alexandraerin | Reframing the debate.

Here's the question we should be asking all public figures who are against a public option or other form of national health insurance:

"[Senator/Congressman/Pundit], how long have you believed that France is better than America?"

It's fairly easy to point to the failings in the Canadian health care system... a system, incidentally, that neither President Obama nor the Democrats in the legislature are looking to as an example... but France, which has a system closely resembling the much-denigrated "public option", has the top-rated healthcare system in the world.

France can manage to provide quality health care to their entire population and we can't? And it would be too expensive for us to match the feat, when they do it while spending less money per person than we do?

I'm sorry, I don't buy it.

I'm sure the reason that the supporters of the public option have been pointing to France is... well... as I've said before, liberals have a real problem with sitting back and allowing their opponents to frame debates. "Speak softly and carry a big stick" worked fine for Teddy Roosevelt, but it wouldn't have worked so well for his cousin Frank, who had to speak loudly and often just to make himself heard. If we pointed to France and said "We want our country to be more like that.", the right would jump on it in an instant... I mean, we're talking about people whose response to half of the things our president does is to say "arugula" like they've made some great and telling point about policy.

But with France using the public option and not just making it work but making it work so well that they have the best medical care in the world, consider the implication being made any time somebody says that the public option wouldn't work in America or that it would result in worse care for most people:

America is less capable than France.

In my previous post on the subject, I framed things in terms of goodness vs. greatness. Well, let's talk about greatness. As I said, we put a man on the moon. Is there any reason we couldn't take the number one spot away from France if we wanted to?

A lot of our political representatives and media figures seem to think so. Let's put them on the spot and ask them why that is.

Flat | Top-Level Comments Only

Sure, the talking points are the same, but without the public option (which is at the heart of what France has accomplished) there's no teeth or guts to any of it. It's a love song to the insurance industry being passed off as reform, and if it passes, then when things don't actually improve they'll be able to say, "Well, we were against this to begin with. We only did what we did as a compromise. Now that government has failed it's time to let the free market take over."

"Competing across state lines" means every insurance company can do business from whichever state gives them the most beneficial regulations instead of having to be licensed to do business in each state.

It means if Delaware says "FUCK THE LITTLE TAXPAYER, WE WANT INSURANCE COMPANY MONEY", you and I have no leverage to exert against them and no real recourse since all the insurance companies are now doing business out of Delaware.

A public option means that the insurance companies have to provide value no matter what state they're doing business from. They can stay in the game by offering things that the government can't/won't... but the public option means they have to compete.

Without a public option, penalties for people who don't have coverage are essentially a tax that exists purely to enrich a single industry. Without a public option, we can give the industry all the "incentives" in the world and it's not going to get universal coverage, nor will it make sure that coverage is meaningful.

The scenario you describe is not what I understand portability to be. Currently, my insurance plan in Ohio would be discontinued if I moved out of state on a permanent basis. I propose that I be able to keep my same plan should I move, or if I so desire, stay in Ohio and buy my plan from a company in Virginia because it's cheaper there. They would certainly have to be licensed to do business in my state, or any other state outside of Virginia they wanted to do business in, much like auto insurance works. Then every insurance company would have to compete with every other insurance company that is licensed to do business in my state. When opened to the whole country, There will be an excess number of providers (supply) for an essentially static number of insured (demand), thus driving costs down.

We already have a situation where every insurance company that's licensed in your state has to compete with every other insurance company that's licensed in your state. The end result of this is regional fiefdoms and informal agreements not to compete because they're selling a basic necessity of 21st century life and it's not like we can boycott them with any effectiveness. The free market ceases to be free when there are no tenable alternatives to buying.

Sure, with portability, you could keep your policy in Ohio or you could buy it from Virginia... assuming the companies stay in Ohio and Virginia. If they can do business from any of the fifty states and be governed by that state's laws (this is an essential feature of "portability"; what allows the companies to do business across state lines and cover you the same no matter where you go is the ability of the companies to ignore differences in the state laws of the consumers' residences), they will do what the credit card industry did when they were likewise deregulated in the name of "increased competition" and "consumer protection": relocate to the state that lets them get away with taking in the most money in exchange for the least value.

Thus necessitating, somewhat ironically, the need for further FEDERAL regulation and involvement in what has been an industry traditionally handled at the state level. But big government is bad, states rights are good! Or was that four legs good, two legs better? I never was any good at slogans.

Again, my understanding of portability is that it doesn't matter what state you are incorporated in, you have to play by the rules of the state the policy is sold in, thus if you practice in 8 states, you have 8 different sets of regulation to play by. Allowing a policy to transfer from one state to another may necessitate changes to the policy, but does not cancel it.

So they sell you a policy from the state that likes them the most and protects you the least.

How is that difficult to understand?

Look at any end user license agreement for any software or product you have that carries one. Most of them contain a line specifying that any dispute you have will be governed by the laws of Jurisdiction X. Why do you suppose they do that? Hometown spirit? No. They do business out of a jurisdiction that's favorable to them.

Why would insurance portability work any differently?

What you're describing as "portability" is what we have now: if an insurance company wants to do business in your state, they have to be licensed in that state and they have to abide by the regulations there. Portability would allow insurers to operate across all state lines. The only way that works... the only way the same policy can work the same way for the same price in all fifty states... is to have a single governing jurisdiction, and that's actually what's being discussed as "portability."

Premiums for people who are judged to be more than a moderate risk would be very likely to increase as we'd all be forced to buy our insurance from companies operating in the state granting us the least protections from pre-existing conditions. Obviously if we get strong federal protections in this area that would be less likely, but with portability being touted as a cure-all that will lower premiums and improve coverage without the need for federal safeguards...

It might result in an improvement for those who are in a decent situation already and make a bad situation horrible for everyone else... much like putting everybody on high deductible/HSA plans would.

Reframing the debate.

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