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To: James Hutton who wrote (219425)	9/9/2009 8:05:55 AM
From: Bank Holding Company	Read Replies (1) \| Respond to of 306849

Medicare IS a public option. We are stuck with an ever expanding public option to the tune of 10K new beneficiaries a day for the next 25 years. Eat your heart out everybody.

To: James Hutton who wrote (219425)	9/9/2009 11:19:26 AM
From: GraceZ	Read Replies (2) \| Respond to of 306849

I haven't heard a lot of people clamoring to get rid of Medicare cause it's coverage is bad; In many states it is almost impossible to find providers that will take Medicare reimbursement for certain services. Never in all the years I've had Blue Cross Blue Shield have I had a provider who would not accept their reimbursement (most say something like, "Oh good, you have BCBS." whereas my attempts to find a primary care physician for my Medicare/Medicaid paying tenant with type II diabetes were fruitless, no one would take her. She ended up going to a hospital clinic where she was treated by a different doctor (mostly PAs and nurses, not doctors) almost every time she went there. In other places you find providers who specialize in those services provided by Medicare. 50% of those on Medicare are eligible for Medicaid, which pays for the 20% that the patient can't afford (that's taxes from the general fund). Medicare/Medicaid reimbursement is subsidized by a large amount of cost shifting to those who carry private insurance. Doctors and providers can only afford to treat Medicare patients because they can shift the costs to their private insurance and cash patients or they are providers whose whole practice revolves around government reimbursement. I asked a friend who works for a mental health provider who treat homeless men. They provide living quarters for the men even though they aren't reimbursed for this. I asked how they could afford this. She said it was cost effective because when they had them living resident they could "treat" them every single day and get reimbursed for that, whereas when they are out on the street, they'd only see them on alternate leap years. Basically they had a captive revenue stream! Frankly, I expected she'd at least give me some medical justification, I even asked her what kind of recovery rate they have, how many of the men were they able to release back into society who could take care of themselves. She basically acted like that was a ridiculous question, that it was well known there was no "recovery". It was sort of like someone trying to sell me on a work out club where everyone was fat and out of shape. - would a public option necessarily provide bad coverage? It would, by necessity, cover better than private at a lower cost to premium payers (how else could they drive people who refuse to pay the price of private insurance into it?) but the problem that would arise is finding providers that would provide services at the price the public option would pay. It is the same problem that occurs in all attempts by fiat to fix prices. Shoes are cheap to buy, there just aren't any shoes. What does it say about the private sector if it can't provide coverage that equals Medicare at less than Medicare's cost? As I said, the cost of Medicare is hidden, shifted to the private sector. Isn't that what Wendell Potter basically said in his Bill Moyers interview - that Medicare overhead is actually far less than private insurance overhead? Because he doesn't understand the difference between price and cost. In economic terms cost is determined by alternative uses for the resources. The real cost of all government services is difficult to impossible to determine by simply looking at the budgets appropriated to the agencies involved. The problem always in any centralized system is one of information, this is the same problem in private insurance as well but the private sector provides much needed trial and error. Centralized systems like HCFA can't possibly keep up with everything changing out there any more than the Soviet bureaucracies could keep track of what prices to put on goods and services (they'd read the WSJ so they knew where to put commodity prices!). The real important information about changes and choices in health care, which is constantly evolving, is played out at the periphery, at the detail of the transaction. I tried to explain this to a very good friend of mine whose job it is to write the regulations that are used in health care decisions for Medicare/Medicaid and she got very angry with me, she said, "This is what I do, I know more about this stuff than any single person could." I said, I didn't doubt that she knew more about what the entire market for health care services cost or what services that were most used are but she couldn't possible know what was best for me personally, she doesn't have enough information to know this and never will. Plus, there is a serious time lag between change and her getting this info. All science moves forward by making mistakes, no bureaucracy would knowingly commit a mistake, they'd have a tendency to "cover their ass" approving known treatments, so the all necessary "mistakes" would move to providers in some other country, essentially moving innovation (read as medical progress) to other countries. I don't understand the other part of the argument that it will push out the private sector - unless the fact of the matter is that the private sector can't compete because of its own inefficiency. How do you feel when people have pointed out that American companies have to compete against foreign companies that are subsidized by their governments, ultimately by tax revenues from that country? Would you say that the US company was less "efficient" if it had a difficult time competing in that situation? Like I said above Medicare is subsidized by the private sector. Almost no one thinks that it will not go bust as the Boomers enter into old age unless the services are cut or the tax base that pays for it is expanded either through higher payroll taxes or, by what I said upstream, bringing in younger healthier premium payers that have much lower health care costs. I suspect, aside from vote buying, this is what this whole "public option" is about. There is no way a public option could beat the price of my private BCBS for a young healthy individual, therefore they will kill my health insurance because they need that young healthy person to pay more than the 2.9% of their payroll they already pay in order to cover the promises already made to Medicare. In the short term it will be priced below private health insurance and offer more coverage, in the long term, cost will have to rise far above what the private sector would provide because there would be no private sector left to shift costs to. We'd approach the kind of tax rates you see in other countries with large embedded socialist systems like Germany. You like Medicare at 2.9% of income, do you still like it at 50% of income? It is clear that Americans want better care than they are willing to pay for, they want the illusion of something for nothing. They will demand this, and the politicians will give it to them even though it is clear that their expanded health care insurance will be paid for by the Chinese (or the next set of poor bag holders), people who are poorer than we are by a large multiple and who have far less access to health care than we do. I guess people think Americans have a birth right to cradle to grave health care but the Chinese don't.