The public option

[zoogs]

http://www.vox.com/2016/8/18/12520820/public-option-health-care-obamacare

In short, if you’ve forgotten what the great public option debate of 2009 was all about — or you weren’t really paying attention the first time around — it’s time for a refresher. The case hasn’t changed much since I first started making it more than a decade ago. But the evidence that we need a public option has gotten much stronger.

Jacob S. Hacker is a Yale political science professor and director of their Institution for Social and Policy Studies. He's been considered the "father of the public option" and penned this lengthy explainer for Vox as something originally meant to be a part of the ACA is re-entering the public debate, six years on.

My background: I paid little attention to the debate at the time and still have little clue what all these terms mean. So, it's been edifying

 

[Danny Bateman]

I was literally just doing some reading about this yesterday. It's a complex discussion, and it is difficult to wrap your head fully around it.

I found a helpful Reddit thread, but I warn you, this is from a subreddit that is largely a liberal echochamber, so it's definitely from the perspective of the left:

To me, I don't understand the opposition to the movement from Republicans. I get it in the sense of small government everything, but not actually from a healthcare outcome perspective. It seems to me a public option would be a significantly cheaper option that would cover a significant chunk of people who cannot get insurance otherwise, and that forcing insurance providers to lower their rates or suffer the consequences would be only a good thing. Isn't that competition?

I guess I need someone from the right to explain to me why getting a public option and moving closer to a single-payer wouldn't drive costs down for everyone? Seems to me that's what most people are complaining about. Is that supposed to somehow hurt the economy as a whole?

 

[zoogs]

I think people still have a hard time with healthcare being mandatory.

But left to individual choice, people will skimp, and everyone will pay the price. Both literally, and in the general sense that we're a stronger country when we aren't saddled with our own denizens who suffer from (often preventable!) health issues they aren't able to deal with.

 

[JJ Husker]

I was literally just doing some reading about this yesterday. It's a complex discussion, and it is difficult to wrap your head fully around it.

I found a helpful Reddit thread, but I warn you, this is from a subreddit that is largely a liberal echochamber, so it's definitely from the perspective of the left:

To me, I don't understand the opposition to the movement from Republicans. I get it in the sense of small government everything, but not actually from a healthcare outcome perspective. It seems to me a public option would be a significantly cheaper option that would cover a significant chunk of people who cannot get insurance otherwise, and that forcing insurance providers to lower their rates or suffer the consequences would be only a good thing. Isn't that competition?

I guess I need someone from the right to explain to me why getting a public option and moving closer to a single-payer wouldn't drive costs down for everyone? Seems to me that's what most people are complaining about. Is that supposed to somehow hurt the economy as a whole?

You need to stay away from those liberal echochambers....

Seriously though, speaking as someone from the right (can't rep the repubs tho-I don't know what the hell they're up to anymore) and who understands way more than I should about healthcare and insurance, the concern with a public option or one-payer system is quality and availability of care. I've chastised the ACA since it's inception that it didn't sufficiently address runaway healthcare costs and skyrocketing insurance premiums. Those are the most critical issues. And yes, any lower cost options would help create competition thereby mitigating these increases but, it doesn't take much to realize what would happen to healthcare in government run or one-payer system. A peak inside the VA would indicate what that might look like.

And as zoogs alluded to, many republicans and libertarian minded people complain about the mandatory coverage provision. IMO, that is just people taking another angle against the ACA and not considering what is required to make healthcare work. I understand the general resistance of people not wanting to be forced to do anything by the government, like absolutely having coverage. But an ounce of common sense tells us that it won't work unless everybody has coverage. The only way around it would be to refuse healthcare service to those without coverage but our society will not allow that. If some people don't have coverage and still receive care, the cost of which gets passed on to everyone else, well then we're right back in the same boat we were- costs rapidly increasing being passed on to those with insurance. This drives up care costs and premium costs.

I am vehemently opposed to government imposed socialist plan type things but when it comes to healthcare, I really don't see any option other than the government getting very heavy handed. I've got lots of ideas of how to get where we want to be but all of them come with the downside of either reduced quality and availability of care or still increasing costs. We've already seen numerous insurers pulling out of state exchange plans because they are losing their a$$ due to the regulations and having to cover all these new sickies and people who prior couldn't get coverage. These aren't fly by night companies pulling out. Some of them are big name insurers who have been around a long time. I believe some states are already down to only 1 or 2 insurers providing plans in the exchange. What happens when it goes to zero insurers?

It is just an absolute sh#t sandwich and I'm not sure there is a good solution. One payer is probably the only way anyone will be able to afford care but I dread what that care may look like if we go there.

 

[Danny Bateman]

I think people still have a hard time with healthcare being mandatory.

But left to individual choice, people will skimp, and everyone will pay the price. Both literally, and in the general sense that we're a stronger country when we aren't saddled with our own denizens who suffer from (often preventable!) health issues they aren't able to deal with.

I wish others had a bit more empathy for their fellow American. But when it comes to the pocketbook, unfortunately, even with a matter as vital as healthcare, that just isn't apparent.

I don't understand a TON about insurance economics, but I do know that in order to drive costs down and be profitable for insurance companies, we need a balanced risk pool. What we have now is healthy people opting out and paying the penalty, meaning the companies have to cover high-cost patients (who have often been putting off serious health concerns until they could get coverage), lose a lot of money on them, and end up pulling an Aetna and withdrawing from the exchanges, citing losses.

I wish healthcare as a sector was not predicated on profit and more on quality and breadth of coverage.

 

[Danny Bateman]

Great post JJ. +1.

I agree that our hands are a bit tied. Our costs have skyrocketed and there's not really a good way to dramatically decrease them beyond moving toward single-payer. I guess we can just hope and pray that the government can find a way to successfully administer it. I'm not a vehemently small government guy convinced the federal government is bloated and incompetent, but even I'll admit it's on them (Dems in particular, as the party of larger gov't) to show that it can actually work well. That said, it's looking more like healthcare should be their guinea pig on the matter, and some legitimate help from the other side instead of bitching and obstructionism would be great.

I agree that people are expecting too much by complaining out of one side of their mouth about rising costs and the other about being forced to get coverage. But it's one or the other, and everyone getting coverage is more sustainable and productive long term.

I was vehemently opposed to single-payer early during the primary due to issues like death panels and much longer wait times for care. One of the benefits of the American system is the promptness of care and the unique control we have to make our own decisions. That said, to get costs down, we'll likely have to do what you've outlined, and adjust to a new single-payer style that's a bit slower and more limited in options.