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Time to throw HR 3962 in the medical waste and the day's single payer news

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For those who argued we should just pass SOMETHING, even if it was a bad bill, because they said we could fix it later, this is what you
get from a strategy of perpetual compromise, a bill that is utterly
beyond redemption. It’s time to throw HR 3962 in the medical waste
bin, and do what should have been done in the first place, build a
new national health care system on what actually DOES work, by
extending the existing economical and efficient Medicare plan to all

Kip Sullivan at Firedoglake:

Jon, Your comment assumes Goldman Sachs has determined that the PO will actually be able to break into all or most insurance markets across the country and not only survive the entry process but become big enough to set its premiums even with or below those of the existing insurance companies. As I read the tiny little Goldman Sachs report (the version available at the Huff Post site couldn’t have been more than a single page long), Goldman Sachs made no effort to determine whether the PO would establish successful insurance companies anywhere in the country. Do you know if that’s correct?

If it is correct and GS made no effort to determine whether the PO will survive and, if so, where and with how many enrollees, why do you give the GS report any credibility?

I don’t know if you saw my question for you on your earlier “Tipping points…” comment, so I’ll post it again here. My question describes the process I believe the Secretary of HHS will follow in setting up the PO market by market,and then it asks you to comment. Here it is again:

Jon, I appreciate your effort to depict what will happen to the PO as the Democrats’ legislation envisions it. It’s a difficult task. Other than you and me, I know of no human being on the planet who has tried to describe the birth and early growth history of the PO.

But your scenarios skip over the birth of the PO. How is the PO created and who will do it? I can’t find anyone, pro or against the PO, who can answer that question.

I posted my own scenario plus some question on one of Jason Rosenbaum’s diaries a week ago and asked him if he thought it was accurate. He answered, “Not interested.” I’m posting it again here. I’d appreciate hearing your assessment of my scenario.

Could you walk us through the process by which the Department of Health and Human Services will set up an “option” plan in any given market, say Boston, under the Senate health bill, HR 3200, or HCAN’s blueprint? Here’s the scenario I believe will occur under both the Senate HELP bill and HR 3200.

* Beginning in 2013, the Secretary of HHS contracts with a “contracting administrator,” that is, a corporation such as Blue Cross Blue Shield, to set up an “option” plan in Boston. The Secretary also loans Blue Cross several hundred million dollars to carry out all the tasks necessary to set up an “option” plan.

* Blue Cross then hires 80-100 people to create an insurance company to serve Boston. These people do the things you’d expect people to do to create a new insurance company, including making cold calls on clinics and hospitals to see if they’d be interested in accepting “option”-insured patients at Medicare rates plus 5% (or about 15% below the insurance industry average).

Question: Do you anticipate that Blue Cross will at some point ask clinics and hospitals to sign contracts with Blue Cross indicating their commitment to be part of the Boston “option” network? Or will contracts be unnecessary?

* After six months of making numerous cold calls, Blue Cross succeeds somehow in inducing a sufficient number of clinics and hospitals to agree to accept “option” enrollees. Now Blue Cross incorporates the Boston Public Option Plan (BPOP) and hires 80 people to staff BPOP.

Question: Does Blue Cross exit the scene now, or do you anticipate Blue Cross will continue to serve as an advisor to BPOP? Obviously, Blue Cross, if it does retire from the project, has to leave in place a contract with BPOP that at minimum ensures BPOP will repay the loan that Blue Cross got from the Secretary of HHS.

* BPOP/Blue Cross now begins advertising heavily and making cold calls on employers seeking to induce tens of thousands of Boston residents to pay their premiums to BPOP in the event that these people are eligible to shop in the MA exchange.

Question: How many people will have to enroll in BPOP in order for BPOP to have sufficient leverage over local providers to get them to accept reimbursement rates even with or below the rates paid by Aetna et al. in the Boston area? I’m not looking for precision, just some evidence that you or someone you know in the “option” movement has thought about this.

* Let’s assume BPOP solves the chicken-and-egg problem of trying to assemble a critical mass of providers and enrollees roughly simultaneously. BPOP formally opens for business. BPOP makes enough money within the next 8 to 9 years that it can repay to Blue Cross the loan it got from the Sec or HHS. Blue Cross in turn repays HHS.

Is this the process you envision?


Kip Sullivan

Attention Maggie Mahar, single payer is privately provided and publicly paid. It is NOT government run. The sound you hear is the laughter of the entire Canadian Embassy that the Washington Post would publish your drivel.

Wanted: Progressive opponent for Max Baucus.

selise on opinion polls.

The House bill does not cover conterceptives.

Next Steps Following our Week from Hell

A conservative Republican sees the light

Dr. Garrett Adams makes the case for single payer.

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Submitted by lambert on

Here's another good post to add to the roundup. I can't figure out how to cut it, so I'm posting it in its entirety:

Are you satisfied now?
Seriously. Are you? Are you satisfied with the health care bill that passed the House? After all the compromises, after all the "asses of Blue Dogs are to be kissed, those of progressives are to be stomped" concessions, after stripping out authorities for state-level single-payer plans and adding in abortion bans, after changing "Medicare plus 5%" to "negotiate one provider at a time," after creating a flimsy, weak, unattractive "public option" consciously designed to be no better than private insurance and which will cost more than private insurance, after creating an individual mandate but omitting any rate caps and removing the prospect of serious competition, after creating a system of what amounts to multibillion dollar taxpayer handouts to the insurance industry, after getting zero concessions from the right or the insurance companies that they weren't prepared to give even before the debate began, are you really satisfied?

Well, no, of course you're not "satisfied" and I know you're not. But here's what I was really asking: Do you think this bill was good enough to pass? Do you think the health care system it creates, the one of the actual facts on the ground, not the lofty rhetoric, is worthy of active support? Would you have voted for it?

I say it was not, it is not, and I would not have.

There was a period of time a few weeks ago when I could have been swayed by the "better than nothing" argument, not so much by the argument itself as by the political impact of a defeat and how it could (would) be spun as a declaration that "the people do not want reform" rather than as "this is not reform enough." That was before the House leadership caved and allowed a floor vote on Rep. Stupid's amendment knowing it would pass and before Tailgunner Joe Lyingman announced his intention to block the Senate version and got no reaction from the party leadership.

It became obvious beyond obviousness at that point that the concern was no longer, if it ever had been, enacting actual health care reform. It was passing a bill. Whatever concessions to politics and platitudes, to conservative endruns and Connecticut egomania, had to be made to get a bill passed were going to be made so long as at the end of the day the Democrats could say "we did health care reform" - even if they hadn't.

To those who say "It's a first step, one that can be built on," I say you can't build a solid house on a foundation of "stubble and straw." Medicare was supposed to be a first step. Medicaid was supposed to be a first step. Yet here we are, nearly 45 years later, still talking about "building" on "first steps." Why are we imagine this time is different?

Have Medicare and Medicaid been improved over the years? Yes, they have - but the point is, they are still Medicare and Medicaid. They have not been built into anything more, anything different. And neither will this, no matter the final form upon passage. Oh, it will be tinkered with, adjusted, over time but it will never become something more if only because - again, just like Medicare and Medicaid - the energy will go to defending the system against being dismantled in the face of unending complaints about deficits and unremitting claims of impending bankruptcy.

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Submitted by DCblogger on

that is the best commentary I have seen yet.