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The Wrongheaded Belief In "The Market" For Health Insurance

By Big Tent Democrat, Section Other Politics
Posted on Thu Sep 17, 2009 at 08:16:56 AM EST
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Senator Ron Wyden (D-OR) is the legislative voice of the view, championed in the blogs by Ezra Klein and on cable TV by Dylan Ratigan, that "the market" can cure what ails health care in this country. Wyden writes a NYTimes Op-Ed arguing for this view:

The problem with these [health care] bills, however, is that they would not make the exchanges available to all Americans. Only very small companies and those individuals who can’t get insurance outside of the exchange — 25 million people — would be allowed to shop there. This would leave more than 200 million Americans with no more options, private or public, than they have today.

Wyden then argues for his bill - which has as much chance of passing as does single payer. Which is to say none. But even if it did become law, it would not work imo. The notion that insurance companies will compete amongst themselves in a way that will improve health care is simply a fantasy (See Scarecrow on the MA experience.) They never have and they never will. The only way competition would actually work to improve health care is where a public option is available. Wyden and his fellow "market magic" advocates do not care about a public option. Certainly their right. But they are wrong, imo. In any event, it is all academic as the Wyden proposal never even can arrive now, much less be DOA. It is a discussion about unicorns.

Speaking for me only

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    The Wrongheaded Belief In "The Market" For Health Insurance | 90 comments (90 topical)

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    The market did not cure (5.00 / 4) (#1)
    by Militarytracy on Thu Sep 17, 2009 at 08:25:45 AM EST
    anything that ailed the now functioning healthcare of any of our sister industrialized nations.  We have "the market" right now, why is health care so sick and why are our people the sickest of the primary industrialized nations?

    A dysfunctional healthcare system. (5.00 / 4) (#11)
    by inclusiveheart on Thu Sep 17, 2009 at 08:49:54 AM EST
    That's what the market has yielded here.

    But it hasn't be a free market.  Let me change health insurance providers on an hourly basis and allow me to sue them when they fail, and then we might see what a market model really would do - I think that it would put the health insurers out of business - because their business model is a failed model - there is nothing viable about it on the free market - that's why health insurance should be left to government - an entity that is not driven by profit-taking and is in theory supposed to act in the best intersts of the people it serves.

    Parent

    We were talking the other day around here (5.00 / 4) (#13)
    by Militarytracy on Thu Sep 17, 2009 at 08:52:30 AM EST
    about how insurers just walked away from New Orleans but we are supposed to trust them with our only real possession.

    Parent
    True, it is also just fine (5.00 / 3) (#72)
    by KeysDan on Thu Sep 17, 2009 at 12:17:15 PM EST
    to have the federal government insure our money (FDIC).  And, I wonder how many people trust those nice free market bankers and AIG type insurers to back-up their cash deposits.  Maybe, we should have private insurers for savings accounts.  I am sure that a eMDIC (ersatz Madoff Deposit Insurance Corp) would fill in any governmental voids.  

    Parent
    Well said... (none / 0) (#26)
    by kdog on Thu Sep 17, 2009 at 09:20:54 AM EST
    nobody knows if a free market would deliver healthcare more inclusively and more efficiently because we've never had a free market in this country...never.  It's been a rigged market since they signed the damn Constitution, and rigged to varying degrees ever since.

    Parent
    C'mon DogMan; (5.00 / 1) (#61)
    by NYShooter on Thu Sep 17, 2009 at 11:37:22 AM EST
    Don't be so cynical.

    No matter how corrupt Congress is, we finally elected a man who promised us he would change the way Washington works. Yessir!

     "Change," is what we wanted, "change" is what he promised.

    (According to the Center for Responsive Politics, Obama still ranks near the top among all recipients when it comes to contributions from the health, defense, and energy industries. Andy Kroll, Salon)

    Parent

    And when the opportunity (4.00 / 3) (#85)
    by cal1942 on Thu Sep 17, 2009 at 04:17:25 PM EST
    for change came about.  When those "little single-payer people" asked about single-payer?

    Mr. Change said -- too much change, we need to stick to what we've got.

    Parent

    Be the Change (none / 0) (#87)
    by Militarytracy on Thu Sep 17, 2009 at 05:30:18 PM EST
    Be the Ball.  If he says it in a speech make him deliver it up or prove he isn't a liar.

    Parent
    It isn't true that nobody knows whether (5.00 / 2) (#64)
    by inclusiveheart on Thu Sep 17, 2009 at 11:50:15 AM EST
    a free market system would work.  The health insurers KNOW that it wouldn't.  That's why they've spent billions of dollars lobbying Congress to protect their profit margins over the past 20 years.  In fact, they are the ones who said that they could not survive without Congress' protection on numerous occasions.  I remember when they said that they couldn't remain viable if they didn't have the right to drop expensive patients from the rolls - so Congress gave them that right.  That right there is a complete and clear admission that providing health insurance coverage is not a viable business model if you are in it for profit.

    Parent
    Of course... (5.00 / 1) (#77)
    by kdog on Thu Sep 17, 2009 at 01:07:45 PM EST
    a free market wouldn't work as well for insurers as the current "rigged in their favor" market does...I was talking about our society at large, would it work better for Joe and Jane Blow? Would it lower costs and increase availability?No one knows because it has never been attempted.  

    I gotta say I'm curious, as an evangelical freedom extremist...it could be a disaster, it could be a smashing success.

    Sadly we will never find out because no one has the stones to try it...definitely not the beneficiaries of the rigged market aka insurance companies, definitely not the government, and not the people because that kinda freedom scares us.

    Parent

    As President Nixon used to say, (none / 0) (#80)
    by NYShooter on Thu Sep 17, 2009 at 02:16:24 PM EST
    "Let me say this about that." Or, as I like to say, "Let's start at the beginning."

    Is health care a "privilege," or a "right?"
    I, along with the rest of the civilized world, believe it's a "right." What could be more important? We have a "right" to be protected from foreign enemies (Our military); we have a "right" to try and extinguish our blazing houses (Fire Department); we have a "right" to drink potable water, and breathe safe air (EPA). So, why not a "right" to expect available, and affordable, health care? All other democracies have figured this out; their citizens demanded it; and their governments provided it. So, this is not something new, radical, or ground-breaking. It's just basic, common sense.

    So what's the problem? Why do we (those that have health insurance) pay more than twice as much per person as other countries, and get "care" that's statistically inferior to most other countries?

    K-dog, you know the answer to that; it's the "vig." It's the blackmail forced on us by the middlemen (insurance companies, HMO's, etc) They are, like our appendix, useless, worthless, and unnecessary entities foisted on us as a conduit to pay their executives obscene incomes, return outlandish "profits" to their shareholders, and provide  a "legal" means to pay-off (buy) our Representatives.

    When your lawn needs mowing, you ask the neighborhood kid, "how much?" he says, "ten bucks," and you've got a deal. You don't go to the neighborhood "agent" and pay him/her twenty bucks to arrange getting your lawn mowed; yet that's exactly what we're doing with our present health care system.

    So, by all means, let's have a "free, open, and competitive system. But it's not free, open, or competitive if you're only allowed to deal with "agents."


    Parent

    I must not be civilized... (none / 0) (#82)
    by kdog on Thu Sep 17, 2009 at 02:44:31 PM EST
    because I don't think healthcare is a right, how could it be when you're depending on someone else's labor to deliver it?  The only healthcare right we have...err should have...is the right to self-treat and self-medicate.  That right can be defended...the right to have someone else set your broken leg cannot.  It's a good, noble, moral idea to make healthcare affordable and available to all...but to call it a right, when it is obviously not, only clouds the issue.  Lets call it a good idea.

    That semantic argument aside...I'm all for cutting out the middle-man...thats a free market principle right there that will reduce costs.  Go to the doctor or hospital, get served, pay the bill...the cost of care goes down significantly right there with doctors/hospitals competing for the business and the leecherous middle-man eliminated, at least on common procedures that don't, or shouldn't, cost tens of thousands of dollars.  

    The rub comes in for the catastrophic illnesses and mega-bucks care that 90% of Americans could never afford out of pocket...the government could play a role there by collecting taxes and putting them aside in a national catastrophic healthcare fund to help out anybody struck with such bad luck pay the bills.  Could swing it with no tax increase too if we disband the DEA, cancel the occupations, and cut the CIA/DOD budget in half...probably with some left over for a tax cut!

    And the dark ages of health insurance companies deciding what procedures are covered, who lives well and who don't, who lives and who dies...are finally forever behind us.

    Parent

    Getting closer; (5.00 / 1) (#88)
    by NYShooter on Thu Sep 17, 2009 at 11:54:02 PM EST
    There's hope yet.

    So, to your point, "let's not get caught up in semantics." Do you believe we, as American citizens, have any "rights?" The Constitution says we do, and furthermore, they put an exclamation point on it with "The Bill of Rights." So, the fact that we do have rights has been established; we're just debating what should be "in," and what should be left "out."

    Now, "semantics" is a funny thing; by using it you can make words mean anything you want them to mean. So, I won't take a back seat to anyone in my love of Freedom, but I'll bet you can't find two people whose idea of Freedom is the same. The Insurance companies believe in Freedom; they want to be free to sell to whomever they want, and charge whatever they want. We, of course, are also free; we can choose to pay their exorbitant fees.....or die. There's a free choice for you.

    Only in America will you find people at the lower rungs of our society "fighting to the death" to protect the 1% Robber Barons' Freedom to fleece the remaining 99%. (Rush Limbaugh's $300,000,000 paycheck is a tiny price to pay for delivering 15,000,000 zombies to the voting booths every November)

    Now, I don't know if you're "civilized" or not. Regardless of your doubts, I'm betting that you are. So, I'll repeat what I said before, "the rest of the civilized world" has made the determination that there are benefits that come with being a citizen of progressive, enlightened, and compassionate countries. Among the numerous "rights" these advanced countries share with their citizens, what could be more important than health care?

    Finally, there's no such thing as "good" government, or "bad" government. There's only good "people" utilizing government for "good" purposes; or there's........George Bush.

    p.s. I like a lot of your ideas too; lemme know where the rally will be.


    Parent

    I think we're on the same page.... (none / 0) (#89)
    by kdog on Fri Sep 18, 2009 at 08:12:29 AM EST
    Shooter...when I think rights I think natural rights, the ones Jefferson said the creator endowed us with...but it makes little difference what we call the good idea of taking care of each other...as long as we take care of each other.

    I don't know how the good people make government work for us as long as good people continue to vote for shady people with D' and R's after their names...this b*tch is broken man, so broken...the healthcare "debate" illustrates the point beautifully.

    Parent

    That makes the p*ssant public option... (5.00 / 1) (#2)
    by lambert on Thu Sep 17, 2009 at 08:39:03 AM EST
    ... a unicorn, too, right?

    Given that it's supposed to be "keeping the insurance companies honest" by introducing a "public option" (or "plan") to supposedly compete with them, right?

    Nope (5.00 / 3) (#5)
    by Big Tent Democrat on Thu Sep 17, 2009 at 08:43:27 AM EST
    A unicorn, as I used it, refers to chance of passage.

    Neither Wyden's bill nor single payer have ANY chance of passage. None. Zero. Zip. Not gonna happen.

    The public option is very much in the game.

    Even Anthony Weiner knows that.

    In your defense, your unicorn actually is the best policy. Wyden's is lousy policy.

    Parent

    So this would really be a meta-unicorn, then (none / 0) (#86)
    by lambert on Thu Sep 17, 2009 at 04:59:12 PM EST
    A bill that would solve the problem and cannot pass is a unicorn.

    A bill that cannot solve the problem and will pass is a meta-unicorn.

    Assuming that a meta-unicorn is not a unicorn, as I think we can.


    Parent

    The exchanges (5.00 / 4) (#3)
    by lilburro on Thu Sep 17, 2009 at 08:41:55 AM EST
    just seem politically fragile to me.  What is preventing a Republican government from coming in and removing all the regulation?  

    I'm among the few who think there's a real possibility that the new regulations will lead to a much more efficient and humane private insurance industry, but it is, after all, only a possibility. It's much likelier to happen, however, if they're protecting themselves against real competition in the market. And if it doesn't happen even in that scenario, then at last people will actually have somewhere to go.  [Ezra link]

    I am increasingly of the school of thought that if you can't even pass a public option, don't bother passing any actual "reform."  And after last year's election that is a depressing place to be in.

    Again, Ezra on Baucus' bill:

    It is, in fact, a moderate Republican bill.

    A moderate Republican bill, eh?  That sort of reminds me of our so-called last "moderate Republican" President.  Think we'll hear Obama called that in the blogosphere?

    Yes he is among the few (5.00 / 1) (#6)
    by Big Tent Democrat on Thu Sep 17, 2009 at 08:44:11 AM EST


    Parent
    Conrad is very proud of his Republican bill (none / 0) (#62)
    by MO Blue on Thu Sep 17, 2009 at 11:38:48 AM EST
    On Andrea Mitchell, Sen. Kent Conrad came on at the end of the show and read off a list of things that Republicans should be so happy to support in the bill. It was as if Baucus and Conrad wrote a bill that caters to the Republicans and his Gang of Six committee. It was disgusting watching him gush when he said there was no public option in the bill because Republicans didn't want it. He then read off more and more things that Grassley wants in the bill and it's as if he really thinks there's a chance in hell that they will vote for his bill. C&L

    Seems if Conrad has his way, the bill could become much worse.

    Parent

    They need to read (5.00 / 1) (#4)
    by Cream City on Thu Sep 17, 2009 at 08:42:58 AM EST
    an LA Times column that lays out the "alarming" stats today:

    Opponents and supporters of healthcare reform toss assertions about them back and forth. Their number is debated -- are they 46 million people? 30 million? Eight million? Their motivations for not having health coverage are questioned: Are they "young invincibles" who think they're too healthy to need it? Too rich to need it? Or just cheapskates?

    And let's not ignore the aspersions cast on their character: "A citizen who accepts personal responsibility for his welfare has no real problem getting health insurance," one reader wrote me recently.  Moral fiber and a clean lifestyle are all that's needed to secure adequate healthcare, apparently. . . .

    But efforts to minimize the plight of the uninsured don't stand up to scrutiny. The latest figures, setting the number of uninsureds at 46.3 million people as of the end of 2008, were released last week by the U.S. Census Bureau, and they make the case for reform stronger than ever.
    Define "reform" (none / 0) (#7)
    by Big Tent Democrat on Thu Sep 17, 2009 at 08:44:50 AM EST


    Parent
    Baucus thinks reform is (5.00 / 1) (#9)
    by inclusiveheart on Thu Sep 17, 2009 at 08:45:57 AM EST
    indentured servitude.

    Parent
    I loved (5.00 / 3) (#12)
    by TeresaInSnow2 on Thu Sep 17, 2009 at 08:50:02 AM EST
    how he and his Cheshire cat grin were standing alone when he announced his "plan".  Nobody else wanted to own it.  That's a good sign.

    Parent
    It is terribly funny (none / 0) (#16)
    by Militarytracy on Thu Sep 17, 2009 at 08:58:02 AM EST
    There any Democrats standing with him and there aren't even any Republicans standing with him.  But it seems that David Axelrod sees something standing behind him in the scary mist.....ghosts of health care reform past maybe?  I think we should all chip in for Axelrod therapy so he can deal with his past issues that are stagnating his current life :)

    Parent
    Will be back to do so -- (none / 0) (#28)
    by Cream City on Thu Sep 17, 2009 at 09:30:11 AM EST
    and enjoy this discussion later; gotta go inflict education on the young "invincibles."  

    Covering the Metis era and culture today and hoping to have them think about how our history could have been so different -- for Native Americans as well, especially women, had the French not lost the French and Indian War . . . and then had not the Brits lost our region again twenty years later.  Our region might have national health care now, and we would be as puzzled as are the Canadians "aboot" you odd other Americans and your resistance to it.

    Anyway, I just found the link an interesting and perhaps useful article to get a few more facts straight.

    Parent

    Uninsured (none / 0) (#29)
    by MO Blue on Thu Sep 17, 2009 at 09:30:48 AM EST
    It would only reduce the number of uninsured by 29 million. That leaves about 17 million Americans/legal residents uninsured (and around 8 million illegal immigrants uninsured). That means 37% of currently uninsured Americans/legal residents will still be uninsured. Baucus's bill will only reduce the number of uninsured Americans/legal residents by 63%. Lots of money, no universal coverage, and almost half the uninsured still uninsured. FDL


    Parent
    But again, looking at the percentage (5.00 / 2) (#50)
    by Anne on Thu Sep 17, 2009 at 10:39:37 AM EST
    of people who will or won't be insured still does not address the real issue: CARE.  I know people are looking at that 63%-insured figure and thinking, "wow - that's however-many-million people who didn't have insurance before - Yay!" but it tells us nothing about what kind of coverage, what kind of cost, what the out-of-pockets and deductibles are - that still may stand in the way of someone actually getting the care they need - and for the life of me, I do not understand why this is so seldom discussed.

    I know I am a broken record, but the focus should have been about CARE, about how more people can get the care they need and not go broke doing it.  Wading through the weeds of the various proposals, including the execrable Baucus Plan, which are head-spinningly complex, and with what looks like oodles of room for insurance companies to wiggle and parse their way to maintaining their business model, it is clear to me that there is no way on God's green earth that even the people who have written these plans could possibly understand and grasp the totality of what they are cooking up - much less Average Joe and Jane who are relying on the media to tell them what they need to know.

    "The market" - sigh.  I guess some people still think those are the magic words that will fix everything, but usually when I hear them, I think those lobbying for its application are really just making sure that they will keep what they have, will make even more money off those who are captive to the market, and those who don't have, and can't keep up?  Well, who needs them, anyway?

    Could we just for once be the people and the nation we want the world to think we are?

    Parent

    I agree that the emphasis needs to be (none / 0) (#63)
    by MO Blue on Thu Sep 17, 2009 at 11:46:09 AM EST
    on health care. Affordable health care.

    The original goal was for universal affordable health care. The Baucus bill does not meet either criteria. A lot of money will be spent and the only beneficiaries will be the insurance industry, Pharma etc and politicians receiving big bucks for their sell out.

    Parent

    It really isn't academic. (5.00 / 4) (#8)
    by inclusiveheart on Thu Sep 17, 2009 at 08:44:56 AM EST
    The thing is that too many of the leading players who are offering up solutions are engaged in either magical or misrepresentative thinking.

    Louise Slaughter is over at Dkos saying that the extremely limited Public Option put forth by Obama is going to reduce healthcare costs.  It won't - it simply won't because it will only affect about 3% of the marketplace if that.  That is not what one can reasonably call a "market mover and shaker".  She may believe it will have an impact - but it will not.

    None of these people seem to have the courage to take this problem head on.  I think they should walk away.  But they won't.  They'll attempt to make it look like they are doing "something" and won't care about how much damage they are doing to the people of the US.  It is a problem.  A real problem.

    Well (5.00 / 1) (#10)
    by Big Tent Democrat on Thu Sep 17, 2009 at 08:49:45 AM EST
    As I have said repeatedly, either you accept it is a "caml's nose under the tent" proposal, or you do not.

    If you do not, then the question is what do you suggest given the political realities TODAY? Wait for different realities?

    It's fun to say no to the public option but please propose a realistic alternative for today.

    Parent

    Will the camel's nose actually be (5.00 / 1) (#14)
    by inclusiveheart on Thu Sep 17, 2009 at 08:53:34 AM EST
    under the tent BTD?  Seriously.  I don't think that it gets in under this plan.  Give the public option the chance to compete in 20-25% of the marketplace and then you have a nose under the tent, but at less than 3% you're just setting up a model to which the GOP can point and say, "We told you that this idea would never work."  All I am saying is that if they pass something that meets few to none of the objectives that have been set forth in this debate - recuding costs being the biggie - then they will be setting themselves up for political disaster.

    Parent
    So you say NO to the public option (5.00 / 3) (#17)
    by Big Tent Democrat on Thu Sep 17, 2009 at 08:58:54 AM EST
    as proposed today because you believe it will fail.

    I disagree with you. 5% of the population (15 million) is certainly a big enough pool to show it will work.

    In addition, if the subsidies are increased and the Medicaid eligibility levels raised, we are putting much more than 5% into a public option. It will be more like 22 million.

    That's not nothing.

     

    Parent

    I believe it will fail to meet the (none / 0) (#30)
    by inclusiveheart on Thu Sep 17, 2009 at 09:33:18 AM EST
    objective of reducing costs.  It might improve access which I care about, but the debate as it has been set up by far too many people, including the President, has been about reducing costs.  If the plan that they pass doesn't reduce costs, then they will be viewed as failures which I think is a bad thing on a lot of levels.

    I don't think that they have the ration right at this point.  Whether I say "No" or not is irrelevant really.  I am just saying that they won't be meeting a key objective with the current plan and that that will come back to bite them - especially if they hold onto those mandates.

    Parent

    But not the costs within (none / 0) (#31)
    by Big Tent Democrat on Thu Sep 17, 2009 at 09:34:12 AM EST
    the public option itself.

    Parent
    The costs within the Public Option (5.00 / 1) (#35)
    by inclusiveheart on Thu Sep 17, 2009 at 09:57:35 AM EST
    itself will be subject to market forces just like Medicare is.  Sure, Medicare is "better" than private insurance administration at keeping costs low, but Medicare is still covering hidden costs that exist because of our dysfuncional for-profit system that dominates the marketplace.  That's my whole point.  Medicare sets rates against an already expensive system so there is only so much they can do to reduce the costs.  That is why so many people are saying that Medicare is going to collapse in eight years - because under the current rate of inflation in the sector - they won't be able to keep up.

    The biggest hidden cost in the current private system is non-payment of claims - that is not just the hospital that treats a patient and finds no way to recoup their costs after the insurance company denies the claim and the patient has no means to even pay a fraction of the cost.  It is all the rates that are set higher to protect against non-payment - the treatments withheld because of claims disputes that end up allowing the patients to get sicker and therefore more expensive - there are surcharges all over the place that are meant to protect the providers from being hit with losses because our system is unpredictable, the negotiated rates are all over the place and the dollar amounts are so ridiculously high at this point that none but the smallest portion of the population would ever be able to pay cash when all else fails.

    Dylan Radigan said this is a math problem, not an ideological problem and he was exactly right.  No one so far in a leadership position is really sitting down and just doing the math here to see what we need to do to reign all of this in.  Well, Baucus has done a nice job of doing the math for the private insurers.  What we need is someone interested in looking at the problem free from ideological restraints from the prospective of this nation and the people who live here.  Then at least they might see that in order to make incremental progress, their plan has to have some statistical and market significance in shifting the momentum away from astronomical healthcare costs.

    Parent

    No Dylan Ratigan is wrong (5.00 / 2) (#40)
    by Big Tent Democrat on Thu Sep 17, 2009 at 10:04:03 AM EST
    For example, Ratigan believes that applying "market forces" to health care is all the change you need. That, I argued in my post, is simply wrong.

    Second, it is not just a "math problem." It is a problem of how to discipline the health care industry. No one does it better than public plans, Medicaid and Medicare.

    Are they perfect? Of course not. What they are is BETTER than private insurance. So will be a public option.

    Parent

    Yeah - Dylan Radigan gets a lot (none / 0) (#43)
    by inclusiveheart on Thu Sep 17, 2009 at 10:12:21 AM EST
    wrong, but not the math problem assesment imo.  10 million people on the Public Option won't be statistically significant on the cost front.  Am I happy that more people might get access to care?  Yes, of course I am.  But that doesn't change the fact that it won't move the needle in the market.  It simply will not.  A more robust public option would and could, but it has to be more robust than this proposed iteration or it will end up being meaningless in changing the cost factor.

    Parent
    On the cost front for those 10 million? (none / 0) (#49)
    by Big Tent Democrat on Thu Sep 17, 2009 at 10:30:13 AM EST
    Of course it will have an effect.

    But I hope I do not have to repeat my camel's nose story again.

    this is getting to be an absurd circular discussion.

    Parent

    Slaughter argues that the PO as is will (5.00 / 1) (#56)
    by inclusiveheart on Thu Sep 17, 2009 at 11:11:35 AM EST
    reduce overall costs of healthcare.  She is wrong.  Will they reduce costs to individuals who qualify for the PO?  That remains to be seen especially since the marketplace won't have any significant mover to drive costs down.  Nothing circular about this discussion.  The Public Option needs to be bolstered if it is to meet a key objective put forth by the President and congresscritters like Slaughter.  Or they should drop the claim and go with access as their selling point.

    Parent
    I don't get your (none / 0) (#53)
    by SGITR on Thu Sep 17, 2009 at 10:56:47 AM EST
    argument. I agree that health care costs (doctors, hospitals, drugs, etc) are too high. Those are the costs that really need to be reduced. If they were then theoretically insurance premiums would go down because of reduced claim outlays.

    So just how does expanding the public option to more people drive down health care costs (doctors, hospitals, drugs, etc)?

    It really does not matter if you had the entire nation on a less expensive public option, that still does nothing to reduce what is charged by the for-profit health care providers.

    As an aside, where this country went wrong is when it allowed the non-profit hospitals to change to a profit model. That is when we lost control of health care costs. Sounds like regulation is in order for that industry.

    Parent

    Much of the wasted money (5.00 / 1) (#59)
    by inclusiveheart on Thu Sep 17, 2009 at 11:29:50 AM EST
    in the system doesn't go towards actual healthcare.  Basically, the system in its current iteration is unstable and unpredictable both of which play a huge role in driving up costs.  Prices are all over the place for instance.  I asked a cardiologist at a summit meeting on minority care a couple of years ago what it cost to have a particular cardiological procedure.  He said it was anywhere between $20,000 and $90,000 depending in large part on where people are when they need the implant.  That's pretty a pretty vast "range".  The particular device we were discussing is sometimes implanted in emergency situations - not always - but sometimes.  In any case, the point is that if you need it and you happen to have been taken to the most expensive hospital in your region, then you're on the hook for the high number.  Then your insurance company may or may not agree with the physician's decision to do the emergency implant.  If they do not, then you're on the hook personally and so is the hospital who knows that your total assets only amount to the low number.  Which is why they charge super high numbers in the first place because they are hedging against patients whose insurance won't pay and can't pay themselves.  It is a viscious cycle that can only be broken by setting prices for procedures the way they do it in Medicare - and paying on claims rather than avoiding paying the way they do it in Medicare.

    Private insurer's economic model is failed.  They would not be making money were it not for Congress enacting a slew of legislation that protects both their monopoly and their "right" to profit.  And at the end of the day, the only winners in this equation are the private insurers.  That is the ONLY reason that this debate has gotten as far as it has.  Had the private insurers shown some small amount of restraint in denying claims, hiking up premiums and shafting providers, there would be no real movement to mess with the status quo.  They over reached and even doctors - their last best constituency - have begun to abandon their cause in droves.

    Parent

    Alright (none / 0) (#81)
    by SGITR on Thu Sep 17, 2009 at 02:39:05 PM EST
    But you didn't explain how expanding the public option beyond it's initial small circle of those covered would reign in those high health care costs you and I both agree with. If anything the public option like Medicare would pay less than private insurers do. That being the case would leave the patient on the hook for even more of what their insurance didn't pay wouldn't it?

    You see the thing is that this entire HCR discussion is centered around insuring and does not even address where the bulk of the runaway costs are, and that is with the hospitals and the care givers. Even the public option doesn't directly address that problem. So expanding it isn't the answer to those problems. Yes expanding it would insure more people but that doesn't get to the core of the problem.

    Parent

    Medicare (none / 0) (#42)
    by TeresaInSnow2 on Thu Sep 17, 2009 at 10:10:06 AM EST
    reimbursement rates haven't kept up with inflation.  That's part of how Medicare remains so cheap in relation to other programs.  

    I'm tired of the argument that putting people on the already broken Medicare is an answer.  Doctors are more and more refusing to take Medicare patients.  Adding more patients to a system with only a limited choice of doctors makes that system even worse.

    Link

    If you look at Russ Feingold's healthcare statements, Medicare reimbursement is always one of his issues.

    Parent

    You've posted this comment umpteen (5.00 / 3) (#47)
    by inclusiveheart on Thu Sep 17, 2009 at 10:20:25 AM EST
    times.  I've never responded to you because you are clearly looking at the problem from such a narrow perspective that it seemed like a waste of time to bother.  Some physicians are opting out while others are opting in because Medicare tends to make good on its promise of payment for one thing.  But the big picture is that just about every market force in the healthcare sector is rising in cost and programs like Medicare are being piched as a result.  They aren't like the private insurers who can decide on a given day that they are going to just reject a certain amount of claims so that they can protect their cash.  Medicare has to pay on those things that they say they cover.  Meanwhile, much of the cost increase is due to the fact that the private insurers make it their business not to pay.  So everyone providers, patients and government programs get squeezed while the private insurers make out like bandits.

    Parent
    Lack of sufficient numbers (none / 0) (#55)
    by SGITR on Thu Sep 17, 2009 at 11:07:24 AM EST
    of practitioners in Medicare is not the only place where insufficient numbers of practitioners may be a problem. I read the other day that if you add 46 million more patients to the system overnight that it could become overloaded, that wait times for appointments could increase.

    Now whether that is true or not I don't have the evidence to say. But it is certainly a possibility and should be researched.

    And even if true I'm not saying that 46 million should not be insured. I guess the solution is hope that their are enough doctors from India that want to come here and practice.

    Parent

    I think Masslib answered (none / 0) (#19)
    by dk on Thu Sep 17, 2009 at 09:05:15 AM EST
    that challenged very well in a comment yesterday.

    Raise Medicaid to 150% FPL(all the proposals do this to varying degrees), make it available to childless adults(all the proposals do this), nationalize it(all the proposals do this), and fund it(not sure any of the proposals give it full funding).  That right there covers half the currently uninsured.

    Raise SCHIP to include young adults up to 26.

    Offer Medicare buy-in for 55-64 year olds(baucus actually proposed less but something like this this spring, Rockefeller has a proposal for this on the table).  

    Pay for these buy giving negotiating power to Medicare Part D, and cutting subsidies to Medicare Advantage.



    Parent
    Sure (5.00 / 2) (#20)
    by Big Tent Democrat on Thu Sep 17, 2009 at 09:09:04 AM EST
    That's not reform though.

    I have argued that if we can't get a public option, then let's scrap the word "reform" and just fund helping less well off people with Medicaid expansion and subsidies.

    And if we can get the 55 age limit for Medicare, so much the better.  

    Parent

    Well, I don't (none / 0) (#21)
    by dk on Thu Sep 17, 2009 at 09:13:02 AM EST
    share your opinion that the inadequate public option is reform either.

    So, if there is no chance at reform no matter what (those unicorns are off the table), I think this, or something like it, is the most empirically supported way to get healthcare to people.

    Parent

    I have said it so often I wonder that I need to (none / 0) (#23)
    by Big Tent Democrat on Thu Sep 17, 2009 at 09:15:28 AM EST
    AGAIN.

    "Camel's nose under the tent."

    Either you buy it or you do not. But let's stop game playing with what I think on the issue.

    Parent

    I can imagine that within 1 year of the (5.00 / 2) (#32)
    by steviez314 on Thu Sep 17, 2009 at 09:47:55 AM EST
    public option taking effect, the Chamber of Commerce will be begging to let small (and big) businesses stick their noses under the tent too.

    I expect that the new town hall meetings will be about "why can't I join the public option?"

    Nothing animates Americans more than wanting what others have.

    Get the 5% in the public option, and watch the clamor for it to get more inclusive, not less.

    Parent

    Right! (5.00 / 2) (#34)
    by Steve M on Thu Sep 17, 2009 at 09:51:40 AM EST
    Anyone who has a gripe with their current insurance situation will want access to the public option.  The political momentum will grow and grow.  There will be no constituency for scaling back or eliminating the public option once it exists, any more than Congressmen were successfully elected in 2006 on a pledge to get rid of Medicare Part D.

    Parent
    I'm beginning to wonder (none / 0) (#36)
    by lilburro on Thu Sep 17, 2009 at 09:58:13 AM EST
    if Obama shouldn't just embrace the "nose under the tent" theory.  People worried the public option will lead to more "government-run" healthcare are right - hopefully, it will.  If it doesn't, it doesn't.  But it is worth a shot.  And this is totally the FDR type of leadership that Obama could've displayed.  He took a shot at it:

    At a White House press conference on Tuesday, Obama said: "Why would it drive private insurance out of business? If private insurers say that the marketplace provides the best quality health care; if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business? That's not logical."


    Parent
    We've had a public option (none / 0) (#37)
    by dk on Thu Sep 17, 2009 at 09:59:39 AM EST
    for 40 years.  It's called medicare.  Where has the clamor been?

    I just don't see your argument being supported by history.  All I can do is look at the inadequate public option being pushed, and the lack of any evidence showing that it will be sustainable in its inadequate form.

    Parent

    Hold up (5.00 / 1) (#41)
    by Big Tent Democrat on Thu Sep 17, 2009 at 10:05:02 AM EST
    Are you arguing there is no clamor for it now? Really? What exactly are you doing?

    Parent
    Not what I'm arguing. (none / 0) (#46)
    by dk on Thu Sep 17, 2009 at 10:15:34 AM EST
    I think a lot of people are clamoring for public option for all, including some more enlightened business folks.

    I was disagreeing at the idea that once the inadequate public option went into effect, the Chamber of Commerce would suddently clamor for an expansion.  Is there any evidence for that?

    Parent

    Here' my question. Why isn't the (none / 0) (#48)
    by oculus on Thu Sep 17, 2009 at 10:22:54 AM EST
    Chamber of Commerce all over the idea of getting employers out of the health care insurance provision business as soon as possible.  Keep hearing what a crippling burden this is on businesses.  

    Parent
    Well (none / 0) (#52)
    by Steve M on Thu Sep 17, 2009 at 10:49:08 AM EST
    it is moreso a burden on the major corporations that need to compete internationally.  The Chamber of Commerce's membership is like 97% small businesses, most of which don't care about competing on a level playing field with foreign companies.

    Parent
    OK. Then why aren't the major (none / 0) (#57)
    by oculus on Thu Sep 17, 2009 at 11:16:43 AM EST
    corporations which do provide employee health insurance to remain competitive hollering to get out of this expensive task?

    Parent
    You mean like Medicare? (none / 0) (#79)
    by DWCG on Thu Sep 17, 2009 at 01:38:13 PM EST
    Again, I wonder how so many people claim to be for a public option that is "like Medicare" (which is a flat out LIE) instead of being for a public option that IS Medicare?

    The program that people want to buy into is Medicare, in large part because it is so much cheaper.  And it so much cheaper because it:

    -operates as a near monopoly (97%) on a segment of the population; and
    -it's huge.

    The public option is NEITHER.  So how people can expect the public option to offer rates comparatively low as Medicare and thereby be something people clamor for is frankly delusional.  

    CBO in it's letter in Enzi confirmed that despite being a non-profit, the P.O. would be the same as those offered in the private sector.  That's likely partially because of the pool of people who would actually qualify for the public option - the only people who will be signed up are those who private insurance don't want on their rolls.

    How this crucial point: the relationship between costs, risk pool and market share is lost on so many is beyond my understanding.

    Furthermore, all of this is academic.  Because as of right now, with requirement to establish a provider network and negotiate fees with every doctor, the public option is designed to not even get off the ground.

    Parent

    Sorry, I didn't mean to (none / 0) (#24)
    by dk on Thu Sep 17, 2009 at 09:18:44 AM EST
    imply that I didn't understand your camel's nose theory.  I do.  I just disagree with it.

    You seemed to be arguing upthread that the bill you support would get people healthcare, and when someone upthread disagreed you challenged that person to come up with an alternate way to do it.  I just think that the method that Masslib proposed would be more effective that what you are advocating for.

    Parent

    If it can be done (none / 0) (#25)
    by Big Tent Democrat on Thu Sep 17, 2009 at 09:19:42 AM EST
    Sign me up.

    I support that approach.

    Parent

    Exactly. Why are they lying to people? (none / 0) (#51)
    by masslib on Thu Sep 17, 2009 at 10:43:14 AM EST
    The constraints on the PO make it more or less leper insurance that the Exchange insurers will absolutely exploit.  Exchanges don't work because insurers collude.  With, or without the exchange, they collude.  So I don't see why anyone is promoting the exchanges at all.

    Parent
    Wyden is right that the limited scope of (5.00 / 2) (#15)
    by MO Blue on Thu Sep 17, 2009 at 08:57:53 AM EST
    of the options, particularly a public option, is a problem with all the bills. The solution is not to adopt the Wyden plan. The solution under the current framework is to expand the scope of a public option by eliminating the restrictions. Unfortunately, protecting the insurance industry seems to be more important than providing affordable health care.

    If Congress ever decides to give out unicorns, I want a genuine unicorn (Medicare for All) and not a faux one (Wyden's plan).

    Your last setence is key (5.00 / 1) (#18)
    by Big Tent Democrat on Thu Sep 17, 2009 at 08:59:28 AM EST


    Parent
    From what I have seen so far, (none / 0) (#22)
    by MO Blue on Thu Sep 17, 2009 at 09:13:09 AM EST
    it will take some type of magical force for Congress to actually deliver affordable health care for all.

    Parent
    As someone (5.00 / 3) (#27)
    by Ga6thDem on Thu Sep 17, 2009 at 09:21:27 AM EST
    who's in the individual market I simply cannot understand why these people simply don't get it? If the market model worked the way they think it should i Would have wonderful low cost insurance.

    I really think all of them are so utterly clueless on this issue. It's sad and I dont think they're going to be able to deliver any sort of "reform" without a basic understanding of the flaws in the system.

    If I were being charitable (5.00 / 2) (#38)
    by TeresaInSnow2 on Thu Sep 17, 2009 at 10:00:02 AM EST
    I'd say, they don't, and can't possibly understand the issue.  They are on one of the most Cadillac insurance plans available (the federal govt plan), as are every single one of their advisors -- and their advisors advisors.  

    They simply have never had to go out in search of insurance on the individual market.

    I'm on individual insurance too.  I've told 3 people about my latest "strife".  The one who's been on the individual market commisserated.  The other two, one on state, the other on federal retirement plans, actually JOKED about it.  The latter two just have no idea how bad it is.  They're on Caddilac plans, have been all of their lives.

    People who live in a bubble prefer to stay in a bubble.

    This rushed through, anything to pass a plan in 3 months, no 6 months, no, this year was just a huge venture into incompetence.  The most logical plan would have included citizen panels that establish what the problems really are.

    Of course, if I'm being non-generous, I'd say that the politicians don't give a fvck what the problems are, just want to rob from our pockets to give to their real constituency.

    Parent

    Actually, my congressman is on (none / 0) (#76)
    by oldpro on Thu Sep 17, 2009 at 12:56:00 PM EST
    Medicare, as he explained to the accuser at his recent town hall here...the 'just like you' was implied, not spoken.

    He supports singlepayer and always has.

    Parent

    Not endorsing it (none / 0) (#39)
    by gyrfalcon on Thu Sep 17, 2009 at 10:02:40 AM EST
    necessarily, but the idea is that mandating everybody get insurance combined with banning the most abusive practices of the insurance companies will level the playing field in the insurance market and therefore permit actual competition.

    Parent
    Not (none / 0) (#44)
    by Ga6thDem on Thu Sep 17, 2009 at 10:14:38 AM EST
    unless there's some sort of cost controls or real competition built in. Anytime you try to make them do something they send out a policy increase with the message that they "had to do this" because "congress mandated it". Mandates would help slightly but maybe not at all if the insurers try to make everyone else share the cost of it.

    Frankly, the only way I see things working is having a public plan that everybody can buy into not just a select few. For the gubmint haters out there I think they should be more than able to spend all their extra dollars and give them to the private insurance companies if they want to.

    Parent

    Mmm (none / 0) (#45)
    by TeresaInSnow2 on Thu Sep 17, 2009 at 10:15:00 AM EST
    Competition?  Only once the premium rates are greatly increased to facilitate the banning of the abusive practices....and the mandates alone would also increase rates.  

    Parent
    I'm not sure maintaining our existing health... (5.00 / 1) (#33)
    by Birmingham Blues on Thu Sep 17, 2009 at 09:48:11 AM EST
    ...insurance system, even with reforms, will do much to improve the quality of health care, because insurers will still stand between patients and doctors.  This Atlantic article addresses the disincentives for cost control and quality improvements inherent in our current setup.  Not sure I agree with the author's solution (he advocates returning to catastrophic insurance only, and I think he proposes covering annual health costs out of pocket up to $50,000 - it's not clear - which sounds really high to me), but he has a good point about the disconnect.

    Right now, people with employer-provided insurance likely have no idea of the true cost of coverage or of care.  People without coverage get charged higher rates for care and don't have the option or the requisite knowledge to negotiate lower prices.  I don't think pushing more people into the loving jaws, um, arms of the insurance industry is going to help us all in the long run.

    And thanks for the link to the LA Times article, Cream City.  I believe I'll send it to my Republican congressman, who bases pretty much all of his opposition on the fear that those dirty illegals might slip through the cracks.  Oh, the horror!  /snark

    A lot of us with employer insurance (none / 0) (#60)
    by Cream City on Thu Sep 17, 2009 at 11:31:12 AM EST
    sure do know what it's like for those who don't -- they're in our families but have aged out of our insurance, so we're having to help them, too.

    After all, 76% of Americans support a public option.  And I personally have seen many people I know who were Repubs and have insurance but have come around to the public option, etc., because they also are -- in our retirements or near-retirement years -- having to help our laid-off, fired, unemployed, furloughed, etc., kids try to keep their homes for their own kids or come back home themselves . . . often because they have chronic health conditions but no health coverage (even with lousy COBRA and the like) now.

    Our generation will be paying for this debacle of an economy for decades -- and the younger generation that just was starting out will be paying for it for many decades more.  A recent study of the projected impact on different generations is appalling.


    Parent

    Which public option do those 76% (none / 0) (#65)
    by MyLeftMind on Thu Sep 17, 2009 at 11:52:10 AM EST
    of Americans support?  I'm guessing that 3/4th of Americans support the concept that it's time for the government to help us out with skyrocketing healthcare costs.

    Asked whether they want to pay higher taxes to give health insurance to more poor people while insurance companies rake in even higher profits, I'm guessing most Americans would respond with a resounding NO.

    Parent

    I've been in those debates (5.00 / 1) (#78)
    by Cream City on Thu Sep 17, 2009 at 01:08:55 PM EST
    and the insured come around fast when they realize/remember that they're already paying for the uninsured through our insanely high insurance premiums.

    Parent
    Question on your analysis. (none / 0) (#54)
    by Samuel on Thu Sep 17, 2009 at 11:04:27 AM EST
    "The notion that insurance companies will compete amongst themselves in a way that will improve health care is simply a fantasy (See Scarecrow on the MA experience.) They never have and they never will. "

    If that's the case, what determines the lower bound for the quality of health insurance in the US?  Is it purely a floor put in place by current regulations?  

    Would removing state to state licensing and employer tax breaks have any effect which could force a revision of the your quoted statement?  Would it have any effect at all?

    If competition with a superior federal insurance option would improve the quality of services rendered by making insurers react to their customer base shifting towards this federal option AND if this federal option was financially sustainable - why would insurers have not already shifted towards the stronger business model?  If the federal government plans on flipping the switch on a sustainable public option that is supposedly a better product than that offered privately - it would seem logical that a private company would have made this move to grab market share already.  Is the reason private insurers have not adopted the model which federal government plans to use because of state to state licensing preventing the advantage a public option would have in being offered nationally, that the federal model really is not sustainable and would have caused bankruptcy or something entirely different?  

    Your question (5.00 / 1) (#58)
    by TeresaInSnow2 on Thu Sep 17, 2009 at 11:28:34 AM EST
    Is it purely a floor put in place by current regulations

    Answer: Yes, most likely.

    Parent

    How can that be true though? (none / 0) (#71)
    by Samuel on Thu Sep 17, 2009 at 12:14:17 PM EST
    Was health insurance regulation in existence before any policies were offered?  What elevated the quality vs cost of policy to a level considered satisfactory to customers?  Is it not reasonable to assume that competition amongst policy providers over consumer preference, the free market as it were, was responsible?

    Parent
    Insurance (none / 0) (#73)
    by TeresaInSnow2 on Thu Sep 17, 2009 at 12:33:08 PM EST
    was originally implemented as a risk pool.  You pay in, you may or may not get anything out of it.  Some got more than others out of it.  It was created for an altruistic purpose.

    Once the for-profit aspects took over the goals of insurance, regulation had to step in.

    The notion that because regulation didn't exist in the beginning that regulation isn't the reason for control of costs now, is a bit naive.

    I'll give you another example where regulation didn't exist early on but is integral now.  Humans have worked for a living since humans have existed.  However, employment regulation is a relatively recent phenomenon.  Just think how bad things would be for employees if we didn't have employment regs now.

    About your second question, the whole reason for insurance reform in this country is that we DON'T have quality for cost.  

    Regarding free markets, our country essentially has one health insurance provider -- Blue cross/blue shield.  There is no free market competition for health insurance in this country.

    Parent

    Here's a (none / 0) (#75)
    by TeresaInSnow2 on Thu Sep 17, 2009 at 12:55:40 PM EST
    document that describes how the "free market" in insurance works.  

    Link

    It shows that while a few other players lend a hand, BCBS dominates.  As BCBS franchises buy up other franchises, competition will only get worse.

    Parent

    Great response. (none / 0) (#84)
    by Samuel on Thu Sep 17, 2009 at 03:27:08 PM EST
    Good points.  Allow me to clarify my question and ask a few.

    "The notion that because regulation didn't exist in the beginning that regulation isn't the reason for control of costs now, is a bit naive." True, that would not follow necessarily nor was that my claim.  My point, which was a counter to the notion that free market competition cannot improve quality in health insurance whatsoever(the original posters' radical claim), in asking "what controlled costs, elevated quality initially" was only to indicate that market competition clearly had to play a positive role in the onset of insurance by forcing providers to offer better services then their competitors to win market share.  

    "...was originally implemented as a risk pool.  You pay in, you may or may not get anything out of it.  Some got more than others out of it.  It was created for an altruistic purpose...Once the for-profit aspects took over the goals of insurance, regulation had to step in."  That's interesting if the first insurasnce was simply a risk pool with all allocations of funds settled by an altruistic self-formed group of clients.  The "for profit aspects" during the transition would be firms filling the demand for 3rd party disbursement through which pool size can be increased, right?  What did regulation provide/remedy at this beginning point?

    "Regarding free markets, our country essentially has one health insurance provider -- Blue cross/blue shield.  There is no free market competition for health insurance in this country." - True dat.  Are you saying that there's no free market competition because of regulation (ie lack of freedom) or cause market equilibrium is a monopoly/oligopoly in health insurance?  


    Parent

    Umm (none / 0) (#66)
    by jarober on Thu Sep 17, 2009 at 11:53:46 AM EST
    The problem is deeper.  We insure the wrong things, and then get surprised as costs rise.  Generally speaking, regular health services should be non-covered, fee for service (akin to oil changes for a car).  Doctors would end up charging market rates for that stuff.  

    What you need insurance for is the big stuff that happens rarely or in an unplanned fashion: accidents, life threatening illnesses, child delivery (etc).

    That stuff is going to be expensive without regard to what we might like, and normal people will have trouble paying for it.  Our mistake is in lumping the stuff that should be out of pocket in with the stuff that should be covered - and then, over time, adding to the list of "should be covered" until the size of the insurance pool can't possibly be big enough to hold costs down.

    The market can handle the non emergency, non critical stuff on a fee for service basis.  Insurance can cover the rest - whether public or private is something of an ideological question, but I think it should be separate from the bigger separation...

    I disagree. Preventive maintenance (5.00 / 2) (#67)
    by oculus on Thu Sep 17, 2009 at 12:02:12 PM EST
    re health care is important but most won't pay out of pocket for it.  But such a savings in the long run.  Incentive.  Think obesity, cardiovascular, diabetes, etc.

    Parent
    Checkups & doc visits need to be free/cheap (5.00 / 2) (#68)
    by MyLeftMind on Thu Sep 17, 2009 at 12:02:28 PM EST
    or people won't see a doctor until their problem is bad (and expensive). If you don't bother to change the oil in your car, tough luck for you when your engine blows up. You don't get a new free car.

    But if you're poor and you don't take your kid to the doc for a minor problem, you increase costs for everyone by needing to use an emergency room on a Saturday night for a problem that should have been dealt during the week.


    Parent

    Free Will (none / 0) (#70)
    by jarober on Thu Sep 17, 2009 at 12:13:17 PM EST
    People will do what they do.  How do you intend to get people to eat better and exercise more via a health care plan?  

    Parent
    Well, the Baucus proposal (none / 0) (#83)
    by KeysDan on Thu Sep 17, 2009 at 03:00:18 PM EST
    seems to think that a free/no co-pay wellness plan will do a lot.  So much, in fact, that Baucus is using the Medicare "savings", from such means,  to fund a major portion of the proposed bill.

    Parent
    I am wondering if the staff of members of (none / 0) (#69)
    by oculus on Thu Sep 17, 2009 at 12:03:42 PM EST
    of Congress have thoroughly consulted with health care providers such as CalPERS.  Huge no. of insureds.  No bar for pre-existing conditions.  Large age range.  Tremendous bargaining power with the health insurance companies.  

    Examples (none / 0) (#74)
    by waldenpond on Thu Sep 17, 2009 at 12:34:23 PM EST
    Here is how the Baucus free market approach will work...

    Insane The government subsidies in the Baucus Plan don't extend deep enough into the middle class in order to protect families from massive health care debt...[ ]. Put another way, mandates would imprison families and force them to buy insurance policies that could still bankrupt them if they actually need to use their insurance for an emergency situation like an accident or being diagnosed with cancer.]

    Klein is not happy with the 'free rider' provision which discriminates against low-income workers.

    Chamber (none / 0) (#90)
    by DancingOpossum on Fri Sep 18, 2009 at 10:07:14 AM EST
    The Chamber of Commerce's membership is like 97% small businesses,

    Not quite accurate. Local chambers of commerce do represent small businesses, but the biggie, the U.S. Chamber of Commerce, represents big corporations.

    The Wrongheaded Belief In "The Market" For Health Insurance | 90 comments (90 topical)

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