Sunday, November 29, 2009

Our Stupid Discourse:

Look, there's something wrong with this thoughtful analysis, can you spot it?

To begin with, a public option would attract only a few million people, the Congressional Budget Office predicts. Those people would probably be sicker than the general population. For that reason, and because their numbers would be relatively small, their premiums would be higher than for private insurance.

A) The Public Option wouldn't "only attract a few million people" it would, as currently drafted, only *permit* a few million people to be eligible.

B) Those people wouldn't "probably be sicker than the general population"--they would definitely be sicker because the Option, at the moment, is limited to people who have essentially been uninsurable for quite some time, or are uninsurable because they have pre-existing conditions, or are poor and have the risk factors of poverty and low status employment.

C) "For that reason..." their premiums would be higher than for private insurance *which they can't get, and won't get, under any circumstances.* There is no "private insurance" system that is taking these people. They have been priced out, or forced out by reason of pre-existing conditions--from the private insurance market. There is no comparison between those premiums and Public Option premiums because the two markets don't simultaneously exist.

People need Health Care, Health Insurance is simply the means we use to deliver the most health care, the most efficiently, to the largest number of people when they need it. If it doesn't deliver health care, if it doesn't do it efficiently, if it leaves a large number of people uncovered or uncared for, if it doesn't offer health care when they need it--the system is a failure. You can create an insurance system that does all these things but it is never going to be successfully "for profit" if it does. You can create an insurance system that does all these things but as long as it can cherry pick its clients, or force the sickest onto someone else's books, it is never going to do all these things efficiently, or humanely, or cost effectively.

Why at this late date are the reformers allowing this fundamental fact of reality to be obscured? Why do we continue having incoherent surface discussions of "what the Public thinks" when there is no clear or honest information being offered about what the various plans do, for various kinds of families, over the course of the lifetime of those families? In addition, why are pundits and pollsters insisting on talking about a generic "Public Option" when no such Option really exists or, indeed, of "Private Insurance" when no such option realistically is offered, or works, for Americans. I'm sick and tired of having pundits explain to me that the "Public Option" ain't all its cracked up to be when they refuse to admit that the Private Option is nothing like its supposed to be.

The simple fact is that even Americans with Employer Based Health Insurance are only temporarily insured. Medicare and Medicaid are already serving as a way that private insurance (and Employers) dump the sickest among us onto the Public Rolls. But the public doesn't know that, because the Administration doesn't know how to talk clearly about the hidden costs of our Health Care crisis. If the Government, at least, would talk honestly about our Health Care needs from cradle to nursing home the public would have a better idea of just how bad the system is, and where reform will make the most sense. The public would also have a better idea of who to thank when the problems were solved. As it is, the goodies in the bill for the average person are not well understood now and never will be. Most people only grasped how bad private insurance was when they got forced out of the system, or tried to buy in. To the extent that the Obama bill will ameliorate some of those things the citizenry will simply never know--anymore than they think about the regulations that give them pure tap water.



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