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The Hill is happy to inform us that some Republicans seem to like Oregon Senator Wyden’s alternative health reform proposal, because it combines exclusive reliance on the private insurance model with a mandate that everyone has to buy insurance. I’m shocked, shocked.
Republicans are so impressed with Wyden’s bill that some are convinced he represents President Obama’s best chance for getting major healthcare reform signed into law this Congress.
It’s distressing to see the otherwise sensible Wyden falling for the nonsense that most Republicans actually want genuine health care reform, let alone want Obama to "win" on a major campaign promise.
For Wyden, the key to passing lasting healthcare reform is finding a legislative solution that can win at least 70 votes in the Senate — and he’s not shy about letting Democrats know that means dropping thoughts of a government-run public plan for the entire nation.
Someone is not paying attention: Number of Congressional Republicans willing to support the stimulus bill to save jobs and the economy during a deep recession: 3 (includes the ever faithful, "I’m not a loyal Democrat" Specter).
Number of Republicans supporting the Budget Bill: zero.
Number of Republicans on the House Energy and Commerce Committee who support the Waxman-Markey climate change bill: zero.
But if the Republicans can convince enough Democrats to abandon health care reform and enrich those who profit from the private insurance model, then yes, 70 votes may be in reach.
There are good reasons why only 21 percent of Americans identify with the Republican Party. It’s because their core supporters are nuts, they don’t deal in good faith and their ideas suck. Why is this so hard to grasp?
So why is Wyden compromising core reform principles to get their votes?
Wyden has sought a middle ground by proposing that the government offer a public plan option only in underserved areas, such as regions where consumers have only two private plans to choose from.
Think about that condition (but no guarantee) for getting a public plan: With 47 million uninsured, and tens of millions poorly-to-fraudulently insured by companies that wrongly exclude them from coverage or deny their claims, the "underserved" condition for a public plan has already been met for the whole country! That ought to be a guiding premise for reform.
Moreover, most of the country is served by an oligopoly — too few dominant firms for effective competition to control prices and encourage efficient care. But never mind "underserved" regions; insurers and providers are often highly concentrated. According to the Urban Institute’s Health Policy Center, many US regions [34 states] have HHIs higher than 1800, a measure of market concentration and market power that prevents effective competition and which should trigger antitrust action by the Department of Justice (if we ever get one back) and/or the Federal Trade Commission, it if ever functions again.
The absence of effective competition is critical. It means that proposals for a health insurance "exchange," prominent in several proposals, miss the point. An exchange is helpful only if you have a competitive market; that means lots of buyers, lots of sellers, no market dominance, ease of entry, and so on. These essential features don’t seem to exist in the health industry.
When "underserved" consumers almost universally know that the problem is they’re being screwed by private for-profit insurance and not-really non-profit systems, the idea that we should force everyone to purchase from that model while doing nothing to ensure effective competition — even a public plan option — is delusional (for Wyden) or cynically corrupt (for Republicans).
Dems shouldn’t fall for this charade.
Other views: Ezra Klein has a favorable view, despite the absence of a public plan. More articles on Wyden plan are here and here.
Reuters: US Workers Paying More for Health Care
Today’s frauds: Wyeth and WellCare.
Update: Robert Borosage cites other studies of market concentration in the health and insurance industry, at HuffPo.
53 Comments
“which should trigger antitrust action by the Department of Justice (if we ever get one back) and/or the Federal Trade Commission, it if ever functions again.” —-well said and absolutely true.
“Dems shouldn’t fall for this charade.”—-nobody should fall for it.
Thank you Scarecrow.
Heh.
I think Senator Wyden won’t get my vote ever again. Under his proposed plan, I would pay for my mandatory health insurance when I file my federal income tax. Right now, I chose to pay my mortgage and buy food, and do with out health insurance (and health care), because I cannot afford all three. Under his plan, I would get to choose between paying my mortgage or eating. I don’t think I like his plan.
To be fair, keep in mind that various plans, including Wyden’s, include subsidies for low- to medium-income people to help pay the premiums. And Wyden’s plan is universal, whereas other proposals, including Obama’s (from the campaign) are not.
This is nuts. The only way that a private insurer can make money on health care is to deny coverage to those that might make claims, to deny or delay claims, and to set premiums as high as possible. It basically is not a real insurance market.
With homeowners or auto insurance, only a minority of policy holders will ever make a claim during the life of the policy. So the actuaries can figure a premium that is profitable yet practical for consumers. There is money to be made, so consumers have a choice of competing providers.
Not so with health–everyone is sick at some point in their lives and most are sick to some degree in any given year. Premiums can’t cover costs and provide profit without chicanery and price-gouging. There are so few providers that competition is almost nil–neither patients nor doctors have much choice. Sweetheart deals with hospitals, diagnostic labs, and drug companies and captive mail-order pharmacies further undercut competition. The overhead that comes with risk shifting, delaying and denying claims adds to the cost of the outright profiteering.
Healthcare is like highways, air traffic control, and the Army: since there is no legitimate way to compete and make a profit, it has to be a public service, not a private cash cow.
thank you.
Bullseye, as per usual.
Thanks scare.
the surprise for me hasn’t been that republicans rally to private insurance-based health “reform” — it’s that the democrats did (and are).
how can we get single payer on the table for discussion?
Big surprise but the govt single payer plan has been around since the 60s. Works fine, called MEDICARE. Over 98% of funds go to actual health care costs. Unlike private insurers. I am in the govt plan, same one that congress has. It is a very good plan-I pay over $200 a month, my share-and they can not drop me, no matter what. If a plan is good enough for congress and all FedGov workers then it should be good enough for everyone, no? Private, for profit plans need not apply.
IMPO the corporate owned congress will cave and go with the plan that the health insurance people want. More money for them and little health care for everyone.
BTW, the govt is also running hospitals and clinics, called the VA.
Typical politician bullshit. Ten votes in the senate is worth more than tens of millions in the street.
surprise surprise is right
here’s where the progressives are missing the thread;
they need to point out there will STILL be private health care and anyone not satisfied with single payer CAN get their own private insurance
they also need to point out that private insurance will be forced to compete against a more efficient model and therefor single payer will reduce the cost of private health care
make these points and simply say;
“I agree, anyone that doesn’t want single payer should get their own insurance”
there is nowhere for them to go once that is pointed out
I bet most of them call themselves Christians too. I am so fucking tired of these people who hide behind their religions could really give a shit about all people having access to similar health care that they receive and then hide behind their false religions. So tired of this horseshit.
these folks are not pro life they are pro $$$$$ and that is it. They could give a rats ass about those without health care
Postpartisanship=Ds do everything Rs want.
Heard Mitch McConnell on Faux News on Sunday fall right in line with private insurance. Trying to find the clip..they do not have the full transcript up.
so many of these guys (mostly men) are Faux Christians too. Hide behind those crosses. while being the men about $$$$$
This is not healthcare reform…this is sellout to monopolistic and corporate insurance companies.
Did we learn nothing from giving away the candystore to the banksters?
Disgusting.
This isn’t going to work. No one will remember Wyden’s role in it, probably. It will be ”Obama’s ’health care reform’ doesn’t work.”
Or maybe they’ll think it works because they won’t have to worry about it anymore.
Funny thing; at the oral surgeon yesterday, he said they don’t take Medicaid anymore. They did when it was purely government-run, but now there are these private companies like Unisyn that you have to enroll with, and it makes it harder for the billing I guess.
So now I don’t qualify for credit and they won’t take Medicaid. But the Blue Dogs are happy, they got their ’pay-go.’
I am not happy.
No. This has been another episode . . .
The mere introduction of some degree of regulation in markets seems to be a radical notion under the current scheme. Such an atmosphere, contrived or otherwise, is bound to push the single-payer model perforce into la-la land.
that is so fucking true, i don’t know if i want to laugh or cry – maybe both?
the dems could push for a well designed single payer system and probably have a lock on national politics for the next 20 years (see social security).
so what do they want to do? sell out to the insurance companies. design a crappy fucked up system that people will hate and give themselves and healthcare reform a bad name.
can someone tell me how this makes political sense? (i get the moral depravity doesn’t matter part)
It’s pretty depressing.
Rarely does my senator do things that appear irrational. I have to question his motives now, and reexamine my support for him. To subject us to the nonsense of 70 votes when it will require only 51 is a very deceiving statement, that has no basis in reality.
If they do not create a government program for health care, there will be no government. They know it, so why do they continue to waste time as the country goes bankrupt?
Sad at this time. Sickening for our future.
The Ds would lose all their campaign contributions from medical insurers, and probably a lot of other corp contributors as well, if corps thought Ds had the balls to stand up to them.
Selise, they seem not to be long-term planners.
I think, judging from my own Blue Dog rep, once elected they have a new priority: Fitting in. If they fit in they think they’ll stay in office. If they represent us it gets scary because we need radical surgery on several systems and they would really rather not deal with it.
Yes, but what I strongly object to is the mandatory purchase of health insurance contributing to the multi-million dollar $alaries/perk$/bonu$e$/dividend$ of insurance executives and related stockholders. I would rather not be forced to contribute, thanks, anyway. If, instead, my total contributions were to go to providing equal access to health care to everyone, I would be willing to forgo my small ‘extras’. Heck, even my doggie
wouldmight be willing to give up his treats. But not everyone will have enough wiggle room in their budgets to make that choice.And don’t be misled about “subsidies for low- to medium-income people to help pay the premiums”; sounds nice, but it won’t be nearly enough. Think about people who have relatively high mortgages (affordable when they had high paying jobs) and are now just able to make the mortgage payment on lesser paying jobs — and/or from their savings. Their income will be too high to qualify for any subsidies. The ‘I got mine’ crowd will say sell the house, but in today’s market, that is nearly impossible. So the choice for many will be food or housing, but not both.
Just think how much health CARE could be purchased with the money that now goes (and still would go) to just a few top health care execs and their stockholders. I realize I am whining, but I am sick of helping the already too rich get richer. I would rather have my glass of cheap wine each day and do without the pap smears and mammograms.
Republics have to prevent health insurance reform by any means necessary. If everyone has effective health insurance, what’s the point of working hard to be born wealthy?
Well if the health insurerance vultures had competition from a public plan they know they wouldn’t have money to contribute in short order anyway.
Health care when needed. Not health insurance.
There is no acceptable “reform” that includes insurance companies.
Thanks Scarecrow.
Soooo, if they mandate we all buy the sham called health insurance what are they gonna do with folks like me who will tell them “Bite me?”
Ask selise what the penalty is in MA. That’s the part of the plan I’ve not understood.
I thought I’ve read that the monster in MA is a disaster.
Unfortunately single payer will never get 60. You would have to run it through in reconciliation which already looks bad. A public plan has a chance of getting 60 but if Wyden’s plan is the one that mostly gets through it is a function of him hustling for it rather than capitulating to the Republicans, because he had these same ideas last year. And the Wyden plan seems better than the McCain plan which was a joke.
Aside from being bankrupt why is it a disaster. *g*
If you can argue that the public plan is a guarantee of something in the marketplace which has standards which are fair and is generally exemplary, then I think you win. The argument has to be about how people are treated by the plan and not necessarily about cost. The other day I got an email from David Plouffe asking for money to help sell the plan, so Team Obama may be worried about how large a persuasion effort they have to do.
The key to understanding a penalty mechanism is that it must be set high enough to discourage non-compliance. If it costs me $10,000 to comply, but the penalty for non-compliance is $5,000, and I still get some type of coverage anyway, there’s little incentive to comply. That’s the flaw in the MA penalty plan.
The MA plan overall has succeed in some ways, failed in others. My understanding is that they’ve come much closer to universal coverage — the number of ininsured has dramatically declined, but the remaining uncovered are harder and more expensive to get. And the legislature has to struggle each year with how to fund the various subsidies. I think this structure is, in the long-run, not sustainable. It’s better than we had, but not good enough yet, and we haven’t solved the funding problem.
Ultimately, we’re dealing with a system that is not competitive, which means govt must step in an remedy/compensate for market failures. Some form of price control seems inevitable, in the same way we regulate profits for public utilities. But we keep trying to avoid what seems obvious.
The substantive problems are hard; they make my head hurt. The political problems are worse. Meanwhile, there are successful models elsewhere that we assume can’t be proposed here.
Another election?
What does Obama think of this, do we know, Scarecrow?
Any explanation for why Wyden’s doing this?
Health insurance companies’ contributions to him in particular, or just Dems in general?
This is shameful.
Actually we shouldn’t fall for this charade. This is all really standard operating procedure for both Obama and the Democrats. Obama’s proposal was already pretty much of a sellout to insurance companies. Then Schumer comes along and says that any government alternative must be as bad as private plans. Next Wyden does his star turn for the insurance companies and says let’s forget about a government plan completely.
This is all done by Democrats before the Republicans commit to anything, and of course, they aren’t going to commit to anything. They are going to vote against the Democratic plan no matter how obsequious it is to insurance companies.
“…a mandate that everyone has to buy insurance.”
This is what is commonly called a “tax.” And it goes straight to the insurance companies. The potential for corruption is enormous.
…waiting to see if AIG starts offering health insurance…
That is just it. This isn’t about healthcare for Americans. It’s about welfare for insurance companies.
During the campaign, Obama backed the inclusion of a public plan that people could choose as on option. If they liked what they have now, they could keep that, but this public plan would always be open to them. He has not backed away from that general concept, but he’s left (so far) the detail to Congress for the time being, while he saves the banks, rescues auto makers, and works on global climate change, etc.
He earlier welcomed the promises of cooperation from the insurance/health industries, pretending to believe they’re acting in good faith. I assume he learned from the previous battles on stimulus, budget, etc, that there is precious little good faith coming from vested/political interests. He seems to work best in stealth, then announce big moves when the way is ready, so we’ll see. Keep in mind that Max Bauchus appointed Chuck Schumer to oversee the development of the public plan, which I wrote about a couple weeks back. That makes me very uncomfortable.
Where is the outcry from the ministerium about Good Samaritan principle? Where is the clamor from the clergy about social justice? Where are the pro-life screeders on this the most important issue of all for healthcare?
Or have they been bought off, too?
the evidence i’ve seen (for ma) is that it’s not better than we had for the majority of people who have had to deal with the new system (see figure on page 11 of report). more importantly, the cost over runs have been taken out of safety-net providers and those most desperately in need are worse off.
i hope everyone has read the report:
http://www.pnhp.org/news/2009/…..is_no_.php
in addition to the report i linked to @44, this is an important read from public citizen: Patients’ Experiences Under Massachusetts Health Care Reform
imo, that’s it exactly.
They are going to bite you back! You will probably have all of your assets confiscated and you will be tasered all the way to jail. Then, you will be subjected to ‘enhanced interrogation’ (it’s not torture because W/Cheny said so) until you confess that the Democrats have WMD.
BTW, your assests will be divied up amongst those who are above the law, and who will be exempt from having to purchase health insurance, ’cause they already have it for free from the gov’ment.
Sorry to be so pessimistic. But our President made me do it. He keeps promising things, and then doing really, really confusing stuff.
Stealth is not leadership. So far Obama has given us change we can’t believe in. Obama should be saving the economy and ordinary Americans, instead he is looting the government to save the banksters. Not sure what it means to save automakers if both Chrylser and GM are in contested bankruptcies. As for the all the hoopla about cap and trade, it’s too little too late and a far cry from a carbon tax (despite the efforts to obscure the differences between the two).
Of course Obama has made some progress. He is escalating in Afghanistan and pushing back withdrawal from Iraq. He is protecting torturers and continuing to spy on Americans. Looks too like he’s dumping gays over DOMA. I can understand Obama’s dilemma though: so little time so many people to sell out.
Thanks for the link to MA report. Now I have something to read on the plane today.
you’re welcome. safe travels.
Just before noon Pacific time, gotta run to work. Both Wyden’s DC # and his Portland # are NOT accepting calls due to “heavy volume.”
KEEP IT UP!! Call every Senator — mandatory private insurance is NOT REFORM! We need Single payer, to get a 3% national overhead cost and avoid the insurance co’s 25% overhead cost — that’s how we afford it, that’s what REAL REFORM is !!
Of course, the so-called Dem’s in Congress generally wouldn’t recognize real reform even after it bites them in the butt and tosses them out of office.
Bravo! This is the essence of the problem and it has only one equitable solution for the average American. This is the reality of health care insurance, and yet not one US Senator has the moral courage and integrity to speak the truth. The truth is that medical and hospital care should not be for profit activities where care is rationed in order to pad some firm’s bottom line. Medical and hospital care will always be rationed, but it should be done so based on sound medical judgment. That’s also a reality. With the savings that could be realized with a single payer system, and to a lesser extent with a public option, consumers would see substantial premium reductions and health care providers would receive the same or more compensation for their services with none of the headaches that are attendant to the health insurance game of delaying and/or denying claims for coverage. Doctors finally would be free to use their best judgment without inappropriate and constant interference from a for profit entity.
Senator Wyden should just go fuck himself if for nothing more to see how his health care provider would treat that particular claim for coverage.
We should just all drop our coverage and get that ER treatment that president Bush said was available to all Americans, and will bankrupt the hospitals and the health insurers in no time.
A little history of the Wyden plan – it was written years ago under Bush. For a Bush era, it was actually a pretty decent idea, and revenue neutral to get Republicans, who controlled things at the time, on board.
Of course, in today’s climate, it’s a ridiculous plan that would tax our benefits and provide no real regulation on the insurance industry. Especially because a public option type plan has the vote to pass, we don’t need the Wyden plan anymore.
Now, Wyden isn’t backing down. Not sure why, but I’d say pride. But the leadership is not behind this plan, Max Baucus has been getting more and more annoyed at Wyden pushing this plan recently, and for my vote, it’s going nowhere.
Not that this means it doesn’t need to be criticized…