Originally Posted by playwrite

...From there, my hope is PO gets added to the final bill ....

While I agree that we need a true Health Care SYSTEM, there is no need to add a public option to compete with private insurance. Just use the current health care system that is in place for Govt. workers as a model and let the private insurers work under tight Govt oversight. This approach has worked well. The real challange is to finance coverage for all those not covered by other insurance. Also, we don't really need 100's or 1000's of insurance companies. Some reasonable number( ~15-20) , chosen by competition, should be sufficient and more manageable.

Originally Posted by radind

While I agree that we need a true Health Care SYSTEM, there is no need to add a public option to compete with private insurance.

But why not include this? Doesn't having a public option make regulation a lot easier?

Originally Posted by haymarket martyr

Independent... you can count to fifty , right?

Not if the thing being counted is honest Senators.

Originally Posted by scotths

But why not include this? Doesn't having a public option make regulation a lot easier?

My first concern is to actually develop a system( using a systematic design approach). Simply adding one more option does not make a system, just adds to current ad-hoc non-system. Also, I do think that a public option added to the current set of randomly developed options would eventually drive out the private insurers. I want to retain private insurers, but in a systematic way that puts everyone in the same insurance pool. The insurers must take all comers and could NOTexclude anyone. The competition should be based on services offered and service provided.( In the Govt employee system, each employee has option to change insurance carriers annually.) The current Govt. employee system also included a number of employee organizations as insurers, in addition to private companies. The analogy for what I am proposing would be citizen based organizations , at national level. I am also not in favor of merely continuing the current non-system where the states and the private companies have most of the power. The people need the federal Govt. to set up a balanced system that so the individual has real choices.

If anyone is interested, information on the Federal Employees Health Benefits( FEHB) program is available at folowing links:

http://en.wikipedia.org/wiki/Federal...nefits_Program

"The Federal Employees Health Benefits Program (FEHBP) is a system of "managed competition" through which employee health benefits are provided to full-time permanent civilian government employees and qualified retirees of the United States Government. The FEHBP allows insurance companies and employee associations such as labor unions to develop health, dental, and allied plans to be marketed to governmental employees."


http://www.opm.gov/insure/index.aspx

"What types of health insurers qualify for participation in the FEHB Program?
We will consider applications only from comprehensive, prepaid medical plans. The FEHB Program contracts only with health benefits carriers that offer a complete line of medical services, such as doctor's office visits, hospitalization, emergency care, prescription drug coverage, and treatment of mental conditions and substance abuse. We do not have the authority to contract with companies that offer limited services, such as dental and/or vision plans, prescription drug plans, supplemental insurance and disability insurance. We can not consider applications from fee-for-service carriers."

I would like to see a national health care system that applies the above approach to every citizen in the USA.

Originally Posted by radind

While I agree that we need a true Health Care SYSTEM, there is no need to add a public option to compete with private insurance. Just use the current health care system that is in place for Govt. workers as a model and let the private insurers work under tight Govt oversight. This approach has worked well. The real challange is to finance coverage for all those not covered by other insurance. Also, we don't really need 100's or 1000's of insurance companies. Some reasonable number( ~15-20) , chosen by competition, should be sufficient and more manageable.

I think this is the French system which is considered one of the best - best outcomes at lowest price. So I believe your thinking is sound.

However, here in the US, "tight Govt oversight" was one of the primary targets of the passing 3T Ray-gun revolution - ultimately, under Bush Jr, even laws on the books were generally ignored.. Is this 4T sufficient to reverse nearly 30 years of effort at drowning govt regulation in the bathtub? I don't think so -- at least not yet.

Even after lack of such govt oversight almost took the US (if not the world) economy into the toilet last year, the steam for any real regulatory oversight seems to have dissipated in the financial sector. As such, its a little hard to see how sufficient oversight of the health insurance sector has much of a chance.

It's why the public option had to be pursued as "providing competition" - the myth, the mantra of the marketplace being all powerful and wise is very very ingrained even in the minds of those who suffer the most under its weight.

Originally Posted by radind

If anyone is interested, information on the Federal Employees Health Benefits( FEHB) program is available at folowing links:

http://en.wikipedia.org/wiki/Federal...nefits_Program

"The Federal Employees Health Benefits Program (FEHBP) is a system of "managed competition" through which employee health benefits are provided to full-time permanent civilian government employees and qualified retirees of the United States Government. The FEHBP allows insurance companies and employee associations such as labor unions to develop health, dental, and allied plans to be marketed to governmental employees."


http://www.opm.gov/insure/index.aspx

"What types of health insurers qualify for participation in the FEHB Program?
We will consider applications only from comprehensive, prepaid medical plans. The FEHB Program contracts only with health benefits carriers that offer a complete line of medical services, such as doctor's office visits, hospitalization, emergency care, prescription drug coverage, and treatment of mental conditions and substance abuse. We do not have the authority to contract with companies that offer limited services, such as dental and/or vision plans, prescription drug plans, supplemental insurance and disability insurance. We can not consider applications from fee-for-service carriers."

I would like to see a national health care system that applies the above approach to every citizen in the USA.

If our representatives were honest to us, then this system would work. I have been calling for this option on this thread for as long I could remember.

Originally Posted by radind

My first concern is to actually develop a system( using a systematic design approach). Simply adding one more option does not make a system, just adds to current ad-hoc non-system. Also, I do think that a public option added to the current set of randomly developed options would eventually drive out the private insurers. I want to retain private insurers, but in a systematic way that puts everyone in the same insurance pool.

Isn't the system you describe roughly what Obama was suggesting with his insurance exchange?

I still don't understand the concern regarding the public plan driving out all the private plans. If the public plan is required to function off of its own premiums without additional government help isn't it essentially a non-profit that just happens to be run by the government? This doesn't seem to give the plan any particular advantage over other non-profits that may be in the exchange. If the government can run a plan so much better than any other organization that all the other organizations are put of business, I would think than that the other organizations aren't even trying to be competitive!

Originally Posted by scotths

Isn't the system you describe roughly what Obama was suggesting with his insurance exchange?

I still don't understand the concern regarding the public plan driving out all the private plans. If the public plan is required to function off of its own premiums without additional government help isn't it essentially a non-profit that just happens to be run by the government? This doesn't seem to give the plan any particular advantage over other non-profits that may be in the exchange. If the government can run a plan so much better than any other organization that all the other organizations are put of business, I would think than that the other organizations aren't even trying to be competitive!

I think you hit it on the Head, Scoths. Most of the liberals on this this board want more of a single-payer (Medicare) public option than a GEHA public option. And the dissenters like myself want more of what Baucus and Obama are offering to the American people.

Originally Posted by wtrg8

If our representatives were honest to us, then this system would work. I have been calling for this option on this thread for as long I could remember.

You have to understand that the govt. employee system is a huge pool of people with sophisticated folks (i.e., govt employees) overseeing it - they can dictate to the insurers what the insurers will provide.

When you say you want that system for everyone, you are essentially saying the gov't will dictate the terms with the private insurers for everyone. Since that pool is universal the government will be essentially be in charge of ALL health insurance with private insurers being just middlemen contractors - either do what the government says or get out of the business.

If you thought the Right went nuts over the public option, you have no idea what they will do with this approach - likely, blood in the streets.

Originally Posted by playwrite

When you say you want that system for everyone, you are essentially saying the gov't will dictate the terms with the private insurers for everyone. Since that pool is universal the government will be essentially be in charge of ALL health insurance with private insurers being just middlemen contractors - either do what the government says or get out of the business.

If you thought the Right went nuts over the public option, you have no idea what they will do with this approach - likely, blood in the streets.

Yes, the right to buy crappy insurance is a critically important one!

I think the idea would be to set minimum standards and allow competition both in terms of providing that well and offering additional things.

Originally Posted by wtrg8

I think you hit it on the Head, Scoths. Most of the liberals on this this board want more of a single-payer (Medicare) public option than a GEHA public option. And the dissenters like myself want more of what Baucus and Obama are offering to the American people.

GEHA is not a public (i.e. government-managed) option. GEHA is a self-insured, not-for-profit association. It succeeds as such because its pool is made up of folks with very secure jobs (i.e. govt employees) that are paid reasonable pretty well by a company (US Gov't) that is very unlikely to not pay its majority share of the insurance cost.

GEHA would go broke if it tried to cover the folks that the insurance exchanges are aimed at - the self-employed and employees from small business, i.e., on a relative basis, small, unstable pools. These folks are going to get screwed by the insurers if there is no public option alternative within the exchange.

This is not rocket science.

Originally Posted by scotths

Yes, the right to buy crappy insurance is a critically important one!

I think the idea would be to set minimum standards and allow competition both in terms of providing that well and offering additional things.

There will be minimum benefits, but there will not be limits on what the insurers can charge for those benefits - that would be socialism. Instead, they will compete against each other. I'm sure they've already divvied it all up.

They are very happy fellows right now. So long as the PO is off the table, they will remain very happy fellows.

Again, this is not rocket science.

Originally Posted by playwrite

There will be minimum benefits, but there will not be limits on what the insurers can charge for those benefits - that would be socialism. Instead, they will compete against each other. I'm sure they've already divvied it all up.

They are very happy fellows right now. So long as the PO is off the table, they will remain very happy fellows.

Again, this is not rocket science.

So if I am reading you correctly, your choice is Medicare for all.

Originally Posted by radind

Great review of health systems in other countries and exactly the type discussion we need to foster to make progress.

Thank you, although it would be nice if the post had generated more comment.

Although not as tightly regulated the underlying approach of the Health care system for US Govt. workers has some common aspects. It is critical that this be implemented primarily by private insurers, with strong Govt. oversight.

I agree.

The major hurdle for the US is to find way to include all who are not covered by an adequate employer plan.

This is not really a hurdle (see below the divider).

The hurdle is should we do it. It's a moral question.

All countries that do things differently from what we do have addressed this moral question. It is a prerequisite to solving the problem. It is probably impossible to achieve real health care reform by without addressing this question.

In the current debate, we (so far) have not addressed this issue and so anything they do is probably doomed to failure.

Our country long ago decided that no American should starve to death simply because they could not afford to buy food. Africans do, but we do not allow that in America. And so we authorized the government to step in and prevent his from happening. And so we don't have children with distended bellies and the reddish hue from kwashiorkor. We used to, 70+ years ago, but not anymore.

So we have decided that adequate nutrition is a human right for Americans. If one cannot provide it for himself, it will be provided for them.

Similarly, we decided, long ago, than no American should be deprived of a basic education just because he cannot afford it. We have decided that basic education is a human right for Americans. If one cannot provide it for himself, it will be provided for them.

One of our former foster children (whose mom used to rent out the apartment to crackheads when she was trying to study) remarked to us that Americans are lucky, here they are given a free education, something not everyone got in her homeland (she came over on the Mariel Flotilla as a young child). Although not gifted intellectually, she studied very hard and got a Master's degree (the most highly educated of all our former foster kids) and now lives a solidly middle class lifestyle in Florida. Her eldest daughter got very good grades and snagged a scholarship for college. Her youngest son is very bright and I am sure is going to do well. Both are very well behaved. This story is an illustration of the reasoning why we Americans have decided that basic education is a human right for Americans.

In many industrialized countries, it has been decided that no citizen shall be allowed to die from treatable diseases, nor allowed to go bankrupt because of medical bills. In those countries people do not die in the prime of life from treatable illness, like more than 20,000 Americans do each year. Likewise, they do not go bankrupt because of medical bills, as hundreds of thousands of Americans do each year.

They have decided that basic medical care is a human right for their citizens.

In contrast, basic medical care is not a human right for Americans We still consider it as a commodity, like a car.

America is not the only major industrial nation that has decided the issue this way. Russia and China stand with us on this. And we share other values. Like America, China practices torture and capital punishment. Russia practiced American-style torture in the past and perhaps still does.

************************************************** ****
The Americans not covered are those too rich for Medicaid, but who fall into two categories: (1) they are too poor to afford insurance premiums against against ridiculously priced American medicine or (2) they are already sick and so cannot obtain insurance because American insurers are allowed to cherry-pick who they cover.

In Japan, France or Germany, insurers must take them, even if they are sick, and since the premiums are set by the government, they are reasonably priced. In Germany the premium is about 15% of your income, split between employer and employee, much like American social security. It's taken out of your check, so you never get the money and so don't have to come up with it out of a tight budget. If you are unemployed the government picks up employer's portion and if your are poor they pay your share. But we have Medicaid dollars that would pay this subsidy, so no new money is needed.

And then retirees also obtain their own insurance just as they did when they worked. If they worked for a big company, the employer pays a share of their 15% premium, much as big companies in American have retiree health plans. If you worked for a small company, were self-employed, the government pays the employer's share. We would get more than enough dollars for this from Medicare.

Finally there is no need for a special socialized medicine plan for veterans. Veterans should obtain insurance through their companies like everyone else. The government would simply pay their share of the 15% premium. The money for this is already allocated to the VA. This way the verteran still gets free health care, he similar can go to any hospital of clinic rather than a special government-run clinic.

And it all works because the government negotiates prices so that the costs are less than the sum of (1) the 15% premiums for non-poor, non-veteran, working-age Americans and American companies (2) current Medicaid outlays (3) current medicare outlays (4) current VA outlays

These four sources of income are more than enough to pay for a universal system with more bells and whistles than any other universal plan on the planet.

So the question is NOT finding a way to pay for it. That's easy. Lots of countries already do it. Some of these countries, Taiwan for example, have universal systems designed by American experts. The much envied French electronic health care records system, was designed by an American company. So world-class knowledge of how to do it exists right here in America.

Originally Posted by Mikebert

In contrast, basic medical care is not a human right for Americans We still consider it as a commodity, like a car.

America is not the only major industrial nation that has decided the issue this way. Russia and China stand with us on this.

I can't speak for China, but you are 100% incorrect as regards Russia. Basic medical care, free of charge, is provided throughout that country.

Originally Posted by wtrg8

So if I am reading you correctly, your choice is Medicare for all.

No, at least not for now.

I actually have an element of Edmond Burke's conservatism in my make-up - something that use to be referred to as a Yankee Republican. Typically, economically conservative while socially liberal, but more so, a willingness to progress as long as the baby doesn't get thrown out with the bath water. If it is possible to find someone more disgusted than a Liberal with "movement conservatives" (i.e., theocons, neocons and thugs) that would be me.

My preference would be the French model (No, Edmond, not that one!), described fairly well by radind and sccoths above. However, I am convinced that right now the tentacles of our passing 3T memes and myths of the-marketplace-can-do-no-wrong-and-the-government-can-do-no-right still gripe our society's carotid arteries so tight that the resulting cut-off of oxygen to our collective brain makes us barely functional any more.

Barring the radind model, I believe the next best approach is the multi-tier approach as outlined here -

http://www.fourthturning.com/forum/s...&postcount=301

and here -

http://www.fourthturning.com/forum/s...&postcount=302

that incorporates the FACT that about a 1/5 of the population is already covered by the government and another 3/5 is covered by employer-sponsored plans. Numerous provisions of the proposed approach would greatly increase the utility of this existing coverage for 80% of the population.

For the remaining 20%, we would finally get some real decent coverage. Of that approximately 60 million, a little over a 1/4 (17 million), the poorest, would be put on Medicaid and a little under a 1/4 (14 million) onto the public option -- together, half on a govt-run program or just 10% of the population added to the govt roles and most of them not currently insured. The other half would be added to the rolls of private insurers - in many cases, with govt subsidies in the form of tax credits.

Let this thing run for a decade and see how it shakes out - do costs come under control, can the insurers compete (if not, why not), does "the curve" bend down, bend up, or unaffected???

A State without the means of some change is without the means of its conservation. -- Edmund Burke

Originally Posted by Mikebert

... It's a moral question.

Bingo!

Although, if done correctly, it could be an economic competitive question as well. (You see? Even I find it necessary... no, its just now reflexive - to add the relatively minor point of its-good-economics! )

Originally Posted by Mikebert

Like America, China practices torture and capital punishment.

We stopped

Originally Posted by playwrite

We stopped

Sez hoo???

Originally Posted by radind

My first concern is to actually develop a system( using a systematic design approach). Simply adding one more option does not make a system, just adds to current ad-hoc non-system. Also, I do think that a public option added to the current set of randomly developed options would eventually drive out the private insurers. I want to retain private insurers, but in a systematic way that puts everyone in the same insurance pool. The insurers must take all comers and could NOTexclude anyone. The competition should be based on services offered and service provided.( In the Govt employee system, each employee has option to change insurance carriers annually.) The current Govt. employee system also included a number of employee organizations as insurers, in addition to private companies. The analogy for what I am proposing would be citizen based organizations , at national level. I am also not in favor of merely continuing the current non-system where the states and the private companies have most of the power. The people need the federal Govt. to set up a balanced system that so the individual has real choices.

I'm all for driving private insurance companies out of business, then again, I'm an evil socialist ( ) that wants a Single Payer system.

Originally Posted by scotths

Isn't the system you describe roughly what Obama was suggesting with his insurance exchange?

I still don't understand the concern regarding the public plan driving out all the private plans. If the public plan is required to function off of its own premiums without additional government help isn't it essentially a non-profit that just happens to be run by the government? This doesn't seem to give the plan any particular advantage over other non-profits that may be in the exchange. If the government can run a plan so much better than any other organization that all the other organizations are put of business, I would think than that the other organizations aren't even trying to be competitive!

At this point , it is not clear to me exactly what the Obama plan is. I still maintain that adding this or any other plan will not correct our current non-system. This requires major surgery, not just one more plan.
-If the exchange is approved , hopefully I will be proved wrong. I have believed for a long time that we need fundamental reform in our approach to health care.Putting everyone in the same insurance pool would be a good place to start , in my opinion.

Originally Posted by Roadbldr '59

Sez hoo???

Maybe pw is Chinese?

Originally Posted by Justin '77

I can't speak for China, but you are 100% incorrect as regards Russia. Basic medical care, free of charge, is provided throughout that country.

Very interesting. So they also have a universal system. How is it funded?

Originally Posted by playwrite

When you say you want that system for everyone, you are essentially saying the gov't will dictate the terms with the private insurers for everyone. Since that pool is universal the government will be essentially be in charge of ALL health insurance with private insurers being just middlemen contractors - either do what the government says or get out of the business.If you thought the Right went nuts over the public option, you have no idea what they will do with this approach - likely, blood in the streets.

Blue-Cross remains a major provider in the federal health care system, so they seem to mange to survive with Govt. oversight. I see no reason for any good insurance company, Union, or other citizen organization not to survive as well. As to right wing nuts, first I think that they are a very small minority and ,second--violence from any source should be promptly stopped, and offenders indicted & tried.

Originally Posted by playwrite

GEHA is not a public (i.e. government-managed) option. GEHA is a self-insured, not-for-profit association. ...
GEHA would go broke if it tried to cover the folks that the insurance exchanges are aimed at - the self-employed and employees from small business, i.e., on a relative basis, small, unstable pools. These folks are going to get screwed by the insurers if there is no public option alternative within the exchange.

This is not rocket science.

GEHA would go broke if we did not provide funding for the currently uninsured.
No insurer should be asked to provide coverage without payment. This is clearly not rocket science, it is an exercise in logic and morality. The USA should establish a health care system and find the will to fund it( I still think that total spent on US healthcare would be sufficient, if all the waste &fraud were eliminated). The public option , to me, is a red herring ; and avoids the issue of fundamental reform. Perhaps, a public option would evolve into a total system over time, and may be needed in this country to start the process. Certainly not my first choice.