Larry Levitt, the health policy wonk of wonks, notes that the public option would not solve a major PPACA issue — getting the healthy into the risk pools.
A public option could bring premiums down and be a fallback in areas without competition. But it mostly wouldn't address risk pool issues.
— Larry Levitt (@larry_levitt) August 18, 2016
There are scenarios where a public option could make the current risk pool worse off.
The question is subsidy attachment.
On-Exchange Advanced Premium Tax Credit (APTC) is calculated as a function of an eligible individual’s family income as a percentage of the Federal Poverty Level (FPL) and the cost of the second price Silver that they can buy. Every individual at the same FPL anywhere in the country who gets an APTC pays the same out of pocket monthly premium. The APTC takes care of the gap between the personal contribution and the actual premium. The APTC is constant. If the person wants to buy a cheaper plan (either the cheapest Silver or a less expensive Bronze plan), they pocket the difference. If they want to buy a more expensive plan (a broader network Bronze or Silver, or all Golds/Platinums) they pay more.
In some regions there is currently a decent size gap between the #1 Silver premium and the #2 Silver. That gap allows for lower income individuals to pay significantly less out of pocket for either the #1 Silver or quite a few Bronze policies than people with the same income in regions where there is only a $1 gap between the #1 and #2 Silvers.
Now let’s insert a Public Option with Medicare like rates into the mixture. In regions where there is active Silver Spamming going on most of the plans are empirically being priced out at near Medicare rates anyways. Nothing will change. In some regions where there is a large gap between the #1 and #2 Silvers, the public option would either be the new #1 (unlikely in the linked version as that pricing is Medicaid driven) or more likely be the new #2 Silver. If it is the new #2 Silver, that means the gap between the current #1 and the new #2 is less than the gap between the current #1 and the previous #2. If that is the case, then subsidized individuals who were marginally attached to buying health insurance would drop their coverage. Those individuals are far more likely to be very healthy as their value proposition for insurance is very different than the person who has weekly doctor appointments and a dozen prescriptions.
Moving off-exchange but still on the Individual Market, the Public Option would improve the risk pool only if it is both significantly less expensive in full price premium and offering a significantly better value (network mainly) than any other current option. In some cases that could be true but it would not be a universal case.
This needs a lot of empirical analysis to see how a Public Option with Medicare like pricing would change the relative prices and thus the risk pool composition on and off Exchange.
It is not a panacea.
Yutsano
You’re forgetting the Shared Responsibility Payment goes way higher in the 2016 filing year. It’s an unenforceable stick but it’s still an incentive to get insured. Unless I missed that in there.
burnspbesq
In discussions about a “public option,” it’s important to define terms. If you put ten self-proclaimed progressives in a room and lock the door for an hour, they will likely emerge with 12 or 13 different descriptions of what a “public option” should look like.
I deal with the NHS on a regular basis (the kid’s UK student visa gets him access). The Swiss system is quite “public” enough for me, TYVM.
piratedan
Is there ever going to be a time where we realize that Health Care (be it a service or a right) is simply going to be something that we have to pay for? That the benefits are not immediately recognized (if you’re an MBA kind of guy) kind of like the idea of clean water and good roads and efficient infrastructure and that taxes, on the whole is something that covers this? That big pharma is already a lot like the military industrial complex in that there are certain benefits and limited competition to government contracts but as a whole, they essentially help to cover the public at large?
Obviously this is simplistic but the idea that somebody gets to make a profit to simply provide me health care that I need seems to run counter to the idea of medicine as a whole.
p.a.
Gorram subtlety, complexity, and gray areas! #panaceanow!
Fake Irishman
So what if we were to default everyone into the public option who doesn’t sign up, and let them actively decline health insurance by paying the tax penalty up front (or switch to a private plan within a month)? Would that increase sign-up rates via a fairly hard nudge (might not solve risk pool problems though)?
Villago Delenda Est
@piratedan: This. We need to decouple health care from profit. Reasonable compensation for the time put into being a health care provider, etc, cover realistic costs, not price tags designed to skim cream, but making a fuckton of money off this needs to end as a paradigm.
brendancalling
I still don’t understand why we can’t just have medicaid for all. I’m on it now, and it’s wonderful. So much better than my Silver Plan. In a few months, I have to change my residency to TN, and I go back on the Marketplace since they didn’t do the expansion. I am dreading it. I don’t want to do it. I’d sooner die (pun very much intended). TN has seen really bad rate increases.
Richard Mayhew
@brendancalling: docs and hospitals would scream and win that fight
D58826
@Fake Irishman: And make the penalty expensive enough that signing up is cheaper.
japa21
@Villago Delenda Est: Depends on what you call reasonable compensation. Should a brain surgeon’s compensation be more than a dermatologist’s? And how do you define profit? Right now, IIRC, the highest paid medical profession is anesthesiologist. Is that appropriate? At what point is the income beyond reasonable compensation?
I don’t have answers to those questions and not sure how the answers should be decided.
BTW, is the question of reasonable compensation not appropriate for all walks of life? Why should lawyers who practice corporate law be paid more than lawyers who are public defenders? Why should a baseball player who hits around .225 be paid over a million dollars per year?
Our society has basically been based on the principle that a person should be paid whatever they can get away with charging.
Ultimately, the thing that may make salaries more equitable is taxation rates.
Major Major Major Major
@brendancalling: A Medicaid-for-everybody-plus-private-stuff plan would be OK.
That is, I will note, what Obamacare was (kind of) supposed to be. Meicaid as a baseline. Thanks, Roberts.
? Martin
Relatedly, free tuition at public universities is not either.
I’ve been saying this for some time. Eliminating tuition is the wrong first goal. The bigger problem is aligning opportunity with educational value. Tuition is a component of that, but one that public universities have already mostly controlled for well. They have not controlled for the opportunity problem as well, nor the value of education problem very well.
The comment regarding GPA and SAT is a bit wrong. SATs aren’t that high at UC, but GPAs are higher. Average GPA at many of the mid-tier UCs are into the 4.1/4.2 range to get admitted.
Major Major Major Major
@japa21: Many doctors are overpaid. They keep this in place partly by the cartelization of medical services and resistance to automation. Many doctors are compensated about where they would be in a reasonable market. Some, who do work on the more ‘charity’ end of the spectrum, are underpaid. But the AMA is a racket.
CONGRATULATIONS!
@piratedan: I find that outcome pretty unlikely. And once serious global resource competition starts happening most health care is simply going to go away.
Major Major Major Major
@? Martin: Wasn’t Hillary’s original plan something like free community college and stuff that poor people actually use and need?
Belafon
@piratedan:
Yes, when people get over not wanting to pay for “those people.”
Paul Wartenberg
Aetna’s attempt to extort the DoJ into letting them merge with Humana is showing the political necessity of a Public Option: making sure the companies in the free market play nice.
? Martin
@Major Major Major Major: Yeah, she was following Obama’s plan more closely and has since moved more in the direction of Sanders’s plan. I think free community college is a straight-up winner. The 4 year public could be, but as presented it’ll be a bonanza for upper-middle class whites.
Major Major Major Major
@? Martin:
Funny how a lot of Sanders’ proposals end up like that.
one_particular_harbour, fka Botsplainer
The panacea is in eliminating the fiction that healthcare is a fungible, flexible cost that is amenable to the regulatory aspects that market competition provides.
Regulate it as a public utility – all of it. Restore the Certificate of Need for facilities and equipment.
justawriter
Sort of off topic, but is there a good nontechnical summary of what has been going on with employer sponsored insurance on a macro level since the passage of the ACA? Through good Richard here we have a graduate level analysis of the exchanges but most people still rely on ESI.
My community is so bombarded with right wing media including the requisite ACA horror stories, many (if not most) turn out to be from people with ESI. Just like any report that “social security and medicare” are in financial trouble because it is two different programs in very different financial conditions, I see lots of stuff conflating anything that goes wrong with either ESI or the exchanges being conflated as “Obama’s fault.” I’d like to read something that will help me separate the sheep from the goats.
MomSense
The problem with the public option is that even the version that passed the house was pretty much set up not to be competitive with private insurers. Access was heavily restricted by income and reimbursement rates were not tied to Medicare. I’m fuzzy on the projections now but I seem to recall that it would end up with a small, sicker population, and wouldn’t be financially sustainable. I have no doubt a well constructed public option would out perform private insurance companies but clearly our Reps didn’t want to allow that to happen.
Chris
@piratedan:
This. But then again, many of the things you mention – clean water and infrastructure and whatnot – are things that a large portion of the population believes aren’t a right or should be privatized or whatever. The knee-jerk anti-government mentality is a hell of a drug.
Feathers
@? Martin: The main problem with “free” higher ed is that it does nothing about the spiraling costs. Because student loans helped create the problem, a discussion of cost controls is needed before we start spending more money. What would be on my list? End of athletic scholarships, most academic scholarships, end of admission preferences for children of alumni, curtailing of luxury campuses, rankings which clearly show overhead versus money spent on teaching and academic support.
Which makes talking about higher ed in this thread actually somewhat on topic, because so many of the issues are the same.
Applejinx
Wonk on, matey. There’s a lot of details you understand that I don’t. Though,
Remember, coverage does not implicitly mean ‘buying health insurance’, just as coverage doesn’t mean ‘the health care is any good’, and ‘ultimate best possible health care in the world’ doesn’t mean ‘functional within society’ (we can probably get to a point where we can make a billionaire live to 200, on Mars, but an outlier like that doesn’t make it effective health care as a rule).
I would not be that upset to see the entire health insurance boondoggle blow up and go the way of the Whigs, but as someone in the belly of the beast I get a feeling you’d prefer reform ;) cool, if that can be done, more power to ya.
If their evilness precludes meaningful reform, it’ll become apparent sooner or later. I know some people think it’s already irredeemable. I’m not convinced of that, I think it could go either way, like so many things in 2016.
Roger Moore
@piratedan:
We have a hard enough time convincing people that infrastructure and clean water are worth paying for, so getting them to accept that we need to add healthcare to the list is an uphill battle.
The Other Chuck
Maybe we’ll eventually recognize that rent extraction from sick people isn’t a business model we want to support anymore. Oh, and now that Aetna and company aren’t playing anymore, we owe them no fucking consideration whatsoever in our next round of policy discussions. Let them die.
Richard Mayhew
@justawriter: TOMORROW :)
WereBear
@Major Major Major Major: I consulted an endocrinologist a couple of years ago, and discovered the job can be done by a reasonably competent spreadsheet.
Order X tests. Compare blood levels to certain parameters. Prescribe Y or tell the patient, regardless of symptoms, they are not sick.
DONE.
LeonS
@japa21: There’s no perfect solution for compensation, including our current market-ish based one. We could compensate more on procedure than role or title however. So surgery gets more compensation than skin diagnosis. Sure there’s still a billion wrinkles (what about surgery x vs surgery y?) and it will always be imperfect, but medical boards could set reasonable procedure base compensation rates, maybe with modifiers based on outcome review, or patient demand, or whatever else. It’s a problem but a solvable one.
As for all compensation, in most cases it is hoped that market incentives do not pervert from desired outcomes (is so far as we care at all, that is). Not sure how its working out with lawyers but DOJ just appears to have decided that it is not working out with prisons. IMO Schools, prisons, LE, Military, and health care are good candidates for non-market based solutions.
WereBear
Privatization was a con game we all paid for.
Amir Khalid
@WereBear:
A few months ago I saw a story on the BBC website which said that in a couple of weeks you can train a pigeon to spot cancer cells on a mammogram as reliably as a human radiologist. While I wouldn’t really advocate replacing the latter with the former, I suspect there is scope for automating certain diagnostic tasks that are currently thought to be too complex for machines.
jake the antisoshul soshulist
@piratedan:
It pisses people off when I say it, but profit is a moral hazard in health care.
Brachiator
@Villago Delenda Est:
One person’s reasonable compensation is someone else’s unreasonable profit. In Ontario, Canada,doctors think that a chunk of money amounts to a pay freeze.
AnonPhenom
@Paul Wartenberg:
Yes.
Now if we could only come up with a ‘public option’ to use against the industry that is the poster-child of using this strategy as a way of undermining marketplace competition.
Cable Television.
That’s right. I went there.
Major Major Major Major
@WereBear: Yep. Same with cancerous moles, or as @Amir Khalid: noted mammograms. Regulatory capture at the FDA is disguised as an abundance of caution, and then there are more obvious things, like the ACA’s medical device tax, designed to limit the industry.
WereBear
@Amir Khalid: That is fascinating! And I’m sure pigeons will work for … Peanuts :)
Amir Khalid
@WereBear:
I’m not so keen on that. I have relatives who are radiologists, but none who are pigeons.
jl
More problems caused by the robot’s breakfast of metals.
I think better to require a standard mandatory plan that everyone has to buy on a very highly regulated market. If people want more coverage, then supplemental insurance plans sold on a separate less regulated market.
If we want to go mostly private insurance, then Netherlands and Switzerland have explored the do’s and don’ts of this approach. We should look to their experience.
RepubAnon
@Richard Mayhew: Not so sure about that – it was true in the 1990s, but the insurance companies’ involvement in day-to-day medical issues has gotten so burdensome that a Swiss-type plan (universal basic coverage via public option for everyone to put them all in the risk pool, coupled with premium plans from private insurers, might be more palatable to the medical profession now. No more uncollectible bills, less hassle with each insurer’s byzantine approval processes…
justawriter
@Richard Mayhew: Thank you Richard. I look forward to it. People have been bitching about their insurance ever since I joined the workforce in the middle of the Reagan era. The only difference now is that, according to many, it’s all Obama’s fault instead of the greedy insurance giants.
WereBear
There really is no substitute for a good doctor. However, that is not something our health care reliably provides. We are lucky to get into ten minutes of conversation before there’s a prescription to mask our symptoms and a cry of “NEXT!”
Heaven forbid that pill doesn’t fix anything. Because if we come back and say it didn’t work, we are now a “problem patient.” We are not cooperating with the system.
There are some things we are fantastic at, don’t get me wrong. But they tend to be things mechanically fixed, where the diagnosis is clear and unambiguous.
Diagnosis itself is becoming a lost art. If it doesn’t show up on the blood panel or X Ray, we are doomed to wander the Internet searching for one.
I should know. Those people who diagnose their own rare condition? Now, I’m one of them.
WereBear
@justawriter: Seconding that. Every single person I have heard complaining about it had insurance already, for many years. And the things they complain about? Not anything to do with Obamacare.
gene108
From what I recall, from when I actually read the GOS, in the run-up to the passage of the PPACA, many liberals view the Public Option as Step 1 in the destruction of the private insurance industry, which will allow government to totally take over healthcare and/or move us towards single-payer.
The goal is not so much to achieve universal affordable coverage by any means necessary, but to destroy private enterprise to be replaced by government control.
Brachiator
@WereBear:
This gets tough, because it gets close to Libertarian fantasy land, where everyone becomes magically capable of making medical decisions. You may know what you are doing, but I suspect that many more people are like a co-workers brother, who ended up depending on healers and alternative medicine for a condition he had, and ended up dying because he was too far gone for standard medicine to treat him.
jl
@RepubAnon:
” a Swiss-type plan (universal basic coverage via public option for everyone to put them all in the risk pool, coupled with premium plans from private insurers, might be more palatable to the medical profession now. No more uncollectible bills, less hassle with each insurer’s byzantine approval processes…”
Go Swiss! (if we are going to stick with mainly private insurance, that is). Or Go Dutch! (but learn the lessons of their similar problems with powerful provider organizations gaming the system).
However, I think you are overoptimistic on chances of the providers signing on, and insurers willing to go with a regulated ‘normal’ competitive profit on mandatory insurance policies and most routine provision of care. Swiss economy is highly cartelized. Problems with monopolistic competition are controlled with a stakeholder negotiation process. So, Swiss doctor and hospitals associations are used to bargaining on uniform tariffs for well-defined services. And used to doing this bargaining with federal and local govt and consumer stakeholders at the table. I think insurers, and providers of all kinds, would fight that tooth and nail here.
Insurance companies would look to optional supplemental market for current rent-seeking and profits from gaming the system. Recently, Swiss mandatory policies have satisfied the population well enough that the supplemental market is disappearing.
Getting the current, well function system (for average person, if not for rent-seeking local monopolists) was a huge long and bitter fight in Switzerland. I think would be even more difficult here to get to it on one go.
Edit: a real problems is what legally and culturally in the US could replace the cartelized association negotiation process, and how would uniform tariff system be enforced. And forgot to mention that rigorous cost-effectiveness tests imposed on covered services.
Brachiator
@gene108:
A “progressive” acquaintance argues the point that if you make the government spend hundreds of billions on social programs, the government will not have money to spend on war.
WereBear
@Brachiator: Oh, I am getting treated by certified medical professionals; we’ll see how much the insurance company cooperates, still a work in progress.
But I have heard so many stories, both in person and online, about the tortuous search for the correct diagnosis, that I think we have an incredible gap in our medical system that we more than have the tools to fill.
And we can save money that way, too.
Calouste
@jl:
Good luck with getting Americans to look a that. Not only are they foreigners, they don’t even speak English.
gene108
@? Martin:
My issue with the Federal government subsidizing college tuition is it lets bad state actors off the hook. Plenty of states have reduced money to colleges because they want to have tax cuts for wealthy folks.
This is one reason public colleges have become more expensive.
Also, would you then have to nationalize college standards, because the Feds are now paying for it? Would there be a standard curriculum for Chem 101 across the nation and any professor / grad-student would have to teach off this fixed syllabus?
There are a lot of issues, with making public colleges free via the Federal government.
LeonS
@gene108:
You say that like you are exposing some demon, but is that really necessarily bad? In general I’d argue that it makes sense in some cases and not in others. Do you wish to replace the government control of judicial law or the military with private enterprise (it is happening to some degree in both cases)?
With health care I think the balance could lean a bit more toward government control, but if Richard Mayhew has taught me anything, it’s that it’s a complicated question.
gene108
@Brachiator:
The military is as much a jobs program as it is a war making entity. There are millions of people making ends meet because they are or were in the military.
And I’m not even counting the jobs held by civilian contractors to provide services.
jl
@Calouste: We were doomed to servitude to furrin stuff when we adopted the Australian ballot. Might was well relax and enjoy the ride to our eventual doom. Just like Trump is doing.
jl
@Calouste: Can’t seem to make my top terrific and the best snarky reply. I think A_str_l__an b_ll_t is now a forbidden worship word on this blog.
gene108
@LeonS:
Government has been given explicit control of the courts and the military via the Constitution. These are clearly defined entities that are to be run by the government based on the founding documents of this country.
There’s no gray area, with regards to who should run the courts or the military.
Healthcare is not so crystal clear.
I have no moral problem with single payer, but I think the end goal should be affordable universal coverage. Other countries have done this via stringent regulations on the private insurance market and on what healthcare providers can charge.
If we can have a viable universal and affordable healthcare system, I’m not married to any one method over the other. If one method still allows C-Level executives their hookers and blow allowance, I’m O.K. with this.
slag
@LeonS:
I, for one, am excited to learn that the Justice Department is ending its use of private prisons. Another area in which government is destroying private enterprise? I hope so!
Major Major Major Major
@LeonS: The government controlling something is neither good nor bad, what matters is that we get the best inputs and outputs we can.
For a lot of the “public option or bust” types, full government control and the destruction of the insurance industry is ipso facto the best scenario, regardless of actual health outcomes.
ETA: for many conservatives, of course, a private system that ‘maximizes liberty’ is the best scenario, regardless of how many people have to die.
Brachiator
@WereBear:
I have heard similar stories as well. I am not convinced that people actually discover the correct diagnosis after their long searches.
Some of this reminds me of techies who make a fetish over wearables that provide them with all kinds of information. But they don’t demonstrate in any way that this information is actually important or that they are competent enough to evaluate it.
I sympathize with your ideas, but don’t know if we are at a point where these potential methods can deliver results or result in any real savings.
Major Major Major Major
@Brachiator: “I understand complex system X, so I can definitely fix systems Y and Z too” is a classic engineer mindset, yes.
WereBear
A good use for government is when profit should be kept out of the equation as much as possible.
Military, judicial, and I think, health care, all fits under this rule.
It’s no wonder our Capitalist Overlords love mucking about in health insurance. A product everyone has to use? Gold, Jerry, gold!
? Martin
@Feathers: The spiraling costs isn’t what it seems to be. You have a lot of the situation that gene108 alludes to where bad state actors remove taxpayer dollars which need to be replaced with tuition. This isn’t a spiraling cost – it’s a shift of funding source. That’s may or may not be problematic depending on how you view taxpayer dollars helping only a subset of taxpayers (particularly if that help tends to be toward the higher end of the income ladder).
The bigger problem as I see it is that you have a consumption smoothing problem. You need a fair bit of capital to go to earn a 4 year degree. You can justify those expenses from future earnings. In fact, you can justify it more today than 20 years ago because the wage gap between college educated and non-college educated workers is significantly higher (it’s gone up a little for college educated but down a lot for non-college educated). Nobody should be troubled by carrying $35K in debt provided they get that degree because their future earnings potential will easily pay for it. That may not be true for $100K in debt though, if you go to a private or out-of-state public. That won’t be true if you don’t complete the degree. That probably won’t be true if you go to a for-profit.
The issue here is not the average $20K-$35K debt load for students (less than the average car loan). The issue is that too many people can’t ever get to that point. They don’t have enough money to get to the point that loans start to kick in and so they are unable to leverage against that future earning potential. That’s part of the opportunity problem. Another part is the lack of public university seats that causes qualified students to be turned away – typically lower performing students, typically from rural or low-income areas, typically minorities. They can never benefit from the free tuition because they can’t get admitted. Then you have problems of completion to deal with – which more often than universities want to admit are financial. CSU just determined that 1/10 of their students are homeless at one time or another and another 20% food insecure. You will find that completion rates among these students are lower than for students that are more financially stable. The loans aren’t the problem – the costs around the loans, the access to the loans, etc is more problematic.
CONGRATULATIONS!
@WereBear: Kaiser’s benchmark is two. Two minutes. And my doc thought that was far too long.
I’m not with Kaiser anymore.
WereBear
@Brachiator: Being a Sherlock Holmes fan, I know the great detective was inspired by one of his creator’s medical school professors:
The Real Life Inspiration for Sherlock Holmes
This was in the late 19th Century, when they might not be able to do much for what you had, but they could, by-gum, figure out what you had. I am asserting from experience when I say that now, when doctors hear hoofbeats, ALL they think of is horses. Some of them will not admit zebras even exist.
I say this is an appalling state of affairs, an area where medicine has gone backwards in the last 139 years. They have great diagnostic tools in the form of medical technology, but if your problem doesn’t show up in printouts or screens… then they decide you don’t have a problem.
Good luck with that.
jl
@? Martin:
” This isn’t a spiraling cost – it’s a shift of funding source. ”
I agree with that. Don’t have time to find it now, but saw some statistics showing relationship between cuts in government support for core activities, like tenure slots for teaching basic subjects and capital maintenance to higher tuition and ‘administrative bloat’. A lot of luxury campus crap, ‘assistant vice sub-deans of synergy enterprise activities’ (edit: aka drummer for support from corporate investments) are a product of scramble to replace the lost support.
And I will add, that some (I don’t think you) on this blog seem to think that all the fancy kollej stuff and talk of reform of post HS educational finance will just subsidize upper middle class kids who want to study some egg head personal aspiration crap. Recently I have spent a lot of time in CA Central Valley, and have spoken with many young folk slaving away at dead end jobs who are having a very hard time putting together money and time to get certificates at community college or technical degree at local CSU. They want to be health care techs, welders, auto diesel and stationary plant mechanics, food industry biological techs, etc. These people seem to be forgotten in discussion of higher ed finance reform.
Edit: and shortage of seats at times convenient for people who have to work a normal hour job is a big issue.
Miss Bianca
@WereBear: I remember having a Reader’s Digest kids’ compilation – I can’t remember whether it was actually stories from RD or just stuff that they thought was cool for kids to know – that had an article about this guy and how Conan Doyle had been inspired by him. As I recall, it was a companion article to “The Speckled Band”, which was the first Holmes story I ever read (and consequently, stubbornly remains my favorite!)
JustRuss
I have a friend who’s an RN who has tons of doctor/hospital horror stories. She also was extremely ill and had to self-diagnose, she’s doing great now.
Raven Onthill
“offering a significantly better value”
Since a public option would be non-profit, would that be difficult? I do not understand how a broad-based non-profit health plan can be more expensive than a for-profit insurance company, unless the for-profit system is really tightfisted or the public system severely constrained.
Raven Onthill
@MomSense: ” I have no doubt a well constructed public option would out perform private insurance companies but clearly our Reps didn’t want to allow that to happen.”
If Sen. Sanders drafted the first version of the public option, just maybe by the time it made it through the sausage-making process it would be good enough.
WereBear
So glad to hear it. And you’d think she had an advantage!
In all of this, I can’t say a bad word about my GP, who was the only one who stayed in my corner and helped me at least figure out what it was not, which turned out to be a help, too. And he is the one I am turning to for lining up the specialists I will need.
The steps I took to treat myself — bouncing them off of him to keep me out of trouble, he did nix some of them — helped me a lot. But I kept running into walls. Now, I know the name of the wall.
jnfr
If you have the time, I’d love to hear your thoughts on the attempt in Colorado to institute a single payer universal system. It’s up for a vote this fall.
Progressives are very split on it. NARAL came out against since other CO law means a state-run system wouldn’t be allowed to cover abortions. Progressive Colorado came out against for that reason and also concerns that the budgetary impacts haven’t been dealt with.
A lot of backlash against those two organizations locally.
Richard Mayhew
@Raven Onthill: depends on how it is built and by region
Brachiator
@WereBear:
I am also a huge Holmes fan, and know very well the sources and inspiration for the character.
I do not deny the strength of your experiences, but I reject some of the conclusions you draw from them.
But I think we might agree on what we are looking for. Accurate diagnosis, appropriate treatment, lower health care costs. Anything that consistently delivers these results for large numbers of people is fine by me.
Brachiator
@WereBear:
Or it might not be relevant to the problem, or might not be relevant to a solution.
By keeping profit out, I presume that you mean eliminating profit paid to shareholders. But you cannot eliminate the profits paid to doctors, technicians, nurses and administrators in the form of salaries and benefits. And you must provide for research, investment and improvements in equipment,
treatment and facilities. And some incentive for pursuing these goals.
Keeping quality and service in the equation is as important, or more so, than in posting sentries to keep out profits. In fact, I do not see that guarding against profits gets you desired health care goals.
Miss Bianca
@jnfr:
H’mm…links?
FlipYrWhig
@Raven Onthill: We’ve seen that process. It doesn’t result in sausage.
Arclite
Nothing is a panacea, but single payer gets all the healthies and the sickies in one pool.
Goblue72
Guy who would be out of a job if we eliminated private health insurance has “reasons” why a public option is just silly hippie nonsense.
Youve been completely biased on this issue since day one.
bob hertz
I believe that Medicare should be the public option, and I would have it works as follows:
1 The penalty for being uninsured should be fixed at 3% of income.
But the penalty would buy Medicare Part A for hospital care for the individual.
The persons who refuse to buy insurance are a healthy group overall. They will not file very many hospital claims.
2. Persons who do have a chronic illness can buy the whole Medicare package for a percent of income, say ten percent. They could buy a Part D plan for what seniors pay, i.e. about $30 a month.
This is a fairly sick group, most of them over 50. They will cost Medicare more than they are paying in.
So we increase the payroll tax that is now 2.90% (higher for incomes over $200K)
This is a way of taxing the millions of high income people who now get employer paid insurance tax free.
If these two steps shrink the health care exchanges, big deal.