Letter to the Editor

[cos]

Last night, I submitted this as a letter to the editor to USA Today:

For decades, private for-profit insurance companies have been spreading fear about "government run health insurance". Despite the fact that people on Medicare - run by the government - are more satisfied with their insurance than people on private insurance, the private insurance companies have been telling us that national health care wouldn't work, because the government can't run a good insurance system, and we're all better off with private insurance. Obama's plan puts their claims to the test, and it's time to put up or shut up.

Obama proposes a compromise between a national single payer system, and the private insurance we have now: he wants to put a public health insurance option in the same market as private companies, to let people choose and see what works better.

Insurance companies' complaints about "unfair competition" are a smokescreen. They want to mislead us into a conversation about how to be fair to insurance companies, while they continue being unfair to the American people.

What the for-profit insurance companies are really saying is that they fear the government can run a better health insurance - that satisfies people more, and leaves us healthier, at a lower cost. They may be right. Congress owes it to us to create a public option so we can try it and find out. Stop worrying about the health of the insurance companies, and care for the health of the American people for a change.

Comments

[cos]

Hmm, I think you may still be confusing some things?

I addressed the mandate portion of this in some long comments on an earlier post. First, to make it very clear, the mandate (everyone must get insurance) is an integral part of the reform, and completely orthogonal to the public plan. Regardless of what happens with a public plan, there will be a mandate.

The reason for the mandate is this: We're going to require insurance companies to cover everyone, accept everyone, and not disqualify "pre-existing conditions". If we don't mandate insurance, that'd leave the option open for people to not pay when they are healthy, and then sign up for insurance once they discover some condition or injury that's going to need ongoing care. We're much better off spreading the risk fairly, the way we do with taxpayer-funded programs. You can't opt out of taxes for a particular service until you feel like you need it.

Now, you say Obama promised that the public option would be different from private insurance because costs for poor people would be offset by wealthier people paying more. That's false. Another integral part of this reform is subsidies for low income people to buy insurance, and that is going to be subsidized by higher taxes on wealthy people, but that is also completely orthogonal to the public plan, and it was always going to be - we're going to have those subsidies, and corresponding taxes, regardless of whether there's a public option in the mix or not. Obama never said differently.

The other way you're talking about is, as I said above, also not a feature of the public option. Congress is going to mandate that all insurance companies accept everyone, and cover pre-existing conditions, and that everyone buy insurance. That'll be part of the legislation regardless of whether one of the options for insurance is a public plan or not.

A public plan will be, effectively, a single-payer insurance, but only for those companies and people who want it. If everyone flocks to it instantly (which is not going to happen) then we'll effectively have national single payer - but Congress won't have chosen it, the people will have voted with their feet/wallets. Obviously a big change like that won't happen suddenly. However, if the government can indeed run a better, more efficient, more transparent, less frustrating health insurance than the private companies do now, then people and companies *will* steadily switch over to it, which will force the private companies to improve their service. Either they'll improve to a point where they're as good as the government, and thus don't lose customers, or they'll find new business models (such as adding extra value), or they'll wither away. No matter which of these happens, the result will be better insurance for all of us.

That's why we deserve to get a public option, and that is exactly the point of my letter.

[lil-brown-bat.livejournal.com]

The reason for the mandate is this: We're going to require insurance companies to cover everyone, accept everyone, and not disqualify "pre-existing conditions". If we don't mandate insurance, that'd leave the option open for people to not pay when they are healthy, and then sign up for insurance once they discover some condition or injury that's going to need ongoing care. We're much better off spreading the risk fairly, the way we do with taxpayer-funded programs. You can't opt out of taxes for a particular service until you feel like you need it.

Sounds good on paper, but (as we've discussed before) this has been significantly botched in the case of Massachusetts, which appears to be the model for this mandate. There are a lot of reasons, but I'll confine myself to three:

• Failure to define "affordability. The Massachusetts mandate failed to define "affordability" in any reasonable and meaningful way, with the result that some individuals are forced to come up with a significant chunk of change every month in order to comply with the mandate (or get penalized). You simply cannot drop a requirement on people to come up with $600 or more out of pocket every month -- the only effect will be to drive them into poverty. The answer that $600 is not typical is true but irrelevant and, frankly, callous: it's a lot more than one or two people (take a look at what a healthy 55-year-old is assessed), and even if it were a tiny minority, there is no provision for them.
  
• Insufficient flexibility in determining income levels. The Massachusetts plan provides subsidies for people making up to 3x the (laughably low) federal poverty level: if your income level is at or below the poverty level, your premium is 100% subsidized; if it's above that, you're subsidized on a sliding scale up to the point where you're making 3x the federal poverty level, at which point you pay 100% of the premium (whatever that is, see bullet point above). 3x the federal poverty level, by the way, is below $30,000 a year, not exactly living large...but I digress. So how much does a farmer make -- or a logger, or a seasonal or temporary worker? Well, if you're a bureaucrat, you assume that they make whatever they showed on last year's taxes. If you're neither a bureaucrat or a moron, you know that what someone in one of these jobs made last year has fuck-all to do with what they'll make this year. It has nothing to do with what kind of money coming in now, and thus, what you can afford to pay now for a monthly premium. Again, these people were callously disregarded when the system was created. For people who claim that they want to move away from reliance on employer-provided health insurance, the proponents of the Massachusetts plan are blind as bats when it comes to looking outside those narrow lines now.
  
• Overloading the system. With many more people suddenly insured, demand for health care services went way up. As a result, if you try to schedule a doctor's appointment in Boston, your average wait time will be 50 days. Yes, that's right -- Five. Zero. And that's Boston -- elsewhere in the state, particularly western Mass, it's worse. One physician in Williamstown reports that his patients typically wait 65 to 85 days for a routine appointment, and that colleagues of his have four month waits. What good is health insurance that you can't use? We all got told that part of the reason for this mandate was to prevent people from using emergency rooms for things that can be handled at a doctor's office, but if you've got a problem that won't wait four months, where will you end up? In the ER, that's where. Fail.
  

I've seen too much hand-waving and ignoring of these issues in Massachusetts. It is simply unconscionable. I want to see these issues addressed before I get behind any national plan.