Saturday, February 23, 2019

Revisiting the public option Obamacare debate of 2009

From a blog posting and column written during the debate of including the public option in the proposals for what became Obamacare.  

October 12, 2009

My August  2019 updated comments in support of a public option:

What the private health care system needs is more competition from government options and non-profits who are not profit and stockholder driven. In addition, all purveyors of public options, including Medicare and Medicaid as constituted now, should be able to negotiate formularies with drug companies. Consumers need to have affordable choices of both public, private and union and employer-provided plans that are not junk and covering pre-existing conditions. How we get there are several ways. Competition is the basic driver of prices. Unaffordable comprehensive policies are no choice. If you can't afford them, a choice of 0 is meaningless.
If you are given no choice but only able to have of a government program, that, too, is depriving consumers of choice. On that basis, I support the public option instead of the Canadian system. Price, taxes, and government costs v benefits are important, but politically "choice" is the more sellable approach. That one plan or another would deprive consumers of choice or insurance they like now that may be better than a public option may be effective lines for those who support the Sanders type plan, but in the long run, consumer choice is a more positive sales point for a public option approach, though it might not be the cheapest in terms of government spending or consumer out of pocket expenses.

October 12, 2009 comments continued:
Last week the Congressional Budget Office gave the Democrats' health care reform legislation an early Christmas present. They put a price tag on the Baucus plan that makes Democrats look like fiscal conservatives and Republicans as penny wise pound foolish. It also gives room to add the public option that polls show 60-65 percent of the electorate want and leaves the congressional Republicans with egg on their faces.

The CBO calculated the Baucus plan would cost $829 billion over the next ten years, $71 billion under the maximum amount of $900 billion the President had set. Furthermore, it reduces the federal debt by $81 billion. The Congressional Republicans, advocating for the continuation of the status quo, are still supporting the “do nothing” option which would be $81 billion more expensive than the Baucus plan.

Of course, what you pay for is what you get. The Baucus plan would leave at least 18 million uncovered, relying on the emergency room for health care, with a 41 percent greater risk of dying prematurely, and leaving the uninsured in danger of adding to the staggering bankruptcy figures.

Baucus also left out the public option. His is the economy model with gas fuel efficiencies when a significant majority of voters still want a hybrid with a choice of a public option.

However, there is wiggle room for both the public option and for more extensive coverage to be added in later on the Senate floor and or in conference committee. There is even a financial incentive to do so. The beauty of the CBO estimate is that there is enough cost slack to allow more of the uninsured to get access to affordable health insurance, to include a public option, and still make the case that the Democrats are more fiscally responsible than the Republicans.

The CBO had “scored” the cost of the public option in the House version as being $10 billion cheaper over 10 years than a version without a public option, because the competition would force down the high private insurer's administrative costs.

Aside from stonewalling, one Republican strategy has been to offer sound-good “alternatives” that look more like the cardboard substitute for a shiny toy the chubby-faced kid in the Ally Bank commercial called “a piece of junk.” Adding insult to injury, there is not even a CBO price tag attached, so an apples to apples comparison of plans cannot be made. Republicans have offered tweaks worthy of adopting, but they ignore their limits as panceas. The oligopoly of private insurers, protected from anti-trust action, makes a farce of the “alternative” to promote competition by allowing cross state insurance purchases. Thirty-five states have already adopted tort reform that caps jury awards with no evidence of impact on health care costs. The other panacea: Let's change human behavior — if you go on a diet and stop smoking, you will get a break on your insurance costs.

This year, 71 percent of doctors, the most adamant group opposing socialized medicine over the past 100 years, are supporting either the Obama plan or the Canadian system. That is the ultimate credible attestation that the summer fear campaign Republicans launched to scare us has no merit. Overwhelmingly, most docs do not believe that reform would be a socialistic government takeover of the medical system, or would get between you and your physician.

The Republicans are still fear-mongering that seniors would lose $500 billion in Medicare benefits. Full disclosure: I am one of the 20 percent of Medicare recipients on the useless Advantage program, targeted for cuts. My Medicare benefits will not be cut. There is a difference between administrative costs and benefit cuts. Wise up, seniors.

The result: Congressional Republicans look like they are stonewalling, heartless grinches, not caring if people die without insurance. They have postured themselves as protectors of the insurance industry and as anti-consumer. They want to deny consumers a choice of a public option. They want consumers and taxpayers to keep on paying private insurers for their premiums that are rising four times faster than care delivery cost and to continue paying for excessive charges for their high salaries and commissions.

Unlike Democrats, they have not even bothered to put consumer protections from insurer abuse into any legislation whatsoever, giving only lip service to some vague future legislation that would outlaw insurer's coverage denial for pre existing conditions or dropping coverage for the sick, and arbitrarily denying claims.

No wonder moderate Republicans outside Congress — New York Mayor Bloomberg, former Republican standard bearer Bob Dole, former Sen. Bill Frist, California Gov. Arnold Schwarzenegger and others — have looked at the polls and are urging moderates to get on board with reform. They must have realized that their party's tactics may not be the best political face they could put forward in the 2010 midterms.

No comments:

Post a Comment