Putting the Vicious Health Insurance Dogs on a Leash

Burning the Midnight Oil for the Next American Revolution

From one of my comments in buhddydarma's most excellent diary:

I'd liken it to a vicious dog behind a fence. Given access to the fence, he will worry it and try to dig under it, or hang out by the gate and eventually get out. Like a group of corporation with massive profits locked behind a regulatory wall, who will eventually find a way to get a loophole put into the wall.

Tie the dog up in the yard so he can't get at the fence, the combination is more effective than either alone.

A robust public option works like the leash tying the dog up. The corporate insurance companies cannot squeeze too much harder than the public choice without losing market share, so it will be much harder for them to organize to break the regulations in the health care exchanges.

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Don't get confused by the "five percenters". This was President Obama trying to mollify the Republicans and also make the extremists look ... like extremists.

But in the preliminary CBO analysis of HR3200, which is where the 5 percent seems to come from, this really is a rhetorical trick designed to make a robust public choice sound less effective than it would be. And if we lose sight of how effective a robust public choice could be, we will not fight hard enough to (1) get it in the bill and (2) kill phony substitutes.

Through to 2019, HR 3200 is scored as adding 11m through Medicaid (since I'm blogging in genteel poverty, I'm one of those), 2m through employer provided insurance, and 30m through the exchanges, with 6m switching (comparing 2019 projection w/out to 2019 projection with) from non-employer provided health care primarily into the exchanges, for a net increase in 37m.

Everyone in the health insurance exchange benefits from the public choice - even those with private insurance. So that is 30m beneficiaries, which is:

• 100% of those in the public exchanges
• 80% of the increase in coverage
• 60% of citizens and documented migrants w/out coverage
• 50% of all people residing in the US w/out coverage

And, yes, 10% of those projected to have insurance after the reform. But the majority of the gap between the percentages in that list and "10% comes from including those people projected to continue to receive employer-based health insurance.

Their stake in the reform is supposed to be reforms that protect what they already have.


Don't get lost in CBO projections

Of course, this is all simply CBO projections. Don't forgot what you know about how our politics and economy really works when wading through the CBO numbers.

And so that brings us right back to the vicious dog model of corporate health insurance. If there are corporate insurance only health exchanges, we all know full well that we will be fighting ongoing battles over corporate health insurance companies trying to open the health insurance exchanges to precisely those people where the public subsidy is more lucrative to their bottom line than employer-provided health insurance.

And if we win some, we will surely lose some.

And so the CBO projection will, of course, fall far short of the entries into the health insurance exchanges and it will be far more than 30m suffering directly because there is no robust public choice in the health insurance exchanges.


Who would a progressive deny this protection to?

Of course, one reason for using percents is that using millions make it seem a bit brutal to say, "a mere 30 million will suffer if we lose the fight on the public option, so lets throw those poor losers to the hounds".

The candy store paupers lie to the share holders
They're crossing their fingers they pay the truth makers
The balance sheet is breaking up the sky
So I'm caught at the junction still waiting for medicine
The sweat of my brow keeps on feeding the engine
Hope the crumbs in my pocket can keep me for another night
And if the blue sky mining company won't come to my rescue
If the sugar refining company won't save me
Who's gonna save me?