Indeed the knives are out for the public option.



And as Bob note - and indeed the following report the same info he does -
even using his wording more or less on occasion - Dear sweet Olympia Snowe,
Republican, well-respected, and considered non-partisan, is selling herself
as a cover for Democrats and at her Thursday June 6 private gathering of
members/staff of Congress discussed the proposals of Pharma (11% of the
nation's heath bill) and the Insurance companies. She is pushing the
"trigger" idea - no public option ever because there would be a trigger as
to how much insurance companies must bring down healthcare costs and expand
coverage that is set so low for turning the public plan off, that the
effects of the welfare check to the insurance companies as to cost of
medical delivery - the computerization of the industry - will take care of
the required slowing down in the increase over the next few years and the
mandate requiring everyone to have coverage will automatically expand
coverage. She's already gained the tentative support of several Democrats
(including Ron Wyden and Thomas Carper).



Other kill public plan proposals are to break up the public option into
small pieces under multiple regional third-party administrators that would
have little or no bargaining leverage (or the equivalent of setting up one
in each state since buying the state legislature is seen as not a tough job
for the insurance companies - many state reps being former insurance
employees), or to bind the public plan not to the Senator Schumer fair
competition rules, but to rules making the public plan charge the same as
private insurers so as to have no competitive pressure. Like Bernie
Sanders, Eric Massa, and John Conyers, we should oppose a fake reform that
fails to include a genuine public option. The let down of no bill will be
less than the let down of a GOP plan passed by Democrats.



If one needs a refresh on the issues, PBS at
http://www.pbs.org/video/video/1050712790/subject/957383245 is not bad. Then
go to http://www.usa.gov/Contact/Elected.shtml and find your elected
officials (by zip code) and write to them that you want any health care
reform bill to include a "full public option", without any of the triggers
proposed by Sen. Snowe. For those that want to take direct action against
there is a Defeat Baucus campaign at
https://www.thedatabank.com/dpg/309/donate.asp?formid=meet&c=8161321



Right now we get none of the benefits of a government-managed plan (such as
negotiated fees for services and for prescriptions) and all of the downsides
as we as taxpayer get our pockets lightened by 8 percent of our families'
2009 health care premiums - $1,100 because our system doesn't provide
continuous coverage for all
http://www.americanprogressaction.org/issues/2009/03/cost_shift.html - as we
pay for the medical care of the uninsured (a nearly $100 billion per year
cost for what is often for preventable diseases or diseases that physicians
could treat more efficiently with earlier diagnosis." (see
http://www.nchc.org/facts/coverage.shtml). Other Western European countries
seem to always record provide better outcomes at half the cost (or less) of
U.S. health care). Meanwhile medical bills underlie 60% of US bankruptcies
as noted at http://www.reuters.com/article/newsOne/idUSTRE5530Y020090604, as
US Doctors support universal health care as noted at
http://www.reuters.com/article/latestCrisis/idUSN31432035 where the journal
Annals of Internal Medicine reports that of more than 2,000 doctors
surveyed, 59 percent said they support legislation to establish a national
health insurance program, while 32 percent said they opposed it.



The garbage that there can be no "fair competition rules" because the public
plan has a line to the Treasury ignores the current insurance company
overcharge up front followed by "claims underwriting" (denying claims you'd
think the language of the policy said you were covered for, or delaying the
approving new treatment or the payment of old until you are dead and there
is no need for further procedures and a less interested person is asking the
insurance company for money). The current insurance company no regulations
on price or performance model makes a mockery of the idea that "competition"
always leads to improved delivery and quality of products and services, at
lower cost to the consumer. That is exactly the opposite of what is
happening in the insurance-based model adopted by the United States. We've
already got examples to draw from - Medicare and VA hospitals - that show us
what can be done with limited dollars. One does not see insurance companies
wanted to take over the Medicare and VA - that is not unless they can get
their 10% of Medicare Cost additional welfare check - the one they now get
when they "compete" with Medicare.



the "American Health Choices Act") has been circulated (6-05 DRAFT) to allow
the members to suggest changes before the bill goes to mark-up.



PRIVATE INSURANCE MARKET REFORMS:

-Eliminates health status rating

-Requires guaranteed issue and renewability

-Requires all insurers to report MLRs (Loss Ratio is a value of premium
concept that is just the ratio of the claims paid to the premiums collected
- thereby exposing overhead and profit) to the Secretary (private insurers
would have to pay out a specified percentage of their premium revenues in
benefits).

-Requires coverage of certain preventive services

-Increases the age at which dependents are required to be offered coverage
to 26

-Prohibits annual or lifetime limits on coverage



STATE-BASED INSURANCE GATEWAYS:

-Provides grants to states to create "gateways" (discussed below) through
which individuals and small businesses may purchase insurance

-Provides reinsurance funding for plans participating in the gateway

-Establishes a Medical Advisory Council that will define, among other
things, "essential health care benefits" that gateway plans must offer and
"minimum qualifying coverage" that individuals must purchase

-For states that do not initially adopt the reforms in the bill, the
insurance market provisions of the American Health Choices Act would
automatically apply

-Would establish (but this draft leaves blank) the benefit levels
(coinsurance, etc.) that gateway plans must adopt

-Would establish (but left blank) minimum MLRs (again the loss ratios -
percent of premium paid to insureds as opposed to overhead and profit) for
gateway plans

-Provides subsidies up to 500% of FPL (this poverty level reference seems to
mean $110,000 for a family of four) for the purchase of insurance

-Establishes small business credits for purchasing insurance (with the size
of "small business" to be determined)

-Gateway plans made available to employees if their employer does not offer
"qualified coverage" or if plan options are not "affordable" (terms to be
defined)

-Includes a play-or-pay employer mandate and possibly an individual mandate
(perhaps similar to the Massachusetts pay or play rules that Republican
Governor Romey approved)

-Establishes HIT program for electronic enrollment in gateway plans



OTHER PROVISIONS:

-Increases Medicaid eligibility to 150% of FPL (150% of the poverty level -
$33,075 - but the eligibility change is in very general language since the
Finance Committee has jurisdiction over the program)

-Establishes a Community Living Assistance Support Service (CLASS) for the
10 million disabled, homebound, and institutionalized individuals

-Provides a credit for employers who auto-enroll their employees into
offered health plans

-Suggests new coverage options for retirees which I hope is a reference to a
Medicare buy-in

- And appears to provide a public plan option, with the Secretary of Health
and Human services establishing the new government-sponsored plan, which
would compete directly with private insurers. The new government-run program
would pay doctors and hospitals at Medicare rates, plus 10 percent.



People would be exempt from the pay or play penalties if "affordable health
care coverage is not available" or if the premium payments would cause "an
exceptional financial hardship" just as Obama recommended. The Secretary of
Health and Human services would establish a panel of experts, the Medical
Advisory Council, to recommend a minimum package of insurance benefits where
the "essential benefits" would include doctors' services, hospital care,
maternity and newborn care, prescription drugs and mental health and
substance abuse services.. If Congress did not disapprove the
recommendations, insurers would generally have to provide the benefits.
Private group or individual insurance company health plan would be required
to provided coverage for children and their parents with the child's
coverage inforce through age 26 unless no longer "dependent".



Grants would be made to the states to establish insurance marketplaces or
exchanges called "health benefit gateways" that would put out information
about premiums and benefits, and assist people in enrolling - again similar
to the current Massachusetts Plan. Reinsurance - the sharing of the risk
that one insurer enrolled more sick persons than the others - would be
subsidized by subsidy payments from the government, with the government
doing the administration of the reinsurance - moving the reinsurance premium
from the companies that enrolled mainly healthy persons to those that
enrolled the more sickly. All of this reinsurance of course is currently
done by reinsurance insurance companies but would now be the responsibility
of the government, with those reinsurance insurance companies no doubt doing
the administrative services - the same way the insurance companies currently
do the administrative services for Medicare Part B.



From: andylang@yahoogroups.com [mailto:andylang@yahoogroups.com] On Behalf
Of fhawontcutit
Sent: Saturday, June 06, 2009 9:57 AM
To: andylang@yahoogroups.com
Subject: [AndyLang] How Pharma and Insurance intend to kill the public
option








http://robertreich.blogspot.com/2009/06/public-option-smokescreens-and-what-
you.html

EXCERPT:
--------
I'ved poked around Washington today, talking with friends on the Hill who
confirm the worst: Big Pharma and Big Insurance are gaining ground in their
campaign to kill the public option in the emerging health care bill.

You know why, of course. They don't want a public option that would compete
with private insurers and use its bargaining power to negotiate better rates
with drug companies. They argue that would be unfair. Unfair? Unfair to give
more people better health care at lower cost? To Pharma and Insurance,
"unfair" is anything that undermines their profits.

So they're pulling out all the stops -- pushing Democrats and a handful of
so-called "moderate" Republicans who say they're in favor of a public option
to support legislation that would include it in name only. One of their
proposals is to break up the public option into small pieces under multiple
regional third-party administrators that would have little or no bargaining
leverage. A second is to give the public option to the states where Big
Pharma and Big Insurance can easily buy off legislators and officials, as
they've been doing for years. A third is bind the public plan to the same
rules private insurers have already wangled, thereby making it impossible
for the public plan to put competitive pressure on the insurers.
-------





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