Nate Silver provides a strong argument that opposition to a public plan as part of health care reform can only be justified based upon adherence to conservative ideology. After all, the facts clearly show that Medicare, the government plan that a public option would be modeled upon, provides health care coverage far more efficiently and economically than private insurance does–and even receives greater satisfaction in polls from beneficiaries.
The only reasons to be strongly opposed to offering a public plan as an option would be either a financial interest in the insurance industry or a knee-jerk opposition to government action regardless of whether it is actually beneficial. Of course those who hold such views typically get their information from conservative sources which cherry pick the facts to show what they believe.
While Silver is right that opposition to a public plan is primarily based upon ideology, the same can also be said about those who see a public plan as crucial to the point of attacking supporters of health care reform who are wavering on this issue. Many who insist upon a public option are actually supporting this as a means of ultimately establishing a single payer system. Of course conservatives who believe that the private market is always better than government should have noting to fear as their ideology clearly argues that government cannot compete with the market. Silver points out that this is true in many areas, but health care coverage is different.
If health care reform was truly successful then a private option would not be necessary. There are really two reasons to insist upon a public plan. In many cases it is every bit as ideological as those who oppose the public plan. In other cases such support is based upon pragmatism, as many fear that, regardless of the laws that are passed, it will be impossible to prevent insurance companies from continuing to game the system to maximize profits by finding ways to deny needed care.
Update: Paul Krugman is kind to provide an example today of support for a public plan which is largely motivated by ideology. Obama, in contrast, provides an example of pragmatism in recognizing that it is foolish to risk reform by drawing lines in the sand. We saw where that got us with HillaryCare.
Sharyl Attkisson of CBS provides a good example of the misinformation which is being spread to attack the public plan. She writes:
And if you do choose a public plan, you may want to keep your favorite doctors but they may not want to keep you. Under government health care, they could be paid 20 to 30 percent less.
With suggestions that the public plan will pay at 10% over the Medicare rate (or even at Medicare rates in the worst case scenario) this fear mongering doesn’t hold up. As I noted when the first outlines of the Senate Health Choices Act were leaked out, this would be very beneficial to physicians in primary care. I noted that a quick review of reimbursement for common charges such as office calls showed that most private plans paid more than Medicare but by less than ten percent.
Primary care physicians would likely make more money from patients in the public plan than from employer-paid health care. It is likely that some subspecialties will come out behind, but as long as primary care physicians are doing better under the public plan than from private insurance there will not be major issues with regards to access to care. It is difficult for surgeons and subspecialists to refuse to accept referrals based upon insurance coverage, especially if a plan has many subscribers.
There are some physicians who do not accept Medicare, but there are also private plans I do not accept as they pay significantly less than Medicare. In making such comparisons it is also important to consider the cost of participating in a plan. While it is necessary to increase staffing due to the burdens imposed by some plans, Medicare is simple to bill to and pays reliably. With clams sent electronically to Medicare my collection rate is pretty close to 100%, with the rare rejections generally resolved after correcting a minor error in the initial claim.
Of course I’m in the camp of “if it is government it must be bad”, but if I weren’t in that camp, where would the best source of info of what specifically is being proposed? Is the bill out there already in print?
There are several bills and they are still being debated in committee so there is no final bill out there. At this point all you can do is review the various House and Senate bills to get a rough idea. The various bills have many things in common but also differences.
AMERICA’S NATIONAL HEALTHCARE EMERGENCY!
It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.
STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.
We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.
And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.
Progressive democrats and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and demand that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).
Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.
In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!
Contact congress and your representatives NOW! AND SPREAD THE WORD!
God Bless You
Jacksmith – WORKING CLASS
I’m amazed that the Soviet Union didn’t do better, since they didn’t have all that GREED and PRIVATE FOR PROFIT DISGRACE holding them back.
Medicare…provides health care coverage far more efficiently and economically. …government can’t compete with the private… Ok, I’m coming in late to this health care debate, so let me ask, do the deductions from pay (and/or) employers for medicare pay for itself, or is it subsidized by more government money? I really don’t know, but based purely on ideaology, I ASSUME one of two things, either A)it really can’t compete with the private sector but for government subsidies (AMTRACK style) or B)it actually can pay for itself but congress steals funds from it. Again, I’ll admit this isn’t based on any facts I know, only a general principle that when the federal government runs something, it either steals from it or it subsidizes it, programs taking care of themselves are a myth. So what is the real answer? P.S-Jacksmith- here are a set of more assumptions, I assume when you say U.S is 37th worst healthcare you are referring to the year 2000 World Health Care report that puts the U.S. as 37th. This report lists Myanmar as the worst in the world and Zimbabwe as the 37th worst. Of course I don’t know what value this list is as it has Columbia listed 15 spots higher than the U.S.,perhaps to help guide people to drive past the Mayo Clinic in Minnesota to fly down to Columbia for far better. I also assume you are just posting and running on to the next blog and will not be reading this feedback.
Mike,
Medicare is financed with government money but it is still possible to compare the amount spent, regardless of source. Here’s a direct comparison between the government Medicare plan and private business. Bush’s Medicare D plan has allowed private companies to compete with Medicare. It is costing 13 to 19 percent more to care for the same patients.
You are right that you have to take health care rankings with a grain of salt. In some cases the US is better than most if not all other countries, such as in tertiary care. If you can go to the Mayo Clinic you will certainly receive better care than in Columbia. On the other hand, many countries have a much higher proportion of their citizens covered, lower infant mortality, and longer life expectancies. Tens of millions of Americans are not only unable to receive care at the Mayo Clinic but can’t receive adequate routine care at home.
I don’t have the reference, other than this blue dog Democrate, Loretta Sanchez (D-CA), that moderates and blue dogs are backing off on the heels on the GBO 2T cost estimate over the next ten years. Even Obama was taken aback by that.
Pile on that this rising unemployment update from the Naked Capitalism Blog:
Consensus forecasts had expected a modest fall in initial unemployment claims this week; instead they rose by 15,000. Similarly, continuing claims rose by 29,000.
Bloomberg still tried to put a happy face on this not-aligned-green-shoots story. This was the third and longest paragraph of a mere four paragraph report:
If Smith is correct and history repeats itself, we’re turning into phase 2 of the downturn, i.e., UE > 10%.
That’s BIG trouble for Democratic 2010 hopes lets alone cost major health care reform.
The Cap & Trade bill is already in trouble (good, for my money) as more and more people are seeing it as a tax increase on those of us Obama promised not to increase taxes. For example:
Tyler Cowen of the Marginal Revolution also says the impact on climate will be almost zero. The cost, however, will not be zero:
Berry Ritholz of The Big Picture Blog calls the Cap and Trade bill what is — a HUGE tax increase for all of us:
This week saw President Obama give us a budget with a projected deficit of $1.75 trillion dollars, and a massive tax increase on the “wealthy.” But hidden in the details was an even larger tax increase on everyone. Obama wants to create a cap-and-trade program for carbon emissions. This is expected to generate $79 billion in 2012, $237 billion by 2014, and grow to $646 billion by 2019. These will be payments by energy (primarily utility) companies to the government. That will cause utilities to have to raise the prices they charge customers for energy. Such a level of taxation is eventually 4-5% of total US GDP. That is not small potatoes. And since the wealthy do not use all that much more power than the rest of us, it will affect the lower incomes disproportionately.
It will take money out of consumers’ pockets and transfer it to the government. You can call it cap-and-trade, but it is a tax. And a huge one. Anything that will take 4% of GDP away from consumer spending is not business friendly. And by driving the cost of energy up, it will drive high-energy-using businesses away from the US to developing countries where energy is cheaper. It will make it even harder for people to save money and drive up costs for the elderly and retired. But it will make the environmental lobby happy.
+——-
A projected 2T 10 year bill, on the possible cusp of a new leg in the downturn, and a Tax (er—I, mean “Cap”) and Trade bill that will undoubtable raise energy costs for everyone while doing close to zip for the climate, and I dont’ think that “opposition to a public plan as part of health care reform can only be justified based upon adherence to conservative ideology.”
Chris- You may know I’m as anti-cap and trade as anyone, but something about that report you posted I’d like to challenge: China has made it clear it won’t tolerate much of a fall (in U.S. currency). How in the world could China stop our currency from falling? They could easily devalue it if they wanted by dumping our currency, but they can’t keep it propped up. What? Will they burn all the greenbacks they already have and then buy up a bunch more? Even if they did that, the Fed would just print up more. I don’t see devaluation of the dollar as saving the U.S. economy either as the article seems to indicate. At the risk of perhaps repeating myself (I can’t remember if I said this already on this blog). Double digit or perhaps even triple digit inflation will be here before the end of Obama’s first term. Politicians on both sides of the aisle know they can’t get re-elected by taking away big ticket benifits or by skyrocketing taxes to try to catch up with payments. The only, I say again, THE ONLY way to continue for politicians is to have the “non-political” (ha ha) Fed to print up the money. This, in turn, must lead to high inflation and that can’t be stopped with all the tea in China.
Hey Ron:
If you want to continue using infant mortality and healthcare as key metrics that demonstrate the failings of our system, please address the following points at your leisure.
1. Infant Mortality and Life Expectancy.
The definition of what constitutes a live birth varies widely from one country to the next. If a severely underweight, premature, or ill baby dies within X number of days after being delivered, is it considered a “live birth” that counts in the nation’s infant mortality stats? Depends on which country you’re talking about, and the more lenient the standards, the lower their infant mortality stats will be.
“Registration artifacts in international comparisons of infant mortality.
Kramer MS, Platt RW, Yang H, Haglund B, Cnattingius S, Bergsjo P.
Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Canada. michael.kramer@mcgill.ca
Large differences in infant mortality are reported among and within industrialised countries. We hypothesised that these differences are at least partly the result of intercountry differences in registration of infants near the borderline of viability (<750 g birthweight) and/or their classification as stillbirths vs. live births….The huge disparities in the ratio of fetal to infant deaths <750 g and in the proportion of live births <750 g among these developed countries probably result from differences in birth and death registration practices. International comparisons and rankings of infant mortality should be interpreted with caution.”
http://www.ncbi.nlm.nih.gov/pubmed/11862950
Read the whole thing. Plenty more where that came from.
2. Life expectancy.
What happens when you control life expectancy stats for mortality that the medical system can’t do much about, like murders, suicides, drownings, falls, and all of the other drivers of mortality that aren’t manifestations of disease progression that doctors, nurses, hosptitals, etc can actually do anything about?
US life expectancy rises to number one in the OECD.
http://www.aei.org/docLib/20061017_OhsfeldtSchneiderPresentation.pdf
If you want to increase life expectancy in the US – initiatives to combat crime, suicides, workplace accidents, auto accidents, etc would constitute a much more rational, data driven, and *non-ideological* response to the mortality data.
3. Quality.
When you visit your doctor or hospital, do you evaluate the care they provide solely in terms that would be captured by mortality stats? If someone suffers from a disease or injury that’s non-fatal, such as – say, severe arthritis or severely damaged cartilage in one of their joints – don’t things like prompt treatment, minimization of pain and suffering constitute meaningful criteria by which to judge the performance of the system that’s delivering their care? Do the metrics that you use to evaluate the US health-care system take any of these factors into account, and if they do – how confident are you that they don’t suffer from the same distortions that make other trans-national comparisons so difficult? Does the fact that someone seeing a medicine man, homeopath, chiropractor, etc is “extremely satisfied” with their care actually tell us much about the quality of the care that they received? How about Chinese peasant’s reflections on his recent apendectomy?
I welcome your non-ideological response to all of the above at your earliest convenience. Then we can move on with a non-ideological discussion of the role of say, cost-shifting in comparisons of public versus private insurance plans.
” China has made it clear it won’t tolerate much of a fall (in U.S. currency).”
The rub with the Chinese, and other foreign investors in T bills (which is what’s funding all the U.S. spending) is this:
Dollar’s slide hurting foreign investors
The other concern is this:
The record of the Great Depression was that over-consuming European countries defaulted on their external debt. While we keep reassuring China that we will take responsible fiscal action, the fact is that if recovery falters, tax revenues will decline, making deficits worse. Indeed, the history of past financial crises suggests that most of the budget deficits resulted mainly from plunging receipts as opposed to discretionary stimulus (this is why Obama and the Democrates are so despirate to raises taxes w/out looking like they’re rasing taxes, e.g., the Cap and Trade bill, the “sin” tax, etc.) In keeping, the usually cautious Jim Hamilton of Econbrowser tells us today, “I’m still looking for, and still not seeing, the economic recovery that everybody is talking about.”
So it is blindingly obvious that the Chinese will continue to lose on their US Treasury holdings, if nothing else due to the long-term prospects for the dollar. Thus the Chinese demands for America to make them whole (which is what this all amounts to) clearly cannot be satisfied.
Given the inability to meet China’s demands on this front. one can presume that China will, in due course, call for other concessions. One has to wonder what those might turn out to be — this is BIG worry for team Obama: how pissed off will China get and what might they do. This is your question Mike b.t.r.m.
There is no obvious way out of the US-China interdependence, and if frictions grow, the dynamic could easily become fractious. This is the danger.
From Reuters:
Beijing is diversifying its overseas investments and pressing U.S. officials for an “exit strategy” from the ultra-loose fiscal and monetary policies that China fears will eventually inflate away the value of its U.S. bond holdings and fell the dollar.
But China’s pragmatic policymakers also know there is no practical alternative to the dollar as the world’s main reserve currency.
Which is why bankers say any rhetoric from Tuesday’s inaugural BRICs summit in Russia about the need for the United States to cede power in global financial institutions should not be taken as a signal that Beijing is positioning the yuan to challenge the dollar’s supremacy…
“Will it replace the dollar?” Dallara asked. “The fact is that I don’t think this is what Chinese officials want.”…
Don Hanna, acting chief economist at Citibank, said China had less to fear from the inflationary potential of the Fed’s quantitative easing than from the dire U.S. fiscal outlook.
Faced with huge future pension and health care liabilities, America’s debt profile was not sustainable, Hanna said. But other rapidly aging developed countries were in the same boat.
OK, you say, so what can China do? We can do whatever we want and they’ll just have to take it.
Wrong says Andy Xie: “If China loses faith the dollar will collapse”
“t’s easy for Americans to pooh-pooh bearish talk about the dollar. Yet the sterling was once the reserve currency, and has fallen, what, by 80% since it lost its standing.
With increasingly dubious accounting and lax enforcement, the US capital markets no longer stand out by virtue of being better regulated. Yes, they still may be deeper and more liquid. But overseas buyers have to look hard at foreign exchange risk. The direction for the dollar in the long term is certain to be down. Overextended debtors trash their currencies (see the Great Depression, the Nordic and Swedish banking crises, and the Asian crisis for a few of many examples).
What is interesting about the Xie piece is that even the stalwart Chinese retail investor has become leery of the dollar. Despite the logic of “oh if you sell, you only hurt yourself”, the flip side is if you become certain you are indeed holding a depreciating asset, it makes sense to exit. You want to be early, not late, out.”
This the biggest problem for team Obama and the biggest worry for foreign investors — the Debt Clock, which exploded under GWB’s reign of error but now accelerated by team Obama.
I think true conservatives, moderate and blue dog Democrats, and just about every finacial expert out there “gets it:” team Obama may push the U.S. and the world into the most serious economic crisis since the Great Depression unless they come up with a REAL plan to manage the debt. Right now, they’re counting (praying) for a fast economic recovery as a function of all the spending. I wish them luck because right now, Ladies and Gentlemen: the US Is Insolvent
“If you want to continue using infant mortality and healthcare as key metrics that demonstrate the failings of our system…”
Key metric? Not only have I not used such statistics as a key metric I have also pointed out the limitations in such statistics in the past. I have also pointed out that the life expectancy is greatly influenced by factors independent of health care. While that is true, we also cannot ignore factors related to problems in our health care system.
On the other hand, I have also noted that conservatives have used scare stories that life expectancy would fall with health care reform. Such scare stories are hard to take seriously when the US also ranks so low.
“If someone suffers from a disease or injury that’s non-fatal, such as – say, severe arthritis or severely damaged cartilage in one of their joints – don’t things like prompt treatment, minimization of pain and suffering constitute meaningful criteria by which to judge the performance of the system that’s delivering their care?”
Certainly. That is one reason why care here lags behind the rest of the industrialized world as so many people are not able to receive prompt treatment and treatment of pain due to being uninsured or under-insured.
Cost shifting is also an important reason why health care reform is necessary. Because of cost shifting, all the conservatives who complain about the prospect of paying for the health care of others are already doing so, even if they don’t realize it. Greater access to coverage would reduce the need for such cost shifting.
Chris- to answer your question, please note that I didn’t say China couldn’t hurt us economically. I was saying it can’t stop the dollar from inflating. In fact, in a kind of “mutually assured destruction” kind of way, China I believe can easily crush our economy by dumping dollars, which pains me to state the obvious, but that would inflate the dollar even more. (choose whatever wore out adverb you wish: massively inflate, rapidly inflate, catastrophically inflate..) Back to my original point, China can’t stop the dollar inflating, and to answer what China will do about it…I really don’t know,I’m no expert on Chinese policy or the way they think, I know they can hurt us, I know they could press us for concessions but I’m sure it would take me by surprize what they would ask for. Perhaps the entire pitching staff of the New York Yankees and a player to be named later.
Mike — or perhaps Taiwan.
What happened to all my liberal friends….massage therapists, psudo hippies, holistic health folks, organic tree hugging self-sufficient go solar, electric car people? These are the very folks who want freedom and change, but now want big government health care? That makes no sense to me, our govt. can’t even collect our taxes right and we want them to decide our health care? Why do we want them to take our hard earned money to do it, don’t we already do this for every other entity we are bailing out? I’m beginning to think that the liberals in this country are really not seeing the big picture! I don’t want to spend any more money on those who won’t do for themselves, let alone the health care thing – get a job!
Carole,
“Get a job”. You think that is the answer? Most people who go into bankruptcy from medical expenses have jobs.
We’re not calling for big government health care at all–that’s just a line from the right to scare people. Reforming the insurance industry does not mean big government health care. The point is to give people more choices, and access to care.
Ron, I understand and respect what you want to see happen. But the end result will be government running the health care system. The transition might take a while though.
That’s largely up to the insurance companies. If they offer actual coverage and stop screwing beneficiaries then they have a chance to stick around. If they continue their current policies then they will not survive and we will have to rely on the government as a single payer.
If nothing is done the system will collapse in the next several years, leaving no choice but for the government to step in. Reforming the system is the only way to prevent either a single payer system or a government run system.
Even if we do wind up with a government run system, it would be preferable to the corporate dominated system which is worse than government control yet leaves so many without coverage. Finding that corporate-medicine is worse than socialized medicine (if we consider Medicare to be socialized medicine) is why so many doctors now support health care reform who opposed government action in the past.
I’m not sure what is the real bigger obstacle, if not outright deal killer — the huge sticker shock of 4 trillion health care reform cost over the next 10 years or the even bigger shock of the level of spending that’s occurring outside of health care.
Sometimes it takes outsiders to really bring one’s problems in to true perspective and sharp focus — the Chinese have had enough:
China Again Throws Weight Against Dollar as Reserve Currency, Calls for IMF Solution.
“The optimists that have long assumed that the dollar will continue to reign supreme due to lack of alternatives have just have their sanguine views challenged as China threw down the gauntlet on coming up with an alternative, non-country-specific, reserve currency.
Many had assumed that the China talk on moving to a special drawing rights regime, or a similar approach was just that, talk to serve as a bargaining chip in negotiations. Surely the Chinese would not jeopardize the value of their dollar holdings!
Well, that simply isn’t a rational view of things. The proper way is to construct a decision tree and look at the attractiveness of various moves going forward. The FX reserves are a sunk cost. Continuing to support the greenback long term is a losing strategy, It just digs the Chinese into a bigger hole.
Make no mistake — this ratchets up the pressure to get the deficits down, and given the state of the economic (and the stakes of the 2010 midterm elections), team Obama is going to have to push for a second stimulus package (cause the first one sucked and, because of that, isn’t working).
Over the past 10 years Michael Jackson apparently spend $10 to $20 million per year MORE than what he made, and died close the $500 million in debt.
Team Obama seem to be adopting MJ’s financial strategy for handling it’s own crisis, and this has brought understandable international scrutiny upon the US from the principal purchasers of our treasuries. They’re worried, and they have cause to be.
If only team Obama and the hard leftests in Congress were as worried, but like MJ, they’re living in Neverland where they believe the real world will never catch up to them.
From Bloomberg:
China’s central bank renewed its call for a new global currency and said the International Monetary Fund should manage more of members’ foreign-exchange reserves, triggering a decline in the U.S. dollar.
“To avoid the inherent deficiencies of using sovereign currencies for reserves, there’s a need to create an international reserve currency that’s delinked from sovereign nations,” the People’s Bank of China said in its 2008 review released today. The IMF should expand the functions of its unit of account, Special Drawing Rights, the report said.