State Public Options

[grantcart]

The bill creates several critical floors (minimum MLR at 80/85% for example).


It also mandates atleast one non profit option in each state exchange.


Yesterday on MTP Dr. Dean said, "We should pass the bill and improve it in conference. There are many good things in the Senate bill that we can build on . . . The House bill has a public option and we should include that. They say the Senate Bill has a substitute for a public option but it isn't really.


He is referring to the requirement that every state public option include atleast one non profit option.

As a reference point here is the Canadian timeline for single payer.
http://en.wikipedia.org/wiki/Canadian_health_care

1946 Saskatchewan Passes the Saskatchewan Hospitalization Act providing free hostpital care.

1957, the federal government passed the Hospital Insurance and Diagnostic Services Act paying 50% of province plans

1961 All provinces enact participating legislation, Saskatchewan enacts first full single payer plan.

1966 Medical Class Act allows provinces to establish universal care.

1984 Canadian Health Act prohibits userfess and any extra billing by physicians becoming truley a single payer system.

What prevents states from passing legislation establishing a state non profit that operates as a Public Option?

What prevents a collection of like minded states from joining such a non profit?

Once enacted those states could also pass legislation increasing private companies MLR.

They could effectively eliminate private companies from the market place.

If Tommy Douglas could do it in Saskatchewan then why can't we do it in states like Vermont?

[kirby]

1. Many states have these now...

Here is a link to Marylands. The coverage it not all the great (especially prescription), it is not really affordable (high co-insurance), its costs continues to grow each year. If you have preexisting conditions, the first year premiums are even more expensive.

http://www.marylandhealthinsuranceplan.state.md.us/

If you click on the 'Application Booklet' (PDF File), it contains the descriptions and rates of the plans.

And here is what happened when the state legilature tried to increase the Medical Loss Ratio (MLR)

"Legislation to increase medical loss ratios for insurers has “hit a wall,” due to negative reaction from the industry, says its sponsor.

The bill, HB 272, was part of a package of health insurance reform measures introduced in February by Maryland Insurance Commissioner Ralph S. Tyler and legislative leaders. The bill sought to increase medical loss ratios – the amount of each premium dollar spent on actual medical care costs – to 85% for small-group and 80% for individual group policies. The remaining percentage goes to administrative expenses, reserves and profits."

Source: http://ifawebnews.com/2009/04/01/medical-loss-ratio-bill-%E2%80%98hits-wall%E2%80%99-after-insurance-industry-reaction/

[grantcart]

4. These are Blue Cross/Blue Shield plans

Which raises the question why medicare has such a higher MLR than non profits?

[kirby]

10. Well...

The money not spent on the medical expenses of the insured goes to administrative expenses, reserves and profits.

This tell us that Medicare (which has a 97.3% MLR) spends much less on administrative expenses, does not invest its money in risky investments (which would increase the amount of reserve required), and does not pay out any profits.

[Dragonfli]

2. I find that idea to be very interesting, I don't know if it could be done.

Understanding the history and the current state of Canadian HC (I live in a border town), I have always wondered why we didn't simply copy their very successful model until I learned how many politicians (Including The President) were beholding to Insurance and drug money received, then it became clear.

I hope some with more understanding of states rights and the insurance company authored bill can further explore this idea here.

It did indeed start with one Provence and the proof of the superiority of that sort of system became clear.

Perhaps it could happen here the same way. That would assume of course that state reps aren't as easily purchased which I have valid concerns over.

Very interesting thought that needs to be explored further.

Recommended for that purpose!

[liberalpragmatist]

3. Also, I've read that a Sanders amendment allows state single-payer

Is this true?

Link: http://www.commondreams.org/newswire/2009/12/19-0

He was working with Wyden to allow state waivers to create their own programs if they could meet the coverage requirements of the bill.

[grantcart]

5. I believe that he had to withdraw the ammendment

They were going to make him read alll 700 pages out loud.

[liberalpragmatist]

6. I thought that was his full single-payer amendment

He was going to offer an amendment for a full single payer system (nationwide).

[grantcart]

7. on review it was for a universal medicare buy in

[grantcart]

8. ..

[HughMoran]

9. Yes, what is to prevent a public option from being enacted at a later date

Either as you describe, or even a federal plan passed as retaliation for insurance companies not acting in good faith (you know they will fuck people over any way they can).

[grantcart]

11. kicking - Boxer suggesting the same

[Cha]

12. Here's to Dean and everyone who wants this

passed to getting all the improvements they possibly can.

[ipaint]

13. The mega health insurance companies with guaranteed lifetime mandates

will make sure NO public option in any state will ever threaten their gravy train. Including the health insurance company goldman sachs is launching in January. And we know who's ear they have.

[slinkerwink]

14. they're called Blue Cross Blue Shield plans. Just reinventing the wheel here.

[grantcart]

17. no those are non profits

I am talking about public option agencies that would be run as a state agency.

[NJmaverick]

15. Thanks this is a very important aspect of the bill

and pretty much solves the cost control issue.

[tekisui]

16. We'll get there one way or another.