Public Option or Bust! (revised)

The most important part of the health care reform is the so-called Public Option. Even if you didn't know anything else, you could tell this by the way it makes Republicans yelp. Republicans say two contradictory things about it. (1) The public option will undermine and destroy private insurance because it will be cheaper and everyone will therefore choose it (2) nobody wants a "public option" because they like their private insurance. duh... So let's all breathe a bit. If all that matters to the buying public is price, they will take the public option. That's why they have Kaiser now. If the public option provides bad care, you can still pay (much) more for private insurance, just like you do now. And if you can't afford private insurance now, at least you'll have something to protect yourself and your family. What's the problem?

The problem is that the Republicans - who are funded by insurance companies that spend some 20-40% of their income on administration and profit - are terrified. These are real figures, btw. Medicare, by contrast, spends less than 7% on administration and doesn't have to find profits.


(reprinted without permission from the Kaiser family foundation - no relation to Kaiser Permanente - which probably won't mind its research being part of the public discussion since it posts it on its website)

This chart shows the dramatic rise in administrative expenditures (the 20-40% figure came from a Washington Post piece I can't find again).

Here's more important information about the cost of private insurance (which shows why the $5,000 tax credit proposed by McCain and still proposed by the GOP is asinine):

And as long as I'm stealing charts. Here's some indication of how inequitably the US spends its health care dollars. Note just how almost half the population survives on just 3% of the health care money. This shows either (1) how much uninsurance and underinsurance there really is (2) how much money is wasted at the top end - or a combination of both. You think we can't find savings if 1% of the population spends almost a quarter of all health care dollars? I bet we can. Just think of how much better life would be for 50% of Americans if we raised the total spent on them from 3% to 4% - a 33% increase.



Conservatives and their insurance company backers know that a public option insurance will be as popular as medicare is and much cheaper. They also know that people will find public insurance to be a better product in other ways. The public knows that the various tricks of private insurers to drop coverage retroactively for sick patients ("rescission" in the terminology) will not be repeated for a public plan, and that alone will persuade many people to choose the public plan. Anyone who has dealt with private insurers know that federal bureaucrats can't hold a candle to them in terms of obstructionism and nastiness.

I, for example, am being billed $3,000 for *covered* emergency room services last Fall even after an appeal (where they granted me an extra $700), and I get no explanation whatsoever, and no choice but to hire a lawyer if I want to. No ombudsman or anything. No due process. And trust me, I know how to do appeals. This is Anthem Blue Cross, btw, and it's a platinum PPO plan. ( The good news is that the hospital itself is being reasonable with me). Any federal plan will give you notice and an opportunity to be heard about denials of coverage.

So the reason the Republicans are afraid of the public plan is that they know that it will be very popular and that private insurance will have to adapt (smaller profits, less cheating and stealing from their customers) or die. It's not true that most Americans like their current health insurance. Most Americans barely tolerate their current insurers, and those that are at all happy are usually those that haven't had to use it for anything.

If there's no public option, all we will get is a mandate to buy overpriced private insurance that doesn't work. It will be a mandate to fill the coffers of bloated private insurance companies that will provide the same poor swiss-cheese plans they do now. See Medicare Part D for more details...