individually subsidizing (and not even getting any pr credit like we do somewhat through foreign aid) the health care costs of the rest of the first world (through higher drug prices).

3. The two best ways of controlling those costs are either a) complete elimination of the employer based model or b) single payer. by eliminating the employer based model we would be putting consumer decisions back in the hands of consumers who currently do not feel the full impact of costs and are unable to freely shop the market. but let's be honest, the elimination of the employer based model through the full taxation of health care benefits is political suicide. the second best option is single payer which would have the govt take everything over and control costs through the power of the government and by having a single pool of consumers. this has been deemed untenable by congress.

3. thus we are left in a situation in which the two best solutions to the cost problem aren't even being discussed. the compromise solution is to inject a public option (available to all) into the current system. since the public option would not have the profit motive that private insurance does it will have an automatic competitive advantage on cost. presumably private insurance would have a competitive advantage on quality. this would inject some competition into the system and reduce costs in the long run by forcing private insurance to either reduce costs or improve services. it is a sound compromise and is actually the free market solution (in the absence of the complete elimination of the employer based system).

if the market is not currently free and the private insurers do not have the competitive pressure to keep costs reasonable there is nothing wrong (and it would be beneficial) with adding another competitor (in the form of the govt) into the system. we literally dont have any other options (if you admit that full taxation of employer benefits is a non-starter and and that congress is unwilling to talk single payer).

Ok, I've had it both ways - for profit health insurance, and goverment regulated.
When the economy went kerplunk last time, I was laid off and unemployed for years. As a single parent, I qualified (thank God) for Medicaid, known as Mass Health here. I went to the same doctors as ever, had referrals to anything and everything I needed, including biopsies for breast cancer, mamograms, you name it. Now that I'm employed, I pay over $500/month for LESSER coverage. I have co-pays every time I turn around, I have trouble getting referrals accepted by my insurance company and I spend an amazing amount of time on the phone arguing with the insurance co. to get bills paid. My doctor's office spends an amazing amount of time on the phone trying to get bills paid. I took one of my daughters to a specialist, with a referral in place, and it took over a year of phone calls to get the bill paid. It sure seemed to me that the insurance co. was hoping that I'd just get tired and give in and pay it myself.
To all those who like to spout about how most Americans don't want to change - I'd go back to Mass Health in a nanosecond if I had the choice. That's the choice I want.
And lastly, for all of those who like to spout about "rationed" health care - try being a female and getting an annual exam scheduled. You're lucky if you can be seen in less than 4 months and woe to you if you need to reschedule. Try getting an appointment for your kid with an ear infection. You're looking at 6 weeks if all the stars are aligned on your side. If that doesn't count as long waits for care, what does?

"Medicare faces an unfunded mandate of nearly 80 trillion dollars."

Hah ! The number just keeps growing every time it gets repeated. Is there a blue ox anywhere in this story ?

"Well it's nice to know that the POTUS is NOT an "advocate of the free market."

I could only wish. You extremist American-hating right wingers keep whining that he's a socialist, when he isn't even a liberal.

"Anyway, the fact of the matter"

When liars like you start talking about facts, it is safe to ignore all that follows.

"the costs will explode and rationing will occur. It is inevitable."

Gee, that's what's happening right now, under your oh-so vaunted "free market" (i.e. restricted monopolistic) system. Interesting that you extremist American-haters never address that problem.