# Public Option Dropped; Medicare Expanded: Net Effect? **URL:** \ **Category:** Great Debates\ **Created:** [December 10, 2009, 4:03am UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691 "2009-12-10T04:03:05Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![sleeping](https://avatars.discourse-cdn.com/v4/letter/s/839c29/32.png) [@sleeping](https://boards.straightdope.com/u/sleeping)\ **Post date:** [December 10, 2009, 4:03am UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/1 "2009-12-10T04:03:05Z")
> [@](#): > > Five moderate Senate Democrats struck a tentative compromise this week with five liberal colleagues over the contentious public option, or government-run health plan for uninsured individuals and small businesses. Rather than creating a federal plan, the proposal would encourage nonprofit insurers (whose ranks include several state Blue Cross organizations) to offer coverage nationally through a federal agency. If none did, then the federal government would develop its own public option. In addition, uninsured people between the ages of 55 and 64 would be allowed to buy into Medicare. > > [Don't kill reform over the public option](http://www.latimes.com/features/health/la-ed-health10-2009dec10,0,1257862.story) Certainly, an appreciation of the political landscape would not be encouraging when a provision favored by a majority of Americans is scuttled by [well-bribed senators](http://www.washingtonpost.com/wp-dyn/content/article/2009/12/07/AR2009120703715.html?hpid=topnews). But what will be the effects in terms of outcomes? And what strategy can liberals and progressives pursue now? Given the Republicans’ recent (disingenuous) defense of Medicare, I think there might be a real foothold for a push to further expand Medicare–say, to anyone 40 years or older. And, even if it’s only 55+ for the time being, it would set the precedent for such expansions in the future. Plus, as others have long argued, a campaign for “Medicare for All” would be far harder to derail than a public option with a myriad definitions. ---
**Author:** ![Squink](https://avatars.discourse-cdn.com/v4/letter/s/b5e925/32.png) [@Squink](https://boards.straightdope.com/u/Squink)\ **Post date:** [December 10, 2009, 4:30am UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/2 "2009-12-10T04:30:42Z")
Happy happy fun fun in the conference committee when they try to reconcile the House and Senate versions? ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 10, 2009, 4:35am UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/3 "2009-12-10T04:35:19Z")
the net effect is that insurance companies get to offload the most expensive customers onto the public, and get to pad their wallets with the cheap-to-insure healthy people. privatizing the profits and socializing the losses, example number 552. ---
**Author:** ![sleeping](https://avatars.discourse-cdn.com/v4/letter/s/839c29/32.png) [@sleeping](https://boards.straightdope.com/u/sleeping)\ **Post date:** [December 10, 2009, 4:44am UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/4 "2009-12-10T04:44:08Z")
> [@Rumor\_Watkins](#): > > the net effect is that insurance companies get to offload the most expensive customers onto the public, and get to pad their wallets with the cheap-to-insure healthy people. > > privatizing the profits and socializing the losses, example number 552. True, but that’s always been a problem. The current bills prevent discrimination based on pre-existing conditions, though they permit price differentials based on age and locale. Also, some senators are working on an amendment to force insurance companies to spend more of their premium dollars on providing care, rather than denying claims: > [@](#): > > This equation is known as the medical loss ratio (MLR), an aptly named figure that is widely seen by investors as the most important gauge of an insurance company’s current and future profitability. In a private health insurance industry that collected $817 billion this year, a 14 percentage point difference in the MLR represents $112 billion a year! Over 10 years, that would be more than enough to pay for health reform. > > Thanks to the efforts of several senators who pushed for a minimum MLR to be included in reform legislation, the current Senate bill requires insurers to provide an annual rebate to each enrollee if non-claims costs exceed 20% in the group market and 25% in the individual market. > > Sen. Al Franken (D-Minn.) is now leading a group including Sens. Jay Rockefeller (D-W. Va.) and Blanche Lincoln (D-Ark.) to introduce an amendment that would go further by requiring that 90 percent of the money consumers spend on health insurance premiums go directly to health care costs. > > [http://blog.alfranken.com/2009/12/06/the-insurance-industrys-lethal-bottom-line-and-a-solution-from-sens-franken-and-rockefeller/](http://blog.alfranken.com/2009/12/06/the-insurance-industrys-lethal-bottom-line-and-a-solution-from-sens-franken-and-rockefeller/) So that should help get the insurance companies to focus on competing for best service, rather than most claim denials. ---
**Author:** ![Simplicio](https://avatars.discourse-cdn.com/v4/letter/s/c37758/32.png) [@Simplicio](https://boards.straightdope.com/u/Simplicio)\ **Post date:** [December 10, 2009, 4:55am UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/5 "2009-12-10T04:55:02Z")
I think its a good compromise. Any public option that got through was going to be neutered beyond much usefulness anyways, while expanding Medicare will help put further downwards pressure on prices, add at least some measure of competition. I think liberal dems got at least a decent trade for (more or less) tossing the Public Option, I was worried they’d be so paranoid about throwing it out that they’d end up just taking some vestigial remenant to get the conservative votes. Of course the providers are going to fight it tooth and nail, so hopefully it passes quickly before they can start lobbying against it. I don’t know anything about nationally managed non-profit plans. Perhaps someone can elaborate? ---
**Author:** ![DanBlather](https://avatars.discourse-cdn.com/v4/letter/d/f4b2a3/32.png) [@DanBlather](https://boards.straightdope.com/u/DanBlather)\ **Post date:** [December 10, 2009, 7:35am UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/6 "2009-12-10T07:35:32Z")
Great move. Most opponents of UHC are too dumb to know that Medicare is govt run ---
**Author:** ![MOIDALIZE](https://avatars.discourse-cdn.com/v4/letter/m/e274bd/32.png) [@MOIDALIZE](https://boards.straightdope.com/u/MOIDALIZE)\ **Post date:** [December 10, 2009, 7:46am UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/7 "2009-12-10T07:46:30Z")
Did the House bill include a public option? ---
**Author:** ![MOIDALIZE](https://avatars.discourse-cdn.com/v4/letter/m/e274bd/32.png) [@MOIDALIZE](https://boards.straightdope.com/u/MOIDALIZE)\ **Post date:** [December 10, 2009, 7:50am UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/8 "2009-12-10T07:50:50Z")
On a related note, I think all the talk of a filibuster-proof Democratic Senate majority was nothing but marketing, meant to induce voters into voting for Democratic candidates on the premise that they would have a free hand in enacting a unified Democrat agenda. So long as they count the Liebermans and the Baucuses as Democrats, this supposed majority will continue to be an illusion. ---
**Author:** ![Dick\_Dastardly](https://avatars.discourse-cdn.com/v4/letter/d/c4cdca/32.png) [@Dick\_Dastardly](https://boards.straightdope.com/u/Dick_Dastardly)\ **Post date:** [December 10, 2009, 5:27pm UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/9 "2009-12-10T17:27:43Z")
Nobody could have predicted this. ---
**Author:** ![Algher](https://avatars.discourse-cdn.com/v4/letter/a/3d9bf3/32.png) [@Algher](https://boards.straightdope.com/u/Algher)\ **Post date:** [December 10, 2009, 6:10pm UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/10 "2009-12-10T18:10:38Z")
Rates will go up for private insurance as more people move to Medicare. Medicare does not cover the costs of many medical procedures - Hospitals and clinics could always count on private insurance covering the rest. With more people on Medicare, the medical care people will either stop taking as many medicare patients and will also have to ask for higher reimbursements from the insurance companies. Those private practitioners in lower income areas might go ahead and retire early as well. ---
**Author:** ![Mighty\_Mouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mighty_mouse/32/7776_2.png) [@Mighty\_Mouse](https://boards.straightdope.com/u/Mighty_Mouse)\ **Post date:** [December 10, 2009, 6:23pm UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/11 "2009-12-10T18:23:39Z")
> [@Algher](#): > > Rates will go up for private insurance as more people move to Medicare. Medicare does not cover the costs of many medical procedures - Hospitals and clinics could always count on private insurance covering the rest. With more people on Medicare, the medical care people will either stop taking as many medicare patients and will also have to ask for higher reimbursements from the insurance companies. > > Those private practitioners in lower income areas might go ahead and retire early as well. These so called “costs” that are not being covered are nothing more or less than the incomes of medical workers. Some of them can and should go down. The ratio of a doctor’s income (particularly specialists) to the median income is one of the biggest drivers of variance in the cost of health care as a proportion of GDP. ---
**Author:** ![yorick73](https://avatars.discourse-cdn.com/v4/letter/y/b5a626/32.png) [@yorick73](https://boards.straightdope.com/u/yorick73)\ **Post date:** [December 10, 2009, 6:27pm UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/12 "2009-12-10T18:27:57Z")
> [@Mighty\_Mouse](#): > > These so called “costs” that are not being covered are nothing more or less than the incomes of medical workers. Some of them can and should go down. The ratio of a doctor’s income (particularly specialists) to the median income is one of the biggest drivers of variance in the cost of health care as a proportion of GDP. Are you taking into account malpractice insurance and the student loans, not to mention the many years of their lives, that these doctors (particularly specialists) have to pay out to get to their current position? ---
**Author:** ![Algher](https://avatars.discourse-cdn.com/v4/letter/a/3d9bf3/32.png) [@Algher](https://boards.straightdope.com/u/Algher)\ **Post date:** [December 10, 2009, 6:32pm UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/13 "2009-12-10T18:32:50Z")
> [@Mighty\_Mouse](#): > > These so called “costs” that are not being covered are nothing more or less than the incomes of medical workers. Some of them can and should go down. The ratio of a doctor’s income (particularly specialists) to the median income is one of the biggest drivers of variance in the cost of health care as a proportion of GDP. No, it is the cost of the physician, rent, malpractice, techs, receptionist, billing team, nurses and supplies. Every time the doctor opens the steri kit, there is a cost. Every single wooden stick, steri cover for the thermometer, clean cloth for the room has a cost. The minimum of 3 people involved in a typical 7.5 minute exam all need to be paid, need THEIR healthcare covered, their workman’s compensation, their social security and FICA taxes, their retirement fund, etc. ---
**Author:** ![Algher](https://avatars.discourse-cdn.com/v4/letter/a/3d9bf3/32.png) [@Algher](https://boards.straightdope.com/u/Algher)\ **Post date:** [December 10, 2009, 6:37pm UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/14 "2009-12-10T18:37:55Z")
Here’s a source for some data on Medicare and Medicaid underpayment (pdf): [http://www.ihatoday.org/issues/payment/charity/underpymt.pdf](http://www.ihatoday.org/issues/payment/charity/underpymt.pdf) > [@](#): > > In the aggregate, both Medicare and Medicaid payments fall below costs and the shortfall has been growing. > > - Combined underpayments rose from $3.8 billion in 2000 to nearly $32 billion in 2007. > - For Medicare, hospitals received payment of only 91 cents for every dollar spent by hospitals > caring for Medicare patients in 2007. > - For Medicaid, hospitals received payment of only 88 cents for every dollar spent by hospitals > caring for Medicaid patients in 2007. > - In 2007, 58 percent of hospitals received Medicare payments less than cost, while 67 percent of hospitals received Medicaid payments less than cost. ---
**Author:** ![Mighty\_Mouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mighty_mouse/32/7776_2.png) [@Mighty\_Mouse](https://boards.straightdope.com/u/Mighty_Mouse)\ **Post date:** [December 10, 2009, 7:14pm UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/15 "2009-12-10T19:14:25Z")
> [@Algher](#): > > Here’s a source for some data on Medicare and Medicaid underpayment (pdf): > > [http://www.ihatoday.org/issues/payment/charity/underpymt.pdf](http://www.ihatoday.org/issues/payment/charity/underpymt.pdf) And here is some on doctors incomes. > **[Greg Mankiw's Blog: Physicians' Incomes and Healthcare Costs](http://gregmankiw.blogspot.com/2009/06/physicians-incomes-and-healthcare-costs.html)** People want to avoid the real problems and talk about the financing. But the conclusion is simple and inescapeable. You need to reduce the amounts your pay (per hour, per pill, per syringe, per piece of new equipment). I have helped prepare hospital budgets. The biggest costs are: Doctors Salaries (even though they are a a surprising small proportion of the staff) Other staff costs Services (cleaning, disposal, maintenance) Equipment costs (primarily reflected as depreciation though there is quite a bit of leasing going on) and then way down we have Drugs Med/Surg Supplies Outside the hospital, in clinical practices, you have 2-3 non-doctors per doctor, but the personnel cost is still 70-80% doctors (if you count nurse practicioners with the doctors) because the disparity in salaries is so high. On the drugs side, the cost of production is a tiny fraction of the retail price. Actually so is the cost of research. Marketing and overhead are the big costs. And guess what? Most of those are income to people working for the pharmaceutical companies. If you want to attack the cost you have to face the reality of where the costs are in the first place. I can see lots of statistics showing that insurers have a 10-20% overhead (premium dollars not paid out as claims) but if the insurers did not provide the function of denying claims (!) the total costs would be higher. It is like to cost of the budget department. You can save money by eliminating the budget department, but you will end up spending ten times as much when costs get out of control everywhere else. People need to understand the position the insurance companies are in. They are paid by one group of people (primarily employers) and they pay out based on the behavior of two highly self-interested groups, patients and doctors, both of whom want more of everything and the best of everything. As a loonie leftist, I have no more love for the insurers than for the pharmaceutical companies or the hospital companies. They all behave badly when they think they can get away with it. I am 100% in favor of a single payer plan, but some strict regulation of private insurance with strong public option is fine with me. But people should understand that either this is going to mean even higher costs or lower payments to providers. Taking out some of the profit motive is going to mean fewer new drugs, fewer new procedures and less brilliant people going into medicine as a profession. I think we also need LESS qualified doctors. The process for becoming a doctor in the US is too long, too rigorous and too expensive for the doctors themselves. So they demand a huge premium in pay compared with doctors in other countries. In some way the market is already taking care of this, by making care provided by nurse practicioners and physicians assistants a bigger feature of health care delivery. ---
**Author:** ![Algher](https://avatars.discourse-cdn.com/v4/letter/a/3d9bf3/32.png) [@Algher](https://boards.straightdope.com/u/Algher)\ **Post date:** [December 10, 2009, 8:25pm UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/16 "2009-12-10T20:25:05Z")
I would like to see a cite with a percentage breakdown of costs showing the the physicians are so much. A short Googling seemed to show that all staff costs are around 1/3 of hospital revenue. Yes, some docs make a mint in income after they have finished their undergrad, grad, specialty and residency programs. A friend of mine is making close to half a million a year - then again, he is considered to be one of the finest in his field and people come from near and far to have him operate. I do not begrudge him his salary at all. ---
**Author:** ![Mighty\_Mouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mighty_mouse/32/7776_2.png) [@Mighty\_Mouse](https://boards.straightdope.com/u/Mighty_Mouse)\ **Post date:** [December 10, 2009, 8:59pm UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/17 "2009-12-10T20:59:28Z")
> [@Algher](#): > > I would like to see a cite with a percentage breakdown of costs showing the the physicians are so much. A short Googling seemed to show that all staff costs are around 1/3 of hospital revenue. > > Yes, some docs make a mint in income after they have finished their undergrad, grad, specialty and residency programs. A friend of mine is making close to half a million a year - then again, he is considered to be one of the finest in his field and people come from near and far to have him operate. I do not begrudge him his salary at all. I can’t cite anything because the two entities I have worked with are not public. Here is one (the other is within 1-3% in each category) Revenue 100% Uncollectibles 9.6% Pre Tax Income 9.5% Interest Expense 2.7% Total Operating Costs 78.2% of revenue Costs categories as a percent of Total Operating Costs Salaries and Benefits 52.0% Other Operating Expenses 21.6% Supplies 19.2% Depreciation 7.2% Other Operating Expenses includes space rent and equipment rent, but the single largest category under “Other” is “Professional Services” which is payments to physicians who are not on staff, but have “priviledges” there. Based on tax returns I have prepared for doctors, $500k is chump change for a top surgeon. I don’t think I ever saw a doctor with less than $300k, but of course those using professional tax preparers are a self selected minority with presumably higher incomes, and more non-salary income (partnerships, consulting, etc) Maybe that is what is coloring my perception of the income of doctors. I do have several doctors in my family. They have done more to damage the perception of the medical profession in my eyes than anything else. All they seem to talk about is money, at least the American ones. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [December 10, 2009, 9:58pm UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/18 "2009-12-10T21:58:27Z")
> [@yorick73](#): > > Are you taking into account malpractice insurance… I do not know about the rest but malpractice insurance is a tiny drop in the health care cost bucket. A lot of the rise in premiums to doctors resulted from insurance companies losing money on investments and not to cover malpractice payouts. Per the CBO: > [@](#): > > Evidence from the states indicates that premiums for malpractice insurance are lower when tort liability is restricted than they would be otherwise. But even large savings in premiums can have only a small direct impact on health care spending–private or governmental–because malpractice costs account for less than 2 percent of that spending.(3) Advocates or opponents cite other possible effects of limiting tort liability, such as reducing the extent to which physicians practice “defensive medicine” by conducting excessive procedures; preventing widespread problems of access to health care; or conversely, increasing medical injuries. However, evidence for those other effects is weak or inconclusive. > > SOURCE: [http://www.cbo.gov/doc.cfm?index=4968&type=0](http://www.cbo.gov/doc.cfm?index=4968&type=0) ---
**Author:** ![sleeping](https://avatars.discourse-cdn.com/v4/letter/s/839c29/32.png) [@sleeping](https://boards.straightdope.com/u/sleeping)\ **Post date:** [December 11, 2009, 2:58am UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/19 "2009-12-11T02:58:19Z")
> [@Whack-a-Mole](#): > > I do not know about the rest but malpractice insurance is a tiny drop in the health care cost bucket. A lot of the rise in premiums to doctors resulted from insurance companies losing money on investments and not to cover malpractice payouts. > > Per the CBO: In fact, it’s probably even less than 2%–more like 0.46%: > [@](#): > > [“Health Spending In The United States And The Rest Of The Industrialized World” > Anderson et al. > Health Affairs, 24, no. 4 (2005): 903-914](http://content.healthaffairs.org/cgi/content/full/24/4/903) > > **Are claim payments higher in the United States? Surprisingly, U.S. malpractice payments (including both cases that resulted in a judgment for the plaintiff and cases resulting in a settlement) were lower, on average, than those in Canada and the United Kingdom**. In 2001 the average payment in the United States was $265,103, which was higher than in Australia but 14 percent below Canada and 36 percent below the United Kingdom.22 While U.S. media and public attention have focused on multimillion-dollar awards at the upper end of the range, the average was actually smaller than in Canada and the United Kingdom in 2001. > … > **Possibly the most important and best summary measure of the magnitude of malpractice awards is total payments divided by total population. On this measure, the United States is only slightly higher than the other three countries: $16 per capita in 2001, compared with $12 in the United Kingdom, $10 in Australia, and $4 in Canada. In all four countries, however, malpractice payments represent less than 0.5 percent of health spending**. > > These figures do not include the legal costs of defending malpractice claims. Legal costs are estimated to average $27,000 per claim in the United States, which adds approximately $1.4 billion in costs to the $4.4 billion paid in settlements and judgments.23 The costs of underwriting insurance against malpractice claims are estimated at an additional 12 percent, or $700 million.24 **The cost of defending U.S. malpractice claims, including awards, legal costs, and underwriting costs, was an estimated $6.5 billion in 2001—0.46 percent of total health spending**. > … > The total cost including awards, legal costs, and underwriting costs was $237 million (PPP) in 2001—0.27 percent of total Canadian health spending. > … > Defensive medicine—tests or procedures ordered by physicians to protect against the risk of being sued—could contribute more to health spending than malpractice payments do. Several attempts have been made to quantify the amount spent on defensive medicine, but estimates vary widely. The difficulty lies in determining what services are purely “defensive”—that is, both inappropriate overuse and motivated by fear of litigation. For example, a physician might ask for a second opinion on a difficult diagnosis, mindful of the potential of litigation, but that second opinion could be considered appropriate care. Other services could be considered inappropriate overuse but were motivated by incentives other than the litigation threat, such as payment policy. These gray areas make precise estimates of the cost of defensive medicine extremely difficult. > > One estimate of this cost has come from HHS, which estimates that $70–126 billion (5–9 percent) in health spending per year would be saved if malpractice tort reform, similar to policies in California, were passed at the national level.26 But if conservatives are so concerned about the costs of malpractice insurance, let’s take them at their word and create a system in which medical personnel cannot be sued by patients. For example, among its great attributes, the VA system does not permit physicians to be sued for malpractice. So, the answer is quite simple: if physicians are government employees and healthcare is guaranteed for everyone, there is no need for malpractice lawsuits and the healthcare system can be made that much simpler and cheaper. ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 11, 2009, 3:07am UTC](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691/20 "2009-12-11T03:07:29Z")
> [@sleeping](#): > > In fact, it’s probably even less than 2%–more like 0.46%: here is the latest CBO estimate on the effects of modifying the tort regime in this country, both on reduced malpractice rates and its effect on defensive medicine: > [@](#): > > CBO now estimates, on the basis of an analysis incorporating the results of recent > research, that if a package of proposals such as those described above was enacted, it would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of the direct reduction in spending of 0.2 percent from lower medical liability premiums, as discussed earlier, and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services. (That reduction is the estimated net effect of the entire package listed earlier, although some components of that package might increase the utilization of physicians’ services, as has already been noted.) CBO’s estimate takes into account the fact that because many states have already implemented some of the changes in the package, a significant fraction of > the potential cost savings has already been realized. [CBO letter to Sen. Hatch on Oct 9, 2009](http://www.cbo.gov/ftpdocs/106xx/doc10641/10-09-Tort_Reform.pdf) [Next page](https://boards.straightdope.com/t/public-option-dropped-medicare-expanded-net-effect/520691.md?page=2)