Public Plan Option
This is the objection the health insurance industry is putting forward in opposition to Obama’s plan to include a public plan option in the health care reform bill.
But critics argue that with low administrative costs and no need to produce profits, a public plan will start with an unfair pricing advantage. They say that if a public plan is allowed to pay doctors and hospitals at levels comparable to Medicare’s, which are substantially below commercial insurance rates, it could set premiums so low it would quickly consume the market.
So let me get this straight. It’s not fair to have a public option because they don’t have to make obscene profits for their shareholders and they can use the leverage of the combined group of medicare and public option customers to negotiate better fees with doctors, hospitals and drug companies.
Isn’t that the point?
One little cavil — not all doctors are money grubbers, and the ones who are tend to be at the power end of the socioeconomic scale. So THEIR fees are likely to be unaffected by “negotiations,” but the medical pros who would maybe like to practice family medicine and do house calls and all that Marcus Welby stuff will continue to be squeezed between the for-BIG-profit medical schools and their lenders, and the stuff we’ve seen with Medicare and Medicaid with ‘crats’ careers being built on “cutting reimbursements and denying claims and charging back,” the same stuff the weenies in the Humanas BX-BSs do so well.
Too many people following the “other” Golden Rule, “them as has the gold, rules — and gets more gold.” Maybe it’s time for a “steel-jacketed Leaden Rule” to encourage observance of the Real Spiritual Actual Golden Rule.
Saying that, I say again I am a Vietvet who gets VA care (not dental or vision, they lack both except limited for “service-connected” problems) and I can tell you that a single-payer systemalong the VA lines WORKS, and works well for most of us (barring the “sucking mean people” you find everywhere.)
Morgan, are yout listening?
JTMcPhee
June 7, 2009 at 8:34 am
when doctors permanently have lower incomes who will want to go through med school and incurr both the cost and considerable time?—my guess is inferior docs will be the outcome for all
doug
June 7, 2009 at 8:52 am
Doug, I OBJECT, you seem to discount the new “progressive” altruism.
PRC
June 7, 2009 at 9:49 am
not sure i want a doctor whose only incentive for going to med school was to make a lot of money. the incentive for actually helping people seems to make for better doctors to me.
kevin
June 7, 2009 at 10:24 am
There is a return on all investments–My wife is a pediatric ER doc at a large city hospital–not a high paying job– but if she hadn’t earned enough in private practice to re pay her school loans and if I didn’t make a good income she could not afford to take her low paying job– don’t kid your self—reduce pay for docs and fewer people will go into medicine
doug
June 7, 2009 at 11:51 am
Maybe the scam that is med school financing might get deflated along with all the rest of the bubble economy that just collapsed, along with the other scam that is “family-funded college education” attached to a lifetime burden of “giving” to the Alma Mater to keep the scam afloat and fund somebody’s “edifice complex?”
Most people who get medical care in foreign lands, where the “educational process” is valued and priced differently though apparently as “quality” as what we have here, seem to be pretty happy with the care (which is generally more humane and supportive) as well as the cost.
In fact, our “Health Insurers” now have planned that up to 27 million American rate-payers (can’t honestly call them “insureds”) will be sent EVERY YEAR on “medical tourism” jaunts to those countries with the SOCIALIZED MEDICINE THAT IS SUPPOSED TO BE SO B-A-A-A-A-A-A-A-D, for treatment of all the stuff that is for a lot of reasons way more expensive here, by usually at least half an order of magnitude. So whether you want to go to Uruguay for your cardiac surgery OR NOT, your “freedom” in our “free market choice” will mandate that you get on an airplane with a bunch of other sickies, burn a butt load of carbon fuel to get you to those SOCIALIZED MEDICINE PROVIDERS in various foreign lands, get your surgery or whatever (and I’m not talking just elective boob and butt jobs and calf implants for the vanity-and-gastrocnemius-impaired, rather hips and knees and every kind of abdomnial surgery. Because why? Because the gentle, kindly insurance execs have determined that it will be a lot more profitable to do it that way.
Good luck, of course, it’ there’s a post-op problem — It ain’t Walmart, you can’t go to Customer Service for a refund and get your old gall bladder back, you’ll have to find a doc willing to take on some other doc’s (albeit less likely) “unfortunate sequelae.” At least you are less likely to get a “nosocomial infection” in many if not most of those SINGLE-PAYER SOCIALIZED COMMIE RED NO-CHOICE MEDICINE COUNTRIES. That’s the so amazingly-frequent infection(s) you pick up in the hospital, due to the “pure business” nature of the institutions, where they can’t drive the cleaning slaves or nursing staff or even OR people hard enough to make those 30% profits without cutting the corners just a little too sharp.
And did I not read that fewer people are going into medicine in the US of A already? On account of the marketing-and-profit-driven mess that weighs us down here, top to fucking bottom? And how many doctors named “Patel” does YOUR wife work with? “Reduce pay for doctors,” my ass — that happens because of the broke-dick bastards that “admininister health insurance” like a dose of arsenic to collect the insurance money. Or thanks to years of “compassionate conservatism,” via the actions of the bureaucrats with their “Mandate for Leadership” training and mindset, who turn our little manifestations of single-payer into some beds of thorns (you know anyone drowning in a “Doughnut Hole?” e.g?), despite which the Medicare-Medicaid-VA “memes” do a much more “efficient” and less costly job than fucking “free-market forces” will ever be able to, no matter how much lobbyable tinkering the POTUS and those fully-insured barstids in Congress do to it.
JTMcPhee
June 7, 2009 at 12:40 pm
Go back to see Michael Moore’s film on the American health system!
Watch the well-off docs in the British health system, who work 5 days a week, get paid well, can pay full attention to their patients without having to spend 1/3 of their staff time pursuing insurance payments. Watch the patients in Britain, Canada and France, who get cared for, without having to prove they are insured.
How satisfied are you with your health insurance now?
We have decent insurance (via Home Depot, where my husband is employed). We pay hundreds every month just to be covered, our daughter is not covered at college in another state, and the co-pay for emergency care is $100 (unless you are hospitalized, in which you pay $250/day copay for the hospital); $25 copay for an office visit; $35 for a specialist (includes the podiatrist and skin doc).
And that’s with GOOD, employer-provided health care.
When our eldest daughter graduates from college next year, her first order of business will be to find a way to get health insurance, and we will still have to pay $200/month so my youngest daughter can still be covered. Is THAT the glory of the American ‘free market’ health system?
MS
June 7, 2009 at 2:10 pm
“reduce pay for docs and fewer people will go into medicine”
So you’re saying that the health insurance industry is concerned that doctors won’t make as much money?
Or are they concerned that shareholders won’t make as much money?
Because, pardon my French, but fuck the shareholders.
Dan
June 7, 2009 at 6:42 pm
Jon, that is exactly the point. However, if anyone looked at the Swiss model, they’d see that insurance companies make good profits, while at the same time consumers receive immediate, good quality care and the government keeps normal health care costs down.
Valerie Curl
June 7, 2009 at 8:28 pm
I hate to say it, Valerie, but for a host of easily identifiable reasons, We Are Not Switzerland, and ‘free market capitalism” of the sort practiced here is anathema to the Swiss. Do you really think that in the face of every possible proof that rapine and greed continue at the heart of every American business model, there is any possibility of a “Swiss model” here?
JTMcPhee
June 8, 2009 at 8:04 am
Dan–I am saying that fewer less qualified peolpe will go to med school if compensation is reduced–that seems obvious—we may want that but be aware of the impact of ones actions—
doug
June 8, 2009 at 2:22 pm
What proof do you offer that a) compensation for doctors will be reduced, and b) that will also reduce the number of doctors going to school?
Additionally what percentage of health care cost increases are due to increasing doctor salaries and not say due to the number of unnecessary tests doctors run to avoid malpractice insurance claims? Or to say inflated costs of non-medical health insurance employees (specifically upper management)?
Oh god, what if upper management salary cuts reduced the number of people getting MBA’s? The horror!
Kevin
June 8, 2009 at 5:34 pm
I agree that it is a bad argument, but it’s an argument against a bad idea.
The problem with healcare costs is the disconnect between the consumer and the cost. Health insurance should be handled the same way as auto or home or life insurance. What politician is leading the charge to reduce those costs?
The best example for predicting the effects of increased governement involvement is the education system. It is heavily, heavily sudsidized by the government and it has runaway costs comparable to the health industry. More government plus less consumer involvement equals higher costs and lower quality.
Rebar
June 8, 2009 at 8:36 pm
the proposal by Kennedy is to have rates set at Medicare plus 10%—that rate structure is substantially below what insures are paying today–and unless the costs of an MD degreee come down substantially the return on that investment by defination will go down–maybe individuals will just suck it up–pay more and make less–but the brightest people will have choices and all the docs I know are telling their children not to go into medicine
doug
June 9, 2009 at 2:00 am
Doug,
To that end, we need to end the “MD cartel” – we need to make it MUCH easier for people to get hold of prescription drugs. Even if it is just non-narcotic. There should be Ready-Clinics in every drug store in America.
We also need to dramatically limit malpractice awards. That’s one of my favorite “wins” that comes from folks arguing for socialized medicine – they all admit we cant be suing the shit out of doctors.
Finally, gotta tell ya – we should be pushing to replace all of Medicare with VA style care. We should be practicing these stunning efficiencies on Medicare before we push everyone else into a program.
Morgan Warstler
June 9, 2009 at 7:16 am
so clear–if you can’t run medicare what makes you think that you can run national healthcare?–agree completely on drugs(most not all) and malpractice
doug newhouse
June 9, 2009 at 9:06 am
The argument that this approach will result in less money, and therefore fewer doctors, is the kind of argument the right usually derides. If the subject is education, for example, the message is to do more with less. An argument that has its appeal.
Another favorite argument of the right is, “Whenever the government runs anything, it spends far too much.” So there would be MORE money in health care, rather than less, by that argument anyway.
And yet you conclude that doctors will make less, rather than more.
I’m suspicious of huge federal programs myself. I’m also suspicious of huge corporations. I don’t know the best way to go. But right now we’re being bled dry by Vampire Incorporated. There has to be something better than the scheme we have. How many millions have to end up with no insurance, and therefore practically no access to medical service, before we recognize the vampire?
The argument that a public plan option will result in fewer doctors sounds fishy to me. Maybe we’ll have more doctors who want to practice medicine and fewer doctors who want to make five million a year. That would be just fine with me.
Malpractice may need reform but again, Vampire Incorporated would like to implement a low-dollar cap no matter how outrageous the malpractice and no matter how egregious the injury.
Try running that by a public that is still sore from the reaming it has had delivered to it by the insurance industry the past nine months. When the insurance industry shoots itself in the head, it demands top-tier giga-billion-dollar triage.
Dan
June 9, 2009 at 3:49 pm
Dan how about this thinking…
England’s UH is based on rationing.
France’s is based on controlling costs.
The VA here in the states does both, and it does it to great effect. Patients fight to get into VA care. The patients are really hurting. But they get both great and inexpensive care.
When you go into the VA, your records are electronic, your doctor may change but he can read all your records, the doctors have a limited budget to work with, so they have no incentive to do needless medical tests.
Whereas, Medicare sucks because while we limit payments (control costs), it works within the current system, so doctors have ever good reason to do unnecessary shit they can bill for.
So here’s my point, before we go trying to push all people satisfied with their healthcare into some universal thing…. why not:
1. Turn the Medicare system into a VA-style system.
2. Use the new VA-style system to cover all the uninsured.
This would give us a tremendous first step toward electronic record keeping, we’d have a fixed yearly budget, so the doctors would have stop needless tests / treatments.
It’s a BOLD move, it is single payer – and it will house everybody who doesn’t have insurance.
And importantly it lets those who have the money to spend, buy all the extra crap their doctor can sell them on.
Morgan Warstler
June 9, 2009 at 4:10 pm
face reality–not every one can have cutting edge health care that other people pay for–there should be a bare bones plan and an a la carte plan for those who want/can pay for it–my wife is an er pediatric doc in a huge city hospital–a poor paying demanding job that she loves–but she only took it (she was in a high paying private practice) because I make a solid living–most doctors I know wolud leave medicine, if they could, if there pay is slashed, red tape increased and malpractice kept where it is–this is reality — a government takeover will fairer it will be lower quality and frustrating with long lines, rationed care and lower quality for those that can afford to pay–with medicare bacically bankrupt I don’t understand how the government can take on a new massive spend program–it will be a mess
doug
June 9, 2009 at 5:59 pm
Exactly right Doug, we need a two tier solution. Basic care done a la VA care. And private premium care.
This will keep the poor out of emergency rooms. It will fix Medicare. It will cover everyone. And the trade off for this needs to be reduced malpractice claims.
Morgan Warstler
June 10, 2009 at 1:54 am
of course the problem is defining basic–
doug
June 10, 2009 at 2:52 am
I have long maintained that insurance is the problem in the healthcare industry – with the consumption of the non-profit health care system, long the backbone of public care, by the profit-making sector over the last 20 years, is it any wonder that that health services have declined for the average American? High infant mortality rates, 72nd in worldwide health rankings, 15% of GDP spent on healthcare, costs since the 1950’s far exceeding the inflation rate are all indicators of a broken system. Meanwhile my 84 year-old father with the beginnings of dementia was convinced to undergo a knee replacement because he had insurance that would pay for it, not because he really needed it and it would improve his quality of life. I’m appalled.
PBS has a great timeline on the mess here http://www.pbs.org/healthcarecrisis/history.htm
Fiona
June 10, 2009 at 6:06 am
Doug, that’s the beauty of VA care – there is a budget, the doctors/ administrators define basic care. They figure out what spend on whom. Basic care = rationing.
Morgan Warstler
June 10, 2009 at 6:44 am
Morgan—sounds right to me–that will be the way it is–
doug newhouse
June 10, 2009 at 11:59 am
doug-
A “a poor paying demanding job” is relative. Have you seen some of the jobs people have in India? I would be careful how you throw that phrase around.
Mark
June 11, 2009 at 2:28 am
we don’t live in India–if thats the standard everyone here is rich–including the unemployed on welfare—try going to med school with $300000 in student loans and paying it back as a government worker afte killing yourself to become a doc–
doug
June 11, 2009 at 3:01 am
Warstler, nice schtick on how VA “rations” health care. That’s pretty much a flat out lie. The big issue is funding, and probably some clubby stuff amongst a few of the “managers” who don’t want to have too big a thing to manage and who really don’t like veterans anyway (bunch of whiners, think they’re entitled to anything for ’serving their country,’ grumble, piss and moan,) with a helping of hypocritical right-wing misery-adding like that rat-infested shithole where they dumped those brain-injured and various-plegic GIs as part of the same “Bethesda” that does such a bang-up job of keeping presidents and other luminaries it tip-top medical condition. “Thank you for your service.” “Support our troops.” Have YOU got one of those little US flag and hypocritical bullshit made in China bumper stickers on whatever you treat yourself to drive? Go fight me a war, says Cheney and Bush and the Real He-Men war wimp right wing shitheads that ran Congress and the VA through all those miserable years since Reagan. Yeah, fight me a war, make the world safe for Saudi oil profits and Blackwater and Boeing and Lockheed-Martin and all the other bloodsuckers, and when you come home all busted up because even a few pieces of armorplate for your Humvee or body armor for yourself or heaven forbid, MRAPs, were not a budget priority in the face of the “need” for a 300-ship Navy and all the F-22s you can eat and V-22s you can stuff up your ass. And where in the funding priorities is the money to fund the most efficient thank-you-for-your-service? Bridge to nowhere, for small starters? The VA is funded by CONGRESSIONAL APPROPRIATIONS, using “suggestions” from the White House as to how much should be “budgeted.” The VA hierarchy does not write its own “budget.”
Do you get VA health care? I do, as one of the groups for which there IS funding. It may not be the Mayo Clinic, but how many of your fellow Americans have “insurance” that gets them what is supposed to be the pinnacle of medical care, on the perfect American model? My wealthy sister and brother in law buy what they need at list price. If I need more than your bullshit “basic care” lie, I get it. I also get excellent PREVENTIVE care (except for dental and vision, there’s no money in the appropriation for that except for certain service-connected problems.) But the VA system is one hell of a lot more efficient and cost-effective than what most of the 80%ers get. Doctor visits, follow-up, a single Electronic Medical Record, low med prices, and all, even with the overhead of a bureaucracy that does what all ‘crats “embedded” by all those years of shitting over the public since Reagan, at much lower cost per unit of service than can ever be provided by the +30% or more “medical insurance industry.”
I do enjoy hearing your lies and distortions and flat-out fabrications though, it reminds me of “what we fought for” in places like Grenada and Panama and Vietnam and Laos and Cambodia and Lebanon and “Somalia” and “Iraq” and “Afghanistan.” Buckets of bullshit, served up by people like you.
I bet you even think the upcoming “FORCED ‘MEDICAL TOURISM’” by which the “health insurance giants” who spurn SOCIALIZED SINGLE-PAYER MEDICINE are going to ship tens of millions of American rate-payers to FOREIGN SOCIALIST COUNTRIES TO BE TREATED BY SOCIALIZED DOCTORS FOR ONE-FIFTH OF WHAT THE SAME CARE COSTS HERE. And then you find your way home, and God help you if you have any need for follow-up care — just try to find a US doc who will pick up some unknown case after somebody else has treated.
Hey, you seem to have as a hidden agenda the need for anyone older than you who is not still working to make you richer to commit suicide. Hey, smartass, why not do what I’ve suggested here several times? Set up a chain of suicide parlors! Franchise! Get Kevorkian to give you testimonials. You seem to have the necessary lack of empathy and decency to pull it off. Go for it, big boy!
JTMcPhee
June 11, 2009 at 4:54 pm