Don't practically all the criticisms against M4All also apply to the public option?

[Humanist_Activist]

Regardless of what words are used to describe it?

As far as I can tell, from a practical standpoint, you have one big conundrum, controlling medical costs. Negotiating rates is a must, whether its a "Public Option PPO" or Medicare, both Medical Care and Rx costs need to be under strict controls of some sort. Whether this is through negotiation or straight up fiat controls, something has to be done.

After that where is the money going to come from for a public options, a lot of ink has been spilled over how M4all will be funded, but a public options that isn't means tested(as promised by Biden) and is overall better than damn near any private insurance is going to have a ton of enrollees within a couple of years. I mean, it would be designed to help the majority of people who can't really afford to use the insurance they have now, or can't afford the premiums for plans on the exchange, so it will have to have some plan offers that are, in a sense, truly universal in pricing(damn near free at service), with nominal fees at worst. So where is the money for all inexpensive medical care going to come from?

And then there is the Red Herring that is "choice" something that even the original ACA promised, but didn't quite deliver, which makes this a silly complaint against M4all, of making private insurance "illegal" would be robbing people of their "choices" in health insurance. Which is weird, because I never had a choice, has anyone else ever had a true choice here? My insurance has always been provided by my employer, and the ACA made sure that was the only choice I had as well unless it hit a certain cost threshold(which it didn't). Not to mention the "market" for health insurance is laughable at best, there's very little competition here, nor would there be, more competitors literally adds inefficiencies and increased costs that are passed down to the patients. We are the product the insurance companies need, not the consumer, people seem to not understand that.

I mean, the illusion of choice that an "ACA+Public Option" has might be enough to allow it to be passed, and frankly I hope so, but I'm too cynical to think that the Republicans and Moderate Democrats won't start attacking that just as viciously as they do Medicare 4 all, and for all the same reasons as well.

[HerbChestnut]

1. M4A is the best option for health insurance reform. Period.

It's disturbing to me so many Democrats are parroting health insurance industry talking points when they argue against it.

Full text of the M4A bill:

https://www.congress.gov/bill/116th-congress/senate-bill/1129/text

[Aussie105]

2. The best medical insurance to have . . .

is to have none at all, and be able to rest assured that your medical bills will be picked up by the government, and not appear in your letter box.

That is how it works in some countries. Even prescriptions have a standard - low - cost to the user, also courtesy of the government.

Wife is undergoing radiation treatment for lung cancer. Cost to us? Just public transport between home and the hospital. Works out to about AU $6 per trip.

I know that is a pipedream in the US, but you got to ask why.
(Ask, if you don't already know.)

[RDANGELO]

3. People don't want to be forced off their employment based insurance.

That is the political reality. I think we will eventually get to a single payer system; running on it right now will lose us the election.

[Voltaire2]

11. People have been deliberately confused and think

that their doctors are tied to their insurance, that if their insurance goes away their doctors go away.

Generally people ‘like’ their insurance companies about as much as they like their cable and cell phone companies.

[MineralMan]

20. That's true, of course. However, convincing them otherwise

before the 2020 election is not going to be easy. It might well be impossible.

Many people are confused about many things. That's the reality candidates have to deal with.

M4A can be explained until the sun burns out, but people will still not understand how it works. They're just not paying that much attention to the explanations.

[Voltaire2]

24. Well for starters if we stopped regurgitating

HIC talking points as if they were gospel we might start eroding the wall of confusion they’ve erected.

[Uncle Joe]

59. +1.

[thesquanderer]

32. But ironically, people today get forced off their current employer-based insurance all the time.

Because they lose their job, or because the employer gets a better deal and switches all its employees to a different provider, or because the insurance company itself discontinues a plan.

[Cuthbert Allgood]

34. Until their employer screws them by changing it or dropping it.

We need to stop with these talking points that the health insurance companies want us to spread. Employer-provided insurance is tenuous at best. It can go away at any time.

[elleng]

4. There is no real 'market' for health care,

little if any competition among the various providers to we the public.

Federal employees/retirees have something like a market, as OPM (Office of Personnel Management) collects plans from various insurers, and packages them for we personnel to choose from. Open Season ends today.

https://hr.nih.gov/benefits/change-open-season/benefits-open-season

[ritapria]

5. Single Payer Drastically Reduces Administrative Costs

Single Payer ends all of the profiteering from the rapacious middlemen. It's time for Single Payer. The rest of the Western World has figured this out long ago . We know it works

[tirebiter]

6. The answer to the OP his is NO

ACA with PO is possible because voters supported it for the last two election cycles.

[Cuthbert Allgood]

35. Because people believed the lies from the health insurance industry

That does not make it the best option.

[JoeOtterbein]

7. K n R ! Thanks for posting! nt

[pnwmom]

8. Warren doesn't think so. That's why she's now saying to START with the public option.

Not to try to do everything all at once.

[OilemFirchen]

9. Individuals with the means to do so will buy into a public option, if they so choose.

Biden's plan specifically states that payment is income-based, up to a maximum of 8.5%. It expands Medicaid and provides Medicare to those under 65, based, again, on income. It's not means-tested, but there's not a flat-rate contribution. It doesn't require a massive influx of government spending, because it relies, in part, on individual contributions and a huge participant pool.

Medicare, BTW, as it exists today, is likewise income-based, with Part B premiums ranging from $135.50 to $460.50 a month.

[Humanist_Activist]

13. Such sliding scale premiums aren't enough to fund Medicare, it will have to also involve...

increasing taxes to be fully funded to a level where its overall more usable and attractive than all the private options.

[TexasTowelie]

10. When I was a state employee I actually had several choices.

There were usually four or five options to choose from. One insurance company offered a HMO and a PPO plan. There were also other insurance plans offered so I could choose on factors such as which doctors within the various plans and the premium deducted from each paycheck (which wasn't relevant since the state paid the entire premium for all employee only plans), If I was having difficulty with my health insurance provider I could switch to a different plan each year during the enrollment period.

I only had one health insurance plan available when I was employed in the private sector, so the public option would have been a nice alternative to choose from, particularly if my employer was willing to pay the same premium amount for the public option plan vs. the private insurer plan.

You also asked where the money is going to come from to finance the public option? The obvious answer is that it comes from the customer who pays the premium. The customer has the choices of paying the premium for the employee-sponsored plan, paying the premium for the public-option plan, searching for and paying the premiums for plans that aren't associated with either of the other two options, or go bare without coverage. With the M4A proposal the consumer loses the ability to make those choices, they are taxed (even if they find a provider who is not involved with the M4A program), and they are required to put blind faith into a government program that has an emphasis on controlling costs rather than patient outcomes.

Unfortunately, I haven't seen any mention in the M4A programs that balances the cost control aspect with the patient outcome aspect. Ultimately, a M4A plan could easily morph if a Republican administration returns to power after a M4A proposal is adopted. And we know what the Republican health care plan is--let them die.

[dansolo]

12. It will cost more. A lot more.

I don't believe for a minute that the cost estimates for M4A are at all realistic. In the end, it will cost significantly more. What is even more rediculous is that the M4A legislation does very little to control costs. All it does is control payments. And even that isn't guaranteed to reduce costs, because if M4A were to be implemented, the payment rates will probably have to be higher than they are now. And people are underestimating overhead costs. Current Medicare has low overhead costs because there is still a lot of insurance company involvement, which hides the additional overhead. I'm also concerned about the quality of care, becaue it will also squeeze healthcare providers with lower payments AND increased taxes. I don't think that M4A suporters give a shit if doctors and nurses will have to end up working more hours for less pay.

[Humanist_Activist]

14. I don't see how a public option would be immune to any of those problems you mentioned. n/t

[TexasTowelie]

19. I don't think that the public option would necessarily be immune to some of the problems of M4A,

but the fact that there would be private insurance companies does inject an element of competition into the health care system. With M4A it would create a monopoly in healthcare and like all monopolies, costs rise while customer satisfaction decreases. While there would be some decrease in administrative costs with the reduced amount of paperwork and training, the administrative costs are at about 8% while under Medicare the administrative costs are at about 2.5% from what I recently read on DU. However, those administrative costs are still less than what are found in many private businesses.

So although there are savings to be found in administrative efficiencies, those savings could easily be exhausted by the increased prices found in a monopoly system The private insurers would try to negotiate lower costs below what M4A pays for both products and services in order to increase their profit margins.

It would also allow the providers of medical services to negotiate their reimbursement rates rather than settle for an artificially low rate that might influence whether some people enter the medical professions since they are no longer lucrative enough to pay off student debt and high tort insurance premiums. We should be trying to fix the problems in the health care system as an issue separate from how much universities and med schools charge their students in order to minimize the amount of economic disruption by trying to combine the issues. I think that Sanders and Warren would be extremely mindful of that consideration since one private college closed in Massachusetts and three private colleges have closed in Vermont within the past year.

In the private sector, consumers abhor monopolies and we have anti-trust laws to break up those monopolies and increase competition. So why would we support creating a monopoly in the public sector that affects nearly 20% of our economy? I don't see the logic in that stance and I believe that competition is a good thing for consumers. The public option promotes competition, while M4A doesn't.

And for those who are so unfortunate that they can't afford insurance through either the public option or private insurance we enhance programs such as indigent care even if they are not perfect. The level of care may not rise to the same level as those who can afford to pay premiums, but if our concern is about basic health care then we can provide those people some reassurance that they aren't being neglected. It may not be completely fair, but inequalities exist in all aspects of life. We shouldn't tear down the system that we built just because there are people who are going bankrupt due to medical crisis The bankruptcy issues can be fixed separately by changes in the bankruptcy laws or granting means-based financial aid that could include loans for the people who still have some ability to pay something or debt forgiveness for those who are no longer employable because of their medical problems. Those solutions would cause far less economic turmoil than a M4A program that affects everyone with additional taxes and eliminates competition.

[thesquanderer]

33. re: "M4A...would create a monopoly in healthcare and like all monopolies, costs rise"

What you're not accounting for here is that, unlike the typical monopoly within a capitalist system, this monopoly is non-profit. The incentive of a typical monopoly to maximize profit is not there.

It's also not a monopoly in healthcare (i.e. any actual medical care), but only a monopoly of insurance. Think of unemployment insurance, which is a non-profit, government-administered monopoly. (A business can't choose a different carrier for its unemployment insurance.) It does not suffer from your proposition that, "like all monopolies, costs rise while customer satisfaction decreases."

[Cuthbert Allgood]

36. But the money we put into insurance companies can now go into M4A.

And if you don't think the government can negotiate pricing like insurance companies do now when the government is the only "insurance company," I'd like to see why that isn't true.

I think a lot of doctors are overpaid. I know insurance companies execs are WAY overpaid.

[TexasTowelie]

44. Okay.

I think a lot of doctors are overpaid.

Did you ever say that to your physician at the beginning of a medical appointment?

[Cuthbert Allgood]

46. Why would I?

That's just bizarre.

[TexasTowelie]

48. You don't seem to have any qualms sharing your opinion on DU.

Come on Cuthbert, I thought you might want to show the same transparency to the individual that you entrust your health to. Let that physician know that you think he/she is overpaid just so you can gauge his/her reaction.

[Cuthbert Allgood]

54. Yeah, a discussion board.

I have friends who are MDs and we have talked about that in a setting that makes some damn sense to talk about it.

But, OK, you do you.

[beastie boy]

15. No. Public option can be added to existing laws, no new legislation needed!

By far, the main criticism of M4A is that it has no chance to pass Congress in the foreseeable future. This is not the case with public option.

[TCJ70]

21. No new legislation needed?

What trick will be used to make that happen?

[beastie boy]

22. The trick is called executive action

The trick is Calle d executive action.
It is routinely used to elaborate on existing laws like Obamacare

[TCJ70]

29. To create a public option? Is there a part of the ACA that allows for a public option to be created?

Otherwise, it's not elaborating on an existing law, it's outright creating a new part of it. Which would require legislation.

[beastie boy]

30. Indeed there is!

https://obamacarefacts.com/obamacare-and-the-public-option/

[TCJ70]

40. Are you sure?

Initially it looked like only state-based options would fly, but recent action in the Senate and additional support from Hillary Clinton and Bernie Sanders, means that a national public option could be on the table too (if Democrats can get an ungutted bill by the Republican controlled Congress).

Did that ungutted bill get passed?

[beastie boy]

42. As the paragraph you erxcerpted from indicates, state-based public option already exists.

Since Obamacare is a federal law, a Democratic President can use executive orders to expand on it without further legislation. here is what is likely to happen: if the president's opponents find an aggrieved party, which will in itself be exceedingly difficult since the system has for years been in existence on the state level, apparently without any parties being aggrieved, the order will be challenged in court. This is a protracted and complicated process, with several courts rendering opinions. It will take a year or more to reach the conclusion of this process, which may or may not be in favor of the executive order, all the while the public option being alive and kicking, This is sufficient time to build popular support for public option (Obamacare itself comes to mind), and then the legislators will have to think twice before they come on record against a popular program. By the time the issue gets to the Supreme Court, it may be politically inexpedient to take the issue any fiurher. But in the very unlikely event of SCOTUS ruling against it, passing public option as a legislative matter becomes so much easier!

The point is, it is far more difficult to repeal an executive order than it is to defeat a bill.

[brooklynite]

16. MfA adds one more criticism: lack of choice

That’s something voters care about...

[Cuthbert Allgood]

37. Choice about what? Who your insurance company is?

They pretty much all suck.

Choice of doctors? Why would that be the case?

[brooklynite]

38. As much as YOU don't like your private insurance, some people do...

...ESPECIALLY Democratic Union members who negotiated hard for good benefits. Perhaps you should go to Michigan and explain how misguided they are?

[The Mouth]

41. Bingo

I like my union earned coverage quite well, thank you. We fought like hell for it, for decades.

Give everybody the option to get covered, fine. Start talking about what you are going to take away (no matter how high and noble you think your reason) and lose.

Some people have no idea of political realities and/or assume that because THEY don't like something or some situation that nobody does, very very dumb.

[Cuthbert Allgood]

43. I like my insurance just fine. And I'm a union member.

So, you know, assumptions.

I also know that with M4A, my union can take that money that my employer currently spends on health insurance premiums (and, in the case of my awesome union, the money they put into a HRA to offset my deductible) and put that into my salary instead. Maybe if we actually started talking to those Michigan union members (not sure why we are singling out Michigan union members, but whatever) about how their salary would go up with M4A, they would have a better understanding of it all.

[TexasTowelie]

45. LOL.

You think you are going to get a pay raise?

[Cuthbert Allgood]

47. So do unions have power or not?

You want to talk about the all powerful unions getting the best health care possible, but they can't negotiate the contract with the funds available from not paying insurance benefits? That isn't a hard negotiation.

[TexasTowelie]

49. I haven't mentioned anything about unions in this thread.

And while I have posted some threads in the past regarding unions, I've never been a union member myself nor stated that unions are all powerful. I've even posted a few threads pointing out corruption in unions such as DoJ press releases.

If anything, I believe that the power of unions has diminished.

You obviously have me confused with some other member.

[Cuthbert Allgood]

55. Sorry. Thought you were the same as the beginning of this subthread. My bad.

[Hortensis]

17. No. Not in the slightest. Try again, Humact.

[ismnotwasm]

18. No

And here I want to add my obligatory no universal healthcare plan is complete without addressing where healthcare will be provided and who is going to be providing it.

We are drowning. The nursing shortage is now. The provider shortage is here. Clinics and hospitals are closing. Or consolidating under single large entities in metropolitan areas.


If you’re in a rural area it’s worse. Some healthcare is done remotely, not bad of itself, as technology advances but what’s driving this is very bad. There are complex Med surg floors where nurses have five patients. ICUs where nurses are completely understaffed and overwhelmed

I want to see the plans for this.

[BeyondGeography]

23. They do if you ask the health care lobby

They're already spreading just as much FUD about the public optionas they do for MFA:

Link to tweet

[Demsrule86]

25. No...M4A ends private insurance...I am absolutely against this...as we will be tossed out of office

and end up with nothing...and let just say I am pissed that some are even running on this with the ACA in court...it give SCOUTUS a out to find against it...millions could lose their healthcare...the right and the left have ganged up against the only healthcare we have and are likely to have.

[Voltaire2]

26. It doesn't.

It allows private insurance that supplements M4A.

But other than repeating the nonsense that everyone loves their private insurance, which is about as accurate as claiming that everyone loves their cable or cell phone company, why would this be unpopular?

[Gothmog]

27. No, MFA eliminated all private insurance for 160 million taxpayers

[Voltaire2]

53. Only private insurance that overlaps coverage.

But again, how many people actually 'like' their private insurance provider? I don't know a single person who enjoys the endless hassle of denial of coverage, the mountain of paperwork, the mystery bills, the out of network nonsense, the deductibles, the co-pays, any of it. What I have heard is people confused that their doctors are somehow tied to their insurance plan and if the insurance plan goes away their doctors go away. That is because the HIC and its agents and useful idiots keep regurgitating the talking point that we loves us our private insurance plans.

[Gothmog]

56. That means that everyone will have to give up their existing coverage

MFA required that 160 million taxpayers give up their existing coverage. That concept polls poorly in the real world

[Gothmog]

28. We need to build on the ACA and offer a public option

Link to tweet

[loyalsister]

31. And then some

A major problem with the ACA is the voluntary participation of medicaid expansion. Hospitals are closing down in states that did not expand medicaid and people blame the ACA itself rather than the refusal of state politicians to expand medicaid and republicans have benefited in my state by expanding their majorities. I don't know the solution, but health care is not being delivered and the provider shortages are getting worse.

[nbsmom]

39. M4A doesn't have a profit motive

Public option doesn't either, except that it does need to market and "brand" itself differently, to grow awareness and membership.


Which makes me wonder, will we need to beef up the HICAP options currently available in each state/region? Transitions require people to process a lot of information, right?

[Recursion]

51. There's plenty of non-profit insurance available now. It's not noticeably better

Harvard Pilgrim was never cheaper than Anthem. Profit motive isn't the problem.

[TexasTowelie]

58. Some people get carried away with the "no profit" mantra.

There should be no profit in any of these areas:

Healthcare
Education
Real estate
Utilities
Clothing
Food
Water
Transportation
Technology
Childcare



All of the above are necessities or near necessities to function in modern society. While I don't believe that people should be gouged, it is also vital to realize that profit is not necessarily evil and it is also necessary if we want progress.

Even members of communes need money. If they believe that money is the root of all evil, then I wish that they would stop begging me to support their choice of lifestyle and crawl back in their caves.

[Recursion]

50. All except one

People with private insurance don't want to give it up. And they will rain electoral hell on anyone who makes them.

[guillaumeb]

52. Single payer works.

The US system does not, except for the companies making money from the current system.

[Aaron Pereira]

57. Great post.

If you think way back to 2009 the arguments used today against M4A were applied to a public option.

First, we were told a public option would put private insurers out of business because nobody in their right mind would choose private (and that was supposed to be a bad thing). Public option was an irreversible gateway to an eventual system of socialized medicine.

Then the compromises began; we would have a public option but only for people over 55 to contain public cost and foam the runway for the insurance industry. Then it became no public option at all after leadership consensus turned against the idea.

The chain of political expedience killed the public option once so I'm not sure why people believe it will be different this time. Only a universal and comprehensive bill will address the problem of delivery cost and provide immunity from compromise.