A real newspaper would report this by saying ...
Are there any real newspapers in the US?

That was yet another front-page editorial masquerading as a news article. Not one substantive quote from anyone supporting the public option.

I've been trying to provide the administration with the benefit of the doubt, but this article makes it pretty clear the folks in charge (cough-Rahm-cough) still believe that if we stick with our principles we'll scare the poor voters.

Or maybe that last work should be "donors"...

If health insurance is mandated what will qualify as health insurance. How about a policy that has a $100,000 annual deductible that pays nothing until the deductible is met. If such a plan existed I would think that it could be quite inexpensive.

And people wondered why I was not enthusiastic about Obama. (Although I was no more enthused by the thought of a Clinton presidency.)

Very interesting, Dean. You are not against the state forcing people to buy insurance. You are only against it if your preferred option is not on the table. Once the public option is available then the state can use all the force it likes. That's the strangest definition of freedom I've ever heard.

MAKE MEDICARE/MEDICAID THE SINGLE PAYER, call Pelosi @1-202-225-0100. DC business hours only, call often, and spread it around.

"Once the public option is available then the state can use all the force it likes."

Dr. Baker has already addressed this. If private tyrannies make a free choice to switch from private to public, democratized insurance, then they have made a free choice to utilize the democratized system. Nobody's forcing anyone to do anything in a publicly-funded, democratized system. If an employee chooses to reject the public option, she may purchase private insurance.

That's the strangest definition of freedom I've ever heard.

Really?

Tom,

I don't know if this has occurred to you, but if having health insurance (of some sort, whether private or governmental) is not mandatory for everyone, we can't stop insurance companies from denying coverage for pre-existing conditions. It's up to you if you'd like to see the latter type of change, and how important it is relative to what you consider other pro's/con's of "reform", but I'm just pointing out the linkage.

Without mandatory insurance coverage for everyone, if insurers had to cover all pre-existing conditions, many people would not get insurance until they needed healthcare (often for expensive tests and/or treatment), which would blow up the insurance business model, at least for the individual segment, because most individuals wouldn't be paying any premiums until they knew that their healthcare was going to cost much more than the amount of premiums.

Well said, Brooks.

Thank you Dean,

I don't always agree with you, but you play the straightest game of the blogs. Thanks again.

"MAKE MEDICARE/MEDICAID THE SINGLE PAYER"

Once again folks, Medicare as it exists now is not single-payer unless you consider single payer to be a plan that a client of necessity (so as not to end up bankrupt if he comes down with a serious illness or has a bad accident) needs to buy 2 PRIVATE insurance plans as supplements. If you have Medicare and are not poor enough to get further governmental assistance, you need a MediGap policy to cover the 20% of your costs that Medicare doesn't pay and a Part D plan for your drugs. Both of these are private insurance and if you want dental and vision coverage, you need insurance for that as well. Or you can pay for all of these services yourself and good luck with that plan.

Most people, even most people living on Social Security alone, are not poor enough to have total coverage. Right now it takes about 3 payers for the average Medicare client to get health care without facing bankruptcy if he really needs serious health care: Medicare, PRIVATE Med-Gap or Medicare supplement and a PRIVATE drug plan.

Mike Meyer is this what you are saying we need????

Brooks,

Aetna and the others will certainly profit if we force the twenty-somethings to get coverage. But is that essential for a viable market? That's not so clear. The twenty-year-old is simply much less likely to need expensive tests, etc.

Another problem with mandatory coverage is that many people live in underserved markets. So we force them to get the coverage, but they can't get the care (long distances, long waits, poor treatment, etc).

Jorge- a twenty something is less likely to need expensive tests but is very likely to grow into a 50 year old.

three mandates must be taken together in context with a public option - (1) required minimal coverage under reform, which eliminates restrictions on pre-existing conditions, (2) individual mandate to have insurance and, (3) mandate on guaranteed issuance of insurance

by dropping the public option and enforcing all three mandates, individuals are forced to take insurance from private insurers who are forced to offer it, free of restrictions on pre-existing conditions

if the individual mandate to have insurance is dropped along with the public option, but the other two mandates are retained, private insurers cannot "deny" coverage of pre-existing conditions to anyone choosing to take insurance under guaranted issuance

but in the absence of choice for a public option, they can certainly jack the price up as high as they like and employ the same aggressive marketing as always to solicit low-risk customers - even if they're required to sell to high-risk ones one demand

the claim of free riders jumping on board when they need insurance is bogus - they'll be dealt with easily in the fine print, despite what the mandates imply, penalties will be allowed to avoid gaming of guaranteed issuance

an individual mandate to have insurance in the absence of a public option only worsens this outcome, providing private insurers with a captive base

it's not about mandates pooling and spreading risks - it's about mandates maintaining corporate welfare for private insurers who won't compete on price under weak reform with no public option

either have an individual mandate with a strong public option that includes access to it by everyone, including the currently insured, or drop the individual mandate if the public option is also dropped

izzatzo,

but in the absence of choice for a public option, they can certainly jack the price up as high as they like and employ the same aggressive marketing as always to solicit low-risk customers - even if they're required to sell to high-risk ones one demand

the claim of free riders jumping on board when they need insurance is bogus - they'll be dealt with easily in the fine print, despite what the mandates imply, penalties will be allowed to avoid gaming of guaranteed issuance

You claim, with no explanation, that if there were a prohibition on restriction/denial of coverage for pre-existing conditions AND guaranteed issuance, there would be a way to prevent people from "gaming" the system (waiting to get insurance until their healthcare cost would predictably far exceed the cost of premiums) by putting some sort of "penalties" "in the fine print". Can you spell that one out?

If the insurer cannot reduce/deny coverage for a pre-existing condition, presumably they won't be allowed some back-door way to achieve the same thing by imposing "penalties" to extract cash from the member to compensate the insurer for the cost of the healthcare the member receives.

Will the government impose this "penalty"? Woudn't that, in effect, be at least a reduction in coverage of a pre-existing condition, assuming the penalty was large enough to provide the proper incentive to deter people from skipping premiums for years until they required expensive treatment?

I'd like to see an explanation on how this "penalty" system could be an effective deterrent without conflicting sharply with full coverage for pre-existing conditions.

D.Flinchum: Co-pays and fees are necessary for Medicare at this time BECAUSE of its ties to Social Security. The SAME day to day pay-as-you-go that pays the SS checks, pays also Medicare/Medicaid expences. These Medicare expences will cause the SS Trustfund to be dipped into earlier than on just Social Security payments alone. Medicare needs to be separated from Social Security, given its OWN trust fund, and YES, pay the TOTAL price of healthcare for its POLICY HOLDERS. Policies can be SOLD to the public at A FAIR PRICE FOR A FAIR PRODUCT and support ALL cost PLUS build a trust fund, invested in T-bills, for that rainy day. Insurance USED to work that way and MAKE A PROFIT until they just plain got greedy.

"but in the absence of choice for a public option, they can certainly jack the price up as high as they like and employ the same aggressive marketing as always to solicit low-risk customers - even if they're required to sell to high-risk ones one demand"

This is basically what we have for under-65 disabled in Virginia. The sole insurance company that will cover these folks charge an exorbitant amount. I don't know of a single person that I have worked with in 2 1/2 years that could afford it.

Mike, what you have described is not "Medicare for all" - it is a totally different system. I'm not disputing the quality of what you say in your second post (as far as you go) but please, please, please stop saying Medicare for all. I have a number of clients who pay at least a third of their income every month for their part B ($96.40), their MediGap ($170+), their drug premium, co-pays, etc ($200+) BEFORE they hit the infamous doughnut hole. Then they dip into savings because they needs current funds for rent, utilities, uh, FOOD, etc. Most of my clients have savings for their burial. They don't want to burden their families. Having to deplete these savings is a crushing blow to them.

Medicare is no picnic as it exists for people who are, as far as most of us are concerned poor, but who do not qualify as poor based upon some government standard. I recently had a young (48 years old) disabled woman break down in tears when I explained the reality of what she could reasonably expect with Medicare. She has MS and had eagerly anticipated being cover by Medicare because then she could afford her drugs and to get the treatments she needed. Only if she could (1) pay for a MediGap (she couldn't) or (2) pay 20% co-pays (she couldn't) AND over $200 a month for drugs (pre-doughnut hole) plus $96.40 for part B.

D Flinchum: Why leave those folks YOU speak of in the linch they're in? Those ARE EXACTLY the very people that NEED change. MOre of the same IS NOT the answer.

Mike, I am not against reform, even though I personally would likely be worse off. I favor reform and in a post on another of Dean's blog entries regarding health care reform, I mentioned that I had spoken in favor of some kind of reform in Bristol at a pro-reform rally on the same day that Obama was in Bristol. Like 99% of everybody, I don't agree with everything in the existing bills, especially Obama's caving in to the drug companies.

My concern with what you are saying - "Medicare for all" - is that Medicare AS IT EXISTS NOW has a lot of problems. When older and disabled people living just above the poverty level are having to spend 1/3 or more of their income ROUTINELY to pay for health care alone, spreading the program in question to everybody is NOT the solution.

We both agree that more of THE SAME is not the answer. You would be surprised at the number of people who believe that once you qualify for Medicare, you have great coverage with no additional cost.