Most of all, the final bill needs viability.

Originally Posted by Ian Welsh

So what does the Public Option need to work?

First: it needs to be populated with enough people to be viable. Here are some possibilities of how to do that with too much auto-enrollment. You don’t need to do all of these, you do need to do some of them or something similar.

On the income tax form, have an opt in box for anyone who wants to enroll, so that every American sees the option, without needing to see advertising
If there is an individual mandate requiring people to buy insurance, if they don’t have it after the first year—if they haven’t bought, auto-enroll them at tax time into the public option.
auto enroll everyone on disability into the plan, as top-off insurance. Whatever the gap between what they get from their disability and public option is covered by the public option
Veterans auto-enroll into the public option as well, in exactly the same way, as top-off insurance. They still get all their veterans care, but anything that isn’t covered by Veterans, that is covered by the public option, they now also get
everyone must be free to choose the public option, including people who are enrolled in corporate healthcare plans (this is baseline, this must be in the plan to give it the ability to drive down costs.)
State rollovers. If a state has a plan that doesn’t cover everything the public option does, then everyone on the State plan is automatically enrolled, and the cost of those health care services is taken out of Federal Medicare funds.
Institute enough of these policies, and the public plan can have a large enough enrollment base to matter, and because it is easy to enroll in can put price pressure on private firms. But even with all of these, the public option will still start out not all that large and have trouble negotiating contracts. So, what else do you need?

Second: it needs to work with Medicare and Medicaid.

Negotiation must take place between the all three plans as one, and providers. This will drive down prices the fastest. It will not just help the public option, it will also drive down Medicaid and Medicare rates.
If a provider accepts Medicaid or Medicare they must also be required to accept the public option. No picking and choosing.
The rate does not have to be the same as the Medicare rate, but it must be based off the Medicare rate. The House plan is Medicare + 5%. That’s fine.
All limits on the ability of Medicare/Medicaid and the public option to negotiate prices with providers (for example, not allowing negotiations with pharmaceutical companies) must be removed. Failure to do so will mean not only that costs won’t be contained, but that the government plans will be at a disadvantage compared to private plans which an do this.
The above are the minimum requirements to create a viable public option. Public option advocates who are not willing to draw a line on the above are advocating for a plan which will, most likely, not survive—a plan that is not viable. The cry of public option advocates has been “saving even a few lives is worth compromising!” But if you compromise to the point where the plan is not viable, you’ve compromised to the point where there’s no point.

Originally Posted by The Grey Badger

Get real fruit and a juicer. My mom had a citrus juicer that was shaped like a grooved cone in the middle of a moat. Halve the fruit, shove the cut side over the cone, twist a few times, and you have juice. Me, I just eat the fruit.

Yup. It's standard equipment at most any bar .

Originally Posted by Ghost Echo

Personally I think Obama may be trying to approach this in an outdated way, and trying for full insurance through the general budget may be a bit too much.

As for a public vs a private option I believe they can compliment each other. Any public option would could only offer basic or catastrophic coverage. To get expanded features,benefits and or coverage, you have to buy private insurance. Not only would it ensure the continuation of the private industry but would reduce the cost of government assisted healthcare.

And instead of the opt-in check form on your income tax return, how about an opt-out check form instead? (You can tell, I've been reading Nudge.)

Originally Posted by Ghost Echo

Personally I think Obama may be trying to approach this in an outdated way, and trying for full insurance through the general budget may be a bit too much.

As for a public vs a private option I believe they can compliment each other. Any public option would could only offer basic or catastrophic coverage. To get expanded features,benefits and or coverage, you have to buy private insurance. Not only would it ensure the continuation of the private industry but would reduce the cost of government assisted healthcare.

The way to get anything achieved is through incremental efforts. We would be wise to look at taking the Horror Stories of grossly-unmet needs out of the health-care mess: people cutting back on medications for lack of funds, people having to choose between such necessities as food and rent to healthcare, people losing or being unable to hold jobs because they fail to qualify for health care.

Throwing a large VAT onto the American people, the only way in which to fund European-style cradle-to-grave healthcare, would be a huge disruption in the way things get done. We could instead go to an "abuse pays" system, in which people who use cancerweed products, alcohol, sugar, corn sweeteners, and fats pay heavily for things that ultimately cause healthcare costs.

This political aspect might have some legs under it, once the focus moves primarily to the Senate -

http://angrybear.blogspot.com/2009/0...in-senate.html

Rural Bias in the Senate

Robret Waldmann

Gang of 6 senators who correspond to 6.5 representatives.

The US senate has an extreme rural bias. It has outdone itself by allowing Max Baucus to empower a bipartisan group of 6 senators to redesign health care reform. The states represented by the 6 senators (Iowa, Maine, Montana, New Mexico, North Dakota and Wyoming) have a total of 13 representatives so the committee consists of half of the senators from states with 13 representatives and corresponds to 6.5 representatives, that is, less than 1.5% of the house and roughly 1.5% of the population.

The 6 are a tad embarrassed by this and say they have tried to take urban concerns into account (that's Democracy at its best -- people counting on the consideration of people they didn't elect). According to Washington rules it is much more important that the bill have bipartisan support than that it have input from people elected by a significant fraction of the population.

Given that priority, it's not all that surprising that they have come up with the worst financing idea ever -
http://angrybear.blogspot.com/2009/0...-tax-ever.html

This has been an issue in other Progressive blogs, one big example -
http://www.dailykos.com/story/2009/7...-supermajority

The 40 Republican senators currently in the Senate, all of whom are expected to filibuster a public option, received 44.2 million votes in their elections.
The 5 Democrats (Conrad, Baucus, Lincoln, Landrieu, and Nelson) who seem most likely to filibuster health care reform including a public option received 2.5 million votes in their elections.
The remaining 55 Senators (53 Dems plus Lieberman and Sanders), all of whom would likely vote for cloture on a reform plan including a public option, received 79.8 million votes (this includes votes cast for the Democratic predecessors in CO, NY, IL, and DE).
To recap:

Votes for seats held by GOP filibuster supporters: 44.2 million
Votes for seats held by Dems who may filibuster: 2.5 million
Votes for seats held by Dems who would support cloture: 79.8 million
Obviously, there's a ton of ways you can slice numbers, but this analysis yields a fairly salient factoid: nearly twice as many people voted for senators likely to support a cloture motion than voted for a senator who is likely to thwart health care reform with a filibuster.

Moreover, the two Democratic Senators leading the charge against a public option -- Kent Conrad and Max Baucus -- have received fewer votes combined (498,345) than 41 Democratic senators have received on their own. Indeed, Kent Conrad -- with 150,146 votes in his last election -- received fewer votes than any other member in the caucus.

Conrad actually received just 0.1% of all votes cast for current Senators (or their predecessors, if they were appointed). Meanwhile, despite the fact that the typical senator in his caucus received ten times as many votes as he has, he's tried to position himself as the kingmaker on health care reform.

Kent Conrad and Max Baucus might have all the confidence in the world that they can thwart the public will, but any politician who wants to keep his or her job ought to look at these numbers and think whose side they really want to be on.

In regard to that last line, what the Senators will look at is the state population that elects them which may very well support their opposition to the public option. However, on a national basis, the majority, possible by far, may support the public option and other major health care changes.

This may bring into question again the age-old issue of 'rural state tyranny" through the Senate mechanism. Perhaps not enough to change the Constitution, but maybe enough for a change in how Senate committees are made up and other arcane Senate procedures that somehow still remain viable today.

This could boil over with a House-Senate reconciliation with the majority of the House being more representative of the majority of the voters in the nation whereas the Senate will be hide-bound by the "rural elites."

There is no Waxman option possible, at least, as yet; perhaps a consideration for this 4T?

Does anyone have data on what the relative % population of each of the 13 colonies against the total at the time of the Constitution as compared to today?

Has the US Senate become an anachronism, if not a hurtful anacrhonism, to the notion of democracy?

Originally Posted by Ghost Echo

Any public option would could only offer basic or catastrophic coverage. To get expanded features,benefits and or coverage, you have to buy private insurance. Not only would it ensure the continuation of the private industry but would reduce the cost of government assisted healthcare.

This will be an item of debate since in some reviews of the bill currently in the House, the option to own private Health care after enactment is off the table. Employer and Public option are the only choices being considered.

"rural tyranny" continued -

This notion has been picked up at a "higher level," i.e., on Krugman's blog but not yet a NYT op-ed whcih would really get things going. Maybe a shot-across-the-bow for our gang of six?

http://krugman.blogs.nytimes.com/

July 28, 2009, 12:11 pm
Hey, we can do this
Yglesias points out that the Gang of Six negotiating the Senate Finance version of health reform all represent very small states — in fact, the combined population of their states is less than that of New Jersey.

So hey, why not let New Jersey do this instead? We can get a committee of, say, three corrupt mayors and three money-laundering rabbis to draw up a plan; it could hardly be worse than what Max Baucus has come up with.*

As we say here in the Garden State, “You got a problem with that?”

*People in the know say not to worry too much about the awfulness of the Finance proposal; the important thing is getting it out of committee, so that it can be fixed in later negotiations. I hope they’re right.

Is this the 'gentleperson' way of doing the Waxman thing in the Senate?

Here's the Ygesias piece that Paul refers to -

http://yglesias.thinkprogress.org/ar...rs-that-be.php

The Powers That Be
Not to just keep flogging a dead horse endlessly, but it does strike me as worth noting that when you read a puff piece in The New York Times about the Gang of Six bipartisan dealmakers in the Senate that vast power is being wielded by people who, in a democratic system of government, would have almost no power. We’re talking, after all, about Max Baucus of Montana, Kent Conrad of North Dakota, Jeff Bingaman of New Mexico, Susan Collins of Maine, Mike Enzi of Wyoming, and Chuck Grassley of Iowa. Collectively those six states contain about 2.74 percent of the population, less than New Jersey, or about one fifth the population of California. The six largest states, by contrast, contain about 40 percent of Americans.

The largest metropolitan area contained in whole or in part within any of those six states is the Albuquerque MSA, population 846,000, the 59th largest in the United States—smaller than New Haven or Fresno or Richmond. And of course if you got together a group of Senators from large states that contain big cities—California, New York, Texas, Florida, Illinois—those senators would still represent plenty of farmers and rural communities. Indeed, California is the most important farm state in America. But when you get the inverse group together you wind up completely excluding the interests of residents of large metropolitan areas—not just city dwellers, but the vast number of Americans who live in the suburbs of large cities—even though such places contain a majority of the country’s population and economic activity.

Will this (rural Senators' tyranny) jump the shark to the mass media in the next couple of days? Be an issue on this comng Sunday talk shows?

http://campaignsilo.firedoglake.com/...f-the-country/

Three Republican Senators Are Worth More Than 76% of the Country

-The three Republicans are Snowe, Enzi and Grassley. The Democrats are Baucus, Bingaman and Kent "co-ops" Conrad.

The Finance Committee was supposed to deal with -- wait for it -- finance. Instead, President Baucus and President Snowe decided that they'd just write the whole damn bill themselves and have included a competing co-op plan that would replace the public plan offered by the HELP committee.

Because three Republican Senators are worth more than 76% of the country to members of the most exclusive club in the world.

They certainly have a mighty high opinion of themselves.

The 76% refers to this latest national poll indicating 76% of the nation's voters want a public option -

http://msnbcmedia.msn.com/i/msnbc/se..._poll_Full.pdf

More Silent BS from Harry Reid.

Typical Silent political BS. "Getting 60 votes" (because he's too spineless to make the anti-Public Option idiots do a real, old-fashioned filibuster) is more important than "what's in the bill".

I am SOOOO sick of this.

Originally Posted by pbrower2a

The way to get anything achieved is through incremental efforts. We would be wise to look at taking the Horror Stories of grossly-unmet needs out of the health-care mess: people cutting back on medications for lack of funds, people having to choose between such necessities as food and rent to healthcare, people losing or being unable to hold jobs because they fail to qualify for health care.

Throwing a large VAT onto the American people, the only way in which to fund European-style cradle-to-grave healthcare, would be a huge disruption in the way things get done. We could instead go to an "abuse pays" system, in which people who use cancerweed products, alcohol, sugar, corn sweeteners, and fats pay heavily for things that ultimately cause healthcare costs.

There is something to be said for universal health care being funded by admittedly regressive means, since it will be the poor who will benefit from it relative to other income groups.

As for "cancerweed products" - I'm a lifelong non-smoker, and this dead horse is getting beaten far too much; and who decides what constitutes "abuse" deserving to be taxed? What if some fundamentalist-type wants to include homosexuality in this category, citing HIV/AIDS?

And the more I see of this debate, the more I see ObamaCare going the way of HillaryCare: Both tried/try to please everybody, and nobody ended up liking it.

I'm sticking by my original prediction of 2023 as the get-it-done date for comprehensive reform of the system - the year a certain birth cohort turns 65, when they would have qualified for Medicare (assuming that hasn't gone bankrupt by then) anyway.

And speaking of which, why isn't Medicare eligibility rising with successive birth cohorts, the way Social Security is? And why isn't the age for albeit reduced benefits available under the latter not rising in concert with the age for full benefits, instead remaining frozen at an obviously archaic 62?

Inquiring minds want to know.

Originally Posted by Ghost Echo

Personally I think Obama may be trying to approach this in an outdated way, and trying for full insurance through the general budget may be a bit too much.

As for a public vs a private option I believe they can compliment each other. Any public option would could only offer basic or catastrophic coverage. To get expanded features,benefits and or coverage, you have to buy private insurance. Not only would it ensure the continuation of the private industry but would reduce the cost of government assisted healthcare.

Why is private health insurance a good thing? Health care is expensive enough without adding parastic profits to the list.

Originally Posted by pbrower2a

... Throwing a large VAT onto the American people, the only way in which to fund European-style cradle-to-grave health care, would be a huge disruption in the way things get done. We could instead go to an "abuse pays" system, in which people who use cancerweed products, alcohol, sugar, corn sweeteners, and fats pay heavily for things that ultimately cause health care costs.

I'm afraid that the compliance costs involved in "qualifying" non-abusers would offset any savings. Start with simple, and make changes from there, if warranted.

Originally Posted by playwrite

... Has the US Senate become an anachronism, if not a hurtful anacrhonism, to the notion of democracy?

Big states should consider the possiblity of splitting into several states. California could easily be 5 to 6 states, itself.

Originally Posted by Marx & Lennon

Big states should consider the possiblity of splitting into several states. California could easily be 5 to 6 states, itself.

I like the idea as long as it is based on population and that it would require the consolidation of some states.

I just wonder where the state line will be drawn across Manhattan Island and which state I will be in.

I see California as two states, North California and South California. Texas was given the right to split itself up, was it 4 ways? Or 5? Anyway, Southeast Texas, Southwest Texas. Central Prairie Texas, and North Texas?

I still think New Mexico should get El Paso, just to legalize what it already is in fact.

However, there's a reason to have small states represented equally with large ones in the Senate. That is to *prevent" total urban dominance and large state dominance pf the national government. Anyone who has ever lived in a state where the state's largest city or cities overrides the interests of the farmers and ranchers with cowboy boots and spurs knows precisely what I'm talking about.

Not to mention that New Mexico has had its share of the urban East imposing laws that make total sense in the urban East on a rural Western state. The experiment with the national speed limit comes to mind.

Farmers, ranchers, and people in remote areas have rights, too.

City mouse (Albuquerque) Pat

The latest extrusion from the Congressional sausage factory is the idea of promoting health insurance co-ops (a.k.a. mutual insurance). This is actually a great idea in basic concept -- far better than the proposed public option.

The devil, alas, is in the details. So far, I've heard two main problems with the co-op system being promoted. First, they really should create a new type of non-profit and exempt mutual insurance from taxation, but that doesn't seem to be the case. Second, the proposed system restricts the new co-ops to individuals and very small businesses, essentially locking in all the mid and large size companies for the existing insurance giants. So, it looks like a good idea with terrible implementation.

Many of the current health insurance companies used to be mutual insurance companies. They changed because switching to the for-profit, shareholding model allowed for much easier access to capital markets (due to various tax laws and securities regulations). It also shifted a tremendous amount of control away from policyholders and up to the bean counters. It almost sounds like the actual effect of the legislation described above will be to prevent major insurance companies from switching back to a mutual insurance model.

Originally Posted by playwrite

Originally Posted by Marx & Lennon

Big states should consider the possiblity of splitting into several states. California could easily be 5 to 6 states, itself.

I like the idea as long as it is based on population and that it would require the consolidation of some states.

I just wonder where the state line will be drawn across Manhattan Island and which state I will be in.

The state of grace is always a good option, though most of the regulars on this forum may find that a difficult option to achieve.

Originally Posted by Marx & Lennon

The state of grace is always a good option, though most of the regulars on this forum may find that a difficult option to achieve.

So that means I get Central Park AND the Theater District! Cool!

Originally Posted by The Grey Badger

I see California as two states, North California and South California. Texas was given the right to split itself up, was it 4 ways? Or 5? Anyway, Southeast Texas, Southwest Texas. Central Prairie Texas, and North Texas?

I still think New Mexico should get El Paso, just to legalize what it already is in fact.

However, there's a reason to have small states represented equally with large ones in the Senate. That is to *prevent" total urban dominance and large state dominance pf the national government. Anyone who has ever lived in a state where the state's largest city or cities overrides the interests of the farmers and ranchers with cowboy boots and spurs knows precisely what I'm talking about.

Not to mention that New Mexico has had its share of the urban East imposing laws that make total sense in the urban East on a rural Western state. The experiment with the national speed limit comes to mind.

Farmers, ranchers, and people in remote areas have rights, too.

City mouse (Albuquerque) Pat

There are a lot of states like that.

Pennsylvania is a case in point - there is the Philadelphia-based "state," which extends outward as far as the Amish country (or even Hershey); it's tied to the New York-to-Washington (or alternately, Boston-to-Washington) corridor, and has no more than a quarter of the state's total area, but at least half its population. The balance of the state belongs to the "North Coast" - a non-pejorative substitute for "Rust Belt," as the Great Lakes can be construed as a northern counterpart to the Gulf of Mexico, in that both have access to the Atlantic (otherwise Chicago would not be considered a "port city") - and is epitomized by Pittsburgh, where if you tell people that Philadelphia is a "blue-collar" town (an imagery actively promoted in the Rocky movies), you will be met with howls of laughter.

Michigan is Greater Detroit, the rest of southern Michigan (up to about Muskegon and Bay City... the Rust Belt containing Flint, Lansing, Grand Rapids, and Kalamazoo), and the forested North.

The health care tyranny

David Sirota

... when tyranny mixes with legalized bribery, constituents’ economic concerns stop mattering.

Thanks to our undemocratic system and our corrupt campaign finance laws, the health care industry doesn’t have to fight a 50-state battle. It can simply buy a tiny group of congresspeople, which is what it’s done. According to the Center for Responsive Politics, health interests have given these 13 members of Congress $12 million in campaign contributions - a massive sum further enhanced by geography.

Remember, politicians trade favors for re-election support - and the best way to ensure re-election is to raise money to for TV airtime (read: commercials). In rural America, that airtime is comparatively cheap because the audience is relatively small. Thus, campaign contributions to rural politicians like these 13 buy more commercials - and, consequently, more political loyalty.

The end result is an amplifier of tyranny: precisely because the undemocratic system unduly empowers legislators from sparsely populated (and hence cheap) media markets, industry cash can more easily purchase tyrannical obstruction from those same legislators. In this case, that means congresspeople blocking health care reform that would most help their own voters.

Of course, there is talk of circumventing the 13 obstructionists and forcing a un-filibuster-able vote of the full Congress. Inside the Washington palace, the media court jesters and political aides-de-camp have reacted to such plans by raising predictable charges of improper procedure, poor manners, bad etiquette and other Versailles transgressions.

But the real crime would be letting the tyrants block that vote, trample democracy and kill health care reform in the process.

more: http://www.sdnn.com/sandiego/2009-07...h-care-tyranny

Ugh, I've just read that there is some major astroturfing going on, organizing the Teabaggers to disrupt town-hall meetings by congresspeople on healthcare. They are also spewing lies claiming that "liberals want to euthanize old people if they cost a lot to care for".

Originally Posted by '58 Flat

There are a lot of states like that.

Pennsylvania is a case in point - there is the Philadelphia-based "state," which extends outward as far as the Amish country (or even Hershey); it's tied to the New York-to-Washington (or alternately, Boston-to-Washington) corridor, and has no more than a quarter of the state's total area, but at least half its population. The balance of the state belongs to the "North Coast" - a non-pejorative substitute for "Rust Belt," as the Great Lakes can be construed as a northern counterpart to the Gulf of Mexico, in that both have access to the Atlantic (otherwise Chicago would not be considered a "port city") - and is epitomized by Pittsburgh, where if you tell people that Philadelphia is a "blue-collar" town (an imagery actively promoted in the Rocky movies), you will be met with howls of laughter.

So is Washington State, split along the Cascades into generally liberal Western Washington and conservative Eastern Washington.

Originally Posted by Roadbldr '59

So is Washington State, split along the Cascades into generally liberal Western Washington and conservative Eastern Washington.

Washington and Oregon both. I vaguely remember a proposal (semi-serious?) that the parts of both states east of the Cascades split off and join each other in a new state, to be called Jefferson. I've been there; culturally and ecologically, they're part of the Rocky Mountain West. You can't really tell them from Utah, Idaho, or Nevada. Or for that matter, parts of New Mexico.

West of the Cascades is an entirely different country.