The public plan would have lower administrative costs than those private plans but would probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees.

Why is this shocking? The narrative from the left has been that the mean ol insurance companies are not accepting pre-existing conditions because they are evil. Surprise, the reason why you do that is because people will take advantage of the system. If you accept pre-existing conditions without making people buy long term plans. The sick will just drop in and out of the system- thus ruining the benefit of having a group pool of money.

I am all for requiring accepting pre-existing conditions but then to make sure people still pay when they are healthy the contract should be a 2-3 year monthly plan.

A public option would be accountable not to stockholders but to voters, whose interests would align much better with public-option policyholders.

Does Noah really believe this? Is there one example of a huge entitlement where voters actually made a difference? Seriously, if anyone thinks the voters will have a say in the public option they are an idiot. Let me put it this way If you complained to Wal-mart and your Congressman about something- which would be more likely to address your concerns the quickest? The PO would be as accountable to voters as the DMV is accountable to voters, which would be close to zero.

Government health insurance plans, such as Medicare, have a track record of maintaining costs below those of private health insurers because they enjoy certain advantages of scale, are cheaper to administer, and don't have to deliver profits to shareholders.

This is laughable. Noah left out the fact that Medicare also pays only 20-50% of the bill. here is some medical math you Noah. A uninsured man goes to the emergency room and the hospital has to treat him by law. The bill is $100K. He qualifies for Medicaid and the government pays the hospital $40k. The hospital has to eat the rest. That is how Medicaid keeps costs low.

This is why few doctors accept Medicaid patients and why these patients use the ER. The ER has to see them if it is an emergency or not. Hospitals get screwed and need to make money so those who pay with cash or insurance get to pay a little extra even if the poor have Medicaid.

This is also why Reid tried to get the Dr fix bill passed. It was essentially a bribe to get doctors to accept lower payments on the front end in order to get cash in the back room. Of course the Drs didn't trust Congress so the deal flopped.

The dirty secret is that insurance companies don't make much profit (3-6%) and the cause of rising insurance rates is rising hospital and Dr costs. The PO will not control insurance costs because it doesn't address the root of the issue- medical costs. The way to get costs down is for the government to put price controls on the medical provider industry. That would be Dr, nurses, hospitals, drug co, medical devices, etc.

The PO is between a rock and a hard place. The PO can't be a better alternative than insurance companies without sucking tones of tax dollars and imposing draconian laws on the public.

gunsmoke:

Why is this shocking? The narrative from the left has been that the mean ol insurance companies are not accepting pre-existing conditions because they are evil. Surprise, the reason why you do that is because people will take advantage of the system. If you accept pre-existing conditions without making people buy long term plans. The sick will just drop in and out of the system- thus ruining the benefit of having a group pool of money.

I am all for requiring accepting pre-existing conditions but then to make sure people still pay when they are healthy the contract should be a 2-3 year monthly plan.

What part of "individual mandate" don't you understand? Why the sick, of all people, would drop in and out of the system, makes no sense. The point the CBO was making is that the insurance companies would find ways to cherry pick their customers, leaving the PO as the plan of last resort.

"here is some medical math you Noah"

Is "Noah" an epithet now? ;)

"The bill is $100K. He qualifies for Medicaid and the government pays the hospital $40k. The hospital has to eat the rest. That is how Medicaid keeps costs low."

You may be interested in this by Uwe Reinhardt on cost shifting.

"Why the sick, of all people, would drop in and out of the system, makes no sense. The point the CBO was making is that the insurance companies would find ways to cherry pick their customers, leaving the PO as the plan of last resort."

There was a University of Chicago economist on Planet Money this summer sometime who pointed out that there is an ignored but growing informational disadvantage in the insurance marketplace. Individuals can now do personal genetic testing with kits at home that they send to private labs for analysis. Rationally, the results will impact the level of coverage you get and thus cut into the insurance profits. Biomedical trends are likely to exacerbate this over the years.

The professor's conclusion was (against his personal ideology) we should go to single payer universal healthcare.

but wait that's socialism. and socialism is bad.

Look, I'd love to see you live a full, long life, but unfortunately, life just isn't fair. You happened to contract cancer, so you have to die. Or, you can live, and we have the technology to help you, but you'll spend all your money paying back the mountains of medical bills. On the good side, you will help create jobs! The free market wins!!!!

What part of "individual mandate" don't you understand?

On inspection there's a lot less to this than meets the eye, i.e. it's very fine for the mice to vote to bell the cat, but the implementation will be a problem.

So Congress says everyone has to have insurance... good so far but...

If I don't then the police will pick me up? No? It will just be a fine?

How much of a fine? $1000 on my taxes? Great, sign me up for that $1000 punishment since it's lower than my insurance.

Oh, you want to make the fine match my cost of insurance? That's fine but I'm healthy, my insurance *should* be very cheap (because that's the amount of risk I add to the system). But if it's cheap, then who pays for the sick? And if it's expensive (as Congress wants) then you're putting me in a position where I have to choose between feeding my children or buying expensive medical insurance that I don't need.

Our health care system has two basic problems. First it's expensive, second that everyone doesn't have full access. Congress is trying to address the later at the expense of the former.

That's a pretty accurate statement, at least from what I had read and studied on the baucus bill.

I'm a fan of the public option, but when I read about a potential fine, i thought the same thing. Being of the age group where I'm knock on wood at my best health, do I pay the fine I can't afford for not having the insurance, or the amount I can't afford for insurance, as you said.

The latter at the expense of the former seems to be a pretty good statement. For now. (hopefully).

This reminds me of Bush's attempt to "reform" Social Security.

Yes, there are problems... but the proposed "cure" is pure ideological agenda that has little to do with the actual problems.

The left wants the gov providing all health care, and if they can't have that then they want us on a road where that will happen eventually. If this makes the existing problems worse (i.e. more expensive health care that is worse) well that's too bad.

There are things Congress could do which would make HC cheaper without totally redoing the system from square one ('big bang' solutions often fail drastically). None of them are on the table, because Congress isn't really interested in making HC cheaper. Ideology is coming first.

And if you do get sick or have an accident, do you promise not to go to the emergency room and hit up the taxpayer for your medical care?

DBuss:

Yes, there are problems... but the proposed "cure" is pure ideological agenda that has little to do with the actual problems.

Yeah, the big problem is that the USA spends more on medical care, 16% of GDP, than any other country on earth while 15% of the population has no insurance coverage with pooe access to medical services. In conteast, every othert developed country has universal health care that not only costs less but gets better results.

Your opposition to legislation that does address actual problems is based on your ideological agenda.

ClaimsAdjuster wrote the following post at 11/02/2009 1:44 PM:

And if you do get sick or have an accident, do you promise not to go to the emergency room and hit up the taxpayer for your medical care?

So you mean these people aren't treated right now? Is that why we're all supposed to be good with our HC becoming both worse and more expensive?

Oh, that's right, they are being treated right now... which implies that we shouldn't make the HC system both worse and more expensive for everyone else.

ClaimsAdjuster wrote the following post at 11/02/2009 1:52 PM: ...every other developed country has universal health care that not only costs less but gets better results.

"Better results" is highly questionable since most of the measurements usually mentioned don't measure things the HC system has much influence over. The US is the fattest and most murderous first world nation, waiting in line to see a doctor won't make us less fat or less murderous.

Yeah, the big problem is that the USA spends more on medical care, 16% of GDP, than any other country on earth while 15% of the population has no insurance coverage with poor access to medical services.

Most of your "15%" with no insurance coverage don't view it as price efficient. They'd buy it if it were cheap, but your reforms in the real world make it a lot more expensive. Granted, the 5% who both want insurance and could reasonably benefit from it are a problem, but the legislation goes way beyond dealing with them.

Your opposition to legislation that does address actual problems is based on your ideological agenda.

For all your pious talk about how much the system costs, none of the legislation appears to address that problem (and if HC were cheaper then more people could be covered and more would opt in).

If employee moral is bad, why is it a good idea for them to be leashed and branded?

If some people don't have access to insurance, why is it necessary to make HC both worse and more expensive for everyone else?

Yes, they are sort of being treated in the emergency room in that the doctor stabilizes their condition. But since the prescription that the doctor writes or the referral that he makes won't be followed through, that is the extent of the treatment.

This cost of this ER visit, which is both expensive and ineffective, is borne by the taxpayer because the patient does not have health insurance. In the case of young immortals, they don't contribute to the medical system because they calculate that they don't need it. Normally conservatives would rail against freeloading but they refrain from doing so in this case so that they can argue "Oh, that's right, they are being treated right now".

After reform insurance companies won't be able to cancel policies because their policyholder got sick or deny coverage because of pre-existing conditions. Alnost everyone will be covered. You have no basis to argue that HC will get worse.

As for more expensive, AHIP, the insurance lobby, predicted a 78% increase in premiums over the next 10 years without health care reform.

This cost of this ER visit, which is both expensive and ineffective, is borne by the taxpayer because the patient does not have health insurance.

You don't get to call it "expensive" when your solution is far more so.

In the case of young immortals, they don't contribute to the medical system because they calculate that they don't need it. Normally conservatives would rail against freeloading but they refrain from doing so in this case so that they can argue "Oh, that's right, they are being treated right now".

Your solution goes far beyond ending "freeloading". The amount of risk the young immortals add to the system is very small, all they need is major medical ins (which is cheap). Everyone who either has or should have major medical ins is a big time loser in the new system because they're going to be forced to buy "comprehensive" (i.e. very expensive) ins which they simply don't need. And when tolerating this "freeloading" is cheaper than the alternative we get to call it "cheap" not "expensive".

After reform insurance companies won't be able to... deny coverage because of pre-existing conditions.

You say that like it's a bad thing. How about we apply that to house insurance too, that way I can wait till my house burns down before bothering to get insurance.

One of the big reasons HC is so expensive is because we misuse insurance. Insurance is designed to spread *risk*. If an event has already occurred then there is no risk to spread. Similarly if my home owner's insurance paid for every burned out light bulb and the associated paperwork and fraud detection, I'd expect that home insurance would also be very expensive.

Almost everyone will be covered. You have no basis to argue that HC will get worse.

No? That's the way it's worked at a state level. <link> My expectation is that taking a hammer to one sixth of the economy is going to present lots of opportunity for things to go wrong.

As for more expensive, AHIP, the insurance lobby, predicted a 78% increase in premiums over the next 10 years without health care reform.

Yep, that's a serious problem... but none of the reforms even pretend to attempt to move the cost curve.

This is like saying that employee moral is bad so let's leash and brand them. The proposed solution is going to make things worse, not better. Various states have tried to address the issue of "expensive emergency care" thinking that they'd save money. The result has always been that costs explode and the budget breaks. Universal care is expensive, it doesn't save money.

DBuss:

Universal care is expensive, it doesn't save money.

Actually it is the American system of health care and insurance that is expensive, the most expensive in the world. Every other advanced industrial economy not only has UHC, it costs a lot less than the USA.

ClaimsAdjuster:

This cost of this ER visit, which is both expensive and ineffective, is borne by the taxpayer because the patient does not have health insurance..

DBuss:

You don't get to call it "expensive" when your solution is far more so.

Comparing apples with oranges never results in sound conclusions. An emergency room treatment for a condition that could have been handled by a primary care physician will always be more expensive.

DBuss:

Your solution goes far beyond ending "freeloading". The amount of risk the young immortals add to the system is very small, all they need is major medical ins (which is cheap). Everyone who either has or should have major medical ins is a big time loser in the new system because they're going to be forced to buy "comprehensive" (i.e. very expensive) ins which they simply don't need. And when tolerating this "freeloading" is cheaper than the alternative we get to call it "cheap" not "expensive".

That is the way insurance works - the healthy pay for the sick. The reform legislation will have major medical. Massachusetts has a young adult plan with high deductibles, no prescription drug coverage.

Of course the reform goes beyond freeloading but that does not mean that this problem can be ignored.

ClaimsAdjuster:

After reform insurance companies won't be able to cancel policies because their policyholder got sick or deny coverage because of pre-existing conditions.

DBuss:

You say that like it's a bad thing. How about we apply that to house insurance too, that way I can wait till my house burns down before bothering to get insurance.

What part of individual mandate don't you get? If everyone is required to get health insurance, this loophole is closed. Furthermore, individuals with chronic conditions have every incentive to get health insurance. Their problem now is that they can't get coverage because the insurance company turns them down.

It is a "bad thing" that the most vulnerable get kicked to the curb because they have a chronic condition. But your sense of fairness seems to be confined to complaining about the young being forced to contribute to a health system that they do use sometimes in very expensive ways such as pregnancy.

ClaimsAdjuster:

Almost everyone will be covered. You have no basis to argue that HC will get worse.

DBuss:

No? That's the way it's worked at a state level.

Health care itself has gotten better in Massachusetts. 97% of the population now have insurance. Access to care is far better in Massachusetts than nationally: for 2007, about 20% of the U.S. population reported not getting or delaying needed medical care at some point in the previous 12 months. This compares to 5% of Mass residents in 2008 reporting that they had to forego care.

BTW, your link didn't work.

ClaimsAdjuster:

As for more expensive, AHIP, the insurance lobby, predicted a 78% increase in premiums over the next 10 years without health care reform.

DBuss:

Yep, that's a serious problem... but none of the reforms even pretend to attempt to move the cost curve.

Not true. the House's robust public option addressed medical inflation by using "Medicare+5" reimbursement schedule to compensate providers. Reform will reduce uncompensated care - thus reducing government reimbursements to hospitals and cost shifting by providers.

After the health care reform passes, the US wll be on a better footing to tackle the issues of medical inflation driven by providers and phramacuetical companies. The status quo is not only unfair - it is unsustainable. You have no solutions - just a bunch of carping criticism.