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Single-Payer Health Care Pros And Cons
back up and starts now as promisedr_j_r_ several course rights for other him posted and his own blog annihilateand has very consultant health care industry so he knows his stuff really well you've helped us before thinking outthis stuff so i want to bring you back
Single-Payer Health Care Pros And Cons, to talk about it petronas to be a history to be here on it so r_j_ i want to go through the arguments that people who are infavor the bills not
you're not totally against the bill butyou're like i am a little split but you see the downside civil right now i i iwould have definitely leaning against the dallas occurrence these things okay so what are you missing they say is what cap of of what the private it insures commits canmake is ten percent because when take ninetypercent and mandate that they spend it on actually
the house character people now that sounds pretty good with what'swrong with that art well uh... you know this is one of thekey arguments for the panel and it's also related to the argumentthat people make that the health insurance industry's profit margins areactually quite low but what people don't realize if theyhaven't looked at the industry closely is that wendy
calculate their profit margins if they pay up thousandsmedical bills for you and then a fact all they're doing iswriting a thousand tracks they will calculate the cost of writinga thousand checks which for argument's sake let's say is the inc and uh... hand a thousand stamps but they will also calculate the cost of the medical bills ping
being paid themselves so if thosethousand medical bills cost a million dollars in total theywould say they had expenses of a million dollars plus a thousand stance and so their profit margins look quitelow in many cases but it's about the accounting the waythey do it why could write you a check and pay your mortgage today and or you're renting claimed that my expenses included your rent
but all it would take me would be thetime it took me to fill out a check and i would look like i had terrible profit margins but i'd be making great money for thetime it took me to regularly check so it's a tough thing to look at if youhaven't been in the business but there are ways to make profit marginseemed quite low are quite high depending on who you're trying tocompress and they play these numbers both ways depending on whether they'retalking to investors or other people it's interesting because if they'retrying to be on the salt pour off limits
our problem are losers solo upwardperilous when a turnaround investors alike youknow that's not really part of our expenses we're makin madmen that's roughly eight pretty much airportticket and and then at is a a small hello that to wear they continue to make more money lost my train of thought on that willcome back to it belittle under the same but you know ithink i know what you were driving out
it was one of the issues that i'veraised in the past which is it sounds like a good idea tosay that your profits have to be limited to ten or fifteen percent of all themoney you collect but think about if i'm running a business and the only uh...money i can collecting keep is profit is ten cents on the dollar what am i going to do to make moreprofits i'm going to collect more dollars because that way if i collect threedollars instead of two i can have thirty cents and profit
instead of twenty so in really it'ssetting up a perverse incentive even though i appreciate the intentionsbehind the bill it would be better to design itdifferently and you could and if you really want to rock some accounting kitsite but we can go at it how it could be designed but essentiallythe the idea is this that if you're doing that they may verywell find a way around it and at the very least you're not reallygiving them much of an incentive to control medical costs you know i'mreally glad i lost my train of thought because i was not carpet and but that'sa really good point is if you say you're
going to make ten percent of summitbegins i mean norma since i have to drive up the prices and so they can make tenpercent of a larger amount and that's not the senate we won't know the exactoffers an incentive where i was going to go with it is thenwith the man did they also get more customers for that also drives up theirprofits so there's there megan ryan absolutelythree different laser all right now on the other hand they say look
these massive subsidies spill minehundred billion dollars worth subsidies silver says that goes to the poor the middle classis said to help pay those premiums is asking don't you want that ninehundred billion dollars what what your thought on that well acouple times one is that makes over on a lot of the people making these arguments are setting up a very phony distinction a false choice that reallyis coming from the white house i'm down that says if you don't pass of this billand this bill means the senate bill and
not the house bill and it leaves thesenate bill with no further modifications we're gonna lose all the good thingsinstead of all the bad things i think that's absolute nonsense i think at the end of the day if thechoice isn't just the senate bill or nothing the choice is the senate bill instamford or the senate bill modified in conference if the president of the united states inthe leadership decide to press it that way and or andi'm not in expert in parliamentary
procedure but and or but i'm not stillgo either and or it's reconciliation is used forsummer all of the controversial provisions of the pill so when people say it like makes oversay uh... you want to lose those ninehundred billion dollars my answer is do you want to lose twenty seats in thecongress because this bill is badly designed do you want to hurt tens of millions ofworking american families because this
bill is badly designed do you want to do all that by setting afalse choices or shouldn't we really being at be having a conversation about thetactics that make sense now r_j_ earlier in the process butwould have been a million per cent with him but at this point we are getting to thatbreaking point where were you we might be at we did get nothing or we get this andthat's why we're having this
conversation recipe asme earlier and youlike this i said hello did and i'd study twenty different ways to fightright uh... now what they're saying is in this partmaybe their best argument slip we've tried this before you know inin the nineteen thirties forties seventies nineteen ninety-five etcetera and every time we didn't pass it he didn't come back to read your laterhe came back to it ten twenty years
later that version got worse so if we haveanother vote here and the bill goes down well then you're not going to get thenine hundred billion dollars united get any of the upside united universal coverage of set at several sowhat's it going to be well i told you i'm still looking atthis issue for staff but secondly again i think that's afalse choice for two reasons one is that nobody not howard dean matter anybody who's apap acceptance their strongest about
this issue nobody is saying wait till next year what they're saying is changes thestrategy today so it's a hard at think that would turnthat logic around and say that's the point of view it really shoots down asthe errors because what if you really saying to us they are saying now when the heat is onan everybody's looking at the president really wants it but still immediate occur bill
and then they'll fix it next year andhelp make all the tough decisions they didn't make this year because theinsurance companies block them off they want to be abortion amendment andother but somehow miraculously when he saw when nobody's looking then they're going to make the billbetter when they wouldn't do it now when thepressure was on that makes no sense to me but that's a really good point and youknow they sell promised we promise will
make a better later but you didn't makeit could now why would you make it betterlater so i carry on that the flip side is act i think it's toolate you're not the only way you change this bill at this point is if you kill because or bombers activities mine near amagnitude is mind they're going to go with this bill
and that this bill is going to come upfor a vote okay my hope is hey you know what if it does go down that may be a llama goes you know whatwe tried that and it didn't work the progress is killed and apparently wecan't ignore the progress is forever and maybe get a good point and it turnsout if you look at the numbers the american people were behind them what we try our juries way yun right and i'm sure that's exactlyhow will put a type of supports i think
that that first of all but is that reali'm sorry to hear a scenario is possible but it's not another i'm sixty well look harry reid does nothave to put this bill to about and what he's going down he's going to pay noheed my question in my mind that's so critical is will they come back in twenty ten as it all right now let's do it right orwill they say all we lost were too scared to pick it up foranother seven years if obama season there that long
and i don't know the answer to thatright there's another little rhetorical trick that goes on here by the way which is a saint paul do you want to wait until next year will next year is two weeks that's a few weeks from now it soundslike twelve months but but i guess i would say the if thedemocrats were smart and if they knew how much damage they were crossing onher lap flag and if they knew how many seats they're going to lose because ofthe way this bill is right
and the way it affects the middle class they would put a freeze on it right now and going to have the negotiation withthe progressives in the house and with the other groups that are opposing that's theunions and the other groups that are very unhappy with some of the provision like the excise tax they'd be smart may do that today whatyou're saying is
they're not going to be smart why iwould see that there's a certain amount of brinksmanship in this if you'relooking at it from a tactical point of view and that if you want this billbetter the thing to do now is to act a hundred percent like you let iteverything go down just from a technical point of view this then i know but you know you knowma'am and theory though i don't know but i'll let you go down i'm tired ofbluffing yet by mistake kill the bill i'm not blow upand say prevalence hilda orchid so now whether we can as a wholedifferent russian so now what we want to
do it as well and discuss on the detailsof the proposal of this version of the bill the senate version of the bill and see if it makes us 'cause as i do been saying about fifty five forty fivep danstett but i could be swayed and i want to runsome of the best arguments that the prowled bill signed has against r_j_who's a little more sixty sixty-five against it yak ever taken for granted he's gottheir very good knowledge of industries so
uh... r_j_ let's go to exchanges theysay look we're going to set up exchanges herepeople can buy insurance through that this could be real competition andthat's been a lower cost is that right i don't think so how you think that if you have open-ended number of plans all offering the same benefit package atroughly the same price that's not really competition
that's just a lot of different peopleoffering the same product let's look at what happened inmassachusetts that's exactly the design they have in the state of massachusetts where there are no other cost controlsbuilt into it and they have a horrendous cost problemthere it did not fix the car but it seems likeit should build logically speaking that's where they're going to do want tocustomers they've got either provide a betterpolicy role or cause i mean it makes sense
well it seems to make sense but it doesn't work in practice andthere are a lot of reasons why that is but basically if you are not doing a better job thanyour competitors aren't doing a better job then it's just as the easy to raiserates the fact of the easier to raise rates then it is to actually try to managethese carts effectively to be fair to some of these insurers ifyou were one of three and a marketplace
and at the other guys are communicatingwith the doctors and trying to really perform a cooperative relationship there there really isn't going to be a littlea lot of expertise on the doctor side or a lot of experience for them and working with aninsurance plan constructively as opposed to it fighting with them the other problem which is very muchrelated to this particularly when we
talk about health reform there are many many markets in thiscountry where there's a basic monopoly situation where one carrier dominates the marketcompletely alabama blue cross of alabama ninety percent of the market that is not at all unusual if you don't have a public optionbrought into a state like alabama you may have an exchange youmade a couple other plans may get in but you're fighting enormous market realquickly rebecca masters first and i
don't know if you know the specificsanswer but why would there be only as an examplethree shrimps companies buying in massachusetts why is it analyzing itfifty well there are more m there are more than three but i think the answer to that it's it's complex in massachusetts youdo have to meet so certain requirements in terms of the benefits you offer andthat type of thing but
it's not a big market the other anyother problem i have with the fact that so much of this bill is based onmassachusetts is let's face it massachusetts isn'tthere so it's been a great laboratory for theentire country to take a state of that size and a state that did not have isbetter a problem with the uninsured as we do asa nation and i think that's much more liberal andyet is not overly enthusiastic about the plan they've got and a state where even there theyweren't able to prepare kar control
costs to use that to try to build on that andsay that's going to be the model for the nation is a problem all right let's go to costcontainment number two they there's a provisional bill on where the office ofpersonnel management can pick appearances sandy already managed federal employees'insurance to mecca take-offs well i think you have to look at thenumbers office of personnel management
is currently for federal employees andpeople compete for their chance to bear on those employees in those types ofthings the details are not been very wellexplained up by this plan so no one is really explain to mysatisfaction why a m exchange inside another exchangeis such a brilliant idea and is going to give us so much morethan just one exchange will get worse remember we're not talking about bignumbers of people who qualify for these exchanges to begin with and if you carve it up and see whatinside these exchange again another
exchange you're not talking about a lot ofnegotiating cut out there so i don't get with the logic is and the other thing about the federalemployees plan that that opium manages now is that it's got pretty nice benefit subsidies and nobody's talkingcelebs employees like it but nobody's talking about the putting the same levelof subsidy in this tax change within an
exchange so could still be prettyexpensive so it'd still be expensive there's nothing in there that'sinherently cost-sharing theory idea s is that somehow that mega exchange that is created won't beas good zero p m i don't really get it if the opium coulddo a better job just give it all to the opium but the logic is not very well thoughtout my pain and one more thing here on
at in other positive for the bills is tolook at this for the medicare advantage which is a huge boondoggle and and is there a way of the future isgoing to be more on the same from services basically but that's true right more or less andmedicare advantage last i would cost about eighteen percent more than regularmedicare there are some extra benefits that uh... that members get but thatmake them happy
but overall think killing medicareadvantage is a good idea but i think if you want to kill medicareadvantage you don't have to do all this other stuff to you can just killmedicare advantage ride that looks a bit deviating it'suntenable for whatever reason to do it alone but but some of this is our we had medicarewithout medicare advantage for forty years you know i love you might not knowwhat medicare dredges solu real quick tell people what it is well why wouldit's basically like a health plan within medicare that you can sign up for
where uh... the government subsidizes some of theindividual benefits you get and then you may pay and additional premium also for some ofthe the additional benefits you get to a few obviously over sixty five in yourmedicare you like your plan but you'd like a little more coverage here orthere and there's a medicare plan that can do that medicare advantage plan thatcan do that for you you can sign up for it but a lot of those extra benefits arepaid for by the government that's why
it's more expensive so the government is in effect subsidizing private insurers to pick offpeople in the medicare then and was the cause if you could sendmore because of the primarily because of theadded benefits but there are people who say that there's too much profit built and so ifthere is a baker advantages doesn't cost anything and and i don'tknow much about medicare advantage allah's cost illegal or something to thethe to the person who's getting it right
as i understand it's subsidized by thegovernment rackets 'em excise costing the government more but as i understand it there alsoadditional prince okay i got your so then let's finally come back to the ideaof mandates now you know what i want all the click here because up i know someonewho was a guest mandates a little while ago he made a very compelling case againstthem and now it's there in the bill let's go to club number fourteen hereand lets you with us to be eight young gentleman is who's against mandates
if a man who was the solution how we cantry that uh... to solve almost missed by more than ever but in my house the remain arises they don't have themoney consult our focus has been on reducing costs making it available i'mconfident that the people have a chance to buy high quality health care that isaffordable they will do so and that's what our plan doesn't nobody disputesthat barack obama racket aahet when he's it looked if eighty right will that brocco bomber
and this uh... let me put it this way this brockobama has never told us what happened to that if he had a conversion experience on theroad to the white house that suddenly made him feel that if youwant to change is plant i think it would have done and some goodto explain to some of the people who voted for him what that was instead ofjust reversing himself on this he's look there are good policy arguments in favormandate but my position all along has been
i think a mandate is political suicideunless they're enough subsidies and cost controls to make it affordablefor people that barack obama was right when he said that if you if you'd people can't afford and that'sbasically what you think that's what it up i need now to the right out on thesenate night with its analogy estrella program i comein to any room of people and i say allright congratulations you all have b_m_w_'s chawla fantastic man i said igive you the money for right exactly well okay but if you want to be in theuniverse was up late and buy it
right and that's why i just put up apost really challenging some of the whitehouse is figures on some of their cost at containment proposals now they'reclaiming from the president on down to his advisers that we're going to control costs somuch that this is going to become affordable but i do not see that in this but theyalways that's the weakest part of their
argument is as a read the white houselog on this as i read the supporters on it theyalways say and plus there is cost-containment their but they don'texplain now at like everything else they explain both the cost containment iscoed first this is costly they want ninetyseconds on what they claim is cost-containment one is the excise taxand they're multiple new studies have come out in the last two weeks showing that that will not convict crossit would just were health plans that have olderworkers and sick or workers and more
women sup but they haven't responded to thatbecause what triggered might post today uh... another is that they'll be amedicare commission to look at medicare reimbursement rates for that's deferringa difficult decision for the future and opm though i don't mind a commission i thinkraises a good and i think it's a great idea but i don't think you can claimthat a future commission is going to make on medicare is going to have
medicare decisions have a ripple effectthrough all of health care that's true but i don't think you can claim that amedicare commission sometime in the future will suddenly make health care soaffordable see that's their problem and i've heardabout this before to be that takes in maybe a twenty fourteen and then the commission begins and thattakes a couple years and they make a decision and they applied and that's acouple of years and that if the it affects medicare and that's a wholebunch of years and then finally gets to
the private insurance premium market in twenty nineteen twenty twenty notpaid i don't know i mean it's season so far down the road that i don'tknow if i may recall stinson so it now that when it comes to costthis bill is a faith-based initiative they have faith that someday some ofthese measures will save cars it but you gotta pay today orissa roosevelt cake that's what you'reworried about politically athol id suicide i'm telling i published a couple studies that havebeen done recently just on this tax
alone and how it affects democrats and others who who might vote for it inthe front ten front-line states and the figures are devastating poster that i talked to whodid the study said he had never seen figures this proc they're very strong voter saying they'remore likely to vote against someone who supports this bill if it's designed theweight is i think there's a demand because of the tax
and idem also others to polls have shown the mandates and and probably the lack of the public option another which three features of the billas it's currently written and particularly when they all worktogether the way they are combined together are going to be politicallydevastate democrats finally a real quick let me let me do my proposal here greatand then i want to get your thoughts on yesterday read all the pros and cons ofthe bill and i am looking at it but it
is yes i have to confirm mark's right but late now this crunch time ineverybody's basically laying out their final arguments on both sides fred so igo through all those things that the and i thought the promise everybody is saying isreconciliation you could boli handle financial mattersright and something things that affect the budget and so you can't get rid of pre-existingconditions and you can get a recession you can't do all this stuff
if you go to reconciliation that will bepart of the bill now summer same hate you know what youpassed that is really popular all louis provision even the republicans are onthe record theoretically as in favor of that allot of republicans are impasse that anyway id through normal vo night believe thati think that's possible but we are so many men did some loopholes onregulations here i thought you know limit wanna make a simpler do of medicare buy-in
for everyone and say if you want to buy in and pay apremium the medicare by it definitely pass a budget and can definitely be brought in through reconciliation and then you have this attractivealternative that's good draw a lot of customers benefit
you know their private shirts continuesto offer bad policies will they will losecustomers or dailies have real now there is a slight problem with thisthat i think maybe you could fix the first overall what do you think that i think there's a slight problem withthat i'm not sure i can fix it haha through the problem is that sand to alarge extent it was a problem with the way the public option was design afterthey've done begun weakening at weakening some of the insuranceprovisions basically what you would wind up withall four in medicare buy-in for
everybody what you are what you want togo under your idea is basically medicareplan that saddam thing for anyone that's likely to be more expensive or a badpress for the project plans and they will use those rules like rescission andsome of the other roles a doctor's appointment target them i'veseen them do it to drive those people out and to drive those people intomedicare so what you will have is ivp at such a expensive and costly group ofpeople in medicare that those premiums will go up so high that nobody that willbe able to afford it but there's a fix i can fix it which is
then what you do is you do that janeplan but you add to it the same rules we were talking aboutworking no pre-existing conditions for insurance companies know rescission and you push those throughreconciliation because at that point those would alsoaffect the federal budget because without them this new open medicare planwould have very terrible financial life anti-technology and would thereforeaffect the budget right exactly know but here's the planthat was that i ran this actually we're
not going to buy some people on capitolhill and and they him the promise the same exact thing thatyou mentioned premiums gets so high right but i think a lot of people like me andall of the people but you know that i know that worked here it says that the they would think that you know what i love the idea of knowing i'mdefinitely cup right right and universal higher premium along thepain that higher premium
if i don't have to worry about theseinsurance guys screwing me when i actually get sick i think you would you know lot more customers that people think itwas and that would drive the premiums well i agree with that think our planwould also control for that part of joint plan and i think the third piece of it isthat if private insurers really have to compete with a rope bustpublic alternative in this in this example medicare they're going to beless likely to pull these dirty tricks
if it means that people have been aflock away from there their products to write more likely tooffer a decent product at an affordable price which was the logic all alongbehind competition the logic that candidate obama soeloquently explained during the campaign last year alright r_j_ estelle withholding imposednight light and campaign for america's future r_j_ thanks so much for being areal pleasure all right we'll be right back
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