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There are leaps of logic in that lambert post that fall short but this is the most jarring: "$350 billion a year is a lot of money to leave on the table, especially to prop up the business model of denying health care for profit."

I don't understand a line of reasoning that includes the idea that the insurance industry needs to be "propped up." "Propped up" isn't the same thing as being left in place with strong regulations to deal with and a competitor that will be cheaper, more efficient and available to everyone. If the PHIP option further entrenched the insurance industry, I'd see their point. In fact, I'm afraid that without enough support from the ground, we will end up with reform that looks like Medicare Advantage and Part D. But to suggest that a strong PHIP option (still in reach, by the way) would do that is unfathomable to me.

"propped up" - Polls and studies have shown quite clearly that, given a reasonable option, especially universal single payer, almost everyone would opt out of the system of private insurance altogether. lambert did jump over it but that's the fear, that's what the numbers show, and that's why NOT doing single-payer is in essence propping up an industry that would fall of its own weight if it wasn't a de facto monopoly.

The other problem is the effect of leaving the for-profits in place to game the system and make sure they rip off the lion's share. That's what happened in Mass and that oh-so-promising alternative is in dire trouble as a result.

Mass doesn't have a public health insurance plan option.

Polls and studies have shown quite clearly that, given a reasonable option, especially universal single payer, almost everyone would opt out of the system of private insurance altogether.

The polls I've seen and my personal experience tell me the opposite. Most people don't want to lose what they have - of course, most people are healthy and don't know that they don't have much.

Mass doesn't have a public health insurance plan option.

Um, yes it does. Or did. I was enrolled in it for a year. Low-income were eligible; you could go with a public plan they'd pay all of or keep your private plan (assuming you had one) and be slightly subsidized. There was also a plan for subsidizing (essentially) corporate health plans by filling in holes (which all the employer plans had - big ones) and/or by having the state pay part of an employer's contribution.

But not everyone could opt out of their private plan. Income levels above a certain point weren't eligible for a public option, I believe. It was intended less as competition than a healthcare safety net for those who were uninsured or way underinsured.

The intent of Obama's plan is different but its structure - or what we can guess about its structure by reading between the lines - seems eerily familiar to me and I see the same holes in the fabric that I saw in Mass: the insurance companies managed to get themselves a set-up that allowed them to cherrypick the best customers, let the expensive ones go on the state, and then game the system by continuing to refuse payment of claims for suspiciously dingy and technical reasons.

The best reason in the world to kill any sort of public-private plan is the way the insurance companies continue to lie, cheat, steal, crib, and deny legitimate treatments & claims. They have no sense of proportion any more and no sense of when they've gone too far. As long as they're involved, they will be focused on destroying any system they can't dominate, period. We need them OUT.

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