"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."
Interesting anecdotes, but it still doesn't show that there is widespread unhappiness with people who are covered by Medicare, especially when people are able to supplement coverage with their own insurer.
"- 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."
So prices would be low, but coverage/services would be poor. So again, the question is, if services suck - and coverage isn't compulsory with no other option - why would people not pay more for better service? Isn't that what people with Medicare coverage essentially do when they get supplemental insurance?
"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."
But if everyone is required to get government health care, there is no private sector as far as health care payments go, right?; i.e., if we're all required to get government health care, as the republicans claim is the end game, then the public/private distinction no longer exists. I guess implicit in that logic is that once we're all ensnared by the government's public plan, everyone's rates will exponentially increase. But again, I don't see any basis for any such requirement.
"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?"
1. Does the current legislation require a public option to provide better coverage than a private option would? You seem to assume that, and I'm not sure what the basis of your assumption is, especially since my question was whether people would go to a public option if coverage was not as good as their private option. If you don't make such an assumption, then the whole argument collapses, because you would have to assume that under a true government option (that provides poorer service), I don't think you can arguet that some people would not pay up for better coverage.
2. The question is whether people will go to a public option if coverage is worse than their more expensive private option. Your answer seems to be only a fear that the government will price other insurers out of the market at the outset and then ruthlessly raise their prices - like any other good old monopolist would. Amtrak hasn't kept people out of their cars and airlines. Nor has the post office priced Fed Ex and UPS out of the market. Unless the government prohibits a private option (and I don't think that's in any of the legislation), I'd say there's no justification for your fears. People will pay up for service. The best analogy to what you fear seems to be is Florida's pricing of reinsurance after the 2004 hurricanes. I'm not an expert on that issue, but I'd say it's a work in progress, and we'll have to wait until the next hurricane(s) to determine whether the program survives. I suspect at some point, nature will kill it.
3. I'll bypass your point about an American company competing against a foreign subsidized company, because that opens up a whole can of interesting, but irrelevant, worms that would have to be discussed on an industry by industry basis - e.g., sugar, ethanol, steel, etc.
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