There is a lot of buzz about a public option for health insurance as part of the promised reform of health care. Lots of rhetoric, not much substance. But here are some things they won't tell you.
One of the public options is "Medicare for all." Ted Kennedy has pushed this for some time. If Medicare is expanded, the initial talk is making it available to those age 50 - 64.
Medicare is a decent plan as long as you can find a doctor willing to treat you. On average, half of doctors refuse to accept Medicare patients. Those that do accept Medicare patients will limit those patients to less than 20% of their patient load. Most would like to keep it less than 10%.
If Medicare is expanded to cover those between the ages of 50 & 64 don't expect more docs to jump on the bandwagon and accept you with open arms. n fact, the opposite will happen.
If you have a regular doc now, he may refuse to treat you once you go on Medicare.
Another public option is to expand the role of Medicaid. According to the Kaiser Foundation, two thirds of the uninsured 46 million (or whatever number you want to use) earn less than 200% of the FPL (federal poverty level). If Medicaid is expanded from the current qualification to 200% you can almost immediately reduce the number of uninsureds to about 15,000,000 or roughly 6% of the population.
That is a much more manageable level and won't take anywhere near the trillion or so dollars of our money the politicians want to spend.
But access to health care will still be an issue because even fewer docs are willing to accept Medicaid patients than Medicare. Given the choice, they will treat Medicare patients before Medicaid.
And try and find a dentist willing to treat you if you have Medicaid or SCHIP (PeachCare).
Fewer than 20% of dentists in GA accept Medicaid or SCHIP patients.
Regardless of how the public option is structured there is one thing you can be sure of. It won't look like any of the literally hundreds of plans available under the FEHBP.
Employees of the federal govt and members of Congress have dozens of plans to pick from and they vary by state or region. There are 22 plans for federal workers in Georgia. Plan 10 from Blue Cross has a 135 page brochure outlining the benefits.
If you decided to compare all 22 plans that means downloading and trying to review and compare almost 3,000 pages of benefit descriptions.
Actually, the rates aren't so bad for plan 10.
Single rates are $489 per month while a family would pay $1120.
At least with this kind of plan you would have access to docs & hospitals in the Blue Cross network.
There are roughly 9 million participants in the various FEHBP's. Expanding coverage to even just double the number of currently insured could not happen overnight.
So the most likely result for a public option is expanding Medicare or Medicaid.
There are roughly 9 million participants in the various FEHBP's. Expanding coverage to even just double the number of currently insured could not happen overnight.
True enough.... Doctors would have to see patients after playing golf on Wednesday's, meaning it probably won't happen. Of course, they will always continue to take Thursdays off, errr, I mean as a day of study and self improvement.
Obama and the reformers are getting a lot of mileage out of the term "cherry-picking." It is actually working out pretty well for them- as in "insurers will not be allowed to cherry-pick who they will insure."
Version 3.0 of the No Cherry-Picking Manifesto will include physicians- as in "physicians will not be allowed to cherry-pick patients based on their insurance, medicare, medicaid, etc.
More and more med students will graduate as indentured serfs who owe years to government programs in return for government loans. This will also be true of the hoards of foreign medical workers we bring in as the Brits are doing now. Then, even if they went into private practice, their reimbursement system will consist of government regulated programs and their patient load will be what the government tells them they must accept. Not surprisingly, many/most will just decide that they want to take a job as a salaried physician down at the government clinic. And thus we will end out with a national health service with the illusion that it is in the private sector.
Change you believe in.
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My dentist said there is a discussion of a tax levied against medical practitioners who refuse to accept M/M patients. If that happens, it may just push him into retirement much quicker.
Which illustrates that Obama and Congress can do what they want but you can't force the private sector to follow.
Don't know why this has to be hard. Mandate that all carriers must offer a GI plan(s) that conforms to a set of minimum benefits - almost like how supps are controlled.
Set the rates to be 25% to 50% higher than underwritten plans (which rewards healthy people) - expand Medicaid to even include 300% of FLP with anyone between 200% to 300% paying a portion of their premium and call it a day.
If we can't get that accomplished at least mandate that every state have a risk pool and the gov't can offset the costs. Much cheaper than 1 trillion.
The carriers certainly don't seem to be worried. Go submit an app where someone has eczema 6 years ago and they're still treating it like terminal brain cancer.
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My dentist said there is a discussion of a tax levied against medical practitioners who refuse to accept M/M patients. If that happens, it may just push him into retirement much quicker.
Indeed.
Unfortunately many physicians will deal with having to take certain plans by simply "aggressively" billing/bilking the plans. Even more than they are already doing. Not good.
I think you might be right on. We have yet to see any back end information on how health insurance exchanges. This leads me to believe they are are going to expand on one of the existing Gov.programs.
Right now the talk is they are going reduce reimbursement
Rates to providers on Medicaid and Medicare by 21%.
The quality of care will go done initially.
On the other side they have to reduce the reimbursement or there will be no medicare in 2017.
This so called 45 million uninsured its estimated that 15 million are the ones that truly need help.
I am in favor of a GI type policy and then tax credits on the premium that people can't afford it.
We have a lot of "2 new cars in the driveway" people who are uninsured by choice. Unless there's a mandate it'll end up being a pool of sick people which is unsustainable.
If auto insurance was not mandatory anyone want to take a guess on the percentage of people who would cancel?
I think you might be right on. We have yet to see any back end information on how health insurance exchanges. This leads me to believe they are are going to expand on one of the existing Gov.programs.
Right now the talk is they are going reduce reimbursement
Rates to providers on Medicaid and Medicare by 21%.
The quality of care will go done initially.
On the other side they have to reduce the reimbursement or there will be no medicare in 2017.
This so called 45 million uninsured its estimated that 15 million are the ones that truly need help.
I am in favor of a GI type policy and then tax credits on the premium that people can't afford it.
Barry promised us a plan just like the feds get. Then folks start talking about what a great plan medicare is and maybe they will end out with medicare for all. All I want to know is if they go the medicare-for-all route, how big a medicare-for-all supplement do I have to buy to get me up to the same plan the feds have?
That would be one part of the solution and a good one at that. Medicare supplement business would be through the roof. But you still have to provide insurance for the uninsurables with a mandate that all enroll in one plan or another. It's the only way to spread out the costs.
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A.M. Hyers
Hyers and Associates, Inc.
Tax credits are meaningless to those who don't pay taxes which is close to half the population.
Therein lies much of your problem.
The ones voting these idiots in are the tax receivers, not the tax payers.
how big a medicare-for-all supplement do I have to buy to get me up to the same plan the feds have?
Hopefully one with a very big commission.
But you still have to provide insurance for the uninsurables with a mandate that all enroll in one plan or another. It's the only way to spread out the costs.
You are thinking like a carrier. The govt doesn't have to do that. Medicare doesn't think that way. Medicaid doesn't think that way.
A national mandate, although necessary, would never work. The only realistic and enforceable penalty would be a tax penalty and we'd turn half the nation into tax cheats. Go research how that mandate's working out for Mass.
The other issue is rate increase control. You might be able to mandate that for my current income I have to purchase a plan costing $450. But what happens 5 years from now when my income's static and that plan's now $700?
Tax credits are meaningless to those who don't pay taxes which is close to half the population.Therein lies much of your problem.
The ones voting these idiots in are the tax receivers, not the tax payers.
I was referring to the 15 million uninsured that can't afford a $600 a month premium through the risk pools. This is the segment that I think needs help.
Everyone of us talks to this prospect a couple of times a month. They are contracted employee, work for small business with no health plan, or have a small business. They are diagnosed with some health condition that leads to a decline.
There budget is $300 a month and the state plan is $600.
If we could get these people a tax credit and a GI this could add sales for all of us and helps us help them.
EIC is a refundable tax credit. Some tax credits are refundable, meaning you will get a check even if you paid no taxes. It also means you can get a refund in xs of the amount of taxes you paid.
Most tax credits are not refundable.
A national mandate, although necessary, would never work. The only realistic and enforceable penalty would be a tax penalty and we'd turn half the nation into tax cheats. Go research how that mandate's working out for Mass.
Mandates only encourage slackers who will find ways, legitimate or not, to avoid the mandate. I haven't checked figures in MA in a while, but early on a significant percentage, maybe 25% or so, covered under the Mass health care plan had insurance before. The Mass plan was so much less they dropped what they had in favor of the taxpayer funded plan.
Even though the continue sending Teddy, Kerrey and Barney Frank to Washington they are not stupid.
Incentives work better than penalties. This is true no matter what you are attempting.
Rewards always produce better behavior than punishment.
Crap, in another blow to freedom in this nation; the idiot Stuart Smalley is about to be certified as Minnesota's new senator as Norm Coleman is conceding. This will make the Senate fillabuster proof which will increase the likelihood of socialized medicine and the public plan option. This is a dark day for liberty and freedom.
Unless someone has an example, I cannot think of any insurance product where the gov't...which can literally print money and take a loss, competes with public companies which must show a profit. Mass. does not have a state plan to compete with the carriers.
Last edited by healthagent : 07-03-2009 at 08:17 AM.
WASHINGTON -- It is more important that health-care legislation inject stiff competition among insurance plans than it is for Congress to create a pure government-run option, White House Chief of Staff Rahm Emanuel said Monday.
"The goal is to have a means and a mechanism to keep the private insurers honest," he said in an interview. "The goal is non-negotiable; the path is" negotiable.
His comments came as the Senate Finance Committee pushed for a bipartisan deal. To help pay for the package, the committee planned to announce an agreement Wednesday with hospitals and the White House for $155 billion over a decade in reductions to Medicare and charity-care payments for hospitals, according to a person familiar with the agreement. That will help pay for the legislation, expected to cost at least $1 trillion over 10 years.
One of the most contentious issues is whether to create a public health-insurance plan to compete with private companies.
Mr. Emanuel said one of several ways to meet President Barack Obama's goals is a mechanism under which a public plan is introduced only if the marketplace fails to provide sufficient competition on its own. He noted that congressional Republicans crafted a similar trigger mechanism when they created a prescription-drug benefit for Medicare in 2003. In that case, private competition has been judged sufficient and the public option has never gone into effect.
President Obama has pushed hard for a vigorous public option. But he has also said he won't draw a "line in the sand" over this point.
The deal with the hospitals follows a similar agreement with brand-name drug companies. And insurance companies were talking to Senate negotiators about cuts worth at least $100 billion over 10 years, according to two officials with knowledge of the negotiations.
Congressional negotiators and the White House hope to lock in support from the industry groups, which are backing a health bill in general terms but have opposed past efforts.
Hospitals and insurers hope to gain some degree of control over cuts to their federal payments. In principle, a health-care overhaul could benefit both groups by raising the number of Americans who buy and have health insurance.
"They've made an assessment reform is going to happen, so it's better to be part of that than not," Mr. Emanuel said.
However, insurers, and most Republicans, strongly oppose creation of a government-run insurance option, saying it would ultimately drive them out of business. Most Democrats support a public option.
The president and his aides already have signaled a willingness to consider an alternative to a public plan under which a network of nonprofit cooperatives would compete with for-profit insurance companies. That is the leading idea in the Senate Finance Committee.
The Senate Health, Education, Labor and Pensions Committee, meanwhile, has put forward its own version of a government-run plan, closer to what most liberals and the White House favor.
On Monday, Mr. Emanuel said the trigger mechanism would also accomplish the White House's goals. Under this scenario, a public plan would kick in under certain circumstances when competition was judged to be lacking. Exactly what circumstances would trigger the option would have to be worked out.
Some Democrats pushing for a vigorous public plan say the trigger idea isn't good enough. Sen. Charles Schumer (D., N.Y.) said in an interview, "If it's not there on day one, those of us who support a public option have a real problem with it."
Public plan premium projected 25% below private plans. That might be true after they force private plans to guaranteed issue. Adding the uninsurables will be very expensive, even if coverage is mandated.
Without a mandate, public and private plans will all go broke. Change we can expect to pay for.
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