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The Other Public Options

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Posted on Sep 14, 2009
AP Photo / Toby Talbot

A Medicare poster taunts a high school student who will probably have to wait decades before he can experience affordable, efficient public insurance.

By Marie Cocco

Now that everyone in politics has concluded that the “public option” is about to be very publicly dropped from health overhaul legislation, perhaps it is time that everyone understands that the public options we already have are working very well.

The upside-down logic of this retreat makes about as much sense as irate Medicare beneficiaries who turn out to protest “government-run health care” while insisting that their own government insurance remain untouched. In our current public discourse, no absurdity is too ridiculous to be called farce.

Yet there are still facts that can get in the way of fictions, as the Census Bureau’s recently released annual report on income, poverty and health insurance coverage reveals. That there is so much bad news, and so much more to come, is taken for granted. Conveniently overlooked is the good news: Government programs that shield the elderly and the poorest among us from economic catastrophe are working precisely as they are supposed to.

The report is a bleak compendium of information on the early impact of the economic downturn on American families. Median income is down—by 3.6 percent, a figure that doesn’t reflect the continuing toll from increasing unemployment as the recession grinds on. Poverty is up. So is the number of people who are without health insurance.

The number of uninsured climbed by 682,000 in 2008, another figure that is sure to rise as the impact of job losses and benefit cuts in 2009 is felt. There are 6.6 million more Americans without insurance now than there were in 2001, at the bottom of the last recession, according to the Center on Budget and Policy Priorities.

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The number of uninsured would have been far higher had there not been an increase in coverage through Medicaid and Medicare. While private health policies continued to decline, Medicare and Medicaid enrollment rose, and these programs now insure 29 percent of Americans. The recent expansions of Medicaid to cover more children have been particularly effective. “The uninsured rate and the number of uninsured for children are the lowest since 1987,” the Census Bureau says.

Those on the opposite end of the age spectrum also have been spared the worst of the recession. People 65 and over were shielded from the drops in income that fell on the working-age population—as a group, income among the elderly was unchanged. The reason, of course, is Social Security. (The report does not measure the decline in wealth or real estate values that have diminished the net worth of some older Americans.) Since Medicare is a universal, guaranteed plan for everyone 65 and over, the elderly have been able to keep their health coverage as well.

The government has safeguarded the weakest in society from the worst of our economy’s failures. It has done so through government-funded (but not government-run) health insurance that relies on private doctors and hospitals to deliver care and, in Medicare particularly, offers a wide choice of providers. Its cost is high. But the growth in Medicare spending per patient has been slower in recent years than the growth in per-patient spending in the private insurance market.

Those who complain that Medicare is “bankrupt” conveniently forget that the Medicare payroll tax rate has been frozen since 1985. The last infusion of new tax revenue into the program came in 1994, when the cap on the amount of income subject to the payroll tax was raised. So the future fiscal imbalance in Medicare is caused partly by our unwillingness to adequately fund it. What private insurer has refused to raise its prices in 15 years?

Truth is almost always a casualty of politics, more so when fear is the tactic used to obscure the facts. The Massachusetts state insurance program is the model for President Barack Obama’s approach, and is a template once hailed by Republicans as a victory for “choice” and private insurance. Yet more than half of the newly insured get their coverage from the two “public options” that were made available, according to the Kaiser Commission on Medicaid and the Uninsured.

We know what can work. Yet the shrillest voices and the most entrenched special interests are insisting that Congress jettison a public insurance option in health overhaul in favor of untested private insurance “co-ops.”

If they fail, there will be more disillusion and anger. And, we can only hope, electoral punishment for those responsible.

Marie Cocco’s e-mail address is mariecocco(at)washpost.com.

© 2009, Washington Post Writers Group


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Purple Girl's avatar

By Purple Girl, September 16, 2009 at 2:00 pm Link to this comment

If the Public option is not included in this bill, all is not lost.
The Civil rights bill was passed but required other bills to strengthen it, such as Affirmative action.
Additional there is also the avenue of ‘amendements’ which are often tagged on to a bill of not relevance.
Medicare age restriction could be lowered the middle aged.
Medicaid could have the income requirement raise to include the working middle class.
I propose the Dems Twist Rhetoric like the Repugs and submit a bill Called ‘The Right to Life’ in the body of the bill will be legislation to aid single mothers making it easier for them to keep their babies. Such as additional help with healthcare, finances, education,housing, daycare…Something a ‘Pro Lifer’ would be pissed if a Repug voted against.
Then tag on the related amendments to medicare and medicaid.Since we can not condone Ageism,Racism or Sexism, even middle aged White males would have to be afforded some of these rights too.
We may have to Lay in wait until we get the Body of the (Trojan) horse through the House Gates, then we attack with stealth and precision.
We have not yet begun to fight, regardless of what they think.

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By AT, September 16, 2009 at 12:35 pm Link to this comment
(Unregistered commenter)

That’s all they are worth! Not very much in comparison to the bankers. Where could they be hiding their money?

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By Earthprisoner, September 16, 2009 at 9:46 am Link to this comment

The bes government money can buy!

Have any other members of Congress received money tied to the health insurance industry? I’m glad you asked. Here are some illuminating figures from Open Secrets . Below are other members of the present Congress who have figures above $200,000. The champ of the list, by far, is Barack Obama, at $1,427,180.

Sen. Chris Dodd (D-Conn.) $767,841
Rep. John Boehner (R-Ohio) $737,260
Sen. Hillary Clinton (D-N.Y.) $697,351
Sen. John McCain (R-Ariz.) $684,787
Sen. John Kerry (D-Mass.) $680,184
Sen. Max Baucus (D-Mont.) $655,899
Rep. Earl Pomeroy (D-N.D.) $611,554
Sen. Ben Nelson (D-Neb.) $522,546
Sen. Mitch McConnell (R-Ky.) $520,327
Rep. Charles B. Rangel (D-N.Y.) $490,098
Sen. John Ensign (R-Nev.) $477,620
Rep. Eric Cantor (R-Va.) $461,850
Sen. Joe Lieberman (I-Conn.) $449,066
Sen. Evan Bayh (D-Ind.) $448,938
Rep. Roy Blunt (R-Mo.) $425,378
Sen. Chuck Grassley (R-Iowa) $422,149
Sen. Orrin G. Hatch (R-Utah) $382,880
Sen. Arlen Specter (D-Pa.) $366,828
Sen. Harry Reid (D-Nev.) $361,750
Sen. Jon L. Kyl (R-Ariz.) $350,968
Rep. Dave Camp (R-Mich.) $350,873
Sen. Kent Conrad (D-N.D.) $339,330
Rep. Steny H. Hoyer (D-Md.) $320,071
Rep. Richard E. Neal (D-Mass.) $316,414
Sen. Saxby Chambliss (R-Ga.) $314,823
Rep. Paul Ryan (R-Wis.) $309,500
Rep. John B. Larson (D-Conn.) $304,900
Sen. Richard C. Shelby (R-Ala.) $285,900
Sen. Susan Collins (R-Maine) $284,830
Rep. John Tanner (D-Tenn.) $250,750
Sen. Judd Gregg (R-N.H.) $248,175
Sen. Richard Burr (R-N.C.) $247,686
Sen. Jim Bunning (R-Ky.) $247,437
Rep. Joe Barton (R-Texas) $243,595
Sen. Mike Enzi (R-Wyo.) $237,750
Sen. Robert Menendez (D-N.J.) $236,725
Rep. John D. Dingell (D-Mich.) $233,950
Sen. Tom Carper (D-Del.) $232,220
Rep. Sam Johnson (R-Texas) $227,808
Rep. Spencer Bachus (R-Ala.) $224,050
Rep. Nathan Deal (R-Ga.) $222,196
Sen. Ben Cardin (D-Md.) $219,854
Rep. Mike Rogers (R-Mich.) $216,250
Rep. Edolphus Towns (D-N.Y.) $204,200
Rep. Charles E. Schumer (D-N.Y.) $203,450
Sen. Blanche Lincoln (D-Ark.) $203,050

The total for these 46 members of Congress is more than $17 million. That’s enough to take a few trips to visit the constituents.

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By voice of truth, September 16, 2009 at 9:42 am Link to this comment

To Herewegoagain….

Your points, and the authors, are either wrong or misleading.  Yes, the tax RATE has not moved.  However, the amount of income that is taxed rises every year, and it rises at a MUCH higher rate than either inflation or wage rates.  So, in effect, the funding does increase every year.

Second, the reason that Medicare is declared by many to be bankrupt, just like Social Security, is not because of one year, but as a result of a very real demographic trend.  Stated simply, the number of workers contributing has been greater than the number of people drawing.  That trend is already switching the other way with population trend (and people living longer).  Also, for many years already Medicare has been running at a deficit.  A private insurer could not do that for very long.

However, also like Social Security, the government can’t keep its hands off a single $$, so instead of that money being “saved” for future spending, it is already gone.

Social Security and Medicare are, by definition, a Ponzi Scheme, and now there’s nothing left to those who have “invested” and are now looking for their “profits”

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By Bliss Doubt, September 16, 2009 at 6:45 am Link to this comment
(Unregistered commenter)

“...the shrillest voices and the most entrenched special interests are insisting that Congress jettison a public insurance option in health overhaul in favor of untested private insurance “co-ops.””

Yes, and the media aids and abets those shrill voices.  This morning I listened to NPR and heard a description of Max Baucus clashing with “liberal democrats”.  Why, just once, can’t NPR, of all media, point out Baucus’ massive campaign finance ties with pharma and insurance?  Why should NPR of all outlets make this an issue of conservative vs. liberal when this is about a want that the American people have expressed. 

When it’s culture wars, it’s all about what the American people want.  When it’s about government spending, it’s always conservative vs. liberal.

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By Squeeky, September 16, 2009 at 12:19 am Link to this comment

I have the best of everything. I have medicare, VA healthcare, and private health insurance. All it took was for me to get my ass shot off in the middle east. Anybody game?

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By CaptRon, September 15, 2009 at 11:24 pm Link to this comment

For all those who still have memory, our last Prez and his party wanted to privatize Social Security as well. You know, take that Social Security money and sink it in the markets or bank investments. I now know the way to go was to buy a CEO. The returns on those people would offset my needs. I also seem to remember that our wars were subsidized from the Social Security Funds. I’m not laying that on Bush alone, there are many faces to this business of war, and if you kill off enough American soldiers, it will help to balance that social security fund. An investment of sorts. Oh, these prognosticators of the financial well being of themselves!! Anybody know an available CEO ???

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By Jean Gerard, September 15, 2009 at 4:32 pm Link to this comment
(Unregistered commenter)

Not clear who “they” is in the last lines of the Cocco article on health care.

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By KDelphi, September 15, 2009 at 10:49 am Link to this comment

If we would extend Medicare for All (HR 676), it could help pay into the program and we could be considered a moral nation, at least in respect to health care.

Fewer and fewer drs take Medicaid every year, as it covers less and less of the cost. Some take it and just yell at their patients about it—seriously. There is no “choice”. There is a list of non-bd certified drs here in my city that I can see. Since I know that they have to cover a specialist from a major medical center if they dont provide one,locally, I get to go to a major medical center (so far)for serious issues—but, i was a Social Worker and most dont know how to do that.

When I was admitted to Cleveland Clinic on Medicaid, for surgery, the mother of a young man having the same surgery and I were talking—she told me that the billing office had told her it would be best to wait until he was 21 and could get Medicare. so he would “get better treatment”, but she said he was too sick to wait—real fricking reasurring, although my surgeon was excellnt. I have had drs scream at me that my Medicaid wont even “pay their fucking light bill” (not my fault—dont take it, asshole!). The truth is that, with public systems, at least drs know that they wil get paid—with private insurance or self pay, who knows?? The complaints are pretty bogus—US drs have higher salaries than drs anywhere in the world and outcomes are NOT comensurate.(esp specialists)

We need HR 676—Medicare for All

A letter from Rep Kucinich:

It is said one should not ask how sausage or laws are made. Are you concerned about a public option? Let me share with you some insight about health care legislation which may not be good for your health.

A lesson in politics. The Kucinich Prediction: Here’s what’s going to happen ...

House will make a big deal about keeping/putting a public option in HR3200 because it competes with insurance companies and will keep insurance rates low.
The White House will refer to the President’s speech last week where he spoke favorably of the public option.
The Senate will kill the competitive public option in favor of non-competitive “co-ops”. Senate leaders like Kent Conrad have said the votes to pass a public option were never there in the Senate.
The bill will come to a House-Senate Conference Committee without the public option.
House Democrats will be told to support the conference report on the legislation to support the President.
The bill will pass, not with a “public option” but with a private mandate requiring 30 million uninsured to buy private health insurance (if one doesn’t already have it). If you are broke, you may get a subsidy. If you are not broke, you will get a fine if you do not purchase insurance.
This legislative sausage will be celebrated as a new breakthrough and will be packaged as health insurance reform. However, the bill may require a Surgeon General’s warning label: Your Money or Your Life!

The bill that Congress passes may pale in comparison to the bill that millions of Americans will get every month/year for having or not having private health insurance.

It will take four years for the new legislation to go into effect. During that time we are going to build a constituency of millions in support of real health care, a constituency which will be recognized and a cause which is right and just: Health Care as a Civil Right.

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By NYCartist, September 15, 2009 at 9:57 am Link to this comment

Medicare, Medicaid, Social Security “working better than ever”?  Yes and no. 
1. My spouse can’t afford to retire - luckily he is
  still well enough to work (teaching college, but
    no retirement;had been long time adjunct).
2. Cutbacks in medicaid are really bad, see
    http://www.adapt.org for point of view of people with
    disabilities; activists.
3. My premiums for Social Security keep going up.  I
    pay about $2200. year for BC/BS Medigap (thru a
    group) - that’s just for the 20% that Medicare
    does not cover.  I’m paying around $100.mo for
    Medicare.  I am at the lowest end of what one
    receives under Social Security because I am a
    woman who didn’t earn as much as men; worked
    as an artist plus office low paying jobs to
    support art and paid in as self-employed
    NOTE:if you are self-employed, be sure to pay
    your social security in case you need Social
    Security Disability = so you are covered.

  Medicare keeps trying to push us into HMO’s; so far
I am resisting.  Basically, Medicare and Medicaid and
Social Security are great concepts.  Payments are too low to recipients and deductibles and monthly deductions are too high.  One should not need medigap.  Without a partner, solo, I’d be in dire poverty and fodder for a nursing home, which loves those social security checks.

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By Random Items, September 15, 2009 at 8:59 am Link to this comment
(Unregistered commenter)

Interesting how little response this got.
It looks like public circus’s are more important to
Truth diggers than the second best means of reforming
health care.
SINGLE PAYER would be the best way to reform.
Demand no less.

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By herewegoagain, September 15, 2009 at 7:39 am Link to this comment
(Unregistered commenter)

Marie Coco writes: “Those who complain that Medicare is “bankrupt” conveniently forget that the Medicare payroll tax rate has been frozen since 1985. The last infusion of new tax revenue into the program came in 1994, when the cap on the amount of income subject to the payroll tax was raised. So the future fiscal imbalance in Medicare is caused partly by our unwillingness to adequately fund it. What private insurer has refused to raise its prices in 15 years?”

Good point, and I would also add that even with the frozen payroll tax rate, Medicare has still typically taken in more than it pays out. Last year it did not, largely because of the recession. As long as we’re comparing Medicare with a private business, how many private companies are considered “bankrupt” just because one year they don’t make profits?

When debating with the business ignorant righties (you know, the ones who worship all things business but don’t have the first clue how business actually operates), kindly remind them of the above.

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By Random Items, September 15, 2009 at 6:50 am Link to this comment
(Unregistered commenter)

Which shell hides the little pea?
What happened to majority rule, a basic of democracy?

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