Why a public option/single payer is more likely with the Senate bill than without it

[BzaDem]

Many people here are against the Senate bill (widely believed to be the only option for enacting reform in this Congress, possibly with a few reconciliation fixes). They are against it for a variety of reasons.

One reason that frequently comes up goes something like this. We currently have an unsustainable system. More and more people are going un or under-insured, and costs for the insured are rising rapidly. Heck, Anthem just raised premiums 39% for various groups of people in California! 39 percent! Eventually, the system will collapse, at which point Congress will enact Single Payer. According to this logic, the Senate bill (by propping up private health insurance) delays or forestalls this collapse, forcing mandated private health insurance on us for all of eternity.

However, there is a reason why our unsustainable system sustained itself quite well over the past 70 years (for big insurance), and why the last 30 Congresses haven't even seriously considered Single Payer (let alone put it to a vote or enact it).

The fundamental reason why the healthcare status quo hasn't collapsed and won't collapse (on its own) basically boils down to this: the healthy vastly outnumber the sick, and the healthy can be charged less than the sick for health insurance.

Insurance companies use this fact to survive and thrive, directing the pain of cost increases (and resulting dropped coverage) away from the healthy and towards the sick. They get millions of healthy customers at low cost who rarely use their health insurance, and who therefore are happy with their insurance. This is why such a high percentage claim they are satisfied with their health insurance when asked by any pollster. People who actually have to use their insurance (and find out that they will either be dropped or gouged) are undoubtedly unsatisfied with their insurance. But the healthy vastly outnumber the sick.

The sick are the ones that bear the brunt of healthcare cost increases. Sure, there are plenty of exceptions (such as healthy poor people who can't afford any insurance). But by and large, the sick are the ones affected most. Anthem's 39% increase actually was the maximum increase among all of their risk pools in California, and it applied to the sickest pools. The healthier pools got much less of an increase.

With the system as it is, change to Single Payer isn't going to be possible, because there isn't going to be enough popular support for it to elect Congresspersons to enact it. How could there be, when 70-80% of the population (predominantly healthy) is satisfied with their health insurance (often because they never need it)?

Sure, we all know that as soon as they actually need to use their health insurance, they will be dropped (or rates will go sky high). But they don't know that. If they were asked about whether we should have universal coverage, many would say yes. Some might even comment how it is morally wrong to deny anyone healthcare. But as long as insurance companies are allowed to charge the healthy less than the sick, many of these people will be paying a low amount for insurance (until they need it). While these healthy people may like the idea of covering the poor or the sick, it won't be the first thing on their mind (or the fifth, or the tenth). They will not go to the polls single-minded focused on electing a candidate to enact single payer. In fact, they probably won't be thinking about healthcare at all in most elections.

The solution to this political and moral problem is community rating. In short, it states that the healthy cannot be charged less than the sick for health insurance. It is present in basically every other modern industrialized nation's healthcare system (in one form or another). It is also present in the Senate bill (and is the foundation of the bill).

With community rating, healthcare costs (and benefits reductions) cannot be directed onto a small pool of sick people (leaving the healthy people untouched and satisfied). If insurance companies want to gouge people to raise profits, they will have to gouge everyone equally. If they want to raise premiums by 39% on one or two pools of people, they will have to do so on all pools.

With all the pain of skyrocketing costs directed equally towards everyone (as opposed to mainly the sick), the system no longer remains sustainable. The healthy (like many of the sick today) will now go to the polls and enact pro-healthcare-reform congresspersons, because they are now personally and deeply affected by every cost increase.

Eventually, Congress will be forced to enact policies that lower cost (either through a public option, Single Payer, heavy regulation/price controls, or a combination of these).

But without community rating, such a Congress won't be elected. Large majorities will still report that they are happy with their insurance, while those that are sick will continue to suffer.

[postulater]

1. Interesting idea.

Here's a trend that I see lately.

Healthy people with 'good insurance' having only routine increases in premium, but having their coverage chipped away by higher deductibles and co-pays. This is happening gradually enough that they don't realize it because of course they are healthy and rarely use their coverage. Pretty soon they only have what we used to call 'major medical' coverage which doesn't help them for preventive care or any early treatment but only for catastrophes.

Deductibles that used to be $250 are now frequently $1500-$2500, even 'in-network'.

For many of these people it is like having no insurance at all. They still end up paying for most of their care anyhow.

[BzaDem]

3. This is true, but

with community rating, they will still have higher premiums (so that the sick can have equal premiums). Deductibles will still be an issue (in the sense that healthy people won't always notice them), but once insurance companies have to treat everyone equally, everyone will have the same premiums and deductibles (more or less, this is oversimplified), and both the premium and deductible will make people aware of how much insurance companies are charging.

[postulater]

4. Maybe then the incentive will be for cost-effective preventive care.

[Lydia Leftcoast]

12. Deductibles should be utterly and completely BANNED

All they do is make people hesitate to get NEEDED medical care.

I know. I have a $5000 deductible, and when I fell on the ice last month, I seriously considered not going to the doctor, despite being in serious pain, because I knew how much it cost last year when I sprained my ankle.

Well, I finally did go to the doctor, and it turned out that I had cracked my elbow, but since I saw two different doctors, I'm pretty sure I'm looking at an out-of-pocket expense of at least $1000, which I cannot afford.

If the orthopedist recommends physical therapy, I will have to refuse it. I have an idea how much it costs, based on the last time I had it, nearly 20 years ago, and I'm sure it hasn't gotten cheaper. I definitely cannot afford it.

Deductibles are EVIL.

The excuse given is that they deter hypochondriacs from running to the doctor with every sniffle.

I wonder what the ratio of hypochondriacs is to people who hesitate to meet genuine medical needs.

[BzaDem]

16. That's fine, but I am pre-supposing that this is not going to happen anytime soon.

If you think that this Congress can enact a law banning deductibles for healthcare, then maybe another thread would be a good place to discus the feasibility of such an idea. This thread is pre-supposing that the only healthcare bill that will ultimately pass this Congress (and the next and probably the one after that too, if not the one after that) is the Senate bill with possibly a few tweaks. I consider this to be such an obvious point that I would rather not get into a debate about it here (at least in the case of the current Congress), though there are plenty of other threads where this is discussed. The point of this thread was to discuss whether or not to pass this bill ASSUMING it is the only option on the table for the year.

[Lydia Leftcoast]

21. All you guys talk about is "feasibility"

Banning deductibles is not "feasible" because Congress is bought and paid for and Obama has not even mentioned the idea. Period.

Through most of my lifetime, having health insurance meant either no deductible or one of $500 or less. Somehow the insurance companies survived.

Their imposition of high deductibles for affordable premiums (or even unaffordable premiums in some cases) is sheer greed. Nowadays, they are no better than the Mafia, and a just government would prosecute them for racketeering.

[Edweird]

2. Yeah, right.

:eyes:

[eridani]

5. People who don't have house fires outnumber those who do

Clearly there is no political support for fire departments as a public good.

The Senate bill leaves regulation to the states, which is no regulation at all in practice

[BzaDem]

6. Fires are much rarer than health problems.

This makes them relatively cheap for the government to handle (on a per capita basis where risk is spread). The increase in taxes for having fire protection are TINY compared to the required increases in taxes for having universal single payer healthcare.

This is not a reason not to enact single payer -- but it is a reason why people don't go to the polls (and haven't for 7 decades since it was first proposed) and elect Congresspeople to enact Single Payer.

After all, the current state of affairs basically proves this. As you well state, we do have public fire departments. Yet seven decades after Truman first proposed universal healthcare, it has yet to be formally considered by any Congress. This is because enacting Single Payer will be a huge adjustment and is therefore politically very difficult, and will require HUGE public support -- not just in response to poll questions but by people actually electing single payer candidates. (As opposed to fire protection, which is cheap and simple enough not to require huge single-minded public support to get it enacted politically.) You aren't going to get this huge support from the status quo, where the vast number of healthy people have little incentive to want change (at the expense of the sick, who are affected most by the status quo but are fewer in number).

The Senate bill (state-based regulation and all) is a VAST improvement over the status quo, where there is ACTUALLY no regulation. A rule that insurance companies can't charge more to healthy people than to sick people is pretty easy to regulate (after all, there is no reason why insurance companies could even ask for your health status if such a rule were into effect). Even if there were some loopholes that insurance companies could exploit on the margins (as I'm sure there will be, such as manipulating the coverage network), such a rule is VASTLY preferable to the current system, where it is perfectly LEGAL for insurance companies to charge sick people 20 times as much.

[eridani]

17. The senate bill is a political and policy disaster.

It will still be legal to overcharge people for being sick. And there is no requirement whatsoever that insurance companies have to pay claims. Nataline Sarkisian and people like her are every bit as dead after "reform." States are not now enforcing such laws as they do have, and the Senate bill leaves EVERYTHING up to the states.

The increase in taxes for single payer is trivial compared to the amount we now spend on premiums.

[BzaDem]

20. The differential would be at most 1.5. It wouldn't be 10-20 like it is now.

The only provision that allows an insurance company to charge certain people more or less based upon health status is certain wellness incentives. But this amount (1-1.5x) is trivial compared to the differential between the healthy and sick today (10-20x). To even compare the two as remotely similar is sophistry.

And I hate to break it to you, but most claims are paid. There are many that aren't (certainly way too large a percentage), and this is a huge injustice, but it doesn't take away from the seemingly obvious point that someone with private insurance with a 70-80% actuarial value is MUCH better off than someone without any insurance. This has been shown in study after study, and to pretend that private insurance provides NO benefit to ANYONE is also sophistry (and is often peddled by people who are taking advantage of their own private insurance plans and would never cancel them).

While the increase in taxes for single payer is trivial compared to the amount sick people spend on premiums (and on the average person overall), the healthiest people would actually pay more in taxes (since the government won't charge healthy people less and sick people more). On the other hand, if we switch to community rating (where everyone pays roughly the same regardless of health status), then the taxes for single payer WOULD be less than the premiums paid for basically everyone.

[eridani]

25. The sicker you are, the less likely you are to have claims paid

The CA Nurses found that 21% of claims were not paid. If you have a broken ankle, your odds are better than that. If you have some condition that indicates that you may turn into an expensive hassle, your odds are far worse.

[PHIMG]

7. Keep polishing that turd.

Both bills strengthens the iron grip the insurers have on our health care system and our political system. If these bills pass as is, it will be a Pyrrhic victory...it will majorly hurt the democratic party.

[ddeclue]

8. Stop making excuses for this piece of shit bill. NO!

[Better Believe It]

9. The fact that most people support Medicare for All now undermines your argument

"With the system as it is, change to Single Payer isn't going to be possible, because there isn't going to be enough popular support for it to elect Congresspersons to enact it."

Single payer has majority support now. If the President of the United States and most Democrats campaigned for it, popular support would grow to a huge majority and would pass Congress.

[BzaDem]

10. There's a reason why the last 30 Congresses have each refused to even consider it.

You can make excuses, and talk about failed candidates/lack of backbone/blah blah blah. But in the end, all the excuses and whining aside, not one Congress has even considered it. The people have a choice. If they wanted to, they could find and elect single payer candidates. There was one Presidential candidate that supported it, and many in Congress. Yet each and every election cycle, this doesn't happen. Every single time.

You can claim all you want that a majority supports it. I have seen many reputable polls of late say otherwise, but let's assume for the sake of argument that a majority WILL respond to a pollster in the affirmative when asked about Medicare for all.

Unfortunately, there is a BIG difference between telling a pollster that they like the idea, and them actually going out of their way to find and elect single payer candidates. It is THIS that needs to happen before we get it (again, all excuses aside). Having community rating will provide a large incentive for people who currently are unconcerned or indifferent about healthcare to actually do something about it (beyond replying to a pollster).

[Better Believe It]

11. Because it hasn't been seriously proposed with legislation until recently.

and because by your own admission only one Democratic presidential candidate supported single payer!

Who do you think that was?

The sad fact is, most Democrats in Congress have refused to even consider single payer. It's off the table for them.

What are voters suppose to do with these politicians, break their arms, beg for support or take your advice and give up?

Now do your research.

Do you know how many co-signers the Senate single payer bill has?

None.

Senator Bernie Sanders has been unable to obtain even one Senate co-sponsor so far!

That's not very many in the Senate.

[BzaDem]

15. Your causation is going in the wrong direction.

You say that Single Payer hasn't been enacted (in part) because only one presidential candidate supported it. But the proper question is, WHY did only one presidential candidate support it? And WHY did he get a negligible percentage of the vote? Why is it the case that every presidential election, the PEOPLE don't take single-payer candidates seriously?

You also say Single Payer hasn't been acted (in part) because it hasn't been seriously proposed with legislation until recently. This is actually false; Congressman John Dingell has been introducing a Single Payer bill in every Congress since 1957. You are basically saying that Single Payer hasn't been enacted because Congress refuses to consider it; I am saying that Congress refuses to consider it because the people continue to refuse (mostly out of indifference) to elect a Congress that will enact Single Payer. You are asking and answering the wrong question. You act as if Congress is some sort of static force immune from all political pressure no matter how much pressure the people exert. You fail to realize that Congress actually is ultimately (directly in some ways and indirectly in others) accountable to the people, and this accountability is frequently realized over the long term even if not immediately realized in the short term.

You can continue to make excuses without realizing that every single one of your excuses is actually just a symptom of the larger problem. But your excuse-making isn't actually helping enact Single Payer. It isn't helping solve the problem of indifference to our healthcare system's problems among most people. Community rating (in the Senate bill) would help solve this problem. But if you don't think so, why not propose your own solution that is actually feasible (as opposed to more excuse-making)? Community rating is one 15 minute roll call vote away from becoming law. If you have another idea that is even easier to help with the problem of healthcare indifference, I'd love to hear it.

[eridani]

18. California passed single payer TWICE

If we get a Dem governor, it's a done deal.

[BzaDem]

19. Because of course California is perfectly representative of America. n/t

[Better Believe It]

22. California is a great representation of the United States.

It has over 10% nation's population and it's very diverse.

Or do you think the "white" rural population states like the Dakota's, Utah, Montana, Idaho, etc., are much more representative of the United States?

[eridani]

24. Actually it is. What happens there will happen all over the country later n/t

[dysfunctional press]

13. medicare isn't single payer.

it's 80% of single payer.

someone else has to pay the other 20%.

and when you cannot get supplemental coverage(like me), that someone is you.

and not everything is covered, either. (think vision, dental, and hearing)

[PHIMG]

23. IMPROVED MEDICARE FOR ALL IS SINGLE PAYER

HR676 is the Expanded and Improved Medicare for All Act, this is what "Medicare for All" is. It is Single Payer, has very comprehensive coverage including all the things you mentioned and and has no ($zero) out of pocket expenses for the patient.

MEDICARE FOR ALL = HR 676 = SINGLE PAYER = REAL HEALTHCARE REFORM.

Accept no substitution.

[slipslidingaway]

14. Unrec - could not get past the first six words ...

"Why a public option/single payer..."

The proposed public option that might cover 6 million people cannot be compared to a Medicare for All national HC plan.