The "public option"

[alfred russel]

If the goal is to increase coverage availability to the less well off, then a public option only seems to make sense if we move to a mexican type system: a public option exists, but it is bad enough that people with means get private insurance. But I doubt that is going to happen.

So if we create a system that is subsidized by the government and still high quality, how will private insurance compete? It seems as though we will end up back at effectively a single payer system.

[DGuller]

If the goal is to increase coverage availability to the less well off, then a public option only seems to make sense if we move to a mexican type system: a public option exists, but it is bad enough that people with means get private insurance. But I doubt that is going to happen.

So if we create a system that is subsidized by the government and still high quality, how will private insurance compete? It seems as though we will end up back at effectively a single payer system.

That's my take on it as well.  The public option will be subsidized, that's just how politics of public insurance work, and it will make it hard for private insurers to compete.  If private insurers would be still allowed to underwrite, then the public option would be a sort of high-risk pool that insures only the crap of the crop.  If private insurers would not be allowed to underwrite anymore, then they'll be shoved aside almost entirely, and we'll have single payer system.  That's really not a bad outcome, but it pains me that the good guys are resorting to intellectual dishonesty to achieve their goals.

[Hansmeister]

Is there someplace where the Obama's proposal is explained?

Obama doesn't actually have a proposal.  It's like with the Stimulus bill: he laid out some vague principles, which were completely ignored by his own party in Congress, and in the end he will sign whatever they cook up (if they are able to come up with anything at all).I think health care "reform" is already a dead man walking.  The democrats are unable to reach consensus on any plan even amongst themselves, and even if they miraculously could reach agreement, they still would have no way to pay for it.  The "public option", which really means nationalization of health care will never fly since there is enough democratic opposition to stop it and there is even less support amongst the public for healthcare reform than there was in '93.  I predict it will die quietly during summer recess, particularly once the CBO releases new deficit predictions which will be much worse than the rosy one used to date.  Add in that unemployment will reach double digits and an expansive, expensive, job destroying health care reform bill which will leave most people worse off will not pass.  The truth is that most people who lack insurance either consciencly declined it even though they could afford it because they're young and healthy, already qualify for Medicaid but are too dumb or lazy to enroll, or are illegal aliens and should be deported anyway.

[Monoriu]

So if we create a system that is subsidized by the government and still high quality, how will private insurance compete? It seems as though we will end up back at effectively a single payer system.

In Hong Kong, the government runs a public hospital system that is essentially free.  It will basically admit all patients for all problems they may have.  Service is adequate.  But there is still a big private insurance market if people want better care, e.g. access to specialists without waiting for months, semi-private/private wards, non-essential surgery, the best and latest drugs, regular medical checks etc. 

[Alatriste]

In Spain things are more or less like this: we have a public system, belonging is mandatory, and the system is 100% free for the patients. Besides, the system works well, doctors are good, and equipment too. Only the best (and very, very expensive) private hospitals can say they are so good as the state owned hospitals... but in them anything non essential is adequate but spartan. If you want a room for yourself, a big bed, private space for your family, etc, etc, then you better pay a private insurance.

In addition, waiting times are short or non existent if the problem is serious, but can get long otherwise: if you just want to check your eyesight, for example, you probably will be in the waiting list a few weeks.

Oh, and dental care for adults is not included other than extractions.

Net result is persons rich enough usually pay a private insurance (far cheaper than American ones, I think; I pay roughly 45-50 euros each month) and use it to get fast access to specialists and comfortable hospitalization for minor surgery, but many of them would vacillate between state and private for major surgery... and should you need to get to an emergency room ASAP the dense network of state health centers can't be beaten (actually, ambulances - many of them private businesses themselves - will carry you to the nearest hospital; private ones have financial deals with the state to cover this service) 

IMHO it would be very difficult to create a workable universal system without a public option, but worse still, why bother? What's so terrible in having a public health service?

[Tamas]

Can someone lock this thread before DGuller puts everyone to sleep?

I lolled.


and the only acceptable form of government-provided healthcare is some low-end insurance for poor pipple. The low level of service received should prompt everyone with a mildly reasonable income to choose a private insurance company.

Obama is turning the US into a socialist long term trap state like whole of Europe is, and this will spell doom for western civilization.

[Iormlund]

If the goal is to increase coverage availability to the less well off, then a public option only seems to make sense if we move to a mexican type system: a public option exists, but it is bad enough that people with means get private insurance. But I doubt that is going to happen.

So if we create a system that is subsidized by the government and still high quality, how will private insurance compete? It seems as though we will end up back at effectively a single payer system.

What happens over here is private insurers offer better non-medical conditions: individual rooms, no waiting lists for OR and tests, etc.
For example, I waited for two months for non-elective surgery (bowel resection). And I've spent a week or two at a hospital room waiting for tests despite being ready to go home (since the same tests would have taken a couple months then).

The good part is I get to see and be operated on by the best. Private insurers have a couple strong points, usually in trauma and other work related accidents (biggest private clinic in my city has a very good burnt unit and microsurgery department) but dealing with chronic illnesses is not one of them.

[crazy canuck]

Isn't that one of the problems with the Canadian system, medicine is no longer lucrative so you have a shortage of doctors?

It is a myth the medicine is no longer lucrative for Canadian doctors.  It is a myth trotted out by the various medical associations around the country whenever they negotiate their billing rates with the government.

But the fact is that the amount they charge the medical services plan for patient visits is often only a portion of the income they recieve.  On top of that many will have private consultations outside the plan, other government payors such as Workers Compensation (which pays directly for doctors to treat workers injured on the job).

When all of it is added up, Doctors are very well payed especially in relation to their small debt burden if they receive their education in Canada.

If we are going to compare apples to apples it would be interesting to compare the amount a Doctor in Canada bills to the medical services plan to the amount a doctor in the US can bill to HMOS.  My bet is that the Canadian doctor has to deal with a lot less red tape, has much more freedom in prescribing treatment and I suspect makes more money.

The biggest discrepency in income is the availability of work outside the medical services plan.  This is a growing area in Canada and the area where doctors can make the most money but American doctors (if they are successful and entreprenurial) can make their whole practice in this area - something few Canadian doctors can do.  But by the same token not all American doctors can do it either.

[ulmont]

the only acceptable form of government-provided healthcare is some low-end insurance for poor pipple. The low level of service received should prompt everyone with a mildly reasonable income to choose a private insurance company.

Considering the low level of service I get out of my private insurance company now, I'd give it a shot.

[Barrister]

And abolishing private insurance is the best way to do that.  That way, the government decides how much the medical people will charge.

Isn't that one of the problems with the Canadian system, medicine is no longer lucrative so you have a shortage of doctors?

Not really.  Doctoring is still quite profitable, and no doctor I knowis hurting for patients.

Trouble is that as a means of keeping costs down spaces in medical school are deliberately surpressed, which leads to lineups and shortages.  Someone once upon a time realized that medical costs are strongly correlated with the number of doctors...

[Barrister]

My bet is that the Canadian doctor has to deal with a lot less red tape, has much more freedom in prescribing treatment and I suspect makes more money.

I think that's part of the problem honestly.  With no cost disincentive doctros wind up ordering a lot of unnecessary tests and procedures, which leads to long waits for those tests to be completed.

[alfred russel]

Someone once upon a time realized that medical costs are strongly correlated with the number of doctors...

Lets hope they don't do a similar cost analysis in other professions.

[crazy canuck]

Trouble is that as a means of keeping costs down spaces in medical school are deliberately surpressed, which leads to lineups and shortages.  Someone once upon a time realized that medical costs are strongly correlated with the number of doctors...

You are wrong about that.  British Columbia has been increasing the number of seats for the last decade or so.  There are also a number of initiatives to attempt to streamline credential acceptance for foreign trained doctors.

The real problem is that we cant convince anyone to become family practicioners anymore because specialists can make a lot more.

[crazy canuck]

I think that's part of the problem honestly.  With no cost disincentive doctros wind up ordering a lot of unnecessary tests and procedures, which leads to long waits for those tests to be completed.

I would rather have that then err on the side of the equation like the US where procedures that a doctor thinks is necessary is turned down by some insurance bean counter.

[Barrister]

Trouble is that as a means of keeping costs down spaces in medical school are deliberately surpressed, which leads to lineups and shortages.  Someone once upon a time realized that medical costs are strongly correlated with the number of doctors...

You are wrong about that.  British Columbia has been increasing the number of seats for the last decade or so.  There are also a number of initiatives to attempt to streamline credential acceptance for foreign trained doctors.

The real problem is that we cant convince anyone to become family practicioners anymore because specialists can make a lot more.

That's exactly it - over the last decade.  With medical school taking 4 years, plus a number of years of residency, plus the delay in actually getting those new openings, those moves (which have been taken in other jurisdictions) are only barely showing any progress at this point.