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Wednesday, March 21, 2018

Right-wing media are pre-emptively attacking a “public option” health care proposal supported by Democratic presidential nominee Hillary Clinton and President Barack Obama by linking it to supposedly “socialist” single-payer systems that have been routinely demonized through the history of health care reform. Conservative media used this tactic to disparage the public option in 2009 during the legislative debates that created the Affordable Care Act (ACA) and to tap into powerful historical tropes that promote misinformation and misperceptions of the American health care system, stymieing much-needed reform and perverting the public opinion.

The Affordable Care Act has become a major topic of conversation leading up to the election. Right-wing media have manufactured scandals by taking former President Bill Clinton’s comments at an October rally out of context and falsely claiming the newly announced health care marketplace premium increases are evidence of the so-called “death spiral” conservative media have been predicting for years — despite no evidence the law is in danger of collapsing in on itself. The newest target of right-wing media ire is the public option, a proposal supported by Hillary Clinton and President Obama, which would introduce a low-cost, government-administered health insurance option into the federally run health insurance marketplaces.

The strategy right-wing media are using to scandalize the public option revolves around linking it to the single-payer systems used in countries with socialized medical options, either implicitly or explicitly invoking the specter of “Big Government.” Some media argue that the public option is a “Trojan Horse” to destroy the current private insurer-based market or claim that the public option is just “single-payer on the installment plan.” Others argue that Clinton “ultimately wanted a single-payer ultimate government control system for health care” and thus will eventually “go towards the single payer option” when she “replace[s] Obamacare with Hillarycare.”

If these attacks sound familiar, it’s because they are. The original draft versions of the ACA included a robust public option that Democrats ultimately dropped, partially because it became politically toxic as a result of concerted right-wing media assaults. Prominent right-wing media figures called the proposed public option a “stalking horse” or a “buy in,” arguing that “such a plan will lead to a single-payer system.” Others argued that the key to defeating the public option is “expos[ing] the positive-sounding ‘public option’ for what it truly is: a government grab.” They used the same fearmongering “Trojan Horse” rhetoric that right-wing media use now to play upon distrust of the government. They also actively demonized the public option as a socialist takeover of the health care system — framing that has significantly impacted public opinion on the ACA and health care policy generally.

But none of this is true. Numerous fact-checkers have debunked the claim that the public option is just single-payer in sheep’s clothing or that Clinton secretly wants a single-payer system. The public option is a government-administered health insurance plan that would compete in the insurance markets against private insurance plans, while in a single-payer system, “everyone in the country would have health coverage provided by the government,” according to Jonathan Oberlander, a professor of social medicine and health policy at UNC Chapel Hill, noted that “‘single payer’ is often used loosely to refer to everything” and argued that “depicting the Affordable Care Act (ACA) as a ‘slippery slope’ to single payer is bizarre.” Thus, efforts to conflate the two actively spread misinformation and make health care policy even more confusing than it already is for the American public.

This practice of scandalizing the public option in an effort to torpedo reform efforts is particularly problematic since the ACA does need reforms. Clinton and Obama both acknowledge the necessity of reforming the ACA to address fundamental issues about affordability and competition in the marketplaces. Recognizing that there are issues with the ACA does not mean the law is failing. However, purposefully stigmatizing a substantive proposal for reforming the current health care system is particularly troubling since Republicans have yet to produce a viable alternative to replace Obamacare. Americans remain seriously uninformed about health care policy, and the media shouldn’t allow conservative media myths to demonize a potentially productive reform before the public even has the chance to properly learn about it.

Reprinted with permission from Media Matters

Photo: Protesters in Minnesota call for smaller government and the repeal of the health care law enacted in March, 2010. (Fibonacci Blue via Flickr)

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19 Responses to Right-Wing Media Use Old Lies To Trash A Public Option For Obamacare

  1. The Two stupidest things in US Healthcare:
    1) Allowing it to be run by deliberately unregulated private insurance companies without a Single Payer Government option.
    2) Writing into LAW that the Government cannot negotiate prices on drugs or treatments. (The exact opposite of a ‘Free Market’)

    The first one allows the insurance companies to treat human beings like cattle to be milked for the maximum profit with no oversight, regulation or control. At least Obamacare began to put some basic human consideration in to their predatory practices… by ensuring that they can’t deny you coverage the minute you become a liability to them, for example. Keep the healthy ones paying… and drop the sick ones like a hot rock using technicalities as soon as you might have to pay something… Great job America! Do you know how many lives these people have utterly destroyed?

    The second means drug and medical device companies can charge the US Government (Medicare and Medicaid Users) whatever they like. You are all like a big fat piggy bank for them to rip off whenever they feel like it.
    This is why your Healthcare is overpriced by a factor of around 100%.
    It’s not because it’s better.
    It’s because you’ve been set up to be milked by companies that don’t give a sh!t about you… or any human being.
    Proof? Check out the costs of the same drugs in Canada… where they DO negotiate on price. Yeah… less than half the price.
    Nice. Work.

  2. Would suggest there are significant cross purposes and conflicting interests here.

    People want to be healthy and will utilize available services.
    New services and options are always being invented, at ever greater expense.
    Doctors have extreme expenses, school, offices, equipment and such. They need to make money. But have only 24 hours in a day.
    Insurance companies want to make a profit. They make this profit by taking in more in premiums than they pay out. Not to disagree with Thoughtopsy, but this is what insurance companies do. It is neither heartless, nor predatory, nor sociopathic. It just is. The companies are there to make a profit.

    So, People want expensive health care. They will use as much as available to them.
    Doctors want to get people the most expensive care possible. They want to maximize their income in a day.
    Insurance Companies want to pay as little as possible.

    The conflict is beyond foreseeable, it’s required. No one should be surprised.

    • Earn $90 each day for working over the internet from comfort of your own home for several hrs every day… Get paid once a week… All you need is a laptop or computer, net connection, along with a little free-time…

    • There are some flaws in this thinking. People only want the health care that they need to get better. That and no more. Nobody sits in a doctor’s office or an ER just for the fun of it; just to kill some time. Doctors want to give their patients only the care and procedures that are needed to restore wellness. This isn’t about buying some consumer product where you want the best for the least, and the store would like to up sell you if possible.

      Private insurance companies for basic health care shouldn’t exist. Possibly for some specialized, optional, non-essential procedures but not for basic health care. Insurance just doesn’t apply to medicine. It’s not something that is highly unlikely to ever happen, but you want to insure against disaster if it ever does. Medical care is guaranteed to be needed throughout your life, and should be applied by the wealthier countries, at least, on a need basis and not on an ability to pay basis. In other words, a human right.

      That’s how the developed world has come to think of health care, generally speaking. It’s not just another good or service in the marketplace that you can either afford or you can’t.

      • Disagree, at least in part.

        1. People will utilize the health care available.

        Look at the lines for the free flu shots. How many would get the shot if they had to pay? It is a different issue entirely whether we, as a society, benefit more than the cost of such shots. How much pre-natal care is enough? The goal of insuring people was, in part, to allow them to make Doctor’s visits before things became bad enough to warrant an ER visit. Any preventive care proves your “get better and no more” idea incorrect.

        2. Doctor’s indeed want their Patient’s to get better.

        But what’s required for that Patient to get better? Aye, that’s the rub. Does the patient need an MRI? Headaches might be a brain tumor. CAT scan? X-Ray might reveal a fracture. I can point to any number of stories of over-prescribed medications, unneeded procedures, unnecessary surgeries, etc. Any way you look at it the Doctor makes money on the covered procedure. The financial incentive is to do the test. They have to pay their bills too.

        3. Insurance companies are supposed to make a profit.

        Corporations are not people. They are heartless as they have no heart. They can not be sociopathic. You see my point that a Private Insurance Company specifically makes it’s money by not paying out. Putting them in charge of deciding what does and doesn’t get paid is absurd.

        So, as it’s currently constructed, the HC System is based on the crossed goals and is inherently unstable.

        • I wasn’t thinking of preventative care, but it is important. My guess is that most people don’t do that even when it costs them nothing. I’m one of them.

          If a GP refers you to a specialist, it’s because he/she knows or strongly suspects that you need to see one. The GP is the first in the pipeline and won’t be paid anymore after you leave, whether he’s referred you to someone else or not. There wouldn’t be any financial incentive for him/her to arrange for additional unneeded care.

          There are cost controls built into a government single payer system. Those controls are wait times for non-life threatening specialist procedures. The wait times are scaled up or down depending on how important this procedure is, taking a bunch of factors into account: possibility of death, patient pain, ability to perform your job, general mobility, etc, etc… That seems more humane and makes more sense to me than weeding people out based on the size of their wallet, if they don’t have full employer coverage. It’s important to note though that walk-in clinics (with MD’s) and ER’s are available in a pinch 7 days a week at no charge in single payer, if needed.

          I just don’t see the medical profession as vacuum cleaner salesman always looking to make another sale, but you may be more intimately familiar with this than where I am.

          • It’s not making another sale, but a choice between something that makes money and something that doesn’t. It’s the Doctor’s choice. You’re not going to argue.

            Get one of the free flu shots. It’s good for you and it’s good for those around you.

            There are ever more cutting edge procedures available. There’s the cloning of your cartilage to inject for arthritis. There’s cloning body parts for replacement surgery. Insanely expensive. But doable.

            Look at lasik surgery. It’s not covered by insurance. 20 years ago the cost was $2500/eye. Now I think I heard a radio ad for $200/eye. The cost had dropped because people have to pay out of pocket. No one really needs lasik. So it’s incumbent on Doctors to make it attractive financially.

            Making Health Care completely out of pocket, no insurance, no government involvement, just cash; has the advantage of being simple and will drop the costs. Probably totally unworkable because insurance does exist.

            But with insurance there’s no incentive to hold down the costs.

            Even a strict single payer has to decide at what point to not utilize the next wonder drug/procedure. Because there’s always something else to do. Some other, expensive, drug to try.

            I wish I had good answers.

          • The idea of paying out of pocket only to lower medical costs would have very limited applicability. Nobody covers unneeded cosmetic surgery strictly for vanity so it may apply there, but you simply can’t shop for medical care on the way to the emergency room. It’s also hard to shop for automotive repair when being towed to the dealership, yet the market for auto repair is competitive. You can imagine, though, trying to individually negotiate the best price on cancer drugs or some highly complex stem cell treatment. How about brain surgery. Consumer shopping just doesn’t apply to medicine.

            I would also say that technology helped bring down the cost of lasik surgery like it’s done for so many other things. The best drivers of lowering health care costs (besides technology) is getting the for-profit private insurance middleman out of the picture and have national governments negotiate with pharma companies for a country’s drug needs. The latter happens.

            You also have to remember that if you’re going cash on the barrel as a health care system, what happens when you don’t have the cash? Universal healthcare based on need and not based on ability to pay is something that you either believe in or you don’t. If you don’t, I can’t talk you into it.

          • As I understand it, there have been no great technological breakthroughs in lasik surgery. There are improvements but the basic idea is the same.

            Health Care based on need is a very nice sounding idea. Like most nice ideas there’s a kicker. Who determines need?
            How is need matched against finite resources?
            How much need warrants how much expenditure, given that expenditure is both limitless on an individual basis and limited in the totality.

            You’ve got a great idea shining on a hill. I want to know how it works out in the mud and blood of practical application.

          • Are you kidding me? There haven’t been major improvements in laser surgery for eyes and for other surgeries over the last twenty years? In laser?

            Today, patients can opt for leading edge laser cataract surgery with the so-called femtosecond laser which allows the eye surgeon to perform steps that were previously done by hand, greatly reducing cost. Patients find there is less invasiveness, less cost, higher precision, and improved outcomes. As well, now you have dropless eye laser surgery which eliminates the need for really expensive eye drops that were constantly needed before.

            Everybody has a different idea on how to give universal health care to ALL of their citizens (except the U.S.). There are a number of hybrid systems out there. If we’re just talking single payer, you could look to Canada, Great Britain, New Zealand, Norway, Denmark and Sweden for good mud and blood examples.

          • You’re making my point for me.

            Assuming these lasik improvements are major breakthroughs why are they bringing down the cost with more expensive equipment? Why do Big PHARMA major breakthroughs send the price through the roof?

            Covered by insurance.

            You push the idea of single payer. Okay. How do we get there from here?

          • Lasik was brought down in cost for the same reasons that a 50″ 4K UHD screen TV is less expensive today than a top of the line TV in the 60’s.

            As to pharmaceuticals, companies buy up the rights to old inexpensive generic drugs, lock out competitors and raise prices. For instance, albendazole, a drug for certain kinds of parasitic infection, was approved in 1996. As recently as 2010, its average wholesale cost was $5.92 per day. By 2013, it had risen to $119.58.

            Novartis, the company that makes the leukemia drug Gleevec, keeps raising the drug’s price even though the drug has already delivered billions in profit to the company. In 2001 Novartis charged $4,540, in 2014 dollars, for a month of treatment; now it charges $8,488. In its pricing, Novartis is just keeping up with other companies as they charge ever increasing prices for their drugs. They know the U.S. can’t say no. Medicare isn’t even allowed to negotiate prices by law.

            But what if the U.S. didn’t require insurance companies to cover all drugs in order to beat the Republican phony claims of death panels in regards to any universal health care scheme? We can see the answer in Europe. Many European countries say no to a handful of drugs each year, usually those that are both pretty ineffective and highly costly. Because they can say no, yes is not a guarantee. So companies have to offer their drugs at prices that make them attractive to these health care systems. A recent survey of cancer drug policies revealed you don’t have to say no very often to get discounts for saying yes. Of the 29 major cancer drugs included in the study that are available in the United States, an estimated 97 percent and 86 percent are also available in Germany and France, respectively.

            As a consequence of the stand taken by those countries, prices in Europe for prescription drugs are 50 percent below what American consumers pay, according to a McKinsey study from 2008. Gleevec costs $4,500 per month in Germany today, and $3,300 per month in France, less than what Americans paid in 2001. At the height of the recent Epipen price scandal where the price went from $100.00 to over $600.00 in the U.S., the price remained at $100.00 in Canada. Canadian drug prices are also much lower.

            Saying no, or even the threat, works to lower prices in the United States too but that happens rarely.

            There are two options. Insurers and government programs can be freed from the requirement to include all expensive drugs in their plans as it’s explained to the public that some drugs are not effective enough to justify their price. There are generic alternatives. If this is done, you can be confident that manufacturers will lower their prices to ensure their ability to sell their products. Or the U.S. can piggyback on the philosophy of bolder countries, and demand that policy makers set drug prices in the United States equal to those of Western Europe, Canada, New Zealand, Australia and elsewhere. Either approach would be superior to the situation today.

            As to one of the different forms of universal healthcare, you’d have to have the Dems in control of all three branches at the very least, with a filibuster proof Senate. Then the right type of Dem might also have to be in the White House. I’m not sure about the one who’s going in. Corporate money has also bought off some Democrats. Then there’s the constitution to think about. The ACA mandated Medicaid expansion was ruled unconstitutional with 100% of funding provided federally for a number of years, and 90% thereafter. Maybe a different type of system is needed other than single payer, or maybe if it was all administered from Washington that might make a difference. I’m no constitutional expert. Maybe it can’t be done at all if one of the two parties won’t participate (guess which one).

          • “Lasik was brought down in cost for the same reasons that a 50″ 4K UHD
            screen TV is less expensive today than a top of the line TV in the 60’s”

            Exactly right. You pay for both. There is no one that will pay for your HDTV if you really need one. No one insures that Samsung gets whatever they want to charge for their HDTV.

            Those items that you do not pay for, you see the price rising. Like the drugs, US Government, Private Insurers, doesn’t matter. Providers will continue to up the price until those paying say no. Without the individual having a financial state, they’re not going to be the one’s to say no. When the insurance carriers do say no, they are bombarded with news stories showing the heartlessness of it all. For Democrats you’ve got the willing RWMO ready to show every possible story on that one. Setting drug prices has its own political cost.

            To my mind, unless we align the costs and the benefits, they system will never be able to function.

            But any meaningful fix will have its own consequences and costs.

          • I know what you’re trying to get at but shouldn’t it be national governments and their agencies doing the pharmaceutical price negotiations for their health care systems, because demand for life saving medication isn’t elastic. The consumer has no option. American consumers have little recourse against sky high drug prices. You’ll go bankrupt if you have to, when it’s not covered by insurance, and insurers are less likely to cover the drug if they can’t negotiate a better price . Do you think you should have to go bankrupt — or remain ill, or die? This isn’t a TV.

            According to the International Federation of Health Plans, Americans pay anywhere from two to six times more than the rest of the world for brand name prescription drugs. Specialty and cancer drugs tend to be the most expensive, but the high American prices can be found in commonly used meds as well.

            Pharmaceutical companies charge high prices in the U.S. simply because they can. There is no rational system in America for managing prices of drugs.

            In other countries the health system is simpler; there aren’t as many organizations trying to buy drugs, so those groups can exert greater purchasing power and that will lower prices. The United Kingdom’s National Health Service, for example, purchases drugs for the entire country’s supply, known as a formulary. However, in the United States, there are individual insurance groups, hospitals and plans that buy for their individual consumers. Plans and groups negotiate their own prices with the pharmaceuticals, resulting in an unregulated variety of pricing.

            In other countries the drug companies have far fewer options with who they’re negotiating with. Because there are limited buyers in other countries, the pharmaceutical sellers have to be more sensitive to how much their customers are willing to pay, particularly when there is often only one customer. That sale negotiation will either make or break whether they can be in that market. It either gets on the drug formulary or it doesn’t.

            Pharma companies are just taking advantage of fragmented purchasing in the U.S.

            No one is talking about governments getting involved in the free market for common consumer products, but we can at least take care of our sick, disabled, and elderly can’t we? Again, you either believe in that or you don’t.

          • “we can at least take care of our sick, disabled, and elderly can’t we?”

            You seem really hung up on that phrase. Problem is that it’s a fuzz word. it’s not the care that’s at issue; it’s the path to achieve that care.

            You raised the issue of the TV. Dumping on me for agreeing with you seems rather unfair.

            Right now, the problem is that insurance does not provide any dis-incentive to the individual to utilize the services.
            Insurance companies have a major incentive to deny or reduce claims.
            Innovation and technology are creating ever more expensive methods of treatment.
            Doctors are buried in expenses and debt.

            Everyone has conflicting interests and rewards. Unless and until you straighten that up, you’re going to be building systems that must collapse.

          • Odd, since that’s the first time I used that phrase in this discussion. Taking care of the sick, disabled and elderly is a pretty important concept, but I don’t know where you are on it frankly. It’s not just fuzz. It IS the care, but there are different ways to get there, agreed.

            It’s tough to just graph one country’s health care system onto another because of societal differences. The way things are structured make it difficult. For example, the French system ranks at or near the top of international rankings consistently and it’s not single payer. It takes care of doctors being “buried in expenses and debt” by making medical education free and eliminating the need for malpractice insurance. The latter is done through the Scandinavian approach of national review boards that act outside of the court system like worker compensation boards, and a national fund that pays out malpractice compensation. It’s hard to see either happening in the U.S., but it could.

            The French health care system costs France 11.2 percent of GDP, compared with 16 percent in the United States, based on 2008 OECD data. In dollars per capita, the gap is even more dramatic. By that measure, the United States spends exactly twice as much on health care as France, with less to show for it.

            There is reason to think that some of the cost-saving features of the French system could be incorporated in US reforms. Lower costs of administering the medical payment system are one example. France does not have a true single-payer system. Not-for-profit insurance funds closely supervised by the government pay most of the cost of care, but people also carry supplementary insurance, similar to Medigap plans, that cover small deductibles and co-pays. There are exemptions for lower income people on that. The health care systems in France, Germany and Switzerland limit the cost-sharing requirements imposed on citizens using care. Cost sharing at the point of service is required in each of these countries, but a number of different policies greatly limit it’s impact on people and families with significant health care needs. Despite the involvement of multiple insurers, the French system spends less than half as much on administration and marketing than the 7% of health care costs reported for the United States. French doctors don’t have the paperwork burden that U.S. doctors do due to a much simpler system for health care payments

            Another area where the French save costs is through more aggressive government bargaining with hospitals, doctors, and pharmaceutical companies. The U.S. government has done much less in this area. For example, under Medicare Part D the government is explicitly prohibited from bargaining for lower drug costs as I’ve mentioned.

            In short, there are a plethora of ways that different universal health care systems abroad use to control costs without having for-profit insurance companies just flat out deny treatment, or limit treatment to something grossly inadequate. That’s not the answer, and those health care systems abroad are not collapsing.

            Healthy people don’t sit in doctor’s offices every day just because they could, and there should not be a major incentive to deny or reduce claims. There’s a better way.

            The French experience, and plenty of others, shows that Americans are not getting their money’s worth. It shows that the possibility of high quality combined with universal coverage is a reality, not a utopia. It can even be achieved without sacrificing freedom of choice either for doctors or for patients. In fact, choices of doctors and treatments are less restricted by public health care systems than by private insurance companies in the United States. They have their own network of doctors and hospitals that you’re restricted to, and private insurance companies dictate to doctors what they can and can’t do, if they want to get paid.

            The politics of cost control in America are pretty daunting. During the debate over the 2009 US health care reforms a broad variety of cost-cutting proposals were raised if you remember, ranging from streamlining the administrative costs of payments and record keeping, to malpractice reform, to striking harder bargains with drug companies. One by one they were rejected or watered down to the point of tokenism. There is a reason that happens. Every dollar of national health care costs represents a dollar of income for someone. Insurers, drug companies, hospitals, medical associations, and other health care providers do not hesitate to deploy the full arsenal of political contributions and lobbyists to defend their interests. I don’t know what the answer is. I don’t know how a country allows private moneyed interests to control government like that. How did it ever get like that?

  3. Under current law, States can seek permission from the federal government to set up their own “public option” plans by getting waivers from the the Obama administration. These waivers would surely be granted and granted quickly.

    If the “public option” is so desirable, where are all the waiver requests?

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