Health reform with a public option, like Medicare, will improve over time

[ProSense]

1965--Medicare and Medicaid were enacted as Title XVIII and Title XIX of the Social Security Act, extending health coverage to almost all Americans age 65 or over (e.g., those receiving retirement benefits from Social Security or the Railroad Retirement Board), and providing health care services to low-income children deprived of parental support, their caretaker relatives, the elderly, the blind, and individuals with disabilities. Seniors were the population group most likely to be living in poverty; about one-half had health insurance coverage.

1966--Medicare was implemented on July 1, serving more than 19 million individuals. Medicaid funding was available to States starting January 1, 1966; the program was phased-in by States over a several year period.

1967--An Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) comprehensive health services benefit for all Medicaid children under age 21 was established.

1972--Medicare eligibility was extended to 2 million individuals under age 65 with long-term disabilities and to individuals with end-stage renal disease (ESRD). Medicare was given the authority to conduct demonstration programs.

Medicaid eligibility for elderly, blind, and disabled residents of a State could be linked to eligibility for the newly enacted Federal Supplemental Security Income Program (SSI). Eighteen million individuals were covered by Medicaid.

1977--The Health Care Financing Administration was established by Secretary Califano to administer the Medicare and Medicaid Programs.

1980--Coverage of Medicare home health services was broadened. Medicare supplemental insurance, also called Medigap, was brought under Federal oversight.

link

THE EVOLUTION OF MEDICARE . . . from idea to law

Chapter 4: The Fourth Round-1957 to 1965


The current House health care bill extends coverage to 96 percent of Americans, and the exchange will be gradually opened to more employers:

SEC. 302. EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS.

(a) ACCESS TO COVERAGE.—In accordance with this section, all individuals are eligible to obtain coverage through enrollment in an Exchange-participating health benefits plan offered through the Health Insurance Exchange unless such individuals are enrolled in another qualified health benefits plan or other acceptable coverage.

(b) DEFINITIONS.—In this division:

(1) EXCHANGE-ELIGIBLE INDIVIDUAL.—The term ‘‘Exchange-eligible individual’’ means an individual who is eligible under this section to be enrolled through the Health Insurance Exchange in an Exchange-participating health benefits plan and, with respect to family coverage, includes dependents of such individual.

(2) EXCHANGE-ELIGIBLE EMPLOYER.—The term ‘‘Exchange-eligible employer’’ means an employer that is eligible under this section to enroll through the Health Insurance Exchange employees of the employer (and their dependents) in Exchange eligible health benefits plans.

(3) EMPLOYMENT-RELATED DEFINITIONS.— The terms ‘‘employer’’, ‘‘employee’’, ‘‘full-time employee’’, and ‘‘part-time employee’’ have the meanings given such terms by the Commissioner for purposes of this division.

(c) TRANSITION.—Individuals and employers shall only be eligible to enroll or participate in the Health Insurance Exchange in accordance with the following transition schedule:

(1) FIRST YEAR.—In Y1 (as defined in section 100(c))— (A) individuals described in subsection(d)(1), including individuals described in sub section (d)(3); and (B) smallest employers described in subsection (e)(1).

(2) SECOND YEAR.—In Y2— (A) individuals and employers described in paragraph (1); and (B) smaller employers described in subsection (e)(2).

(3) THIRD AND SUBSEQUENT YEARS.—In Y3— (A) individuals and employers described in paragraph (2); (B) small employers described in subsection (e)(3); and (C) larger employers as permitted by the Commissioner under subsection (e)(4).c

(d) INDIVIDUALS.—

(1) INDIVIDUAL DESCRIBED.— Subject to the succeeding provisions of this subsection, an individual described in this paragraph is an individual who— (A) is not enrolled in coverage described in subparagraph (C) or (D) of paragraph (2); and (B) is not enrolled in coverage as a fulltime employee (or as a dependent of such an employee) under a group health plan if the coverage and an employer contribution under the plan meet the requirements of section 412. For purposes of subparagraph (B), in the case of an individual who is self-employed, who has at least 1 employee, and who meets the requirements of section 412, such individual shall be deemed a full-time employee described in such subparagraph.

(2) ACCEPTABLE COVERAGE.—For purposes of this division, the term ‘‘acceptable coverage’’ means any of the following:

(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE.—Coverage under a qualified health benefits plan.

(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER CURRENT GROUP HEALTH PLAN.—Coverage under a grand fathered health insurance coverage (as defined in subsection (a) of section 202) or under a current group health plan (described in sub section (b) of such section).

(C) MEDICARE.—Coverage under part A of title XVIII of the Social Security Act.

(D) MEDICAID.—Coverage for medical assistance under title XIX of the Social Security Act, excluding such coverage that is only available because of the application of subsection (u), (z), or (aa) of section 1902 of such Act.

(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE).— Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.

(F) VA.—Coverage under the veteran’s health care program under chapter 17 of title 38, United States Code.

(G) OTHER COVERAGE.—Such other health benefits coverage, such as a State health benefits risk pool, as the Commissioner, in coordination with the Secretary of the Treasury, recognizes for purposes of this paragraph. The Commissioner shall make determinations under this paragraph in coordination with the Secretary of the Treasury.

(3) CONTINUING ELIGIBILITY PERMITTED.—(A) IN GENERAL.—Except as provided in subparagraph (B), once an individual qualifies as an Exchange-eligible individual under this subsection (including as an employee or dependent of an employee of an Exchange-eligible employer) and enrolls under an Exchange-participating health benefits plan through the Health Insurance Exchange, the individual shall continue to be treated as an Exchange-eligible individual until the individual is no longer enrolled with an Exchange-participating health benefits plan.

(B) EXCEPTIONS.—(i) IN GENERAL.—Subparagraph (A) shall not apply to an individual once the individual becomes eligible for coverage— (I) under part A of the Medicare program; (II) under the Medicaid program as a Medicaid-eligible individual, except as permitted under clause (ii); or (III) in such other circumstances as the Commissioner may provide.

(ii) TRANSITION PERIOD.—In the case described in clause (i)(II), the Commissioner shall permit the individual to continue treatment under subparagraph (A) until such limited time as the Commissioner determines it is administratively feasible, consistent with minimizing disruption in the individual’s access to health care.

(2) OPT-OUT.—In no case may an employer automatically enroll an employee in a plan under paragraph (1) if such employee makes an affirmative election to opt out of such plan or to elect coverage under an employment-based health benefits plan offered by such employer. An employer shall provide an employee with a 30-day period to make such an affirmative election before the employer may automatically enroll the employee in such a plan.

edited for clarity.

[katandmoon]

1. Did the health industry own congress then the way it does now?

[PretzelWarrior]

2. very good points

[firedupdem]

3. Rec'd n/t

[John Q. Citizen]

4. Medicare started going backward with part D. Privatization. that's what Dems stand for.

The Republican inspired bill is nothing like the publicly run tax funded medicare.

This is a Republican Bill. "Market based solution." Republican. It will only get worse. If you will stand for this crap, next time they will get even more from you.

[valerief]

5. Or it'll get worse. Like our job market. Or education system. Or election process. nt

[jmondine]

6. Social Security is another example

When it started in 1935, it didn't cover federal employees, service industry workers, nurses (and most other hospital staff), agricultural labor, or part-timers. And one of the main causes for the weakening was conservative Democrats on the Senate Finance Committee.

This is health care's "All men are created equal" moment. That phrase, as ground-breaking as it was, explicitly excluded women, and implicitly excluded non-white and non-property owning men.

If health reform passes, we have the opportunity in the upcoming years to improve it. If it fails, we may have to wait 15 years for another launch window.

[Hekate]

8. Good point. nt

[SpartanDem]

12. If it were 1935 the DU purist crowd

would've been calling for FDR to veto the Social Security Act. The bill had numerous flaws as you point out and it would've taken 7 years to be fully operational monthly checks weren't supposed to start until 1942 though that was moved up to 1940. I suspect many would've said that this was social security in name only and that this only to pretend that he was helping average Americans.

[CTLawGuy]

15. there would have been threads entitled

"FDR = Ulysses S. Grant?"

[HopeOverFear]

7. K & R

[tex-wyo-dem]

9. Thank you, Prosense...ther is a very imortant lesson in this...

And it doesn't just apply to Medicare and and present day HCR, but just about every significant revolutionizing change that has happened in this country and, really, throughout the world. Revolutionary change almost never happens all at once, but in steps and stages.

I have been a single payer proponent from day one, but I knew that making a step-function change from a largely private insurer dominated industry to a wholely government funded system was probably unrealistic given the politics of the situation.

What is needed is a long, sustained and consistent pressure from the public.-- if this is done, single payer (which is the only thing that makes sense, IMO) will come to be reality.

Google writings, discussions and speaches by Noam Chomsky...he has discusses many times how true progressive change requires a long and consistent struggle by the people.

[Politics_Guy25]

10. K & R

[ipaint]

13. Almost 100 years of struggle.

A Brief History: Universal Health Care Efforts in the US

The campaign for some form of universal government-funded health care has stretched for nearly a century in the US On several occasions, advocates believed they were on the verge of success; yet each time they faced defeat. The evolution of these efforts and the reasons for their failure make for an intriguing lesson in American history, ideology, and character.

....In 1906, the American Association of Labor Legislation (AALL) finally led the campaign for health insurance. They were a typical progressive group whose mandate was not to abolish capitalism but rather to reform it. In 1912, they created a committee on social welfare which held its first national conference in 1913. Despite its broad mandate, the committee decided to concentrate on health insurance, drafting a model bill in 1915. In a nutshell, the bill limited coverage to the working class and all others that earned less than $1200 a year, including dependents. The services of physicians, nurses, and hospitals were included, as was sick pay, maternity benefits, and a death benefit of fifty dollars to pay for funeral expenses. This death benefit becomes significant later on. Costs were to be shared between workers, employers, and the state.

http://www.pnhp.org/facts/a_brief_history_universal_health_care_efforts_in_the_us.php


Well we are coming up on the 100 year anniversary in a few years. I wonder how much longer we have to struggle for something better than half assed industry written reform.

[quantass]

11. America doesnt enact change..it stumbles into it.

Every country has its interpretations of "for the people". America's version just involves getting its cut from it, first.

[eridani]

14. Mandating priivate insurance is pure unadulterated shit

SS and Medicare did not start out mandating anyone to deal with thieves and parasites.

[slipslidingaway]

16. Medicare did not have to compete with private insurance, there were not subsidies...

to buy a competing private insurance plan.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6833315&mesg_id=6834293

Medicare was open to everyone 65 and older, the government did not give subsidies to people over 65 to purchase private insurance, therefore knocking out the competition.

Medicare had a ready pool of subscribers which allowed them to negotiate prices with providers, the public option has no such ready pool as people can chose to purchase from a private insurance company.

Over 90% of seniors were enrolled in Medicare by the end of the FIRST year.

Obama says that just over 3%, according to the CBO estimate he quoted, would be enrolled in a public option by 2019.

The basic benefits were automatically available to everyone over 65 and financed by an increased payroll tax.

It did not have to be self-financed in contrast with the current public option bills.


From your favorite site, instead of smearing them this time maybe you can point to language in the bill where it specifies exactly how these optionS will be built in various markets.

http://pnhp.org/blog/2009/11/01/what-role-insurance-companie/

"...And here we come to my main point: The major difference between an “option” that really does resemble Medicare and the little one proposed by Democrats is that the little Democratic “option” can’t be rolled out all at once at the national level. Rather, it must be implemented at the local level market by market – in the Bay Area market, in the upstate New York market, in the Chicago market, in the Iron Range-Duluth market, in the Fort Worth-Dallas market, and so on....


...To sum up: If we know only that the proposed “option” (1) is expected to compete with insurance companies, (2) will be small, and (3) won’t be given advantages that insurers don’t get, we can predict the “option” will have to be built market by market. We can predict, conversely, that such an “option” cannot be implemented with the simpler and less expensive national-level activities that would suffice to implement a large “option” that truly did resemble Medicare. Exactly how small the “option” has to be before we can predict it must be implemented market by market is not clear. But it seems safe to say that the little zero-to-six-million-enrollee “option” proposed by the Democrats falls far below the critical mass required for a publicly financed health insurance program to be implemented with the relatively simple tools with which Medicare was implemented.

Finally, if we reach the conclusion that the Democrats’ “option” must be implemented market by market, then we must also reach the conclusion that the locally implemented “options” will look different from one another. Why? Because the market-entry barriers they will have to overcome will differ from market to market. Such an “option” will be “national” only in the sense that the federal government will be financing the attempt by the “option” program to break into every market in the US, and in the sense that the federal government will set some minimum criteria (such as minimum benefit levels) that “option” programs must meet in each market..."


Also this from the end of the article, people just seem to run away when asked to clarify the "public option or options" and that happens at DU as well.


"...My question for HCAN blogger Jason Rosenbaum, posted October 27, 2009 on Firedoglake’s blog:

Could you walk us through the process by which the Department of Health and Human Services will set up an “option” plan in any given market, say Boston, under the Senate health bill, HR 3200, or HCAN’s blueprint? Here’s the scenario I believe will occur under both the Senate HELP bill and HR 3200 assuming the “option” actually survives...."


And the reply...

http://seminal.firedoglake.com/diary/11290#comment-89248

"In response to kipsullivan @ 13

Sorry Kip, not interested.

Reply
selise October 27th, 2009 at 9:38 am 16In response to Jason Rosenbaum @ 15
Sorry Kip, not interested.

kip asks important (and informed) questions that are of wide interest. if you don’t know enough about the topic to respond, i wish you would say so instead of the pretending otherwise. it’s really rude and especially uncalled for given the out of line comments you have made previously (see here for example, and my responses in the same thread @29 and @30).

on the other hand, if kip’s questions reveal a potential weakness to or raise doubts about assertions you have made here, then you have a real responsibility, in the name of intellectual honesty to either address the issue or concede the point.

which reminds me, you owe me a couple of responses re claims you’ve made and i believe where shown to be false. in one case you claimed there was legislative language and have said more than once that you would get back to me with it.

http://seminal.firedoglake.com/diary/8617
http://seminal.firedoglake.com/diary/8746#comment-82143

Reply
lambertstrether October 27th, 2009 at 2:03 pm 17No doubt. That’s because you have no answer. But then, we would expect a paid lobbyist posing as a blogger to have one. So, we’ll take your silence as assent to Kip’s process."

[ProSense]

17. That's really funny

"Medicare did not have to compete with private insurance, there were not subsidies..."

The point of the OP is not comparing Medicare to a public option based on their similarities. It's simply stressing that legislation is often passed and then improved upon.

Another thing: a public option based on Medicare rates would still have to compete with private insurance and still include subsidies.

[slipslidingaway]

18. What's funny is you expect people to believe that you are not trying to draw...

similarities between the public option and Medicare.

"Health reform with a public option, like Medicare, will improve over time...

The point of the OP is not comparing Medicare to a public option based on their similarities. It's simply stressing that legislation is often passed and then improved upon..."


Maybe you can address Kip Sullivan's new article this time, one option or several options (you got lost last time and then when pressured played cut and paste games) and point to the language in the bill as to how these options will be set up.


"...Option advocates offer no information on who will create and run the “options”

...To shed some light on this issue, it would be helpful if we could find discussions about the implementation of the “option” in documents prepared by “option” advocates, by the staff of the Democrats who wrote the “reform” bills, or by independent consultants who reviewed the “option” proposal. But, amazingly, the available documents contain not a word about how the “option” will be created. The following documents about the “option” say nothing at all about how “option” plans will be established:

* Jacob Hacker’s 2001, 2007, and 2009 papers describing the “option”;
* All three reports on Hacker’s version of the “option” by the Lewin Group (the first two of which Hacker and his allies endorsed);
* Press releases and other documents about the “option” prepared by representatives of Health Care for America Now and of the Congressional Progressive Caucus;
* All five reports by the Congressional Budget Office to members of Congress about the impact of the “option” on the uninsured rate and on federal spending issued between July and September as well as CBO’s latest (October 29) report on the “option” in the House bill.

On October 27, I attempted to induce Jason Rosenbaum, a blogger for HCAN, to explain how the Democrats’ “option” would be implemented....


...Thanks in large part to the bait-and-switch tactic employed by the leaders of the “public option” movement, the high probability that the “option” will be a balkanized program created and run by insurance companies is not obvious to the public. The constant description of the “option” as “like Medicare” and “available to all Americans” has created widespread confusion about every aspect of the “option,” including how big it will be, whether it will be uniform like Medicare or balkanized into dozens or hundreds of local programs, and who will create it. Given this confusion, I definitely understand why some people thought Byrne’s article overstated the role insurance companies will play in the “option.” But that doesn’t excuse them. The movement for universal health insurance does not need ditto-heads. We need well informed people capable of playing a role in improving, not diminishing, public understanding of the Democrats’ “reform” legislation..."

[John Q. Citizen]

19. The POs in the house and Senate bills will most likely be run by the private insurance companies

They will also be tiny multiple POs that have different pricing and different rules in different markets.

They won't control costs and they won't keep private insurance companies honest.


They will end up as the dumping ground for people the privates don't want to insure.

If you call that reform, let me put my coffee down first, I don't want to ruin my keyboard.


http://pnhp.org/blog/2009/11/01/what-role-insurance-companie/

[Odin2005]

20. K&R

I have noticed an apocalyptic "if we don't get Single Payer RIGHT FUCKING NOW we never will!!!" train of thinking on the issue, it's ridiculous.

[slipslidingaway]

21. Comparing this public option to Medicare has been disingenuous, although if you...

try and point that out, someone comes along and says...

"if we don't get Single Payer RIGHT FUCKING NOW we never will!!!"

even though single payer was not even mentioned.

:(

Maybe you can address the points raised by Kip Sullivan, the HCAN blogger ran away as well.

No answers...just diversions, smears and crickets.

[slipslidingaway]

22. crickets again n/t

[bikingaz]

23. Improve for who exactly?

Insured or insurers?

[ProSense]

24. Reading is fundamental n/t