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Paul Abrams

Paul Abrams

Posted: October 7, 2010 04:55 AM

A little-discussed provision of the Affordable Health Care Act (i.e., "Obamacare") provides an extraordinary opening for Democratic gubernatorial and state legislative candidates to deliver a simple message that will resonate with voters and sweep them into office. Yes, this year.

Moreover, they will be loved for the enemies they make -- the health insurance industry.

In a nutshell, this is it: Although a federal 'public option' failed to make it into the law, states were granted the power to generate their own public option.

Let us recall that the public option was insanely popular. Further evidence of that popularity emerged recently when it was "discovered" that 30% of those who said they "do not like" the healthcare reform were disappointed that it did not go further.

That was the federal public option, attacked as a 'federal takeover', nonsense that the populace seemed to shrug off. After all, Medicare was a federal takeover of care for the elderly and that has worked out pretty well for them. Even Tea Partier Marco Rubio in Florida is running an ad claiming that his opponents took money from Medicare -- and he, Rubio, would restore it! How's that for right wing piety! [And, if you believe it, I have a war in Iraq to sell you].

But, the state public option alternative even avoids the federal takeover nonsense.

If I were running anywhere this year, for governor or state legislature, I would propose that my state enact a public option for itself. Its costs would be negligible, as the federal government provides the necessary subsidies to enable those who cannot afford it to buy it, whether it is from a private insurer or the state. The state would establish it as "just another" insurance option, with individuals paying premiums -- only the premiums would likely be lower as the advertising, administration and salaries would all be lower. It would be run not at a loss, but at slightly above break-even. If, as is likely, the insurance companies lowered their premiums to be competitive, the premiums would be the same as the private sector, but lower than they would have been without the competition of the state public option.

Negligible cost to state taxpayers. Lower EVERYONE's rates in the state. Make the state more competitive for businesses to grow jobs because the state public option would keep health insurance premiums as low as possible.

Too good to be true? Well, almost. The one flaw is that this program could not kick in until 2014 according to current law. That is not so bad, as the elections will be held in November 2010, the laws would be passed and signed in 2011. It would take about a year to get the program established, so the earliest it could be implemented would be 2012 anyhow.

What pressure do you think governors, legislatures and the people of each state would bring upon Members of Congress to accelerate the implementation date in the federal law? That would be an inexorable force. Moreover, even if it would only take effect in 2014, is it not better to get it enacted, and be ready for it?

And, what about the politics in 2010? Democrats ought to be able to take this simple message, based upon an entire year of discussing it at the national level, and make it resonate with voters in their states, who already supported the national public option by large majorities anyhow. The state public option should be even more wildly popular.

And the Republicans? What can they do? Twenty attorneys-general have filed specious lawsuits to overturn health care reform. To be a Republican candidate, you must oppose it. So, they are going to deny the citizens of their states a very low cost insurance plan that will lower EVERYONE's premiums? And, allow other states to become a more attractive environment for growing businesses...and jobs?

And, stand forthrightly with the...insurance companies?

I would take that contest in any state, any day of any week.

And, what about those Republican candidates and members of Congress who voted against this bill in the first place, and now want to repeal it? They will have to conduct their campaigns in the face of this "state" onslaught.

If there is anything we should have learned this year, it is that election chances can turn around on a dime. Nearly all the Tea Party victories came in the last week or two, closing enormous gaps with the anointed party candidates.

So, Democratic Governors' Association, what are you waiting for?

 
 
 
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SamEllison
I feel so clean!
01:33 AM on 10/08/2010
"So, Democratic Governors' Association, what are you waiting for?"
The checks to clear from the lobbyists....
Just say no to the lobbyists......
04:36 PM on 10/07/2010
This is a great suggestion, but, unfortunately, it requires a voting populace with intelligence and an attention span of more than a sound-bite to understand.

I can hear the Republican argument already - "They want ANOTHER government takeover of your insurance!" The idea's dead in one sentence, since voters rarely get beyond the initial shout.
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HUFFPOST BLOGGER
Paul Abrams
09:04 PM on 10/07/2010
Except, if I might suggest otherwise, this is the STATE, not federal, so that the bogeyman of the "federal government" isn't there--i.e., there's no "they". The major objection would be cost for states having to make huge cuts due to the fallout from the disastrous Bush Administration.
But, there are no costs--it's a public insurance company into which people who want it pay premiums, calculated, as with all insurance, to cover costs. It's just that costs will be less.

You are quite right that the initial labeling will be as you say--but, one has to grit teeth and get through that. Afterwards, the more the Republicans attack it, the more publicity it gets, and the more people can see the benefits.
HUFFPOST SUPER USER
Omnix
Hey, Karma, I have a list of a few you missed...
03:35 PM on 10/07/2010
I'd like to know why the Democrats don't identify the insurance companies antitrust practices to the people, and push for legislation to repeal that protection. The insurance companies are engaged in one of the largest rackets in the world, and manipulating our government through bribes, extortion, and propaganda. The bribes and extortion also make it qualify under RICO. I used to work for a large insurance company that operates in several states; and I've seen very clearly how they work. Here's a synopsis:

The insurance company forces the hospital/doctor's office to pay them to include the provider in their network. The provider and insurance company then agree on the rate/schedule for covered costs, like $50 per Tylenol or $300 for an x-ray. The insurance company then takes the position that it won't pay the full amount, but only a portion (say $35 for the Tylenol and $250 for the x-ray). This is still a huge markup over the actual cost of the procedure/product; but it makes the insurance company look like a good option to their customers - even when the customer pays a large premium, a co-pay, a large deductible, and many procedures aren't covered. It's almost humorous to note that the co-pay is about what the actual visit would cost, in most cases, if insurance wasn't running this massive racket.

Note, also, that a large portion of other costs in healthcare are in the additional administrative costs of handling/processing insurance claims.
HUFFPOST SUPER USER
ProudLiberalDan
Standing up an fighting conservatives since 1987
07:09 PM on 10/07/2010
"I'd like to know why the Democrats don't identify the insurance companies antitrust practices to the people, and push for legislation to repeal that protection."

----------------

You know the answer. It's all that corporate campaign cash that funds both major parties.

Theoretically, Republicans should be calling for this anti-trust legislation too, since they claim to love "free" markets. Turns out they love corporate campaign cash even more.
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HUFFPOST SUPER USER
norman60
03:20 PM on 10/07/2010
If the Democrats cannot use health reform to win midterm election, what do they need again? If they lose this election, then I'll change party. This health care reform is one historic achievement for all Americans, particularly the middle class Americans. Point one thing Democrats have done for Americans in the past two years: healthcare. point one thing Republicans have done for Americans in the past two years: NOTHING

And the Republicans? What have they done? Twenty attorneys-general have filed specious lawsuits to overturn health care reform. They are going to deny the citizens of their states a very low cost insurance plan that will lower EVERYONE's premiums? And, allow other states to become a less attractive environment for growing businesses...and jobs. Is that what any American in is right mind wants? Nope.
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HUFFPOST BLOGGER
Paul Abrams
03:28 PM on 10/07/2010
On the healthcare front alone, Dems have also placed tobacco under the aegis of the Food and Drug Administration. The President also made stem-cell funding available.
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HUFFPOST BLOGGER
Paul Abrams
03:12 PM on 10/07/2010
By the way, Republicans, how are you going to handle this. You want to elminate the individual mandate. Your paymasters, the health insurers WANT the individual mandate, but want the regulations removed. Republicans pledge to re-enact the insurance regulations.

What are you going to do??? Remember, you have to keep your paymasters happy!
05:07 PM on 10/07/2010
If the states want to enact their own "public" options, that's fine, under the 10th Amendment, powers not delegated to the federal government are retained by the state or the people. This certainly falls within that rheum.

By the way, the Democrats are the ones who passed the bill as it is, and it mandates everyone buys health insurance. I think the Democrats have the same "paymasters".
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HUFFPOST SUPER USER
TrekBear
02:51 PM on 10/07/2010
Yeah, you don't know Texas. Texans are poised to re-elected a dumb as rocks governor, Rick Perry. Any sensible suggestions are shouted down and ridiculed here as they're spoken!
02:24 PM on 10/07/2010
Yeah, OK, that's why 29 businesses have just had to be exempted from Obamacare or else they would have had to drop HC for their employees. You guys lost this argument a long time ago. The majority of Americans do not want this bill or the government intruding in their HC and their choices. It's over.
Genders
Love, Tolerance, Enlightenment
02:51 PM on 10/07/2010
The waiver program is intended to provide continuous coverage until 2014, when government-organized marketplaces will offer insurance subsidized by tax credits, says HHS spokeswoman Jessica Santillo. . . .
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HUFFPOST BLOGGER
Paul Abrams
03:03 PM on 10/07/2010
Of course, people do not want government intruding into insurance companies' actions raising premiums outrageously, dropping you from coverage, denying them coverage due to pre-existing illnesses. On, no, please don't do that.
And, you know how much they don't want it--Republicans "Pledge" will enact it after they repeal it!! Read the idiotic Pledge.
Oh, and people really don't want government messing with their Medicare, do they? You mean Medicare IS the government? I did not know that
01:38 PM on 10/07/2010
If the democrats had been intelligent enough to have proposed an extension of medicare instead of the hopelessly compromised and bureaucratic bailout of private insurance companies that they passed people would be much more excited about voting for them. The entire drawn out health care debate at a time of severe unemployment and with all the unsavory deals that were made served only to illustrate how corrupt and disconnected the politicians really are.
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HUFFPOST SUPER USER
TrekBear
02:52 PM on 10/07/2010
There was a proposal in Senate debate for a Medicare "buy-in," but Joe Liebermann, among others, shot it down.
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HUFFPOST BLOGGER
Paul Abrams
03:04 PM on 10/07/2010
actually, it would have taken only an amendment to drop the words "65 and older", and it would have been done.
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HUFFPOST SUPER USER
iam7545 r
01:25 PM on 10/07/2010
the HCR law will bankrupt the states as it forces them to pay more Medicaid - several Gov candidates are using it against their Dem opponent
01:37 PM on 10/07/2010
They are wrong. In fact, many states will actually benefit from the fact federal health care subsidies stop at $80,000 for a family of four.
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HUFFPOST SUPER USER
iam7545 r
01:50 PM on 10/07/2010
here - read this =- http://www.puppetgov.com/2010/04/05/five-words-in-the-health-care-bill-that-will-bankrupt-states/

BTW - what kind of dog is that??? Mutt?
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HUFFPOST BLOGGER
Paul Abrams
03:05 PM on 10/07/2010
then those Democratic candidates should turn around and prpose the above--it will save citizens of the state a ton of money!!
HUFFPOST SUPER USER
Cleverboots
01:21 PM on 10/07/2010
Since Governor Christie has been any kind of progressive legislation, I suspect he would not sign this
kind of bill if it were put on his desk.
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HUFFPOST BLOGGER
Paul Abrams
03:31 PM on 10/07/2010
he's also not a Democrat! But, he will be up for re-election, so it will be a good thing to run against him with.
HUFFPOST SUPER USER
Cleverboots
05:00 PM on 10/07/2010
You're right. A lot of his constituents are Democrats so the future of his administration and his re-election will be interesting to watch.
HUFFPOST SUPER USER
Omnix
Hey, Karma, I have a list of a few you missed...
01:14 PM on 10/07/2010
I'd like to know why the Democrats don't identify the insurance companies antitrust practices to the people, and push for legislation to repeal that protection. The insurance companies are engaged in one of the largest rackets in the world, and manipulating our government through bribes, extortion, and propaganda. The bribes and extortion also make it qualify under RICO. I used to work for a large insurance company that operates in several states; and I've seen very clearly how they work. Here's a synopsis:

The insurance company forces the hospital/doctor's office to pay them to include the provider in their network. The provider and insurance company then agree on the rate/schedule for covered costs, like $50 per Tylenol or $300 for an x-ray. The insurance company then takes the position that it won't pay the full amount, but only a portion (say $35 for the Tylenol and $250 for the x-ray). This is still a huge markup over the actual cost of the procedure/product; but it makes the insurance company look like a good option to their customers - even when the customer pays a large premium, a co-pay, a large deductible, and many procedures aren't covered. It's almost humorous to note that the co-pay is about what the actual visit would cost, in most cases, if insurance wasn't running this massive racket.

Note, also, that a large portion of other costs in healthcare are in the additional administrative costs of handling/processing insurance claims.
01:31 PM on 10/07/2010
The only thing I'd like to add is the huge management fees charged by the for-profit insurance companies to their non-profit subsidiaries, for example BCBS. In the state of Maine these charges amount to $200 million a year for 200,000k enrollees.
HUFFPOST SUPER USER
Omnix
Hey, Karma, I have a list of a few you missed...
03:34 PM on 10/07/2010
Yeah, the BCA, who is closely affiliated with Health Care Services Corp (HCSC), is yet one more layer in the scheme. The BCA forces the BCBS members to pay obscene amounts, ostensibly to be members of the Blue Cross Organization/Family (think mafia, not parents and siblings). Now, until just a few years ago, it really didn't amount to much; but I know that they started putting in infrastructure for processing and eRecords. So, I'll give them a slight pass, since they are starting to add some value. However, overall, these entities really just act as a distraction, since the people in charge of the BCA also jointly own many of the BCBS and affiliate members. Either way you look at, it's still a racket.
04:08 PM on 10/07/2010
I am happily not covered by insurance (my savings cover my medical needs). However, from the outside looking in, the insurance policies seems enormously complex.

I'm wondering if you believe the above scenario for state-run public options described by Abrams would help alleviate the insurance industry problems (gouging racket) you refer to.
HUFFPOST SUPER USER
Omnix
Hey, Karma, I have a list of a few you missed...
11:41 PM on 10/07/2010
Do I think it's possible that the state-run public options could alleviate many of the problems? Sure, assuming the state-run program is not profit driven, and operated properly, then it would provide adequate competition to the profit-driven companies and force them to lower their profit margins.

However, there are many variables; and a public-option certainly is not a panacea. I believe either the state or federal government should enact anti-trust laws; or the federal government should revoke the laws protecting insurance companies. Doing these things concurrently would provide the best protection for consumers...
12:43 PM on 10/07/2010
Although, I agree that a public option for a state or group of states would help the cost problem. In rural states, it may not because of the exemption for anti-trust.
The same concept could be used to negotiate lower drug prices.
But the real cost savings, reduction in medical errors and advancement in medical research comes from determining what "Best Medical Practices" are, on a continuing basis, and implementing them across the country.
HUFFPOST SUPER USER
ProudLiberalDan
Standing up an fighting conservatives since 1987
01:00 PM on 10/07/2010
That the anti-trust provision wasn't included in the bill was as shameful as the public option being ditched for corporate campaign cash.
01:19 PM on 10/07/2010
'm hoping in the lame duck session Congress grows a pair and passes:
Cram-down for mortgages
Cap and rebate on energy
"Home Star" program with financing through PACE bonds
Removing the anti-trust exemption.
But I can only hope.
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steve11407
pending approval and won't be displayed until ...
12:31 PM on 10/07/2010
Pie in the sky.
12:45 PM on 10/07/2010
No, American engineering. If we created the inter-state highway system of Healthcare IT. Cost control can done through IT automation. By creating a public-private open-source Healthcare Information Technology process between HHS and the Healthcare Industry and using the best evidence based-medicine from around the world come up with “Best Medical Practices (BMP)” diagnostic and treatment interactive-electronic-medical-workbooks using: XML, XML schema, XForms, Dita and web-services which are IETM Class V compliant documents that when each step is filled out is checked for accuracy and completeness in real-time and saved to one of the telecoms (third-party). Savings OMB Director Orszag's 700b a year using BMP, since your insurance is based on BMP it could be fully automated, savings Senator Sanders 400b a year in administrative costs, since the workbook format is public the HHS like the IRS could offer rewards to independent programmers savings 60b a year in fraud. Like Newt Gingrich has said if you're using BMP, a malpractice case should never go to court savings 100b a year. Your personal EHR is also at the telecoms secure with bio-metrically audited access and no name or address attached, from anywhere in the world. The DOD, IBM, and many others are already using these technologies. Now there is no Healthcare or Medicare deficit.
12:46 PM on 10/07/2010
Of course the medical provider's ICT (Iphone) would need a camera that doubles as a barcode reader, Voice Recognition software, GPS unit and a bio-metric auditing device at a minimum.
Now the government has predicted the future, because of that, investors can invest and innovators can innovate. Now the home medical office is a reality.

References
EHR http://en.wikipedia.org/wiki/Electronic_health_record
XML http://en.wikipedia.org/wiki/XML
XML schema http://en.wikipedia.org/wiki/XML_schema
XForms http://en.wikipedia.org/wiki/Xforms
web-services http://en.wikipedia.org/wiki/Web_service
IETM Class V http://en.wikipedia.org/wiki/IETM
DITA http://en.wikipedia.org/wiki/Darwin_Information_Typing_Architecture
A presentation by IBM using DITA
IBM http://dita.xml.org/sites/dita.xml.org/files/IDCMSBlue.pdf
Cloud Computing http://en.wikipedia.org/wiki/Cloud_computing
SaaS http://en.wikipedia.org/wiki/Software_as_a_service
An excellent article from a Brookings Institute Study from a medical standpoint http://www.brookings.edu/reports/2009/0901_btc.aspx
HUFFPOST SUPER USER
Omnix
Hey, Karma, I have a list of a few you missed...
03:48 PM on 10/07/2010
So you prefer HL7 over X12 (UN/EDIFACT)?

BTW, if they make it Android, instead of iPhone, you'll already have the barcode reader, voice recognition, and GPS. Plus, more manufacturers and telecoms support Android, it's a mostly open platform, and it's generally lower cost. Just my 1/50th of a dollar...

F & F'd
12:27 PM on 10/07/2010
".....only the premiums would likely be lower as the advertising, administration and salaries would all be lower."

Why do you think that government provided insurance would have lower administrative costs or salaries?
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HUFFPOST BLOGGER
Paul Abrams
12:39 PM on 10/07/2010
Because Medicare's administrative costs are around 2-3%, and private health care insurance's are around 25-30%. That is why one regulatory item in the Affordable Health Care Act was to impose a maximum of 15-20% for total "non-medical" costs.

That is, we know both sides from long experience. It is not a guess or pie in the sky.
05:55 PM on 10/07/2010
Do your administrative costs take into account the fraud and abuse? Or the taxes insurance companies are required to pay that Medicare does not?

http://www.realclearpolitics.com/articles/2009/06/27/the_adminstrative_cost_benefit_myth_97193.html

http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf
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ProudLiberalDan
Standing up an fighting conservatives since 1987
12:42 PM on 10/07/2010
Because that is the way it works all over the world. Medicare has much lower administrative costs than corporate insurance.
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GeorgieGirl9
Liberty, In God We Trust, and E Pluribus Unum
12:17 PM on 10/07/2010
Like Medicaid for all? Yeah, that works. For no one.
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ProudLiberalDan
Standing up an fighting conservatives since 1987
01:00 PM on 10/07/2010
It works beautifully around the world.