RSS Feed MenuAs Washington struggles to figure out what went wrong with Obamacare, and what will become of its centerpiece — the public option — much of the focus has been on the strategy, or lack thereof, for passing this complex legislation.
Should the White House have waded into this debate earlier and made clear that the public option was a sine qua non of health care reform?
Should Democrats have pushed the comparatively radical Medicare-for-All proposal of its Progressive caucus, understanding that the public option would be a negotiated fall-back?
Should the White House have pushed reform and the public option on moral grounds, rather than as cost savings devices?
All are legitimate questions. But this inside-baseball strategic debate misses perhaps the central variable in Obamacare’s collapse — the public option must sound incredibly odd to those citizens who do not spend their lives thinking about politics. In other words, as progressives rush to defend the public option, it is easy to forget just how weird their key proposal likely appears to the town-hallers.
Consider the arguments of Rep. Anthony Weiner (D-NY). Earlier this week, he made the cable television rounds to defend the public option. Against the charge that the public option would crush private insurance companies, Weiner responded that such an outcome would be acceptable because that is how competition works.
The problem for Weiner and the liberals demanding a public option is that this is not how competition works. At least not as understood by the vast majority of privately employed Americans.
I imagine that the middle-class Americans Obama is so eager to win back hear this argument and wonder:
If that is how competition works, then why not promote government run airlines and auto manufacturers to keep those private industries honest? For that matter, why not get into the hamburger business to discipline McDonald’s and Burger King?
What Weiner and the left argue matter of factly — that it is entirely consistent with free markets to have the government providing services in competition with private industry — has to sound off-the-wall when pitched to citizens at these town hall meetings. When defended openly and aggressively, as Democrats are defending it now, the public option appears fundamentally at odds with the understanding of free markets and liberal societies experienced and expected by the vast majority of Americans. The government should be in the business of providing public goods that private industry cannot provide. But it emphatically should not be in the business of competing with private industry. As the polling indicates, this expansive understanding of the government, as not only a market regulator but as a market actor and creator, is proving a tough sell to an American public that goes to Best Buy and finds Toshiba and Sony competing with each other and providing decent products, even absent a government-option in the television market.
With progressives taking the lead in selling the public option, it has become ever more clear that the difficulties for Obamacare are far too significant to be solved by some shift in strategy. The problem for the left is not merely overcoming the fear (Democrats would argue the misconception) of citizens that the public option will displace existing health coverage with inferior care and a higher tax burden. And their problem isn’t in the selling. The problem is that with their attempt to have government competing with private companies, Democrats are pushing a foreign sounding product that the American people just won’t buy.
And no amount of Washington strategery is going to change that.
ottovbvs // Aug 22, 2009 at 1:22 pm
sunroof // Aug 22, 2009 at 1:12 pm
“There isn’t a healthcare system in the world that doesn’t have its positives and negatives. Instead of highlighting the weaknesses of other systems, the US should be looking to cherrypick strengths.”
…….Philosophically I agree with you but you can’t ignore political and organizational reality…..we are where we are…….whatever passes in the fall is going to evolve over time as we discover what works and what doesn’t …….that’s what’s happened with all these European systems two of which I have personal experience of (Britain and France)
Churl // Aug 22, 2009 at 1:24 pm
Otto, so you don’t know much about the European health systems you seemed to be promoting.
I apologize for asking for details; I mistook you for a while like a fount of knowledge just waiting to gush wisdom to us unelightened ones.
Churl // Aug 22, 2009 at 1:25 pm
correction “I mistook you for a while to be a fount of knowledge…”
ottovbvs // Aug 22, 2009 at 1:39 pm
Churl // Aug 22, 2009 at 1:24 pm
“Otto, so you don’t know much about the European health systems you seemed to be promoting.’
……..I know quite a lot about two of them because I’ve been treated in them…..I also know the rest are a) universal b)feature a mix of private/public insurance c) they are all closely govt regulated d)they all cost about half what ours does c)none of the citizens of these countries would choose our shambolic and expensive system over their own……..sorry if this knowledge is offensive to you
ottovbvs // Aug 22, 2009 at 2:03 pm
Churl // Aug 22, 2009 at 1:25 pm
” correction “I mistook ”
………Call me Gradgrind if you like……what I find harder to understand is your enthusiasm for commenting from a position of semi or total ignorance…..is it genetic or cultural
liv&win // Aug 22, 2009 at 3:19 pm
balc: indirect labor costs include the percentage of labor used to bill, collect and redistribute taxes from the IRS to CMS. http://www.bcbs.com/issues/uninsured/Sherlock-Report-FINAL.pdf
In the attached, the author also discusses that claim and service functions outsourced to private industry in Medicare are not accounted for in their administrative expenses. There are other “management” costs which are not accounted for. For example, the percentage of time and expense of congressional deligations and assistants devoted to Medicare. The government also utilizes other agencies efforts and budgets at times to assist them in their functions.
My point is that public accounting is far different and less accurate than private accounting when analiyzing administrative expenses. A private firm would have to account for all plan adminsitrative aspects whereas the government doesn’t. The government also borrows money to fund its activities. the interest on the debt attributable to Medicare is not accounted for in its budget.
Balc, if you can show me a detailed budget on Medicare, I would like to see it. My point in main is that let’s understand that the comparisons we are making are often apples and oranges. Either we admit that and explain why the apple is a superior fruit, or we make an honest attempt to equalize apples and oranges so that comparisons are fair, honest and understandable.
If you have read my posts, I don’t think health care costs can be reduced by increasing competition amoung insurance companies within the present system. The cost of health care, and therefore health insurance is determined by how much it costs to see the doctor and how many times in a period of time you visit the doctor. I also don’t think medical care competition is best served within the concept of prices. Health care should compete on the basis of quality, efficency and affectiveness. Those that win at that game should be compensated better than those that don’t provide the consumer with a better experience.
there is also the problem that medical care as it is currently organized doesn’t fit with tradional supply demand models. In medical care, suppliers have too much control over both supply and demand. For example, a doctor simply tells you he wants you to come back next month for a follow-up, regardless of if you are feeling well or not, and you comply. Who controlled supply and demand?
In my recommendations, I am taking these data points into consideration when attempting to build a better system. So, as I said, lets get all the data points out on the table and develop something that addresses them all. You may also recall that I am in favor a system that is similar to single payer, universal coverage for primary care services (medical, dental, oral, vision, mental health and alternative therapies like accupuncture and chiropractic). For secondary services, knowing the data points as I do, I think private insurance which has a national network of hospitals and specialists, where there are no pre-existing conditions, no employer mandate, fully portable and consumers can vary their coays, coinsurance, deductibles, out of pocket maximums to whatever level they need to to fit their needs and their budget is an idea worth exploring. I say this because one of the things I want more of is freedom, freedom from government interference in my life choices.
liv&win // Aug 22, 2009 at 3:25 pm
otto, don’t be a grind by insulting people. Or are you getting paid more for rude and hostle posts?
ottovbvs // Aug 22, 2009 at 4:09 pm
liv&win // Aug 22, 2009 at 3:25 pm
“otto, don’t be a grind by insulting people. Or are you getting paid more for rude and hostle posts?”
……….Why do you feel it necessary to keep repeating these falshoods about Medicare’s funding problems……if any of my claims about the real nature of these is incorrect tell me where…….Mr Gradgrind btw is a character in the Dickens novel Hard Times who is overly addicted to facts
ottovbvs // Aug 22, 2009 at 4:21 pm
liv&win // Aug 22, 2009 at 3:19 pm
“balc: indirect labor costs include the percentage of labor used to bill, collect and redistribute taxes from the IRS to CMS. http://www.bcbs.com/issues/uninsured/Sherlock-Report-FINAL.pdf”
……..Before even taking a look at this(which I will because I’m genuinely interested) I’m going to guarantee it’s written by some consultant who has been paid by a group of insurance companies to produce the report……this probably had something to do with it’s conclusions
liv&win // Aug 22, 2009 at 4:32 pm
Otto: From the GAO:
“While today’s debt numbers are large, they do not represent a measure of all future claims. They exclude a number of significant items, such as the gap between currently scheduled Social Security and Medicare benefits and the revenues earmarked for these programs as well as the
likely cost of veterans’ health care and a range of other commitments and contingencies that the federal government has pledged to support. For example, the Statement of Social Insurance in the 2007 Financial Report of the United States Government disclosed that as of September
30, 2007, for Social Security and Medicare alone, projected expenditures for scheduled benefits exceed earmarked revenues (i.e., dedicated payroll taxes and premiums) by approximately $41 trillion over the next 75 years in present value terms. Of that amount, $34 trillion is related to Medicare and $7 trillion to Social Security.”
That is a fiscal deficit of $34 TRILLION. Please explain why you think Medicare is a fiscally prudent and well managed program?
liv&win // Aug 22, 2009 at 4:38 pm
otto:”……..Before even taking a look at this” I am going to argue that because it is written by someone I don’t like, all their facts and conclusions are erroneous.
that otto is an ad hominem logical fallacy. Do you get paid more to post logical fallacies? How much do you get paid to post here anyway?
ottovbvs // Aug 22, 2009 at 4:56 pm
liv&win // Aug 22, 2009 at 4:32 pm
“That is a fiscal deficit of $34 TRILLION. Please explain why you think Medicare is a fiscally prudent and well managed program?”
……..Still misrepresenting I’m afraid…….these are the likely liabilities Medicare will incur in paying for medical care for enrollees over the next 75 years……It is NOT the cost of administering the Medicare program……I’m beginning to wonder if you understand the difference……..all this proves is that the govt has, of now, underfunded one of it’s major social programs leaving aside the fact that 75 years is an utterly ridiculous timeframe(do you think govt is going to do nothing about this for the next 75 years)……..What you’re essentially complaining about is the concept of Medicare not how it’s
administered.
……..And I did a quick eyeball of the Sherlock report, and guess what, it’s from a consultant hired by BCBS……….I’ll read it in more detail when I have time but I immediately spotted one inconsistency in the exec summary……Sherlock claims insurance admin costs average 9.18%…….I then checked this against the 2009 financial results from Wellpoint who are the largest health insurers in the land(about 35 million enrollees) and actually operate the BCBS franchise and their admin figure is 17.1%!
ottovbvs // Aug 22, 2009 at 5:01 pm
liv&win // Aug 22, 2009 at 4:38 pm
“How much do you get paid to post here anyway?”
……..Zippo…..I told you exactly what my background was while you continually avoid it leading me to conclude that you’re probably in the insurance brokerage business
” I am going to argue that because it is written by someone I don’t like, all their facts and conclusions are erroneous”
……..No it means I’m going to treat it with some scepticism because, guess what, I know consultants get paid by companies and trade associations for writing slanted reports……..I’ve commissioned the odd one myself
liv&win // Aug 22, 2009 at 5:43 pm
otto: I don’t think you get it. I know what administration in health care is. While I have argued with you about administrative costs, my arguement has always been the unfunded liability issue. And that is an issue you consistently sweep under the rug. By doing so, I am certain you don’t get it. 75 years is indeed a long time. But not nearly as dramatic as a $34 Trillion deficit.
Medicare was established in 1964. By 1970, the deficit disaster was well recognized. that was nearly 40 years ago. 40 years ago, consultants and advisors stood up and said, “hey there, we have a big problem coming down the road.” Almost every year since, the report has been the same. “we have estimated revenues and estimated expenese, and there is going to be a huge deficit.” And the brilliant politicians said the same thing you did, “oh thats 75 years away…we can’t worry about that” (not exactly your words).
So, I wonder, do you think the actuaries just make this stuff up? that is will all just go away? Do you have any point of comparison of what $35 Trillion is?
Further, when you are advocating public universal health care, I would appreciate it if you would at least recognize that you are advocating a permanent plan. And to be permanent, it must be sustainable from one generation to the next. Your generation F#&#ed that up for the next generation and now you want to F$&K it up for the next 4 generations.
every american under the age of 45 should start a revolt. They have been screwed, before many of them were born, by the baby boomers and greater generation.
liv&win // Aug 22, 2009 at 5:54 pm
Let me say that again, if you are under 45 years old, you have been screwed by your parent’s generation, probably by your grandparent’s generation and possibly by your great-grandparent’s generation. For you who are much younger, you have been screwed since long before you were born. the previous generations did nothing to provide you with a sustainable system. they ruined the environment, they raided the treasury, they heaped trillions of dollars of debt on your backs. They never thought about what comes next.
Those that are blindly supportive of a government takeover of health care are also guilty of not considering what comes next. They refuse to address that. That will be your burden and the burden of your children and theirs.
Do you know why their is such fierce, illogical appeal to government run health care? Because the boomers want to make sure you fund their retirement. The boomers don’t give a shit about you. Their entire existence has been about them. It was always about them. It will always be about them. F*&K them back, take your country back and make them pay!
ottovbvs // Aug 22, 2009 at 6:13 pm
liv&win // Aug 22, 2009 at 5:43 pm
“I know what administration in health care is. While I have argued with you about administrative costs, my arguement has always been the unfunded liability issue.
……..Actually your argument has not been about the unfunded liability……..You obviously hate Medicare as a concept but have always muddied the waters by trying to make it about the cost of administering Medicare
“And that is an issue you consistently sweep under the rug. By doing so, I am certain you don’t get it. 75 years is indeed a long time. But not nearly as dramatic as a $34 Trillion deficit.”
……….I’m not sweeping anything under the rug……I’m well aware we have a 34 trillion Medicare deficit(although 75 years ludicrous way of measuring it)……. almost all of it for the provision of care…….so the problem is to contain the growth in the cost of care which btw will equally afflict private insurers
“And the brilliant politicians said the same thing you did, “oh thats 75 years away…we can’t worry about that”
……..For the 44 years since passage Republicans have been in power for 28 years and Democrats for 16…..neither show any enthusiasm for eliminating Medicare….nor should they……the bottom line of any liability grows out of the fact we’re running a non universal program that costs twice as much as anyone else……bring our costs into line with our peer group and 34 trillion becomes 17 trillion in round terms
liv&win // Aug 22, 2009 at 6:23 pm
To those under age 45, who don’t believe me. Look what is in store for you, courtesy of the GAO:
For example, under our alternative simulation closing the fiscal gap would require spending cuts or tax increases equal to 6.7 percent of the entire economy over the next 75 years, or about $54 trillion in present value terms. To put this in perspective, closing the gap would require an increase in today’s federal tax revenues of more than one-third or an equivalent reduction in today’s federal program spending (i.e., in all spending except for interest on the debt held by the
public, which cannot be directly controlled) and maintained over the entire period.
My young american friends, very little of this is your problem. Why should you be burdened by the failings of the prior generations? This report says that for the rest of your life, and most of the life of your children, you will be paying out the ass for those that came before you. this is debt, not a capital building campaign. You are not getting anything in this bargain. All you are doing is paying off someone else’s debit. You will not be saving more, enjoying life more. You will be in virtual servitude to the boomers. You need to wake up NOW.
ottovbvs // Aug 22, 2009 at 6:52 pm
liv&win // Aug 22, 2009 at 6:23 pm
” My young american friends, very little of this is your problem. Why should you be burdened by the failings of the prior generations?….you will be paying out the ass for those that came before you.”
……..Au contrare…. to the rather hysterical rantings of my young friend they’ll actually be paying out the ass for themselves most of the time because they’ll all be dead before the 75 years is up…..with current life expectancy anyone over 45 is going to be dead in 35 years still leaving 40 years on your timeline to run
……..Now let me see on a 75 year time line if you’re 45 that means in 20 years time you’ll be partaking of this largesse which will still leave 55 years of it to run…..you’ll be dead about 15 years later which would still leave about 40 years of the timeline to run
……Now take a 25 year old, you’ll be partaking of this largesse in 40 years time with 35 years of the timeline to run…..you’ll be dead 15 years later, say 20 for increased life expectancy with still 15 years of the time line to run
……….His other numbers are bs too……these GAO calculations are based on the assumption no one does anything about cost for 75 years, annual growth rates of around 2.2% when we’ve averaged abut 3.3% for ever
……….liv&win…..bs ever was thy name
liv&win // Aug 22, 2009 at 7:13 pm
Thanks otto for making my point. You prove my thesis about boomers.
ottovbvs // Aug 22, 2009 at 7:28 pm
liv&win // Aug 22, 2009 at 7:13 pm
“Thanks otto for making my point. You prove my thesis about boomers.”
………..and you claim you’re ultra logical?…what a laugh ……the majority of the 75 year time line is consumed by the under 45’s not the over 45’s……….Btw when are you going to start sending me some checks to cover your education………not that it seems to have been that beneficial in the math dept
LFC // Aug 22, 2009 at 8:48 pm
And here is what we know, Medicare is on its way to insolvency despite its monopoly for people age 65 and older. Medicare has no competitor and it is failing financially.
I find it amusing that people point to Medicare’s woes, but fail to note that payments (premiums) into Medicare are less than those going to private insurance companies, or that Medicare picks up the most expensive people to insure.
We already have a direct comparison of Medicare vs. private insurance. It’s called Medicare Advantage, and it costs the taxpayers 14% more than Medicare. That tells me that we’re better off funding Medicare instead of paying a huge premium to cover private insurer’s profits.
Spartacus // Aug 23, 2009 at 12:42 am
If a public plan would inevitably eliminate all private insurers, why are private insurers thriving alongside public options in California, Singapore, France?
If a public option will crush all private insurers, how do you explain the fact that private insurers in the Netherlands resulted in the elimination of the public plan there?
The conservative/GOP argument against the public option on the grounds that it will eliminate private insurers is the closest thing we have to the long-ago proven false arguments that the world is flat and the sun revolves around the earth.
Conservatives and the GOP are simply impervious to facts.
ottovbvs // Aug 23, 2009 at 2:34 pm
Spartacus // Aug 23, 2009 at 12:42 am
“Conservatives and the GOP are simply impervious to facts.”
………Unfortunately yes so they substitute spin, obfuscation, mcguffins, and if they don’t work out, downright lies…….they are desperate to maintain the status quo and have no viable alternative……..not that any of this stuff matters because at the end of the day the Obama admin will pass this