WSJ - you won’t be able to “keep your health-care plan”

[Anonymous]

8:25, I can't agree with you. My stepfather had had 2 new hips (same side) before he was 40, because of a single dose of steroids given for asthma as a child. What a loss if he had been relegated to a wheelchair!

As a physician, I believe that society (me and my taxes) doesn't need to pay for such procedures, but I will fight to the end for your right to privately contract for such services if you can afford them, or for your ability to purchase insurance that will cover them. You should want that right!

I don't like all of HR 3200, but there's nothing in it that prohibits private contracting, or eliminates private insurance (though I am wary of the public option and believe it genuinely poses a threat to the private insurers).

[Anonymous]

Can someone explain to me why there is a need for a public plan, and all of the tax dollars that go into it, if private insurers will have guaranteed issue, no ability to cancel policies for health status reasons, and have to offer a basic benefit package at prescribed rates?

[jsteele]

Anonymous wrote:Can someone explain to me why there is a need for a public plan, and all of the tax dollars that go into it, if private insurers will have guaranteed issue, no ability to cancel policies for health status reasons, and have to offer a basic benefit package at prescribed rates?

I am sure there are a million reasons, but here are two that are important to me:

1) Assuming the public option is as good or better than what I obtain through my employer, I would join the public plan so that I wouldn't have to change insurance every time I change jobs. I am sick and tired of choosing new PCPs (and right now I don't have one because the one I had died).

2) I support single-payer health insurance, but recognize that you can't nationalize health insurance over night as it would be too disruptive to the industry. The public option is a good first step. Also, it can be a sort of pilot program. If it works well, it would remove some of the fear of a "socialist" program. On the other hand, if it is a disaster, even people like me will abandon our single-payer dreams.

[Anonymous]

The private options on the exchange will not have "prescribed rates". Supporters of the public option (I am not one) believe that thisis the only way to create price competition. I think the market will drive competition just fine.

The public option in HR 3200 will not be available to most employees; that version contains an employer mandate for most employers and those workers will not be eligible for the public plan.

Jeff, your #2 is chilling. I am lucky to have the option of retiring now (or whenever) if we should move to a single-payor system, but not all physicians are in that boat. Patients and physicians should always be allowed to privately contract. Otherwise rationing becomes an issue of total unavailability rather than an economic issue, and the quality of health care goes straight down the tubes. It's the difference between "can't get the care at any cost" vs. "you can get the care if you pay for it".

[jsteele]

Anonymous wrote:
Jeff, your #2 is chilling. I am lucky to have the option of retiring now (or whenever) if we should move to a single-payor system, but not all physicians are in that boat. Patients and physicians should always be allowed to privately contract. Otherwise rationing becomes an issue of total unavailability rather than an economic issue, and the quality of health care goes straight down the tubes. It's the difference between "can't get the care at any cost" vs. "you can get the care if you pay for it".

Single payer insurance does not prevent private contracting for services. As an example, in Canada supplemental insurance is common and purely private services are available.

I also don't accept the idea that the distribution of health care should be purely a financial issue (if you can pay for it, you get it). I'll accept that the poor should perhaps forgo purely cosmetic surgeries while the rich enjoy them, but I don't agree that the same should be true for live-saving procedures. Insurance companies can and do make life or death decisions daily for their customers. I'd like to remove the profit motive from their analysis.

[Anonymous]

But if the single payer system were the panacea that you make it out to be, Jeff, then why would a parallel private system be available in Canada? Or Australia? Or the UK? Individuals needs are not met by the single payer system, so after being taxed terribly for a system that doesn't meet their needs, they then have to pay even more (after tax, presumably) to get the care the need through a private system.

Make the private system meet basic needs, and we can skip the expense of a socialized single-payer.

[jsteele]

Anonymous wrote:But if the single payer system were the panacea that you make it out to be, Jeff, then why would a parallel private system be available in Canada? Or Australia? Or the UK? Individuals needs are not met by the single payer system, so after being taxed terribly for a system that doesn't meet their needs, they then have to pay even more (after tax, presumably) to get the care the need through a private system.

Make the private system meet basic needs, and we can skip the expense of a socialized single-payer.

Well, you can't really demand on the one hand that private insurance be available and then on the other hand use the existence of private insurance as a reason to condemn single payer. Obviously, nobody expects the public option or any single-payer system to be a gold-plated plan. If it were, you would be complaining about why your tax dollars are going to pay for so and so's breast enhancement, etc. Yet, people want choices. Maybe the vast majority of citizens don't need orthodontist or vision coverage. In that case, don't put it in the public plan. But, allow people to buy riders just like they do now. About 45% of Canadians only have the single-payer insurance. They may very possibly aspire to have a private supplement. However, in the US, we have a number of citizens that have no insurance. In which group would you rather be? The insured group that would like more insurance or the uninsured group that would like any insurance at all?

The private system has had plenty of time to get its act together. Instead of concentrating on providing the best service possible, they have concentrated on high profits and success on Wall Street. Read what former insurance insider Wendell Potter has to say:

http://commerce.senate.gov/public/_files/PotterTestimonyConsumerHealthInsurance.pdf

"The average family doesn’t understand how Wall Street’s dictates determine whether they will be offered coverage, whether they can keep it, and how much they’ll be charged for it. But, in fact, Wall Street plays a powerful role. The top priority of for-profit companies is to drive up the value of their stock. Stocks fluctuate based on companies’ quarterly reports, which are discussed every three months in conference calls with investors and analysts. On these calls, Wall Street looks investors and analysts look for two key figures: earnings per share and the medical-loss ratio, or medical ?benefit? ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits. "

Maybe this type of system is fine for you, but I don't want to be at the mercy of people who are financially incentivized not to provide me with service.

[Anonymous]

The current plans in both house and senate would dictate for the companies who can be offered the plan and how long they could keep it - no more cherry picking. And medical loss ratio is limited in HR 3200. All obtainable without a single payor system.

[Anonymous]

...and regulating medical loss ratios and prescribing 2:1 age rating as contained in the bills also dictates the prices at which benefits will be offered, contrary to what a prior poster stated.

[Anonymous]

jsteele wrote:

Here are facts:

1) we don't know what, if any taxes, will be included;
2) we don't know the amount of penalties companies will pay for not providing insurance;
3) we don't know the cost of the public option;
4) we don't know what will be offered in the public option.

Without knowing any of that information, it is impossible to say something like "Many of those companies will say hmm I will pay the tax the government hits me with for not giving healthcare and those people will be driven to the public option." What if the tax is higher than the insurance cost? Then, your theory is likely to be wrong.

It is not true to say that healthcare reform will cause people who are currently happy with their insurance to lose it. You can only offer your opinion that under certain scenarios, that might happen. Yet, you present it as fact.

Similarly, there has been no discussion of legislation that will outlaw the private delivery of medical services. Your contention that out-of-pocket payment for medical treatment is prevented in Canada and England is wrong. I don't know whether you are lying or uninformed, but either way, you are not telling the truth. Similarly, you are not telling the truth when you say that healthcare reform in the US will prevent out-of-pocket payment for medical treatment (given that there is no support for such legislation in Congress).

There is a certain dishonestly to your entire approach to this debate when you continually say "Obama will do such and such" or "Obama talked about such and such" and proceed to attack that as if words go from his mouth directly to law. You completely ignore the sausage-making process that is taking place in Congress. Why not debate the Congressional bills rather than out-of-context remarks from Obama?

Why you should support healthcare reform:

1) Because reducing medical costs for everyone will benefit you;
2) Because when our citizens are healthier, the entire country is better off.
3) Because a lot of our fellow citizens are one medical emergency away from bankruptcy, and that shouldn't be the case;
4) Because the "rationing" you fear is already taking place with faceless insurance company bureaucrats who are paid not to pay for our services making the decisions. I have experienced within my immediate family what it is like to have the insurance company refuse to cover procedures.
5) Because lower health costs will help make American companies more competitive internationally.
6) and, because a failure to reform the current system will lead to even more Americans losing access to necessary healthcare.

I am very late to this game, but I so vehemently disagree with this that I can't resist chiming in here:

"we don't know what, if any taxes, will be included"

Yes, actually, we do -- the surcharges against the so-called wealthy have already been announced. This means that my husband and I will be paying more out of our pockets -- even though we have good insurance that we are happy with -- to support you and yours. That makes me angry. What we don't yet know (and here's where you are right) is whether the so-called "middle class" will now also be on the hook for the bill (given the statements last weekend -- "whatever it takes"...).

"we don't know the cost of the public option"

Didn't the CBO just release its estimates of the cost of Obama's plan that absolutely dwarfed the administration's estimates of the same? Haven't several economists made the point (even Obama's own economists this past weekend, indirectly!) that you can tax us "Richie McRichies" to high heaven and it still won't cover the costs of this trainwreck?

"we don't know what will be offered in the public option" / "Because the "rationing" you fear is already taking place with faceless insurance company bureaucrats who are paid not to pay for our services making the decisions. I have experienced within my immediate family what it is like to have the insurance company refuse to cover procedures."

We don't know for sure, but here's where your Pollyanna responses to other PPs really bother me; how do you suppose the government will attempt to (a) extend health care coverage whilst simultaneously (b) allegedly control costs? It's not possible without some form of (aggressive) rationing of care. This is just common sense. You don't need to know the details of any plan to understand the economics of (a) more care plus (b) lower cost = lower quality of care. The worst part of this plan, unfortunately, is that (see above to the "cost of the public option" comment) the cost of the care will likely -not- be lower, but the quality of care will be.

As for the latter point, this is certainly true, but right now people have a choice to go to another (more expensive plan) that suits them better. That choice won't exist if the new monopolist (the government) wipes out the competition. Then you get one choice, period.

"Because reducing medical costs for everyone will benefit you"

Possibly true, given the system we have now, whereby the uninsured are treated in emergency rooms. I'd be interested in seeing some hard numbers that would actually compare what we pay for the uninsured now versus what we will pay to insure those same people. Some economic data might make me more inclined to support some type of "universal" coverage for those currently uninsured (if I will actually be paying less in that scenario). however, given the surcharges that will be directly applied to my taxes, plus the fact that I will still be on my employer-based insurance coverage (presumably paying the same amount), I don't believe that, overall, I will be paying less because some amorphous "total" number is reduced. (If indeed the total costs are reduced.)

"Because when our citizens are healthier, the entire country is better off."

This is just moralization on your part; you believe that, I don't. I believe that you're responsible for keeping you healthy, and I could care less whether or not you do that.

"Because a lot of our fellow citizens are one medical emergency away from bankruptcy, and that shouldn't be the case"

Again, this is moralization and a subjective point of view (a very liberal one); I have a fundamental belief that differs from yours, and that is that -I- shouldn't be paying the bill to keep someone else away from bankruptcy.

"Because lower health costs will help make American companies more competitive internationally."

This assumes lower health costs. An alternative solution would be lower taxes. But, from your other points, I'm guessing that you're part of the "high taxes are patriotic" crowd. (Please get back to me if/when Obama raises your taxes. I'll be pleased if you feel the same way then.)

---

Overall, I believe that revolutionizing the existing health care system for the benefit of the few (that's right, the few; the vast majority of Americans actually ARE insured; and many of those who are not insured -could- avail themselves of insurance if they wanted it, but choose not to, mostly because they are young, cheap, idiotic, and think they're invincible and that paying for their care should be someone else's problem) is a travesty. I simply cannot believe that so many people would vote blindly for such a universal health care system without considering the implications if THEY were the ones being charged for it. But Obama's pandering to the "have your cake and eat it, too" crowd. He's telling people, "I won't raise YOUR taxes; you won't have to do anything for a fabulous new health care system; you just sit tight and enjoy yourselves; I'm just going to tax the 'rich' to high heaven; they'll pay for it. Don't you worry!" I look forward to the fallout when the not-so-rich are finally affected by these ridiculous policies.

Finally, I don't disagree that we need a better solution for health care than the one that is currently in front of us. One solution would be to remove the antitrust exemption from insurance companies -- this would provide true competition among insurers. Right now insurance companies are allowed to act as de facto monopolists; while there is some competition, it's not great, and costs -are- high. If we removed the exemption, insurers would be forced to compete with increased output, better pricing, etc. Another solution, in addition to the above, would simply be to mandate insurance coverage and even, perhaps, extend some type of Medicare/Medicaid option to those who are truly denied coverage because of a pre-existing condition. This would not include those youngsters who would simply rather spend their money on beers than on health insurance; that is what the mandate would be for (akin to car insurance).

Anyway, I always appreciate an intelligent discussion of the issues, but I feel that much of your rationalization for Obama's plan is simply your belief that we're all "entitled" to insurance because it's our right as Americans. Or something like that. Many may agree with you. I do not. Judge Richard Posner had a great quote that George Will cited for one of his articles recently:

"As society becomes more competitive and more meritocratic, income inequality is likely to rise simply as a consequence of the underlying -inequality—which is very great—between people that is due to differences in IQ, energy, health, social skills, character, ambition, physical attractiveness, talent, and luck."

I believe that this is the fundamental difference between how conservatives and liberals view the world, and it colors our views on everything from taxes to education to this health care plan: I think (based on your comments here) that you believe that everyone should be "equal"; whereas I believe that everyone should be afforded equal -opportunity-, but what you make of it is up to you. In other words, no one owes you anything but a chance. If you blow it, so be it.

[Anonymous]

Anonymous wrote:
I believe that this is the fundamental difference between how conservatives and liberals view the world, and it colors our views on everything from taxes to education to this health care plan: I think (based on your comments here) that you believe that everyone should be "equal"; whereas I believe that everyone should be afforded equal -opportunity-, but what you make of it is up to you. In other words, no one owes you anything but a chance. If you blow it, so be it.

Then why don't they follow that advice when building the roads or subsidizing the airports or subsidized home ownership through the mortgage interest deduction or paying for public school and subsidizing state universities? Somehow someone decided they owed me a chance with regards to these items instead of making me pay the full cost.

One might argue that it is in the interest of society to pay for these public goods. I would argue that this is true as well with health care. A country cannot be a strong democracy with a huge gap between the haves and the have nots. While our gap has not been as large as that of other countries, it has been growing in recent years. I am interested in the long-term survival of our democracy and I don't see it as being in our interest to have a segment of our society which is impoverished through medical bills.

[Anonymous]

PP-can I hug you--kiss you???? This was a thoughtful answer and one that I completely agree with.

Let's not forget how much Obama lies!!!!!!! I can't believe that he is now having his pr person Ann Douglas go out with lies about single payer healthcare. What her on youtube but also watch the videos where he talks about the wonders of single payer. Just a few years ago, he is caught on video talking about single payer healthcare and not just once but several occasions at various speaking engagements and now...he through Ms. Douglas is asking us to believe that it was all a misunderstanding and that he isn't for single payer? This is what I hate about him. I wish he would just admit what he is all about--frankly people like Mr. Steele would be for single payer but many many many people including many who voted for him would be against it. His arrogance is just amazing to me. I am also sick of how he double talks on rationing. I watch him talk about how for some people medicine would be better than an operation.. THAT IS RATIONING--hopefully no one is every in a place where a doc says hmmmm I looked at the stats for your age and I just can't financially justify this surgery so I think it's time for you to organize your papers and here..have a pill to take the pain away.

Finally I am disgusted at the vilification of people who don't agree with him. Anyone who doesn't agree gets painted with words like "radical" "mean spirited"--town hall are "stacked" against the democrats. What?? What about during the election. Then it was wonderful. America speaking up? He can't handle criticism. What doesn't he stop just pushing what he wants and really look at what the people want as a whole. What about the new query to Americans to send in the names of people who are against his plan. What??? Are we turning people in now? Am I going to be turned in because he is a fraud? My only happiness is seeing his number go down so I believe are on to him finally.

[Anonymous]

hear hear to 12:05.

[Anonymous]

Anonymous wrote:PP-can I hug you--kiss you???? This was a thoughtful answer and one that I completely agree with.

Let's not forget how much Obama lies!!!!!!! I can't believe that he is now having his pr person Ann Douglas go out with lies about single payer healthcare. What her on youtube but also watch the videos where he talks about the wonders of single payer. Just a few years ago, he is caught on video talking about single payer healthcare and not just once but several occasions at various speaking engagements and now...he through Ms. Douglas is asking us to believe that it was all a misunderstanding and that he isn't for single payer? This is what I hate about him. I wish he would just admit what he is all about--frankly people like Mr. Steele would be for single payer but many many many people including many who voted for him would be against it. His arrogance is just amazing to me. I am also sick of how he double talks on rationing. I watch him talk about how for some people medicine would be better than an operation.. THAT IS RATIONING--hopefully no one is every in a place where a doc says hmmmm I looked at the stats for your age and I just can't financially justify this surgery so I think it's time for you to organize your papers and here..have a pill to take the pain away.

Finally I am disgusted at the vilification of people who don't agree with him. Anyone who doesn't agree gets painted with words like "radical" "mean spirited"--town hall are "stacked" against the democrats. What?? What about during the election. Then it was wonderful. America speaking up? He can't handle criticism. What doesn't he stop just pushing what he wants and really look at what the people want as a whole. What about the new query to Americans to send in the names of people who are against his plan. What??? Are we turning people in now? Am I going to be turned in because he is a fraud? My only happiness is seeing his number go down so I believe are on to him finally.

Welcome to the beginning of Socialism clad in the banner of democracy. I am a centrist. I hated when the Republicans mean-spiritedly bashed the Democrats, but it is ok for the Dems to do the same now to people who are trying to get their points across at an open forum. Next thing you know, the Dems will start holding town halls for just a select few proponents, just like the Reps did. If the extreme Left or Right controls the debate, and ignores the popular sentiment -- or caters to only to one majority (here the middle class)- true democracy is lost.

[Anonymous]

excuse me..someone wrote in before I posted..I meant 1205 as well. As for people not getting healthcare. It is not society's role for me to pay for you and your family. I have paid my bills and paid for healthcare since I got out of school with no problems. The segment of society that can't afford it is so small it can't be taken seriously. Even the 52 million number is inflated because it takes into account people who have lost their job and go without insurance for a month, week, whatever and don't choose to pay COBRA. Then throw in the illegals and the people who choose not to get healthcare through work and it's a complete joke. I wish people would stop buying into the false notion that we don't have great healthcare. We do. I heard about the disaster during the early nineties with Clinton and we were fine then and are fine now. Can we tweek and make better. Yes but that doesn't include dumping 52 million people in a system when most of those people bring nothing to the table. Enough of the poor people rhetoric. I am tired of it. Work hard and stop asking the government to take care of you. Can you imagine how overused the doctor's office and yes the hospital will be if people who weren't insuranced now are?? How often do you see people overuse things when they are perceived to be free..Perceived is a good word because although the smart person knows nothing is free..a loser will look at the public option as free money and those losers will be at the same place as the hardworking people who are forced into public because their employer gets rid of private insurance. And the thank you all the tax payers will get for their hard work is awful insurance and the spectre of being told that they can't get a needed surgery because the wait is too long for them to survive. Nice. Bet that was a change you didn't need. Hopefully one of Obama's nuts are reading this post.