who thinks the pubic option will control costs. me.

Forcing people to buy health insurance at inflated prices and offering little in the way of healthcare will cause resentment.

The resentful can easily retaliate by comsuming useless but 'preventative' health care, useless but costly tests such as colon etc screening, and on and on. One patient can run up 10 tiems the amount of the insurance premiums in one or two months each year.

And who wil encourage that?

doctors ama, etc

ad on and on.

who thinks the already economically devasted is going to pay for sham healthcare? not me.

I am certain that when all is said and done, our elected representatives will have applied the vigilance to health care reform for which they are famous, and the American people will get the kind of health care reform that they deserve.

Doc: What seems to be the problem?

Patient: Choices. Every time I make one, it hurts. No matter what I choose, it costs more and provides less. What should I do?

Doc: The test results show you have a phobia of private insurers and providers and death panels and rationing, typical of Public Option supporters. Is there something you haven't told me?

Patient: Well, yes, I'm one of those Closet Competitionists who everyone attacks as a Socialist. Do you have some pills for multi-ideology disorders?

as long as the health care system is "managed" by employers, politicians, and health care corporate executives, the system will continue to serve corporate interests

Zeke Emanuel's voucher idea would remove the "management"layer and make people a greater driving force in healthcare

if everyone had $ to choose a health insurance plan on our own, the "health care profits political machine" would be broken up, the collusion would end

The figures who write New York Times editorials congregate with high-ranking plutocrats, industry barons, even the people at the top of the health care cartel. They talk to each other over dinner and drinks, they do business deals together, they do time shares on vacation properties. They golf together. They all went to school together at Harvard. They go to each others' childrens' birthday parties. They sometimes even sleep together.

This, Dean, is why New York Times (and Washington Post) editorials transform pragmatism into ideology. The culture that produces the editorials couldn't comprehend viscerally the need for pragmatic reforms of a big sort. The figures who write and edit these pieces and the owners and investors around them have never faced health care needs without a viable, affordable coverage system in place. These are the elites that Fitzgerald was convinced really *are* different.

By the way, please do keep up the important work of your public writing and media appearances. There are just too few voices like yours.

Posted by: some guy in a cube

I've managed to escape the cubes myself, but just barely ... I am in an (overcrowded) office just meters away from the cube farm. Escape while you still can!

"Why Is Using a Public Health Care Plan to Drive Down Health Care Costs Ideology and Not Pragmatism?"

I can give one example why that is the case: Germany.

I am working in Germany at the moment, and as I got more details I was surprised. Germany's health insurance is NOT government insurance, they just call it the public plan. It is actually a private market where you can choose from hundreds of providers, but the minimum benefits and the costs are heavily regulated.

Thus, given this other option (among other possible options), to only discuss a directly government run health insurance program almost has to be ideological.

Monopsony controls cost by squeezing providers. Extremely high deductibles might controls cost by getting consumers to shop around and economize on tests and procedures.
Lowering the barriers to entry into health-care e.g. replacing licensing that only servers to increase the income of providers with sensible licensing could lower cost by increasing supply. Everything else seems me to have only small effects.
So is the public plan Ideology or Pragmatism?

Aditya Savara: "[German] minimum benefits and the costs are heavily regulated"

Which is what's missing in any US proposal.

Aditya Savara: "to only discuss a directly government run health insurance program almost has to be ideological"

Or practical politics. A public option is more likely to pass than any serious regulation of costs and benefits.

IIRC all German health insurers are also not-for-profit, as is the case in most other countries that use that type of system. Switzerland forced that status on their insurers when they went to UHC. Do you really think a bill to make all health insurers not-for-profit would pass the US congress?

The article Baker links to is by Adam Nourgary (sp?) which explains the biased language.

The NY Times editorial board is better, of example from Oct 29

"The Senate should pay attention to the health care reform bill unveiled on Thursday by House Democratic leaders. The bill would greatly expand coverage of the uninsured while reducing budget deficits over the next decade and probably beyond. It includes a public option that is weaker than we would like, but it still deserves to be approved by the House."

I gained new respect for the NYTImes when in a front page article, they made an oblique joke about Baker using the $8,000 housing bubble subsidy even if he doesn't agree with it. I agree with Baker's opinion and would do the same but it made me laugh!

Dean,

I don't know if you really can't see an ideological aspect to this or if you're just pretending to be unable to see it, but it's quite easy to see why someone could have a reasonable view of the support or opposition to the public option, particularly as some envisioned with provider payment rates tied to Medicare rates (without which there wouldn't be much/any savings), as ideological.

Some aspects of this "reform", investments in medical IT and comparative effectiveness research (in itself), are non-ideological(other than the libertarian objection that government should do close to nothing). Questions related to their attractiveness pertain to the financial ROI as an analytical matter, as well as concerns some have about some ways in which they could be used, which aren't objections to those initiatives per se.

By contrast, a public option with payments tied to Medicare would use leverage from law, governmental carrots & sticks, and/or scale to achieve a lower cost-structure than private competitors (who lack this leverage, and to whom there could be cost-shifting due to lower compensation for care provided to those in the public plan). Unless the result of these lower public plan payments is far fewer providers willing to accept public plan patients (something that may not occur insofar as the government ties other revenue sources or other funding to accepting these patients), the result would be a public plan that offers superior value vs. the private plans and starts capturing much of the market (for eligible segments of the population, which could eventually include everyone), with the market share gains feeding back into the cost structure advantage and superior value, until we get to single payer or close to it.

If one accepts at least the plausibility of the above scenario, then the question is: Is preference for, or opposition to, single payer ideological? And I'd say it's not unreasonable for someone to consider it ideological. Even leaving aside any related redistribution of income (which is ideological), it's not hard to see how some would consider ideological a shift from a market in which private firms compete, seeking to offer superior value in the eyes of particular segments, to a government monopoly or near-monopoly, with government deciding who gets how much of what under what circumstances.

Brooks man, you really have to learn how to punctuate a sentence. You're putting us to sleep. Start with simple declarative statements. You know, one subject, one verb and one object. String some of them together using the basic rules of Western logic. Don't worry about appearing stupid. The sign of a really good mind is the ability to simplify.

Don,

I realize I lose some people with very limited reading comprehension skills. There's nothing wrong with my punctuation* or my logic (feel free to point out any errors if you can and wish), and in my comments on blogs I generally choose not to dumb down my sentence structure to accommodate folks like you.

As a note, I do adopt simple sentence structures where appropriate in some of my professional writing (sometimes even at the 2nd grade level you request), but on blogs I generally grant myself the intellectual liberty of using more complex sentence structure when such structure is optimal for expressing myself precisely.

Oh, and there are things I worry about, but "appearing stupid" is very rarely one of them.

* Unless you are calling me "Brooks man" you ironically made a punctuation in the sentence in which you told me to learn how to punctuate a sentence.

I figured you'd say something like that.

Brooks, Don was trying to help you with your writing so you'd stop being so boring and, thus, get your points across to more people. Isn't this what you want? Your coming off like a real asshole in your reply.

Yeah, I'm with Don, Brooks. A crapload of lines of meandering verbosity to get to your punchline:

Is preference for, or opposition to, single payer ideological? And I'd say it's not unreasonable for someone to consider it ideological.

What a waste of time, space, and memory! All the verbiage -- the relentless asides -- seems to be a cover for the triteness of your point. Stop being a pompous contrarian windbag with little to say, get a life, and post short posts that better represent the shortness of your thought.

I liked Gladstone better.

Don -- Boy, you're so smart. Here's a gold star sticker for your forehead.

Brooksaningrate -- My guess is that you are one of the regular commenters here but you've created a new handle rather than speaking for "yourself", perhaps because you're one of the many petty grudge-holders here still nursing your wounds from times I simply challenged you to engage rationally. As for Don, someone who makes completely baseless remarks about some supposed lack of punctuation and logic on my part doesn't come across to me as someone who is simply offering well-intentioned constructive criticism.

Anyway, to anyone who has trouble following something I say due to sentence structure, I suggest you give it a shot to develop your reading comprehension skills (and I mean that seriously, not as snark), and if it's still unclear, ask me to spell out in easier to swallow spoonfuls the part you still can't understand.

Of course, there's also the option of just skipping my comments, which makes the complaint that I'm constantly "putting [you] to sleep" kinda weird, unless there's some reason you feel compelled to read my comments.

Again, I have no intention of limiting my writing style on blogs to that of a child. I realize that makes me an imperfect person inasmuch as I want to educate and influence people in a societally-beneficial way and my writing style on blogs is often suboptimal vis a vis those objectives, but hey, I'm not a saint; I don't wish to experience the unpleasantness of dumbing down my writing on blogs. I lose some people. So be it.

Hey "Imwithdon",

Could you make it any more obvious that you are just one of the grudge-bearing regulars here creating new handles "Imwithdon", "Brooksaningrate" to create the false appearance of additional people expressing what you're expressing?

Brooks,

I didn't bother to read your reply. Your semi-literate ramblings cause too much pain. But, strangely enough, I will post a rejoinder.

I'm pretty stupid, but there's one thing I do know. Namely, you, Brooks, are not half as smart as you think you are. Your writing style shows this. You think you are so rational and logical when your posts show nothing but a sad addle brained buffoon crying for attention. Your compusive insertion of parenthetical information in every god-damn sentence shows a fogginess in your fore brain. You really should see a neurologist.

You took two nanoseconds to reply to the posts above. Don't you have anything better to do? Get a life, my man. Stop obsessively trolling this site.

But if you must post, please, sweet Jesus, please, make your posts readable! Think about what you want to say and be parsimonious with your words. Parsimony! Isn't it a lovely word, Brooks?

Remember, you don't have to incorporate every neuronal firing that goes on inside that skull of yours into each sentence you write! Parsimony!

LOL, hoo boy. Someone's projecting, big time. Thanks for the chuckle.

Of course it isn't ideological. In the health care debate, ideological principles don’t run deeper than those in the movie "Dr. Strangelove."

"It's Socialism!" Or, "You're hindering the free-market."

To what ideology could we trace any of the of public option opponents? Is it Adam Smith? Is it Keynes? Is it Friedman? Find me a sentence in this debate where anyone has brought up corporate government run insurance plans (FDIC, FHA Mortgage Backing). This is economics in a vacuum. If anyone form of ideological existed, opponents to this plan would have been screaming about other government subsidies and plans decades ago. The only purpose the phrase "free-market" is propaganda.
If opponents object to a public option on the grounds of ideology, what is the ideology? We know, based on the minimal opposition to other forms of government insurance (not to mention all the other enormous government programs that compete with private industry), that the ideology cannot bear any relation to the “free-market.”

Of course it isn't ideological. In the health care debate, ideological principles don’t run deeper than those in the movie "Dr. Strangelove."

"It's Socialism!" Or, "You're hindering the free-market."

To what ideology could we trace any of the of public option opponents? Is it Adam Smith? Is it Keynes? Is it Friedman? Find me a sentence in this debate where anyone has brought up corporate government run insurance plans (FDIC, FHA Mortgage Backing). This is economics in a vacuum. If any one form of ideology existed, opponents to this plan would have been screaming about other government subsidies and plans decades ago. The only purpose the phrase "free-market" is propaganda.

If opponents object to a public option on the grounds of ideology, what is the ideology? We know, based on the minimal opposition to other forms of government insurance (not to mention all the other enormous government programs that compete with private industry), that the ideology cannot bear any relation to a “free-market.”

Alex, the Germany ones are for profit. I agree it would be unfeasible to make the sector non-profit by law.

Dean,

The NYT did a pretty good job today in this piece:

http://www.nytimes.com/2009/11/11/business/economy/11leonhardt.html

Wikipedia

http://en.wikipedia.org/wikiHealth_in_Germany

says only 12.5% of German health insurance is private. The state has controlled health insurance since Bismarck so private health-care industries have never got the political foothold they have in the U.S. Krugman has called attention to the quasi-private Swiss system, which converted fairly recent.

Ron,
The article had some goofy logic in it though:

"If it (tax exclusion) were to disappear, employers would have an incentive to sign up for well-run insurance plans, leaving more money available for workers’ salaries."

Nope, the lack of taxes on medical benefits does not affect the incentive for employers to choose well-run plans.

They hinder plans not offered through employers.

They subsidize the higher income tax ratepayers more than those with lower income.

Its the same deal with mortgage interest deductions.

Extremely high deductibles might controls cost by getting consumers to shop around and economize on tests and procedures"

and the health insurance companies are putting costs online to guide "policy holders" to implent the "consumer driven health insurance model they have strategized

It's not ideology, it's pragmatism all the way down. The question is of demonstrated preferences in the market. The culture of oligarchy rules in the U.S. market, and it is unlikely that the insurance companies would ACCEPT having to carry a non-profit coverage for everybody, reducing their profit and salaries by perhaps 50% or more, and only having private-profit add-ons at the top.

This is to describe in abstract a two-tier system. I personally think a two-tier system would be best for the U.S., but it cannot be done without a public option to transition the system to having a baseline nonprofit preference.

The private insurer's function has little need for a market system to keep it most efficient. It's more like a deadweight loss to healthcare welfare by a distorting tax. You can save on insurers' profits, insurers' administrative costs, and most costly (though often left out) save on doctors' and hospitals' administrative costs. So it is smarter collapsing the whole thing to an accounting column. This could save 20-30% of the total healthcare dollar right there. Nobody wants to say it -- because there, they are ideological shills.

After the public option gets large enough, the entity might be reverted to the insurance companies for management. But that's a long way off, and right now the U.S. private insurers' demonstrated preferences should be clear. They have rescinded, ruined, and killed people for profit. We just bailed them out in the financial crisis. They embarked on a major disinformation campaign about reform. They whine like dogs.

Brooks. Don here.
I apologize. I mean that sincerely. It's not for me to tell you how to write. You are, after all, a sovereign human being and may express yourself in whatever manner pleases you.
Having said that, I am slightly perplexed by your referring to the basic processes of symbolic logic as being appropriate for second graders. After all, only by reducing compound arguments to simpler propositions can we assay their validity and truth. To say "some of this is that" or "all of this is that" etc. enables us to write syllogisms. And "this and that", "this or that", and "if this then that" etc. form the basis of transistor logic which, as you know undergird computer programming.
Without being facetious, I can't say I've ever heard anyone else describe what computer programers or logicians do as being the province of second graders.
Finally, nowhere in my original statement did I either say or imply that you are stupid.
Now let's get back to Dean's stuff.

Don,

Nice of you to apologize. Not necessary, but nice.

Re: nowhere in my original statement did I either say or imply that you are stupid.

I didn't say you implied that. I was responding to your statement, "Don't worry about appearing stupid."

Re: logic, I don't see what argument you think you have, unless it's the invalid argument that the ONLY way to construct a logical statement or set of statements is via simple sentence structure. There is no reason to presume that a statement with a simple sentence structure such as "If X, then Y" is any more logical, than some statement with more complex sentence structure, containing various clauses for precision or any other purpose, such as "If X, then unless A and/or B, Y, other thing equal". (Or put more in the language of logic, "If X and neither B nor C, then Y, other things equal.") So I don't see what your point is regarding logic. If you just wish to point out that it's harder for some people to follow the logic of an argument if presented via more complex sentence structure, well, ok, I agree, and as I've said, I'm willing to live with that drawback.

Speaking of logic, tell me what you think of the following pair of statements.
Statement #1: The following statement is true.
Statement #2: The preceding statement was false.

As for getting back to substance, feel free to present any questions or comments about the argument I presented.

I wouldn't normally point out this typo, but since it occurred in a discussion of sentence structure and logic:

I didn't mean to put a comma before "than some statement..."

Don,

Also: Which came first, the chicken or the egg?

(I think it's ok for us to go off topic for a bit longer for one or two brief logic games. If not, I hope Dean will advise.)

skeptonomist, that wikipedia article is misleading. The plan's price and basic services are fixed, but there is wiggle room for additional services, and there is competition. This link better explains it (that there is competition among "Krankenkassen").

http://www.howtogermany.com/pages/healthinsurance.html

However, it seems that I was mistaken in that they are non-profit. My german coworkers simply call them "private companies" rather than "non-profits". But one could do the same system without making them non-profit.

Speaking of logic, tell me what you think of the following pair of statements.
Statement #1: The following statement is true.
Statement #2: The preceding statement was false.

Your statements seem perfectly nice and well-formed. Of course, we can't say that either one is true or false.

What's next a description of Godel's Theorem!? We should keep in mind that the blog is: Beat The Press - Dean Baker's commentary on economic reporting.

Paul,

Correct, but next time show your work.

Thanks for playing, but seems hypocritical for you to do so while also saying it shouldn't be done.

Actually, the idea that a public option of any description would be a check on costs IS ideology. The only ways to contain costs in health care is not more competition as is the justification for most versions of the public option. The strong public option linked to Medicare payments might have this effect...but that is not going to pass.

More important than the public option would be to standardize payments to providers which is called "all-payer" or the single-payer route. I realize we are all supposed to dismiss single-payer out of hand here but frankly that's where the cost savings is.

Having a smallish public plan negotiating for rates in competition with private plans is not a recipe for reduced costs in health care. Study what other countries do and look where the costs have mushroomed here. Hospitals compete with each other by adding facilities and perks, not becoming "lean and mean".

Dean Baker is ordinarily quite a perceptive economists but I can't believe he has bought the public option rap hook line and sinker. It's depressing...

Thanks for playing, but seems hypocritical for you to do so while also saying it shouldn't be done.

Hypocritical? I prefer the term inconsistent. No pun intended.

Despite all the fulminating by Brooks, Dean's point is obvious and well-taken. Although there are ideological arguments for a public option, there are also clear pragmatic reasons why it should be included. The label "ideology", in this context, carries a negative connotation that obscures most arguments in favor of such an option.

Huh? What? Guglielmo Marconi...1066...The Missouri Compromise...what was the question?
Oh that.
In answer to your two conundrums.
I'm kinda a zen guy, you know. I believe knowing is a doing as well as a mental state so, with that in mind let's proceed.
Find yourself a rock; this may be a good time to get your old pet rock out of the shoebox in the back of the closet. With the rock in front of you, flat side up, write on it with a magic marker "Turn me over". Now sit back and admire your work. Next, Obey The Rock.
You should now be looking at a clean surface of your pet rock. With your magic marker, write "Other side up". Take a moment to congratulate yourself on a job well done. Then, Obey The Rock.
Continue to Obey The Rock until given further instructions.

In answer to the chicken and egg thing...To get to the other side, of course!

Now go wash your bowl.

P.S. If you really want to drive the first lesson home, use an anvil.

Oh Don, how disappointing. Maybe you didn't feel comfortable trying to answer to those little puzzle questions. ok.

Paul -- it's inconsistent AND hypocritical, the latter because you were telling someone else to refrain from doing something that you were doing. Since you have this..er..flexibility, wanna give me your chicken-or-egg answer?

Brooks, you know I can't resist puzzles. Even if when doing them makes me an inconsistent hypocrite or a hypocritical inconsist.

I have to say the chicken and egg is a puzzler. It doesn't have the purity of the mutually contradicting statements puzzle. I suspect that it might be a trick that relies on something outside mere logic.

Chickens lay eggs but eggs come from chickens. If a chicken came first, then what about the egg it must have hatched from? If an egg came first, then what about the chicken that laid it? The only answer I can think of is that the question is not answerable. There's no first cause. No beginning to the process. So it can't be true or false that the chicken came first. Ditto with egg.

Here's one for you: Is it always true that every even integer 6 and above is equal to the sum of at least one pair of prime numbers? Have a blast working on it!

We should both stick to the real subject of Dean's magnificent blog after you solve this puzzle.

Paul,

Re: Is it always true that every even integer 6 and above is equal to the sum of at least one pair of prime numbers?

I just started trial and error, but right after 6 I got to 7, which doesn't fit, so answer is "no".

Re: chicken and egg, here's my take:

Whatever we call the first chicken was the result of genetic mutation (evolution). It came from an egg laid by a non-chicken. So the egg from which that first chicken came existed first. That said, if by "the egg" we mean "the chicken egg", then the question is what defines a "chicken egg" -- is it an egg laid by a chicken or an egg whence comes a chicken. If the former, the egg came first, if the latter, the chicken came first.

Paul,

oops, just saw that you said "even" integer.

Paul,

I took a look at a list of prime numbers up to 101 (I assume that's not cheating, since constructing such a list would just be grunt work). Other than 2, they are all, of course, odd (and the sum of any two odd numbers is an even number), and I see that, starting with 3, the intervals are all either 2, 4, or 6. If that is true infinitely, I it seems that one could always find some pair that would sum to a given even number. A prime number + 1 equals the next higher even number, +3 equals the next even number after that, and +5 the next after that, so as long as the gap between prime numbers is no greater than 6, apparently one could always add two prime numbers to get a given even number. What I don't know is whether or not that interval of 6 continues infinitely, which is a key assumption.

See
http://en.wikipedia.org/wiki/Goldbach%27s_conjecture

Andrew,

Thanks. My reasoning seems the most simple and clear, and I don't see why it wouldn't be correct as long as the interval between primes remains either 2, 4, or 6 (and perhaps even that isn't necessary). I didn't see my reasoning at that link, which I find curious.

Again, if the interval between primes is either 2, 4, or 6, then for any given even number, there's a prime number that is either 1 less, 3 less, or 5 less than that even number.
If it's 1 less, then summing 1 + that prime yields that even number.
If it's 3 less, then summing 3 + that prime yields that even number.
If it's 5 less, then summing 5 + that prime yields that even number.

Right?

Whatever we call the first chicken was the result of genetic mutation (evolution). It came from an egg laid by a non-chicken. So the egg from which that first chicken came existed first. That said, if by "the egg" we mean "the chicken egg", then the question is what defines a "chicken egg" -- is it an egg laid by a chicken or an egg whence comes a chicken. If the former, the egg came first, if the latter, the chicken came first.

See, I knew it would be more than a logic puzzle! That is, assumptions are needed outside the problem statement. The logical essence is: A begets B, B begets A. Which comes first A or B?

Yeah, I threw in the Goldbach Conjecture. It's not solved yet so it's kind of a trick question.

The primes become sparser as you get into the higher integers and there are arbitrarily large gaps between two successive primes. In fact, but a little imprecisely, the number of primes less than or equal to n gets closer and closer to log(n), the larger n is. Give or take some wiggling.

Paul,

Gee, thanks for throwing my way an unsolvable puzzle ;-)
Anyway, I feel good about my "solution", even if it was based on an assumption that turned out to be invalid (that the intervals between primes would remain 2, 4, or 6) and thus doesn't suffice.

Re: that egg, I see your point re: extraneous information (evolution or more precise definitions) rather than a soluble logic puzzle, but my recollection is that Aristotle emphasized the definition of terms in his discussion of logic, and when I approached the question I thought to ask what is meant by "a chicken" and what is mean by "the egg". I guess the lesson is that one must sufficiently clarify the premises one intends to plug into one's logicizing.

Gee, thanks for throwing my way an unsolvable puzzle ;-)

Sorry about that. However, it's not unsolvable (as far as we know). The puzzle just hasn't been solved yet for a few hundred years. So it my trick wasn't so nasty!

The largest difference between primes is NOT 6.

example:
Here is range of numbers in which the primes occurs with a difference of 30.

1000001 = 101*9901
1000003 = prime
1000005 = 3*333335
1000007 = 29*34483
1000009 = 293*3413
1000011 = 3*333337
1000013 = 7*142859
1000015 = 5*200003
1000017 = 3*333339
1000019 = 47*21277
1000021 = 11*90911
1000023 = 3*333341
1000025 = 5*200005
1000027 = 7*142861
1000029 = 3*333343
1000031 = 41*24391
1000033 = prime.

Andrew,

Well, given that (per Paul) mathematicians have tried unsuccessfully for centuries to solve it, I assumed (after Paul informed me of the above) that the condition of my conditional "solution" (assumption of maximum interval of 6) was invalid, as opposed to thinking I had solved the puzzle so easily -- some regulars here may not believe it, but I don't have that big an ego ;-)

Did you work that all out yourself? I hope not -- seems like a lot of work, I mean unless you're Rain Man.

http://www.usi.edu/science/math/prime.html

Why do I have a craving for prime rib?