Obama Drops Public Option, Showdown With Pelosi Looms

You do realize that:

(i) the proposed public option is strictly limited to those without employer-based coverage, and is designed to compete with private options, and that it’s sole point is to keep costs down (it would be very easy just to subsidize people to purchase very expensive coverage)?

(ii) about 40 percent (this is off the top of my head, but I think it’s right) of healthcare spending in the United States now originates with the government. Medicare, covering all seniors, is basically a Canada-style single payer system. The VHA, covering military veterans, goes even further and is basically a UK-style single-provider system. Overall, this means a larger public role than the systems in countries like Germany and France. Do you propose to abolish medicare?

(i) without employer based coverage

Meaning what exactly – if your employer pays your coverage, or if it is offered, but you have to pay? E.g., employer covers the cost for the employee, but the employee has to pay out of pocket for spouse/dependent. Would the spouse/dependents qualify for the public option? If not, then they are really getting screwed.

C Matt – if you have employer-based coverage, nothing changes. This was an issue during early negotation and it was decided to restrict to public option only to those out on their own and in small busineses.

SB– I have never made such a magical claim, and you know it. But we do have a very good comparison — Medicare and private insurance. And we know that while costs are rising unsustainably in both, the rise is actually smaller in medicare. Of course, everybody focuses on the explicit cost on the public balance sheet (taxes), but not the implicit cost on household balance sheets (rising premia preventing wages from increasing).

On why the cost per capita is twice as high in the United States, there is no simple answer. Part of it is insurance company profit-seeking and administrative– single payer is able to keep costs in check by simply efficiency gains — spreading risk over the greatest number of people and having a single administrative system. That’s an important part of it, but it’s not all of it. Like everyone else who follows this issue seriously, I was impressed by Atul Gawande’s little cost experiment. And here is the paradox — on one hand we have so many people left behind (47 million with no insurance, 25 million with insufficient insurance, widespread rationing by cost) and yet on the other hand we clearly have a lot of treatment that is not needed. And this happens in places where the income of a doctor or healthcare provider is tied directly to the quantity of treatments ordered. This is a classic market imperfection, as the healthcare provider is exploiting an information asymmetry in a way that maximizes his revenue. In places where doctors are paid a salary, or where income is pooled, you do not see these problems with ineffiency (the Mayo clinic is a good example here).

So, there are really 2 issues — access and cost. Access is actually not that hard — dish dish out a lot of money to subsidy coverage at whatever cost demanded by private insurance companies. I think everybody would agree that this is unsustainable. We must also trim costs. The public option is a small step in that direction — though it is not neutered that I doubt it will do much good at this point. The big cost issues remain outstanding.

MM,

C Matt – if you have employer-based coverage, nothing changes. This was an issue during early negotation and it was decided to restrict to public option only to those out on their own and in small busineses.

This is simply not true. Under all of the public option proposals, ANYONE (including illegal immigrants) can chose any plan in the HIE including the public option. Even if such a restriction were added nothing stops the employer from opting to drop it’s employees into the public option.

Matt: No public option covers illegal immigrants. The congress and the president have already said they will not agree to any legislation that says this. The only way they get treatment is by going into emergency rooms where hospitals are morally obligated to give them care if the injury or sickness is serious.

The part of this article that shows the lack of intellectual honesty with many conservative pundits, is that when President Obama proves that he is not a liberal ideologue, when he shows that he believes in bipartisan, pragmatic governance – no one commends him on it. They only talk about “show downs” and his political problems as if he failed. What hypocrisy!

And Art Deco, what part of your post is in any way Catholic? I challenge you to get in front of any congregation in the country as say that.

“Do you propose to abolish medicare?

Git ‘r done.”

Here:

http://the-american-catholic.com/2009/08/03/so-what-about-the-other-10-million/

Yes, I’ve made it a zillion times because it is A FACT. I have no doubt that a single-apyer system in the US would reduce costs and increase coverage, and be better aligned to the requirements of Catholic social teaching.

A little more epistemic modesty might be in order, wouldn’t you think? In discussing any policy issue of any magnitude, 100% certainty amounts to overconfidence and bias. Has it never crossed your mind that the same forces that have caused Americans to spend so much more on health care — including via government spending, which isn’t subject to your canards about administrative costs or insurance company profits — may well continue to be in place? That this will cause Americans to overuse medicine in a single payer system to an even greater degree, thus causing overall costs to rise?