I write this diary as an actuary and a former federal employee.
The Daily Kos is a fact-based community. We need to get our facts correct. As leader of the progressive blogs, kos has a moral responsibility to get his facts right: he diminishes the progressive blogosphere's credibility when he doesn't.
In a recent diary, kos claimed that Sen. Joe Lieberman once supported the public option. kos uses the following quote from Sen. Lieberman's 2006 election:
I have offered a comprehensive program, [...] MediChoice to allow anybody in our country to buy into a national insurance pool like the health insurance pool that we federal employees and Members of Congress have.
The Federal Health Employee Health Benefits Program (FEHBP) is not a Medicare-like, single-payer, public option. I should know this as a former federal employee. As snaxattack pointed out in a comment,
The only difference between plans from the FEHBP and the insurance plan I'm on is that the federal government is making a contribution instead of my employer. Because the federal government is the employer. Comparing the FEHBP to a public option is at best a misconception, at worst deceptive sleight of hand.
Indeed, FEHBP allows federal workers a menu of choices. When I was a federal employee, I always chose Blue Cross/Blue Shield Standard Option. That's certainly not single-payer.
Every single Democratic proposal includes some program similar to FEHBP. It's called a health exchange. The Baucus proposal contains a health exchange. The HELP committee proposal contains an exchange. The House proposal contains a health exchange. The Wyden/Bennett proposal, which Lieberman is a co-sponsor, contains a state health exchange. The question is whether or within the exchange, a Medicare-like option, or the public option, will be allowed to compete with the public plan. The Baucus and Wyden proposals do not allow a Medicare-like option to compete with the other private plans within the exchange; the HELP Committee proposal and the House proposal do. Lieberman does not favor allowing this Medicare-like plan to compete with programs in the health exchange program. That is all.
We may not agree with Joe Lieberman's position, but he most certainly is not lying.
One other thing, and I write this as an actuary:
I fear that the public option will just become solely a pool of people with pre-existing conditions. I also fear that Democrats are spending their political capital in the wrong way by elevating the public option to litmus test status.
If insurance companies have even the slightest bit more liberal underwriting rules than the public option -- i.e., insurance companies are allowed to charge more for pre-existing conditions, age, and/or region and the public option is not, or the the public option is required to accept and renew everyone while insurance companies are not -- then the public option becomes a pool solely for people with preexisting conditions, and either the public option becomes unaffordable, or the taxpayers subsidize the public option of people with pre-existing conditions. Meanwhile, insurance companies profit from having a much lower risk population.
If insurance companies have indentical underwriting rules as the public option, won't the public option and insurance companies have similar administrative costs? And aren't underwriting costs the main costs of administrative costs? So how much money can really be saved by using a public option?
Even more, suppose that a bill contains a public option, but in order to hold down costs, the bill completely phases out subsidies at 300 percent above the federal poverty level, and/or the date of enactment of the bill is pushed back to 2014? Wouldn't we rather have a bill with no public option but phases out subsides completely at 400 or 500 percent above poverty level, and has a date of enactment in 2011? Wouldn't we rather have a bill that caps out-of-pocket expenses (which the House bill does) than has a public option? If subsidies are phased out completely at 300 percent of poverty level, this means that the recent single college grad working in NYC and earning $40,000/yr. will receive no government help while phasing out the subsidy at 400 percent above poverty level will allow this recent college grad trying to start her career some assistance. At the family level, the 300/400 phaseout level the difference between a teacher and a firefighter in Fairfax County, Virginia receiving no help and some help. This makes a huge difference.
So my belief is the following:
The goals of this health care reform shouldn't be about whether or not there is a public option or whether or not everyone has a choice of doctor. Here's what the goals should be:
- Insurance companies should not be able to deny or refuse to cover certain pre-existing conditions based on health status.
- Insurance companies should be required to accept and renew all applicants (unless the applicant misses a payment, etc.), and only be able to charge higher premiums based on zip code, family size, and age, and charge higher premiums by age by a limited amount.
- Everyone should have access to a minimum amount of health insurance -- regardless of health status.
- No American should be required to pay more than a certain amount of out-of-pocket expenses.
- Annual and lifetime benefit limits should be removed.
That's about it. Other than that, I have no feelings about universal health insurance. Please share your feelings.