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The Private Option
Democrats argue that a Public Option won't crowd out private health insurance. It will just give them "healthy" competition. I'm skeptical, in large part because the government can and will simply legislate away the normal aspects of competition (the need to balance the books, to make cost/benefit calculations, and to negotiate on price/quality, rather than on "...or else we'll regulate you into submission"). Policies designed to keep down health care spending will not survive against politicians up for reelection.
The people responsible for Trillion dollar deficits are unlikely to usher in an era of health care spending restraint.
Other Democrats have just come right out and acknowledged that a public option would eventually crowd out private health insurance.
A public insurance plan able to use Medicare's bargaining power to secure deep discounts for its customers and ensure the maximum possible network would be cheaper and more efficient than private insurers. Over time, this increased efficiency would make the plan more attractive because it could offer more coverage for less money. As consumers recognized this fact, they would increasingly migrate towards the plan, and the public insurer would become, if not a de facto single payer system, something close to it. The public insurer, in this scenario, is a game changer. [...] Insurers, predictably, howled that a public insurer with access to Medicare's market power would put them out of business. (Generally speaking, liberals agreed with that.)
Still other Democrats have pointed to the education system as an example of universal coverage with private alternatives. On Twitter, Pandagon's Jesse Taylor argued that a Public Option wouldn't affect private insurance...
What healthcare choice can you exercise right now that a.) would be gone under a public option and b.) couldn't be taken away currently?
Politicians who make this argument should be confronted with this question: What school choice can you exercise right now that would be gone if we had vouchers and school choice for everybody?
Democrats refuse to level the playing field between the public and private options in education. They will do the same thing in health care.


Comments
Why
..does there have to be an "even playing field"? The Insurance Companies created the quasi-Monopoly that exists in Healthcare now. There are only a few, maybe a handful of behemoth Healthcare Insurance companies that control a huge portion of the insurance market.
They have shown themselves to be motivated by profits only, and willing to game whatever they have to game to maintain their stranglehold on the Health Insurance market.
Why should we make it easier for them to compete? We'd be better of with more responsive, smaller, more focussed insurance companies, and cheaper costs for all.
In countries like Canada and England, there is a healthy, active market in private, for-profit "supplemental" insurers who sell policies to make up for whatever shortfalls their clients perceive in their policies, just like Medicare clients buy supplementals from Empire, Cigna, and other HMO's.
I see no reason why the National Insurance Plan has to look out for the Insurance industry after they've proven themselves to be bad actors for generations of Americans with their undermining, lobbying, and abuse of the insured.
As to this question:
The answer is simple: The choice to fully fund a Public Education choice for everyone that wants one.
Lots of observations
What does it mean to "control" a market? And once you've answered that, please describe how an oligopoly forms -- without government assistance.
Be specific: what are they gaming?
You seem to be under the impression that the big insurance companies will fold in the face of regulation before the smaller companies will. But typically, regulatory compliance costs fall hardest on smaller companies, which tends to create the kind of oligopolies and monopolies you claim to abhor.
Would you object to a voucher up to the variable cost of sending a child to public school? That way you could reduce class sizes in public schools, maintain the infrastructure and still give families a real choice between schools.
Would you object to vouchers for kids in the bottom half of the test-score distribution, and/or kids with a history of disciplinary problems? Their fully funded public education isn't working so well for them, and they may be dragging down their public school classmates. Meanwhile, the research I've read indicates that kids in the bottom half of the distribution show the greatest academic improvement from voucher programs, and parents report much higher satisfaction with the discipline when their kids move to voucher schools.
How about vouchers for minors who have already dropped out of the public school system?
Answers to your questions
1. To "control" a market means that the companies involved control supply, and can therefore control price. Economics 101. How can an oligopoly form without government assistance is simple: The oligopoly buys the votes it needs from government via campaign contributions and effective lobbying. It does not need Government assistance, it has all the assistance it needs from wthin Government to see its interests served, and served well.
2. What do they game? Regulation: Corporate governance limits, anti-monopoly statutes, merger and size limitations, campaign contribution limits, lobbying restrictions, patients' rights provisions, rescision limits, reimbursement and coverage, are you freaking serious??
3. No, you show a complete ignorance of how a market works. Hardly surprising, Pick, since you seem steeped in helping address Big Corporation interests. Small companies exist BECAUSE they are more responsive and can fill market niches the big boys have to let go. They cannot compete with Empire, therefore they will write the policies that Empire won't or can't.
4. This is a completely separate discussion, but OK.
- Yes, I would object to any sort of voucher program. The money is better spent improving whatever problems exist in Public Education, rather than funding for-profit Charters or Academies which have had very mixed results.
- Yes, I would object to ANY vouchers for ANY kids. If there are better methods, better ways to help these kids, bring them into the public schools like they do already in America's best-performing school districts.
- For minors who have already dropped out of the Public-School system, I would keep their money and use it as they are already doing in many systems to establish new public Academies and special schools under the PRESENT public school systems.
Bloomberg and Klein in NYC have had tremendous success reducing drop-out rates, improving literacy, reducing violence, improving standardized test scores, improving attendance, engaging parents, creating school communities and making a very good Public School system better.
The only people who favor vouchers are
a. Evangelicals and religious folk who want state-funded religious education,
b. Parents who want free Private School, and
c. Corporatists who want to make money off America's parents.
If you want your child to turn down a Public-school Education and go to the Private School of your choice go for it. This is America. Go to work and pay for it. Don't expect your tax dollars, which are busy providing a better society for everyone by kicking in your share of the money needed to help special-needs kids, emotionally- and learning-disabled kids, terminally violent kids, disadvantaged and dysfunctional kids go to school, to follow you.
Thanks. Point by point:
1a.
How do companies control supply? I'm leading somewhere.
1b. I said, "please describe how an oligopoly forms -- without government assistance." You proceeded to say that oligopolies form because of government interference. That's exactly my point, thank you: we should dismantle the anti-competitive regulations we have in place, thereby improving things for consumers.
2.
Yes, I'm serious, thanks. So, to keep their stranglehold on the insurance market, they game:
3.
You got me. I do help address Big Corporation interests on occasion, but I have no interest in saving them from free market competition. I believe that the bigger they are, the more important it is that they be allowed to fail.
Think I'm ignorant? Why do incumbent Big Corporations so often line up behind regulation with high compliance costs for their industry? Could it be that they can afford to handle it (scale and access to capital), but their smaller competitors cannot?
Take licensing restrictions. Try starting a restaurant that serves alcohol in California; you will pay through the nose trying to figure out how to comply with byzantine ABC paperwork, while big chains like TGI Fridays have a department of people who do nothing but handle liquor license applications.
Small companies can and do compete with the Big Corporations where they are allowed to do so. I personally know people who work in small businesses that would do far more business if bad, inefficient government regulations didn't prevent it.
Moral of the story: regulation kills far more niches than it can possibly create.
4a.
Public schools have very mixed results, which is putting it charitably. And this would mean more money spent on each public school student, so I can't see why you have a problem. Don't teachers constantly advocate for better infrastructure and smaller class sizes when they try to pass propositions for bond money?
If some parents are so dissatisfied with their public school that they are willing to take a chance on those "mixed results" for their children, why shouldn't they have the choice to spend some of the money that would already be spent on their child, only in a different school?
4b.
You assume that public schools can replicate what those private schools are doing for the kids who benefit from them. But that assumes that you can just change to a superior "method" -- and that public schools would be willing to do so without any competition showing them how it's done.
Have you considered that a completely different environment might be the reason certain groups of kids show much greater improvement in voucher schools than other kids who make the switch? It sounds quite plausible to me that different environments could work for different kinds of kids.
America's best-performing school districts may succeed for all kinds of reasons you can't replicate in other districts: parents who have the initiative and resources to move to good districts for their children, better environments, teachers with extraordinary talent choosing to teach in the best schools.
4c.
You think this is more effective than offering a widespread voucher system and allowing schools to pop up everywhere to serve them? Remember, these are kids who are so fed up with the public system that they gave up on it.
4d.
I'm none of the above. I could definitely support an all-secular private school system, I'm not a parent, and I'm not in that line of business.
But why do you have a problem with parents who want affordable private school education for their children, but not with parents who want free public school for their children? Are the former greedier than the latter somehow?
And wouldn't it be good for those capitalists to spend their time trying to figure out how to provide education that people want for their kids? Wouldn't it be good to get them to raise capital to build new schools and hire new teachers? If they can provide something that parents prefer over public schools, why not allow them to make money? After all, everyone working in the public school system is making money off of America's parents.
4e.
I just got done arguing for vouchers to specifically help those special-needs, disabled, terminally violent, disadvantaged and dysfuctional kids go to a school that will treat them better than the public schools that are clearly failing them, and you rejected it.
I'd love to see you tell a parent of one of those kids (maybe one of the poor families that benefitted from the DC voucher program) that they can send their kid to another school when they can pay for it, instead of letting them choose how some of the public money (at least some of which was taken from them in taxes) is going to be spent on their child.
And they're already working for at least some of that money. (Everyone pays some kind of federal, state and local taxes.) Are their kids not part of that "better society for everyone" you're talking about?
Conceptual Error
The fact that you asked this question indicates that you do not understand what "competition" means from an economic standpoint. We should always want to make competition easier because it drives prices down.
Free markets had their chance, the results are a disaster
Hence the need for a public option. It seems the horrific results of the "free-market" 16 years after Clinton tried healthcare reform isn't enough for conservatives.
Guess you need to see 100 million uninsured and health costs continuing to rise in order to believe insurance companies are in the profit business, not the healthcare business. Profit means insuring the healthy, denying coverage to the sick, and finding any reason not to honor someone's policy. Reform won't come without government stepping in.
When did we have a free market in health care?
The government already spends a huge amount of total health costs in this country, and health insurance markets have been distorted by regulations and unbalanced tax treatment since at least the days of FDR. Drugs are heavily regulated; licensing raises the cost of treatment; and state mandates interfere with competition and individual choice.
As far as I can tell, health care is the second most regulated industry in the country, after the financial sector. More of our health care is private than elsewhere in the developed world, but then, if you discount murders and fatal accidents (not to mention different classifications of stillbirths and premature births), our life expectancy is #1. So maybe that relatively big private market is doing us some favors, eh?
The regulations that try to remove the profit motive from insurance are what is responsible for people being denied coverage. You're blaming the market when the government is the reason insurance companies are restricted from profiting from helping the sick.
See, if insurance companies were free to set rates according to risk, they would generally just raise your rates instead of denying you coverage. If the government didn't tilt the field toward employer-provided insurance, we could all offset the risk of those higher rates with health-status insurance and have long-term, reliable, portable insurance.
Bogus study
The "study" that was the basis if the article you link to was from the American Enterprise Institute - which means they set the goal of demonstrating that the US was tops in life expectancy and then came up with the data and then the methodology to prove it. One of its authors acknowledges that the statistical methods used were flawed.
Look again
The Bailey article I linked to already mentioned one of the concerns of the WSJ "Numbers Guy": see the 4th paragraph. It's not a "bogus" study -- it used a regression for simplicity, and that is what the author acknowledged.
Mr. Haub would have preferred a different method, but then, that wouldn't be 100% precise either. After all, we can't bring those people back to life and see how long they would have lived without the murder or accident, so simply removing them from the data set as Mr Haub suggests wouldn't take account of whether they were more or less likely to die from other causes. Somebody could go to a lot of trouble to estimate their life expectancy by looking at other risk factors, I suppose...
But I think we can agree that widely varying rates of homicide and fatal accidents do affect the life expectancy dramatically.
I welcome you to provide estimates that take Mr. Haub's concerns into account. I'll give brownie points for a study that includes differences caused by birth statistics.
Edit: Oh, and don't poison the well. I understand being skeptical of a given institution if you believe some people there have done sketchy things in the past, but saying that the authors made up data and methodology requires some evidence.
Sums up everything that is wrong with think tanks
Read the WSJ piece. The method that was used was shoddy, and I'm sorry but "I used this method even though it is wrong becasue it is simple" is NOT a valid justification for anything, much less something intended for publication. And then tools like you pick it up and wave it around to claim that our system is perfectly fine and not in need of change.
Name-calling won't get you anywhere.
I don't think the system is perfectly fine. I just got done arguing that we should tear down the massive edifice of regulation and subsidy that has distorted insurance markets, thwarted competition, raised costs and encouraged the kind of traumatic loss of coverage we've been talking about. So you've got it backwards.
I did read the WSJ piece before I posted. The method that Ohsfeldt and Shneider used was not terribly shoddy -- they were making a limited point, and they admit as much. Mr. Haub's method is "wrong" too, but he thinks it would be "more precise." And please note that Mr Haub didn't say whether his method would make the US look better or worse.
So I invite you once again to provide numbers that do things Mr. Haub's way. I'm confident that no matter what method you use to control for murders and fatal accidents, the US is going to come out looking much, much better.
Where do you define the limits of the point you made?
So, the point being made was "limited"? Srsly?
Here is what you said:
Here is what the article you linked to said:
I'm not seeing any qualifiers there - I'm just seeing a made-up data point.
Srsly
It's not "made-up". It's a method that you seem to be dissatisfied with, even though you haven't provided any evidence that the conclusion is wrong.
In the WSJ article, one of the authors of the study is quite open about the limited point he was making. How would you prefer me or Bailey to qualify that claim? "If you discount murders and fatal accidents by applying the same rates to other countries and using regression analysis, our life expectancy is #1"?
Carl Haub would prefer for the claim to go like, "If you discount murders and fatal accidents by removing those who died from those causes from the data, our life expectancy is #_." And Mr. Haub, once again, doesn't say whether that would make the US look better or worse than Drs. Ohsfeldt and Schneider's method.
I invite you a third time to retrieve life expectancy figures that account for accidental deaths and murders (bonus points for childbirth discrepancies) by another method, like Mr. Haub's.
Siiiigh...
There hasn't been a free market in health care since WWII!
The whole reason we have employer-based health "insurance" are the wage and price controls of the New Deal. Medicare and Medicaid then killed any semblance of a free market in 1965. The high cost of U.S. health care is because of government. So how is turning more of it over to government going to make things better? Cheaper just means government-imposed rationing, which is how it has been accomplished everywhere else. Better requires less government.
In actuality, the health care per capita GDP gap between the U.S. and the other OECD countries is exaggerated because they don't spend enough. As I explained in another post, the blunt measures of life expectancy, live births, etc. have little to do with the health care system and its financing; cultural and genetic factors and statistical methodology are more responsible. Real medical outcomes such as cancer survival rates, life expectancy post-MI, etc. are the measures that are more reflective of health sytem characteristics. The U.S. leads in almost all of these legitimate measures.
Trying to argue against irrelevant leftist talking points and convince in-power ideologues that live in an alternate reality is causing much of the political frustration. This "through-the-looking-glass" health care plan must be stopped as it is nothing more than another leftist Trojan Horse for control of the economy (i.e. "climate change" energy taxes).
Good Points
and I agree with most of them, buttttt....
Our current debate about heath care reform is not about 'quality,' but availability, portability, and cost. The US lags in those vital areas. 22,000 people in America die per year from a lack of insurance. Half of all bankruptcies are a result from a medical crisis. Corporation bear an ever increasing burden that our foreign competitors do not. The Republican could have shared credit in an historic bill by ensuring the quality of health care in any bill. However, Republica have once again, with a quarterly mindset, are taking the most partisan path, the easiest path by believing they'll be back in power by killing health care reform. It's not going to happen and where will the Republicans be when health care reform is popular (like Medicare, Medicaid, SCHIP and Medicare prescription D) in 2010 or 2012?
Reform?
Health care RE-form is already popular, but what is being proposed is health care DE-form, and it deserves to be killed.
Businesses are able to deduct health care as an operating expense, unlike individuals, which is an inequity that could be changed legislatively relatively easily. This would unload much of the health care costs from employers, and translate to increased wages allowing employees to buy their own "insurance" and increase portability. Especially if they are able to buy "insurance" across state lines and through Association Health Plans (AHPs) and Health Savings Accounts (HSAs). Oh, and decreasing the highest corporate tax rate (preferably to 0%) in the OECD (along with Japan) would do even more to improve profitability, innovation, and increase employment. Those would be wildly popular reforms, not just a Trojan Horse wrapped in hope and change.
As a suggestion, to be taken seriously, don't cite Families USA's faux "studies" cum press releases. They have been shown to be methodologically horrible and downright deceptive (purposely, I assume).
Likewise, "half of bankrutcies due to medical bills" has long since been debunked. The authors' conclusions were based on survey respondents listing medical bills (which included costs due to gambling and drug/alcohol abuse) as a contributing factor, then presuming it to be the proximate cause. In actuality, it was closer to 17%, and even then, most likely in respondents nearer to the poverty line as one would suspect. The most likely #1 cause based on multivariate regression analyses was (shocker of shockers) credit card debt.
These are the types of "factoids" (i.e. leftist talking points) that need to be overcome in the debate. As they fall one-by-one, people are seeing how they have been manipulated; and hence, the outrage being displayed by the real grassroots. Similarly, the desperation on the Left when they can no longer rely on popular ignorance is being exhibited by their mean-spirited and condescending slanders and libels targeted at the informed opposition.
"The trouble with the world is not that people know too little, but that they know so many things that aren't true."
--attributed to Mark Twain
Re: Reform?
I agree with you on the economics. That rising health care cost make our business less competitive with our competitors. I'd point out that allowing individuals to buy insurance accross state lines would require even more federal regulation to insure there is a basic standard; e.g. can't deny insurance to a person with a pre-existing condition, etc. And decreasing corporate taxes need to be coupled to raising income tax to make it defecit neutral.
I'd like to see the links disproving Family USA press release. After all, they're are just passing along information from the Institute of Medicine, who in turn advices Congress. Plus, the data is along lines from the Urban Institute. How many do you think die from the lack of health insurance? 5,000? 10,000?
Thanks for the link about bankruptcies, but I don't see any debunking. I would have been more impressed by the study if it were not sponsored by Americ's Health Insurance Plan (the health insurance misinformation lobby). Here's the rebutal from Himmelstein. Even taking the 17% level would indicate how crappy insurance is in this country. Why quible about what constitutes middle-class, when insurance is supposed to prevent families from bancruptcies, yet it fails in nearly 1 in 5 times.
Your wish is my.. well, you know.
"When the Families USA report was first released, The National Center responded pointed out how the group distorted the data to reach its conclusion."
"It turns out that Families USA arrived at these numbers by manipulating data..."
"Family USA's state-by-state economic analysis of an SCHIP expansion should be withdrawn or at least simply ignored."
"Families USA’s Flawed Health Insurance Numbers" My comment at this site:
Nope
None of your links refuted the study stating that 22,000 die annually from a lack of health insurance. The last link disputes the Ohio figure, but does not refute the national figure. Perhaps the Institue of Medicine's numbers are solid. 22,000 Americans die yearly from a lack of health insurance
You're learning!
Actually, they refuted the methodology for the 50 individual states's reports.
The IOM (in 2002) said 18,314 due to a lack of preventive services, a timely diagnosis or appropriate care, then attributed lack of insurance as the sole cause and that these same people never got insurance or care throughout their working lives. A lot of suppositions to get there, but at least it's a credible source. Of course, that number is only 0.06% of their assumed 30M working-age uninsured. But let's take it at face value, and assume it is correct: I'd be willing to bet that 0.06% of the insured die for the same reasons -- lack of preventive services, timely diagnosis, appropriate care -- even though they have "insurance", even in universal coverage countries. Always watch for "single-entry accounting" in such studies.
The question should be excess deaths, which necessarily would be even smaller, and establish a causal link that excludes other possibilities (i.e. other behavioral characteristics or barriers). You have to look behind the numbers cynically, critically, unemotionally, and not assume anything.
At least now you're using a credible source in the IOM, which was my point in the first place. I'm making progress, I guess.
There You Go
Good questions deserving of answers. However, I feel those numbers are conservative because science trends toward conservatism in a sense scientists don't make claims unless they can back them up.
It is a very small number of people who die from a lack of insurance (45M). The odds look like 0.04%. How many would have died even if they had insurance? Well, that is a problem with medicine itself rather than the problem of lack of insurance.
My point is FamilyUSA is using Institute of Medicine's numbers and the Urban Institute and that 22,000 Americans die from a lack of insurance is a credible number.
No, you misunderstand
"making it easier to compete" means givng them help in facing competition, not creating more competition. Duh.
We'd be better of with more
We'd be better of with more responsive, smaller, more focussed insurance companies, and cheaper costs for all....thank you Stop Dreaming Start Action | Rusli Zainal Sang Visioner | kenali dan kunjungi objek wisata di pandeglang | mengembalikan jati diri bangsa | Sukabumi | lowongan kerja | webdesign murah
re:
That's not an argument for competition. That's the argument of a monopolist.
These democrats are amateurs
I am now more than ever convinced that this administration is not capable of implementing a national health care strategy. They are merely amateurs. One of their main arguments for a public plan is the following (as quoted from the original post)
<< A public insurance plan will be able to use Medicare's bargaining power to secure deep discounts for its customers >>
This assumption shows a total lack of understanding of business. You see, if i am a drug company, and you are the only buyer, then in no way shape or form are you going to get a discount from me; especially if you are the government.
I will not allow you to purchase my "wonder drugs" if you don't meet by desired price. I will hold out. If your system is starved from the drug, your government will suffer severe repercussions from the people. You'll experience public outcry, your reputation will be severely damaged, and you will eventually lose your power.....which is your greatest fear.
As a result, all in the name of keeping the peace, you will cave, meet my price (which i probably put another 15% on), and actually end up paying more....all because i know that what you really want is a satisfied people...at whatever the cost...and as a businessman, i will exploit that to my advantage.
And that is what those democrats...who seems that the majority have never run a business, do not understand. They all seem to believe that they can just dictate what they will pay...and that is so not the case.
Thats whats going to happen under a single payer or public option system that always will morph into a single payer system. They are so unprepared for reality.
Um, It Doesn't Work That Way In Canada, Britain, Germany, ...
Japan, etc, etc. They get quite the discount on their drugs. I don't see any reason why the U.S. gov would not get similar break. After all, most of the basic research is done in our university system or government labs.
Families USA makes ACORN look legitimate...
of all the farLeft, astro-turfed to death, faux-"grassroots" advocacy groups run by sleazy trial lawyer types, Families USA has to be the prize-winning tops. Their reports and studies are so bogus, not even the DailyKos or HuffPo take much note of them anymore.
Trusting in their "studies" or reports is about as useful as working to find an honest man in the House Democrat Caucus. Families USA was corrupted by the lure of a seeming access to power long before ACORN and the NAACP and NOW and Human Rights Campaign slipped into bed with whatever Democrat promised them the biggest lay at week's end.
No wonder Todd takes them seriously... on his side of the argument, there is nothing that approaches reality or legitimacy to glum onto. He has to bottom feed. Sorry pup, that couch-potatoe Todd is.
Oh, No, A Mighty ACORN
Get a grip, Mountain. FamilyUSA passes along studies from health and urban organizations. There's nothing phony about that.
I've never taken serious the accusation that ACORN 'stole' the election in 2008. Sheesh, who knew that all the Soviets had to do was fund an voter registration front and they could have run their own candidate. The more I see how conservatives operate, I'm not sure if their ignorance is fake, but real. Willful ignorance. A pschological need for ignorance to mitigate their feeling of rejection. The 'anger' stage of grief is unproductive and usually doesn't last this long, but Republicans can't seem to operate without anger.
Trusting in their "studies"
Trusting in their "studies" or reports is about as useful as working to find an honest man in the House Democrat Caucus. Families USA was corrupted by the lure of a seeming access to power long before ACORN and the NAACP Sandals(Slippers)|Visvim Men Sandals|Birkenstock Men Sandals|Colin Stuart Women Sandals|Juicy Couture women sandals|Abercrombie&Fitch men sandals|Clarks Sandalsand NOW and Human Rights Campaign slipped into bed with whatever Democrat promised them the biggest lay at week's end.