Wednesday Morning Open Thread: Nancy (Once Again) Smash

May her shadow never grow less!:

Democrats are wandering around in the wilderness once again, shut out of power in Washington after losing a close, hard-fought presidential battle. The last time this happened, after the 2004 elections, the newly reelected president, George W. Bush, over-read his mandate and launched an ill-fated effort to partially privatize Social Security, providing a rallying point for Democrats to begin turning things around.

In an interview with me, House Dem leader Nancy Pelosi argued that history might repeat itself, if House Speaker Paul Ryan — with Donald Trump’s blessing — makes good on his hints to press forward with his plans to privatize Medicare. Pelosi vowed that Democrats would remain united in the battle to stop Ryan’s plan, a goal she described as crucial to defeating it, just as unity enabled Dems to block Bush’s Social Security plan…

In that 2005 fight, Pelosi recalled, Democrats actively avoided developing an alternative plan to Bush’s. Instead, Democrats said their plan was to defend Social Security, a very popular government program. At the time, some Democratic strategists warned against uncompromising opposition. But the gamble paid off. Observers noted that Bush’s plan sank in popularity as Dems remained unified behind a refusal to budge in defense of Social Security, a move that was widely credited with helping to put Dems on track to winning back Congress in the 2006 elections.

Pelosi argued that if Republicans did try to privatize Medicare, it would afford a chance to underscore “the difference between Democrats and Republicans” at a time when Democrats are trying to regain their footing after this year’s loss. “This is such a stark difference that people know we have to be unified,” Pelosi said….

… Pelosi adamantly stated that Democrats would not give any ground on the core ideological dispute here, which is over whether to maintain a government coverage guarantee. “We are not going to a casino — this is a guarantee,” Pelosi said. “This is a value system for us, and we will fight for it. Is it a guarantee, or not?”…

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Apart from vowing to fight on, what’s on the agenda for the day?



And the Lord said, whack ye all the serpents which crawl on their bellies …

Warren(1)

Warren2

What’s the Warren equivalent of Nancy Smash!?



Tuesday Evening Open Thread: I’m With Her, Too

Nacy Pelosi plays the Good Cop. And the Bad Cop? Well, last week, there was this Politico report:

“I’ve never been too good at math, but I can figure that one out. I think he better do a little mathing,” Reid said…

Reid went on to say that while Sanders has the right to continue his presidential campaign, he doesn’t recommend extending it.

“No, I don’t think he should. I don’t know what that’s going to prove. Sometimes you just have to give up. I’ve lost before. The numbers aren’t there.”

Sen. Sanders has had all the fun made the best impact he can in this election cycle. Anything less than a gracious concession, at the very least, is not going to make his future career path pleasant…



Good news everybody

Just some more good news:

and the good news will probably continue for the first quarter of 2016:

So in 3 years, all of the data sources suggest that we’ve cut the uninsured rate in half and slowed the cost curve. There are another couple percentage points of easy gains once the rest of the Confederacy and the everyone between the Mississippi’s left bank and the Columbia’s south bank expand Medicaid.

Then we’ll actually need to take another whack to get the last 5% of the population covered AND get better coverage for 25% to 30% of the currently covered population.



Good news everybody

The CDC  has released their initial 2015 uninsured population counts.  Good news, for all residents of the US in the US through September 2015.  Remember, this percentage will go down a bit more as Montana and Alaska are expanding Medicaid and the 2016 Open Enrollment period pulled in more people.

 

CDC 2015 uninsured rate

These numbers are a bit lower than Gallup and other sources because this data set includes kids and the elderly.  Both of those groups tend to have a higher insurance rate because there are more government programs aimed at those two populations.  Working age adults have a slightly higher than national average uninsured rate.



Public option and provider reimbursement nudges

On Twitter, there is a long and productive discussion about provider pricing and the recent study on commercial payer rate variations.  Part of the discussion went back to this Washington Post article on price suppression from October 2010.

 

The administration decided not to seek lower drug rates for Medicare, and it didn’t press for a “public option,” a government-run insurance plan that people under 65 could buy into. While supporters of the public option sold it as a way to compete with insurers, the real target was hospitals and doctors. A public option would have created a nationwide purchaser of health care that could have exerted leverage on providers to cut prices. This would have lowered the law’s costs by reducing the subsidies needed to make insurance affordable….

“The public hates the insurance industry and trusts doctors and hospitals,” said Richard Kirsch, head of the liberal coalition Health Care for America Now. “But what killed the public option was the hospitals, not the insurance industry.”

The public option would have been a marginal pressure to reduce prices.  There were several flavors on how providers would be paid in a  public option.  The two most common were Medicare plus X where X was some percentage between 5% and 15%, and negotiated rates.

Under Medicare plus 5% or Medicare plus 15%, the public option would be a non-differentiated product in competitive insurance markets and a narrow network product in non-competitive markets. Mayhew Insurance is in a competitive market region for the Exchanges.  The lowest priced Silver plans offered by all of the insurers in this region are narrow network HMOs where the providers get paid Medicare rates plus 5% to Medicare plus 10%.  The public option would be just another plan that is in the cluster for the 2nd Silver subsidy point.  If the network is a broad network like the rest of Medicare, the public option would probably be overpriced compared to similar products because the public option network would include a lot more high cost providers than the targeted narrow networks.

In noncompetitive payer and provider markets, the public option at Medicare plus 5% or Medicare plus 15% would be a fairly narrow network.  Medicare can get away with offering fairly low rates in non-competitive markets and still have most hospitals and providers sign up for traditional Medicare because Medicare can promise volume.  The Exchanges can’t promise volume.  The Exchanges for this year are projected to insure 4% of the US population, and it is a fairly low utilizing population when compared to Medicare.  That means providers don’t need the Exchange volume to cover their fixed costs.  Under a Medicare plus X regime, quite a few providers would not sign the contract.  They would not want to set a precedent of taking Medicare based rates.  So the public option in provider dominated markets would keep the dominant insurer honest but the pricing differential after a year or two would not be tremendous.

If the public option was a negotiated rate product, it would be similar to the 2nd Silver chasing products in competetive markets.  In minimally competitive insurance markets, it would probably have a broader network than it would under a Medicare plus X scheme but the pricing difference between it and the lowest priced Silver from the dominant carrier would be smaller.

I think the public option is something that should always be presented by progressives as a budget pay-for as it will produce significant savings to the federal government through lower subsidy levels but it is not a panacea.  The Exchanges are not big enough pools of patients and dollars to drive hospitals and other providers to completely change their pricing models.



Good news everybody

What an amazing failure — goals are being met, costs are being contained, and the expenditure curve is still looking better today than it did seven years ago.

Can we have more amazing failures like this

:)