So says CommonwealthUnbound (email, full article posted at Jamie Eldridge's site):
Congressional Republicans saw their sweeping midterm gains as a mandate to roll back the nation’s sweeping new health care reform package. After staging a loud but symbolic repeal vote in the House, national health care opponents are now focused on weakening the new regime’s funding at every possible turn.
The other side isn’t garnering nearly as much ink, but their strategy is much more direct – defending the new health care law by expanding its reach. Public option health insurance plans figure prominently in this effort.
Congressman Steve Lynch said this week he’ll be a vocal proponent for the new public option push. Lynch’s back-and-forth stances on health care votes earned him a challenger from the left wing of the Democratic Party last year. Speaking at a New England Council breakfast this week, the South Boston politician called House Republicans’ health care repeal efforts “a colossal waste of time,” and said that, instead of fighting over a law that’s already in place, Congress should focus on lowering its costs. Public option health plans and the revocation of health insurers’ antitrust exemption should be at the forefront of those cost-lowering efforts, Lynch said.
Ah really. Lynch finally got religion on the public option — a year-and-a-half late, I might add — and just in time for his Senate run! I don't ever know what that dude's thinking, but this is welcome.
I also can't help but think the GOP has stuck its neck out so far on repealing health care, they can't help but have it cut off — if Dems are aggressive. (Good luck with that — ever.)
Sen. Eldridge is proposing a public option for Massachusetts. Why not? Let a thousand flowers bloom. I don't think that will deal with our most critical issue, which is provider costs. (Yup, just what the insurers say. They're right.)
I’ve never seen a good explanation. Of every $100 spent on health care in this country, how much goes to:
* Prescription drugs
– research
– manufacturing
– marketing
– profits
* Non-prescription drugs
– research
– manufacturing
– marketing
– profits
* Medical devices
– research
– manufacturing
– marketing
– profits
* Medical disposables
– research
– manufacturing
– marketing
– profits
* Non gov’t run hospitals/clinics/doctor’s offices
– amortized cost of the building
– wages of doctors
– wages of nurses
– wages of technicians
– wages of support staff [janitors, maintenance, etc]
– wages of administrators
– utility bills
– profits
– transportation of patients
– transportation of medical items
* Private insurance
– wages of hourly workers
– wages of salaried mid-level workers
– wages of executives
– marketing
– profits
* Government administered insurance and care
– wages of hourly workers
– wages of salaried mid-level workers
– wages of executives [cabinet-level?]
– marketing
– the hosp/clin/dr office breakdown too for VA and active US Mil, etc.
* Other
– torts belongs here somehow, but I’m not sure how
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p>Why is this so hard to get a handle on? Where’s my pie chart with big wedges, and each wedge broken out into smaller wedges? I’m sure I’m not breaking down to exactly the right major [and minor] categories, but this is what I need to really understand just where we’re spending our money. Is it true that (wages+marketing+profit)/person in the private insurance area vastly exceeds (wages+marketing)/person in the public sphere, adjusting for ages, etc? Is it true that doctor’s wages are a large cost? Is it true that malpractice insurance is a huge drag?
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p>We spend a lot of time talking about how fast the cost to provide health care is increasing, but do we know just what makes up the cost to provide health care? Do we know which portions are increasing? Are we investing our public research dollars on techniques which will drive up care [help someone live longer in a very expensive state] or on lowering costs [refining currently expensive techniques to lower average cost]?
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p>Give me my pie!
Sorry; I couldn’t resist. Here’s one:
Is “gov and private admin” the insurance industry? Hospital administration? This is one way to cut the data, but I’m not sure it’s quite what I had in mind.
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p>31% goes to hospitals. Where more specifically?
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p>The other bit is… what is the growth in each section? If health care costs are going up 10% a year, is that a 10% increase in each category, or are some growing much more quickly?
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p>I just wonder where the comprehensive strategy is on all of this. We know health care costs are growing quickly, but we (or just I?!) don’t know exactly what components are growing quickly, why they’re growing quickly, etc. Where’s the strategy?
This is America, dude. National strategies in dealing with major societal problems are a communist plot to create the world-wide Caliphate.
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p>/sarcasm off
Neither this chart nor your other chart below show insurance administrative overhead. Reports are all over the map as to exactly how much this is, but it surely must figure into, and be accounted for as part of, our healthcare spending.
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p>I’d furthermore like to see this insurance overhead broken out into overhead incurred within the insurance company (e.g. salaries and the cost of the insurance company doing business) and overhead incurred outside the insurance company (the extra hospital employees who are needed to shuffle paperwork and claims for seven different insurance companies, etc).
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p>Where are these numbers?
you can walk into any hospital or doctor’s office and look at how much time doctors, nurses and administrative assistants spend on health-insurance related issues. Most studies I’ve seen have suggested that 20% of what we spend on health insurance is administrative waste, but I think that’s putting it lightly when you factor in every dollar and cent spent at health care providers on dealing with insurance-related issues, all time that isn’t spent with patients.
From here:
You haven’t found the one yet that shows the 20% administrative costs by evil insurance companies, the justification for single payer. If teh money is really spent on hospitals and doctors, where’s that ‘peace dividend’?
I did file a public option bill this session — and as the Legislature tackles health care cost-containment, I will be working to make sure a public option is part of the conversation.
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p>While there is significant evidence to suggest that providers are driving a lot of the cost increases in the system overall, consolidation in the health insurance market in Massachusetts isn’t a good sign for consumers. Providing a public option as an alternative could help prevent monopolistic behavior on the part of private insurers.
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p>Although I believe a public option is an important first step, the truth is that no country in the world has been able to control health care costs and guarantee universal coverage without instituting some sort of single-payer health care system. It’s for that reason that I have also filed “An Act establishing Medicare-for-all in Massachusetts” this year (More information). This bill would create a single payer health care system — “Medicare for All” — for Massachusetts, guaranteeing first rate health care coverage for every resident of the state, while saving money for state and local government, businesses, and residents.
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p>Yes, passing these bills is going to be an uphill battle in this current political climate. But until we start to have what Speaker Boehner might call “an adult conversation” about the realities of our current health care system and what has and has not worked elsewhere, we’re never going to truly cut costs to a sustainable level AND guarantee access to health care to everyone.
A question or three,
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p>I can’t seem to locate the public option bill you filed this session. Can you point out the number of the bill or other reference?
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p>Assuming a public option was signed into law, would the commonwealth simply start-up an insurance company? Hire a “CEO”, a staff of actuaries, claims processors, accountants, ect.?
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p>Surely a successful is no small undertaking. Any idea of the initial costs of a ‘public option’?
For reasons that are beyond me, none of the bills that have been filed this session are available on the Legislative website yet. (The importance of posting public documents in a more timely fashion and making our government websites more user-friendly and accessible is a topic we’ll have to save for another time!)
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p>But I’ve posted the text of the legislation up on my website here so you can take a look.
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p>(You can also see summaries of the other 90 or so bills I’ve filed here, if you’re interested.)
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p>To answer your second question: basically, yes. The bill would direct the Commonwealth Connector to set up a public option program and work out the details. Certainly some staff would need to be hired to manage those functions.
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p>The savings comes in avoiding some of the overhead that gets eaten up at private companies by things like profits, excessive administrative and marketing costs, and high executive salaries. A public option could provide a good deal for consumers, and would also keep pressure on private insurers to keep their policies affordable and to treat their customers better. Competition is pretty much always a good thing for consumers.
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p>As to your third question – I don’t have an estimate for that. It’s based on a lot of factors, including how much demand there would be for the product. I’d look forward to working with the Connector and EOHHS to come up with a better estimate as the bill moves through the legislative process.
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p>And you’re right, it’d be no small undertaking indeed. But I’d note that the state already knows how to run a very popular and successful insurance program. It’s called Medicare.
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p>Thanks for your questions!
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p>Claiming savings, without having an estimate of the costs is rather reckless. Or, impossible.
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p>And in breaking news, Massachusetts, according to Representative Eldridge runs Medicare, which apparently until today was a Federal program.
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would understand the usage of the word “state”.
the intended usage of the word.
Consider this. Representative Eldridge proposes a private option run by the state of Massachusetts. Then says the state already knows how to run a very popular and successful insurance program. It’s called Medicare.
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p>So brain, two options: one, he’s claiming that the State of Massachusetts runs Medicare. Patently incorrect. Or two, the state (referring to the Federal government) runs Medicare and Massachusetts should adopt a private option (per the Rep’s legislation) and has experience. Also incorrect because massachusetts again, has no experience. Under neither option does the State of Massachusetts have experience running a private option based on its experience with Medicare.
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p>And, anyone with a brain could have thought this through rather than resorting to an otherwise irrelevant vocabulary lesson.
The Federal Government (state) runs Medicare. I’m sure that you know that Senator Eldridge knows this, and that you are just throwing out absurdities because you think it is fun.
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p>Massachusetts can learn from the federal government’s experience while crafting a public option.
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p>You incorrectly describe the Eldridge proposal as a private option. Read his post again, his bill is for a public option.
Senator Eldridge,
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p>Thank you for filing this legislation and for providing more information. I would encourage everyone who is in support of this legislation to get on the phones and start writing some letters! Rep. Smith and Senator DiDomenico will be hearing from me shortly. Budgets being what they are there’s a really opportunity to make the health-care system here in Massachusetts more sustainable. Here’s hoping we can have those adult conversations!
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p>Kirth I’d love to see pie charts for both public and private health care so we can make some comparisons about where $$$ is being spent. For instance, I know public systems spend much less on administrative costs.
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p>I found a discussion about it here (from July 2009): http://voices.washingtonpost.c…
Single Payer is the ideal way to go, regarding Health Care Reform. I’m no less supportive of badly-needed healthcare reform in this country, but I think that
the Obama Administration and the Democrats in Congress should’ve scrapped that warmed-over GOP body of legislature that was enacted in March 2010 as a “Healthcare Reform” bill, gone back to the drawing board, put their heads together, and constructed and implemented a genuine healthcare reform bill that entailed Single Payer with Universal healthcare/Medicare for all Americans.
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p>It’s disgusting that the Obama Administration and the Democrats didn’t have to courage and strength of will to do so. Equally, if not more disgracefully, the Obama Administration and the Democrats in Congress allowed abortion rights to be thrown under the bus in order to get this current “Healthcare Reform” bill passed. What a shame!
then, maybe at the negotiating table, we’d have ended up with a health care reform that was much better (not to mention politically popular) in the end.
I continue to feel that President Obama shares the strategic goal of government-sponsored single-payer health care.
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p>I think he, and we, had a tactical problem to overcome: most Americans simply cannot (or are unwilling to) follow the logic that leads to that outcome. I know it’s arrogant, but I think our side simply see more moves ahead in the chess-game than most Americans.
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p>I, therefore, think that President Obama used the HCR bill as a tactical move to advance the game. The HCR bill will fail. It will not solve the problem, especially without a mandate. When it fails, our side can legitimately point to it and say “we tried the best alternative, and it failed.”
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p>Even without further legal erosion, the current health care reform bill will fail. Insurance costs WILL continue to skyrocket. Health care provider costs WILL continue to skyrocket. Outcomes for Americans will continue to fall further and further behind the rest of the civilized world.
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p>As that result becomes more and more clear to Americans, popular support for government-sponsored single-payer health care will continue to climb. We Democrats and progressives will be on the right side of that realization, and the right wing will be on the wrong side.
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p>I think that is President Obama’s game, and I think its a winner.
I am an advocate for Medicare for all. The Republicans are really not too bright. They would really do a better job of representing their monied interests by supporting universal medicare for the following reasons:
1) A VAT tax which could be used to pay for everyone is really regressive because all would be paying the same tax regardless of income level or employment status.
2) The VAT would be best imposed on health-harmful products such as cigarettes, fast food and sugary sodas.
3)Taking the burden of providing health care off of business would be a boon, expecially for hiring new employees, and businesses would not need any so-called tax deductions.
3)Fairness. What a simple concept: fairness. I never understood (but very happy to be a recipient now) why people over the age of 65 are somehow entitled to wonderful health care at very low cost while the rest of the society has to scramble around like it’s some kind of open air market in Africa to find a good, affordable health plan. How about the republicans just try to be “fair” for a change?
4)Medicare puts an end to all of those bizarre situations about what is covered, when, and by whom. It also puts an end to all of those horror stores about death panels on one end of the spectrum and welfare cheats, on the other end of the spectrum, getting “free” health care while the reast of us have to pay for “them.”
Given the fact that you can go to any doctor (who accepts Medicare) and hospital, the cost is really quite reasonable for that supplement. In my case I had an aortic aneurism (was lucky to survive) and if I had had to pay for this open-heart surgery it would have bankrupted me. When you think of all the incredible advances in medecine over the last fifty years, the procedures and medications now available to save and enchance the quality of life, why would people be averse to paying a reasonable hidden tax to be covered? And why should I be covered simply because I am 65 or older? There are a hell of a lot of people out there more deserving.
The medications, the devices, etc.?
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p>I only mention this because there is an implication that Medicare is all-inclusive and all-paying – and it’s not.
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p>Your deservingness is irrelevant to health CARE, although it might be for health INSURANCE – which are not the same thing, despite being used interchangably by many.
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p>Also – if the tax is reasonable, why does it need to be hidden?
$95,000., so you can see that it makes the difference between financial disaster and a medium term debt. When you consider the true cost of medical care (50 years ago they didn’t have the medical procedures or the medicines which save lives today) it is a wonderful benefit. I don’t blame the insurance companies for the increases in health insurance/care; just look at the procedures being done today. Cripes, I was scolded in January because I had never had a colonoscopy and was told that now every man 50 or older must have one every two-three years. We are doing more and more of this stuff; someone has to pay for it.
The Value Added Tax is hidden in the sense that it has alredy been added to the product or service, unlike a sales tax which is imposed at the point of sale–and thus is not “hidden.” Most Europeans know that the “hidden” tax is there. Without some sort of revenue source we will reach the point where only the very wealthy will be able to afford health care. As you probably have guessed by now, I am conservative by nature, but I think that our country can do better for all of us by letting all of us contribute to a univeral medicare program. There are lots of people younger than I who have endemic health problems; just because they haven’t reached the age of 65 does not make them any less worthy of health coverage.
I still believe, that, as despicable as the Republicans have been acting, and I agree that many of them aren’t too bright, that the majority of Democrats, including President Obama pretty much blew the opportunity for a really comprehensive healthcare reform bill by taking Single Payer off of the table, even after having campaigned for it while a POTUS Candidate, and, I also stand by my position that letting abortion rights get thrown under the bus in order to get a really toxic and punitive “Healthcare Reform” bill passed that’s really a warmed-over 1990’s GOP-written bill enacted was equally, if not more disgraceful.
sadly, popular support just isn’t there. The GOP anti-HCR agenda got far too much public support last November to ignore.
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p>Our premise is that government-sponsored single-payer health care is the ONLY approach that works. If we are are correct (and I am convinced that we are), then events ultimately will play out to reinforce this reality.
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p>As I see it, our job is therefore to ensure that Americans see the impact of this inadequate approach and see how single-payer solves the worsening problems.
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p>In the newspaper business, this is called “show, don’t tell.” I think it’s the most effective political strategy available to us right now.
What suggests to you that Obama has any strong interest in single payer?
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p>He ditched the public option before the negotiations even started. Where was the fight, the use of the bully pulpit, even if it wasn’t possible this time around?
The waste and inefficiency of having overly bureaucratic health insurance companies — and all the extra staff they force every single hospital and doctors office to have to service those insurance plans (in part because there’s so damn many of them) — at the very least rivals the “provider costs” problem. Furthermore, I think it’s important when speaking about “provider costs” to define what that means — it’s not necessarily doctors overcharging, it’s the practice of ordering too many tests, procedures and drugs that are not only completely unnecessary, but also collectively reduce our health.
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p>That said, there is a real cost savings with public option plans, at least according to the CBO, but if we do it, we have to do it right — because it will be more difficult and more expensive to do it at the state level than it would in creating a national option. We’d need to design a system that was intent on delivering a high-quality and efficient product that a lot of people would want to ‘buy into’ so we could ensure the pool would be sufficiently large. That may mean cracking down on some of the plans on the Connector, ensuring none are offered that deliver a worse quality of service, as well as offering carrots and sticks to get as many people who receive subsidized health care on the Connector to choose the public option. I also think making it a ‘default option’ that people are auto-enrolled in would be a good idea.
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p>What’s the total cost of all of those tests, both the right number and the too many? Is it 10% of our health care costs? 1%? 0.1%? Without knowing the number, it’s hard to know if your complaint (a common one) is having a substantial impact or not.
You wanted pie. I gave you pie – two of them. Now you don’t like the pies you got for free. Next time, buy google your own. 8-]
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p>Seriously, though – I’ve been visiting doctors’ offices a lot the last couple of years. My experience is that about half the time I’m actually interacting with someone in one (as opposed to waiting), it has to do with insurance. That means somebody paid by the doctor is spending a larger amount of time just on my insurance. It has to be a huge amount of overhead.
I 6’d you for your pies, though they didn’t subdivide with enough information to get at my queries.
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p>The overhead for dealing with your insurance is certainly too large in an absolute sense, but how does that cost add up to the many figure salaries of specialists? Of equipment? Etc etc.
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p>Perhaps more importantly, which are the pie slices which would shrink if we went to single payer? How big are those pieces in particular?
Compare what we spend as a country on health care to what most of the rest of the developed world spends. We’re just north of 15% of GDP, they’re for the most part just north of 10% (and get better care).
If my wife got really sick, the amount I spent would have nothing to do with the Gross stomv-household Product.
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p>It’s entirely plausible that two nations with significantly different GDPs have identical health care systems with identical costs. The poorer nation which spends the same dollars on health care is willing to live without other things in order to have the same health care as the richer nation.
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p>The differences in which tUSA spend health care dollars and the way [insert Can-European nation here] spend dollars are many and varied. It’s not just in health insurance profits, marketing, and billing. Different cultural views on death, public health policies, cuisines, urban planning policies, non-health tax subsidies, day care availability, retirement ages, and so forth all influence health care expenditures.
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p>So really,, it ain’t that simple. The left has done quite a bit of this when arguing for single payer, and it ensures that we’re ignored because our ideas aren’t sufficiently developed and defended. Your comment belongs at the beginning of a position paper, not the end.
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p>That’s a strawman. Across the population, what we spend on health care compared to what other countries spend on health care is absolutely relevant, and speaks a lot to the bang for the buck we’re getting, particularly when most of those other countries are getting a better quality of care.
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p>Where did I say it was? In fact, quite the opposite.
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p>Um, no. We’re ignored because we live in a corporate-established world where it’s been somehow turned into a communist plot to bring up the word “single-payer.” It’s not because our ideas aren’t well-argued, it’s because we live in a world where too many in the media and too many in the government aren’t even willing to listen. We need another crash or two before they will.