On these estimates: Sounds right, sort of; I thought that Obama was cool to the public plan option, was surprised on looking back at the campaign statement to see it there.  Maybe a minor point, but I'm not sure I see how you conclude that in the campaign literature (as opposed to now"essentially, the "new public plan" is the Federal Employees Health Benefits Plan FEHBP. "   Obama's campaign statement called for a National Health Insurance Exchange, which is in itself just an office that connects people to actual insurance plans; this is a version of the Federal Employees Health Benefits Plan, which is the office that arranges for coverage for federal employees (but is not a health insurance plan - it doesn't enroll people or pay bills, it just send out the choice of insurance options). Construing the "pubilc plan" to mean something like the FEHBP would have been really redundant.  If there is an NHIE, what would be the role of a duplicate FEHBP-like exchange?

Baucus' plan of Nov. 2008 is explicitly clear that he means a Medicare-like program when he refers to a "public plan," that is a public insurance program, not a link to one. He has reportedly abandoned this idea.  Obama may have also abandoned it, but I don't think this is reflected in the campaign material; I think public plan there means a public plan (e.g. something like Medicare). 

(I couldn't open the actual Lewin analysis from Oct. 2008 on this computer, but read a number of summaries related to it, including one from Heritage; these are consistent with the idea that Obama meant a Medicare-like public plan. The Urban Institute is online and clear: "The
NHIE would offer a number of private plans aswell as a new public plan option."http://www.urban.org/UploadedPDF/411754_obama_health_proposal.pdf)

In this case, the Lewin and Urban Institute estimates were of an Obama proposal that included both an NHIE (the FEHBP equivalent), and something like a Medicare equivalent.

So conclusion #1: Without a public health insurance program, and only an NHIE/FEHBP, the costs would actually be a lot higher than Lewin and Urban estimated.  

Shifting gears to the present: These days if and when Obama refers to a public plan he probably does just mean the NHIE/FEHBP.  But seems we're not the only ones who aren't sure.  The March 1 NY Times article by Robert Pear quotes Rep. Frank Pallone, chair of the Health Subcommittee of Energy & Commerce: "Mr. Pallone asked: Does the president favor an “individual mandate,” requiring all Americans to carry health insurance? Or should the requirement apply just to children at first, as Mr. Obama said in the campaign? Will Mr. Obama insist that the government offer a new public plan, to compete with private insurers? Insurance companies adamantly oppose that idea."

Conclusion #2: A program that mandates payments by individuals and employers, and does not include an actual public insurance program, is nothing but a direct subsidy to the insurance industry.  On which point  I am sure we agree. Thanks, Joel. - Ellen

Joel Albers wrote:

Obama's proposed HC spending as part of his newly released Federal 
budget.

F/u on Linda and Ellen's comments. (based on Nancy's posting of 
MoveOn's positive critique).

Here's more context: It all boils down to the Federal Employees model 
or the Medicare model, the latter being the gold std.

Last week Obama proposed $634 billion over 10 yrs for HC spending 
with no specific details, but goal of covering the uninsured. Details 
left to congress to debate as next step in budget process. Bottom 
line: good start on financing mechanism (half from taxing the 
wealthy, and $177 billion more from repealing overpayments to HMOs 
which contract w/ Medicare, which caused HMO stocks to tumble). To f/ 
u on Linda's post, i too see nothing so far about fed. govt replacing 
HMOs in negotiating drug prices for seniors.

But, "devil in details". Obama's HC economics advisers are not you 
and me. They are: David Cutler, David Blumenthal, and Jeffrey Liebman 
all of Harvard; Stuart altman of Brandeis; Austin Goolsby of U of 
Chicago. (Dashle never got confirmed, didnt pay taxes, AND major 
conflicts of interests, ties to insurance industry). Their advice 
resulted in Obama CAMPAIGN'S Universal HC plan (which Ellen 
posted,see below), essentially,the "new public plan" is the Federal 
Employees Health Benefits Plan FEHBP model, retains COSTLY HMO 
insurers. FEHBP would be available both to employers who choose to 
pay in, or uninsured individuals (eliminating pre-existing conditions 
on the front end,only to not pay on the back end).

Obama DID campaign on the Medicare model as an additional option to 
FEHBP (ONLY after pressure from edwards campaign), but this appears 
to have been scuttled. Problem is, FEHBP is a managed competition 
model, pools 9 million Federal employees who receive voucher (premium 
support payment) used to pick among HMOs,PPOs etc by comparing cost 
and quality. Managed competition has been discredited, essentially 
because huge insurers can't compete with themselves.

So estimated cost of Obama's Universal Health Care proposal which he 
campaigned on (Federal Employees model), was $1.17 trillion over 10 
yrs by Lewin Group ( their 'econometric" model is generally 
reasonable, yet difficult to verify, proprietary); Urban institute/ 
Brookings Institute est. was $1.6 trillion over 10 yrs. Hence, 
discrepancy between these estimates which assumed UNIVERSAL coverage 
and the $643 billion over 10 yrs, which wont come close to UHC.

In contrast, Physicians' for National Health Program's (and most of 
the rest of the world's) UHC estimate uses a single-payer, Medicare 
for All model: a std of efficiency (stdized benefit, uniform payment, 
automatic coverage, no oop costs) which costs $350 billion by 
eliminating insurance company admin waste, covers all, pays for 
itself, all in the first year of implementation. (47 million 
uninsured persons in the U.S. x $7,000 per capita cost of HC, you 
get about $330 billion to insure the uninsured; covers it).

So those are the two basic models: Federal Employees (HMO insurers) 
and Medicare (government-funded, a public good). Anything moving in 
the direction of the Medicare model will be good first steps: govt 
negotiating Rx drug prices for seniors, getting HMOs out of Medicare, 
Medicare setting global operating budgets to replace current (DRG) 
billing for hospitals. finally, Obama's $750 stimulus pkg does little 
to make STRUCTURAL changes in HC, and in the future if we are going 
to solve both the HC and economic, structural changes in Hc is what 
it will take.

joel

Joel Albers Pharm.D., Ph.D.
Clinical Pharmacist, Health Economics Researcher
Universal Health Care Action Network - MN
Community/University Collaborative Research
www.uhcan-mn.org
email: joel@uhcan-mn.org
phone: 612-384-0973
address: 3500 35th ave S
Mpls, MN, 55406

On Mar 1, 2009, at 7:57 PM, Ellen Shaffer wrote:

> Obama's campaign plan, which I was still able to find online, said 
> this:
>
> " (1) OBAMA'S PLAN TO COVER THE UNINSURED. Obama will make 
> available a new
> national health plan which will give individuals the choice to buy
> affordable health
> coverage that is similar to the plan available to federal 
> employees. The
> new public plan
> will be open to individuals without access to group coverage through
> their workplace or
> current public programs. It will also be available to people who are
> self-employed and
> small businesses that want to offer insurance to their employees.
>
> "(2) NATIONAL HEALTH INSURANCE EXCHANGE. To provide Americans with
> additional
> options, the Obama plan will make available a National Health 
> Insurance
> Exchange to
> help individuals who wish to purchase a private insurance plan. The
> Exchange will act as
> a watchdog and help reform the private insurance market by creating
> rules and standards
> for participating insurance plans to ensure fairness and to make
> individual coverage more
> affordable and accessible. Through the Exchange, any American will 
> have the
> opportunity to enroll in the new public plan or purchase an approved
> private plan, and
> income-based sliding scale subsidies will be provided for people and
> families who need
> it. Insurers would have to issue every applicant a policy, and charge
> fair and stable
> premiums that will not depend upon health status. The Exchange will
> require that all the
> plans offered are at least as generous as the new public plan and meet
> the same standards
> for quality and efficiency. Insurers would be required to justify an
> above-average
> premium increase to the Exchange. The Exchange would evaluate plans 
> and
> make the
> differences among the plans, including cost of services, transparent."
>
> http://www.barackobama.com/pdf/HealthPlanFull.pdf
>
> It suggests that he would support a public health insurance plan.
>
> However, he has not written and probably will not write 
> legislation, as
> you note, though HHS and the White House health reform office will
> likely be in regular contact with Congress. There have been informal
> reports from the Finance Committee that the public plan is not viable;
> this is not the final word, but at least reflects the strong 
> opposition
> they are hearing.
>
> I haven't heard of Obama expressing support for any health reform
> legislation recently All the members and committees you mention are
> reportedly working on legislation. Commonwealth recently published a
> Lewin analysis of a range of health reform bills from the last session
> of Congress; it lumped in HR 676 with HR 193, which it 
> characterized as
> Medicare for all bills (not quite accurate). It showed Stark's HR 193
> as the only plan to cover everyone, and would also save money. Could
> influence the debate, and the discussions in Congress.
>
> - Ellen
>
> Lindazf@aol.com wrote:
> > Ellen,
> >
> > Am I understanding you correctly that a public plan option is now 
> out
> > of Obama's plan?--not that he is proposing one any more but
> > leaving details to Congress, as I understand it. Out of which plan,
> > HELP and Kennedy's, Waxman's? Who actually is developing
> > legislation? Those are the ones that Obama will support--not 
> Conyers'
> > or Stark's.
> >
> > And has Obama actually changed from his campaign position/promise 
> that
> > his health care reform would have a public plan as an option? Or 
> am I
> > mistaken that he promised that?
> >
> > Also does anybody know if White House is putting out a list of 
> who is
> > invited to the health summit meeting? I looked all around their
> > website and could not find a list of who was invited to the fiscal
> > responsibility summit. It seems to me that these names should be
> > public--or it looks too much like how Clinton health reform was 
> developed.
> >
> > Linda
> >
> > ----------------------------------------------------------
> > Get a jump start on your taxes. Find a tax professional in your
> > neighborhood today
> > <http://yellowpages.aol.com/search?query=Tax+Return+Preparation+% 
> 26+Filing&ncid=emlcntusyelp00000004>.
>
> -- 
>
> Ellen R. Shaffer, PhD MPH
> Co-Director, Center for Policy Analysis
> San Francisco Presidio
> P.O. Box 29586
> San Francisco, CA 94129-0586
> phone: 415-922-6204
> fax: 415-885-4091
> cell: 415-680-4603
> www.centerforpolicyanalysis.org/www.cpath.org
>
> [Non-text portions of this message have been removed]
>
>
> 

[Non-text portions of this message have been removed]

-- Ellen R. Shaffer, PhD MPH
Co-Director, Center for Policy Analysis
San Francisco Presidio
P.O. Box 29586
San Francisco, CA 94129-0586
phone: 415-922-6204
fax: 415-885-4091
cell: 415-680-4603
www.centerforpolicyanalysis.org/www.cpath.org