From the WSJ:

Liberals are making a bid to restore the "public option," ObamaCare's most controversial and destructive inspiration. Some 18 Senators as we went to pressled by Colorado's Michael Bennet and growing to include New York's Chuck Schumer on Thursdayhave endorsed slipping this government-run insurance entitlement in the reconciliation process that would let Democrats abuse Senate rules to hustle ObamaCare into law with 50 votes. Vehemence among House progressives is also at a fever pitch, though it always is.

What, specifically, is wrong with a "public option?"

The Journal does us the favor of admitting the problem:

Rational Democrats killed the public option because it is hated by the insurers that will be driven out of business by its subsidy advantage, by the doctors and hospitals that will be forced to accept its below-market rates, and by the taxpayers who will get stuck with the bill.

Ah.

So you mean Medicare and Medicaid currently bill at below-market rates, and by doing so constitute a cost-shifting subsidy that is then forced upon both privately insured people and those with no insurance (but who do have money), who get to at gunpoint pick up the bill for those who are on these government programs?

So given this fact, where, may I ask, are the Republican "free market" calls for ending this practice?  For making it unlawful to bill two different people differing amounts for the same procedure, drug, or device, with the difference in cost predicated only on who pays the bill?

I thought Republicans were "free market" people?  That they believed in a fair, free, competitive marketplace?

How can you have such a thing when you have a bunch of government thugs that force private parties to pick up the cost of subsidized care not through generalized taxes, which are quite visible and against which the people can vote, but instead by co-opting so-called "private insurers" who then take the heat for policies that are forced down their throats by these very same government goons?

There are only two solutions to this health care mess:

1. The plan I put forward previously, or something darn similar to it.  Barring differential billing predicated only on who's cutting the checks, forcing all "insurance" companies to accept anyone who wishes to buy into their plan under the same terms as they offer to anyone else, barring as a matter of federal law cost-shifting for those who show up without insurance and real tort reform.  Do those four things, plus drop all protections against "reimportation" (in other words, if you buy it, it's yours, and you may sell it to anyone you wish) and a huge change in the health care cost picture would instantaneously occur.
   
   
2. A true single-payer system.  Vastly inferior to the above, because such a system rations by definition, and provides little or no incentive for people to manage their own costs and health.  This is, in essence, the destruction of the capitalist free-market health system.

But we haven't had a capitalist, free-market health system in this country since the 1960s and early 70s.  The day when you last wrote a check directly to your doctor for care as a routine part of your visit was when it died.

The day when you have a "prescription drug card" and paid $5, $10 or $20 for your drug, no matter whether it cost $25 or $250 if bought in cash, was the day it died.

The day when you got charged through cost-shifting of Granny's care to you, her drug cost to you, and the illegal alien who shot himself in the foot with a nail gun - is the day our capitalist health system died.

We cannot recover our capitalist health system without addressing these points.  The four-point plan, along with federal legal strictures against anyone trying to bar someone's "first sale" rights, will restore our capitalist health system.

If we can't do that, and I suspect we cannot because we refuse to hold politicians to account for being bribed wholesale while we all demand something for nothing, then the only rational alternative remaining available to us is to ditch the current financial rape room party run by the "medical establishment" and expose the entire mess as a line item on the federal budget, so at least we know exactly how badly we're all being bent over the table each and every year.

That has the potential to lead to people being voted out of office somewhere down the road.

I don't like where Obama's proposals are going in this regard, but if there is to be a move toward forced "insurance" for everyone then there must be the choice for individuals to buy into a public option where the prices are known and so are the standards.

Without this we will continue to be serially violated by the health insurance and care companies, who have ramped up prices by a double-digit percentage - doubling them on average every five years - while claimed "inflation" has been in the low single-digit percentages.

Those are the only two choices folks, and if I can't get a capitalist system then I want and will support a Canadian one, with all its faults.

Back on July 7th I wrote a piece on Health Care Reform and laid forth some general principles.

I have since done some more synthesis on this and have a more-fully-fleshed out, and yet simpler, set of proposals to solve the problem.  With no further ado, here they are:

If you sell "insurance" to anyone in a given state, you must accept all persons in that state on the same terms and at the same price.  If an insurer has a "we accept anyone at the same price" policy for a business, you must be able to buy into their plan for the same amount of money that the employer is charged on a per-person basis.  That is, all plans must be "open enrollment" for everyone within the state - period.  This immediately gets rid of the "tie" between employment and health "insurance", and it also removes one of the biggest issues that small business and self-employed people face - the inability to buy insurance at any reasonable price if there has ever been anything wrong with them medically.  The solution to the "adverse selection" problem is identical to that which exists in corporations - you typically can only elect out or in of a policy or plan on an annual basis - that is, you're obligated to participate for a full calendar year.  Enforcing the same terms (you can only opt in during one month, and are obligated for the entire year) solves the problem of someone deciding to buy only when they get ill, as you would have to wait for the enrollment window to open.  For acute conditions where adverse selection becomes most important this restriction resolves the problem.

All "insurance" companies must offer a true insurance policy covering only unlikely-but-catastrophic events on the same terms as their "full service" policies.  These were formerly called "major medical" or "hospitalization" policies, and have become very difficult to find.  They're relatively inexpensive as they do not cover routine doctor's visits or medications, but do cover catastrophes (e.g. a heart attack, cancer, stroke, etc.)  We must provide consumers with a reasonable-cost alternative to HMO/PPO coverage, and this is it.  If a company wants to sell "full-featured" policies that are unaffordable to a huge percentage of the population, we must mandate that they also offer affordable catastrophic coverage for those who prefer it (or can't afford anything else!)

All health providers must publish a price list and may not bill or accept payment at anything other than that price; doing so becomes a violation of Robinson-Patman and exposes the provider to civil suit for treble damages.  This instantly stops the practice of billing the uninsured or privately insured at a higher price than Medicare, for example - a practice that is rampant, particularly among hospitals.  Every hospital has a detailed price list for every function and thing in their health care panoply - this enforces even billing and even pricing for everyone, without discrimination.  The complaint that health providers cannot make a living at Medicare's reimbursement rates does not give that provider license to cost shift the expense of government-subsidized care to privately-insured or uninsured patients.  That sort of discrimination is outrageous and must be made unlawful.  Everyone would raise hell if your car was three times as expensive if you worked for Ford than if you worked for GM, yet it is accepted that if you're not insured by Kaiser (for example) your heart bypass surgery costs a different amount.  If Medicare's "price schedule" is inadequate the solution is for providers to refuse to provide the service at that price, not cost-shift the care of older Americans onto younger.  This is a more than $200 billion dollar a year rip-off of working-age Americans and it must end.

No event caused by the provision of your treatment may be billed to you.  Period.  Specifically, MRSA infections and similar contracted in a hospital cannot result in billing of that treatment to the consumer.  If you call someone to fix your roof and they break a picture window, they have to eat it - they can't bill you for the roof and the window which they broke!  The best incentive for better-quality care, particularly when it comes to controlling in-hospital cross-infection rates, is to make it ruinously expensive for hospitals to fail to prevent these adverse events.  Prohibiting by federal law the billing of any amount for a condition caused by the provider of health care (or a health facility) puts in place a very strong free-market disincentive for lax infection and process control. 

If you show up without insurance or ability to pay with a life-threatening condition, you will be treated, but the hospital cannot cost-shift the bill - it instead bills The Federal Government.  We have created an expectation that if you show up needing emergency treatment you will get it, irrespective of ability to pay.  This creates a monstrous problem for hospitals and results in the $30 aspirin, among other outrageous distortions.  The solution is to have The Federal Government receive all uninsured and unpaid bills, with the debt being immediately paid by the government.  Said debt then becomes a collection item against the citizen - a debt to the Treasury, administered by the Internal Revenue Service.  If you cannot pay cash, that's fine - the IRS will be happy to take payments (at interest.)  If you're an illegal alien the Federal Government will be mandated (by statute) to collect from the other nation, and if they refuse to pay, to deduct any such amount from foreign aid of any type and source on a dollar-for-dollar basis.

Five points and a fully free-market solution that brings affordable health care coverage to all who can buy it, yet protects those who cannot, while, to the greatest possible extent, forces everyone to bear the cost of their own decisions.

If you choose not to be insured and pay cash you are free to make that choice.  If you have a catastrophic illness or injury, insist on treatment but have no means to pay then you are subject to attachment of wages and assets by the IRS, a debt that is only discharged by your death.

Simple, fair, free-market and this path will dramatically control costs as free market competition will be forced to the forefront among health providers who will be compelled to make available their pricing schedules to everyone before they show up for treatment and are presented the bill.

Health care "reform" is the current hot-button, with the Obama administration now talking about a "public" health-insurance system to "keep the system honest."

Uh huh.

Look folks, you want to know why we have the health cost problems we have?  I'll lay it out for you - in a way you can't refute or argue with:

1. There are no published prices.  In no other line of work is it legal to do this.  Nowhere.  You can't sell someone a hot dog and tell them after they eat it what it just cost them.  You can't hire a lawyer and have him tell you "I'll tell you what this will cost when we're done."  You can't hire an electrician and have him tell you "I'll make up a bill when I'm done."  In every line of work except health care, this is illegal.  There are even laws for "major" consumer work (e.g. contracting, auto repair, etc) where they must give you a binding written estimate before beginning work! 
2. Robinson-Patman makes it illegal to discriminate against like kind purchasers of goods in pricing decisions when the effect of doing so is to lessen competition.  While it does not apply to services, it darn well should.  Whether you are paying privately, you have private insurance or you're a Medicare patient if you need to have a breast reconstructed due to cancer the complexity of the procedure does not change.  Yet it is a fact that the privately-billed amounts for uninsured ("rack rate") patients are often ten times or more that billed to insurers or Medicare.  Try charging a cash purchaser 10x more for a TV than someone who finances that TV on your in-house credit facility and you would be shut down and thrown in jail.

#1 and #2 exist because of explicit efforts by the "health care" industry to exempt themselves from the laws that every other merchant of every other good and service in the United States must adhere to.

To put this bluntly the medical industry has intentionally put forward a system by which it can screw you with impunity, obtaining exemptions from the laws that cover every other area of commerce, thereby effectively forcing you to buy overpriced services you do not want to purchase lest an unexpected life event literally wipe you out.

This is an extortion racket and absolutely none of the proposals being put forward have done a thing to address any of it.

If we want to fix the health care pricing problem we can do so.  It isn't very difficult.  Here's the prescription:

1. All health care providers must publish a price list for the procedures and services they offer and the patient must be presented, when possible, with that information before services are performed or goods (e.g. medication) supplied, consenting to the charge in each case.  All normal anti-trust provisions with regards to collusion between providers apply.  If a physician doesn't like "flat-rate" billing they're free to publish a per-hour fee much like an attorney.
2. No physician or group may discriminate based on the form of any external payment.  If they want to internally finance procedure(s), that's fine - they can charge interest or discount for that, or whatever.  But for anyone who pays via any other means (including the government) money is money - the price may not change based on the source of payment.
3. No event caused by your presence in a medical facility or the actions of an employee there can come with cost to you.  It is absolutely common for people to be billed for treatment of MRSA infections acquired in the hospital!  That is equivalent to a mechanic that through incompetence or even malice cuts a wiring harness in your car while it is on the rack having the oil changed and then tries to charge you to fix what he broke!

Now clearly #1 doesn't work so well when you're unconscious due to a heart attack or just wrecking your car.  But setting your broken leg or performing a cardiac procedure is something that's done for people who aren't incapacitated too, so guess what - the price is already published and thus the charge known.

This prevents the common practice of hospitals gouging private payers, it exposes prices and brings competition to pricing, and allows the free market to work.  It ends the preference for "insurance" on routine procedures.

Next up, if you want to sell "insurance" in a market you must sell it to all persons in that market, defined as an area of at least one US State.  You may discriminate in your pricing only based on age and gender - nothing else.  If you sell that "insurance" product to any person you must sell to all persons within that state at the same price, and you must publish all your plans and offering prices.

"Insurance" products that are not true insurance products may not discriminate on reimbursement dependent on where the service is performed.  The practice of requiring "in network" doctors or even hospitals lest you get "rejected" must end.  In addition pre-qualification for any bona-fide non-elective procedure must be absolutely barred as a matter of law.

Finally, all providers of "insurance" must sell a true insurance product.  Common HMO/PPO plans are not insurance - they are pre-paid medical care.  Insurance is the purchase of a contract to cover damage caused by an unexpected event.  Everyone needs health care of some form.  Those who want to sell "pre-paid health plans" may do so, but they must also offer true insurance (e.g. covering ONLY hospitalization and related events, etc.)

These changes instantly destroy the connection between health "insurance" and employment.  If you leave your job you have the absolute right to keep your health plan by continuing to pay for it.  If you don't like your health plan or move out of the state you can buy any plan offered to anyone in your state, at your choice, for the same price they pay.

All mandates to provide specific services and products under "insurance" are federally preempted.  Women should be able to choose a health plan that does not include abortion (and/or pre-natal!) services, for example, if they would never use either.  Some women (e.g. those who have chosen to have a tubal ligation!) can't use these services, yet they often wind up paying for them in their premiums.  Men should be able to choose a plan that does not cover things like Viagra - or, if they choose, perhaps they do want "ED" coverage.

If the health lobby won't cut out the nonsense and work for this sort of change to the system then I am forced to advocate for full nationalization of the entire health system, effectively placing everyone under Medicare.  This will lead to forced rationing due to cost but that's happening already, and such a forced system will put a stop to the discriminatory practices of insurers, physicians, hospitals and others in the medical field who commonly bill private parties ten times what health "insurance" plans or Medicare pay for the very same procedure, while playing "let's deny coverage any time we think we can get away with it."

It is my opinion that we should be treating those in the health-insurance lobby, including hospitals, physicians and health-insurance providers, as co-conspirators in a racketeering scheme that effectively trades on the fear of disease and imminent bankruptcy to bamboozle and screw the population, while waving around their "hippocratic oath" - something better described as the "hypocritic oath."