nancy's full conference support sounds good...
despite the delay such a normal process entails...
more possibility for sanity, perhaps. more time for the progressives to expose failures and beat the drum for changes...

Policy making in the Era of the Kooks

Pelosi: There certainly is a great deal of appeal about putting people 55 and older on Medicare. That's something that people in the House have advocated for for years.

The kooks hate the phrase public option.
The kooks have a harder time hating Medicare extension.

The moral of the story?
Framing is everything in the Era of the Kooks

No public option is absolutely OK by me IF and only if there is a real, no-bullshit, non-Conradized Medicare buy-in option from age 55. Progressives should not accept less.

I agree on the need for a full conference. This proposal needs a lot more massaging in our direction.

I'm sorry, but lowering Medicare age eligibility without some revenue countermeasures seems like a big gift to the insurance industry. By removing from their expense statements a class of individuals which by definition requires more costly healthcare, it's an instant profit generator.

How are we paying for this?

The public option was the ultimate public policy red herring. While everyone was busy talking about something that only 10% of everybody would have access to, the real details were getting hashed out without all the political hassle. Pelosi and Reid ran interference, and that's all.

Ever since they scrapped the "Medicare +5" rates in the P.O., the thing hasn't had much cost control value, at least not enough to have a massive ideological battle over it.

Barring hard-and-fast cost controls, as long as the government can guarantee competition in the near-monopolistic insurance markets, whether it's government run or some kind of nonprofit seems like a formality to me. Far from Josef Mengele medicine in any case.

I just wish they'd open the exchanges to everyone. If people could actually choose from a large variety of plans each clamoring for their business, we might actually see some real market efficiencies emerge. We might actually see insurance companies that have a stake in lowering their payment and overhead costs.

If I'm going to have "skin in the game" in the form of endless deductibles and copays, so should they. So should providers.

Right now where I work I can choose from 2 carriers and 3 plans once a year-- with another 14% premium increase coming due next year, and all kinds of exemptions and caveats. Why should they change? It's a profitable business. But something's gotta give. Let me decide what plan to buy, and let the plans fight for my business.

The Public Option never had the clout to merit the trepidation or tribulation it received. A perfect distraction.

In the end, I think the bill will be real reform, and it will give us the policy apparatus to deal with cost containment once we're forced to, but not before. I say push it through and work out the kinks as they arise. And that's what they're doing. Good.

How are we paying for this?

My understanding is that an extension of the entitlement is NOT being considered, but rather allowing buy-in at what presumably would be an actuarially sound premium. If done right this should be self-financing.

Senator Feingold pointed out that the CBO calculated that a Public Option plan saved at least $25 billion, and he doesn't see how a non-profit plan run by private-sector insurance companies can deliver those kinds of savings.

Me neither.

The most disgusting thing about this is that I am sure that when the public states that it supports a public option it is thinking "a public option that I can buy." None of the public options on the table, for many many months, have been available to more than a tiny fraction of the public.

What a spineless bunch of jerks we have as an excuse for a Democratic Senate caucus.

Itstrue, you can't seriously be suggesting that a buy in of 55+, available to only to those on the exchange, would actually cover mor than 10% of the public.

That's absurd. BS all you want, but even the weakest public option would have covered FAR more people than this will.

I'm a huge fan of a robust public option. One where the plan is aggressively run to keep prices low. One available to anyone who pays their premiums. And one that goes into effect NOW.

But some time ago I figured a reasonable alternative is a trigger that lowers Medicare qualification in inverse relation to periodic measurements of insurance company behavior. I confess that I sure didn't see the lowering of eligibily standards from the get-go.

I like it. I like it a lot. Only wish the criterion were based on need, not age (although I haven't a clue how to measure/enforce this). It is a plan that is sure to push HCR toward single payer. Whoooopeeeeeeeeeeee!!!!! Now let's watch to see how the Dumb-ass-Donkeys destroy this idea.

"Itstrue, you can't seriously be suggesting that a buy in of 55+, available to only to those on the exchange, would actually cover mor than 10% of the public."

That's not what I said, nor would a public option (or any other plan) cover 10% either. It would only be offered to that 10%. Some would buy it, some would buy something else. It might even not be worth buying in the more competitive markets.

I was just wishing the exchange were open to everyone, maybe with the Medicare option open to the AARP set, and the full entitlement at 65 (or 67, or 69?)

In any case, a Medicare buy-in for the 55+ crowd makes good actuarial sense, giving the Medicare pool a younger demographic, a real connection between premiums and outlays, and everyone else a bit of relief from older people's claims.

It's also a Medicare expansion; an idea that's popular, efficient, and grants access to a government program that we know works, instead of something hypothetical and full of caveats. People like Medicare. Let 'em have it. I say let us all buy in, but that's not going to happen.

My mom's in the individual market now and is pushing 60 with health conditions. She could sure use some relief in the form of a public system with real cost controls now, instead of a toothless wonder in 2014 that might not even be cheaper than whatever else is on sale then.

I say it's a good compromise. It might not even be a compromise at all, just a different approach that gets the votes this thing will need.

The Republicans have never lost an election by underestimating the intelligence of the American electorate.

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