Will the plan contain a public option?

The comment about "reformers who think much more about the uninsured than the insured" is not really true.

We real reformers, single payer advocates, strongly point out the problem of UNDERinsurance, and the inherent conflict-of-interest that the private insurance companies have against actually providing efficient access and care (we call it care; they call it medical loss ratio).

For example the high rate of people depleting saving, having to borrow or going bankrupt if they actually get sick even if they have/had insurance.

Indeed that issue is a large part of the argument for why not "reforming" through the private insurance insurance industry is the better way.

Because of progressive taxation Gov. provided health insurance will probably be cheaper for most people. Service may suffer but most expensive healthcare seems to have little impact on health.

Incidentally, Dr Steve illustrates nicely my problem with the lack of discussion of a present option. What incentive outside of regulation (which can never produce the pressure you want) will make certain the coverage will actually produce the proper amount of healthcare? The whole point of having a public option is to address this issue as well as a cost. By having a market participant that provides a better product at a better rate the other players are forced to do the same. Regulation can not achieve the same outcome because of how companies view regulation. It's a thing they hire lawyers to get around or comply with to the letter, but only to the letter. Whereas, again other market participants who are providing cheaper and better services force their hands. Healthcare or not- this is business 101. So, again, why are't you discussing a public option?

If you have healthcare in the manner most Americans do, your employer is paying several hundred dollars a month for that. What would reform do for people who are already insured? Several hundred dollars a month in increased pay.

Ezra,

This doesn't really make sense for something as complex as health care reform. It would be like saying-- in order to determine if the plan helps the uninsured, we're not going to look at the policy, we'll just ask the uninsured if they think the plan will provide them coverage. The devil is clearly in the details-- details that most people just don't have time to work through themselves./ This ultimately leads to impressions before formed by the next battle of HCAN vs. Harry and Louise. So let's assess whether the policy helps the uninsured and insured based on examination of the actual policy, not using public opinion polls.

godplay,

regarding this: Regulation can not achieve the same outcome because of how companies view regulation. , I think that's historically (and obviously) true in industries like like housing and the financial sector, but anytime you have a private entity playing with public dollars (as you do in a Medicaid or Medicare HMO, and as you would have here, presumably, for this new public mechanism) the regulations are vastly more rigorous with extensive data reporting requirements and lots and lots of audits. My guess is it wouldn't really so much be 'regulated' as it'd be enforced by contract, and all the private companies would respond to an RFP. The contract would no doubt have lots of punitive measures built in for lack of compliance.

Another way of looking at DrSteve's argument: the things that will make things better for insured individuals -- security of care, economic security from health disasters -- may not be achievable with private insurance as currently structured.

As the recession continues, we will probably be seeing ever more stories making this clear -- people who lose jobs and thus coverage, people whose employer alters coverage in ways that exclude treatment they need.

Do you want a for-profit business making decisions about your health care?

Besides the fact that our archaic system is costly and unsustainable, it does not provide the best care.

For-profit health care insurers can deny doctor recommended treatments based on their bottom line and sometimes people die.

But the CEOs still get their bonus at the end of the year.

I encourage reporters and anchors to bring this up the next time someone says they don't want the government involved in their health care.

I always remind people with health care coverage that they are already paying extra to cover the uninsured, often in a very inefficient and more costly manner.

For-profit health care insurers can deny doctor recommended treatments based on their bottom line and sometimes people die.

They can in some cases do but one still get the care by paying and in some case the state mandates care BUT the big problem is that they OK way too much care and pass the costs on to the insured.

edited:
For-profit health care insurers can deny doctor recommended treatments based on their bottom line and sometimes people die.

They can and in some cases do but one can still get the care by paying directly and in some cases the state mandates care BUT the much bigger problem is that they OK way too much care and pass the costs on to the insured. Note people die from too much care also.

See: Brownlee "Overtreated" and Nortin Hadler "The Last Well Person"

a) The healthcare industry is already heavily regulated. This has not affected it's ability to meet the letter, but not the goal of better healthcare. There is no difference between how industries react to regulation. They will try to skirt it. It's why they hire lawyers. More importantly, this does not change the fact you want market incentives rather than just regulations because it changes the dynamics in a way they can not skirt without going out of business.

b)Again, contracts also can not, by themselves, create a situation in which people are not trying to skirt contract language. No contract can cover every angle. This requires one of two forces to protect the greater goal- good faith or self interest. Good faith is not going to happen with private insurance companies because they are in business to make money. So, I am thinking the best way to convince them to act in the right manner is the self interest of economic survival. If they can produce better and cheaper products and services on the market place. To ensure that, we need a large public option that forces this issue. Again, from a business stand point- I don't understand why this is not being discussed.

I am not an expert. But, this is basic businss 101 of how you create the right market.

So, we get to keep our same crappy health insurance run by companies that we have been fighting endlessly to cover procedures, pay bills, and not exclude us? I don't see this situation improving overnight when the government steps in with more regulations. These insurance companies are built around the concept of making money, which they are good at, not at providing the best health outcomes at the least cost, which I think is the goal here.

It seems that you are taking the large number of people who say "It wouldn't make much difference" as a neutral-at-worst attitude.

I'm not so sure that's right. Another way to say that is "It won't help me." And if I think that it will be expensive, either raising my taxes or taking money from other things, and I don't think it will really make that much of a difference to the country or to me, then I'm not going to be inclined to support it.

It's true that it's better than if people think they will be worse off. But I don't think it's sufficient.

It seems to me that an important point about Drew Altman's poll chart is whether those percentages shift as more and more people lose their jobs in the coming months. I suspect they will, so that the proportion of those who see a benefit form health insurance reform comes closer to the proportion that see the nation as better off with it. In a way, President Obama has some leeway to act prudently before the number of uninsured middle-class or formerly middle class people reaches a critical mass and there is sudden HUGE pressure to do something *NOW* -- but at that point, the pressure could be so great that Congress acts too quickly, just cobbles together whatever it thinks will pass muster with the lobbyists, and we end up with the wrong reform that then takes another 15-20 years to fix. Better to move towards some form of single payor now, or at least reach for that: Obama can always retrench a bit later if single payor fails to be passed. But not to even try for it is a mistake. And single payor via folding everyone into FEHBP would be enough -- it wouldn't have to be the direct-payments-to-providers model the Canadians have.

No, the salient fact is that 99% either do not have any insurance now or know they could lose it tomorrow if they lose a job. That undermines confidence in the future, which undermines the economy. We must de-couple the open-ended catastrophic part of insurance from employment, and at the same time remove that unpredictable burden from the employer. Socializing the risk of catastrophic loss -- a risk we all share equally over the course of a lifetime -- will allow pre-catastrophic insurance to be reduced in cost dramatically. For starters, there will be no profit taken on the catastrophic exposure. Rationalization of coverage assuring payment to providers will also bring enormous savings while improving equality of access.

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