Obama’s solution is to pay the enemy
President Obama, with Vice President Biden and Speaker Pelosi behind him, delivers a joint address to Congress on September 9 (Alex Wong/Getty)
During his speech before a joint session of Congress, President Obama called for the creation of insurance exchanges, a system designed to allow consumers to see varying prices and programs so they can comparison shop. Obama only mentioned the P-word once, and even then the public option name drop was immediately followed by the caveats “We should remain open to other ideas that accomplish our ultimate goal,” and the public option is only a “means to an end.” Read: It’s a nice idea, but drop it.
Elsewhere, Obama recycled the usual reasons for why single-payer healthcare, the Progressives’ other favored solution, just isn’t possible right now (at the mere mention of single-payer sporadic cheers broke out in the audience.) “I believe it makes more sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch,” said the president. This dismisses Marcia Angell’s idea of a gradual expansion of Medicare, a slow transition that wouldn’t have violently jolted our beloved system of privatized healthcare.
But nevermind. Back to the insurance exchange idea. Obama means citizens will be required by law to purchase their coverage from private insurers. Similarly, Max Baucus’s disastrous recent proposal calls for mandates that will literally force individuals and families to purchase insurance from the enemy — and one of the great culprits of the entire reform debate — Big Insurers. Without a serious public option (and not the “I’m humoring them, have they shut up yet?” approach Obama seems to be suggesting,) the insurance industry has a captive market, the American people, who will be held hostage in a for-profit health insurance scheme.
Between Obama’s peddling of exchanges and Baucus’s mandate pimping, Americans are faced with the nightmarish bastard of corporate whoring and endless concessions: no public option, possible mandates, and healthcare exchanges. Seriously, if you had asked me at the start of this process what my worst case scenario would be — short of a meteor slamming into the Earth — this is it.
Exchanges are like a watered down version of the original watered down compromise of co-ops. And let’s remember that the public option was supposedly a compromise derived from Progressive’s true desire, universal healthcare.
Under Obama’s proposal, insurers may not be able to deny double mastectomy procedures anymore, but without a public option, breast cancer victims will continue to pay skyrocketing premiums, which is also no treat when cancer is ravaging one’s body. Once again, Americans are being asked to let the free market solve all their problems, but without some heavy regulation, it’s unclear how an insurance exchange will successfully control costs.
So going into final negotiations for healthcare reform, the Progressives are being asked to enthusiastically support a watered down version (exchanges) of a watered down version (co-ops) of a watered down version (public option) with a little unlubricated sodomy on the side (mandates.) By the way, the second Progressives act less than hysterically positive about Obama’s speech, we’ll be called everything from stupid idealists to naive, unserious, political amateurs.
Obama said all the right things about death panels being a lie, and private insurers doing very bad things, but then he sacrificed his credibility by calling the public option a “means to an end.” What end? I kind of thought insuring every American was the “end,” and the only way to do that is with the public option. If private insurers are permitted to exploit sick people, then whatever “public option” ultimately emerges in the healthcare bill will be too small and superficial to help the majority of uninsured and underinsured Americans.
Laughter broke out when Obama conceded than many details still need to be ironed out. Yeah, a biggie will be how these insurance exchanges will control costs and seriously compete with private insurers. Otherwise, Congress is working toward legally requiring citizens to purchase healthcare on the private market with all its skyrocketing costs and shady practices.
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I put this in the “open thread,” Allison – but I’ll repeat it here for you:
The President – “But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear – it would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.”
What is a public option worth if the vast majority of the public can’t opt for it?
It’s a good question, Mark. The only way a public option could seriously compete with private insurers is if it was big and the private insurers were heavily regulated. Otherwise, this version of a “public option” feels very much like the Democrats humoring Progressives.
In response to another comment. See in context »“…this version of a “public option” feels very much like the Democrats humoring Progressives.”
And I’m not laughing. I just hope the progressives in Congress keep applying the pressure.
In response to another comment. See in context »[...] wind, and see the growing dissatisfaction with Obama’s preemptive Health Care Surrender (and here as well). The Liberal base is going to be very, very disappointed when Team Obama shows their [...]
Allison- I’m going to be blunt and you’re going to be angry with me (although you already are pretty angry so maybe its a good time.) You really, truly need to understand health care policy a whole lot better.
The fundamental concept of the public option was to fit it into a public exchange as another option for people to choose.. In fact, the public exchange is at the very heart of every single bill that has come out of committee including a public option. Federal employees- from senator on down – have what is probably the best insurance in the nation — and they buy it on a public exchange. Indeed, that is where the idea came from.
I think we all get that you feel that it has to be a public option or the world should come to an end. I’ll say it again – I like the public insurance option approach. I swear to God I do. But what Obama said is absolutely right – the point has always been about curbing health insurance abuses that harm people and overcharge them while providing coverage to those who do not have it.
Your belief in a public system or nothing shows a complete lack of understanding of the pluses and minuses of health care systems throughout the world. There are great pluses in single-payer systems and some significant minuses. Just like there are pluses and minuses in our system. For my money, the best system is Australia’s which provides everyone with government health care but also provides serious government incentives to those on the public plan to move to a private plan. In fact, the Australian government owns the largest private insurance company in the nation! At the moment, their system is working better than just about anyone else’s.
This death match over the public option is doing as much to distract from the real objective as death panels were designed to do. While you are speaking of the “enemy”, I’m focusing on how to help real, live people who need health care. That’s what its about – not enemies. This so reminds me of the hatred stirred up by Bush’s faith based initiative program. While the progressives sat around the table at a nice restaurant sipping good wine and bitching about how wrong the idea was, there were people out on the street who would have gladly taken a sandwich from anyone who would give it to them -even if it was a church! Sadly, Bush was being cynical and never intended to use that office to help people who needed help. It was all a political bunch of crap. But don’t you think we should give some thought to the actual people who are in need rather than arguing about the enemy? I’ve asked you a bunch of times what you would do about the problem if we are not going to get the public option. You haven’t answered me yet except to imply that if there is no public option what’s the point of bothering? Well, there are lots of people out there in a lot of trouble who really cannot live with that solution. They need us to keep bothering and they need us to not be satisfied that we’ve lived up to our progressive ideals and can sleep fine at night because we stayed true to the end. They will still not be getting health care, they will still be going broke trying to pay for their health disasters and they will still be dying. There is, more than likely, not going to be a public option. You can keep howling at the moon or you can put your considerable brain power to work finding other ways to skin the cat. But if you simply say “my way or the highway”, I really can’t see a difference between you and the Republicans.
Rick – I think we can have a disagreement without being condescending or taking cheap shots at each other. I get that we disagree fundamentally on Obama (and the Democrats’) approach to reform — but really — let’s not be childish.
You can’t seriously be proposing that there’s hasn’t been substantial mission creep during the healthcare reform debate. I think the emergence of triggers is a pretty good indication that the public option has been consistently watered down.
The insurance companies are very much the enemy in this scenario, Rick. Obama even listed heartbreaking example after heartbreaking example of their cruel practices to illustrate the need for reform. No one is seriously defending the system as it stands, and everyone agrees there needs to be change. Accepting corporate donations from the entities responsible for the broken system, and inviting them to “fix” the damage, is pretty insane, and it’s a guarantee of the continuation of a rotting system.
A majority of the American people want a public option, so this isn’t a matter of my “way or the highway.” This is what the people want, and in a democracy, I was under the impression that such a majority should be respected. My posts seem to really upset you, so I would suggest in the future you not read them.
A word of advice: I’d figure out a different way to approach a debate. Being rude and dismissive of people that disagree with you (and there are plenty) will almost always get you ignored. Let me be clear: I’m always, always up for a civil debate, but name-calling is boring and beneath both of us (I think.)
In response to another comment. See in context »Actually, it wasn’t my intention to be condescending so, to the extent that it came across that way, I do apologize. I was being serious (not snarky) when I pointed out that I think it would be a good idea if you spent some time learning health care policy rather than just reacting. If I am wrong in this assessment, again, I apologize.
In response to another comment. See in context »However, I can’t help but notice that I just can’t seem to get an answer to the question of what do we do if we aren’t going to get a public option. I think I’ve asked about five times and don’t understand why you chose not to discuss this. Setting aside the tone of my comment, isn’t this what is actually important?
Rick – You really have me chuckling over here. I’ll have to take your word that you meant none of your comments in a condescending manner. I haven’t invented any of the facts in my articles out of thin air, and I do always bow to the experts when it comes to hard data, but there are many experts (smarter than both of us) that believe a public option is the best thing for America, and that the current reform debate doesn’t do enough to enforce such a plan.
I feel like this may be the third or fourth time I’ve answered this question from you, Rick. I do hope you get the response this time. (You seem to bring it up in every response you leave on my blog.) I think the public option is critical to reform, but the Democrats miscalculated negotiations this time around by immediately sacrificing universal healthcare and beginning compromise from the position of the public option. Without a strong public option in this bill, I would rather Progressives vote it down, wait a year, regroup, and approach negotiations anew from a universal healthcare stance. That way, even the compromise is a strong public option rather than the watered down mess we’re getting this time around.
Once again, we disagree, and I know you have very specific ideologies that you don’t like people challenging, but the internet is chockfull of dissent, so let’s embrace it.
In response to another comment. See in context »Well, the experts you refer to may be smarter than you but I don’t necessarily think they are smarter than me.
OK. I have your answer. Unfortunately, next year all of Congress must run for re-election so there is not a chance in hell this can be brought up again next year.
So, the next time someone is in my office freaking out because they have cancer and their insurance company is denying their ability to have a CT scan or the chemo regimen their doctor has recommended (that is on the schedule for tomorrow), or when someone else can’t get coverage because of a pre-existing condition and is freaking out because there is a long history of heart disease in that person’s family (both situations that would be remedied if the vote were taken today), I’ll just tell them that they should give Allison a call because she thinks it’s better to do nothing for a year or two because she didn’t get what she wanted. You good with that??
In response to another comment. See in context »The reason we need a public option, even those of us who are pretty die-hard for Medicare-for-all/single-payer realize this, is because we need something to bend costs down. And how do you stop profit-greedy, bloated insurers from constantly jacking up rates? You force them to compete with a popular not-for-profit alternative.
That’s why it’s make or break. Throwing billions at the insurers is not a good idea, it’ll just sour the country’s feelings on any kind of universal care.
In response to another comment. See in context »Sorry…I forgot something.
“and I know you have very specific ideologies that you don’t like people challenging, but the internet is chockfull of dissent, so let’s embrace it.”
When it comes to health care, the only ideology I have is that I don’t want to see one more person suffer than I’ve already seen. And I see them every day, up close and personal. I know that when a person is seriously ill, or their child is seriously ill, the last thing they give a crap about is liberal vs. conservative…republican vs. democrat. All they want is to be made well. The truth is I don’t much care for ideology because it gets in the way of doing things for people that need to be done while allowing everyone to sleep at night safe in their “rightness” while real people are suffering. To me, anyone on either side of the political fence who is willing to stake other people’s lives and health on the line for that individual’s “principals” is equally guilty. And while it may be giving you a chuckle, this stuff is pretty real to me – not just abstract political dinner talk. I promise you that there is absolutely nothing funny about it.
And, not for nothing, now who’se being condescending?
I was chuckling at your repeated instance that you’re not being rude when you’ve made several condescending comments about my intelligence during what I thought was a debate about Obama’s healthcare speech. Maybe your remarks are coming across far more cutting than you intended, but I assure you, they seem extremely rude on my end. I wasn’t chuckling about the issue of healthcare reform, which I know is a deeply serious matter, and one I take very seriously.
I take it so seriously, in fact, that it really angers me to see the Democrats water reform down so badly. If I didn’t care, I would probably be a happier person that goes with the flow, and claps when Obama delivers pretty speeches. Believe me, I have been one of those patients suffering because I didn’t have health care coverage, and I have many family members and friends who have faced horrible decisions because they were either uninsured or underinsured, so I’m not some sniveling elite shooting the breeze over cocktails. This stuff is real to me, too.
In response to another comment. See in context »First of all, whatever system we put in now will likely be in place for decades. So while I’m sympathetic to your hypothetical freaking out person in your office, I’m a little more concerned about the long term. The urgency right now is on the side of the health insurance companies who are drooling over 50 million forced subscribers.
Second, equating Allison with Republicans merely reveals how shallow your thinking is.
In response to another comment. See in context »If I may, I really do have a question.
“In fact, the Australian government owns the largest private insurance company in the nation!” I don’t understand this, Rick. If the government owns the company, what makes it private as opposed to public? I’m sure I’m revealing my own ignorance but hey, that’s how one learns. No?
Also, I’d like you to address two points for me, if you will.
The first is the question asked by Anthony Weiner all the time – What do the insurance companies do for their cut of the money? What of value do they bring to the healthcare system and what do they do to improve our health?
The second is regarding the current plan, which I know is hard since we don’t have a final version. How do we stop the insurance companies from plowing through every little loophole they can find in whatever reform gets passed? Since they’re going to have even more profits, with the millions of new customers coming their way, and more freedom should the Court grant corporations even greater access to the political process, how do we stop them from tearing reform to shreds once it’s passed?
My own opinion is that now is maybe the last chance we have for real reform and we’d better go for broke. If we can get at least a STRONG PUBLIC option, that EVERYONE can choose if they wish, there may be enough people who join and are happy with it that the politicians won’t dare touch it no matter what the big money says. Much like they won’t really mess with medicare for fear of being strung up!
Hey Mark – I know you want Rick to answer the Australia question since he brought that up, but I wanted to interject on one point. I was just on a radio show where a caller asked if she should still be hounding her representatives for that strong public option you were talking about, and I said ABSOLUTELY. As you already pointed out, there’s not a final bill, so every second matters. Call, write letters, make your voice heard.
In response to another comment. See in context »AMEN!
In response to another comment. See in context »To be fair, Allison, I don’t think Rick is bieng rude, especially with the last part you quoted which he did put a
at the end of.
It seemed a cutesy way to end an otherwise pretty condescending remark. And when it follows a post in which the thesis is “You don’t know what you’re talking about,” you can see why I reached the conclusion that this was a continuation of a less than healthy debate.
<– Genuine smiley!
Anyway — Continue healthcare discussion! I don't want this to hijack the thread.
In response to another comment. See in context »Mark- the private company owned by the Australian government operates as a for-profit company. The only difference is that the stock of the company is owned by the government rather than private- or public-investors. Profits are put back into the company. It’s an interesting system. The government subsidizes people to switch to the private program (all private programs-not just the one owned by the government.) They make it very attractive so that the public wants to go to the private system. And it seems to work out reasonably well. Not to say Australia doesn’t have its problems – like every health care system in the world, they too are struggling with out of control prices.
As for you other questions, I rarely find myself in the position of defending the business of private health insurance in this country. Indeed, I’m not their favorite person by a long shot. However, to pretend that our system has not grown up based primarily on private enterprise (after a very short stint where the insurance companies were non-profits) would be to just kid ourselves. I’m not sure it was the right decision when it comes to something as important as health, but that ship sailed a long time ago.
As a result, our system grew on the premise that by buying health insurance we were covering our bet that we might get sick. If we don’t get sick, then we wasted our money but that’s no different than home insurance, car insurance, etc. As a result, the payment system in health care became dependent upon the pool of money formed by everyone covering the change they might get ill. The insurance companies collected the money and invested it. In return for our payments, their job is to promise (and honor the promise) that if we do get sick, they will pay off just as a life insurance policy must pay off when we die.
The system works well – until it gets corrupted. When insurance companies try to maintain profits by not paying off when they should, they are breaking the promise and not honoring the bet. When they cherry pick who they let in and who they won’t, they go from being a public service to being a gambling casino where the odds are fixed in favor of the house. When they raise premium rates by a higher percentage than costs of medical care plus inflation, they are gouging. This is what has gone wrong. Thus, if you make it illegal for them to engage in this behavior, theoretically, you solve the problem and all is well.
Now, a you point out, they begin looking for the loopholes to avoid the laws. They will do this – the difference is that you now have a Department of Justice – plus private attorneys everywhere- battling them to keep them in line with the law. Not perfect but way better than in it is now.
You have to remember that, public or private, the system runs on insurance. The public option is a public INSURANCE option. Medicare and Medicaid are insurance programs. We buy these insurance policies through the deductions taken out of our paycheck. It may not feel like insurance, but that is exactly what Medicare and Medcaid are. So, we aren’t likely to get rid of insurance as the means of providing health care in the forseeable future. But, hopefully, we can force the privates to play the game according to the new laws intended to regulate their behavior.
My God, this Rick guy is one stupid asshole! No offense of course.
[...] source [...]
Hope you won’t mind if I interrupt the conversation to add my two cents. I agree, Allison, that “reform” without a public option will be useless. Less than useless.
Here in Texas, our electric companies are deregulated so they can “compete” for our business. We have an online exchange, where we get the wonderful privilege of shopping for rates. Would you like a high rate, a higher rate, or an extremely high rate? They’re all there. Oh, you wanted a LOW rate? Well forget it. You’re out of luck.
So now, here we go with a health care exchange. Oh goody. I HAVE to buy a policy. I have lots of high-priced choices. And the insurance companies rake in the bucks. What a deal.
Sirota:
OBAMALOGIC FAIL:
How do you create pressure on private insurers when those they cover are denied the opportunity to choose a public plan? Obama’s version of a public option doesn’t create competition within the insurance market; it creates a parallel market whose customer base doesn’t overlap at all with that of the private insurers. Even Ezra Klein recognizes this:
“whether reform passes or fails, we’re almost certainly going to need to revisit this issue again in 5-10 years in a pretty big way.”
And for reasons Rick points out, that opportunity may not come.
The public/private university analogy is completely off: The weak public option Obama is proposing is more akin to saying public universities can only accept people who have been rejected by private universities.
But even if it were an apt analogy, should he really have pointed to higher education as an ideal of successful cost-containment? College tuition costs are even more out of control than health care costs!!!!:
more here
At the risk of pissing most of you off (there seems to be a general consensus amongst the author and posters that a public option is of prime importance), I hope you will entertain my question.
I make no pretense of being a health care/health insurance expert. It seems that there are two schools of thought on health care. For the sake of brevity, I’ll refer to them as the progressive view (health care is a fundamental human right), and the libertarian view (it is up to the individual to ensure their own needs are taken care of).
My questions are these:
1. By your own estimates, what portion of the country falls into the progressive/heath care is a right camp?
2. If 80% of the country is generally happy with their health care, is a public option morally acceptable to foist upon them, as well as tax them to pay for the health care of others. I realize there’s a Baskin-Robins number of flavors of how this could be implemented, but I am talking about a 30,000′ foot view of this topic.
Again, my questions are not meant to piss anyone off. I am just trying to understand a different point of view. Thanks in advance.
Hm, is this another comment that only seems rude, but isn’t really rude, Rick?
Yes, Rick. As we all know, I hate cancer patients. Grow up. Far more people are going to suffer if they continue to go uninsured and underinsured, which they will if there’s isn’t a widespread public option.
So, the next time someone is in your office freaking out because they aren’t covered under Obama’s watered down, terrible bill, you can tell them, “Hey, it’s better than nothing, right?” Followed — maybe — by a high-five. But that may be pushing your luck.
You don’t think it was presumptuous to claim that these experts were smarter than Mr. Unger? The man created “X-Men: Evolution.”
“Yes, Rick. As we all know, I hate cancer patients.”
I feel for you, Allison. Rick like to make those straw man arguments to defend Obama & the Senate Dems’ endless preemptive compromising.
But let’s take a step back from the debate about the public option. At this point in the process, before all alternatives have been exhausted, there is simply no reasonable basis for preemptive compromise after preemptive compromise by Obama.
In terms of rhetoric, Obama should have demanded that a robust public option be in the bill, and why. If Congress fails to pass a bill with that robust public option, then at least he gave it his rhetorical best. Instead, as Allison observed, he hems and haws (“We should remain open to other ideas…”). Obama seems to be unfamiliar with the concept of a bully pulpit.
Beyond the rhetoric, there are actions. Why should supporters of a robust public option not do everything possible to fight for it? Whether it’s through reconciliation or any and all other procedural maneuvers — why give up without a real fight? Force the obstructionists to stand up and filibuster. Call out the obstructionist corporate whores like Baucus, make them stand up and cast their vote against a public option instead of allowing them to get away with self-fulfilling prophecies like “I support it, but it won’t pass.” Go all out for a robust public option, and if it doesn’t pass, then go back and try for a weaker public option; if that doesn’t pass, compromise further. It may take a little more time and a little more effort, and the end result isn’t guaranteed to be any better, but what isn’t it worth the fight? Doesn’t Obama owe that effort to those who are suffering and dying?
The counterargument is that Obama would undermine his ability to be effective for the rest of his term if he upset the Congressional applecart by resorting to “extreme” tactics to push through a public option. But what the hell else is left? He’s expanding the futile wars in Afghanistan and Pakistan, and he’s gutted EFCA. If he fucks up health care reform as well, what else is left to distinguish Obama’s first term from Bush’s third? The Lilly Ledbetter Act? Gee, what a legacy.
So, Rick, stop with the absurd pretense that you’re the only one who doesn’t want to see people suffer. What you in your infinite wisdom fail to recognize is how your advocacy of preemptive compromise only ensures that the suffering will continue.
Sorry for misspelling your name, Mr. Ungar. At least I didn’t litter my post with malapropisms.