Would any public plan really force insurance companies out of business? Would it burden the government with significant new financial obligations? Is "public plan" really just a cover phrase for "single payer in 10 years?" This is a complex debate, but Congress is certainly capable of crafting a public plan that doesn't compete very well in the marketplace. Indeed, health reform advocates can make the case that a weaker public plan might be preferable to a stronger one. That sounds counterintuitive, but it's not. One reason why the Democrats refer to a government-run option as a "public plan" is that it's more easily swallowed that calling it a "government plan." That's the first knock against it. Advantage: private insurance. Then you've got to have faith that the Democrats can design a plan that would be attractive to people. Maybe they will. But if they're keen on putting the plan under the supervision of, say, a bipartisan team of well-meaning health care experts, they might produce a clunker. The private health insurers have advertisers and marketers and decades of experience selling their plans; the government has no comparable experience, and an expert-run plan might not be salable enough. Potential advantage: private insurance. Three: will a government plan require doctors to participate? That's the big concern of the American Medical Association. Let's assume that it won't. That means that, so far as one's choice of doctors is a value, you're likely to decide to perhaps pay a little more to preserve that choice. Potential advantage: private health insurers.
Four: the primary public policy rationale for a public plan is
that it would foster competition because the government could use its
size and purchasing power to negotiate agreements with providers and
drug companies. Medicare can do this to a degree, but the public plan
won't be Medicare. And if it's not initially subsidized, if it doesn't
quickly grow, it won't have the same leverage, assuming that it really
does remain revenue neutral -- that is, assuming that it's paid for out
of the premiums and fees of its members. Five: let's assume that the
government option is able to provide roughly the same level of care and
benefits at a lower cost to employers and individuals. It doesn't
necessarily follow that employers won't (a) try to get the insurance
providers they like to give them a better deal, that (b) the
company's existing relationship with the insurance company has no
intrinsic value, that (c) the companies, particularly if they are
small, want to deal with the federal government on a daily basis
regarding insurance, and that (d) the government will easily replicate
the (supposed) Medicare overhead premium with a relatively healthier,
younger pool of insured people.
I suppose I
should make a self-exonerating flip here: it is more likely than not
that a well-designed public option, even if it starts off fairly small,
will evolve into a source of competitive pressure. And insurance
companies will undoubtedly face significant pressure to reduce costs. It's just that there are plenty of uncertainties and unexplored
assumptions that will determine whether it forces the insurance
companies to consolidate, or to lose business.
For heaven's sake, how many times do we need to explain to the D.C. press that the rest of the civilized world (and forget about Canada and the U.K.) has well-crafted public plans that work to everyone's satisfaction? Is that so hard to grasp? If you WANT to set up a good public plan, you can do so. Why should we care what happens to Anthem?
The problem is in paying for a public insurance, but that's another matter--and it can be solved as well.
I don't want to single out Marc's reporting because he's no worse than others. But it's all about process.
I don't think we need to forget about Canada and the UK, they've only been picked out for demonization by the right because they happen to speak English. And in the short term we do need to care about what happens to Anthem and the other private insurers for two reasons. Firstly as the introduction of the program takes place we want all the players cooperating and not trying to sabotage what is going to happen. Secondly, these are huge enterprises employing hundreds of thousands of people. The process of adjustment needs to spread over several years to avoid massive and premature job losses.
The first thing you have to recognize is that there is a lot of kabuki dancing going on at present but it's quite clear to me the admin and most Dems in congress want a public option and they want it for a very clear reason. It's one of the major tools they will need to squeeze cost out of the system. I've equally no doubt it will be in the program even if Obama has to pass the bill with Democratic only votes. Is it the thin end of the wedge to a single payer system. Quite possibly but not inevitably. After all private and public insurance markets operate in many of the western countries offering universal care. However, it would undoubtedly be a smaller, very different, and less profitable private market. This is all such uncharted territory that it's impossible to say how it will pan out. But the admin need a public option and I'd say they'll get one.
Slag - the issue is that people drastically underestimate the impact of advertising on themselves. So, maybe it's true that the thousands of insurance ads you've seen over your life won't have an effect on your choice, but for many people, they will have a subconscious impact, such that, when provided with a list of possible insurers, they will go with the name they know, everything thing else appearing to be equal. Sure, you'll look at the premiums and the network, but if those look vaguely similar, then many people will choose Aetna or Cigna or United or whatnot over a generic provider.
Thank you. I took Rhetoric 101 too.
If cost and convenience were "vaguely similar", then a public plan would be pointless. In which case, I certainly hope we wouldn't waste our efforts in implementing one. But if the government can provide me a lower cost/more convenient alternative, I'm taking it. I'm not picking out running shoes; I'm picking out insurance. This isn't something I want; it's something I need. As long as the public plan can tell me how much it costs and whether or not it covers a doctor in my preferred location, that's all I need to know. Honestly, I don't think this attitude is at all unusual for selecting utilitarian items, such as insurance.
God warned against insurance (surety) in the Bible. That means there is a better solution. No insurance means employers and employees do not pay insurance fees, leaving more money for them. Insurance is costly in time and administration costs and does not add good health. Whoever wants to buy it can. Prayer, faith, herbs and healthy eating have proven to be effective against even cancers. All others will know they will pay bills if they get sick. They will choose better foods and activities that make them healthier. Family, friends and their faith communities can pay for any other necessary costs a person cannot.
We are captive to our own ways. We chose to trust man to heal us and we have agencies that keep us employed to be able to get money for insurance. Now the financial crisis means we cannot afford to end jobs if we stopped insurance programs (God's solution).
The solution to this and other world problems is to turn from the employment lifestyle that is destroying our health with stress and pollution of our air, land, water and food, and turn to a garden paradise lifestyle where we choose trees, plants and pets that provide fresh food around us. That solves the major world problems quickly, easily, and inexpensively and it is the only sustainable development available. It will last through eternity. Unprocessed, fresh foods provide good health; that is what real health reform would include.
A daily, 20mg dose of Zyprexa might help, also.
The public plan solution presumes that insurance companies are the whole problem; you get rid of the insurance companies, you get rid of the problem. What if the problem is a health problem, not a healthcare problem? (Much less an insurance problem...)
I'm not arguing that the insurance companies are the good guys; just that they're doing the job they've been assigned to do, and doing it more effectively than just about any other player in the system.
The evidence isn't actually accumulating that if you take, say, a single mother living in poverty who works 50 hours a week in uncomfortable shoes and gets all of her food from McDonald's because it takes an hour to reach the nearest grocery store and suddenly give her health coverage - that her health (or that of her children, who are already covered under Medicaid) will actually improve all that much. Severe, chronic stress isn't treatable by modern medicine - and severe, chronic stress is exactly the condition that Americans tend to suffer from, which is overwhelming our healthcare system and everyone who interacts with it.
If I'm starting to sound a little bit like MarieDevine, it's because she's got a point.
My advice to the single mom - get more comfortable shoes. It makes more of a difference than you might think. And you've got to start somewhere.