Monday, August 17, 2009

Being President Barack Obama X

There has been a lot of talk over the weekend about there not being a public option in the health care reform bill. If President Obama does not deliver on a public option for We the People when it is clear that most Americans want an option with the majority of Democrats in the House and Senate, will he not render himself ineffectual, incapable of leading effectively thereafter? After all, President Obama promised that he would not sign a bill that did not include a public option. According to Kathleen Sebelius, the Health and Human Services Secretary, a public option is "not the essential element." If this is President Obama's new position, I'm not feeling terribly good about his leadership today.


Dave Wheeler said...


If the purpose of "health insurance reform" is competition for insurance companies and coverage for all then I don't understand all the flap over why the "public option" has to be a government run program rather than non-profit co-operatives. The only folks I have really seen get tweaked over this possibility are the some of the progressives who see the government public option as the route to a single payer system...Maxine Waters and Howard Dean for example. Of course, I'm still trying to get past the obvious conflict of my being told I can keep my current coverage out of one side of their mouth while the other side is telling me the current system isn't sustainable and has to be reformed. Any "public option" that makes it profitable for a business to pay a penalty rather to continue to provide the "private option" is gonna eliminate the private insurer rather than create competition. What kind of choice does that leave the consumer? Maybe some day, if there ever is a health plan to dicuss...these questions may get answered. I think he's showing a bit of leadership perhaps on this issue, particularly as devisive as this option is. Time will tell...

Judith Ellis said...

Dave - I don't know what you mean by "non-profit co-operatives" but there are plenty of non-profit hospitals and insurance carriers out there and they act as for-profit agencies with regards to their availability of those who work just as hard in for-profit entities that do not offer health care, often working three or four jobs. The reality as I see it with out a public option there is no reform. Why would you think that a "non-profit co-operative" would be any different from a for-profit entity or the non-profit ones who seek ways not to pay for surgeries after premiums have been paid? I’ve spoken to insurance claim reps; they get paid to refuse claims. It's all about NOT performing after collecting premiums.

The government has competition in various areas such as in mail delivery services. Why not here? The insurance company is a 600 billion dollar yearly industry and the whole idea that the government cannot offer a plan for those, the least of these, is frankly disgusting! I think you are also a bit misinformed if you think that the only people who wish for an option are Waters and Dean, die-hard liberals. I would not consider Arianna Huffington such a one, nor would I consider myself a die-hard liberal. Although, I think I’m becoming more and more of something. What? I’m not altogether sure yet.

The reality seems to be that there is a very large percentage of Americans that want a public option. Krugman, by the way, wrote an excellent article on the issue over the weekend. It is not by accident that the same arguments that we hear now were made when Medicaid was on the table. The sad thing is that reform is needed not only for those who are without insurance, but to fix our system. Many of those in Congress are paid and bought by the insurance industry; Blue Dogs and perhaps some other "dogs" seem to only care about themselves. Maybe we should make them pay for their own insurance. Yeah, let’s strip them of theirs.

By the way, the reason the public option is divisive is because it threatens the billions that the insurance companies receive. Medicaid was divisive. The Veterans Administration was divisive. Anything that threatens to take away the lock-down insurance strong hold is divisive. Anything that threatens to cut into a kind of monopoly of such is divisive. Lobbyists seem to be running Washington--not the People.

Here is Krugman on the matter:

"Switzerland offers the clearest example: Everyone is required to buy insurance, insurers can't discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies.

"In this country, the Massachusetts health reform more or less follows the Swiss model; costs are running higher than expected, but the reform has greatly reduced the number of uninsured. And the most common form of health insurance in America, employment-based coverage, actually has some "Swiss" aspects: To avoid making benefits taxable, employers have to follow rules that effectively rule out discrimination based on medical history and subsidize care for lower-wage workers.

"So where does Obamacare fit into all this? Basically, it's a plan to Swissify America, using regulation and subsidies to ensure universal coverage.

"If we were starting from scratch we probably wouldn't have chosen this route. True "socialized medicine" would undoubtedly cost less, and a straightforward extension of Medicare-type coverage to all Americans would probably be cheaper than a Swiss-style system. That's why I and others believe that a true public option competing with private insurers is extremely important. Otherwise, rising costs could all too easily undermine the whole effort."

zorro said...

You left this piece out from Krugman's article.

"But a Swiss-style system of universal coverage would be a vast improvement on what we have now. And we already know that such systems work. "

Liberals tend to go overboard. The screaming about the public option (the all or none crowd) from my point of view are doing what liberals always do that does nothing but make the country more reactionary.
It is why Gore lost to Bush (Nader made an all or none stand and took enough votes away from Gore to win Florida).
Nader did it for ego and today people like Ed Shultz and others are playing the same ego game.

Dave Wheeler said...


The use of "progressive" to describe Ms. Waters and Dr. Dean was simply using the label they have applied to of the government option is ones choice, regardless of political persuasion.

Not sure the folks who are out in force voicing their opinions are all proponents of insurance company profitability. I think many see the "public option" for what it is and it's the government running health care that is devisive. They may not be economists but the see the obvious "disconnect" of paying for one gigantic government run program by eliminating the wastes and inefficiencies in other gigantic government run programs (Medicare/Medicaid). Controlling the reimbursements for services provided is the vehicle the government has to control costs and why co-operatives or any reform that doesn't have the government option available isn't likely to pass. You don't get to single payer and the revenues going to the governemnt unless you eliminate private coverage. Maybe single payer is the answer...maybe not.

As for Mr. Krugman...his casual "costs are running higher than expected" statement is an understatement indeed...From a WSJ Blog post "“Health-care reform is not sustainable financially and it’s also not sustainable politically if the best we can do is more taxpayer money and shifting costs to consumers,” Nancy Turnbull, an associate dean at the Harvard School of Public Health and member of a state board that oversees the program, told the Globe. “We have to find other ways [to raise money and control costs] and we have to find them very quickly.” Of course with the government option controlling reimbursements...maybe that is why folks are concerned about rationing care.

Real change and reform? Nah...that will happen when the policy is the priority, not the politics. The goals of reform again are alledgedly coverage, cost containment, and competition correct? This means the governement option is the only option?

Judith Ellis said...

Zorro - I want to see a bill that allows those who can't afford private health care insurance to get it and those who offer it not be able to use schemes to forbid payment to those who have been paying their premiums when they get sick; many insurance companies do this regularly. A public option from what I've read so far does this, not to mention if there was a such an option it might keep them more honest and competitive. I also wonder about a kind of collusion among these providers.

Judith Ellis said...

"Not sure the folks who are out in force voicing their opinions are all proponents of insurance company profitability."

Dave - You may be right on this although many ARE employeed or gathered by conservative lobbyists who count of idealogues who vote against their interest time and time again. Many of these town hall people are very much like those who disgraced Senator McCain at his campaign stops, call the President Hitler, carry semi-automatics at presidential events, and yell "Heil Hitler" at a 50ish year-old Israeli man whose parents may have escaped Nazi Germany.

It is absolutely amazing that we seek to as Arianna said "drown government in a bath tube" but yet it is government that bails out the likes of big business capitalist repeatedly. It is absolutely astonishing that ethics in an industry such as health care means so very little. It is absolutely disgusting that someone who works three jobs or small businesses cannot buy health care insurance or offer it to their workers because it's too expensive. Private insurance does not appear to be for the people. They appear to be for themselves. OK. This is the capitalist way. But let's make it so that those who can't afford health care insurance gets it. The public option as I have said seems like the best way.

"“Health-care reform is not sustainable financially and it’s also not sustainable politically if the best we can do is more taxpayer money and shifting costs to consumers,” Nancy Turnbull, an associate dean at the Harvard School of Public Health and member of a state board that oversees the program, told the Globe. “We have to find other ways [to raise money and control costs] and we have to find them very quickly.”

This statement is not wholly disagreeable. But from what you have extracted here, the good professor has not given ways of how this might be done. Or, did she? What is for certain is that there is a lot of fraud and abuse in many government areas and a lot of this is not in the government itself but loop holes "provided" for private industry.