Thursday, August 20

Is the Public Option a Trojan Horse for Single Payer? You Betcha! So?

There are a ton of distortions and ridiculous claims coming out about the various Health Care proposals working their way through Congress, but the one claim that actually does need to be addressed is the issue of whether a Public Option is really nothing more than a Stalking Horse for Single Payer and the elimination of Employer Based Health Care.

This is what the (relatively sane members of the) RIght are Currently Saying Amongst Themselves.

In 2003 before he was even a member of the Senate Barack Obama did admit that he was a proponent of Single Payer and that he supported it. (Uncut version of one of the clips above)

“I happen to be a proponent of a single payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

Over the past Six Years, Obama's position on this has indeed changed and become more nuanced - and if he hadn't become more informed over the last six years, we should all be worried - but the primary issue eroding the trust of those on the right, is the idea that any type of expansion of the Public Option will inexorably lead to Single Payer.

The real issue is that can Private Insurance openly compete with a Public Option. Will simply creating the ability of people to buy their insurance from a non-for-profit public supported system completely destroy the ability of all private insurance companies to funcction?

The simply answer is "No".

Assuming that it will, is like assuming the Public Schools would put Private Schools out of business. They Don't! It would be like assuming that Free and Public Police would put Private Security firms out of business - It Doesn't. All a Public Option would do is reset the minimum level of available care.

Further proof of this is actually to look at counties that already have single payer, such as France, Germany, Canada and England, and simply note that all of them Also have Private Insurance Companies, the difference is that those companies do not dominate their economy the way that they do in America.

(Pardon the Gap, Happens with Tables in Dkos)
HDI RankExpenditure on health (% of GDP)PublicPrivateCombined
12 United States6.98.515.4
106Occupied Palestinian Territories7.85.2 13
88Lebanon3.28.4 11.6
123 Sao Tome and Principe 9.91.6 11.5
150 Timor-Leste8.8 2.411.2
22Germany8.22.4 10.6
10France 8.22.310.5
15Austria7.82.5 10.3
1Iceland8.31.6 9.9
4Canada6.83 9.8
29 Portugal 7 2.8 9.8
86Jordan4.75.1 9.8
2Norway8.11.6 9.7
13Spain 5.72.4 8.1
16 United Kingdom71.1 8.1

We literally do spend more for care than any other country in the world and frankly we get lousy results for it. As has been repeatedly mentioned the World Health Organization ranks the United States at 37th in Health Care, between Costa Rica and Slovenia. France ranks Number #1 yet they get that care for about about 1/3rd less than we spend as a portion of GDP.

In per capita terms it's literally Half as much.

(Top UN Ranked Countries by Human Development Index with Per Capital Health Care Expenses 2004)
1 Iceland 3,294
2 Norway $4,080
3 Australia $3,123
4 Canada $3,173
5 Ireland $2,618
6 Sweden $2,828
7 Switzerland $4,011
8 Japan $2,293
9 Netherlands $3,092
10 France $3,040
11 Finland $2,203
12 United States $6,096

So the argument truly is whether we have better health care for less cost - Or NOT!

The other fact is that the Right has used selective editing to ignore the Rest of what Obama has said, which in the years since he joined the Senate and began running for President isn't exactly what they claim.

2007 SEIU Health Care Forum (The Volume on this Video is Very Low, the relevant section occurs about 1:45)

Obama: I would hope that we can setup some system that would allows those who can't go through there employer to go through a federal system or a state system of some sort. I don't think we can eliminate employer coverate immediately, there's gonna be potentially going to be some type of transition process. I can envision a decade out or 15 years out or 20 years out where we have a much more portable system. Employers still have the option of providing coverage, but many people may find that they get better coverage - or at least coverage that gives them better coverage for the dollar they spend outside of their employer, and I think we've got to facilitate that and let individuals make that choice to transition out of empoyer coverage.

Even in this discussion from just two years ago Obama did not say that Employer-Based or Private Health care even after "15 or 20 Years" would be eliminated, he said that people may find the public system both cheaper and more effective (as both Medicare and the VA already are) and that more of them may choose it rather than Private Insurance - but Private Insurance Would Still Be THERE!.

This isn't an arguement of having Private Care vs some Soviet System where the Doctors and Hospitals work for the Government (which is actually what Does Happen in the VA and Tricare) and all choice is a thing of the past, it's a question of whose paying the bill and what are they charging you for that care?

If the public system isn't cheaper and better - People Won't Use It, and will freely be able to leave it. So exactly what's the problem here?

Current private insurance companies have a 10.6% profit margin plus 20% overhead costs compared to 4% in Medicare (with no profits), a great deal of that overhead goes to high administrative costs trying to find way to Deny Care to people. If you had a childhood disease and didn't include it in your paperwork, they use that as an excuse to drop your coverage. If you get Sick, they drop your coverage. It takes and veritable Army of Insurance Bureacrats to seperate you from your coverage day-in and day-out. Even if the Public Option does get split off and dropped from the main Health Care Bill only to passed own it's own later as I suggested yesterday - that one change alone, plus the Health Care Exchange, would IMO give us all a huge net savings in all our premiums.

All of the current plans on the table would ban this practice and eliminate the costs the these companies are currentiy incurring to not give people the coverage they've already paid for.

Will a Public System with better outcomes and lower cost ultimately lead to a significant shrinking in the Private Health Insurance Market? Yeah, it probably will. But then again, should we really mind getting 5-7% of our GDP back from these companies - I certainly don't, and neither does the Openly Conservative Rand Corporation

The study found that excess growth in health care costs has adverse effects on employment, output and value added to GDP in the U.S., and that these effects are greater for industries where high percentages of workers have employer sponsored insurance. For example, the study estimated that a 10% increase in excess health care costs would reduce employment by about 0.24 percent in an industry such as motor vehicles, where about 80% of workers have ESI, compared with about 0.13% percent drop in the retail trade, where about one-third of workers have ESI. Economy-wide across all the 38 industries, a 10% increase in excess health care costs growth would result in about 120,800 fewer jobs, $28 billion in lost revenues, and about $14 billion in lost value added.

It's simple, as the cost of private insurance continues to go up - our jobs and take home pay goes down. Those who argue that having the Ability to Choose a low cost high quality Public Health Care Option is somehow a loss of "Freedom", seem to be defining that freedom as the fastest way to lose your care and to lose your job.

That's not my idea of Freedom or of America.

Now in all seriousness, IMO a properly implemented Public Option probably won't lead to a tax payer funded Single-Payer System like Medicare-for-All. The current plans on Capital Hill such as HR 3200 work as a Public Insurance Program, paid for predominantly by premiums from it's members and run like a Non-Profit Health Care Insurance program the way that Blue Cross/Blue Shield used to be, but that may never progress any further if it accomplishes the goal of expanding coverag (via subsidies to the poor), while lowering costs and improving overall quality. A strong Public Option alone will be good enough, but we'll have to try it first and find out.



Hugh said...

Excellent article, especially the tables of statistics that makes very clear the differences between the U.S. healthcare system and the European and Canadian.

I had one question. I understood from other sources that France was, strictly speaking, not "single payer" because it has a mix of private and public.

Vyan said...

No system is strictly 'single payer' - all have various mixtures of public and private providers. it's just a matter of how much either covers, compared to the other, but most - like France - use taxes to pay for their public portion. Other than initial startup costs and subsidies for the poor (up to 400% of the poverty line) the Public Option as it's been proposed by the HELP bill in the Senate and HR 3200 would be paid for by premiums from individuals and/or their employers. It's not really publically paid for - it's a Not-For-Profit Option without the need to increase it's stock price for shareholders.