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Over at Fire Dog Lake, Jon Walker challenges those with the “we can fix it later” mentality (which may or may not include enough senators to pass this bill) to hold the individual mandate out of the bill as a hostage to ensure that Congress will have leverage to come back and replace all the things they have compromised away in this bill already.
Progressives should make the rallying cry of “no public option, no mandate” an unmovable demand, now and in the future. Progressives in Congress should refuse to support the individual mandate until it is accompanied by the government guarantee of a decent, cost-effective public health insurance option.
To me that sounds like killing two birds with one stone – we could get a bill without a public option as the Republicans have worked so hard to remove already and we could get a bill without an individual mandate which is the most serious infraction contained in the bill (more serious than the public option ever was).
I would be perfectly content, if the bill passes now without either of those provisions, to never come back and “fix the bill” (at least the way he is thinking of it). But I’d rather gain a temporary victory against the individual mandate and have to come fight against it again in the future, than have the individual mandate pass and face the prospect of having to try and reverse it later.
33 replies on “No Public Option, No Mandate”
MANDATES MUST GO! THE FILIBUSTER MUST GO! It’s undemocratic. It was created to subvert democracy and the will of the people. The Constitution Of The United States only calls for a simple majority vote in the Senate (51 votes). The Senate should pass the strongest Public Option it can with 51 votes by Reconciliation.
The Senate bill is a Swisses cheese of loopholes for the insurance industry. Without a strong Public Option, insurance reforms in the bill are worthless and have no teeth.
CRITICAL!! From jacksmith – Working Class
My Fellow Americans and People Of The World
A strong Government-run MEDICARE like Public Option is CRITICAL!!
A Medicare Buy-in at 55 is a GOOD! idea. But!, not a substitute for a strong Medicare like public option CHOICE for everyone. Nor is the (FEHBP). Without a strong public option on day one the Senate health-care bill is a disaster for the American People and the World. Therefore you must KILL!! it. Without a strong public option the health-care reform bill is MUCH WORSE! than what we have now, and what we have now is a catastrophe. SO YOU MUST KILL!! IT.
What is proposed in the Senate is the worst case scenario for health-care reform. It would shift trillions of taxpayer, public and private dollars into the hands of the private insurance industry (The single most costly, deadly and dangerous product sold in America). And it would compel by law millions of Americans to financially support this oxymoronic criminal enterprise. You cant have a MANDATE WITHOUT A STRONG PUBLIC OPTION CHOICE!
You will have NO! realistic way of controlling cost and quality. Cost will continue soaring through the roof bleeding the American people dry, and KILLing our economy. And our quality of healthcare will continue to decline below our current ranking of “WORST! quality of healthcare delivery in the developed World”.
H1N1 IS A WEAPON OF MASS DESTRUCTION!
I have to tell you now that the H1N1 virus is a man-made WEAPON OF MASS DESTRUCTION! and TERROR! It is a WEAPONIZED version of a flu virus. It has swept the planet infecting millions. And causing a global pandemic that has killed tens of thousands, and injured millions.
The H1N1 virus is the product of the DISGRACEFUL, GREED DRIVEN PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! It was released in the U.S. in Texas in early January of this year, but not recognized until around April in California. The reason I know this is because when it came to America, it came to see me FIRST! How sweet…
This was around the time the MEDICAL INDUSTRIAL COMPLEX! assaulted the Whitehouse with all their devils deals to cripple and weaken YOUR! healthcare reform. Especially your right to have a single payer system like HR676 (Medicare For All) which most of you wanted.
They don’t even want you to have your HUGE!!! compromise position of a strong government-run MEDICARE like Public Option CHOICE. To compete with their DISGRACEFUL, GREED DRIVEN, MURDEROUS, PRIVATE FOR PROFIT PRODUCT (The single most costly, deadly and dangerous product sold in America).
They also wanted to take away your rights to have your government meet it’s responsibility to use it’s full power to regulate, negotiate, and control drug cost, healthcare cost and quality. Something every other civilized country in the developed World has done for it’s people. Their Greed! moral degeneracy and lack of patriotism knows no bounds.
Many of you will remember that before we knew about H1N1. I posted a open message to the President and Congress warning them to be vigilant about their health, and cautious about any medical advice they received. As I said then “they will not hesitate to try and hurt you”.
The U.S. and the World have been under a BIOLOGICAL TERROR ATTACK! for over a year now. It is CRITICAL that We The People Of The United States take away control of our healthcare system from the GREED DRIVEN MEDICAL INDUSTRIAL COMPLEX!
For our own National security, and the security of the world.
A Strong, government-run, MEDICARE like Public Option CHOICE. Available to everyone on day one, with the full unfettered power of the federal government to regulate, negotiate, and control cost and quality. Would be the most workable way to deal with this global crisis at this time. Including patent suspensions as needed for national security or the greater good.
As an American I invite the peoples of the World to help us fix our healthcare crisis. And bring pressure on our government to meet it’s responsibility to protect global security by controlling, and removing the corrupting influence of GREED and the PRIVATE FOR PROFIT motivations from healthcare in the U.S. and around the World.
I call on the governments of the World and the global intelligence community to track down these MASS MURDERERS, and bring them to justice. CONNECT THE DOTS! And be vigilant that they don’t slip in another viral strain on you under the cloak of H1N1 sequestration.
Further, the proposed patent protection on biologic’s must be stripped from the US bill. And greatly shorten/restricted, or abolished completely. This is a grave danger to humanity and global security.
I think President Obama is doing the best he can at playing the disastrous deck of cards he inherited from the previous administration. And I think he is doing an excellent job. But the wolves and devils of the medical industrial complex! are trying to exploit, and take advantage of his good heart, and desperate desire to help suffering Americans. But we must be strong and insist that healthcare reform be done right for the American people. Or everyone loose’s.
This is all I can say in a message post. I’ll try to find a way to tell you more later.
God Bless You My Fellow Human Beings
jacksmith – Working Class
p.s. The so-called nominal H1N1 virus is designed in such a way as to make it more lethal to children and young adults. The medical community must be more vigilant of secondary bacterial infections in the young caused by H1N1. And remember, a viral infection is also a transfer of genetic code to you. Think about it, and be vigilant. 🙁
Without the Mandate you lose guarantee issue and guarantee renewal. They are a packaged set.
Without guarantee issue and guarantee renewal(basically these ban rescission and and end pre-existing condition insurance denial) their is no reform.
I don’t like this bill but I can see where this is going, The democrats want to start working the discussion of the nation towards the acceptance that health care is a basic human right and from this perspective I can support even the crappy senate bill.
Really public option was about cost control not part of the reason for the mandates. Without some sort of public option in the bill the insurance industry won’t have any reason to rein in the costs. So the 6% yearly health care inflation in the private industry will eventually leave us where we are now with people being unable to afford coverage even with the subsidies, around 2020 average health plan(for a family of 4) is going to be over $26,000 per year.
The median income in the united states is around $40,000 so you can be assured that sometime in the next half dozen or so years we will be forced to revisit this issue.
The Multi-payer fee for service based model of private health care is fundamentally broken, sooner or later this nation is going to be forced to accept this fact.
Ron,
I don’t see why Congress cannot pass rules about guaranteed issue and guaranteed renewal without offering the insurance companies an individual mandate as compensation. Last I checked the insurance companies are not allowed to opt out of federal regulations.
I was not suggesting that the public option was a reason for the individual mandate and neither was Jon Walker. The logic of his demand was the if we give the insurance companies an individual mandate they will have no reason to negotiate in the future, they will simply lobby for no change (it’s not in their interest to have a public option, but it is in their interest to have individual mandates). Jon was suggesting that by keeping the insurance companies’ ultimate prize out of the bill they will have incentive to not oppose future reform efforts.
Of course my position is that future reform efforts should also reject the individual mandate.
Jack,
It sounds like you’re off your meds. I’m as skeptical of the H1N1 hype as anyone, but “a WEAPONIZED version of a flu virus” and “a BIOLOGICAL TERROR ATTACK” – that’s a bit paranoid.
By the way, nobody has a “right” to a single payer system. Next thing you’ll be arguing that everybody has a right to a $50,000 per year salary in order to eliminate poverty.
Without the Mandate everyone would wait until their sick to get insurance premiums would skyrocket. That’s why their a complete set. Because their is also going to be community rating regulations the effect of leaving guaranteed issue/renewal without the mandate would be even worse on overall insurance rates.
The problem with this reform is that it doesn’t handle the 6% medical inflation rate. Which means costs double every 11.5 years( ln2 / rate = doubling time ). Sooner or later the medical inflation rate will return us right back to where we are now, piles of people priced out of care. exponential growth is such a pain =p.
I absolutely agree that not addressing costs and cost inflation is the primary reason why this reform is useless at best. (Of course I think it’s much worse than useless.) An individual mandate, even coupled with everything the bill once had would not change that.
The idea that people would wait to get sick before purchasing insurance is silly. Nobody does that now, and it’s not just because of the pre-existing condition rejections. Besides, insurance companies do some checking before they issue a policy. Even if they were required to accept people they would still do checking to set their prices. When the insurance company evaluates their medical history and turns up the fact that they have some disease, even if the insurance companies are not allowed to deny them coverage, they will set their prices based on their findings from the person’s medical history and the disease they have already been diagnosed with. It’s not possible to get a policy fast enough to get sick, get insurance, and get treatment before the insurance company discovers that you were sick. Insurance companies will find ways to protect themselves.
reform includes community ratings, so rates go up for all not for the idiot who didn’t buy before.
How can they change the rates for those who already have their policies in place?
regulations only applie to policy’s in the insurance exchange. The subsides only applie to insurance bought in the exchange.
So it won’t effect peoples current employer provided insurance at all. Big problem with current reform is that if you don’t like what you have your stuck except in a few cases where certain criteria meet in relation to cost of that employer provided plan.
. . . until your employer decides it’s cheaper to simply drop their plan because all their employees will get coverage through exchange plans.
If the tax exemption for employer coverage dies, then employers will drop plans like hot potatoes. The individual mandate is little more than a tax levy directed to private industry. The White House is yapping about 30 million more people covered when they mean that 30 million will be required by law to purchase insurance of unknown value and an unknown cost. Yes they are mandating that insurers can’t turn you down for pre-existing conditions but they aren’t saying what is covered, how much the deductibles and co-pays are, nor is anything being done to reduce costs.
This bill should be defeated. I hope progressives have the guts to vote with the Republicans to kill this thing. I doubt they will because they will get no money from the corporations and no help from the White House in 2010 and that’s much more important to most of them than passing good legislation.
Theirs a penalty for doing that, 4.5% payroll tax payed by employer I believe. small business’s with 50 or fewer employee’s are exempt from this tax however.
Anyway I would have though you would be for separating employer and health insurance?
Charles,
If this bill passes over the increasing public distrust of the bill the White House may not be able to offer any help in 2010 to progressives who voted for the bill.
Ron,
It doesn’t take much thinking to opt for a 4.5% payroll tax in exchange for dropping an employee health plan that is eating up 10% of your payroll. You’re right that I would like to see health insurance separated from employers – people should be free to take their plans with them across jobs. The way I would start encouraging that as a policymaker would be to give individuals the tax benefits for individual health insurance premiums that businesses enjoy. I know that doesn’t totally solve the problem, but it reduces it – employees would be better able to opt for a plan outside the limited choices offered by their employer.
“It doesn’t take much thinking to opt for a 4.5% payroll tax in exchange for dropping an employee health plan that is eating up 10% of your payroll.”
Don’t forget the tax write off as well.
“The way I would start encouraging that as a policymaker would be to give individuals the tax benefits for individual health insurance premiums that businesses enjoy.”
This is not affordable. The current Employer write off costs the government $300 Billion per year, If you add individuals to that write off it grows to $600 Billion Yearly and if you add health expenses beyond insurance premiums it jumps to a number well over $1 Trillion dollars Yearly.
Even the Republicans haven’t proposed this, their plan HR 3400 would create a $2,000-$4,000 tax credit, this only costs a few hundred billion per year(about double to triple what the senate bill costs).
Health care inflation will make this form of coverage expansion very expensive over time for the government and would make the current deficit a walk in the park.
The tax write off is that they don’t pay taxes on the money they spend on benefits so unless they are taxes at a rate of 55% they still come out ahead to drop the benefits.
we are talking past each other, I am sure the individual would do fine under a tax write off system, I am saying the government can’t afford that approach.
Yes, we are talking past each other. I was not even addressing the issue of individual tax write-offs in my last comment – I was talking about the continued financial benefit to businesses to drop their employee health benefits and pay the penalties associated with dropping those benefits. Even with the 4.5% penalty and the taxes on that income they come out ahead of keeping a benefit that costs 10% of their payroll.
ok this might sound funny, but that’s a good thing. Rather then employee’s working to keep their health benefits they will be able to push for wage increases.
Having the health costs come out of their pocket rather then having a huge chunk of costs hidden behind the payroll will make the cost of health care in the current system very poyient to the average person.
With a bit of luck maybe the new wage pressure will help stop the wage stagnation trend that has been going on sense the Reagan era.
I actually agree with you there. That would be the an example of market forces in both wages and the price of insurance. In fact, I think that would do more to apply market pressure in health care than the ability to purchase across state lines.
“I think that would do more to apply market pressure in health care than the ability to purchase across state lines.”
I don’t buy that. Over 85% of markets are high concentrated, The anti-trust exemption is left in place in the senate bill, and the individual mandate is rather weak.
Don’t get me wrong the mandate isn’t the right way todo this, With the weak mandate which is 95$ in 2014 and raises to $1,500 by 2020 where it is then set to inflation. The young and even some middle aged people are going to opt out of insurance and pay the fee instead and that will create a large adverse selection effect. The sick and old will push the price of insurance up possibly greater then the current inflation rate.
This is going to force the passage of a bigger fee for not having insurance(political suicide), or to start moving the system towards social insurance.
I was not aware that the Senate bill would do anything to encourage the decoupling of insurance from employment. Even if it does I think there are a few things that you are missing. Even in a monopoly market, where one insurer provides virtually all insurance, people have the ability to allocate their money to the plans of their choosing. If you go through your employer you have the option of two or three plans – I don’t think I’ve ever heard of an employer offering more than three choices – whereas if you purchase on your own you can choose from the entire range of available plans. Perfect? No, but it’s an improvement over the status quo.
Also, I think it’s interesting that those who favor universal insurance don’t seem to acknowledge the disconnect between their argument that 85% of the population is ensured and the other 15% desperately need insurance and yet they also argue that those who least need insurance will opt out. Obviously some of those 15% are healthy and choose not to have insurance, but if most of the uninsured want insurance then we are talking about possibly 5% of the population opting out of insurance – that’s too small a population to “create a large adverse selection effect.” The fact is that the vast majority of young and healthy people already opt in, but that won’t stop our Congress from trampling the Constitution that they have sworn to protect.
I’m not following that last paragraph. If we have universal insurance, there is no “opt-out” – universal insurance would cover everyone. If we mandate purchase of private insurance in the manner currently being proposed, we are merely imposing a tax on those who for whatever reason (naivete of the young, inadequate income, mistrust of the insurance industry) are not now enrolled in a private insurance plan. We aren’t really providing coverage – the bill doesn’t require that all policies cover people completely for everything. We are forcing individuals to buy a product on the market that may or may not be useful should they incur expenses for health care.
If we were to extend Medicare down to age 55 as an option (that is directed ONLY at individuals in that age group that do not already have adequate insurance), then obviously it would attract those most in need of care. If we extended Medicare to everyone in America and eliminated private insurance boondoggles like Medicare Advantage and the Prescription Drug Coverage by simply covering everyone for everything their doctor prescribes from birth to death then everyone would select it and we would save billions a year.
The tax (“it’s not a tax”) that you are referring to is what people will use to opt out. I understand how extending medicare is going to attract those most in need of care, but if that is a large population (which is probably is) that would indicate that the individual mandate is a thinly veiled power-grab, not an actual vehicle to improve the system. On the other hand, the birth of medicare predated the explosion in health care costs – I have a hard time believing that extending it in breadth and depth (covering everyone for everything) is going to “save billions a year” for the nation.
The mandate is a power-grab, but not one by government, one by private industry using a corrupt government to take advantage of the people. As I’m sure you’re aware, merely predating the cost explosion doesn’t mean there is a cause and effect relationship.
If we look at health care expense as a percent of GDP or as a per capita amount, the US spends far, far more than nations who have universal coverage. By eliminating the superfluous costs and profits caused by our inefficient private system, we would stand to gain a great deal more of our GDP and our personal incomes to spend on other things.
It really does not matter if it is a power grab by government or by private industry – the power grab comes through government so it needs to be stopped through the government – in other words, kill the bill that includes the power grab.
I understand the fallacy of “post hoc ergo propter hoc” but I did not need to prove that Medicare caused the explosion of costs. The fact that Medicare has been around the whole time that health care costs have been growing out of control does immense damage to the idea that Medicare has the capacity to reduce those costs.
I certainly support killing the bill. It is worse than worthless.
Medicare can only reduce costs for those who participate in it and it does do that. The only valid comparison would be do estimate what it would cost to simply subsidize the elderly to purchase private insurance. That would be a great deal more expensive. A lot of the cost and expense in Medicare comes from the corrupt government trying to turn it into a cash cow for private interests. The crux of the problem in health care cost is the tension between the moral obligation to insure that no one dies or suffers needlessly because they can’t afford health care and fiscal obligation to hold down costs. I doubt there are any easy solutions.
I heartily agree that there are not likely to be any easy solutions.
“The fact that Medicare has been around the whole time that health care costs have been growing out of control does immense damage to the idea that Medicare has the capacity to reduce those costs.”
Medicare for all would allow Bulk Payment, Global Budgets, which would greatly slash the amount of administrative personal in the system greatly.
All those corporate bureaucrats between you and your doctor add enormous amounts of cost to the system. One of the great features of single payer is that any form of regulation between you and your doctor adds more costs then it saves so you are relatively free from bureaucrats of any type private public or otherwise.
In Medicare for all their is no need for doctors and hospitals to check coverage, file claims, pursue payment, handle every little thing as a separate charge, track payments of thousands of claims at any point in time, pursue unpaid amounts of patients and insurance company’s, write off 10-15% of their practice to unpaid services, etc. And I haven’t even listed all of the administrative personal in the insurance company’s. All of this adds administrative cost and Medicare for all would have very little of this overhead, As it only needs enough personal to track their monthly bulk payment, for their yearly global budget payment, and patient records which can be nationally standardized to further reduce costs.
Medicare for all would allow for us to negotiate drug prices on a national level, getting the best prices possible.
Drug re-importation is such a funny solution, why re-import them for better prices why not just buy them cheaper here in the first place.
Medicare for all removes the silly idea of a “provider network”, private industry keeps us fenced into certain hospitals due to insurance company ownership or beneficial agreements etc etc, in a medicare for all system every doctor hospital is in your provider network, well every hospital and doctor in the Nation anyway.
Having 1,300 insurance company’s negotiating agreements with often the same doctors and hospitals just adds a lot of administrative costs.
Medicare for all would eliminate all of the 2 million Medical bankruptcy’s every year as well further saving us a pile of money.
I understand the theory behind the idea of single payer but why do the insurance companies pay for all this overhead if it does not provide more benefit than cost? Assuming that there is a logical explanation for that, why do these same forces not apply to other economic sectors? Why do the prices go down in retail due to competition but go up in health insurance due to competition?
Insurance companies and HMO’s had a period when they achieved profitability by cutting costs – payments to doctors, hospitals, etc. Then they came to the point where providers could not accept payments any lower and still stay in business, so the profit shifted to increasing premiums, rejecting claims, and cherry-picking people to insure. The demand for health care is not like the demand for appliances or toys. When people need care they have to have it, so if you are insured and need care you are going to go get it. If not, you will take chances and often become more ill or even die as a result.
The other observation I would make here is that competition is rarely present. In many places, one insurer dominates the market. Even when there is competition, participants are locked into plans for one-year periods so responding to price pressure is delayed at best. Also, as we have discussed, while you might buy paper towels from Walmart simply because the price is lower and you know the quality variation is minimal, you are not likely to buy medical care based on price because you simply don’t know the quality variation. Even with insurance it is difficult for the average person to understand what is and is not covered by a plan.
This suggests that moving to single payer will only buy us some time. Insurance companies were able to cut costs for a while, but eventually they ran out of ways to do that in their overhead and they were left with trying to find profits from denying payouts. If that’s the case (and it sounds right) then we have to assume that the reduced overhead of a single payer full coverage system would eventually reach its limits and the prices would again begin pricing us out of the health care market, except this time it would be pricing the whole nation out rather than individuals.
“If that’s the case (and it sounds right) then we have to assume that the reduced overhead of a single payer full coverage system would eventually reach its limits and the prices would again begin pricing us out of the health care market, except this time it would be pricing the whole nation out rather than individuals.”
Theirs a point where so many are priced out that everyone is priced out. A person without insurance still incurs costs to the system, except that they do pay into the system to spread those costs out. Without reform for example most California Hospitals will be bankrupt within the next 5 years due to uncompensated ER costs. This is why the Medicaid expansion wasn’t fought with much in the bill even the insurance industry understands bankrupt hospitals effects them.
“Why do the prices go down in retail due to competition but go up in health insurance due to competition?”
retail benefits from a low cost between their wholesale cost and their retail price, they are drive by maintaining high volumes of sales. and the only way to maintain the volume is through price competitiveness.
Health insurance benefits from high costs between their wholesale price(what doctors/hospitals charge) and their retail price(your premiums) because their volume is not tied to their retail price, their customers are locked in through their employers and even on the individual market its hard to switch providers. And their customers have a predictable disease rate ensuring enough volume to maintain their wholesale price with the care providers. So you will see 3 difference effects from this model,
1. inverted adverse selection, that is to say they want as many healthy people as possible and to exclude as many sick people as possible
2. Once a large enough pool of individuals has been obtained and wholesale price is at its lowest, then additional customers will provide little benefit. A ever increasing customer base will then be subjected to means to reduce services use( co-pays, larger deductibles, co-insurance) this adds to profits at the same time so the insurance company sees it as all good.
3. As service costs increase the insurance company will seek better methods of removing non-profitable customers, Recession and refusal to renew plans, and claims denial come from this.
These all result in ever increasing administrative costs, care cost shifting, externalization of costs.
These all increase medical inflation above what it should be. Now their is likely a plateau that will be reached on the administrative cost end sooner or later and medical inflation would go down, if the basic real cost is high enough however their would be a driver of inflation to medical costs from uncompensated care(this is probably occurring already).
Real medical inflation is likely around 3-4%, private industry medical inflation is currently above 6%, This difference is drive by the administrative overhead of the industry that has grown at a rate much faster then doctors for the last 20-30 years.
Now the “real medical inflation” is still higher then CPI, its drive by increasing costs from new technology and sooner or later that will come to ahead. Now I know that doesn’t sound like its a big difference, Remember we are talking about an exponential problem. At 6% costs will double ever 11 years(its a bit above 6% so its closer to 10 years) but at 3% its 23 years to double in cost and at 4% its 17years to double in cost.
Why is that an important thing to note, well eventually I believe technology will start bringing about cost savings, A cure to any disease requiring continuing care would save trillions over time. We just have to keep the costs down long enough to not go bankrupt in the mean time.
Thanks for the evaluation of the differences between retail competition and health insurance competition. Difference #1 makes perfect sense. I’m not convinced on difference #2 (please don’t try to convince me, you would probably just be repeating yourself without winning me over). Difference #3 is one place where I agree that there are legitimate reforms for Congress to make although I think they’re going about it the wrong way.
#2 relates to the idea that reducing service use is cheaper then increasing service capacity, Its primarily a libertarian argument and likely only applies within the confines of a market with low amounts of competition or a situation resulting from a trust based oligarchy. But yea I can understand disagreement here this is purely speculation that would vary greatly from regional market to regional market.
as to #3, I can understand not liking the mandate, but without it the rest of the package would essentially destroy the market for insurance from the effects of adverse selection. You could do community rating without the mandate, but Guarantee issue/renewal without mandate would have disastrous effects on premiums in the market.
I should make one more comment on #1, The insurance company really couldn’t care about rather the person is sick or healthy as long as the pool is predictable, the main reason that sick people tend get get weeded out entirely is because of the higher variance in risk not because of the higher overall cost. Cost atm can easily be transferred to the customer in higher premiums and out of pocket expenses.