Congress still debating the public option...

[30ashopper]

I posted on another thread, but does anyone know completely what a public option is (good and bad) and do they unmderstand it. I don't completely understand the different proposals and I work with the federal government everyday (in DC now). I understand most of the marketing plans that have been promulgated, but not the legislative plans. This goes for public option, trigger, and republican plans. The devil in the 1000 pages of detail is my problem...
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Basically a government run insurance company - a new federal department or program, managed by HHS. The government would handle all your claim work and set rates. If you got sick, the plan would dictate what providers could offer based on the issue, just like current plans. Claim recaps, paperwork, bills, etc.. would come to you from Uncle Sam. You would pay regular out of pocket costs yourself, and premiums would be paid for through payroll deductions or automatic draft from your bank account.

Provider pay out rates would match Medicare pay out rates. (Not sure if providers would be forced to accept patients under the plan though, they can refuse Medicare subscribers.)

The big difference being that this insurance company would have a direct tap into the U.S. Treasury, with unlimited funds with which to work with and no need to turn a profit or break even financially. Book keeping would fall under general accounting and the regular budgetary process.

Private providers are not integrated and would remain private.

 

[rapunzel]

Two plans were defeated in the Finance committee today, one that would tie reimbursement to Medicare RBRVS reimbursements (and which most providers agree would force them to stop accepting government backed RBRVS plans) and one that would create something akin to non-profit insurance companies in each state (like Minnesota's successful model).

Although the government would ultimately pay the claims after collecting premiums from subscribers, I believe the public option programs would be based on the Medicare model -- meaning insurance companies would be contracted to be Medicare Secondary Payors, and contract with the government for an ASO fee for claims paid (usually like 3-4% of total claims paid). The insurance companies still make money off of government programs, just more modest levels of profit. After making money like pirates for the past decade, they are obviously not wanting to bid against each other for ASO contracts.

I, personally, am a big supporter of the trigger option. The trigger option would kick in to offer a public option when certain criteria are met -- criteria related to lack of competition in a market (ie Alabama, where one company controls 85% of the market share and can dictate reimbursments to providers and premiums to every Alabama based business) or where the costs of healthcare deviate from the national average by a huge margin.

I had the rare opportunity to manage financials for a renowned surgical center that attracted patients from all over the country. I could pretty much guarantee a patient from Alabama, Kansas, North Carolina, or Arizona would never see her claim paid. A patient from California or Oregon would be never get a prior authorization for the surgery. Patients' insurers from New York or Florida would pay the surgeons twice as much as most other states, so we'd always move mountains to get them a surgery date. It was the rare states with lot of competition and especially those with co-ops or not for profits such as Ohio and Minnesota that somehow struck a good balance. Not every state needs a public option -- but there are a few out there that desperately do, and the spectre of a public option may just bring back competition to other markets where insurance oligopolies have carved up the territory and allowed service to decline while rates rose and their coffers filled a bit too easily to say Adam Smith's invisible hand has been at work.

The other reason I think we need to stop this shrill cry for a public option in every state is this -- even NPR led tonight with a story casting the 15-8 vote against a public option as a defeat for Obama. I believe that that is the very reason we've been hearing the right make such a big deal about it -- to make the GOP look less impotent and to make the President look a bit weakened. The national public option is not something the President felt was important enough to go to the mattresses on, and he made that clear in his address to the joint session a few weeks ago. It was a starting position in a negotiation -- never something he campaigned on or championed with zeal. The right has played the more radical elements of the left on this one, I fear.

The public option is not and never was the lynch pin of meaningful healthcare reform, but if it's played that way by the Democratic Party, then we may just end up throwing the baby out with the bathwater.

 

[30ashopper]

Two plans were defeated in the Finance committee today, one that would tie reimbursement to Medicare RBRVS reimbursements (and which most providers agree would force them to stop accepting government backed RBRVS plans) and one that would create something akin to non-profit insurance companies in each state (like Minnesota's successful model).

Although the government would ultimately pay the claims after collecting premiums from subscribers, I believe the public option programs would be based on the Medicare model -- meaning insurance companies would be contracted to be Medicare Secondary Payors, and contract with the government for an ASO fee for claims paid (usually like 3-4% of total claims paid). The insurance companies still make money off of government programs, just more modest levels of profit. After making money like pirates for the past decade, they are obviously not wanting to bid against each other for ASO contracts.

I, personally, am a big supporter of the trigger option. The trigger option would kick in to offer a public option when certain criteria are met -- criteria related to lack of competition in a market (ie Alabama, where one company controls 85% of the market share and can dictate reimbursments to providers and premiums to every Alabama based business) or where the costs of healthcare deviate from the national average by a huge margin.

I had the rare opportunity to manage financials for a renowned surgical center that attracted patients from all over the country. I could pretty much guarantee a patient from Alabama, Kansas, North Carolina, or Arizona would never see her claim paid. A patient from California or Oregon would be never get a prior authorization for the surgery. Patients' insurers from New York or Florida would pay the surgeons twice as much as most other states, so we'd always move mountains to get them a surgery date. It was the rare states with lot of competition and especially those with co-ops or not for profits such as Ohio and Minnesota that somehow struck a good balance. Not every state needs a public option -- but there are a few out there that desperately do, and the spectre of a public option may just bring back competition to other markets where insurance oligopolies have carved up the territory and allowed service to decline while rates rose and their coffers filled a bit too easily to say Adam Smith's invisible hand has been at work.

The other reason I think we need to stop this shrill cry for a public option in every state is this -- even NPR led tonight with a story casting the 15-8 vote against a public option as a defeat for Obama. I believe that that is the very reason we've been hearing the right make such a big deal about it -- to make the GOP look less impotent and to make the President look a bit weakened. The national public option is not something the President felt was important enough to go to the mattresses on, and he made that clear in his address to the joint session a few weeks ago. It was a starting position in a negotiation -- never something he campaigned on or championed with zeal. The right has played the more radical elements of the left on this one, I fear.

The public option is not and never was the lynch pin of meaningful healthcare reform, but if it's played that way by the Democratic Party, then we may just end up throwing the baby out with the bathwater.

Now that is something I did not know. I thought providers received payment from government, without private insurance involvement. Do you have any information/links on this and how the public option stacks up compared to this model?

 

[MommaMia]

I posted on another thread, but does anyone know completely what a public option is (good and bad) and do they unmderstand it. I don't completely understand the different proposals and I work with the federal government everyday (in DC now). I understand most of the marketing plans that have been promulgated, but not the legislative plans. This goes for public option, trigger, and republican plans. The devil in the 1000 pages of detail is my problem...
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This video on YouTube has a very good explanation. [ame="http://www.youtube.com/watch?v=dBi8A_HutII"]YouTube - Robert Reich Public Option Video[/ame].

 

[mtlinscomb]

From a CBS from two days poll I heard 65% of Americans wanted a public option? Sounds like no one is listening to the people--like, so what else is new?

The Rasmussen poll has it at 35%. My guess is, just as it is on most issues, we are split at 50/50.

 

[TooFarTampa]

Punzy -- we need your voice in this debate. Please provide insight when you can! I agree with your logic 100 percent, though I don't have nearly your background and insight. More, please.

 

[Winnie]

Two plans were defeated in the Finance committee today, one that would tie reimbursement to Medicare RBRVS reimbursements (and which most providers agree would force them to stop accepting government backed RBRVS plans) and one that would create something akin to non-profit insurance companies in each state (like Minnesota's successful model).

Although the government would ultimately pay the claims after collecting premiums from subscribers, I believe the public option programs would be based on the Medicare model -- meaning insurance companies would be contracted to be Medicare Secondary Payors, and contract with the government for an ASO fee for claims paid (usually like 3-4% of total claims paid). The insurance companies still make money off of government programs, just more modest levels of profit. After making money like pirates for the past decade, they are obviously not wanting to bid against each other for ASO contracts.


The public option is not and never was the lynch pin of meaningful healthcare reform, but if it's played that way by the Democratic Party, then we may just end up throwing the baby out with the bathwater.

Could you cite a source for that? Everything I've read shows they already make a "modest level of profit," not "money like pirates." Lower levels of profit than some other businesses.

 

[GoodWitch58]

Could you cite a source for that? Everything I've read shows they already make a "modest level of profit," not "money like pirates." Lower levels of profit than some other businesses.

Rapunzel probably has other data, but because my interest has been in the regulation of the industry, I keep up with that.

Here is a link to the testimony from the National Association of Insurance Commissioners from July 08 that speaks to the issue:

http://www.naic.org/documents/testimony_0807_goldman.pdf

"Combined premiums now top $1.4 trillion. As a share of the U.S. economy, total insurance income grew from 7.4 percent of gross domestic product in 1960 to 11.9 percent in 2000. In 2005, while insurance companies were absorbing record losses, they were also making record profits. Profits and surplus have continued to increase each year since. Insurance company surplus is now over $500 billion for the first time ever.
Clearly, this is not an industry that has suffered under State insurance supervision. In light of the record profits just cited, one should look skeptically at claims by some in the industry that appropriate rate regulation is harming their ability to compete. "

There are numerous reports available from the Association.

 

[TooFarTampa]

Rapunzel probably has other data, but because my interest has been in the regulation of the industry, I keep up with that.

Here is a link to the testimony from the National Association of Insurance Commissioners from July 08 that speaks to the issue:

http://www.naic.org/documents/testimony_0807_goldman.pdf

"Combined premiums now top $1.4 trillion. As a share of the U.S. economy, total insurance income grew from 7.4 percent of gross domestic product in 1960 to 11.9 percent in 2000. In 2005, while insurance companies were absorbing record losses, they were also making record profits. Profits and surplus have continued to increase each year since. Insurance company surplus is now over $500 billion for the first time ever.
Clearly, this is not an industry that has suffered under State insurance supervision. In light of the record profits just cited, one should look skeptically at claims by some in the industry that appropriate rate regulation is harming their ability to compete. "

There are numerous reports available from the Association.

Any idea how this breaks out by category? ie health, homeowners, auto, life, etc.?

 

[GoodWitch58]

Any idea how this breaks out by category? ie health, homeowners, auto, life, etc.?

I think they have it broken out by categories and by state--I just didn't have the time to search for them all.