I am all for an "Opt-out" plan for health care reform.

As long as what the states are "opting-out" of is universal single payer government run, guaranteed coverage. Otherwise....FUCK NO !!!:dem: :patriot:

Yeah, I've got your number.

Lesson learned.

that red states might not get.....

You have a lot to learn.

"States" are abstractions. Their borders are often arbitrary; Mother Nature doesn't paint nice neat lines on her planet.

"States" are made up of people. Real people. Some are rich, some are poor. Some have insurance, some don't.

Compassion would have us allowing individuals to opt out, but not state governments on behalf of all their citizens. Oh, sure, in ten years or so, when those opted-out states have rising rates of illness and higher mortality rates and businesses move out, sure, maybe then they'll change their minds and opt in.

But what about the real people who have died or gone bankrupt in the meantime?

You know, of course, that the bankruptcy laws are federal laws. Will bankruptcy for medical bills no longer be allowed because some states have opted in and no longer have medical bill bankruptcies and it wouldn't be fair to give "special" treatment to those poor assholes who stayed living in their red states after their governors opted them out?


Teh styoopid. It killz.



Tansy Gold

There is no room for compassion in politics. The main goal is to destroy the enemy, not give him health care after he spits in your face.

Are you saying I should just pack up and move out of Arizona?

there damn well is room for compassion in politics. That's what it's all about.


As someone else in this thread said, good luck with that thinking.


good luck with that attitude, too.



TG

Republicans need healthcare too.

and even a few socialists in Arizona and I'm sure there are lots of them in other "red" states, and you've just blithely tossed us all in the trash along with the pukes.

If a state opts out, ALL its citizens, even the ones too young to HAVE a political affiliation, get opted out.

It's no longer a "public" option, or don't you get that? It's a "state" option, and the public -- Dem, puke, commie pinko, it doesn't matter -- be damned.

Remember that stupid story someone -- Beck, Hannity, Bachmann, who the hell knows or cares -- was spreading that if a "public option" passed, only Democrats would be included? YOU JUST MADE THAT LIE TRUE.

Universal health care is just that -- u ni ver sal. got it? EVERYBODY. Dem, puke, male, female, gay, straight, pink, green, blue and orange striped (for all my fellow Illini and Bears fans).

I don't expect anyone to see the error of their ways as a result of a posting on DU, but I keep trying.

More the fool I,


Tansy Gold

That's what we should be all about. That's what health care reform is all about.

We are trying to get healthcare for the people who don't effectively have it. That is a huge number of people, but you are not concerned about the ones who live in "red" states?

This proposal gives it to them. I fail to see the problem - it's what they've always wanted.

And perhaps rethink their party affiliation.

by the way, here is a book I highly recommend.... if you want to understand why consequences really don't matter...

Deer Hunting with Jesus...

California voted for a repug governor and look what happened.

Lessons need to be learned.

Do YOU need to learn a lesson?

Well, you'll get one whether you want it or not.


Sorry, Charley, even though you voted the right way, your friends and neighbors just said you get no PO.


Tansy Gold

The lesson to be learned is don't vote for a puke and obviously I already knew not to.

The only people that would be learning a lesson are the people voting puke.

Duh.

:crazy:

you'll be paying the price for others to "learn a lesson."

Is that fair? You didn't do anything wrong, but you have to pay for their mistake? You and your children and your parents and your friends?


Unless, of course, you have employre paid insurance or you're covered by your parents' insurance or you're on Medicare or MediCal or you're so rich you don't care.

See the problem with the opt-in/opt-out option is that even the people who did the right thing get hurt -- and in the blue states even the people who did the WRONG thing get the benefits. (How will they EVER learn THEIR lesson?????)

Ain't this is wonderful option!!! :sarcasm:



Teh styoopid. It killz.




Tansy Gold

The thing is that something is better than nothing.

I would rather have state opt-out than no real healthcare reform. At least it would be somewhat of a step in the right direction.

But there's no question the Dems should fight for real healthcare reform for people in all states.

Improvement implies change, but change doesn't necessarily mean improvement.

Look, let's agree that the problem, ultimately, is with the insurance companies. We either have to fundamentally alter the way they do business or we have to do away with them. If we leave them alone, none of the problems they've caused will be fixed. The very worst thing we can do is give them MORE power and MORE money.

A plan that requires people to buy insurance from the insurance companies, or pay a fine that will go to the insurance companies, does not fix any of the underlying problem. Yes, it gives the uninsured some insurance, but at a price many of them can't afford. Or it fines them. Or it subsidizes them, which means everyone else pays for them. And the insurance companies not only are not penalized; they are rewarded for creating this mess!

Forced to be self-supporting, the so-called "public option" is essentially another name for co-op. If people have to pay into it ahead of time to build up a pool of money to pay on claims, they're essentially gambling that they won't get sick and need the "insurance" until there's enough money. If the government provides seed money, then again, the tax payers are paying for something not everyone can use. And if the people who choose the "public option" because nothing else is available or affordable for them are also the sickest and most likely to use the funds, their contributions may end up being higher than premiums to the insurance companies. SOME of them may actually use the funds, and deplete the pool quickly while others, who have put more in, may end up never using it. Obviously, that's the same kind of gamble as any insurance, but because they're really not given any other choice, their contributions are going to be much greater -- and they may be the ones who can least afford it.

What we have now is a horror. If the "new" plan makes the situation actually worse for some and unchanged for others, it's not a net improvement. And I haven't seen yet where there's any really productive, positive change offered. It sure isn't in this so-called "public" option.


Tansy Gold

.

Even the most liberal "Public Option" (HR 3200) will be run by a private corporation that will be a consortium of the For Profit Health Insurance Corporations called "The Exchange".
The most optimistic projected price advantage is around 10%.
There are some reports that the Public Option could be more expensive than the cut rate packages offered by the For Profits on the "Exchange".

The CBO Projects (and Obama agrees) that 4 out of 5 of those FORCED to buy Health Insurance from "The Exchange" will prefer to buy it from the For Profits.


Schumers "Opt Out" plan will only further WEAKEN any "Public Option" by diluting and shrinking the enrollment base.
This will be BAD for EVERYONE! (not just the red states).

Those of you thinking "Opt Out" is a good idea better rethink your position.
"Opt Out" WILL make the Public Option WEAKER for EVERYBODY, and the Public Option is already SO WEAK, it it is almost invisible.
Obama was 100% correct when he said the Public Option was a "thin sliver".
Now some here want to make it even smaller? :shrug:


One thing you can take to the bank:
If DLC Schumer likes it, it is BAD for Americans who work for a living.

comprehension problem?

Actually, I GOT it.
I just don't believe many others will.

How many DUers do you think realize that the Public Option being offered by The Democrats is NOT "government run Health Insurance like Medicare".

Not most people, but most DUers.

I'm tired of playing footsies with the corporations. Why can't citizens have the choice? Why is it at the state level? And, why can't citizens have choice of opting in to Medicare and paying extra--since we are already paying into medicare?

I certainly wouldn't dream of forcing something shitty on states. Why would you?

I agree with Obama.
The Public Option is already a "thin sliver".
Why make it smaller? :shrug:

What's hard to understand about that?

*

with the public option, which is one insurance plan included in the exchange. It is a government run insurance plan. The remainder of the plans in the exchange are private insurance plans. States would be opting out of including the public option in the exchange - not opting out of the exchange.

Even states that opt out of the public option still get the benefit of all of the insurance reforms, including the exchange, the mandatory issue, the premium parity, the coverage for pre-existing conditions, and the subsidies. The individuals eligible to purchase insurance from the exchange will just have one less choice in the exchange - they will not be able to choose the government run insurance plan.

Unless you can find language in HR 3200 that authorizes the government to set up the framework for administering the Public Option, I tend to give this analysis of the nuts & bolts of HR 3200 & the Help Bill a lot of weight.

>> (a) ESTABLISHMENT.—There is established within
9 the Health Choices Administration and under the direc10
tion of the Commissioner a Health Insurance Exchange
11 in order to facilitate access of individuals and employers,
12 through a transparent process, to a variety of choices of
13 affordable, quality health insurance coverage, including a
14 public health insurance option.<<

In other words, the public option is one of many insurance plans in the exchange.

From Section 221:

24 Consistent with this subtitle, the public health insurance
25 option shall comply with requirements that are ap-
1 plicable under this title to an Exchange-participating
2 health benefits plan, including requirements related
3 to benefits, benefit levels, provider networks, notices,
4 consumer protections, and cost sharing.

In other words, it has to follow all of the same rules as the other insurance plans.

Section 221 also authorizes the framework for administering the public option:

>>SEC. 221. ESTABLISHMENT AND ADMINISTRATION OF A
4 PUBLIC HEALTH INSURANCE OPTION AS AN
5 EXCHANGE-QUALIFIED HEALTH BENEFITS
6 PLAN.
7 (a) ESTABLISHMENT.—For years beginning with Y1,
8 the Secretary of Health and Human Services (in this
9 subtitle referred to as the ‘‘Secretary’’) shall provide for the
10 offering of an Exchange-participating health benefits plan
11 (in this division referred to as the ‘‘public health insurance
12 option’’) that ensures choice, competition, and stability of
13 affordable, high quality coverage throughout the United
14 States in accordance with this subtitle. In designing the
15 option, the Secretary’s primary responsibility is to create
16 a low-cost plan without comprimising quality or access to
17 care.

...snip...

10 (c) ADMINISTRATIVE CONTRACTING.—The Secretary
11 may enter into contracts for the purpose of performing
12 administrative functions (including functions described in
13 subsection (a)(4) of section 1874A of the Social Security
14 Act) with respect to the public health insurance option in
15 the same manner as the Secretary may enter into contracts
16 under subsection (a)(1) of such section. The Secretary
17 has the same authority with respect to the public
18 health insurance option as the Secretary has under sub
19 subsections (a)(1) and (b) of section 1874A of the Social Se
20 Security Act with respect to title XVIII of such Act.

Edited to add: Section 1874A authorizes the government to contract with private entities to carry out the necessary functions to implement Medicare A/B - so the public option is permitted to farm out the same functions that traditional Medicare is permitted to farm out to private entities. (Not to be confused with Medicare Advantage (part C), which essentially substitutes private insurance for traditional Medicare)

In your own post the authorization is to enter into contracts with private corporations.
It does NOT authorize the "government" to operate the public option.

to private contractors - in the same manner as it does with traditional Medicare. You might want to read the bill, if that is a concern for you, rather than relying on a summary which is missing significant detail. The relevant sections are 221-225.

The Secretary of Health and Human Services is required to provide and design the option (Sec 221(a)). The Secretary is required to establish an Ombudsman (similar to the Medicare Ombudsman) (Sec 221(d)), establish geographically based premiums (Sec 222(a)(1)), establish payment rates to providers(Sec 222(a)(1)) - with the initial payment rates to providers set at the Medicare reimbursement rates (Sec 222(a)(2)), authorized to change payment rates to providers (Sec 222(a)(1)), establish conditions for provider participation (Sec 225(a)), is permitted to design and implement innovative payment mechanisms and policies (Sec 224(a)-(b)). Medicare providers under Part A/B are automatically providers under the public option unless they opt out. (Sec 222(b)(3))An account is set up in the US Treasury for receipts and disbursement of funds attributable to the operation of the option (Sec 222(b)(1))

The Secretary is prohibited from transferring the insurance risk to any of the subcontractors performing the various subcontracted functions (Sec 221(c))

The overall responsibility for the plan, and for each of the statutory duties listed above, ultimately lies with the Secretary of Health and Human Services. Is the Secretary required to directly employ all of the individuals performing the administrative functions of the public option - no. Just like traditional Medicare (Part A/B), the system people have been touting as the model of single payer - and the plan many people wanting health reform have been saying should just be extended to everyone, the Secretary is permitted to subcontract certain services. That isn't the same thing as being a private insurance plan.

In fact, it FORCES the government to subcontract everything.

Unless there is a provision for establishing a NEW bureau to administer the Public Option or a provision for hiring NEW public employees, that statement MEANS subcontracting everything.
So far, like myself, you have been unable to find anything that applies to hiring NEW federal employees or the creation of a government office to administer the Public Option.

The language in the bill is permissive, not mandatory - and the functions that may be subcontracted out are limited to the very same functions the Medicare program is currently permitted to subcontract, which are specifically identified in the Medicare statutes.

Implementation of federal statutes is typically handled via regulations (which contain more of the detail you are looking for). The department of Health and Human Services, under the direction of the Secretary, will need to write these regulations after the legislation is passed. Statutes for undertakings this complex generally only provide the limits of the authority congress is granting, and the obligations that mus be met (which I recited for you in the earlier post).

There is nothing unusual about this - and I would not expect to see authorization for hiring of employees, the creation of a government office or establishment of a new bureau. The bill authorizes the program, sets limits, but leaves the details to the Secretary - Medicare A/B works the same way - the details are contained in the regulations promulgated by Health and Human Services, not the statutes that authorized the program.

We will see.
:hi: