Giving away a key negotiating point (public option) early in the process is not a very good strategy.

Nothing weird about the line. Rather, for an American system to evolve to the most efficacious form (single payer) we need a public option.

You may find it weird, but it is hardly a trivial fact. American healthcare has more insurance stakeholders than others and thus without the public option an evolving system will skew in their favor rather than the publics.

In the past, you have reinforced your opposition to single payer, or admonished its adherents and doubted its bona fides. But I disagree with your assesments and its a good thing Howard Dean does too.

Regarding Dean's past politics:

This may be earth shattering, but often people change positions depending on where they sit. Dean was a Governor, hamstrung by the constrictions of an office holder at a time when universal healthcare was a more dangerous issue.

Today, he is a relative outsider with much more flexibility to express himself. Leaving office frees one to do as they please.

Isn't the difference between subsidies and public insurance just semantics?

This is not 2004.

I like how history matters to you sometimes, but, at other times, it does not. How is it weird that Dean now believes something he did not believe 5 years ago? Is it weird that you believe things now that you did not believe 5 years ago?

And, as for your confusion, the point is marketing as much as policy and economics, and therefore nothing wrong with that. Thus, the choice of language. It's negotiation 101 rather than figuring out what DC says first.

The fact is that of all the elements, this issue, the public option, is the one that most directly and simply defines whether one is for or against the public's interests. It's something that is simple to understand.

Remember how last night I mentioned the trust issue? That comes up here as well where it seems, whether true or not, that the system is being rigged in favor private insurance companies. Afterall, the only real argument against the public option is that it creates competition for the private insurance companies. These companies are essentially saying they can't compete. Therefore, they want the system rigged (like the banks) in their favor rather than in the interst of the public.

What's the most clear headed way to address that perception that does not require a PhD in doublespeak?

Ezra: I am curious as to what a health care system without any public option would look like? What would it be? How do you get everybody rich and poor covered? How do you pay for it? Can you point to any real world examples?

looks to me like going where the controversy is

Ride to the sound of the guns, because that's where the fight is.
-

It's hard to get worked up for it because it is all so unknown. It could end up being something with the admin cost and provider selection of Medicare with the coverage and IT of the VA or, it could end up being something that has the benefits of Medicare Part D and, like, Alabama Medicaid with the provider choices of a Medicaid provider in Greenwich, CT.

I love this. This is the perfect use of Dean, to build that moral high ground just a bit higher, when the forces of compromise will be tempted to chip it away in the final negotiations.

He's the perfect "outsider" to help push this wagon, and I have total respect (and gratitude actually, speaking as an uninsured person) for his decision to stoop to the wheel in this way.

You could imagine... and a pretty good health system with no public option at all.

Well, you might. Want to tell us how it looks? Or, more to the point, the prospect of that being put into law, without having the public option at hand to scare the living shit out of the for-profit insurers?

Count me as someone who is very much interested to see how you can possibly have a good health system without a public option.

From what I can tell, we've tried that solution for 60 years and it has proved impossible.

But hey, thanks for showing us your inherent centrism.

But it's hardly the main determinant of real reform: It's more the most politically controversial element of reform.

Ezra: surely it is single payer that is the most politically controversial element of reform. I realize there's not a credible proposal in the offing to get us there soon, but by contrast, merely enabling an optional public sector plan -- along with the continued existence of private insurance firms covering tens of millions of Americans -- by rights oughtn't to be particularly controversial among the public. And yeah, I realize "the public" isn't the same thing as "insurance companies and their many friends in Congress." But still. When even large numbers of upper middle class Americans are feeling nervous about health care security, proposing an optional government plan ought to be positively popular among a sizable majority of the public. If Obama and company play their cards right, they'll win the PR war with Big Insurance hands down. It's the war with Democrats in the Senate that's got me worried.

I just want to make sure I've got this right. I just read the NYT article and what I see is this:

“There’s a lot of us that feel that the public option, that the government is an unfair competitor,” Senator Charles E. Grassley.

and

"The main selling point for a government-run program would be its low cost. It would have a much lower overhead than private plans, with no need to make a profit or spend money on marketing or brokers’ commissions. And, if allowed to flex its muscle, the government would buy medical care at much lower prices."

So the problem here is that the gov't -- which Reaganite free-marketeers have for years been screaming is the most inefficient organization possible -- can provide health services more cheaply to the customer. (?!)

That's it; that's Repub rationale for opposing the public option: It's no good because the customer gets a better deal, or rather, "It's no good because the gov't has to guarantee that the insurers make hefty profits."

See, where I come from out here in the free market (I know, a quaint term these days) I start a business and nobody guarantees me shit. My businesses compete with all comers, and if someone else provides the same service less expensively, he wins and I lose. And don't kid yourself, lots of us compete against the gov't and win -- by offering better range of options, more personalized service, etc. Just ask FedEx, for instance.

Did I miss something in Eco 101?

I know Ezra Klein used to write this blog...who does it now?

Every other post these days is "don't rock the boat."
Topple the thing!

Definitely requires public option.

You can sign Dr. Dean's petition here:

www.StandwithDrDean.com

Ezra,

Your thinking of this from a policy, rather than political question. As we've seen thus far, Republicans are going to push the debate further and further to the right, so someone, somewhere, has to make a lot of noise about this.

Consider the recent reporting about the lack of discussion during the stimulus debate focusing on the bill being too small. That's because there wasn't a group pounding away at that idea. So it just got shuffled off to the side and ignored. By bringing it up, by hitting it hard, it becomes an issue, a point of discussion. That doesn't mean anyone is going to take it seriously as policy (though the should), but it's far more likely to be taken seriously if he does it.

Additionally, we'll more likely get some comprehensive health reform, which will get us over the hump. Good ideas never die, so in five or ten years (or sooner), it will seem like the obvious solution.

And another thing:

When the Republicans (and assholes like Bayh) start bellyaching about the plan, somebody needs to look at the polling and stand up and say, "Hey, 70% of Texas' voters want public healthcare, but 0% of their Senators do, and 72% Tennessee's voters want it but 0% of their Senators do," etc.

It's time to ask loudly and publicly "Whom exactly do elected representatives actually represent."

Without a public health insurance plan option, you're trusting the insurance companies to do the right thing with no effective pressure on them to do so. It's fantasy to imagine that would work. Dr. Dean is right to fight for this provision as is the Health Care for America Now campaign. I'm shocked to read that you don't agree.

I love that the first comment is bemoaning Dean's inability to cave during some hypothetical negotiations.

We have Medicare, but must support our son and family who in Idaho must cough up 1100/month although the mother is insured by the employer!

Better to vote with Dr. Dean to have a general Medicare insurance (with Dental care, eye care) and let the regal ones get their private insurance IN ADDITION!

We also need room for alternataive care in all its forms which saves money.
Healthy school lunches, Information on the junk foods sold in the grocery stores ,wellness checks and physical exercise support a healthier population that does not need to run to the medical establishment at every turn (oh how they'd hate to see their bubble burst!)

Dean has another good idea which is to give insurance free of charge to everyone under 25.

First CAF and EPI and other supposed progressive think tanks sell out single payer sometime in 2006, concluding that it's so important that Democrats deliver something like health care reform that it's just too risky to take on the insurers.

So HCAN is born, and the major players urge single-payer advocates to line up with this weak tea. They do so via posts from people like Ezra, telling us how there'll still be a route to single-payer in the Dems' reform because the public pool component will be the thin end of the wedge.

This is already crappy politics, because encouraging a strong and credible single-payer movement would be the best way to guarantee that the public pool component ends up being accepted as the compromise position (that it in fact is).

Having marginalized single-payer advocates, libs are now fighting a defensive battle against energized insurers, who know Obama's with them, with the public pool as the front line. A recent Boston Globe article covered this.

So public pool is not an optional position. It's the ball game. Just like card check isn't an optional part of the Employee Free Choice Act: It's the key victory.

Now, apparently because it's important to Ezra's credibility that he stay to the right of DFH Howard Dean, the man who helped explain how weak-tea reform with a public pool would still be a route to single-payer in the future ... is giving up on the public pool!!

This isn't a game, Ezra. There are freaking millions of us out here with no health insurance and no jobs, and there are a couple of hundred thousand more of us every week. Mandates to buy crappy private insurance are not my idea of "reform".

Liberals who can't resist slicing off their left flank, no matter how much it weakens them politically, aren't trustworthy allies.

What Nell said. There's nothing I can add.

One thing I was wondering about the public option is how do proposals guard against the possibility the public plan will wind up being more expensive than private insurance, because private insurers can cherry-pick? That caveat aside, I like the idea of every American having an alternative to the insurance companies. No doubt there are many fine insurance companies, but there's no harm in having an alternative.

First CAF and EPI and other supposed progressive think tanks sell out single payer sometime in 2006, concluding that it's so important that Democrats deliver something like health care reform that it's just too risky to take on the insurers.

So HCAN is born, and the major players urge single-payer advocates to line up with this weak tea.

That's not what happened. HCAN was born of three realities:

1. The American health care delivery system is an immoral one that costs people their lives; fixing it so that everyone in the country is covered is imperative and 2009 is our best shot at that happening.

2. There is no political will at all among our leaders for the US to switch wholesale to single payer health care. It's a non-starter. The sort of public pressure that would have to be brought to bear to change that reality is not available to us because ...

2. There is only limited will among the populace for the US to switch wholesale to single payer. And that will is fatally fragile in the face of terrifying "change is bad" propaganda from the bad guys.

Part of my job is to organize for the HCAN campaign so I'll never be perceived as unbiased. Nonetheless, it is the truth that HCAN is fighting day and night on all fronts to include a strong public health insurance plan in any reform we get this year - among other good ideas - that will rein in the insurance industry.

If you live near Philly, be sure to come out for the Bridge to Health Care event on April 4.

Too Big To (Let) Fail?

I give you:

Public option - Too Important To Pass!

eRobin, I appreciate your hard work and wish all success on April 4.

But the difference between what I said about selling out in advance and "There is no political will at all among our leaders for the US to switch wholesale to single payer health care" is linguistic.

HCAN exists to fight for the public pool component. The politics of that would be a lot easier if there were strong single-payer advocacy outside HCAN pushing from the left. But HCAN has co-opted single-payer supporters. That makes the fight for a public component itself the front line, and a life-or-death fight.

High stakes!

Which is why Ezra's post is so gobsmackingly clueless.

Whoa Nell(y)...

You're equating being liberal with being supportive of single-payer? Am I less liberal because I only support universal access with an openness to one day migrating to single payer? Is Ezra less liberal because he can detect that there is some nuance to these arguments?

Don't frame this as a case of who is more liberal or you leave us no better than our counterparts on the other side of the aisle. Let's debate the ideas here.

And right on eRobin. Though I think you picked a crappy march route for your event. Stop by Rangoon for tasty-as-hell Burmese food at 9th and Race (the 1000 layer bread w/spicy sauce will change your life).

Reform without a public option will only work if

1) Insurance companies are strongly regulated by law, and

2) The regulators are adequately funded and staffed by the current government as well as all future governments, and

3) The regulations somehow bring down costs, including reining in health insurance companies' profits.

I don't think ANY of those three conditions is achievable in the U.S., much less that all three are.

(This is my third try to get past the captcha - what's going on?)

@ThomasEN: I'm not saying what you interpret me as saying. I couldn't care less about who's "more liberal" than who.

Many, many people understand that single-payer, 'Medicare for All', is the only real solution to the health care conundrum. It's truly universal, it takes the burden off employers, creates the bargaining power to lower costs, and would end the horrific struggles of those who have insurance but are almost no better off than those who can't get coverage.

But a whole lot of people who would like to see such a system in place can't see how we can get there politically. The grip of the insurers and Big Pharma on Congress is too powerful.

So people whose analysis is that the opportunity of 2009 cannot be squandered came up with a plan: fight for the inclusion of a strong public health insurance component in whatever employer-tied, insurer-blessed "reform" gets pushed. The hope/plan is that this public pool will be a possible path to someday single-payer.

The risk is that, if this fight failes, there's no real fix at all, and no path to single payer. There's just cost containment and a mandate to purchase some private insurer's product, with the hope/promise of government -- the same government that was too in political thrall to Pharma and the insurers to legislate their racket out of business -- regulating the insurers on our behalf.

In this situation, in which the existence and quality of the public pool is effectively the ball game, there isn't in fact "nuance" where the public pool component is concerned. It is simply and coldly not the case that any form of health care "reform" without a public insurance pool is not reform.

Before this post, given the existence and role of Health Care for America Now, I'd have said that Ezra must surely understand this.

Now? I'm baffled. It's as if Ezra is utterly unconnected to the politics of a campaign I thought he'd been part of for the last two years.

left wing= single payer
center= public option
right wing= fully private
far left wing= single payer, seize the holdings of insurance companies
radical left wing= kill their execs, too
reasonable= then eat them

So, Thomas, that would make Ezra a right winger on the world stage.

I am very supportive of the public option. Nevertheless, there are plenty examples of good systems around the world that don't have a public option. Germany for one. What makes it work? For one thing the sickness funds originally had cooperative governance (the members elected the boards) and they are tightly regulated.

One of the reasons I support the public option is that I think it is unimaginable in the US with a strong private for-profit health insurance industry that we could ever get the level of regulation needed to make it work--and avoid regulatory capture by the industry once it was in place.

The public option is a more likely alternative.

Nell,

Re: "Many, many people understand that single-payer, 'Medicare for All', is the only real solution to the health care conundrum."

You can't understand something when your belief is false

All the things you say about single payer are also true of multi-payer systems in Europe. They are truly universal, take the burden off employers, create the bargaining power to lower costs, and end the horrific struggles of those who have insurance but are almost no better off than those who can't get coverage.

It continues to amaze me that people believe the following two propositions:

1. Health insurers are too powerful and crafty to be successfully regulated and given a new business model that makes them compete on increasing value in the health care system.
2. Health insurers are weak and/or stupid enough that you can somehow blow single payer by them and wipe them out of existence.

It's as though you were to say: This giant is too powerful to be harmed...let's kill him!

In case it isn't clear: proposition #1 is false.

It's false in part because creating the right kind of multi-payer system doesn't do any harm at all to those insurers that are not for-profit companies (about 1/3 of all privately insured). It perhaps does harm to publicly-traded companies after the initial bloom of getting everyone insured is over, since profits would presumably be tightly regulated. This is much like the public utility model. But isn't it true that there were publicly-traded utilities, and before Enron weren't they seen as a good place to put money for conservative investing, similar to blue-chip stocks?

Yes, regulation means eternal vigilance. But you never escape that with single payer either. The US military is a single payer system, and it produced boondoggles in private contracting which boggle the mind. Medicare has been captive to specialist physicians for the last 20 years in its rate-setting and produced gross distortions in the practice of medicine that plague us all.

Don't kid yourself that you are escaping corruption and waste by going single payer, or that you need any less vigilance. There will always be a need for the next reform.

As for those who are saying that Dean's position is essentially about politics rather than policy: seems reasonable to me. Probably smart.

But I will add this: it is stupid for anyone to think that our biggest political obstacles to real reform right now are the insurers. Ezra is right about that.

Do you really think that providers want single payer? If you get within a mile of it, AHA and AMA will come out guns blazing. And if you don't understand that, you don't understand either the economics or the politics of health care.

You could imagine a very poor health reform that includes a public option and a pretty good health system with no public option at all.

Yep.

For the latter, you would need price controls, price controls, price controls -- on the insurance companies, the drug companies, the doctors, the hospitals, the clinics, the labs.... And at a minimum, all the insurance companies and hospitals would need to be non-profits. Then you remove all the financial and physical barriers to care that you possibly can so that everybody can go to the doctor or hospital as often as they want to.

Fifty years ago Canada, France, Germany, Japan, Australia, some others, they all had shorter life spans than the US. Now they all live longer, healthier lives than we do.

Single payer, multi payer, public option or not, what they all have in common is that they don't stint on the amount of actual care.

They have more doctors than we do, and more hospital beds, and they go to the doctor and the hospital more often, they stay in the hospital longer, they take more drugs than we do.

We, on the other hand, are going to get stuck with the former: a crappy and predatory private system with [if we get one at all] a gutted and pathetic 'public option' with all its competitive advantages removed so that the 'playing field' will be 'level' for the privateers.

JD, this is gold:

1. Health insurers are too powerful and crafty to be successfully regulated and given a new business model that makes them compete on increasing value in the health care system.

Such thinking is uninformed at best, defeatist at worst. It can be done, has been done, and will continue to be done.

Health insurers are too powerful and crafty to be successfully regulated and given a new business model that makes them compete on increasing value in the health care system.

Such thinking is uninformed at best, defeatist at worst. It can be done, has been done, and will continue to be done.

Yes, but when was the last time it was done well? If there is skepticism it is in the "will continue to be done," because continuing what has been done seems like no reform at all.

Your position leads to more apathy on the matter, but who cares, right?

Now? I'm baffled. It's as if Ezra is utterly unconnected to the politics of a campaign I thought he'd been part of for the last two years.

Welcome to Petey's world, I think.

Such thinking is uninformed at best, defeatist at worst. It can be done, has been done, and will continue to be done.

Should also have been italicized in the my post above. Oops. Really wish there was a preview option here.

I'm impressed with how many here still believe for-profit corporations are controllable. They've nearly destroyed our economy, they've very creatively taken over our defense and intelligence procurement systems, and they've bought and sold at least two of our branches of government.

Health care is not about making sure people live longer, better lives. The goal of the system is to make sure corporations make longer, better profits. Single payer threatens that, and so does a public option.

I've resisted until now, but it's becoming pretty clear that Ezra is trying hard to maintain access and pushing for that oh-so-sweet "centrism." He's been sensible on health care, and for him to casually toss something so major away suggests that this really is just a game to him. It doesn't smell intellectually honest, certainly not without far more background than he gives it.

The road to hackdom is paved with good intentions.

Insurance company efficiency as measured by medical loss ratios and administrative cost ratios show that as little as 55% of premiums can be used to pay for medical expenses.Where do we think that hundreds of millions in lobbying expenses, tens of millions in executive pay and the salaries of claim rejectors come from? Our premiums.
If we are to keep insurers in the game, they should be non-profit, banned from using premiums for lobbying, made to accept all applicants, with executive salaries linked to administrative efficiency. Or, we can simply adopt a single-payer system with those features.

Ultimately, if we are to control health costs, there is an even more unpalatable task, that of making decisions about limiting the cost of care for certain individuals. If our health care is to be prevented from growing to be our total gross national product, then cost per quality-adjusted life-year must be a criterion used in determining whether treatment is undertaken.

Insurance company efficiency as measured by medical loss ratios and administrative cost ratios show that as little as 55% of premiums can be used to pay for medical expenses.Where do we think that hundreds of millions in lobbying expenses, tens of millions in executive pay and the salaries of claim rejectors come from? Our premiums.
If we are to keep insurers in the game, they should be non-profit, banned from using premiums for lobbying, made to accept all applicants, with executive salaries linked to administrative efficiency. Or, we can simply adopt a single-payer system with those features.

Ultimately, if we are to control health costs, there is an even more unpalatable task, that of making decisions about limiting the cost of care for certain individuals. If our health care is to be prevented from growing to be our total gross national product, then cost per quality-adjusted life-year must be a criterion used in determining whether treatment is undertaken.

I'm impressed with how many here still believe for-profit corporations are controllable. They've nearly destroyed our economy.

I'm not saying they're controllable. I'm saying that you can't put AIG in the same bucket as a non-profit, hospital-owned, local Medicaid or Medicare HMO. If you look at NCQA scores, those sorts of plans are already doing very well in areas of health outcomes and patient satisfaction so there's no reason to believe a similar regulatory structure couldn't work elsewhere (and no I don't work for one).

Hi Nell :) Thanks for your good wishes. I agree with this completely:

HCAN exists to fight for the public pool component. The politics of that would be a lot easier if there were strong single-payer advocacy outside HCAN pushing from the left.

But this part I haven't seen in my work:

But HCAN has co-opted single-payer supporters. That makes the fight for a public component itself the front line, and a life-or-death fight.

We work in my state, when we are able, cordially with single payer people but we haven't co-opted them as far as I know. I don't agree with those among them who say that it's better to get nothing now in the hopes that the suffering will be so great eventually that people will rise up and demand single payer.

I'm not suggesting that something is better than nothing a la Clinton and NAFTA, Kennedy and NCLB and the whoever it was on our side that made Medicare Part D possible. Sometimes nothing is better than something. And if we lose the strong public health insurance plan option, we will be sunk. But we haven't lost it yet so my wish is that all the single payer energy would go to making sure that we get that part in any reform and then that we all stay vigilant and active to make it the best option there is and that the private options are forced to be better (expand coverage and services) to compete.

Also - I agree that the insurance industry isn't our only enemy here or even the most powerful. But that's too sad and frightening to consider right now when we're fighting so hard for this first step of making sure a strong public option remains. After that's won, I can think about the other enemies on the horizon.

ThomasEN: Thanks but I didn't plan the route. That's above my pay grade.

I'm with Nell et al.

And I'm also gobsmacked by Ezra's completely bogus argument points: How in the hell would Vermont (a state) have a public insurance option if the federal government doesn't make it available?

WTF? This is indefensibly disineguous

Without a public option, healthcare reform will simply fail. We need a public option to keep not only the insurers and the politicians but also -- perhaps more important -- the regulators, honest.

One reason the insurance companies are so powerful is that they are regulated by the states (be great if that changed as a result of the financial meltdown, but don't hold your breath). Back in the day, when the early 20th century Progressive reforms still lingered on, Wisconsin, as well as a few other states, had a state insurance program. I think in Wisconsin it only sold term life, and the rates were very low. They weren't allowed to advertise, but word got around. Insurance companies had to compete against that as a benchmark, and regulators used it as a yardstick.

Not so coincidentally, Wisconsin at that time was widely regarded as having one of the best insurance commissions in the country.

Eventually, of course, we lost it in the deregulatory, free market mood that swept the nation.

Without a public option, healthcare reform will simply fail. We need a public option to keep not only the insurers and the politicians but also -- perhaps more important -- the regulators, honest.

One reason the insurance companies are so powerful is that they are regulated by the states (be great if that changed as a result of the financial meltdown, but don't hold your breath). Back in the day, when the early 20th century Progressive reforms still lingered on, Wisconsin, as well as a few other states, had a state insurance program. I think in Wisconsin it only sold term life, and the rates were very low. They weren't allowed to advertise, but word got around. Insurance companies had to compete against that as a benchmark, and regulators used it as a yardstick.

Not so coincidentally, Wisconsin at that time was widely regarded as having one of the best insurance commissions in the country.

Eventually, of course, we lost it in the deregulatory, free market mood that swept the nation.

No, I could not imagine a pretty good health care system with no public option at all.

@eRobin:

I don't think we really disagree much. I like and trust you, but not some of the self-styled allies leading HCAN.

Nell: the fight for a public component [is] itself the front line, and a life-or-death fight.

eRobin: if we lose the strong public health insurance plan option, we will be sunk.

Nell: HCAN has co-opted single-payer supporters

eRobin: my wish is that all the single payer energy would go to making sure that we get that part [public pool] in any reform

That's "co-opting" in my book: asking us to put our energy into a proposal in which the public pool that might someday lead to single-payer is the 'last stand'. My political judgment is that the energies of single-payer advocates would be better used to go after what we really want, leaving the HCAN proposal as the compromise that has to be settled for. We're a precious resource: organizations pushing for weaker tea should have access to a wider swath of Obama libs.

I'm not at all saying that nothing is better than something. I share completely your analysis that not getting something this year means getting nothing for a long time to come -- because I think Democrats will pay a severe political price across the board if we can't deliver some concrete health care victory. The question is what's the best way to get the strongest reform we can now.

I'd be much, much more persuaded to get behind the HCAN plan if I didn't see signs of sellout all around: CAP, an HCAN steering committee member, openly advocating for the inadequate, pre-crippled "level playing field" version of the public pool.

And people like Ezra, who sold the candidates' health care proposals to us on the basis that they'd be a path to single-payer, now purporting to express surprise at anyone choosing public option as the place to make the fight, and (in the 'primer' post a few threads forward) writing off the only worthwhile public plan, 'path to single-payer', as unwinnable.

This evidence of caving in advance by purported allies only makes me less inclined to push directly for some too-clever-by-half plan. Now that there's Senate and House legislation embodying a solution I actually believe in (thanks, Sen. Sanders), I'd rather fight for that and force CAP and other sellout forces in your coalition to stop inching right.

It's time for HCAN to get real with potential supporters about what the coalition sees as acceptable and unacceptable versions of a public choice component of health care reform. The unions in HCAN who previously endorsed single-payer need to be ready to walk if, as it appears, CAP has an understanding with the White House that HCAN's willing to settle for the "level playing field" option.

The public plan is the entire game.

We need to have a 2-pronged strategy for this to work. We need to regulate the heck out of private insurance companies. (1)Have a uniform, generous benefit package that they must offer if they want to sell health insurance. (2) Same price for everybody--community rating. (1) & (2) will go a long way toward prevention of Cherry Picking. (3) No exclusions or penalties for age or pre-existing conditions.

Then, with the tough regs in place, institute a public plan to compete with private insurance on a level playing field. This should keep premiums low and (hopefully) get rid of co-pays, deductibles, and co-insurance.

Public plan is absolutely necessary.

If you are interested in reading a more full development of my opinions, come and check out my blog @ http://twobaddogscafe.blogspot.com

The public plan is the entire game.

We need to have a 2-pronged strategy for this to work. We need to regulate the heck out of private insurance companies. (1)Have a uniform, generous benefit package that they must offer if they want to sell health insurance. (2) Same price for everybody--community rating. (1) & (2) will go a long way toward prevention of Cherry Picking. (3) No exclusions or penalties for age or pre-existing conditions.

Then, with the tough regs in place, institute a public plan to compete with private insurance on a level playing field. This should keep premiums low and (hopefully) get rid of co-pays, deductibles, and co-insurance.

Public plan is absolutely necessary.

If you are interested in reading a more full development of my opinions, come and check out my blog @ http://twobaddogscafe.blogspot.com

ThomasEN:

You took yourself to be agreeing with me, right?

"JD, this is gold:

1. Health insurers are too powerful and crafty to be successfully regulated and given a new business model that makes them compete on increasing value in the health care system.

Such thinking is uninformed at best, defeatist at worst. It can be done, has been done, and will continue to be done."

That was exactly my point.

Oh yeah, agreeing...