President Obama's sales pitch for major health care reform will not be easy. A key exchange at his press conference yesterday underscored the challenge.
Notwithstanding his general popularity (the latest New York Times-CBS poll puts his job approval rating at 63 percent), and notwithstanding strong majority support for the concept of a government-administered health insurance plan that would compete with private insurers (nicknamed the "public option"), Americans are generally wary of expanding government's role. National surveys, during the past week, report that only 34 percent think Washington should do more to tackle national problems, while, in response to a separate question, 69 percent voice "quite a bit" or "a great deal" of concern about an enhanced government role on issues such as health care.
Those stats came to mind as I watched Obama pitch the public option during the press conference. Here's how he framed it early in the hour: "Now, the public plan, I think, is an important tool to discipline insurance companies. What we've said is, under our proposal, let's have a system, the same way that federal employees do, same way that members of Congress do, where we call it an 'exchange,' but you can call it a 'marketplace,' where, essentially, you've got a whole bunch of different plans. If you like your plan and you like your doctor, you won't have to do a thing. You keep your plan; you keep your doctor. If your employer is providing you good health insurance, terrific. We're not going to mess with it."
But later in the hour, Jake Tapper of ABC News spotted the potential flaw in Obama's pitch. What happens, he asked, if an employer who provides good health insurance decides instead to dump that coverage and go with the public option - even if the workers like their private plan and want to keep it?
Tapper told Obama: "It does seem logical to a lot of people that if the government is offering a cheaper health care plan, then lots of employers will want to have their employees covered by that cheaper plan, which will not have to be for-profit, unlike private plans - and may, possibly, benefit from some government subsidies, who knows. And then their employees would be signed up for this public plan, which would violate what you're promising the American people, that they will not have to change health care plans if they like the plan they have."
They bantered for a few moments, sparking much faux laughter in the room, as reporters sought to lighten the vibes, because Obama did seem particularly testy yesterday. Then Obama tried a general response. Which was actually a non-response:
"We are still early in this process. So, you know, we have not drawn lines in the sand, other than that reform has to control costs and that it has to provide relief to people who don't have health insurance or are under-insured. You know, those are the broad parameters that we've discussed. There are a whole host of other issues where ultimately I may have a strong opinion, and I will express those to members of Congress as this is shaping up. It's too early to say that. Right now, I will say that our position is that a public plan makes sense."
His filibuster continued: "Now, let me go to the - the broader question you made about the public plan. As I said before, I think that there is a legitimate concern, if the public plan was simply eating off the taxpayer trough, that it would be hard for private insurers to compete. If, on the other hand, the public plan is structured in such a way where they've got to collect premiums and they've got to provide good services, then, if what the insurance companies are saying is true, that they're doing their best to serve their customers, that they're in the business of keeping people well and giving them security when they get sick, they should be able to compete. Now, if it turns out that the public plan, for example, is able to reduce administrative costs significantly, then you know what, I'd like the insurance companies to take note and say, hey, if the public plan can do that, why can't we? And that's good for everybody in the system. And I don't think there should be any objection to that."
The president kept going - I'll spare you the next 300 words - yet he never addressed Tapper's specific concern. The reporter's question was, what if employers dumped a private health plan that the workers liked and wanted to keep?
When Obama finally stopped talking, Tapper sought to follow up: "I'm sorry, but what about keeping your promise to the American people that they won't have to change plans even if employers - "
Obama interrupted with another lengthy non-response: "Well, all right - when I say if you have your plan and you like it, and your doctor has a plan - or you have a doctor and you like your doctor, that you don't have to change plans, what I'm saying is the government is not going to make you change plans under health reform. Now, are there going to be employers right now, assuming we don't do anything - let's say that we take the advice of some folks who are out there and say, 'Oh, this is not the time to do health care. We can't afford it. It's too complicated. Let's take our time,' et cetera. So let's assume that nothing happened. I can guarantee you that there's the possibility for a whole lot of Americans out there that they're not going to end up having the same health care they have. Because what's going to happen is, as costs keep on going up, employers are going to start making decisions. 'We've got to raise premiums on our employees. In some cases, we can't provide health insurance at all.' And so there are going to be a whole set of changes out there. That's exactly why health reform is so important."
Note how, in the first sentence, Obama declared that "the government is not going to make you change plans under health reform." Again, that's not what Tapper was asking about. The question was whether the private employer would compel you to change plans. Again, Obama didn't address it.
Obama went on to make a few decent points - under our burdensome status quo, there's nothing to prevent employers from switching private plans with even greater frequency, and thereby messing with coverage that their workers like - but he never addressed the core concern raised by Tapper: That if the federal government gets involved, it might screw things up and compound the health coverage woes we already have.
Obama's core theme, gleaned from his second long reply, is that the status quo can no longer be tolerated and that government-driven reform would surely be an improvement. But, as I noted earlier, there is considerable public nervousness about an expanded government role - in the latest Washington Post-ABC News survey, 61 percent of swing-voting independents favor a smaller government with fewer services, rather than a larger government with more services - and Obama will likely need to leverage every percentage point of his personal popularity to calm those public qualms. Assuming that he can. His signature domestic proposal may well depend on it.
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Hypocrisy update:
More woes for the party that prides itself on conservative "family values." John Ensign, the Nevada senator whose dreams of a 2012 GOP presidential bid were dashed when he 'fessed up to canoodling for nine months with the wife of a senior aide, has now been joined on sin row by fiscal conservative champion Mark Sanford - who, until now was probably best known for rejecting Obama's stimulus money until ordered by the courts to take it.
The married South Carolina governor and father of three, who had nurtured dreams of a 2012 GOP presidential bid, basically blew up that scenario this afternoon when he 'fessed up to visiting an extramarital lover on the sly in Argentina. Over Father's Day weekend, no less. After his staff had told South Carolinians that Sanford was off communing with nature on the Appalachian Trail. After driving to the airport in a state car.
Turned out he was working on his own stimulus package.
Posted by Dick Polman @ 11:03 AM
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111 comments
"Peasantry"....you said it, not me.
June4: What's the yearly salary for a member of congress? What's the average salary in this country? My point is that members of congress can afford private insurance; many people can't afford insurance, or are underinsured.
...and along those lines, and from the same source you used, here's a paper that takes a deeper look: http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf -- Similarly, the folks at the Heritage foundation, while hardly objective, make a decent point here: "Medicare beneficiaries are by definition elderly, disabled, or patients with end-stage renal disease. Private insurance beneficiaries may include a small percentage of people in those categories, but they consist primarily of people are who under age 65 and not disabled. Naturally, Medicare beneficiaries need, on average, more health care services than those who are privately insured. Yet the bulk of administrative costs are incurred on a fixed program-level or a per-beneficiary basis. Expressing administrative costs as a percentage of total costs makes Medicare's administrative costs appear lower not because Medicare is necessarily more efficient but merely because its administrative costs are spread over a larger base of actual health care costs.
Administrative Costs per Person
When administrative costs are compared on a per-person basis, the picture changes. In 2005, Medicare's administrative costs were $509 per primary beneficiary, compared to private-sector administrative costs of $453. In the years from 2000 to 2005, Medicare's administrative costs per beneficiary were consistently higher than that for private insurance, ranging from 5 to 48 percent higher, depending on the year (see Table 1). This is despite the fact that private-sector "administrative" costs include state health insurance premium taxes of up to 4 percent (averaging around 2 percent, depending on the state)--an expense from which Medicare is exempt--as well as the cost of non-claim health care expenses, such as disease management and on-call nurse consultation services." - http://www.heritage.org/Research/HealthCare/wm2505.cfm
"Vandy: no apology necessary." Thanks for the civility, Still. But back to your study, I recall a similar examination of the "savings" seen in Canada's single-payor system versus the U.S. But that seems to mask a few things. For example, private insurers have a cost of capital (e.g., interest on a loan) that public plans do not...however, the fact that the public plan relies on taxpayers masks this and introduces a deadweight loss into the system.
Will the politicians enroll in the same health plan that they are trying to force down the throats of the peasantry? If they opt out of their plan to join, then count me in.
the idea that the goverment could do ANYTHING efficiently or effectively (besides spend money) is laugh out loud funny. I'm *sure* that the new federal bureaucracy that grows like kudzu around healthcare will quickly teach the private sector a thing or two about keeping expenses down. As long as Congress ends up in the program as the currently unisured peasantry, I guess it will be ok.
This is not a very good argument at all... employers already have the power to change coverage options and prices any time they feel like it, and they frequently do. My former employer's insurance plan changed 4-5 times in the 8 years I was there, and the price went up each year! So what's the big deal if the public option causes changes to an employer's plan? If it leads to lower prices, so much the better. But the main advantage of a public plan to me would be that I think it would force coverage of pre-existing conditions, which private insurance companies currently refuse to touch!
Vandy: no apology necessary. Nice to know someone actually read something linked to. You were actually on to something. At some ppoint in that report, they tried to "apples to apples" the numbers between Medicare and private insurance. First, they compared admin costs versus payouts for medicare against premiums for private insurance. Then, acknowledging that Medicare patients use more health care per capita (due to age), tried to normalize the data. Basically, Medicare still paid less in administrative costs, but not as dramtically so.
Vandy: the graph is valid, but meaningless out of context. Medicare, by definition, covers the old. They cover the vast majority of seniors in this country. Seniors, per capita, use a huge amount of health care. Medicare doesn't cover young, healthy people. Of course Medicare pays out more per person in claims... As for the bone marrow thing, I'm not advocating whether any state or Medicare does or doesn't mandate it. My point is that is if no state mandated it, then there is a greater chance that anyone would cover it, or at least not charge exhorbitantly to do so. ... ACS is for some reason mixing states that require coverage of bone marrow transplants in general with Medicare's coverage of bone marrow transplants for breast cancer only. For most applicable cancers, Medicare DOES cover bone marrow transplants.
I'm 100% for dumping my employees into the public option and having you chumps pick up the tab. More money for me.
My apologies for an earlier post, Still. I mixed-up denominators and numerators; my bad. But this graph is still valid, I believe: http://www.ibdeditorials.com/images/editimg/issues04062209.gif
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"Say they remove the mandates to enable out of state shopping. If I need a bone marrow transplant, that coverage may no longer be available. I am now uninsurable." There are only 10 states that mandate bone marrow transplant coverage, yet many plans still cover it anyway...note that Medicare does not, by the way, for breast cancer patients: "Many insurers, including some of the nation's largest, routinely cover Bone Marrow Transplantation for breast cancer, although some still deny coverage for the treatment because it is considered experimental. Ten states currently require insurance coverage of Bone Marrow Transplantation or a mandated offering of the coverage option. Medicaid covers Bone Marrow Transplantation in some states, and coverage is provided to all beneficiaries of the Federal Employees Health Benefits Program. Medicare excludes Bone Marrow Transplantation coverage for breast cancer because the Health Care Financing Administration, which administers the Medicare program, considers the treatment experimental." -ACS
Note to Obama: Ram public healthcare down their throats! Who cares if people are nervous. They're always nervous.
From your paper, Still: "Our comparison of Medicare versus private health insurance administrative costs shows that Medicare does indeed have lower administrative costs as a percentage of total costs (benefits paid plus administrative costs)." So because Medicare can force providers to accept smaller payments, thereby decreasing the denominator in your equation, that makes them more efficient??? Forget percentages that have other variables; here's actual spending: http://www.ibdeditorials.com/images/editimg/issues04062209.gif
"This is a self-defeating argunment. If the plans are truly low cost, then there are little premiums to offset the cost of the sicker." The key would be volume, Still. Bringing in 10 low-cost individuals doesn't do much. Bringing in 13.2 million new low-cost individuals is meaningful. "In the parlance of the health care industry, Ms. Boyd, whose case remains unresolved, is among the “young invincibles” — people in their 20s who shun insurance either because their age makes them feel invulnerable or because expensive policies are out of reach. Young adults are the nation’s largest group of uninsured — there were 13.2 million of them nationally in 2007, or 29 percent, according to the latest figures from the Commonwealth Fund, a nonprofit research group in New York. -- Yet the average insurance premium for a single adult is $900 a month, according to a spokesman for the State Insurance Department.
“At this point, I can’t really justify it monetarily,” said Ian McElroy, a musician who moved to Bushwick, Brooklyn, from Omaha, last year. “It’s not like I think I’m invincible, I’m 29, the world can’t touch me. It’s the very opposite of that. I’ve got to make rent and eat. -- Of course, there are those who do feel invincible, like Eric Williams, who is 24, unemployed and currently in the middle of a six-week snowboarding adventure in Wyoming, Montana, Colorado, Utah, British Columbia and California. Mr. Williams said by cellphone near Bozeman, Mont., that he looked into buying health insurance before he left, but abandoned the idea after being unable to find anything for less than $400 a month. Instead, he is just trying to be careful, though not always with success.” You have to make cheaper plans affordable to these young people just starting out, so they can get into the system while all is well. -- http://www.nytimes.com/2009/02/18/nyregion/18insure.html
Vandy: out of state shopping can only be implemented IF you remove state mandates. Again, if a provider met all your state's mandates there's a good chance they'd already be licensed in your states... Say I live in NJ. Say they remove the mandates to enable out of state shopping. If I need a bone marrow transplant, that coverage may no longer be available. I am now uninsurable.
Vandy: and here's the best analysis I could find of Medicare's administratice costs versus private insurance. http://www.cahi.org/cahi_contents/resources/pdf/CAHIMedicareTechnicalPaper.pdf
"Vandy: you can focus on some of the ridiculous mandates (like acupuncture)." Glad you can recognize the need to eliminate this, which will help lower costs right away. As for other things, just because it isn't mandated doesn't mean it can't be offered; removing the mandate simply increases the breadth of offerings to the public, leading to more choice for consumers.
First of all, I can't believe that it's legal for health insurance companies to be "for profit." Yeah, it IS legal and it's a disgrace. They boost the bottom line for stockholders on OUR backs. And secondly, Obama pointed out a biggie-- there's nothing stopping employers from changing your insurance right now. And they do it ALL the time! And it's never for the employees' better! So what's the deal with reporters virtually asking him point blank if he's gonna promise to keep this from happening in the future if there IS a public option in the plan? No one is stopping it now, right? BTW, I hafta buy my own-- seems a 3/4 position entitles me to nothing at my job. So mine just went up from 5XX a month to 7XX a month. Just for me. I'd LOVE to stick it to the Insurance Man. Oh, yes, yes, yes I would!
"Now if you shopped for an out of state provider and needed, say a bone marrow transplant, unless they already happened to cover it, you would now be uninsurable." So if you already live in a state that doesn't cover it, you're outta luck from Day 1, right? Please explain how removing inter-state boundaries increases the number of uninsured.
Vandy: "If an insurer makes those bare-bones plans available, that draws more individuals into the pool...most of whom will utilize few services while adding their premiums into the mix to help offset the sicker among us." This is a self-defeating argunment. If the plans are truly low cost, then there are little premiums to offset the cost of the sicker.
Vandy: you can focus on some of the ridiculous mandates (like acupuncture). You asked why would out of state shopping would lead to more uninsured? Well, some of the things NJ, for example, mandates are: Autism, Bone Marrow Transplants, Diabetic Supplies, Colorectal Cancer Screening, Mammograms, and Second Surgical Opinion. Now if you shopped for an out of state provider and needed, say a bone marrow transplant, unless they already happened to cover it, you would now be uninsurable. And if the out of state provider met all of the mandates in your state, then they would probably be licensed there anyway.
Here's the reality: there are no answers at the moment. That's the purpose of convening the xperts and congress--to try to develop solutions to problems that have existed for a very long time. In my opinion, we need to look closely at the *creators* of the problem--the makers of medical devices who charge OUTRAGEOUS amounts of money for their machines, the providers of lab services that charge insurers amazing amounts for the simplest tests, while paying a mere pittance (minimum wage, often) to the techs who actually run the tests, and big pharma, which continually lies about "recovering research costs" to justify highway robbery. The people with the most influence--the insurance companies--can control costs by simply refusing to pay the jacked-up fees for labs and tests, and by taking high-priced pharmaceuticals off formulary so that pharma is forced to lower their prices to insure that doctors will continue to prescribe them. And speaking of doctors, I recently went to a well-advertised sports medicine specialist for knee treatment, and the patients were packed in there to the tune of at least 50 per hour. How on earth can 5 doctors see 50 patients per hour? At some point in time, overhead gives way to greed. Doctors whine that they are providers of health care and not paper-pushers or bean counters, but to me, many of them look like robber barons.
"Medicare if ran by private insurance companies would cost 40% more because of administrative costs." Prove it. CMS is hardly an efficient administrative machine.
Obama and his allies want exactly that: employers will stop offering coverage and people will be forced to get the "public option". Then they'll control everything. But the public option will be a minimal coverage HMO-type system. And as Vandy states, what makes anyone believe that a gov't run system will lower administrative costs? And wouldn't the current cost of paying for the uninsured through higher premiums just be replaced by higher taxes?
To correct health care in the USA we will need more doctors and more private insurance companies which would increase competition. That is the only role government has in health care. Currently, government controls the number of doctors produced from medical schools and that practice keeps the number of doctors artificially low. This increases costs for all of us by supply-demand. Obama has no answer to that equation and that is why he doesn't answer questions in that area directly. The free market, through competition and if left reasonably unfeathered by government regulation, will improve the care we receive. If Obama's plan kicks in all of us will pay more in taxes and receive less in care. Private insurance companies will go out of business leaving us with less choice in the long run. In he end, Obama's plan will bankrupt this country and leave us poorer and more sick.
Senate Panel Hears of Health Insurers' Wrongs
Ex-Insider Testifies to 'Fear Tactics'
Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released yesterday by the staff of the Senate Commerce Committee.
The report was part of a multi-pronged assault on the credibility of private insurers by Commerce Committee Chairman John D. Rockefeller IV (D-W.Va.). It came at a time when Rockefeller, President Obama and others are seeking to offer a public alternative to private health plans as part of broad health-care reform legislation. Health insurers are doing everything they can to block the public option.
At a committee hearing yesterday, three health-care specialists testified that insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that do not cover needed care. Rockefeller said he was exploring "why consumers get such a raw deal from their insurance companies."
The star witness at the hearing was a former public relations executive for major health insurers whose testimony boiled down to this: Don't trust the insurers.
"The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent and accountable -- publicly accountable -- health-care option," said Wendell Potter, who until early last year was vice president for corporate communications at the big insurer Cigna. http://www.washingtonpost.com/wp-dyn/content/article/2009/06/24/AR2009062401636.html?hpid=topnews
Your insurance premiums at work...........The top recipients of health insurance contributions in the House and Senate:
TOP 10 SENATE RECIPIENTS:
McCain, John (R-AZ) $251,834
McConnell, Mitch (R-KY) $200,200
Baucus, Max (D-MT) $183,750
Lieberman, Joe (I-CT) $101,400
Chambliss, Saxby (R-GA) $98,600
Collins, Susan (R-ME) $96,500
Kyl, Jon (R-AZ) $90,450
Warner, Mark (D-VA) $89,700
Hatch, Orrin (R-UT) $85,903
Nelson, Ben (D-NE) $83,300
TOP 10 HOUSE RECIPIENTS:
Cantor, Eric (R-VA) $113,850
Camp, Dave (R-MI) $112,923
Pomeroy, Earl (D-ND) $104,500
Boehner, John (R-OH) $101,200
Deal, Nathan (R-GA) $100,000
Towns, Edolphus (D-NY) $87,750
Rogers, Mike (R-AL) $74,000
Blunt, Roy (R-MO) $72,800
Ryan, Paul (R-WI) $69,000
Tanner, John (D-TN) $68,500
Of note here is Senator Baucus who is the chairman of the Finance Committee -- one of the two Senate committees dealing with healthcare reform right now.
kelprod1: Only an idiot would ever vote Republican again after the last 8 years. Bush's tax cuts were 1.8 trillion. His war 2 trillion.
Dump the Sick......A former senior executive with Cigna, Wendell Potter, testified on the Hill today that his former employer routinely "dumped the sick." [T]hey confuse their customers and dump the sick, all so they can satisfy their Wall Street investors," former Cigna senior executive Wendell Potter said during a hearing on health insurance today before the Senate Committee on Commerce, Science, and Transportation. [...]
"They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment," Potter said. "…(D)umping a small number of enrollees can have a big effect on the bottom line."
Small businesses, in particular, he said, have had trouble maintaining their employee health insurance coverage, he said.
"All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year's premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether," he said.
Is this what you were talking about Vandy when you said you can't imagine the insurance companies not doing everything they can to satisfy there stockholders. http://www.abcnews.go.com/Business/Health/story?id=7911195&page=1
From the perspective of the patient or the general public, The French, Swiss, German, Austrian, Danish, Italian systems are all equally tops, i.e. you get top quality healthcare for free everywhere in these country. Why are we ranked 37th when we spend the most money in the world on healthcare. I guess you guys want to stay the course.
Only a complete & total uninformed idiot would support any kind of national health care initiative...for 3 reasons..1.) we cannot afford it- we are broke and $11T in the hole. Obama and his band of congressional fools have no plan, intent or desire to fund this stupidity under their watch, which make sit borderline criminal...2.) by Obama's own numbers (which we all know are typical Obama self serving BS) only 15% of individuals are without some form of health insurance and the CBO has said that fully 14% of those folks are illegals- so Obama has chosen that weak case to declare a "crisis" (he is really good at doing that) to justify blowing up the entire system....and 3.) our private, profit motivated pharma, health care and health insurance industries continue to successfully provide employment, cutting edge R&D, investment, growth & prosperity. Once again, only an uninformed dolt would supprt this stupidity...
Vandy:Bzzzz Wrong again. Medicare if ran by private insurance companies would cost 40% more because of administrative costs. You really are clueless. The executives at these private insurance companies get paid millions in bonuses. That won't happen under the govt. Plus you wouldn't have to worry about your premium paying off Congress in the millions in donations. So much for what you know.
stoky: Where were you the last 8 years when Bush was robbing the country. We sure could use that trillion we spent in Iraq. Lets not forget the health care we are going to have to pay for decades for the 50,000 soldiers who were injured for a lie.
You people are clueless. Per dollar we pay the most for health care and are the 37th ranked nation behind Morocco when it comes to quality of healthcare. Private insurance should be destroyed. As soon as you have a serious illness they drop you. So when you get sick good luck with that. That's what most of your premium goes to. They pay people to look for who to drop. The nations insurance companies were on capital hill telling Congress they won't stop dropping people if they get sick. Now how sick is that.
Tapper is the best jornalist out there.
Poor Polman. Couldn't bring himself to criticize his hero without slamming some Republicans before signing off. Yet Clinton's shenannigans were OK.
we are on the road to slavery... If this plan goes through we are finished as a free nation.
CD75 - The American public IS that dumb. Thus our current situation.
liberal, to tag along with you- if you take care of a lot of the small stuff, you can avoid a lot of the catastrophic payouts
"Another misperception in some of these discussions is that a lot of money can be saved by providing only catastrophic coverage, leaving out a lot of little stuff." The public good is providing these low-cost plans to healthy individuals who currently choose not to obtain insurance and roll the dice because presently available plans cost too much due to having too many bells and whistles. If an insurer makes those bare-bones plans available, that draws more individuals into the pool...most of whom will utilize few services while adding their premiums into the mix to help offset the sicker among us. Lowering healthcare costs is a separate issue from this.
Another misperception in some of these discussions is that a lot of money can be saved by providing only catastrophic coverage, leaving out a lot of little stuff. This would be a prudent approach, but it wouldn't actually solve the cost problem because the catastrophic expenses account for most of the cost of health care coverage.
In a lot of the discussions of preexisting conditions there seem to be incorrect assumptions. If you're already covered under a plan, of course the plan can't deny coverage for cancer, heart disease, etc. However, if you lose coverage under that plan (changing jobs, company drops the plan, insurer drops the company, etc.) then you're uninsurable. We don't know how many people live under that particular sword of damocles, but it's surely more than 5% of the population.
"we now have the largest deficit..." Thank goodness Obama is decreasing it, right? Wait, when I said 'decreasing,' I meant 'quadrupling.'
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Chasing History, Medicare and Medicaid seem like a good plan to the user. The government makes hospital's accept their 30 cent on a dollar remebursement because Uncle Sam will shut them down if they don't. So what really happens is other users, with or without insurance, pay a premium to make up for M/M. The same with happen with a public plan. Hey, hospital, if you don't like our payment rates, your done. A private plan must negotiate a reasonable rate or the hospital can just say, we won't take your patients.
I'm sure that there's a number of young people with pre-existing conditions but is there anyone over 40 who doesn't have a condition that an insurer wouldn't like to use to cancel coverage. As was posted before, insurance companies exist to make money, not pay hundreds of thousands to treat. They's love to have only healhty 25 year olds on the books. Small companies wrestle with premiums based on the last two years of claims. They get hit with double digit increases if there's a cancer claim in their folder. BTW one large insurer will tie up pharmaceutical claims because they don't want to pay certain companies.(One of the companies has over a dozen products either on the "won't cover" or "script from God" list)
Obama's plan for reform is missing the reform. In reality, all his plan does is double the size of Medicare by making those who are uninsured eligible for benefits and raises taxes alot inorder to pay for it. All the while destroying the private health insurance market place. That's all it is. With all the talk of reform all he is really proposing is expanding a government entitlement program. That is not reform. That is growing government.
Still, as a follow-up to my last post, here's a better summation of my argument than I could have provided: "New York requires every insurance policy sold there to cover podiatry. Acupuncture coverage is mandated in 11 states, massage therapy in four, osteopathy in 24, and chiropractors in 47. There are an estimated 1,800 or so such insurance "mandates" across the country, and the costs add up.
A 2004 study by eHealthInsurance.com found that a typical insurance policy ($2,000 deductible, 20% co-insurance) for a family of four could be had for as little in as $172 per month in a reasonably regulated locality like Kansas City, Missouri. But in New York that family's only option--managed care--would run $840 per month, and in New Jersey family policies run a whopping $1,200-plus. -- Nor, contrary to the self-interested arguments being put forth by the BlueCross BlueShield Association--which has effectively monopolized many highly regulated markets and fears the competition--would free commerce jeopardize the "risk pool" (i.e. the overall pool of money that makes insurance possible by allowing the healthy to subsidize the sick). In high-cost, guaranteed-issue states the young and healthy don't participate in the individual insurance market anyway; a larger national market can only improve matters. -- As a major side benefit, interstate commerce in health insurance would remove a huge barrier to the efficient allocation of human resources in our economy. Right now untold numbers of Americans fear moving, switching jobs or starting their own businesses for fear of losing their health insurance. That would change if they were able to shop nationwide for policies that would follow them wherever they go." -http://www.opinionjournal.com/editorial/feature.html?id=110007011
"If your sole goal is to lower insurance premiums, by all means allow out of state shopping. This will, however, come at the cost of MORE uninsured." Why? Prove it. If it's a cost of doing business in the USA instead of a cost of doing business in a given state, what's the difference? If anything, you'd increase the risk pool from 50 smaller ones into a much larger one. Moreover, people who live in states where policies are forced to carry tons of (for them) needless benefits that come with a higher price can instead find policies from states, still regulated, that fit their specific needs.
Still, you seem to be accusing me of something I don't support. To be clear, I'm NOT opposed to government regulations of private health insurers; never have been. Quite the opposite, which is why I cited the auto insurance area. What I am opposed to is government getting into the business of PROVIDING health insurance.
Vandy - are you pulling a Tom here? From your article "A majority of Americans, about 160 million, get insurance through the workplace, where health plans must cover everyone regardless of medical background. It's not the same for the estimated 15 million people who buy their own coverage. Most states let insurers reject applicants because of pre-existing conditions. " So that 5 million uninsurable number is only out of those who DON'T have employer-sponsored health coverage. Again, it's state mandates that make them cover everyone in these plans.
Vandy: is they allow out of state shopping, then the number of "uninsurables" goes up. Again, much of what's covered is mandated by the state. Now if you were an insurer, would you cover whole classes of people with expensive ailments? No. You only do it because it's a cost of doing business in that state, which you want to do to make a profit on the young and healthy. .. If your sole goal is to lower insurance premiums, by all means allow out of state shopping. This will, however, come at the cost of MORE uninsured.
"and they don't allow out of state shopping." Again, they should remove those inter-state boundaries.
Still, I'll go up to 5 million medically uninsurable (1.5-2% of the population), with a citation: "The 47 million Americans without health-care coverage include 5 million uninsurables such as Kendra -- people locked out by private insurers because they have costly ailments." http://www.bloomberg.com/apps/news?pid=newsarchive&sid=a4BEIIi_OauQ
Vandy: yes, they do have private insurance - because states mandate that they cover these conditions if they want a license to offer any insurance in their state, and they don't allow out of state shopping.
We seem to be forgetting that insurance companies do not exist to provide healthcare benefits. They exist (like all businesses) to make money. It is a gross corruption of the principles of a free market system to primarily provide a benefit to the general population. Yet, somehow, the free marketeers on the right have gussied up the preservation of the for-profit model in that gown. It's nonsensical. All of the propaganda naysaying a healthcare plan that benefits the people is designed to distract us from the point that the insurers and the lawyers don't want to lose their pieces of eight. Nothing to see here, people. Move along. Any talk of providing quality healthcare to people in our advanced, civilized society regardless of ability to pay will cause the downfall of capitalism. Don'tchya know. I mean, really. If we can't view illnesses and injuries as entrepreneurial opportunities, where can we hustle a buck? Injured? Call Allen Rothenberg. He won't get paid until you get paid.
A straight answer from Barack Obama? Now there's any oxymoron, if ever there was one.
"Sorry, but a very significant percentage of Americans would be uninsurable in an actual free market system." Says who? So you're saying that private insurance companies don't cover oncology drugs? Nonsense. Many of those persons in your post do, in fact, have private insurance right now.
Vandy: have you ever dealt with a "pre-existing conditions" clause with an insurer? It's nowhere near 1%. Let's just start with cancer (all stats from ACS). There are over 1,000,000 diagnosed a year. It's estimated that in 2005, over ten million people were living with cancer. A male has an almost 50-50 chance of developing cancer in his lifetime. Granted much of that is in older patients, but anyone with a cancer history, without government mandates, would be either uninsurable or close to it. Move on to cardiovascular disease. As of 2004 (last data I could find), over 17,000,000 Americans were living with a cardio vascular disease diagnosis (from HHS). You can count them out, too. 1% starting to seem a little optimistic, isn't it. Did you know that until certain laws were changed (and some lawsuits), some insurers considered pregnancy a pre-existing condition? Jaundice as a baby? Pneumonia? ... Sorry, but a very significant percentage of Americans would be uninsurable in an actual free market system.
Let's face it. Employer-sponsored Health & Welfare coverage is just another benefit of the labor movement that Businesses have been trying to roll back since the first collective bargaining agreement was signed. Not counting the "golden parachutes" offered to CEO's and other highly compensated employees, how many non-union firms offer a company paid pension? Once the gov't started taking care of retirees, the private sector didn't have too. Plus, by paying Social Security taxes, private firms ARE contributing toward a "pension" plan. Employer based plans are destined to fade away as they become too expensive to be offered. Wasn't the pensioners' H&W plan the albatross hanging around GM's neck that dragged GM into insolvency? The model is broken. Maybe we could ALL enroll in Tricare? There's no fee if you're under 65 (SOURCE: http://www.military.com/benefits/tricare/tricare-prime/tricare-prime-overview#cost) and it seems to be single payer administered. «SNIP» TRICARE For Life is administered nationally by a single contractor «SNIP» (SOURCE: Page 3 on http://www.tricare.mil/mybenefit/Download/Forms/TFL_Handbook_rev_08.pdf) Nahhh. That's too much like Socialism???
"What you still haven't addressed is the uninsurable." Good! We've taken care of 99% of the population and whittled it down to the 1% that are truly medically uninsurable because of pre-existing conditions. On the one hand, charging different premiums based on health will encourage more young, healthy people (especially single young adults who believe they are invincible and would rather buy a Wii than insurance) to obtain bare-bones plans to protect against catastrophe, and putting premiums from people who are unlikely to utilize services into the risk pool will help absorb the others to a degree. And for those 2.5-3.0 million people, I don't have a problem with government subsidies at all, while recognizing that it is not inappropriate for those who utilize more insurance services to be asked to pay higher premiums.
Vandy: I'm FOR what safeway is doing. Of course cutting back on smoking, losing weight, eating right, and exercising are all important. We should reward healthy behavior and punish unhealthy behavior through premiums. The point that you seem to be (intentionally?) avoiding is the "uninsurable". Lots of cancer patients are not smokers (I believe the majority). Many people have high cholesterol due to heredity. My sister runs several marathons a year yet has mild hypertension. All of these people would be prohibitively expensive or even uninsurable (especially the cancer ones) without goverment mandates. In the "let the market decide" solution to health care costs, how do you address this?
tom: you can get the cheap tests whenever you want (blood work, Xray, even MRI). I have Aetna, and can go to Quest with nothing more than my doctor's script. However, the expensive tests, such as a CT scan, are not nearly the way you describe them. And no, this was a standard HMO.
still...your scenario reminds me of a managed care plan.....in which, as the name portends, care is managed. A lot of insurers have gone away from that type of plan and offer multiple options to employees. However, imagine a government plan in which all care is managed and no other option is available. That is what you will get with Obamacare. My plan enables me to get a referral at 2:00 and go across the street to either Quest Diagnostics or another lab and get the test needed. All I need is a referral either faxed or taken over my me. No "gatekeeper" involved. That will never happen under the gov't option.
"Obesity is the only one that can (almost) definitely be prevented by behavior." You don't think lung cancer rates would go down if people stopped smoking?!!!! You don't think that cardiovascular issues would decline if people got more exercise and had a better diet? You don't think the risk of diabetes declines as overweight kids lose weight??
Why not just open government clinics for the poor? They pay nothing, they can have below average doctors, they can use 1980's technology, and still have better health care than 90% of the people in the world. Set it up as a lower level of care, with longer waiting for services. It's still coverage, but won't cannibalize the premium services that we would like to remain for those of us willing to pay. Is anyone offended by the concept of giving poor people below-average care by design? If so, why? Is health care a natural right?
If the argument about a government-provided health insurance option is that it would underprice private insurance, then it is completely incoherent to cite the Post Office, Amtrak, or some supposedly incompetent government service as evidence, since if the government health insurance option was inefficient, the private systems could underprice the government system.
Many people who use the "rationing" argument have the false idea that if there's a government program they can't spend their own money (or have their own private health insurance) to provide broader care. This is not the case in the great majority of Government-run systems--England, France, and Germany for example. You can get any care you want if you pay for it and can get it cheap in India or Mexico if you're poor. (ironic comment).
tom, delighted you miss me. I'll make you feel better by noting how incoherent your posts are on this topic, which you share with a lot of the other folks who just can't abide a government health program as a gut issue, even though they have no logical ammunition against it. First of all, if the only way to reduce costs is to ration health care--which is certainly true in a way, how is this an argument a government-run system, since the private system must also ration, and already does ration as any insured person who has been sick knows perfectly well. Second, as to fraud in medicare and medicaid, fraud in these areas is a federal crime and the local US attorneys have put quite a few docs and others in federal prison over it. How are private insurers better-situated to prevent fraud? Finally, as to the public perception of private insurance, see my post above.
you also have to factor in the mandates that insurance companies must abide by do offer insurance in certain states......Medicaid is administered state by state and they also include similar mandates by the State Medicaid authority. Never heard of hairpieces being covered - note to self: check my insurance policy ;). But I would agree, that comparing public plans like MC and MA to private insuraners is comparing apples to ornages.
Most people outside of the health insurance industry are clueless to the fact that private employers are aggressively dumping health care as a benefit for two reasons: the overall cost, and the fact that all employees must generally get the same benefits, so the plan is an obstacle to structuring their compensation the way they'd like it. If you like your employer=provided health care, too bad, because next year it is very likely to become less generous. The idea that it will stay satisfactory is a fantasy. The share paid by employees is continually increasing, so those who can't afford it will continue to drop out.
tom: "How about when a 75 year old who needs a knee replacement is denied due to a negatively skewed cost/benefit analysis?". I don't know, I had a close relative with cancer wait almost two months for a CT scan (during which no treatment could occur) while her insurer (a major company) waited for the cost/benefit analysis report from the company they subcontract to. The "doctors" working for thast company, btw, get bonuses based upon their denial rate. So to answer your question.... um, nothing different than now? ... On a different note, what is your problem with the USPS? They charge so little for a stamp because our government decided that cheap, reliable mail service was crucial to businesses and the growth of the country. They aren't supposed to be making money.
Vandy: first, I have no way to know if "70% of all health-care costs are the direct result of behavior", nor do I know who was studied (by that I mean that for the young, whom are probably represented disproportionately in some lower paying industries,health care costs probably are a more direct result of behavior than in older patients). Also, the statement that cardiovascular disease, cancer, diabetes and obesity cause the vast majority of health care spending is true yet non-sensical. Water causes most drowning deaths. What's the point? Obesity is the only one that can (almost) definitely be prevented by behavior. Don't get me wrong - i LOVE what Safeway is doing. I wish my employer would do the same (then again, I am a daily working out non-smoker with no chronic conditions). What you still haven't addressed is the uninsurable. As many have pointed out, no medical insurer in the world would have touched John McCain, a multiple-melanoma surviving septagenarian - who was espousing the market solution. My friend's son, as an exmple, battled Hodgkins as a child. While he has been cancer free for over ten years, he'd still be basically uninsurable except for HIPAA and similar government mandates.
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please explain all the success Medicare and Medicare have in controlling costs. Please explain how all the fraud prevalent in both Medicare and Medicaid can be prevented in a government option. Please explain how a private insurance company, which must report to its shareholders, can compete against a government option which does not need to report a profit.....tom, I haven't done enough reading or research to compare costs controls or fraud prevention between a public entity (CMS) versus priavte insurer. However, I could ask you the same question. What has the private sector done on these issues? To answer Vandy's question, the old are already covered through Medicare if they paid into Medicare. If not, and their income is very low, they may qualify for Medicaid.
Life insurers are able to charge more for behavior....smoking, obesity, risk taking lifestyle (i.e. skydiving, auto racing, etc.). They can also charge more for pre-existing conditions, and choose to not insure someone. Health insurers should be able to do many of the same things...although denying coverage leaves a person maybe unable to afford care, which is morally repugnant. However, health insurance is not currently a right. Many uninsured choose not to have coverage because they are young, healthy and stupid. And whatever happened to Liberal, Swedesboromike, and NEPhilly....did they run off together?
"Would the equivalent (the old and the sick) just be left out?" Medicare already covers the old, right?
chasing....please explain all the success Medicare and Medicare have in controlling costs. Please explain how all the fraud prevalent in both Medicare and Medicaid can be prevented in a government option. Please explain how a private insurance company, which must report to its shareholders, can compete against a government option which does not need to report a profit. In fact, looking at the current businesses run by the government (AMTRAK and USPS), they operate at a deficit every year and just ask for higher subsidies. If the post office wanted to operate at a profit, stamps would be selling for a lot more than 44 cents (or whatever they cost now). The only way costs can be controlled in health care is through rationing of care, as is done in Canada, the UK and every other country with nationalized health care. Ever wonder what would happen to the government option the first time a person who is used to needing an MRI and getting one within a week suddenly has to wait, say three to four months for that same test under Obamacare? Think that will cause a public outcry? How about when a 75 year old who needs a knee replacement is denied due to a negatively skewed cost/benefit analysis? All that is coming under a government option...which is why it will never fly. Look at the NYT/CBS poll, which was touted as the public in favor of a gov't option. In that poll, 63% think a gov't plan will cause the quality of their own care will get worse; 68% think it will limit their access to care; 77% are satisfied with their current care; 37% (majority) believe it will hurt the economy; 77% believe their current insurance is affordable; see the paradox? And this poll was made up of Obama voters by a 2 to 1 margin.
"there are people who choose not to drive because insurance costs are too high, and many others who have insurance ONLY because of state mandated high-risk pools." People who are bad drivers pay higher premiums than people who are good drivers. That is fair, AND it encourages bad drivers to try to become better. Check out the Safeway plan: "Safeway's plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity).
Safeway has done nothing more than borrow from the well-tested automobile insurance model. The big difference between Safeway and most employers is that we have pronounced differences in premiums that reflect each covered member's behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.
Employees are tested for the four measures cited above and receive premium discounts off a "base level" premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families. Should they fail any or all tests, they can be tested again in 12 months. If they pass or have made appropriate progress on something like obesity, the company provides a refund equal to the premium differences established at the beginning of the plan year.
The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent. In addition, 76% asked for more financial incentives to reward healthy behaviors." - http://online.wsj.com/article/SB124476804026308603.html
Vandy: but following your analogy, there are people who choose not to drive because insurance costs are too high, and many others who have insurance ONLY because of state mandated high-risk pools. Would the equivalent (the old and the sick) just be left out? Yes, those with clean driving record can get relatively affordable car insurance, as can healthy people with no pre existing conditions. ... Unrelated - I did answer you last blog.
"It's a strategy to hold down the rise in costs compared to doing nothing." Chasing, this graph clearly shows that, over the past 40 years, government-run healthcare costs have risen faster than non-government entities: http://www.ibdeditorials.com/images/editimg/issues04062209.gif -- I don't think we should do "nothing," but the answer to more efficiency is never to create a mammoth new government beaurocracy. Why not just eliminate the artificial inter-state boundaries within the private market and provide tax credits to help those who need assistance with premiums.
"car insurance is mandated because you don't have to drive." That's not quite right, is it? People in San Francisco aren't mandated to have earthquake insurance, even though they don't have to live there, for example. My point in comparing auto insurance is that it proves comprehensive coverage can take place--from gold-plated "cadillac" plans to the "we keep you legal for less" plans that protect against catastrophe--WITHOUT a wasteful, publicly funded option.
So implementing a taxpayer-funded public plan when unemployment is at 10% makes sense why??....It's a strategy to hold down the rise in costs compared to doing nothing. While you may not agree with it in princeple, or the timing, I found this article from Peter Orszag, director of OMB interesting. http://www.ft.com/cms/s/0/6c0ec9ee-59d9-11de-b687-00144feabdc0.html?nclick_check=1
tom: housecleaning as you like to put it - it wasn't the numbers I was taking issue with. It was your characterization of them. "the CBO already said a government run option will cause 22 million people to lose their current health care and be forced into the gov't plan". You now acknowledge that these are numbers "True this is without any government option". How do you reconcile the two statements? Which is it? ... As to the numbers, if an analysis states that 20 million will lose employer coverage but five million will gain it, isn't it disingenuous at best to state that 20 million will lose coverage under the plan? Can I pick one day the stock market goes up and say "The stock market has gone up under the Obama administration?"
"More people out of work = less state tax revenue to fund the Medicaid program." So implementing a taxpayer-funded public plan when unemployment is at 10% makes sense why??
Phrossty/Vandy: car insurance is mandated because you don't have to drive. You can hitch rides w/ friends, take the bus, ride a bike, walk, etc. Unless you wish for death, when you get sick you must get medical treatment. Auto insurance is only mandated if you wish to apply for the privilege of a driver's license.
And how is Medicaid working out for the taxpayers in the two largest states, California and New York? .....More people out of work = more people on Medicaid. More people out of work = less state tax revenue to fund the Medicaid program.
How does that lower administrative costs?...I'm sorry, I was responding on the accountability issue, not the cost issue. And my point about my wife's practice is purely to demonstrate that private insurance companies have little oversight on the timeliness of paying claims. That is affecting my wife's practice from a cash flow perspective.
CD75: I notice you did not respond to any of my points yesterday. I can only conclude that, by your silence, you agree with the points I made. And yet here you are again, beating the same dead horse you always beat (albeit more economically). Why?
"My wife has her own practice, and is paid promptely by MC/MA while private insurance companies can take between 90-180 days to pay claims." How does that lower administrative costs? The example of your wife simply tells me that the private companies have better cash management strategies than the government. And how is Medicaid working out for the taxpayers in the two largest states, California and New York?
The United States practices heroic medicine. This is an admirable trait of our citizens, but it absolutely drives up the costs. Consider someone with a recurrent brain tumor. In Europe, another surgery would be largely out of the question (medicines provided for the pain and quality of remaining life), while it would be considered cruel in the U.S. to deny such an expensive procedure that has a small chance of clinical success.
Because the public plan isn't accountable to anyone, why on earth would you believe that it would "lower administrative costs"?....you're wrong Vandy. Both Medicare and Medicaid have an appeals process that is overseen by an independent entity if there is a dispute regarding denial, payment, etc. issues. My wife has her own practice, and is paid promptely by MC/MA while private insurance companies can take between 90-180 days to pay claims.
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this is news? When is he specific about anything? His platform of hope and change was one of the most stupid slogans I have ever heard yet the ignorant voters liked it. He is an appeaser who never takes a stand. What a dope, can he be worse than GW???
"Now, if it turns out that the public plan, for example, is able to reduce administrative costs significantly, then you know what, I'd like the insurance companies to take note and say, hey, if the public plan can do that, why can't we?" Here's my principal beef. Because the public plan isn't accountable to anyone, why on earth would you believe that it would "lower administrative costs"? That's absurd! Of all the things you can say about insurance companies, you can absolutely bet they are doing all they can to lower their administrative costs and thus boost the bottom line for their shareholders.
what is the problem with a public option for health insurance.....I have no problem with the public option. CMS which administers Medicare and Medicaid are efficent entities despite what the Right would have you believe. I was just commenting on Phrosty's post about how a public option may lead employers to dropping coverage all together or limiting the coverage thereby pushing employees into the public option.
Comment removed.
What about tort reform? Of course that is not on the table since obama is a lawyer.
Obama knows almost nothing about the structure of this "reform", and less about how it will operate in the real world. All he knows is that he wants it, and is willing to pony up 1.5 trillion to create a program that once in place, can never be repealed.
Not sure if you're talking to me, chasing history, but I think the public option is there to 1) short term, reduce the cost of health care by forcing private insurers to lower their profit margins to stay competitive; and 2) long term, via a slow bleed, to put them out of business as more and more people decide, of their own volition, that the public option is preferable (cheaper, less haggling, more doctors in its network, you can't lose it if you lose your job, etc. etc.). As Michael Moore put it best, in our current capitalist system, "even cancer has to turn a profit." If firefighters do a good job putting out fires, and we rely on them to save our lives from them when needed, and they are government employees, what is the problem with a public option for health insurance. Of course Obama (nor any other high-profile Democrat) can go around admitting that (2) is a likely longterm consequence of a public option. Because that would scare the stupid public out of its wits. Which is part of the reason why this debate is occuring over the summer months - the majority of nitwits will be tuned out throughout vacation season. And this might pass by September with little of the rancor seen from Hillarycare. (If that's true, watch out for great progress to be made especially in August.)
Then give the public a real choice of coverages and carriers....so you are saying that employers could not drop employees coverage, but could offer plans that are more expensive than the public options thus driving people to the public option?
People do not realize that they are subsidizing those with no insurance, by the higher premmiums they are paying. They also do not realize that the high cost of hospitalization is because hospitals subsidize those with no insurance to the tune of many millions of dollars per year in "charity and non-payer" care.
I am dumbstruck that the "single payer" option is not on the table. I know its not because it puts the private insurers out of business, and of course we can't have that, can we. Spending time parsing Obama's words is as useless a pursuit as it was parsing Bush's words.
Obama is the king of talk without substance or details. The American public is not that dumb.
"That if the federal government gets involved, it might scrüe things up and compound the health coverage woes we already have." This is the fear-mongering logic the insurance companies use to keep the status quo (i.e., their profit margin) in tact. While it's a legitimate concern, it's overstated, over-hyped and over-used. I like Vandy's point. How come car insurance is mandated, but health insurance isn't? Make being uninsured illegal. Then give the public a real choice of coverages and carriers. As noted in the article, employer-sponsored plans are going the way of the Dodo á la pension plans. Keeping Aetna, Blue Cross & UHC in the money is NOT a solution to the crisis. (Posting denied a few times before I figured s-c-r-e-w is a Bozo no-no.)
the government will not be forcing those with insurance from their employer into the public option. But if the employers themselves do that, that's a problem between you and your employer.....I'm not sure how you get around this since this has been going on for years in public health insurance programs operated by the state. Example: PA sued Wal Mart because many of their employees were so poorly paid, that they qualified for Medicaid thuis allowing Wal Mart to drop their coverage. I wonder what the outcome was.
Not to mention: many people may themselves and voluntarily dump the crappy insurance their employer provides (say, anything from AETNA), especially if they don't use it often (or at all), for the public option. Not only would it possibly be better insurance, it would save them money. Instead of their raises being eaten by their increased contributions, they'd have that money to spend on whatever they wanted. Another stimulus.
Understanding here is that all businesses (except those in the business, of course, of supplying health insurance) WANT the public option to be able to get out of the onerous costs of health care. Which adds to the logic of doing reform this year - this could be a greater boon to the economy than any stimulus package. And might save a lot (GM, Chrysler) of struggling companies.
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Seems Obama answered the question, sort of like a Zen master, by his nonanswer. Which is that the government will not be forcing those with insurance from their employer into the public option. But if the employers themselves do that, that's a problem between you and your employer. Not you and your goverment. Likely if you work for a generous employer - say, Google - you'll keep your employer plan. But if you work for a struggling company - say, GM - or an ungenerous company you'll be dumped faster than they can pull up the dumptruck. This may have the effect, however, of lowering your premium (if the public option is successfully cheaper) and increasing your salary (if some of that money saved by not paying for health insurance is returned to you as compensation).
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