9 Responses to “Straight From the Horses Mouth”

1. makfan says:

   Not a detractor, but I wonder about some unintended consequences. How many businesses will opt to stop offering their health plans and push more people to the public option?

   I’m for single payer, plus allowing private plans, groups, etc. to offer whatever kinds of upgrades they want. That seems like such a pipe-dream now.

   September 21, 2009 at 6:40 pm
2. Lesley says:

   I haven’t read the details of the latest incarnation but I hope it’s not the dreaded Baucus plan.

   Although it includes the three things mentioned in that slide, his plan was written by private insurers to benefit private insurers.

   If you haven’t seen last Friday’s Real Time show, I strongly recommend it. Bill Maher interviewed Wendell Potter, former private health insurance chief executive who outlined the problems with the current plan.

   Potter had the courage to blow the whistle and to speak out against health insurance companies. He’s fighting for a public plan. http://tinyurl.com/nbeply

   September 21, 2009 at 7:57 pm
3. Lesley says:

   Btw, Potter said the reason Republicans don’t like the Baucus plan – even though it increases profits for private insurers – is because it’s not free market enough for the goons. The GOP wants no public option.

   The trouble with the Baucus plan from a progressives point of view is it will mean even higher premiums for the middle class and higher deductibles ensuring more people will go bankrupt paying for their health care.

   September 21, 2009 at 8:01 pm
   • blurb says:

     Lesley, I watched that Bill Maher show. I agree that we need a public option or expanded Medicare.

     Reform is going to be a lot less than progressives want and a lot more than the party of no wants.

     September 21, 2009 at 9:25 pm
   • Nathan Pralle says:

     From all that I see, the Baucus plan is a poor compromise because it craps on the middle class, the likes of which is having the hardest of times with medical coverage, because we make enough to not get help, but not enough to have no worries if something happens. To place even MORE burden on us seems anti-productive. Increase my cost a smidge to ensure no big increases in the future and to cover more people? Sure, go for it. But increase my contribution by a LOT and offer NO reassurances that it’s going to hold down costs == BAD.

     September 22, 2009 at 8:56 am
4. nobody says:

   - He says people can keep their insurance if they like it — but his regulations would make that insurance much more expensive for a lot of people. So that’s a promise he can’t really keep.

   - The package is very expensive, and it isn’t paid for. No one — absolutely no one — believes this thing can be paid for with savings from Medicare. (And if those savings existed, they should be used first to fix the financing problems that make Medicare unsustainable.)

   - The cost sharing and deductible caps would prevent exposing consumers to the actual costs of their care. Consumer cost indifference is a huge contributor to medical cost inflation, but the package would make that problem worse.

   So it makes promises it can’t keep, it’s very expensive, it isn’t paid for, it diverts resources from urgent financial problems. And it does nothing for the core cost problem except make it worse.

   September 22, 2009 at 5:51 am
   • Nathan Pralle says:

     – Keeping Insurance: That’s a hole even I can see, more of the fact that if there’s cheaper public options and so forth, what’s to keep businesses from dropping health plans entirely? Will the subsidies/tax breaks they receive be enough to make them hold on? I suspect at the start you’ll see a mass exodus to the public option, then it’ll come back the other way, and eventually you’ll reach an equilibrium as prices level off. How long that’ll take, I don’t know.

     – Expense: Part of it is that I want to know WHAT expenses are expected that aren’t already covered — for instance, the public option is self-funded, so that’s not an expense, but setting it up probably will be, so how much will that cost? And then the details of cost-savings. I realize a bunch of the cost-savings will be in forcing the market prices for care down, so that might be hard to quantify, but ballpark figures would be nice.

     – Consumer Cost Exposure: I agree and disagree with this point. The problem is that there’s an information issue — patients don’t always know what’s good for them; in fact, most of the time they don’t. Doctors are specialized for a reason.

     If I have a lump in my leg, will I accurately diagnose it? Doubtful. So when my doctor says, “You need X”, who am I to say, “No, let’s not, I don’t think it’s serious.” I don’t know crap about it. But if you say to me, “Look, we should do X, and it’ll cost $OMG” and I have to shoulder a good portion of that, then I’m likely to say, “$OMG? Wow. Uhm…maybe I’ll take my chances for awhile.” because I have small kids and food on the table is my responsibility. And it might be nothing, or it might be a cancer that, if caught early, could be cured, but because of cost and a lack of information, I chose against it. THAT is the scenario I do not want to put people in.

     September 22, 2009 at 9:02 am
     • nobody says:

       The public option must be subsidized to make it affordable. It’s been scored as very expensive by CBO. Likewise the Baucus proposal. And cost-savings from “forcing market prices down” is illusory: the prices are government imposed, and to the extent they don’t cover costs, the costs are shifted elsewhere.

       Consumer cost participation would work in ways subtler than you describe. No rational person would forego an indicated cancer screening. But if that screening cost $5000 in an open MRI, and $1000 in the tube variety, and the patient was sharing in the costs, they would be more likely to deal with the claustrophobia of the tube. Patients would compare costs for elective procedures, and those competitive costs would set baseline standards for similar activities in more urgent settings. Et cetera.

       In general, patient questions about alternatives and costs would become more frequent, and doctors would have to spend more time thinking about them, and providers that did a better job delivering quality at a lower cost would get more business. Over time, _every_ aspect of the system would be scrubbed for cost and quality as patients respond to costs and providers respond to patients’ concerns. A market sets prices, over time, by considering tradeoffs in excrutiating detail — and quickly revisits those prices for changes in those details. No bureaucracy can balance so much information with anything like the same level of detail.

       September 22, 2009 at 12:55 pm
5. Nathan Pralle says:

   I love the President’s plan. I think it’s clear, makes sense, and provides good solutions for a complex problem. There’s issues to work out in the details, of course, but for the most part, I’ve probably not felt more confident of a government program before.

   That being said, the President’s not making the laws, Congress is, and they’re going to come up with something that is a shadow of what the President’s plan could be. So I’m looking for a few things, here:

   1. Congress needs to get it close enough to the plan such that the major points are covered and the minors can be fiddled.

   2. The President needs to put his foot down and stick to his guns, schedule and bipartisanship be damned, and if the plan submitted to his desk does not meet the standards of his plan, the Veto pen needs to go, “snicker-snack” and do it’s job.

   I await to see how that plays out. I hope we see some real balls going into place over it.

   September 22, 2009 at 9:06 am