A strong one would probably be one that anyone could buy into. A weak one would probably be one that would require very specific parameters for someone to buy into.

It's a matter of accessibility and financial strength, then ultimately the effect it has on the health insurance industry as a whole. If you open the pot and allow as many people to pay in as demand would allow, you are fully accessible and there would be the financial stability to allow lower premiums that could drive down private competitor's premium costs. A weak one would be so limited so as to pose no threat to private insurance, thus allowing private insurance to continue raising premiums and raising their own overhead unchecked.

Chris, a strong, robust Public Plan Option would actually reimburse providers at actual cost plus a reasonable profit. Unlike Medicare, which currently reimburses below actual cost and penalizes states such as Washington for being efficient. The plan would also pay for success ratios rather than number of procedures. Again, a staple of Medicare.

Chris, there's only one plan that will be viable:

1) Regulations to prevent private insurance companies from being predatory competitors by cherry picking.

2) Providing people with the option to buy into a Medicare-equivalent plan. Medicare is just a highly efficient purchasing and payment system. We must leverage the economies of scale to give patients power in the marketplace.

Kurt Chapman is simply factually wrong and putting out spin about the situation with Medicare.

1) Public plan reimbursement should at a negotiated price between buyers and sellers. That's the market in action. Buyers are we the patients acting collectively to have enough market power to defend our best interests. Sellers are doctors in their role as providers. Doctors also have the role of patients so we are not talking about an fully adversarial market. They can try to act collectively, but given the selfish (Ayn Rand sense here) interests of doctors in their roles as sellers, there would be effective market control of costs.

2) The current regional variations in Medicare reimbursement rates have nothing to do with penalizing efficiency. That's a talking point that misrepresents the situation for political advantage. The current situation is a historical result of changes in demographic patterns. Progressive Democrats are already starting to address that in Congress and of course equalizing Medicare reimbursement rates subject to the market forces described above should be in the final plan. And by the way, it's an self-aggrandizing myth that Washington and Oregon are much more efficient, there is just less care here and it is of poorer quality because of the low reimbursement rates. When we have serious medical problems in our extended family if at all possible we get them the hell out of the NW for treatment. Regrettably, we can generally only do that for family members fortunate enough to be on one of the two public plans in this country (Medicare or TriCare) and who have paid a relatively small amount for supplemental insurance. Is the point here about a public plan clear enough?

3) He is right that the system should be based on optimizing patient outcomes rather than encouraging pathological business models designed to maximize the number of tests and treatments. However, this is not something that is honestly being addressed in this reform process. In part this is because it has nothing to do with tort reform as even Obama dishonestly indicated in his speech, because it's not driven by legal liability. Rather it's actually driven by a combination of laziness and lack of curiosity on the part of far too many providers and by the fact that it's profitable to game the private insurance industry in that way rather than to focus on outcomes.

I'm skeptical that even a strong public plan could solve the problems, but changed dynamics might open new political and policy possibilities.

There is no "solution" or ideal plan. The only issue is what gives us a system which is as much better as it can be from what we have now.

Using that basic broad criterion, all of the public plan proposals left on the table appear to be weak, face-saving ones, lacking the capacity to change system dynamics.

Obviously you are quite correct about that. However, the rest of the industrialized world has provided all the factual examples we need about how much better things could be and the national health insurance solutions which can make that possible. The correct conclusion is that it's now up to us to tell the individual Democratic politicians who collectively make up the majority in no uncertain terms that they WILL either put a strong public national health insurance plan back on the table, or we will make sure they no longer have their jobs. Ideally that will be with another Democrat, but the stakes are such right now that removing such Democrats is our first moral obligation and priority. I'm confident that once we face up to that moral obligation many incumbents will do the right thing just so they can get re-elected, and there are plenty of better Democrats with whom we can successfully replace those who don't.

These kinds of questions are obfuscatory. Just to ask them is to invite defeat. The Mad As Hell Doctors (http://www.madashelldoctors.com) are traveling the road to victory for the victims of Obamascam and all the other "options".

If you really are a Single Payer advocate, then don't fall for the bait-and-switch. Just do it.

A strong public plan is any government system that functions as a placeholding strategic move that leads toward the demise of profit-seeking corporations throughout the healthcare system.

There are two parts to a strong public option, first is coverage. It needs to cover all medical, dental, vision, and mental health treatments to include hospitalization, convalescent care, drugs, physical therapy, oxygen and medical equipment. The co-pay needs to be in the $5-$10 range. Cosmetic treatments (medical and dental) would not be covered nor would contact lenses, or fancy eyeglass frames. There should also be an option for a long term disability insurance policy with an additional premium.

As to all the rest, the plan needs to be open to everyone, it needs to be national, it needs to be able to negotiate drug and equipment prices as well as payments to doctors, hospitals and other care providers. It needs to be able to join with other government medical systems (i.e. VA, Medicare the Military) in purchasing co-operatives to get the best prices.

It does not need to be a government system it could be operated by a quasi-public organization provide it is non-profit, uses government pay scales, and is subject to full public oversight. It could include Medicaid, but the government would be required to pay the same premium as everyone else.

PNP wrote:

"Public plan reimbursement should at a negotiated price between buyers and sellers."

Medicare does not 'negotiate' price. It is has the legal authority of the federal government, and sets it's own price.

That's not 'negotiation' between buyers and sellers.

David from Eugene wrote:

"It needs to cover......."

This is the problem with cost. People want it to cover nearly everything at little to no out of pocket expense.

My homeowners coverage is there in case of a catastrophe (fire, tornado, flood, etc)

It does not cover light bulbs when they burn out, or the garbage disposal when it is shot and needs replacing. It does not cover a new furnace or water heater, or new flooring if the kids get crazy in the bathroom and get water everywhere so that the wood underneath rots. It does not cover a lot of things that I have to pay out of pocket for.

Health insurance, in order to be affordable, should cover what you reasonably cannot cover out of pocket.

If your car broke down and you had a $500 bill to get it back on the road, you would find a way to pay it.

If you go in for a check up and the Dr runs a test and the bill is $500, it should not take insurance to cover it, especially since most Drs will take payments, unlike your auto mechanic.

If you want health coverage that covers everything, it is going to be expensive.

The problem is many liberals are convinced that they can have 'free' health insurance that covers nearly everything.

Let's start with this: Nothing is 'free'.

And then we can talk about what is should reasonably cover.

A mandate for universal coverage would likely bump healthcare's share of the GNP from 15% up another 1% or $250 million. About 80% of health care spending goes to providers and roughly 20% to private insurers.

It is time to split the providers, who would benefit from increased business, from private insurers who are opposing the public option. Private insurers are getting a moderate boost from the mandate for universal coverage and in exchange need to give something up - their monopoly.

What is a strong or robust public plan option?

I love the exercise of abstracted intellectual discussion, but we are in danger of doing little or nothing to fix our woeful US healthcare system. Looking at the unfortunate sausage-making going on in Congress, we may actually make matters worse.

If we were able to reasonably approach the matter of reform, we would look at the successful healthcare systems around the world [successful at providing quality healthcare to all people at a sustainable cost] and adapt their strategies. There are a variety of successful models, some single-payer, some not.

But our politics is so corrupted by the money supplied by interested industries that a reasonable approach is impossible. Since the amount of money extracted by for-profit insurance companies and for-profit providers IS the major problem with US healthcare, there is no way to solve the problem while those interests can protect their profit making with campaign contributions and independent political expenditures.

Obama may have been able to overcome the political power of the healthcare profiteers with a passionate and consistent appeal to voters, but instead he has chosen to negotiate, compromise, and seek bi-partisanship. As FDR discovered, you can't win a rigged game. Success depends on changing the rules, and Obama, it seems, is not a rule changer.

To answer your question directly, a strong or robust public plan option would be either single-payer or a government-run insurance option coupled with banning for-profit healthcare entities and allowing no qualifying metrics for insurability beyond being a living human being.

Chris,

HR676 would be a simple, sensible, effective way forward. I support it too. Unfortunately, Obama's tendency toward compromise and the perceived need to "succeed" at healthcare reform, whether or not the reform is illusory, makes it almost impossible to pass this reasonable, albeit radical, single-payer system.

Kucinich is now talking about using the four-year phase in period of the Senate Finance Committee plan to build support for single-payer. Government scolding and eventually fining of people for not maintaining a policy with a private insurer will lead some to see the advantage of single-payer, but, of course, thousands will die in the meantime for lack of healthcare.

Oh well, I suppose that will, at least, "reduce the surplus population".

Watchit Chris, yer gonna get pilloried for mentioning NPR.... heh.

Joe: would you mind telling us what you do for a living? And could you tell me if you have ever lived in poverty or been scraped clean and knocked down by life's chances? I am honestly asking. I listen to your reasoning, and it just strikes me that maybe you have had a few hard knocks but you have never ever really found yourself without any backup to lean on or somehow the muscle to get yourself around the obstacle. I think maybe you've never found yourself really, honestly, helpless and vulnerable to a degree where you authentically had to depend upon decency from others?

I truly am trying to understand your reasoning. Can you lay it out for me?

Re: "Obama may have been able to overcome the political power of the healthcare profiteers with a passionate and consistent appeal to voters, but instead he has chosen to negotiate, compromise, and seek bi-partisanship. As FDR discovered, you can't win a rigged game."

Your (and most leftish Democrats') attempt to apologize for Obama is deceptive. What you seem to be saying is that Obama is a good guy who's just not very smart; that he fails to understand FDR's realization as well as the obvious realization by anyone who has ever negotiated for anything that you need to begin negotiations from a much stronger position than what you're willing to accept.

However, Obama is not stupid. In fact, he is a renowned Constitutional scholar who knowingly continues to violate the Constitution. He is a sophisticated politician who knows well that his original position in negotiations will end up being compromised. In short, Obama is a corporatist and a militarist who continues to laugh at his acolytes who fail to understand that he has not been outflanked by a more astute rightwing, but rather that he is part and parcel of that rightwing.

The historical function of the left in America has been to make the center "respectable." If there is no left alternative, the Obama proposals will become the "left" proposal, and this will severely limit whatever reform he will finally be able to get. (Why Obama Needed Single Payer on the Table, http://www.counterpunch.org/navarro09072009.html)

Even if the health industry's hired man, Senator Max Baucus, had not deep-sixed the public component, the insurance industry could swallow it like a python swallowing a field mouse. It's sometimes argued that a decent single payer system would be functional to U.S. capitalism, since industries like the auto sector would be liberated from the burden of health costs. There are scores of decent policies that would be functional to US capitalism. But the soul of US capitalism is wedded to indecency. (http://www.creators.com/opinion/alexander-cockburn/health-plans-and-death-plans.html)

rw wrote:

"I think maybe you've never found yourself really, honestly, helpless and vulnerable to a degree where you authentically had to depend upon decency from others?

I truly am trying to understand your reasoning. Can you lay it out for me?"

Those who truly cannot afford health coverage ALREADY qualify for Medicaid, do they not?

I just don't see the point in destroying the health coverage that the overwhelming majority of Americans have and want to keep in order to pretend that we're 'fixing' a problem.

You want to argue that Medicaid should be beefed up? Go ahead and make that argument.

But don't tell me we have to destroy private insurance to 'help the poor.'

I simply don't buy it.

The 'public option' is about nothing else other than destroying private insurance. You know it. I know it. Obama knows it.

We're all adults, let's not pretend.

Re: "The failure and stupidity of negotiating against themselves was a collective one by the D leadership as a whole."

My argument is that Obama and his fellow DP elites are NOT stupid, not with regard to health care and not with regard to the slaughter and torture that has been rebranded and repackaged as "Overseas Contingency Operations". Vicente Navarro (not Alexander Cockburn) thinks Obama is "a decent man" who has been acting like an idiot, with which I disagree. But his claim that, "If there is no left alternative, the Obama proposals will become the "left" proposal.." is something that progressives have been saying for a long time. That Obama always understood this, but was using "public option" as a bait-and-switch tactic (Bait and switch: How the “public option” was sold, http://pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%E2%80%9Cpublic-option%E2%80%9D-was-sold/) seems obvious to me. Obama is not smoother or less ostentatious than Clinton to anyone unfettered by ideological blinders. As Matt Taibbi put it, he's "the same old deal dressed up in black skin and a natty suit".

Dear Joe: NO, there are enormous cracks in the system. Clearly you beg the question. You have no direct experience with that level of vulnerability.

I am not going to go daffy in self-referential and research-nerd polemics to explain the many specific cracks and failings as well as built-in barriers to "WELFARE"/medicaid. You won't hear it, it won't help you understand a reality you've not had to endure or survive. Not saying you are too stupid to - just pretty sure 1. you may not have the open-minded willingness to take an experienced and intelligent person's word for it; 2. not sure you would be interested enough to hear what I know of it directly from surviving bad news myself; working as a health access advocate; working in policy; working in the insurance industry; working in clinics and clinical trials; working in public health and also intervention design and deployment....

In other words, Joe, I'm all over this one and wish I could help you understand you are pointing at a broken, half assed system, Medicaid.

Really. And, in case you were not aware of it, that program has been fecking CLOSED for three fecking YEARS in Oregon, save for brief, limited openings created maybe once or twice! You missed that news b/c it truly does not concern you directly.

For those to whom the consequences are death, loss of wellness and permanent sequelae, it's something that is noted.

rw wrote:

"You have no direct experience with that level of vulnerability."

I raise probably more kids than anyone on this board.

And probably have a lower income than most. Yes, I'm sure I'm well below the line.

And I buy insurance.

Don't give me this 'you have no experience' schtick.

Joe

”But don't tell me we have to destroy private insurance to 'help the poor.'”

We don’t have to destroy private insurance; it is rapidly self destructing without outside help. In the process of which it is failing individual policy holders and the nation as a whole; hence the need for reform.

On an individual basis a growing number of policy holders are discovering that when they need the coverage it is not there. The double-digit annual premium increases we are currently seeing are causing the typical premium to double every five to seven years, making insurance unaffordable for more and more businesses and households.

Nationally, rising health insurance costs are contributing to the budget crisis that state and local governments are facing and to the growing national deficit. Roughly 1800 newly uninsured who are daily joining the existing 30 million uninsured. There are the roughly 450,000 bankruptcies caused by medical expenses, which has left American Businesses holding billions of dollars in discharged debt. It is also slowing the national recovery by diverting money that could have gone to raises or new hires to pay rising health insurance premiums. And lastly there are the 18,000 Americans who die annually because of lack of health insurance.

I gather from you postings that you are satisfied with your current health insurance, I hope that it continues to be the case, that you will be able to continue to afford it and that should you need it; it will be there for you. But from what I am hearing and observing I am less the optimistic that will be the case.

On a different note, in a comment to an earlier posting I made to this thread regarding what constitutes a robust public option you said “Health insurance, in order to be affordable, should cover what you reasonably cannot cover out of pocket.”

My goal is good healthcare not health insurance. I do not believe that the insurance model is the best method of providing health care. Insurance works best when the risk being covered is a rare event that is unlikely to happen during the life of the policy. The problem with health care is that it will happen during the life of the policy, the only question is how much.

Oh and I have no expectation that the public option will be free, I do expect that it will be 20-30% cheaper then an equivalent private policy and in time that gap will increase.

SO, Joe: why did you not answer the question originally, choosing instead to present your misunderstandings of the medicaid system? And you still have not spoken specifically. You are making generalized statements as to how you "probably" are more dad than any parent on the blog; and are "probably" more poor than any other blogger here; and buy insurance. Nothing much here to see if you are looking for an honest disclosure to empower understanding...

You are dodging a direct request for you to provide your background so we can understand your thinking.

And Joe: you have no experience with being unable to buy insurance or finding your critical medical needs listed as "below the line" of coverage for the impoverished.

This is what I said, dopey.

You still have not provided anything like an answer. I find it unsurprising that you turn pugilistic as soon as one asks to understand your specific circumstances so as to find any way to engage with your logos.

I can promise I make less by far than most. Indeed, I worked in public health for most of my life, deeply underpaid. And then at OHSU before they eked out minimal improvements to the clinical servant class' employment packets. All the while, pestered within an inch of sanity for that eleven dollars an hour and biohazard buckets of production with high quality judgement and analysis attached..... get the picture? Grad students aren't the only ones required to provide sterling thought product and error-free service with liability attached for shit wages. :)... I may have more in common with you than you can honestly respect!

David from Eugene wrote:

"I do not believe that the insurance model is the best method of providing health care. Insurance works best when the risk being covered is a rare event that is unlikely to happen during the life of the policy. The problem with health care is that it will happen during the life of the policy, the only question is how much."

Then you must be against life insurance as well since it is certain that the covered person will die.

C'mon David. Insurance actuaries aren't stupid. They know that 'health care will be needed, it's only a matter of how much'.

They know this.

They've crunched the numbers, believe me, and you're not telling them anything new.

The single payer option offers a blank check model instead of a risk model.

Want to drive costs thru the roof? Tell folks 'everything is covered, and it's free, courtesy of Uncle Sam'.

Punctuation alert for Joe White: the following are called QUOTATION MARKS for a reason. Use 'em.

" "

Not: ' '

Re: "Do you have sources that his admin is conducting torture?"

It's amazing to me that you doubt this. Have you not heard of Obama's support for "rendition"? Don't you read anything to the left of your sainted Democrats?

Google (I can't get a list of links published here, so you need to find these titles):

Dennis Kucinich, U.S. Playing a New Rendition of an Old Song-Torture

Jeremy Scahill, Little Known Military Thug Squad Still Brutalizing Prisoners at Gitmo Under Obama

Tomgram: Alfred McCoy, Back to the Future in Torture Policy ("...a turn away from a dark, do-it-yourself ethos and a return to the outsourcing of torture that went on, with the support of both Democrats and Republicans, in the Cold War years.")

NYT, Rendition of Terror Suspects Will Continue Under Obama ("...human rights advocates condemned the decision, saying it would permit the transfer of prisoners to countries with a history of torture and that promises of humane treatment, called 'diplomatic assurances,' were no protection against abuse.")

Obama Brings Guantánamo And Rendition To Bagram (And Not The Geneva Conventions)

Obama, American Ideals, and Torture as ‘a useful tool’

Why is the Obama DOJ Trying So Hard to Block Torture Lawsuits? ("If the Obama administration has its way, no torture victim will ever have his day in court, and future administrations will be free to pursue torture policies without any fear of liability.")

Watching Obama Morph Into Dick Cheney ("Given the proclivity of American police to brutalize U.S. citizens, nothing can save the victims of rendition from torture.")

One more thing that the acolytes need to consider: "looking forward and not backward" when it comes to war crimes and crimes against humanity is a war crime, in and of itself.

rw wrote:

"Punctuation alert for Joe White"

'Single or double quotation marks denote either speech or a quotation. Neither style – single nor double – is an absolute rule'

rw wrote:

"Nothing much here to see if you are looking for an honest disclosure to empower understanding...

You are dodging a direct request for you to provide your background"

Yeah, and I'm not going to give you a financial statement either.

My position doesn't depend on how much I make or don't make. It doesn't depend on how much you make or don't make.

My position is predicated on the idea that I don't necessarily have a right to what is yours just because I want or need it.

rw wrote:

"you have no experience with being unable"

You've got no idea what I've got experience with, so stop guessing.

rw wrote:

"I worked in public health for most of my life, deeply underpaid."

It was your choice where to work. And you weren't 'underpaid'.

I am sure they paid you what you agreed to work for. You were properly paid.

You're welcome. If you're a peace and justice activist, I recommend that you start paying attention to leftist critiques.

Democrats have refused to listen to the truth when it comes to the Dear Leader. Obamascammers have coopted the energy of those who otherwise would have been out in the streets rioting over policies that McCain or Bush would have supported, including torture.

I am not a psychic, and I don't believe anyone else is either. I do, however, believe that as citizens we have the duty to judge our rulers according to what they do as well as what they say. Obama, as you can see, is the latest in a long line of criminals who have occupied the Oval Office. U.S. Presidents are best seen as Mafia chieftens rather than as democratic heroes, and Obama is no different from the rest in this regard. If you were not among those who worked for Obama and deceived people about his true nature during the campaign, then I apologize.

Joe, you are a piece of work. I did not ask for your financials, but your nebulous claims of being impoverished and also The Old Lady Who Lives In A Shoe... and then the attack upon my statement as to what a skilled public health worker is paid .... you are just a real piece of work.

Are you always this angry, reactive, pugnacious? Are you really such a blind ideologue and pompous arse?

You were invited to make yourself human, to provide barely enough detail to support some understanding.

You choose, instead, the path of bellicosity and assumption.

Sure bet: you know how kids swing like a pendulum? You are raising a horde of airport singers!

Emmit - that was a good post, and the response good too. I am watching Obama closely. And my own visceral reactions to his grace and subtlety.

It's time, far past time, for the cheerleading to die down and now seriou analysis of his activity to take up here where the middle of the road meet, the mainstream post. His campaign was a little more clean than the opposition's. I watched for that. We are well past the golden hour now.

ps... i did not mean your post calling him a criminal is good. You had posted good links to read and digest. But slid right into name calling and extremist postures as soon as you got some encouraging response. Damn it. I wish those of you who are committed extreme lefties would drop the "beat the man, down with the pigs" kind of old school stuff. It's not effective. You have important things to say, and the callow immobility of the mainstream IS maddening.... but the more shrill and anti-authoritarian the expressions, the more-easily dismissed.

rw: Not wanting to intrude on Emmit's territory, but:

One who commits crimes, as Obama and Bush most certainly have done, is a criminal.

And: Being opposed to anti-authoritarianism makes you an authoritarian.

1 + 1 = 2.

Only a callow anti-democratic authoritarian could dismiss the logic.

As I wrote in the 02Aug Gazette-Times, a public option must be:

1. It has to begin with tens of millions of people, that is, it has to begin like Medicare began, representing a large pool of people the day it commences operations;

2. Subsidies to individuals to buy insurance will be substantial, and only public option enrollees can get subsidies (people who chose to buy insurance from insurance companies will not get subsidies);

3. The public option and its subsidies have to be available to all non-elderly Americans (not just the uninsured and employees of small employers);

4. The public option has to be given authority to use Medicare's provider reimbursement rates; and

5. The insurance industry has to be required to offer the same minimum level of benefits the Public Option has to offer.

Only a plan that meets all of these requirements is a true "Public Option," designed to lower costs. Don't be fooled by anything less.

The ideal plan would begin:

1) The option for anyone to buy into Medicare;

2) No insurance reform. Let the greedy bastards keep on behaving as they have- except without blocking the Medicare buy-in option. Let them continue to limit choices, ration care and dump the sick, dis-employed and invent new "pre-existing" conditions to cheat people out of coverage. In short, they do all the things are are falsely claiming the public option will do and worse.

Just don't let them continue to block reform which is nothing short of the willful murder of 45,000 Americans a year on the part of the Insurance industry.

No subsidies or government payment for premiums to the greed players. That is the ultimate hypocrisy for they who claim the sacred mantle of "the free market."

Let the Republicans have the right to choose to stay in their sacred cow private insurance. Let them pay 30% more for less secure and inferior service.

Let Republicans have their end of life discussion, not with doctors but with there insurance adjusters.

The conversation will go something like this. "Sorry, no coverage. Drop dead." That is unless the hospital feels the need to kite a huge medical lien on some poor dying persons estate by employing ridiculous end of life heroic measures. One of the greed players dirty little secrets. More on hospitals and this goulish death industry later.

Say yes to Medicare buy in option. Say no to insurance reform. They want to make their bed in their fairy tale "free enterprise system?" Let them sleep in it.

Hell yes health care reform will be the death of so called- health insurance industry. It is only logical.

And what liars they are. They are claiming only a 5% per year industry wide profit. What, are they writing off all of their losses on junk bonds and hedge-hog funds?

Or are they just playing clever accounting games? We need independent study on this one because I do not for a second believe anything self serving from them.

All the time they were raising their rates they were pouring vast sums into bad mortgages and "insuring" bad investments. These companies do now nor have they ever been focused on the health of the nation or it's people.

Health care is not like commodities. Greed controlled management of health care is inherently evil.

Insurance companies do not deliver health care. Their profitability is based on denial of care. They have no place in a just or cost-effective system.

Get the money changers out of the temples of the healing arts.

hahahah... because I like to hear what is being said instead of the shrieking sound in which it's screamed? Ok. I"m The Man.

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