Health Care Reform: How Do Employers React to A Pay-or-Play Mandate?

Early Evidence from San Francisco Is Positive

In 2006 San Francisco adopted major health reform, becoming the first city to implement a pay-or-play employer health spending mandate. It also created Healthy San Francisco, a “public option” to promote affordable universal access to care. Using the 2008 Bay Area Employer Health Benefits Survey, we find that most employers (75%) had to increase health spending to comply with the law, yet most (64%) are supportive of the law. There is substantial employer demand for the public option, with 21% of firms using Healthy San Francisco for at least some employees, yet there is little evidence of firms dropping existing insurance offerings in the first year after implementation. -- How Do Employers React to A Pay-or-Play Mandate? Early Evidence from San Francisco by Carrie Hoverman Colla, William H. Dow, Arindrajit Dube (NBER Working Paper No. 16179 July 2010).

This paper can be purchased on-line in pdf format for $5 for electronic delivery from SSRN.com.

Health Care Reform: What's the difference between "the public option" and Medicare for All?

The opponents of reform have sown considerable confusion about the differences between single-payer health care -- Medicare for All -- and the various health care reform alternatives, including the so-called public option, being debated in the House and Senate. Here are some more resources to help clarify the difference:
Report Card for Single-Payer and “Public Option” (pdf)
More of the Same Is Not Health Care Reform, It’s a Placebo by Leonard Rodberg, PhD
Hold out for single payer by Nick Skala
Bait and switch: How the “public option” was sold by Kip Sullivan
The “Public Plan Option”: Myths and Facts
Health Policy Q & A with PNHP Co-founders Drs. David Himmelstein and Steffie Woolhandler (pdf)
Tell them why they’re wrong when they say single-payer is not politically viable! (pdf)
Dr. Len Rodberg, of Physicians for a National Health Program, made a great presentation on single-payer and the public option at a teach-in in New York City. Download Len Rodberg’s slide show (ppt)

And here's a rap kicker.
It's not over 'til it's over. Contact your representatives and let them know you want Medicare for All.

Sonameme further reading about the public option:
Trigger Happy (Time 2009-11-18)
One-Two Punch: Unemployed and Uninsured (Families USA 2009-10)
The House Public Plan: Yes, It's Worth It (The New Republic 2009-11-05)
Trigger Unhappy: What Experience Can Teach Us About Why We Should Not Delay the Implementation of Public Plan Choice by Timothy Stoltzfus Jost (Washington and Lee University)
Trigger Unhappy (The New Republic 2009-11-22)

Health Care Insurance Reform: 30 senators sign letter backing public option

"In the past, it's been House Democrats who've been most vocal in supporting the public option. Now, Senate Democrats are getting on the bandwagon.

"30 Democratic senators (really, 29 Democrats and one independent who caucuses with them, Vermont's Bernie Sanders) joined together on Thursday to send a letter to Senate Majority Leader Harry Reid in which they ask him 'for your leadership on ensuring that the merged health reform bill contains a public insurance option.'"

The rest of the story: 30 senators sign letter backing public option (Salon 2009-19-08)

Health Care: Other Options

Universal coverage, private competition and reduced deficits

"Re-read that headline. I am not making this up. A health care bill exists that would accomplish what the headline says.

"Moreover, it has been verified by the Congressional Budget Office (CBO), in a letter signed in May 2008 by the office's then-Director Peter R. Orszag, who now directs President Obama's Office of Management and Budget.

"It's called the Healthy Americans Act (the HAA). It has been fully vetted for years, written in legislative language, scored by the CBO and has substantial bipartisan support. [Here are] the two basic, simple concepts of the HAA:

"Universal coverage, attracting liberal support — i.e., all Americans are required to purchase health insurance just like auto drivers are required to purchase car insurance.

"More consumer choice and private-market competition, attracting conservative support — permitting everyone to purchase their own insurance policies in open, competitive 'state exchange' marketplaces, each of which must include the Blue Cross/Blue Shield 'Basic' policy, the lowest-tier option available to all federal employees and members of Congress or its functional equivalent."

The rest of the story: Universal coverage, private competition and reduced deficits by Lanny Davis Universal coverage, private competition and reduced deficits (The Hill 2009-10-05)

Clip File: Last Chance for the Public Option?

Reports of its demise could be premature.

Writing in The American Prospect, Paul Waldman suggests that when push comes to shove conservative Democrats may prefer to side with a Democratic president than with the political opportunists who are trying to bring him down.

If it could turn back the clock, the Obama administration would probably go back to late November and undertake an elaborate war game on health-care reform. It would lock its smartest people away in a secure location for a week or so and have them play out every conceivable scenario and subplot, detailing plans for all eventualities. Then, when the time came, it would be prepared for anything.

Administration officials don't appear to have done that. But if nothing else, they should have been able to predict that the public option -- a Medicare-like program from which Americans could chose to get their health insurance -- would eventually become the ideological flashpoint of the entire debate. You didn't have to be a genius to see that coming.

Though it took a while, the public option is now at the center of the discussion. Among other things, this means that progressives are finally getting to participate, beyond defending the administration against the ridiculous claims of critics. People who don't like the public option are hurrying to declare it dead, but it may yet have a chance.

I think the mistake was more profound than a bad sales job on the public option. The public option is a flawed idea, made worse by being difficult to explain. The decision to open with the public option also had the effect of skewing the debate to the right. "Medicare for All" would have been easy to understand and much harder to oppose. The public option is all we have. If Waldman is right, we have one more chance to get it passed.

The rest of the story: Last Chance for the Public Option? by Paul Waldman (The American Prospect 2009-08-25)

Insurance Reform: Save The Insurance Companies!

In the fight over health care insurance reform, the underlying conservatism of many so-called liberal Democrats is being exposed. Sen. John Kerry is the latest, demonstrated by his proposal to delay the creation of a public option for 10 years by including in the legislation a "trigger" that would activate competition only if the insurance companies fail to control costs by 2020. The insurance industry had more than half a century to show that it can operate equitably and efficiently. It didn't. It hasn't. It can't. It won't.

Insurance companies like the public option because it will give them a government-supported refuse heap on which to dump people with expensive health problems while the companies haul off premiums paid by healthy folks. It's good business practice to cherry pick government contracts for goods and services that are cheap to provide while burdening the public with tough, costly problems. It's done all the time, in areas as diverse as security, transportation, education, utilities and prisons -- wherever public officials are too corrupt, stupid or craven to protect the public interest.

The plan providing for a publicly funded insurance option being advanced by the administration and supported by most senate leaders (even Arlen Specter wants a public option provision) already represents a retreat from progressive policy. Universal public insurance -- the so-called single-payer system most familiar to us because it is the way that Canada provides for its citizens -- that removes insurance overhead and bureaucracy from the health care system is the method used in most countries, for good reason. It would be understandable that Kerry would support his president's proposal. But his effort to undermine even the public option can only be understood if you accept that the debate in the senate is not over the health of the people but the health -- the continued profits -- of the insurance industry.

Insurance companies have failed to control costs and rein in greed in the more than 60 years since FDR, in his call for an "Economic Bill of Rights," cited "the right to adequate medical care and the opportunity to achieve and enjoy good health." Senator Kerry has to know the insurance companies aren't going to change now and or in ten years or in another half century, as he agreed when he supported the immediate adoption of the public option when it was first proposed by the president. Yet now he is willing to undermine the best chance this country has had to catch up with the rest of the world in providing its citizens with universal access to health care by neutering the White House's already timid proposal.

As the wealthiest solon, John Kerry is probably beyond the reach of corruption. And, although it's possible that a privileged lifestyle has rendered him clueless about the lives of the ordinary citizens he claims to represent, there is no evidence he is stupid. Maybe he's just too craven, too pitifully afraid of being called bad names -- radical! anti-capitalist!! oh, horrors, socialist!!! -- by Rush Limbaugh and Glenn Beck to stand up for the people against the powerful, greedy and unscrupulous insurance industry.
Or maybe he's just another of the corporatist shills who sit like obedient school children in the semicircle of desks on the senate floor waiting for industry lobbyists to teach them what to do.