On Tuesday, the Senate health committee voted 12-11 in favor of a two-page amendment courtesy of Congressman Tom Coburn that would require all Members and their staffs to enroll in any new government-run health plan. It took me less than a minute to sign up to require our congressmen and senators to drink at the same trough!
Congressman John Fleming (physician) has proposed an amendment that would require congressmen and senators to take the same healthcare plan they force on us (under proposed legislation they are curiously exempt).
Congressman Fleming is encouraging people to go on his Website and sign his petition (very simple). I have immediately done just that at:
Fleming Poll
Make your thoughts known - vote! And just for the sake of intellectual debate rather than the partisan stuff we will hear in the mainstream media (if we hear about this at all), let us know here what you think!
I have signed the petition. I'm sure nobody is surprised.
I too have signed. I'm sure nobody can guess my position on this.
Who were the eleven who voted against this, and what reasons did they give?
I have no problem with the basic philosophical point of this amendment, but I can see problems arising from, e.g., not offering the same plans to all members. A more serious piece of legislation would make the plan apply to all members.
But the amendment refers to a "public, federal government run health insurance option." Is there a bill that would, as RiceDoc writes, force a government health care plan on us?
(09-28-2009 04:40 PM)S.A. Owl Wrote: [ -> ]I have no problem with the basic philosophical point of this amendment, but I can see problems arising from, e.g., not offering the same plans to all members. A more serious piece of legislation would make the plan apply to all members.
But the amendment refers to a "public, federal government run health insurance option." Is there a bill that would, as RiceDoc writes, force a government health care plan on us?
Eventually, as a practical matter, yes.
The "public option" could be manipulated in such way as to make that result inevitable.
Of course, if we can depend upon our public servants to act ethically, that is not a problem.
Of course, if we could depend upon our public servants to act ethically, half the problems we have now wouldn't exist.
The "public option" can be manipulated to achieve that result.
Will it be manipulated that way?
Nothing is certain, but I know which way I'd bet.
"Forced" is perhaps technically inaccurate. But if the deck is stacked, certain choices become inevitable.
Next year, I have a "choice". I can choose to go on the government option known as Medicare. Or I can go without any insurance at all. My choice. Nobody is "forcing" me to do anything.
Technically, I guess governmentites would say that it is my current health care plan that is forcing this. But I think it would not be happening if I didn't have the "option" of medicare. It is no accident that they say coverage will end the first day I am eligible for Medicare, whether I accept it or not.
Like I was told when I got my draft notice, I didn't HAVE to join the service. I could always go to jail instead. So I guess a military draft doesn't mean forced conscription. It really means volunteerism.
Some people leapt from the World Trade Towers rather than burn to death. A forced choice is not a free choice.
When people stack the deck, then tell you that you have freedom of choice, that is more sinister than than just "forcing" us. Rather than be lied to and manipulated like that, I would rather they just be upfront and force us.
The word has meaning. You were forced to join the service because not doing so would have violated the law. I'm not taking a stand on a government option. All I'm saying is this: If a bill doesn't force enrollment in a government plan, I don't think the debate is advanced by stating the opposite. The debate is advanced by addressing its merits as an option and/or how to ensure the deck isn't stacked.
(09-29-2009 09:35 AM)S.A. Owl Wrote: [ -> ]The word has meaning. You were forced to join the service because not doing so would have violated the law. I'm not taking a stand on a government option. All I'm saying is this: If a bill doesn't force enrollment in a government plan, I don't think the debate is advanced by stating the opposite. The debate is advanced by addressing its merits as an option and/or how to ensure the deck isn't stacked.
My problem with that approach is that I simply do not believe that the deck will not inevitably be stacked, no matter what attempts are made to prevent that. The plan will be driven by politicians and bureaucrats, and I simply to not trust either group to behave in an ethical manner.
(09-29-2009 09:35 AM)S.A. Owl Wrote: [ -> ]The word has meaning. You were forced to join the service because not doing so would have violated the law. I'm not taking a stand on a government option. All I'm saying is this: If a bill doesn't force enrollment in a government plan, I don't think the debate is advanced by stating the opposite. The debate is advanced by addressing its merits as an option and/or how to ensure the deck isn't stacked.
All words have meanings, and they differ from context to context. You are using it in a more legalistic way, I am using it in the practical way that it affects events. I guess the way that should hold is the way the original poster meant it.
As a general rule, I think Congress should not be exempt from any of the laws they pass.
The way I intended that "force" comment was that it was a plan that would we would have to live with whether we like it or opt in or not. It would be the law and we would have to work within its guidelines in making whatever limited decisions we are allowed to make. As a practical matter, the options are such that there is or, in my opinion, will be no real option - sort of a do you want to take a plane from Houston to Honolulu or do you want to walk/run/swim? I, like OO, think that as a general rule,Congress should not be exempt from any of the laws they pass. I further think that if they were not exempt, then they would give it more serious consideration instead of a 10,000 foot wave.
If given the choice, would ANYONE choose Medicaid or VA type care over private insurance other than for cost?? Seriously??
So why is "the public option" such a great idea??
HERE is the REAL problem....
How do insurers maintain profitibility??
a) maximize income through higher premiums
b) minimize expenses through negotiated costs
c) minimize expenses through denying coverage (in a variety of ways)
d) spread the pool of risk
How would this be different for the government?
a) is somewhat limited by the markets... but the government has no competition
b) I don't see that the government is any better at this, and they certainly seem to get worse care overall than the private insurers... but we can call this a wash
c) true and a problem... but one that the government could fix by mandate/oversight without offering a beauracratic competitor
d) Insurers do this by offering a better/cheaper product... which is GOOD for the consumers... The government does this by mandate or manipulation (offering a $5,000 package for $1,000 by "taxing the rich"), which is not.
Serious question.... can someone give me evidence that a public option is necessary? I mean, if the government simply kept their function of deciding who and what gets covered (which they do anyway though legislation and the courts) and got away from the duplicative administration of policies... wouldn't that solve the only real reason for NEEDING a public option
Congress should never be exempt from any law that applies to the rest of us.
Not even once ever.
There are no circumstances under which congressional exemption is justified.
None.
Period.
I agree with you all on no exemption for Congress. At any rate, it looks like the public option won't happen. As I hinted at, I've never been able to convince myself one way or the other on it.
I still like the French approach. Universal health insurance to provide a relatively low level of coverage, with supplemental insurance available to cover more elective procedures. 90%+ of French people have supplemental private coverage. N.B., that is a significantly higher rate of private insurance coverage than we have here--and they are the ones with the universal coverage.
There is little government role in the system. The government does provide catastrophic umbrella coverage kicking in at a very high level (on the order of $100,000), and in return insurance companies don't cancel policies or deny coverage for pre-existing conditions. The universal plan is run by insurance companies (who make money by investing the float between premium collections and payments, which to them are basically fixed). The government functions in that system pretty much the way your employer does in ours; they collect payroll taxes and send along to the insurance consortium the portion of social security applicable to health insurance. Basically people who work pay for everybody in the country. The "free" system is not really free; there are (pretty hefty) copayments to discourage overuse. The "free" system is intentionally limited; you can get just about anything on the "free" system, but there are intentional long delays for non-emergency elective procedures.
If you want surgery now, you go to the "pay" side. The "pay" side works a lot like our system, except it's a whole bunch cheaper because it isn't carrying a lot of the costs that we have to. You can buy insurance to cover yourself on the "pay" side, employers can provide coverage (which most do, because it's cheap and it gets their workers back on the job sooner), or you can just come out of pocket. I don't believe the French have anything like health spending accounts, but they would obviously work well with this model.
It's more of a free market system than we have. They basically have a free-market universal system. They certainly don't have--or need--a "government option."
Anybody with experience with the Swiss system? It seems even less intrusive than the French model. Obviously, an op-ed cannot get into the details, but it sure feels to me like some things are being glossed over here.
http://www2.timesdispatch.com/rtd/news/o...07/293912/
Open to others thoughts on this one.
Swiss system is very much like the French, and so is the German.
I have personal experience with French but not the other two, and my preference for French is based largely on that experience. Also, as I understand it, there is less direct government involvement in the French system than the German or Swiss, but all three have less government involvement than we do, or at least less than we are going to have if any of the versions of Obamacare become reality.
Both of those systems sound at least generally like my system. Obviously they are dealing with reality and I'm just a bozo looking at numbers in the marketplace... but if it makes sense to a numbers geek and works at least reasonably well in other countries, OF COURSE Congress won't go for it. It requires them giving up control of billions.
Interestingly, COngress would already exempt themselves from mandated care... they would simply vote for coverage to be part of their compensation.
Its amazing what happens when the employees get to choose their salary and perks
That's what's really frustrating to me about this debate.
If we only open our eyes, there are some very good models out there that do exactly what we want and do it quite well.
And yet, we don't look that way.
Democrats won't look that way because there's not enough government involvement to suit them. I truly think they are more interested in power and control than in improving health care.
Republicans won't look that way because.... I don't know, and can't figure it out. Maybe they are more interested in their own brand of power and control than in improving health care.
So we get months of hyperinflated rhetoric from both sides when a week trip to Paris, Berlin, and Zurich would probably give them a far better idea how to go.
And people wonder why I'm frustrated with the American political system.
(09-30-2009 03:43 PM)Hambone10 Wrote: [ -> ]Both of those systems sound at least generally like my system. Obviously they are dealing with reality and I'm just a bozo looking at numbers in the marketplace... but if it makes sense to a numbers geek and works at least reasonably well in other countries, OF COURSE Congress won't go for it. It requires them giving up control of billions.
Interestingly, COngress would already exempt themselves from mandated care... they would simply vote for coverage to be part of their compensation.
Its amazing what happens when the employees get to choose their salary and perks
Actually, Hambone, the French, German, and Swiss systems are a LOT like your idea.
I think the reason we don't see republicans OR democrats wanting this is that they lose control of THE MANAGEMENT of $1trillion dollars. Instead, they'd only collect payments and dole them out based upon some very simple and transparent rules... you know, like $5,000 per enrolled person. As opposed to the current accounting fiasco that creates opportunities for "pet" projects
I mean, I understand why Dems don't want insurance companies running the show, and I understand why republicans don't want the government running the show... but if the only part of the show the government ran was the IMPORTANT part, you know, ensuring that the insurance companies paid for covered services for covered people (pretty easy to figure out... either they paid it or they didn't... either they are covered or they aren't)... then BOTH should be saitisfied... but neither side can hide anything in that system. You can't collect more in taxes than you pay out in premiums without people knowing you've got a $100byn beauracracy.
(09-30-2009 08:39 PM)Hambone10 Wrote: [ -> ]I think the reason we don't see republicans OR democrats wanting this is that they lose control of THE MANAGEMENT of $1trillion dollars. Instead, they'd only collect payments and dole them out based upon some very simple and transparent rules... you know, like $5,000 per enrolled person. As opposed to the current accounting fiasco that creates opportunities for "pet" projects
I mean, I understand why Dems don't want insurance companies running the show, and I understand why republicans don't want the government running the show... but if the only part of the show the government ran was the IMPORTANT part, you know, ensuring that the insurance companies paid for covered services for covered people (pretty easy to figure out... either they paid it or they didn't... either they are covered or they aren't)... then BOTH should be saitisfied... but neither side can hide anything in that system. You can't collect more in taxes than you pay out in premiums without people knowing you've got a $100byn beauracracy.
I think you're onto something.
What does the U.S. health insurance industry think of the French model?
(09-30-2009 09:40 PM)S.A. Owl Wrote: [ -> ]What does the U.S. health insurance industry think of the French model?
Haven't seen much on that, but I can say that the French health insurance industry loves it. The "free" plan gives them exactly what they want--a steady stream of cash to manage. They make a nice profit off the float. This is how plan proponents got them onboard in the first place. Plus they have the latitude to get pretty creative with the "pay" policies they offer.
And they got the docs onboard with a combination of helping with med school costs and malpractice, and putting the doc-patient relationship back in the driver's seat on health care decisions.
There's nothing there we couldn't do.
I wonder about the overhead/management challenges that having 51 (or is it more with the territories?) different states plus DC and their individual insurance regimes. That's a huge challenge to overcome in any solution that might be closer to the French/Swiss/German models, don't you think? I know many here think it's a problem (I do to), but how does one get around that one?
(09-30-2009 10:31 PM)gsloth Wrote: [ -> ]I wonder about the overhead/management challenges that having 51 (or is it more with the territories?) different states plus DC and their individual insurance regimes. That's a huge challenge to overcome in any solution that might be closer to the French/Swiss/German models, don't you think? I know many here think it's a problem (I do to), but how does one get around that one?
It's 57, don't you remember, and Obama's been to all of them.
Seriously, there's an easy remedy, define health care as interstate commerce and the state differences go away. Not sure that's a good answer, but it is a quick one.
I'd rather see it handled another way, and I think it can be. If we had the two-tier plan, exempt the first tier from state regulation, and allow the states to do what they will with the elective tier.
69, not only a steady stream of cash, but an even wider pool of applicants to spread the risks... and let's face it... over time, if people become healthier... it is possible that their earnings could increase by having lower payouts and longer lifespans for their life insurance subs...
Educate me here sloth,...
If the federal government decided that "these" items were mandated to be covered at a cost of "x"... with certain requirements (I'm sure there would be plenty of lobbying for what those items were and what the cost was) What (at least broad strokes) would some of the issues be??
Personally, I'm closer to 69's thought where we simply mandate coverage and administration and let the states and feds oversee. Even as a Republican who believes in local decisions, I don't know that the people in one state want LESS coverage than people in other states. I mean if certain states want to add additional coverage mandates, that would be okay under this plan... you just can't offer LESS.
Not sure I can educate anyone on this topic, but I posed it for anyone who might be more familiar with the reasons for the divisions into state regulation. I'm sure there's tons of case law and/or formal laws around this one. You can be sure that the insurance commissioners (not an insignificant lobby, from my understanding in political power circles) would fight this one tooth and nail, breaking down those barriers. However, at the level that I think you’re getting at, Hambone, the states do get occasional mandates from the federal government that they then need their own laws to implement it within the confines that are managed/monitored/etc. by the state insurance commission.
In concept, I'm all for breaking down the barriers. And maybe 69's suggestion about a federal level for the base coverage, with the states still regulating the elective procedures, is the right model. However, I'm not sure you're getting the best efficiences by leaving the elective side in the states regulatory hands, as you'll still probably not have the diversity of participation (as noted in the column I linked to, there are currently only 18 carriers in the state of Virginia, with 2 owning 60% of the market) that could drive true cost savings. This scenario really doesn’t seem any different than what we have now. If anything, it might be worse for them, as the carriers have lost the more regular, consistent part of their business (the preventative consultations and simple procedures). Not sure where the competition is going to come from to get more participation unless the state barriers are broken down.
Hoping someone smarter in this stuff can add insight.
(09-30-2009 10:38 PM)Owl 69/70/75 Wrote: [ -> ]It's 57, don't you remember, and Obama's been to all of them.
It was "57, no, 58...one to go".
(10-01-2009 02:21 PM)OptimisticOwl Wrote: [ -> ] (09-30-2009 10:38 PM)Owl 69/70/75 Wrote: [ -> ]It's 57, don't you remember, and Obama's been to all of them.
It was "57, no, 58...one to go".
My bad
(10-01-2009 02:58 PM)Owl 69/70/75 Wrote: [ -> ] (10-01-2009 02:21 PM)OptimisticOwl Wrote: [ -> ] (09-30-2009 10:38 PM)Owl 69/70/75 Wrote: [ -> ]It's 57, don't you remember, and Obama's been to all of them.
It was "57, no, 58...one to go".
My bad
Not YOUR bad.
Let me say that, coming perhaps from more to the left than most of the posters on here, I am totally on board that Congress should be required to follow the laws they pass. They should all get Medicare and any new health care plan enacted.
One thing I found interesting in listening to Pacifica Radio the other day is that some on the left believe the public option as it is being proposed now is being set up to fail. If I understood the argument, they say more sick people will sign up than healthy ones, and a few years down the road the costs will be such that it will be declared a failure and we will never get "real" single payer.
Frankly, I don't know a lot about this, but the French system sounds good to me. Anyone know why something like that is not on the table? Too much of a change to the current system, I guess?
(10-01-2009 04:14 PM)Owl75 Wrote: [ -> ]Let me say that, coming perhaps from more to the left than most of the posters on here, I am totally on board that Congress should be required to follow the laws they pass. They should all get Medicare and any new health care plan enacted.
One thing I found interesting in listening to Pacifica Radio the other day is that some on the left believe the public option as it is being proposed now is being set up to fail. If I understood the argument, they say more sick people will sign up than healthy ones, and a few years down the road the costs will be such that it will be declared a failure and we will never get "real" single payer.
Frankly, I don't know a lot about this, but the French system sounds good to me. Anyone know why something like that is not on the table? Too much of a change to the current system, I guess?
I will probably offend your liberal sensitivities in saying this, but the reason I believe the French option is not on the table is because I don't think any of the principals involved in health care reform really give a damn about improving health care. It's a power grab, pure and simple. And the Obama democrats are just as intent on pulling economic power away from the people as the Shrub republicans were intent on pulling personal liberties away from the people. Either way, we get screwed. That's my opinion, at least.
If this were about improving health care, the French/German/Swiss approach would be front and center. But those plans don't give government bureaucrats the kind of life and death power that they enjoy in single-payer/single-provider systems. Yes, "death panels" are real, although oddly enough it's not the part of the house bill that was removed after those protests that gives rise to the concept. There simply is no way to run a single-payer or single-provider system without either skyrocketing costs or agencies with "death panel" powers to ration care (or, what usually happens, both).
Just one more iteration of the standard left-wing mantra, "This is a terrible crisis, and if you just turn it over to the government, we will solve it." Except that the bureaucracy created to solve the problem quickly realizes that once the problem is solved they aren't needed any more, so the first thing they do is make sure that the problem gets worse (so they get more money to solve it) rather than better.
Meanwhile the republicans are asleep at the wheel. I think they have proposals, but they can't explain them to me in ways that cause me to think that they have a clue what they're talking about.
I have little use for either major party.
I appreciate the perspective sloth...
18 providers with 2 having 60% of the market certainly implies that you can break even with pretty small market-share. In MY world, the costs and risks to the insurance companies would be spread across state lines, just as they generally are now... Medicaid contracts would be administered by BCBS, UHC, Cigna etc. I mean, from a practical standpoint, they're all doing the same thing anyway. The doctor lists and payment amounts might be different, but its the same idea.
75, see... THIS is where I believe the public is being lied to. Those we seek to insure (the poor) are already getting medical coverage... but it is usually in the emergency room (which is expensive) or at the "free" clinic (which isn't really free) or shows up in other parts of the economy like lost productivity, welfare and other checks we're already writing. People don't get paid when they have to spend the day at the clinic, or lose their jobs... The're getting bad, innefficient and expensive care. If they could go to the Walgreens clinic when they had an upper respiratory infection instead of waiting until it was pneumonia and going to the emergency room, we'd ALL be better off... and the costs wouldn't be any more...
My PROOF (honestly its just a theory) is that we currently spend $3100 PER PERSON on healthcare in this country... and that is just the PUBLIC portion of funds... not to mention the $3800 per person in private funds... The state of Michigan (iirc) mandates an insurance policy with 34 MANDATED coverages and it costs $3100/yr. That is, IF you offer insurance, you MUST cover these 34 areas... If Michigan can do it for that amount, then "the country" should be able to do it for even less.
See, to ME... the beauty of the system we are talking about is this...
Who determines how much the policy can cost? The government... but since the money isn't going into THEIR coffers to do something with, but into the coffers of corporations.. they have no reason to have that number be high... in fact, it is politically expedient for them to have it be as low as possible. NOW there comes a tug of war between doctors and insurance companies with the government being the arbiter... and the check they decide to write being the prize... I mean, ultimately... if the doctors or insurance companies want more money, they have to ask congress to increase taxes.
The argument would be simple... and the numbers should be easy and transparent. Sure, we could argue about corporate policies on bonuses and things... and PERHAPS you reach a point where insurers refuse to do it... but I REALLY like the idea that politicians are ONLY motivated to provide me with the MOST care for the LEAST cost... The left mandates 50 areas of coverage, the right wants 25... we settle on 35.... Congress decides it can be done for $2500pp, Industry says it can be done for $3500pp. Arbiters put the figure at $2800 and we roll along. It would REALLY be that simple from our perspective because it would be on everyoned 1040 form... How much are we talking PER PERSON or PER POLICY... not some masive figure of $3 trillion divided by some round figure of 250mm people... but we covered Joe and Mary and Steve etc... at income of $2800 per person and expense of 2790 per person.
69 it would take a lot more than that to offend me. I think our current system works well if you have money or work for a big company (or Congress). So I would like to see an improvement to the system, not for "power" but to have a better result for most people. Maybe others in Washington are about power but its hard to know. I imagine if anyone introduced the French ssytem it would be attacked very much as the worst kind of socialism. By the way, I don't identify with either major party much, but more with the Ds, at least in Texas. If I lived in Mass. maybe I would find the Rs better.
The french system isn't really socialism any more than "the public option" is.
By that I mean, the public option is billed as a way to convert the hodge-podge delivery of emergency type services into a system of care that will be more effective and less expensive. Unfortunately, the model for this care is Medicaid and the VA. Notorious for poor care and fraud. The PRIVATE version of this is an HMO... notorious for denying coverage.
The difference is, while the government doesn't WANT fraud, they really aren't incentivized to stop it... and if you don't like the quality of your care, they don't really care. You can complain to your congressman, but what can they do about it short of "overhauling Medicaid."
At least if the care were private, you could choose between BCBS, UHC or others and address your complaints to Congress who could threaten to kick one or more of them out of the "pool"... and if the care were mandated, denial of coverage wouldn't be an issue.
(10-01-2009 09:09 PM)Owl75 Wrote: [ -> ]69 it would take a lot more than that to offend me. I think our current system works well if you have money or work for a big company (or Congress). So I would like to see an improvement to the system, not for "power" but to have a better result for most people. Maybe others in Washington are about power but its hard to know. I imagine if anyone introduced the French ssytem it would be attacked very much as the worst kind of socialism. By the way, I don't identify with either major party much, but more with the Ds, at least in Texas. If I lived in Mass. maybe I would find the Rs better.
Actually the French system is very much less socialism than the public option or the two models that the democrats seem to like so much--Canada and UK. And I see many reasons to believe that the public option is intended as nothing but a step on the way to NHS or Canadacare, and no reasons to believe otherwise.
The French have a very derisive term for the UK NHS--they call it "socialized medicine" and want nothing to do with it.
I would say that attacking the French system as socialism is completely misunderstanding it. That's what I find ironic about Michael Moore's movie--he praises French health care at the same time it's obvious that he does not understand how it works. I heard him say in an interview, "We need a single-payer system like France." Only problem, France is NOT a single-payer system (nor is it a single-provider system).
Calling the French system socialized medicine dovetails neatly with the bait-and-switch tactics of some leading democrats--I've heard several of them say, "France has great health care; therefore we need to copy UK (or Canada)." Worse yet, people are falling for it.
I would like to believe that our nation's leaders really want what is best for the USA and American citizens. It's been far too long since we have had a leader that I believed that about.