A public healthcare proposal that satisfies both Republicans and Democrats... your take?

I am at a complete loss as to why any person who actually understood the public option would not support it. I cannot conceive of a single reason with any merit whatsoever not to support it wholeheartedly.

So let me see if I understand this…You want people over a certain income to pay for a healthcare system that you would make them ineligible for? I am a conservative and I would say I am against any nationalize Healthcare system and really against one that I would have to pay for that I could not reap any benefit from

Ditto-ing Niki.

I have acknowledged that taxpayer support from the conservatives is difficult, as my boyfriend pointed out. But I was sort of just mulling this over out loud, and he jumped on it, saying he thought it was a great idea to satisfy both sides… and I found that odd, since we rarely agree on anything political. That’s the main reason why I brought the question here… if one fairly staunch conservative could find a way to see public healthcare in a positive way, maybe he’s not the only one.

@softtop67 Are you saying you would rather have 60% of your premium going toward an executive salary, with premiums increasing and benefits decreasing?

Or would you rather have an option, provided by the government, that through competition, will help control the costs of insurance and healthcar.

spellcheck edit

@softtop67: I’m ineligible for welfare, social security, etc… and I pay for them. Some day, I may need them. Just like some day, I might lose my job, and I’d be in need of public healthcare.

From each according to his ability, to each according to his need…

~Karl Marx

@MrKnowItAll and we see how well that worked

@Yetanotheruser: I think you may have misunderstood what I presented. There’s not really a competition between public healthcare and private insurance firms in what I suggested. All it is, is a way for those who can’t get it to have it, and those who have it to keep it.

Isn’t that Medicaid? Or are you thinking of an expanded similar program?

@Yetanotheruser Sorry, I meant Groucho

@janbb: expanded similar program. Medicaid doesn’t really do squat, as I’ve found out working in a hospital.

Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies.

Groucho Marx

@MrKnowItAll: I can google clever quotes myself, thanks. I’m looking for opinions and discussion.

@niki: I personally don’t want my insurance changed. If they can figure out a way to make a public healthcare program that I’m not forced to take part in, without costing me any substantial amount of money, then woohoo! I’m all for it. If my insurance changes or I have to pay more, I’m not for it. For example.

Once again, conservatism makes its lack of education so obvious. @softtop67 demonstrates so many misunderstandings in one small comment, that it’s hard to know where to begin.

First of all, the principle of insurance is that it shares risk. All taxpayers are in the same risk pool anyway, since hospitals can not turn people away due to inability to pay. They just shift the costs over to the privately insured, anyway. Of course, that’s a stupid and inefficient way to share risk. It costs so much more.

Second of all, it demonstrates a selfish attitude and a misunderstanding of what a progressive tax system is. Wealthier people should pay at higher rates, because they make so much more. Poor people shouldn’t have to pay at all.

Third of all, no one is talking about a “nationaliz [sic] Healthcare system.” We could be talking about nationalized health insurance, which is a very different thing, but we’re not even talking about that. We’re talking about a private system for 40% of the people, with a public health insurance plan as one of the options people can use. Nationalized health care is where the government hires all the providers instead of just paying for most of them.

Don’t forget, Medicare, Medicaid, Veterans and Currently enlisted soldiers health care is already funded publicly, via taxpayer dollars. I think that publicly funded health care already counts for about 60% of all health expenditures in the US already. The private sector is just a carve out that guarantees profits for the health insurance industry, and asks them to add nothing of value. Well, they hire a lot of people to do completely unnecessary work. It’s a boondoggle make-work program that only benefits certain large corporations.

Fourth of all, @poofandmook, if you say that the public program isn’t for people who already have insurance, there will be a huge incentive for companies to drop coverage, if the public plan is cheaper, which it will have to be, if it is to be made affordable.

The most efficient way to pay for and administer health insurance is if you put everyone in the same risk pool, and you make everyone pay for the insurance according to a progressive fee schedule (i.e., progressive taxes).

This whole issue is purely ideological. It has nothing to do with facts and everything to do with how people align themselves politically. I.e., what their definition of being “American” is. God! The horror of it all! The horror!

@poofandmook: The public option is, by definition, optional. The only way it can affect you is that if your employer meets certain requirements, your employer may be able to choose to no longer offer health insurance. And then you would still have the choice to either pay for private insurance, as many people do now, or you could take the more affordable public option.

@nikipedia: It’s not really an if, since healthcare costs companies money. Especially with the economy the way it is, companies are looking for any way to spend less. Health coverage would be a prime place to start. And then the rest of us have to shell out hundreds more for the same coverage, or take a non-negotiable, non-customizable coverage plan. No thank you.

@daloon states, “Medicare, Medicaid, Veterans and Currently enlisted soldiers health care is already funded publicly, via taxpayer dollars. I think that publicly funded health care already counts for about 60% of all health expenditures in the US already.”

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Is anyone else noticing that the smaller population is costing the most money? Now, maybe it’s because of the population itself. Maybe those folks are just sicker than the larger population on private healthcare? Or maybe, just maybe, it’s the inefficiencies of government that are inflating the costs? One thing is for sure, it’s certainly not because those programs are world leaders in terms of quality and customer satisfaction.

@poofandmook: The “if” is whether the employer will be permitted to drop your health insurance, not whether your employer will choose to do so. The vast majority of employers will not have this option (at least not right away).

From politifact:

Pending legislation in the House says that only individuals and small businesses of fewer than 10 employees would be able to use the exchange during the first year, and only individuals and small businesses with fewer than 20 employees in the second year. In the third year, businesses are allowed in “based on the number of full-time employees of an employer and such other considerations as the Commissioner deems appropriate.” This sounds like employers will gradually be allowed into the exchange based on size, as well as “other considerations as the (health exchange) Commissioner deems appropriate.” This obviously gives tremendous leeway to the commissioner, who is presidential appointee in charge of the health exchange. So year three becomes a question mark as to how many businesses will be allowed into the exchange.

Incidentally—how customizable or negotiable is your current health care? (Mine is absolutely not either of those…)

Some of these answers seem to make the assumption that those who oppose health care reform oppose it for intellectual, or moral reasons. They oppose it because they are being paid (through contributions to their campaigns) vast sums of money by the health care industry. That’s what almost always moves votes in Congress: money. If we had a strict public financing law we would be better able to pass legislation that was in the majority’s interest.

Of course, some it is political on its face: some Republicans are also motivated by their wish to inhibit the goals of the Obama presidency, whatever they may be, which to me is valid, and I don’t argue with their legal and moral right to do just that – they are expressing the will of their constituents, who never wanted Obama to succeed in the first place.

@robmandu I did get one thing wrong. However I will now correct it. In 2007, the public sector financed 45.2% of all health spending in the US—close to half of all health care spending. The public sector spent 3,429 per capita for health care, while the private sector spent 3,991per capita. These are data from the CMMS. Source.

As to the efficiency of Medicare and Medicaid compared to private insurance, we’d need to look at severity-adjusted per capita spending per outcome—a measure that links both severity of illness coming in, and quality of outcome going out per cost per person. I haven’t found any data on that, yet. You’d need to control for health history, race, income, education, and health practices (and probably a few other things) in order to make a useful comparison.

sure, @pdworkin.

So, let me get this straight. Politicians who are for the universal healthcare plan are perfectly moral and intellectual. They get no graft from the special interests in any way and are above reproach.

Politicians opposed to the plan are uniformly making a play purely at the behest of the private sector, little guy be damned, where’s my money, money, money?

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I don’t trust any politician as far as I can throw them. Of any stripe. At least I’m bipartisan in that way. But it’s statements like yours that I think does a disservice to your position.

@daloon. Good stats. I agree it’s hard to make a case with those numbers at face value one way or another.

@robmandu I don’t disagree with anything you say. It’s just that in this particular example the money is going to those who oppose public health care. On other issues the money flows differently.

The government can’t run healthcare? You want a prime example of something they run just fine, take a look at our military. It’s the best/most efficient in the world. And honestly, for all the crap the post office and DMV are getting, I’ve NEVER in my life had a bad experience with either. And the post office competing with UPS and Fedex is a great example of low cost not-for-profit government not beating the private sector (UPS controls around 90% of the shipping market).

And everyone is complaining about “socialized medicine” having all these downfalls and being terrible… take a look here http://www.photius.com/rankings/healthranks.html I believe you’ll find the US ranked 37th worldwide (behind such great nations as the United Arab Emirates, Chile, Coasta Rica, and Columbia). Who’s ranked #1? All mighty evil terrible socialized health care France. In fact, all the big “socialized” countries that come up as argument against a government plan (Sweden, the UK, Switzerland, France, Germany, etc) are ALL at LEAST 10 ranks higher than the USA.

And lastly, the plan in question isn’t even a government take over. It’s a government option. None of the private plans would be forced to close, except for the ones that refused to bring their prices down to reasonable/fair levels.

The Republicans are fighting this purely because it’s what Obama wants, and if they can stop him, they’ll probably regain power. That’s why they make up all these lies about Death Panels, concentration camps, elderly/sick people being denied healthcare, etc. When they’re out of ideas, all they have is fear mongering, and damned if they don’t use it a lot.

@Westy: I so didn’t ask for a liberal rant about how terrible the big bad Republicans are. Thanks.

@westy81585, I’m always curious exactly what metrics go into such rankings. One thing is for certain – and something I think everyone here is interested in maintaining – is that the U.S. is indeed home to the best physicians, best hospitals, best procedures, and best drugs. Everything important is pioneered here.

It ain’t cheap (and perhaps cost is a very large factor in the rankings), but when it’s the life of you or a loved one, folks often want U.S. healthcare when they can get it.

@robmandu That fails to take into account outcomes. We are far down the list in infant mortality, life expectancy, etc. etc. I think you know that.

@poofandmook It wasn’t a rant about republicans. It was a rant about the stupid arguments being made against healthcare reform. The same arguments made back when medicare and medicaid were in legislation (you know, the two most popular/successful programs the federal government has). The Republicans were only brought into question at the end, and for your information, I have nothing against Republicans. I actually voted for Bush in fact. What I am against are complete idiots and fear mongers (on both sides). At the moment that is the Republicans that are lying about healthcare reform.

@robmandu Granted we have the best doctors and tech (overall, but to be fair in specific areas we ARE in fact behind some of the other nations worldwide). But that’s not whats in question here. The fact is, there are drugs being made by the same companies, that cost twice as much here as they do in Europe. Procedures that cost twice and three times as much as they do in Europe. People who can’t get health coverage because they already have a condition (not an issue in Europe).

I myself am a recent college grad, working 2 jobs (around 60 hours a week). One of those jobs is for the largest food manufacturer in the world. And it’s not some working job, I’m a lab tech running analytical tests for an entire line of product. The only health option I can afford through my employer (and it’s a BARE BONES plan), would LITERALLY cost me about 1/5–1/6 of my yearly income. And as I can’t afford that thanks to student loans (the free education much of Europe has is a whole separate problem I have with our country), I go without healthcare. Basically I brush 4 times a day and pray I don’t get injured or something. If I want to see a doctor, I basically have to wreck my car (thank god for auto insurance being cheap).

I would be happy with a public option that only people who had no access to other insurance, or people who could get other insurance only at a cost of over x% of their salary or y% over the cost of the public option could qualify for. My concern is universal acceptance…no one can be turned down for pre-existing conditions, no one can be denied essential care because the insurance company deems it too expensive, and no lifetime maximum benefits. And these same requirements would have to be mandated for the for profit insurance companies. We need to cap costs for individuals and ensure care…no one should die for lack of access to health care, no one should be unable to maintain his health because of lack of access to insurance to pay for health care, and no one should lose everything they’ve worked for their entire lives because of unpaid medical bills. I think you need to make sure that your boyfriend understand that a public option is publicly financed insurance, not publicly financed care and with this option, the government is NEVER going to be able to make our medical decisions for us, because in the case of a public option, the government is simply paying the bill….you are still going to your choice of doctor and deciding on your own course of care (the main Conservative arguments I’ve been hearing confuse that point). As I’ve pointed out in another thread, one real concern is that a public option is going to put private insurance out of business, and another is that the government administering it is going to make it an inefficient system, riddled with poorly managed care, long waits,etc. I would point out that if the public option is so inefficient, it will not be desirable to those who could get private insurance. And if the coverage IS as good or better than private care, the only way it’s going to replace the private options would be if it ALSO undercuts costs. And if we have a publicly financed system that’s better than what we have now, AND cheaper, why shouldn’t we implement it?

I’m here respectfully, to learn, contribute, and to join the discussion civilly. So @daloon, I’d appreciate it if you didn’t insult me, and tell everyone what you think my political party is (which was incorrect last time, btw) and didn’t attack me in general.

@poofandmook : I’m still feeling my way through this issue, so I have questions about it as well. Please correct me if I seem not to be getting it. I don’t know that I think it’s fair that not everyone would be able to reap the benefits of a public option health care system. It seems that when you tier the benefits according to income, it’s once again, the middle class which is getting the worst of it. And here’s why, I think that. Again, if this is not what you’re asking about, please tell me.

Employers pay for the public option, right? Or if you’re self employed, you pay for it yourself. Employers pay some payroll tax to the government to pay for the program. Employers must charge more of customers for their product to compensate for this new tax. Soooo… for the poor, who never had disposable income to spend on that product to begin with, nothing changes except now they have awesome health coverage. For the middle class, they are now spending more on that product, and they get the mid level of health coverage. The wealthy can still afford that product because they have the most disposable income, and while they get the least of the health coverage, they can also afford to compensate for that elsewhere if they need to. But this doesn’t seem good to me because that just keeps the wealthy paying whatever insurance companies ask of them to keep themselves alive. So the middle class, especially the self employed (which I plan to be in the foreseeable future) gets the short end of the stick.

@ubersiren: I am having trouble finding a reliable source to back this up, and I would love it if someone could provide me with one (without having to read the entire text of the bill).

As I understand it, the cost will be shouldered entirely by the extraordinarily wealthy, not by the middle class:

“The proposal calls for a surtax on individuals earning at least $280,000 in adjusted gross income and couples earning more than $350,000, said the chairman, Representative Charles B. Rangel of New York. . .

“But emerging from daylong committee negotiations Friday, Mr. Rangel said the income surtax would take effect in 2011 and begin at 1 percent of adjusted gross income — earnings before deductions like those for mortgage interest and charitable contributions — and would apply to individuals earning more than $280,000 and couples earning more than $350,000.

“The surtax would be increased for individuals earning more than $400,000 and couples earning more than $500,000, and step up again for individuals earning over $800,000 and couples earning above $1 million. The precise extent of these increases has not been announced. ”

from a NYT article that’s over a month old.

It has not been decided how it would be financed yet, that’s an issue yet to be tackled, that was simply one proposal. Another was to tax benefits on so called Cadillac plans.

@dalepetrie From what I hear “in the street” it seems that any plan to tax benefits is dead in the water.

I think it is important to get some kind of reform program going sooner rather than later. Health care in its current form is literally killing people and costing us far more than it should, not only in premiums, but also in productivity and affecting our ability to remain competitive in the world market.

I say lets pass it now, it can be tweaked later (much like Medicare has been adjusted several times over the last few dacades).

@nikipedia : I’m not responding to the current plan. I’m responding to @poofandmook‘s question regarding a fictional plan described in the details of her post.

@Yetanotheruser – I heard the same. I’m of the opinion that nothing is either dead or alive until a final bill is ready to be voted on.

Looking only at the tax increases necessary to pay for increased health coverage is a narrow view that ignores the entire picture. It’s like fishing with a pole instead of a net across the river. You complain about the cost of the pole, when if you got a net, you’d catch a hundred times more fish. Universal health insurance will have exactly the same impact on the US economy! The benefits of universal coverage means that we should be scrambling all over each other to be first in line for higher taxes.

The funding of health care reform is a very complicated issue. Taxes might go up, however, employers would have to pay less for health insurance, over all. Health insurance rates would go down, as cost-shifting is eliminated, and as the population gets healthier due to access to care and especially, preventive care. As a result, employers would become more profitable, and workers would demand that employers share those profits with them via higher salaries. Out of Pocket costs would also be significantly reduced.

The net result, according to analyses I’ve seen (unfortunately unpublished), is that people would have more money in their pockets, not less. People all focus on taxes instead of the overall economic benefit of universal health insurance. Yeah, taxes go up, but so does income and wealth, and the net result is favorable. You have to look at the whole picture with this.

Another way to look at it is how much we, as a nation, spend on health care. In 2009, 17.6% of every dollar made in this country will be spent on health care source. We now spend more than one out of every six dollars we make on health care each year! This is up from one in every seven dollars only eight years ago in 2001 source.

Despite all this money spent, we ranked only 37% in the world back in 2000, the last time the WHO compared nations. In 2007, when 16% of our GDP was spent on health care, the next closest nation was France, at 11% source. The take-away message is that our health spending results in much poorer outcomes. We aren’t spending all that money very wisely, as far as the overall population is concerned.

The main difference between these nations is that in the other countries, everyone has health insurance, and in this country, fourteen percent of the population has no health insurance. That means the uninsured have less access to health care, no access to preventive health care, and when they do get care, they force hospitals to take on a huge burden of uncompensated care, and their illnesses are much worse than they would have been if they had health insurance and went to the doctor as soon as the first symptoms appeared.

It seems obvious that with universal coverage, we, as a nation, would be much better off. Yeah, taxes might go up at first, but productivity would go up much faster, and we’d spend fewer dollars as a percent of GDP on health care. What would we do with all that money that would be freed up? Buy cars, DVDs, second homes, giant flat screen TVs….. vacations? It would be the biggest stimulus package this nation has ever seen!

@dalepetrie The Schrödinger’s cat version of health care reform? ;-)

@daloon There’s that damned cat again!

@daloon – a pretty apt observation (at least until we know what’s under that box labeled Health Care Reform).

@dalepetrie but if you peek, you might kill it.

@Yetanotheruser – it’s been peeked at many times, and I fear that HAS killed it.

@ubersiren: I didn’t think through or post any fine details about it… this was just a very general question about the general wishes of each side and their views on what healthcare in this country should be like.

The reason why I’m not completely okay with a public healthcare option is because I am concerned about the private insurance companies. Yes, I pretty much think they’re insane with what they can get away with, between the costs and the denials, and how they don’t get punished when their clients die because they were denied important care. The problem I have though, is that unemployment right now is through the roof and frankly, we can’t afford to lose all those jobs. Bottom line on that one. My only interest in private insurance companies is the employment they provide.

@poofandmook – consider a few things. 1) A public option is not an immediate death knell for private industry. It would require a public option to become successful and popular enough to mandate that all insurance become publicly financed. That will not happen in any scenario I can imagine before our economy improves. 2) For a public option to become this wildly successful, it would need to over perform on service and undercut on price compared to private options which essentially means that private industry has every chance in the world to step up to the plate and provide service that is as good or better than a public plan at a competitive price, their fate would be in their hands. 3) Where do you think all these people who have industry experience would go? Wouldn’t they be the first to apply for the public jobs that would be CREATED if the private system were replaced by a public system? Wouldn’t there be gains in the public sector jobs to offset losses in the private sector, making your concern a non-issue?

And remember, we are NOT talking about health CARE, we are talking about health INSURANCE, AND we are not talking about replacing the private industry with a public one, we are talking about offering a public option to run alongside private insurance. The only way we get from where we are to what your stated concern is would be the type of slippery slope thinking that at this point is unrealistic, and which only becomes realistic at a fairly distant point in the future, and only then if private industry can’t live up to the mantra the right wing has sold us on for years that for profit businesses can do any job better than government bureaucracies. If people are so sure that this is true, then they should have no worries about this slippery slope, should they?

@dalepetrie: I’m also against excessive government control… and government programs are notoriously short-changed, but serve their purpose. Sure, you may have to wait a week for a doctor’s appointment, but you’ll see a doctor, whereas you may not have gotten that chance. I, personally, am willing to pay a bit extra to be able to see a doc the same day, whoever I choose, and I don’t want anything messing with that. If the government could find a way to make a public healthcare plan that allowed me to keep mine, didn’t put ANY restrictions, demands, limitations, deadlines, etc. on an employer’s insurance offering, then fine. My concern is because I read something, somewhere, and I wish I hadn’t just cleaned out my bookmarks… it said something about there being plan coverage requirements, and if a company was grandfathered in, they didn’t have to dump their insured into the general pool of these coverage plans for 5 years. If the company wasn’t grandfathered, they’d dump their clients into the pool in a year (maybe? I don’t remember)... and in that year, if anything in the policy was changed, the policy would then be changed to one of the new-fangled government plan concoctions.

I know that’s roundabout and sounds horrible, but I’ve been googling for an hour and I can NOT remember where I read that.

@poofandmook – I’d have to see it as you know to even understand what they were trying to say (and to consider the source), but as far as I know, a public option is an option, one that is out there for two reasons…one, to provide a source of insurance for those who have no other source and two, to provide an option for people whose private insurance is not working for them for whatever reason (likely cost). If you look at other systems around the world where there are public insurance options or even public care options, you will find that invariably they still offer private health insurance in one form or another for those who would prefer a higher, more expedient level of service. So, I think the fear is unfounded, because like I said, no matter how inefficient the public option might be, it will never replace private insurance. Indeed the ONLY way anyone will be forced onto a public plan is if they have no other choice, and yes, some small employers will give up on offering insurance because of this, but that’s good for business…this is crippling too many small companies right now, and that more than anything is why our economy is struggling…too many expenses for the little guy to make it. The only way a private system is going to go away and be inaccessible to you personally would be if the public system turns out to be more efficient and effective at a lower cost than the private plan, and as someone who realizes that government is not generally the most efficient at anything, you should realize how ungrounded that fear really is. Even in England and France where they have completely socialized medicine, you can buy private insurance. Bottom line is though, even if you work for a small employer which wants to transition to a public plan after a year or two, you will probably end up with a plan that is better than what you had in that if you need to go to the doctor, you will be able to go and not worry about it, and if you are still dissatisfied, you would be able to opt out of a public plan (there is no requirement built into this bill for you to be insured if you don’t want to be), and you could contact a private company and look into individual plans.

@dalepetrie: I also read that you wouldn’t be able to choose your doc… but I’m going to keep looking for the source.

@poofandmook that is somewhat true under the present system. With many existing plans you can choose your doctor as long as that doctor is on the “approved” network. Same think with hospitals or other facilities.

@poofandmook – I wouldn’t be surprised to see networks, because there are always some doctors who refuse to take less from an insurer, but you can be pretty sure with the backing of government paying hte bills, most doctors aren’t going to want to be considered outside that network. You would still be able to choose your doctor, but if for example you go to a doctor who charges a ton of money, he or she might not be on the list, but the list would likely include over 99% of physicians you’d want to see. I base that on health plans I’ve been in before and am in now. I have a network of providers, but every single person I’ve ever even kind of wanted to go to was in network.

Because of changes in employment, and the resulting change in insurance plans, our family has had to “bounce” between two primary care doctors over the past ten years. One of the doctors I mentioned this to says it’s not unusual to have a patient drop off and then come back after several years because of this.

There is absolutely no way that the republicans would ever accept anything that the Obama administration proposes. Despite all of the arguments, lies and excuses, they will not accept anything that shows that this administration accomplished anything They want Obama to fail, they want power back and they will do anything to insure that the regain power. This is the most disgusting position that I have ever seen in any minority party in my 63 years.

If Christ came down from heaven and announced that he was running for office as a Republican, I wouldn’t vote for him either.