Are you reading this Jason ?

I’d agree, a mandate without a public option is nothing but a bailout to the insurance industry.

I’m glad you agree Jason BUT what are you hearing re “The problem, however, is that such assistance without controls at the provider level will render the assistance moot. Save for some price stickiness in the short-term, the presence of the subsidy to tax payers will simply be rolled into the price of the coverage; making it a de facto subsidy to the insurance companies (which begs the question why already immensely profitable corporations should receive subsidies). In short, it will just induce spot inflation in healthcare prices; almost ironically the exact opposite outcome purportedly underlying today’s renewed focus on healthcare reform. In shorter, we’ll be right back where we started in no time, and presumably with even fewer tools to make fundamental changes.” ??

This is why we are having such a hard time agreeing on the terms of the bet.

I pay a ‘co-payment’ per my ‘income level’ regards where I live -in CA- to the VA for services and they let me make payments on my bill; where in the ‘public option’ discussions on Capitol Hill is such being specified/discussed? Oh, and the VA charges more for a diuretic than what I would pay at a pharmacy for the same but I don’t mind as it subsidizes those vets with less income than my meager SS.

How would the ‘public option’ being discussed on Capitol Hill address that?

” Sen. Edward Kennedy’s brain cancer is in remission and he is expected back in the Senate after the Memorial Day recess to spearhead healthcare reform, according to Democratic colleagues.

Senate Majority Leader Harry Reid (D-Nev.) said Tuesday that he spoke with Kennedy’s wife, Vicki, in the past few days and was told the 77-year-old lawmaker is “doing fine.”

Reid said Kennedy’s cancer is in remission and added that while the lawmaker is going through another regiment of treatment, the procedure “is not unusual.”

“This is something we expected,” he said.

Kennedy, the chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, has been mostly absent from the chamber for the past year, recovering in Florida and Massachusetts.

He is expected to lead a markup of highly anticipated health reform legislation in his first month back – one of the biggest bills of the year and a signature domestic initiative for President Obama. “

http://thehill.com/leading-the…..05-19.html

Nor are tax incentives – rebates, credits, deductions – the preferred way to pay for it.

They are a monetary and procedural sop to the haves, including CongressCritters and their donors on and off K Street, who think primarily in terms of what’s in it for them regardless of whether or how well a government program meets its stated objectives. Liberals are not saints either, but they more often want both effective programs and a dollar in their pocket instead of just the dollar. Some liberals even want just the program.

Tax incentives reduce government revenue when it’s needed to pay for an expensive program. They appeal to high-income earners in higher tax brackets (all low right now, reducing the incentive). The incentives do not directly reduce the cost of mandated insurance on those in lower tax brackets or who pay little or no tax. Tax credits, cash returned directly to tax payers, typically once a year after returns are filed, are rarely enough to meet more than a small part of the annual cost of health insurance.

Mandated coverage available only through private insurers is the equivalent of outsourcing the military to Blackwater. The public would be forced to pay a cost over which it would have even less control than it does now. Insurers would have no incentive to reduce costs – except possibly a hollow threat that Congress might change the program in future. A laughable risk.

There would be no incentive for insurance companies or health care providers to be more efficient or reduce costs. Worse, it would give insurers even more leverage over the kinds of health care we receive than they have now. There would be no Tennessee Valley Authority, no publicly run competitor to provide basic coverage or to illustrate to voters how much they could gain at how little cost, by reducing the percentage of their health care dollar that subsidizes private profit. And there would be no incentive for insurers to cover “all risks”, including the elderly, the sick, and those with pre-existing conditions.

If Congress fails to address those inverse incentives, the perverse leverage insurers have acquired over our personal health care, its costs and the general lack of access to it, they will mark themselves as water carriers, not legislators.

One more thing Congress will have avoided doing by going this route, they will have sidestepped taking action to make US companies more competitive with their foreign rivals, whose employees receive government provided health insurance or care. That will make “reorganizing” General Motors and many more companies much harder.

I repeat the suggestion mentioned several times on this blog. The pressure on Congress should be to limit its own retirement and health care options to those provided to the general public. CongressCritters are overwhelmingly millionaires already. Why should the public subsidize their care, when they care so little for the public?

Another thing about our current private healthcare system is that it is not sustainable. The current industry strives to insure healthy rich people only. People who need care and people who can’t afford care need not apply. Only people who do not need insurance will be sold insurance. Insurance companies are thus working a business model that depends on selling nothing for an enormous price–a perversion of what a free-market should create.

Why does this happen? Obviously, it happens because healthcare is not in any way a free market. The insurance companies fight to keep healthcare costs from being spread evenly across the insured population. They use group membership to contain costs by excluding as many of those likely to incur healthcare expenses as possible and by forcing providers to accept sub-market reimbursements. They use co-insurance and co-payments to shift as much as much of the aggregate cost of care back onto the insured as possible. They negotiate premiums with a company that does not directly depend on receiving benefits and the company then passes as much of the cost as it can to its workers. The uninsured go to the emergency room, where the costs come out of the providers’ bottomline (leading to closure) or get passed to the public (socialization of risk).

There are NO normal free-market mechanisms in force and no relationship between supply, demand, and cost in our current system. Since we are a captive market (we all get sick), single-payer, government insurance is the only way to distribute costs evenly across all insured persons and the only wahy to make insurance work as insurance is supposed to work. What we have now is not insurance. It is a fraud–bait-and-switch marketing for the patient and stiffing creditors on the provider side.

Indeed. I’m becoming of ever heightened concern that precisely the condition described in this diary will become to be seen as the most politically advantageous, not simply because it curries favor with the insurers, but because Democrats will be able to stand on the “The individual mandate makes it universal!” as a political victory, and the Republicans will be able to stand on “We blocked the public-plan, boo socialized medicine!” as a political victory as well.

It’s a confluence of conditions that too keenly services everybody with a seat at the table, which is to say everybody except the citizens. Thus my concern, I feel legitimately, that not only are these “precariously dangerous pair of opposing compromises” a possibility, but further that the incentives at play make it almost a certainty.

Excellent post, excellent comments, thanks to all. Recommended.