38 Responses to Has the Public Option Bait and Switch Finally Gone Mainstream?

1. Hugh October 28th, 2009 at 10:14 am «

   It is important to step back and assess the overall debate. It remains about insurance and dollars and not about actual delivery of affordable healthcare to all Americans. It continues not to control costs in any meaningful way. It continues to look like an excuse to slash Medicare. The nuts and bolts remain a sellout, and all the politicking kabuki. The problems that were identified at the beginning with the public option are still there. Obama and Rahm have not changed their stance an iota on anything either. It has been for them inside corporatist baseball from the start.
2. Jim White October 28th, 2009 at 10:27 am «

   Not available to 200 million, ever. Yeah, how’s that for robust?

   Thanks for this important detail.
3. montanamaven October 28th, 2009 at 10:39 am «

   Trudy is a treasure. She was around for the 1993-1994 health care debacle which was also an attempt to reform the insurance business. Ha. Ha. Ha. Hugh is right this is an excuse to slash Medicare as a precursor to going after Social Security. This is classic Shock Doctrine.
• ralphbon October 28th, 2009 at 11:47 am «

  Here’s some depressing déjà vu on restricted health reform debate, from FAIR’s magazine, Extra!, July/August 1993. Plus ça change…

  (Yes, I’m showing off my newfound diacritical-mark moxie.)
• montanamaven October 28th, 2009 at 12:14 pm «

  Excellent find! Look how Robert MacNeil treats Dr. Stephanie Woolhandler.
  

  Near the end of the discussion, MacNeil said he was asking the last question of Woolhandler “since you’re in the minority”–to which she responded: “Robert, I’m not in a minority. Polls are showing two-thirds of the American people support government-funded national health insurance.”

  MacNeil continued: “If this [managed competition] is the program that has a political consensus and the other one that you advocate [single-payer] is considered impossible politically at the moment, why are you then against the one that is viable and would produce a large amount of reform?”

  Woolhandler responded by rejecting the assumption that managed competition would provide meaningful health reform. But the other assumption of the question–that a proposal supported by up to two-thirds of the population should not be seriously debated if it doesn’t have a “political consensus”–speaks volumes about the health of American journalism.

  Amazing the doctor continues to advocate for single payer with the deck continually stacked against it.
  Time to start learning French, Spanish or Danish. Or maybe mosey up and over the border to Calgary.
• selise October 28th, 2009 at 2:29 pm «

  wow. woolhandler was right then. she was right about the ma reform (that it would not contain costs). what are the chances she’s right now too?

  Adding a public insurance plan option can’t fix the flaws in Massachusetts-style reform. A public plan might cut private insurers’ profits, which is why they hate it. But their profits account for only about 3 percent of the money squandered on bureaucracy. Far more goes for marketing (to attract healthy, profitable members) and demarketing (to avoid the sick). And tens of billions are spent on the armies of insurance administrators who fight over payment and their counterparts at hospitals and doctors offices. All of these would be retained with a public plan option.

  And overhead for even the most efficient competitive public plan would be far higher than Medicare’s, which automatically enrolls seniors when they turn 65 and disenrolls them only at death, deducts premiums directly from Social Security checks, and does no marketing.

  Unfortunately, competition in health insurance involves a race to the bottom, not the top. Insurers compete by NOT paying for care: by denying payment and shifting costs onto patients or other payers. These bad behaviors confer a decisive competitive advantage. A public plan option would either emulate them – becoming a clone of private insurance – or go under. A kinder, gentler public plan option would quickly fail in the marketplace, saddled with the sickest, most expensive patients, whose high costs would drive premiums to uncompetitive levels.

  In contrast, a single-payer reform would radically simplify the payment system and redirect the vast savings to care. Hospitals could be paid like a fire department, receiving a single monthly check for their entire budget, eliminating most billing. Physicians’ billing could be similarly simplified.

  Eight decades of experience teach that private insurers cannot control costs or provide families with the coverage they need. A government-run clone of private insurers cannot fix these flaws. Only single payer national health insurance can assure all Americans the care they need at a price they can afford.
• ralphbon October 28th, 2009 at 4:55 pm «

  Ah yes, those were fine moments when the tri-committee chairs allowed a little token SP testimony so as to avoid a repeat of the Baucus embarrassment. Woolhandler and others made great use of their moments in front of the microphones. And then darkness descended (apart from Kucinich and Weiner).
• letsgetitdone October 28th, 2009 at 7:21 pm «

  Yeah, she’s right. So was Kip.
• letsgetitdone October 28th, 2009 at 7:12 pm «

  You’re not the only one having those thoughts. Is Calgary any colder than Montana?
• letsgetitdone October 28th, 2009 at 7:05 pm «

  Hi mm, Too bad for them we’re not shocked. Let’s go get ‘em.
4. djfourmoney October 28th, 2009 at 10:47 am «

   If we already knew the truth about the PO (4-5 million). I can tell you for sure, I have to inform people at work about the PO because they have not one clue. So if this the case in most of America, like many other things that are going on, they have no idea!

   So informing them through the “Gas Bags” if you want to gain wider public support makes sense to me. Who mostly watches those wonky political shows anyway???
• ralphbon October 28th, 2009 at 11:11 am «

  God knows, I don’t watch those shows. For that matter, I don’t have cable, so I only pick up on cable coverage that people highlight on the intertubes.

  Still, the little treatise that Rachel Maddow gives prior to the Wyden interview (use the link in letsgetitdone’s diary below) was one of the best summaries of the continuum from socialized medicine to ObRahmacare I’ve seen, and I think a multiplier effect is at least possible.
5. selise October 28th, 2009 at 11:09 am «

   …is this a classic case of what Fairness and Accuracy in Reporting describes as a “Now It Can Be Told” story — ie, one in which the opportunity for the information to do any good has already long passed?

   yes.

   suburban guerrilla quoting the la times today in: Did Big Insurance Win?

   Reporting from Los Angeles and Washington – As President Obama’s push for a healthcare overhaul moves toward its final act, the oft-vilified health insurance industry is on the verge of seeing a plan enacted that largely protects its financial interests.

   That achievement, should it stand up in the final legislation, would be the capstone of a sophisticated lobbying and strategic campaign that began even before Obama was elected president.

   The specifics of the healthcare legislation are still being hashed out on Capitol Hill, and key details will evolve in the days ahead. Even so, there is broad agreement that the final plan will, for the first time, require Americans to buy health coverage, with taxpayer subsidies for millions who cannot afford it.

   For the health insurance industry, that means millions of new paying customers. What’s more, there are likely to be no limits on what insurers can charge, while at the same time the plan is expected to limit competition from any new national government insurance plan that lawmakers create.
6. selise October 28th, 2009 at 11:10 am «

   thanks ralphbon. another awesome diary. i regret i only have one rec to give. would like to see this post at the top of the list for a long time.
• ralphbon October 28th, 2009 at 11:24 am «

  Oh, please. It’s just another excuse to pimp my PÖ-henge post.
• selise October 28th, 2009 at 2:21 pm «

  it was fookin’ brilliant!
• letsgetitdone October 28th, 2009 at 7:14 pm «

  As are many of Ralph’s posts.
7. scottishlass October 28th, 2009 at 3:03 pm «

   So Robert MacNeil is just “another one of these”. Well! Even PBS was doing it, way back then, two against one. Great!

   But, seriously, ralphbon, thanks for this article (I don’t watch the ‘Sunday Swamis’) with the links to Trudy and Sullivan. Most interesting was the latter’s account of the bait-and-switch, from an elephant-to-a-mouse tactic. Devious!

   I remember watching Chris Hayes on a Utube, he was participating on the Bloggers Convention (I think) and explaining what the public option really is.
• ralphbon October 28th, 2009 at 4:57 pm «

  Thanks, scottishlass. In happier times, remind me to tell you about the kilt malfunction I experienced in my high school production of Brigadoon.
8. kipsullivan October 28th, 2009 at 5:28 pm «

   Fascinating comment, Ralphbon. Fascinating because of that great factoid on the MSM’s complete complicity with the PO movement’s bait-and-switch strategy that Trudy L’s research produced. And fascinating because your discussion of Wyden’s campaign to open the PO up to EVERYONE raises the question, What will PO advocates inside and outside Congress say about Wyden’s effort? Will they remain silent and hope Wyden’s amendment fails so that the PO will remain cute and inoffensive and “politically feasible”? Or will they agree with Wyden’s logic (and those of us who have criticized the PO movement for accepting a shrunken PO)and aggressively support his amendment?

   I suspect HCAN et al. will lift, at most, their left pinky to help Wyden. If expanding the PO were truly a priority for HCAN et al., it wouldn’t be Wyden raising this issue, it would be Schumer or Rockefeller, and the issue would have come up last June or earlier, not in mid-October. Perhaps I’m wrong. Perhaps HCAN will at long last see the error of its deceptive, know-nothing campaign. Perhaps HCAN will surprise us and seek, at the 11th hour, to join Wyden’s effort to undo some of the damage done by the PO movement’s the bait-and-switch job. Maybe. But I’m not holding my breath.

   Kip
• ralphbon October 28th, 2009 at 6:03 pm «

  Thanks, Kip. I don’t know much about Wyden’s 11th-hour efforts, but I don’t see how they could be any less quixotic than the Weiner HR 676 floor vote.

  I would love nothing more than to learn that HCAN planned from the start to lure corporatist Democrats into voting impotent POs out of committee only to unleash a massive wave of citizen activism to convert those POs into something as far-reaching as the June CPC criteria, or even full-frontal Hacker. In a heartbeat I’d take back every snide thing I’ve ever said to or about them and bow to their prowess at 11-dimensional chess.

  Short of which, it’s at least heartening to see some accelerating consciousness-raising prior to a bill-signing. We were, after all, not expecting much widespread outrage about the 18-inch PO until after it had already descended and gone into effect. Some good, or some attenuation of the bad, may come of this.
• letsgetitdone October 28th, 2009 at 7:34 pm «

  It may. Wyden’s been getting some media support on MSNBC. He’s a favorite of Dylan Ratigan and has been on KO, Ed, and Rachel’s shows in the evening. At first he just wanted an exchange open to everyone. But now he’s including the PO.
• letsgetitdone October 28th, 2009 at 7:31 pm «

  I don’t know what HCAN will do, but Wyden’s Amendment won’t get in there if we need 60 votes to put it in. On the other hand, dumbJoe’s move to support the rethugs in filibustering means that Reid will have to go to reconciliation if he wants to include the PO. That gives Wyden a chance to amend the bill with only 51 votes, since filibusters don’t apply in reconciliation. Of course, dumbjoe may yet chicken out. Too bad. I think the way things are developing I think it would be better for progressives if they couldn’t get 60 votes on cloture.
• kipsullivan October 29th, 2009 at 3:26 am «

  Yes, even if the Wyden amendment were to pass, I question whether the PO would be strong enough to influence the insurance industry’s behavior. A victory for the Wyden amendment would mean that one of the five criteria Jacob Hacker originally proposed for his elephant version of the PO would be restored (and that a grand total of two of the original five would be in place).

  But if the Dems don’t restore either the pre-population requirement or the requirement that only enrollees in the PO get subsidies, I don’t see how the PO overcomes the chicken-and-egg problem (the problem of building up a critical mass of both customers and providers roughly simultaneously, market by market). The chicken-egg problem will be very difficult to overcome even with the Wyden amendment.

  So my curiousity about how HCAN, Howard Dean et al. will respond to the Wyden amendment shouldn’t be construed as a vote for the PO if the Wyden amendment passes. Given what’s at stake — an enormous infusion of cash into the coffers of the insurance industry — I would urge a no vote on the Democrats’ “reform” bill even with the Wyden amendment.

  Kip
• selise October 29th, 2009 at 3:44 am «

  kip, i thought the po (well, one of them in either legislation or advocate’s wishful thinking) was going to be able to access medicare providers (with an opt out option for the providers)? did i dream reading about that one?
• kipsullivan October 29th, 2009 at 5:14 am «

  Selise, you’re remembering correctly. HR 3200 has the provision you’re thinking of — one which says it is assumed that providers who participate in Medicare will also participate in the “option” unless they say they aren’t. That sentence reads: “Health care providers participating under Medicare are participating providers in the public health insurance option unless they opt out in a process established by the Secretary [of HHS].”

  In a paper for the PNHP blog, I described this sentence as one of “two useless sentences” in HR 3200 that have got the PO movement’s leaders and the Congressional Progressive Caucus all jacked up for no good reason.

  This “opt out” sentence is like saying it’s assumed you’re going to vote Democrat unless you opt to vote Republican, you’re going to buy oranges unless you opt to buy apples, and similar blather. Unless the Secretary makes the process of “opting out” very onerous, what’s the point of saying providers can choose not to participate in the “option”? There is no language in HR 3200 that says Congress wants the Secretary to make the process of opting out onerous, so my prediction is the Secretary won’t make it onerous, and if he does, he’ll get sued by the AMA and he’ll lose.

  Kip
• selise October 29th, 2009 at 6:28 am «

  kip, thank you! duh, slapping head, i remember now.

  guess i was thinking that if po rates were medicare+5, medicare providers wouldn’t be motivated to opt-out even if it was easy (maybe that’s all wrong?).

  but apparently that doesn’t matter because reports are that medicare+5 was stripped out by the house. (jon’s post)
9. letsgetitdone October 28th, 2009 at 7:37 pm «

   Great piece Ralph. I came late because I had a really long-winded exchange with a few folks here. But this has been a very good discussion on one of my favorite topics.
• ralphbon October 29th, 2009 at 2:30 am «

  Thanks; I’ve been poking my head in on your thread and hope to read through all the comments at my (heh) leisure.
10. selise October 28th, 2009 at 9:41 pm «

    from david swanson: Healthcare Hoax from Hell

    Lies, damn lies, and promises from Democrats. An amendment allowing states to create state-level single-payer healthcare has been stripped out of the House healthcare bill, after having passed in committee back in July by a vote of 27 to 19. And rumor has it that a vote on national single-payer that was promised in July in exchange for skipping a committee vote on it will now be denied.

    worse than a bait and switch. a hoax.
• ralphbon October 29th, 2009 at 3:15 am «

  I doubt Pelosi will block the Weiner vote. It’s cost-free, purely symbolic, and gives Pelosi the opportunity to pretend she cares about the CPC’s priorities. The Kucinich amendment was substantive; that’s why they killed it.
• selise October 29th, 2009 at 3:40 am «

  yes.
11. ralphbon October 29th, 2009 at 3:36 am «

    OT, meanwhile, my morning scan of the pharmaceutical trade press shows that Pfizer has just approved million-dollar bonuses to two executives instrumental in putting together the Wyeth merger. I do hope the thousands of folks thrown out of work by the merger get the ax before December 31, so they’ll at least qualify for the ARRA subsidy on COBRA premiums.
12. kipsullivan October 29th, 2009 at 8:15 am «

    This issue about whether the PO should be authorized to use this rate or that rate is irrelevant until it has been shown that the PO will be big enough to make any rate below the market average stick. The great debate about whether the House bill should authorize the PO to use Medicare plus 5% is a flaming red herring. Until PO advocates propose a PO that will achieve large size, there’s no point in authorizing the PO to pay providers below-private-sector rates. Authorizing the Dems’ pathetic little PO to use low reimbursement rates is like authorizing me to fly to the moon. Great, thank you for the “authority.” Now could you give me the tools to fly to the moon.

    The decision by clinics and hospitals to accept PO-insured patients at rates even with or below the insurance industry’s rates will hinge on how big the PO is IN THE PROVIDER’S LOCAL MARKET (as opposed to nationally). Until we have some assurance that the PO in any given market will have enough market share to induce providers to accept below-average rates, there’s no reason to debate whether we want the PO to have the authority to chare this or that rate.

    Incidentally, Medicare was never “authorized” to reimburse at rates below te private sector. Medicare just does it and gets away with it because it’s so big — and big UNIFORMLY across the country. So, if the PO is so “like Medicare,” why does it need “authority” to charge Medicare-like rates?

    Similarly, there is no law that says providers have to accept Medicare patients. So if the PO is so “like Medicare,” why does it need the ridiculously vaporous “opt out” provision in HR 3200, or anything resembling a stick or declaration designed to make providers accept PO-insured patients?

    This PO rabbit hole we’re in is sooo strange.

    Kip
• selise October 29th, 2009 at 1:06 pm «

  thanks a lot kip. makes sense and clears up a little of my confusion. i’ve got to learn to take NOTHING the po boosters are saying at face value.

  sure looks to me like the rabbit hole we’re in was created for us with malice and forethought. iow, the confusion, misinformation, distractions, etc are a feature. not a bug.
• ralphbon October 29th, 2009 at 3:23 pm «

  What selise said. Sometime shortly, I’ll quote this comment in a new post to rescue it from scroll-off purgatory. You make an absolutely crucial, and poorly understood, point with superb clarity.
13. ralphbon October 29th, 2009 at 3:44 pm «

    Incidentally, Medicare was never “authorized” to reimburse at rates below te private sector. Medicare just does it and gets away with it because it’s so big — and big UNIFORMLY across the country.

    But wait. If CMS answers to no one, then why and how is Congress tinkering with physician reimbursement rates in current legislation?
14. selise October 29th, 2009 at 4:56 pm «

    speaking of strange….

    http://fdlaction.firedoglake.com/2009/10/29/house-health-care-bill-a-death-sentence-for-my-fellow-breast-cancer-survivors/

    if i got anything wrong, i’d love to be corrected. was kinda on my own, but thought i had to try.