About that public option

[pecunium]

We all want one right?

Maybe not. I want one if it actually makes real healthcare available. If it's some version of, "catastrophic coverage", or has some unworkable, "trigger mechanism"

The trigger is, at present, dead, but it's not completly out of the question, and it's not good. The last time anyone tried to make some aspect of healthcare "affordable" they stuck one in.

Mr. Emanuel said one of several ways to meet Mr. Obama's goals is a mechanism under which a public plan is introduced only if the marketplace fails to provide sufficient competition on its own. He noted that congressional Republicans crafted a similar trigger mechanism when they created a prescription-drug benefit for Medicare in 2003. In that case, private competition has been judged sufficient and the public option has never gone into effect. (WSJ, 7 July, 2009)

We all know how useful that's been. The advertising companies have made a lot of money, because the insurance companies are pushing the private coverage people need to survive, "the donut hole"

That would be bad enough. But there is more to consider. A public option which provides barely adequate coverage is better than nothing, but it might be worse than nothing too. People are amazingly willing to put up with an inadequacy. They may do it from ignorance (the insurance lobby has done a great job of that on this subject, look at all the people who think France, Britain, Canada, etc. is full of people dying because they are not allowed to get care from the national healthplan). They may do it from fear, "What I have isn't the best, but it could be worse."

A poor public plan is likely to make more substantive change much harder.

I want single payer. If I can't get that, I want a pubic option which is well-funded, has a slew of customer protections, competes head to head with private insurance (hey, if the "free market" is so damned good that it can sure all ills, let's put it to the test. So far, on this subject Adam Smith seems to have been right People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices., but that's for another day).

What I don't want is the public option to be used as cover for another handout of my money to the money-grubbers who are presently running the "death panels" which are killing people (not just grandma, but people my age (42) and children), or consigning them to lives of misery and poverty, shortened by illness and ruined by despair.

That is something which could happen. Max Bachus, Chuck Grassley, Olympia Snowe; and their fellow travellers, are more than capable of putting a different sort of poison pill in the bill (in committee, or in conference). They could stripthe protections people need (no retroactive recission, no-prexisiting condition, keeping the anti-trust exemptions the insurers have, etc.). We would be told these "compromises" were made to get a neutered ghost of a real public plan created. That without them no public option would ever be passed.

Ten years down the road, when the indsutry is still doing well, when the poor are still struggling to get real healthcare (but they have something), when the costs are still grossly higher than any other nation on earth, and someone tries to change it... inertia will kill it aborning. People would be willing to cling to an inadequate plan, for fear the new would be worse.

If you doubt me, just look at the town-hall meetings, where people who don't have the sort of coverage single payer, or a well crafted public plan, would provide; who are paying more than they would have to, to get lesser coverage, are fighting, tooth and nail, to keep the status quo.

A huge majority want's single payer. A larger percentage want's a public option (though much of that is overlap, people like me who will support a public option because we have been told single payer is off the table)>

We need real reform. We need real coverage. We need to make sure the rhetoric (public plan, healtcare for everyone), lives up to the ideal.

Comments

[texaslawchick.livejournal.com]

I think the public option should be an HMO modeled after Kaiser. Kaiser has unbeliveably good satisfaction rates, has been very good at keeping costs down for decades, and has a sophisticated medical record keeping system that improves quality of care substantially. I realize that HMOs are not popular with consumers, since they must go through the PCP for referrals, but I don't think that the public option needs to be necessarily the most consumer driven plan in the world.

ETA: don't you find it funny that no one took to the streets for Medicare Part D, which had a price tag of $534 Billion and only gave seniors drug prescription benefits.

[harimad.livejournal.com]

I was going to take exception to something you wrote but I think I shall inquire further instead.

Tell me what you know/think about the so-called death panels.

[pecunium.livejournal.com]

I am going to take exception to what you wrote, because the tenor of the subtext in, "tell me what you know/think" implies I need to be educated. If you think I am wrong about something, it's probably best to ask the question you want answered, rather than to attempt to finesse it out of me.

As to what I know/think.

1: The deathers are daft. No one is going to put old-folks on ice-floes.
2: End of life counselling is a good thing.
3: Insurance companies make economic decisions, based on profit, which kill people.
4: No plan can cover everything, and even what can be covered can't be covered right now.
5: Mistakes will be made, and sometimes people who would benefit from a procedure/drug will be mistreated.

Clausewitz strikes again

[harimad.livejournal.com]

tell me what you know/think" implies I need to be educated.

Well drat, this is what I was trying to avoid by asking the question. I'm trying to get myself educated, about what you understand "death panels" to mean.

We can't have a proper conversation about these if we aren't starting from the same place. We could, however, have a fine rousing fight - which I'd rather avoid.

So: Before I say "I think you're wrong about [something]," I should make sure that I understand what *you* mean. (Sorry about the convoluted sentence. I've rewritten it several times, trying to be both clear and, um, unexceptionable. That is proving difficult.) With a hot button topic like these, it'd be real easy to misunderstand or make inaccurate assumptions. Given all the different interpretations of the phrase running around, I want to know what _you_ understand them to be, before I start a conversation about them.

Re: Clausewitz strikes again

[pecunium.livejournal.com]

It's ok to ask me questions. I've been known to write with rhetorical flourishes, some of which get lost.

So asking me what I mean when I say, "death panels" won't bother me.

Re: Clausewitz strikes again

[harimad.livejournal.com]

So, um, nothing left to say right now - I see what you mean and, at this hour, have nothing to add.

That it's this hour (1 am) is 100% your fault. You got me started with Jon Stewart on YouTube. Thoroughly awesome!

[anton-p-nym.livejournal.com]

Tell me what you know/think about the so-called death panels.

I'm not the one asked, and if I'm out of turn on this please sound off, but in my opinion the "death panels" are the greatest invention since elephant repellant and rapid-firing anti-chimera cannons.

In other words, they're mythical and have as much bearing to the discussion to-hand as unicorn belly futures.

-- Steve thinks that the closest the US is going to get to Death Panels is the system they already have, with HMO bureaucrats denying coverage for life-extending procedures based upon profit/loss statements.

[harimad.livejournal.com]

the closest the US is going to get to Death Panels is the system they already have,

Funny, this is the logic I use to explain why we already ration health care.

On second thought, not so funny.

[don-fitch.livejournal.com]

Countering that last opinion, I'd suggest that large not-for-profit HMOs (& insurance companies, and a good public-option plan) aren't likely to be significantly obnoxious about this because denying coverage wouldn't be more than trivially profitable to anyone.

That said... ummm... I wouldn't be surprised if even good not-for-profit HMOs & insurance companies put at least some stress on cost-effectiveness when a choice is medically about 50/50. (I could have fought for, and probably gotten, reconstructive surgery when a malignant tumor in my nose rappeared six years after radiation treatment. None of the HMO people more than barely mentioned that, and on balance I'm still not certain it would've been better than the (presumably less-expensive) rhinectomy and provision of a prosthetic nose.)

[anton-p-nym.livejournal.com]

I think it's impossible for any health care system to give unlimited support for every possible treatment; there are going to be some forms of treatment that are disproportionally expensive for the probable outcomes or just too unlikely to succeed to justify tying up doctors and beds that could be helping people better. But this isn't the Death Panel arrangement so touted by the Birthers and their kin; this isn't a judgement on who is worth treating (and who instead gets Carousel euthanised) but rather a judgement on whether a procedure will do enough good to be used.

-- Steve does agree that taking dividend pressure off of health care coverage will lead to fewer claims denied on the basis of the bottom line.

PS: I do think that the US would benefit from taking a closer look at end-of-life care, but I don't think that's possible in the current superheated political climate.

[don-fitch.livejournal.com]

The system we already have, yes -- which includes not only (some) HMOs and (most) Insurance Companies, but also (which you didn't mention) a very large number (though less than the "40 million" often quoted) who simply can't afford any plan coverage, or much (or any) medical care they'd have to pay out-of-pocket. So, there's a significant amount of rationing (or dealing-out of untimely death) on the basis of means, which is something I think society/government ought to minimize (& at which MediCal and most states' similar back-up/poverty-level systems don't do well enough).

[jpmassar.livejournal.com]

A counterad to death panels

http://www.youtube.com/watch?v=ja8h2wxTzJY&feature=player_embedded

[lyorn.livejournal.com]

Tell me what you knowthink about the so-called death panels

A bunch of insurance bigwigs in a boardroom, deciding on profitability goals.

[summers-place.livejournal.com]

This.

[eyelessgame.livejournal.com]

man. pecunium, this is what you get for trying to be clever, and using a loaded term in an ironic way.

Listen, folks. pecunium is one of the good guys. His reference to 'death panels' is describing our current situtation, where insurance companies routinely make life-or-death decisions based on profit/loss calculation. I've been reading him more than long enough to know pecunium is not a bagger, birther, deather, packer, larouchie, dittohead, or randroid.

He is, in other words, a rational human being.

If you, harimad, on the other hand, think we don't have 'death panels' now, I invite you to read any of the plethora of available horror stories of people learning their insurance company has decided it's more profitable to kill them than pay for their treatment.

But it's hard to say what you meant, because you were much harder to decode than pecunium was. :)

[harimad.livejournal.com]

Did I make more sense the second time around, hopefully?

[harimad.livejournal.com]

PS - I totally agree that Pecunium is one of the good guys.

[pecunium.livejournal.com]

Easy. He's been around a while too. I was, perhaps, too sniffy with him (no offense intended shinymarigold, it's just that you used a locution which gets up my nose. I didn't take any personal offense at it).

He wasn't being "hard to decode" he was trying (I think), perhaps a tad too much, to give offense by publically assuming I wasn't being sarcastic/ironic.

[burger-eater.livejournal.com]

There's another version of the public option I'd like to avoid: the one that gets left with all the citizens private insurance doesn't want to take. If it becomes a dumping ground for cancer patients and other people who need expensive care, the costs will be extravagant and that will "prove" that government spends too much.

I wish employers had access to the public option, too, but that may have to wait.

[don-fitch.livejournal.com]

I don't feel guilty about not having read the proposed bills, because legislative legalese is one of the many languages in which I'm functionally illiterate. But considering that the medical care system -- big pharm., hospitals, insurance -- is both the largest and the most profitable entity in the nation's economy (well, _probably_ out-stripping the military-industrial complex), and that the various branches of it can and do contribute enormous amounts of money to political campaign funds, I'd be willing to bet a lot of money that if any legislation gets passed, it'll be loaded well beyond the Pimsoll-line with loopholes that will _not_ benefit the consumers, the government, or our society in general.

We can and should try to get something decent, of course, but it looks to me as though the dice are loaded against us.

[harimad.livejournal.com]

What do you think of Oregon's system? Both what they hoped to get and what they ended up with?