Doesn't Schumer's "Middle Ground" make it very hard for a public plan to survive?

If the public plan can not get funding from the government, then how will it bootstrap itself? Where is the initial capital going to come from?

Ezra, do you really think this "Middle Ground" is anything other than a pre-determined death sentence for any forthcoming public plan?

Anyone who suspects Schumer of being non-captive of Wall Street has moved well beyond 24/7 pot smoking into the depths of meth addiction of the rotten teeth variety.

Exactly how is the Schumer plan a 'public option'? The forced separation from Medicare gives up any prospect of a unified health insurance system down the road. It must pay MORE than Medicare to providers, but can receive no public tax funds: how is that fiscally possible? And providers aren't required to accept the public option payments/patients? Come on, this is a joke, but a very cruel joke. Too clever by 90%, and too crippled to be a serious proposal.

captcha: kkkksr (again!)
[the klan keiser]

Chuck might be giving away the farm a bit. Making it a requirement to be independent of government subsidies doesn't really make it analogous to a private insurance plan. Quite the opposite. Looking at Medicare and Medicaid HMO’s as the best corollary; none of the biggest carriers only offer a Medicare or Medicaid plan, they offer lots of employer-based plans. A strong argument could be made that they supplement their Medicare/Medicaid HMO products in the same way they’re saying we can’t supplement a public option. They might not do it with straight cash; but if you look at things like technical infrastructure, physical overhead, and network recruitment and development, all the Wellpoint’s and Americhoice’s of the world are getting lots of economies of scale via their for-profit big brothers (Blues and United Healthcare, respectively).

And this, “The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.” To really be a ‘level playing field’ are we also going to say that all the future carriers of the connector plans are opt in? If United/Americhoice currently has a provider contract that is specifically written to be ‘opt out of new products’ will the legislation supersede that to truly level the playing field? I’ve read a terrifying amount of provider contracts and many are written as opt out and there is often vague, catch-all language around “new products” which insurers are going to try to interpret as inclusive of the new connector plans.

If this makes it into law, I expect the insurance companies to be the ones who compete unfairly- set up contracts with providers that have sweeter deals for partners who refuse the public option or give it worse rates. Insurance companies will do anything to undermine their biggest threat as early as possible.

Conceptually, I think the idea of "profit" is sacred even if insurance profits aren't necessarily.

The insurance industry should be worried. Hundreds of thousands, maybe millions, of people have lost their jobs and their health insurance with it.

Soon, they will start to demand help with medical care issues and pols will have to provide that help.

The insurance industry can get on board or get rolled. A public plan is coming.

This is, it should be said, the same public plan offered by the Center for American Progress and the New America Foundation. The bit about paying more than Medicare just means that it can't use the rates Medicare sets through legislative fiat (which are generally considered the very lowest possible, save for some Medicaid deals). This is a weaker public plan, of course. But if you can't get Medicare-for-All, you probably also can't get Medicare-for-Most.

You’re absolutely right – the health insurance industry doesn’t want a public plan because they don’t want to compete against it. But it’s not because they’re afraid of competing on a level playing field. It’s because they are absolutely convinced that it will eventually set prices even if it starts out on level playing field (look at recent comments from CEOs of WellPoint and Humana). What’s to stop a Dem. Congress from changing the rules once the public plan is established? Nothing. It’s much easier to kill the public plan at the start.

And trust me, health insurers are doing the heavy lifting but lots of other industries are opposed to it and will become more vocal if it looks like a public plan will pass. Let’s start with pharma, medical device companies, bio-tech, and pharmacy benefit managers – just to name a few. A public plan could eventually set prices and reduce the profits of each of those industries.

This is a much bigger issue for the entire private sector health care industry than most people realize.

Maybe the initial proposal should have been Medicare for All, that way the watered down compromise could have been the public option plan.

Oh well, I wonder what else the Democrats will give away as they negotiate against themselves. Too bad they don't control Congress.

This is, it should be said, the same public plan offered by the Center for American Progress and the New America Foundation.

True, but no one is talking about network design yet. I’d argue that there are several industries waiting to hear the specifics (and actively trying to influence the specifics) before sharpening their pitchforks. The single most important factor to consumers in enrollment - more important than cost of the plan – is the answer to this question, “Is my doctor in the network?” Insurers know this and know that any plan that’s tied to the Medicare network will kill them. However, the insurers intend to do exactly the same thing with their existing networks.

As much as I would prefer single payor, and not getting that,as much as I would prefer a public option that is an extension of Medicare, I think that we need to recognize the enormity of the problem, both in terms of dollars and the opposition (Congress, insurers, pharma, etc).

I don't think we should ignore the good while pounding on the table for the perfect. Schumer may get our foot in the door and we can expand from there.

Can Sen. Schumer KILL the public plan? Yes, by doing these devil-details.

¶The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

¶The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

¶To prevent the government from serving as both "player and umpire," the officials who manage a public plan should be different from those who regulate the insurance market.

Gheesh, WTF is Schumer thinking? Who does he work for, anyway??

Oh, I forgot, as Schumer's congressional colleague stated so clearly the other day, members of Congress all work for the Banks. And the Banks loan funds to the health insurance companies and Drug Co's.

And all the CEO's of the Banks, and Health Insurance Cos and the Drug Cos sit on each other's boards so are positioned to do each others' bidding.

Which leads to saying "ditto" to this:

"Maybe the initial proposal should have been Medicare for All, that way the watered down compromise could have been the public option plan.

Oh well, I wonder what else the Democrats will give away as they negotiate against themselves. Too bad they don't control Congress."

Gheesh, WTF is Schumer thinking? Who does he work for, anyway??

For us. Schumer is 100% correct -- from a progressive standpoint -- to take this position.

While I would prefer a bonafide, Medicare-style public option from the getgo, that doesn't look particularly feasible, politically. Far better to get some kind of public option enacted -- even if it's incredibly watered down -- than to enact a law requiring people to buy private insurance. Once a public option gets its foot in the door, it will be hard to kill. Eventually, the financial realities (and inanities) of private health insurance will create enormous pressure for a more robust government. The acid test of whether I'm correct in my assessment will be the reaction of the health insurance industry. My guess is they'll vigorously oppose even this watered down, Schumer-care, because they know what its adoption implies for their industry in another five or ten years' time.

Too bad they don't control Congress.

One assumes you're being facetious, but the fact is the Democrats sadly do not control Congress. It's true they possess a technical majority in both houses. It's also true that in the Senate, enough of their members are sufficiently sympathetic to Republican concerns as to render their majority incapable of passing much of the progressive agenda, even given the existence of the reconciliation option.

Can everyone please stop the pathetic whine, "Democrats do not control congress?". Please?

The middle road corporate Dems don't want anything different from the Repugs.

We don't need Schumer to help save single payer. Single payer will be the ultimate result, regardless of how much money Obama will waste in the process.

Ed Schultz and others are now insisting on single payer on television.

We don't need Schumer for anything.

The victory will be all that much more satisfying because we will force the Dems to accept. They really have no excuse to blame Republicans anymore, and they insulted us all by "taking it off the table" at the beginning.

Does anyone really think scum like Dirty Harry are honest Democrats and not Republican at heart? Get real.

A couple of thoughts:

-- I personally support a system where a "public option" follows market rules and regulations. My concern would be eventual consolidation into one single-payer. Democrats are really speaking out of both sides of their mouth: "Ideally, I'd want single-payer, but that's not politically feasible" and also "Competition is good, what's wrong with some competition from a public option?" Its very effective politically, but its intellectually dishonest. I'm do believe a single-payer leads to less innovation of ideas on cost control/rationing/quality control, etc.-- but would be fine if that competition was made up of competing government-backed options. So I'm no industry apologist here.

-- Ezra, you're too comfortable with the continual concessions by the Democrats. At some point, the watered-down version is a failure-- it'd be nice to see you actually prospectively say what principles are core to your necessary reform package, at which point, you would deem it a failure. Otherwise, the "apologist" criticism is fair to a point. Stick your neck out a little and make a stand.

-- Why is doesn't it make sense to says its almost impossible to have a level playing field? The devil is in the details, and the NYTimes article asked a number of reasonable question on what would be required to create a level playing field. Its fair to ask if regulatory scrutiny can be equal between public and private plans, when as administration is openly supportive of a public plan. Similarly, would they let a public option go insolvent? Hard to see that being the case. And if not, its not a level playing field. I'm not what why you think that Ignani point doesn't make sense. Does to me.

Ed Schultz and others are now insisting on single payer on television.

And this is a very good thing. The private insurers need to be reminded that there is an entirely coherent position that is very easy for the public to understand, channels widespread resentment at their operations, and entails putting them out of business.

"The public plan he has proposed will not be subsidized by the government or partnered with Medicare. It will not be supported by tax revenue"

You mean the public plan will pay federal and state income taxes on its profit, and be required to earn profit? I doubt that, myself.

Swine flu (A-H1N1) and Healthcare In America

Well my fellow Americans, and people of the World. That was yet another very close potential catastrophe. Especially for those of us that live in America with our busted, greed driven, private for profit healthcare system. What ever you do World. Don’t copy our current healthcare system.

If that virus (A-H1N1) had emerged just a few months earlier our busted healthcare system in America would have collapsed. Just like our economy almost did. And hundreds of thousands more Americans, if not millions would have needlessly lost their lives. As hospital ER’s became choked with the sick, and dying.

All on top of the hundreds of thousands of Americans who needlessly lose their lives in America each year from a rush to profit by the private for profit healthcare industry. Rich, middle class, and poor a like. Insured, and uninsured. Men Women, Children, and Babies.

This was yet another big WAKE-UP! call for America, and for our Government. It’s time for Congress to end the debate. And stop dancing around the issues of how they can continue to try and justify protecting the private for profit healthcare industry, and the private for profit healthcare insurance industry. These industries are killing hundreds of thousands of Americans every year in America, and endangering our National security.

“the health-care system is, first and foremost, for the American people—not the companies that profit from it.” (Tom Daschle | NEWSWEEK)

IT’S OVER! The Private for profit healthcare experiment in America is dead. It FAILED! And it was a DISASTER!

"NOT FOR PROFIT, TAX PAYER SUPPORTED, SINGLE PAYER, AUTOMATIC, FREE UNIVERSAL HEALTHCARE FOR ALL. Is the ONLY! way to go.

Essentially HR676 (enhanced, and expanded medicare for all). Just like every other CIVILIZED! country in the developed World has. There is no other way to truly fix or reform our current disastrous healthcare delivery system. NONE!

Congress, fix our healthcare crisis while you still have time.

President Obama, VP Biden, the Obama administration and the rest of his advisors, along with Speaker Pelosi and Harry Reid are doing an excellent job of protecting you. And also an excellent job of representing you and the best interest of the World. But it’s time for the rest of Congress to get on board.

To those of you who keep standing up and fighting for single-payer universal healthcare for all. YOU! are Americas true HEROES! And I am proud of you. :-) Don’t let up.

I will have more to say about this VERY! unusual virus (A-H1N1), and flu in general, later. There are some things you really need to know and think about... All of you.

Till then, God Bless And Keep You All

Jack Smith — Working Class

The comments here are relatively sane compared to so many sites where single payer ideologues insist that only they are right. The scene in the Finance Cte today made them look crazy, but in a way it also made the rest of us look a lot more pragmatic! Never hurts to have someone to your left shouting and making a scene.

In the midst of all of this, there is actually a very effective competition between public and private plans, here in California where Medi-Cal (our Medicaid plan) has a number of different "experiments" going on in different counties. In some counties there is a "public" plan that must compete for beneficiaries with a private plan (mainly Blue Cross). The public plan has not driven out the private plans and vice versa. They co-exist, giving Medi-Cal beneficiaries a real choice. They play by the same rules and both are thriving. Why aren't we talking about this more?

Once a public option gets its foot in the door, it will be hard to kill.

This is such a tired and misleading trope. The answer is exactly what they are doing: you make that foot broken and withered, slam the door on it a few times, and then don't bother to kill it - just let it lie there. You enact some pointless lie of a program, designed to fail, and call it a "public plan". You delay all action for a few years because "we've got to move on with the rest of our agenda" and "we have to let the process work itself out". Then you can point to a program limping along on inadequate funding, having had all the people who need health care dumped on it by the happily profitable private insurance companies, and say, "Well, hippie, it doesn't seem like your vaunted public plan is doing all that well, does it?" And nobody will ever talk to anyone with a different opinion, because they're not "reasonable".

And Ezra will be there saying, Well, if we just compromise, and accept political reality, maybe we'll get something good by the end of the century. You'll fit in well at the Post.