Public Plan
Conservatives Sunny About the Public Option (No, Really!)
Published September 17, 2009 @ 09:16PM PT
Two weeks ago, I imagined a parallel health care universe. Now I seem to be living in it. The only people who are more dead-set that the insurance industry against giving Americans the choice between private insurance and a high-quality public health insurance option, modeled on the reliability of Medicare, are Republicans. So why is it that the most positive things said today about the public option were by not just run-of-the-mill conservatives, but conservative icons?!
Bill Frist was until recently the Senate Majority Leader. He was widely expected to make a 2008 run for president. Since leaving the U.S. Senate to “go back to medicine,” he’s found copious time to serve on boards with a stake in the health care industry, become co-chair (with Tom Daschle) of the bipartisan ONE ’08 campaign, and appear in a commercial for Coke with James Carville. Still, between his years leading a Republican Senate under George W. Bush and his financial interest in the health care industry continuing to be fabulously profitable, you absolutely would not expect him to have a more favorable analysis of the odds for the public option than Democrats. Yet there he is in Fierce Healthcare (an industry newsletter) proclaiming, “There will likely be a public plan as a backup, and they haven't put that out yet, but I predict at the end of the day that that will be part of the plan.” Sure, it’s the public option with a trigger, but still -- Bill Frist, people!
That was shocking enough. But then Bill O’Reilly, of all people, nearly caused me to go into cardiac arrest with this doozy of a statement: “I want that. I want, not for personally for me, but for working Americans, to have an option, that if they don’t like their health insurance, if it’s too expensive, they can’t afford it, if the government can cobble together a cheaper insurance policy that gives the same benefits, I see that as a plus for the folks.” Don’t take my word for this -- watch the video.
What... the... hell.
Now granted, O’Reilly is also convinced the public option is dead, so perhaps he feels somewhat liberated to admire it. And it's not clear if he understand the difference between the Health Exchange and a public option (he sure seems to be describing the latter). But I’ve also always thought the Republican Party doth protest too much on the public option. After all, economist Jacob Hacker’s idea was that public and private would be in dynamic tension based on competition, to the improvement of both times of insurance. Could it be that as we move to the endgame and begin to leave behind some of the name-calling rhetoric and existential opposition to reform, that we’re beginning to actually come together on the notion that private insurance isn’t the automatic answer, and its business practices can’t always be defended?
Maybe. But then again, maybe someone slipped something funky into my coffee and I hallucinated the whole thing. We’ll have to see.
The Public Option: Popular Everywhere But the U.S. Senate
Published September 14, 2009 @ 10:34PM PT
Many sound notes of exasperation that the public option continues to be the focal point of the health care fight, both on the right and the left. But at this point, their exasperation is itself becoming exasperating. At its core, we’re talking about a policy point that, despite eight months of pummeling, remains popular except in the halls of the United States Senate and the corridors of the headquarters of the insurance companies. It is the latest incarnation of the people vs. the powerful -– and I’d say folks have a right to be angry that the people seem to be losing.
Two bits of news today reinforce the unmistakable trends of continues popularity and support. Washington Post-ABC News released their latest poll, finding support for health care reform in general is split right down the middle. But giving people the choice of private insurance or the ability to voluntarily buy into a high-quality, government-administered public health insurance plan, similar to Medicare, scores better at 55%. But that’s the tip of the iceberg! When actually described correctly as being an option available only to those who don’t already have insurance, support jumps to 76%. It’s like the August of our discontent never happened.
One of the canards about the public option is that physicians won’t support it because they’ll refuse its presumably lower negotiated payment rates. But today’s New England Journal of Medicine should put the lie to that once and for all. A survey by email and phone of 2,130 physicians (well above the 800-1,000 sampling of most polls) finds tremendous support among doctors for the public option -– 63% of doctors support health reform that incorporates a choice between public and private coverage, whereas only 27% prefer reform where private insurance is the only option. Even surgeons, slightly more conservative and skeptical of reform by nature, come in at 59%.
Oh, and tomorrow the AFL-CIO is set to endorse a public option formally, after their incoming president has warned darkly about primary challenges for Democrats who vote against it.
Now I should note that popularity does not always correlate to the right policy, particularly on something as complex as health care. But let’s review. All three major Democratic nominees for president endorsed a public option two years ago. This year, so did the leadership in the House and the Senate, as did all but one committee chair with jurisdiction over health care. The last committee chair released a blueprint with a public option months ago, before changing his mind. 100 members of the House are threatening to vote against a health care bill that doesn’t contain it. The Senate Majority Leader is for it, as are the number two (Durbin) and the number three (Schumer) Democrats in the Senate. A still-popular President of the United States devotes a significant portion of his health care stump speech to it. Progressives are for it. Labor is for it. Doctors are for it. The American people are for it.
What’s on the other side? Entrenched Republican resistance that has already said jettisoning the public option isn’t enough for them to vote for the bill. And an insurance industry that’s dishing to Business Week about their ability to influence centrist senators like Baucus and Conrad and Blue Dog congressman like Ross.
It’s one thing to year in and year out lost to the lobbyists and special interests whose money and influence control the levers of power. It’s quite another to have our noses rubbed in it.
(Photo credit: The White House, via Sen. Max Baucus' web site.)
Guys, Obama Supports the Public Option (Still)
Published September 12, 2009 @ 07:19PM PT
Because so many conservatives consider giving private insurance competition in the form of a public health insurance option to be a non-starter while so many progressives proclaim any bill without a public option is a non-starter, the level of conflict couldn’t be higher. And the new gravitates to conflict stories like moth to a flame. Reporters are convinced that President Obama will drop his insistence on a public option in health care reform as part of negotiations imminently, and are watching him like a hawk so they can be the first to report on it when he does. Commentators rack up fees proclaiming the imminent demise of the public option. Yes, even on NPR and MSNBC. And yet, in every public statement -- including today -- Obama spends a lot of time defending it and saying it's part of his plan. Still.
In short, what gives?
I feel like I’m stuck in health care Groundhog Day. I’m literally having the same conversation about President Obama and the public option over and over again. I went back and checked out this post of mine from February 27, when the blogosphere was ablaze that Obama was about to drop the proposal. Suffice to say, it didn’t happen then, which is why we’re still talking about whether it's happening today.
I can’t prove, obviously, that somewhere within the sanctum sanctorum of the White House that high-ranking officials aren’t preparing a “Sorry, we tried” speech. But I do know these three points:
- Say what you want about Obama, he’s pretty up-front about when he’s going to disappoint his progressive base on make-or-break issues. In 2008, he deviated wildly from his previous statements to vote for the reauthorization of a FISA bill that allowed for warrantless wiretapping. It was a blow for liberals and civil rights. But he then proceeded to explain his reasoning in-depth in public statements and interviews, including having his foreign policy advisory team answer questions on his Web site for hours. Obama has also been up-front about what he’s giving up on health care. We knew from the minute he took office that single-payer was off the table. We knew, despite progressive hopes to the contrary, that there’d be no additional funding for abortion or undocumented workers or a roll back of the Bush Tax Cuts for health care. We knew the requirement that every American buy coverage or pay a fine, which he had campaigned against, was now likely to be part of reform. We knew because he told us.
- The dude is expending a lot of energy defending a policy that people say he’s about to drop. It's pretty easy to tell the difference between something he weakly supports and something he strongly supports. On Wednesday, has not Rep. Joe Wilson proven to be an ass clown, the main story of the day would have been Obama's seven-minute defense of the public option. Today in Minnesota, he devoted a couple of paragraphs to it, in contrast to medical malpractice (not one word) or the John McCain idea of high-risk pools for those with pre-existing conditions (not one word) [Correction: he did mention this pool for those with pre-existing conditions. I missed the reference the first time.] On his brand-new “Obama’s Health Care Plan” page on whitehouse.gov which only went up 3 days ago, he mentions it again. If he’s not seriously trying to get it, he’s wasting a huge amount of time making it look like he is.
- The fact that commentators seem to have reached a consensus is uncompelling to me. According to pundits, we should be talking right now about how well President Hillary Clinton is doing. Or we should be talking about how prudent it was or was not for President Obama to put off tackling health care for a few years to focus on the economy.
Look, getting a public option is going to be the hardest part about reform, and the sexiest fight for the news. Winning a public option still has a lot more to do with who’s in the Senate than who’s in the White House. But the surest way not to get it is to stop asking for it.
(Photo credit: Official White House Photostream on Flickr.)
A Public Health Insurance Option By Any Other Name
Published September 10, 2009 @ 09:32PM PT
In reaction to President Obama’s big speech on health care reform, Senator Chuck Grassley could only say the president “passed up a big opportunity” to eliminate the public health insurance option. Given that Obama gave a spirited defense of the public option, a proposal that polls better than reform as a whole and whose removal would spark open rebellion among the liberal lawmakers he needs to pass any plan, I would say he openly chose to do the exact opposite of said “big opportunity.” But there was one opportunity involve Obama and the public option that he clearly passed up –- the opportunity to give it a less sucky name.
This is sadly one stereotype that Democrats too often live up to. We cannot compete with Republicans in coming up with awesome names for big initiatives. No Child Left Behind. The Clean Skies Act. The USA Patriot Act. Operation Iraqui Freedom. The policies may have been deplorable, but man, those were some damn cool names. FDR's lucky that he came up with the "New Deal" early, because most of the new deal programs wound up being alphabet soup: the FDIC, the SEC, the WPA, the NLRB, the CCC. That's not even trying. What have been modern-day Democrats' best efforts this year? The American Recovery and Reinvestment Act (yawn), the Lily Ledbetter Act (an important name, but one that reads like a nursery rhyme), SCHIP, and the pieces of health care legislation that read like we threw buzzwords down on the page and rearranged them. It's like a word challenge -- come up with a name that incorporates “Choice”, “Health”, “Affordable” and “America” and you got yourself a bill. The one attempt to rebrand the effort as “Health Insurance Reform” instead of “Health Care Reform” was, frankly, no improvement at all. It went over about as well as trying to call the stimulus something else after we’ve already called it the “stimulus” for months. I understand the idea –- bring the focus on curbing the abuses of the insurance industry into sharp relief –- but it appears to have been rightly ignored by anyone not reading directly from talking points. Last night, Obama was back to saying the topic of the day was “health care.”
But nowhere is Democrats' apparent lack of concern over branding more apparent than the public health insurance option. I’ll grant you, it’s loads better than the original name of “the public plan,” which is so vague that it was easily mistaken for health care reform in general. At least it’s got “health insurance” in there, so you vaguely know what part it involves. It’s got “option” in there, which screams “no one gets forced into this.” But it’s about as uninspiring a name as “affordability tax credits.” I can’t tell you how many meetings, panel discussions, or volunteer brainstorming sessions I’ve gone to that have been sidetracked by someone trying to come up with a better name. The people in a position of power to do something about it –- Congress and the President –- just haven’t been trying. The Senate Health, Education, Labor and Pensions Committee renamed their public option (yay!), but they renamed it "the community health insurance option." How was that an improvement? Who got reassured by that, other than people who have had bad experiences with their local public library? Honestly!
It’s not that there have been a shortage of more creative names. Jacob Hacker originally came up with Public Plan Choice (Ok, that’s still lame.) Maggie Mahar came up with Medicare Part E (“for Everyone”). Chuck Schumer came up with “Plan USA.” Some bloggers on Daily Kos suggested we call it the Kennedy Health Plan. But the one thing that we know about the public option is that the more they find out about it, the more they like it. A more descriptive name won’t win over people dead-set against any government competitor whatsoever. But it sure would make the sales pitch easier for those who legitimately don’t know what it is or how it would help.
Come on, folks. Throw Axelrod and the real life equivalents of the cast of Mad Men into a room. Come up with a better name. To coin a phrase, just do it!
(Photo credit: http://www.flickr.com/photos/bbaunach/ / CC BY 2.0)
9 New Surprises in President Obama's Speech
Published September 09, 2009 @ 11:09PM PT
A week ago, before tonight’s presidential address before Congress was even confirmed, I asked if President Obama had anything new to say about health care reform. I asked it even knowing that in many ways, it was the wrong question. The reality was he didn’t need to say anything new -- all it needed to be was new for most of the country. All he needed to do was say it better.
Not that the content of the speech being mostly rehash is at all a bad thing. If you read this blog regularly, or even every-so-often, you’re far more deeply enmeshed in the contours of this debate than, I believe, most Americans are. Although Obama’s town halls have been televised, although there was the press conference dedicated to health care, and the night of Q&A on ABC, although there have been op-eds, and blog posts, and Web casts and radio interviews a-plenty, most people just haven’t had the time to follow it. As a result, not everyone knows that the uninsured aren’t just sad unfortunate folks completely unconnected to us, but that our skin is in that game as well, with at least $1,000 hidden cost for uncompensated care for those of us with insurance.
People may know about pre-existing conditions, but they haven’t heard the story of Robin Beaton, the Texas nurse whose acne years prior was used an excuse to drop her health insurance precisely when she needed it the most to fight breast cancer. People know costs are going up but don’t realize, as the president said, “Our health care problem is our deficit problem -- nothing else even comes close.”
And they don’t hear nearly enough, nowhere nearly enough about the moral deficit of not fixing health care reform: “That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America.”
Health care reform doesn’t exist in a vacuum. It’s not a good idea because it’s ideological or because the Obama plan is how anyone would build a system from scratch. It’s a good idea only to the extent that it solves an immediate problem. The structure of Obama’s speech was therefore elementary: you need to know the problem first, then you need to know how the solution relates to it, and then you need to be shown how all the stuff the media fixates on -- bipartisanship, “death panels,” illegal aliens, you name it -- how that doesn’t even relate to either the solution or the problem. Did Obama get a big enough audience or make a big enough impression to sway public opinion? Time will tell.
But since novelty is the spice of life, I have to share the nine things that I had legitimately not heard before, either from a policy or political perspective. Not all of them were positive, mind you, but I have to confess that the answer to the question of my earlier post -- does Obama have anything new to say about health care -- is yes.
What Is the Public Option?
Published September 06, 2009 @ 05:51PM PT
The public option has become the central front in the fight for health care reform. It’s become a litmus test on the left and the right, with the House Progressive Caucus saying they won’t vote for a reform bill that omits it, and with Republicans generally united against it, even one with a delay or a trigger that would kick its implementation down the road. It’s been discussed almost constantly since February 2007 when John Edwards made it part of his health care plan, with both Barack Obama and Hillary Clinton soon following suit. It’s become a proxy fight for health care reform in general. But for all that, many people are still confused as to what it is, who would have access to it, or why it might be a good idea in the first place.
It is not, in and of itself, the entirety of the health care reform proposal in Congress, or what President Obama proposed on the campaign trail as a fix for our broken health care system. Reform encompasses everything we need to do to finally begin controlling our health care costs, expanding access and improving quality. All three of these goals are the focus of the House bill (HR 3200) and the Senate Health, Education, Labor and Pensions Committee.
The moving parts of this bill covers an incredibly wide gamut of issues, from developing new doctors and new nurses, particularly in primary care; to giving tax credits to small businesses in order to allow them to afford benefits for their employees; to filling in the “doughnut hole” in the Medicare prescription drug program to provide cheaper drugs to seniors; to creating regulation or prevent or curb the most abusive practices of the insurance industry.
The House bill is 1,018 pages long and the whole package is estimated to cost $1 trillion over 10 years -- all or most of which is already paid for by savings and new revenue earmarked in the bill. But the whole package is not “the public plan” or the “public option.” Of the 1,018 pages, only 12 of them deal with the establishment of a public health insurance option.
The Snowe Effect on Health Care
Published September 05, 2009 @ 02:35PM PT
There are two people who hold health care reform in the palms of their hands – at least this week. One is President Obama, set to make a big speech Wednesday night in which he (possibly) unveils a bill of his own, or (possibly) explains what he’d like to see in the health care bill, or (definitely) outlines some principles or features and spends the rest of the time making a big sales pitch. But the other is Sen. Olympia Snowe, the moderate Republican from Maine who sits on the Senate Finance Committee. Bloggers have spent the past week asking, “What does she want?”
Snowe was always going to be relevant to the debate. In order for there to be any Republican votes, and thus pass a filibuster even if the health problems of Sen. Robert Byrd and the late Ted Kennedy, the math required that the two Republicans from Maine be on board – Snowe and her fellow moderate Sen. Susan Collins – at least vote for the bill. She not only sat on the “gang of six” negotiators with Max Baucus, she has had “an open line of communication” to the White House.
The good news is that Snowe seems legitimately interested in solving the health care problem and not just having a coveted spot on the Sunday morning talk shows (Sen. Kent Conrad, I’m looking at you.) Jon Cohn breaks down the positives: she wants less variance in premiums by age than, say, fellow Republican Mike Enzi, so that a hypothetical $5,000 plan for a 30 year old would cost no more than $10,000 for a 60 year old (Enzi would prefer that plan cost $25,000 for a 60 year old, as many of them do now). She’s open to raising the level of subsidies for those in the Exchange to 400% of the poverty line, although she’d prefer the 300% line, leaving behind about 3 million uninsured. Finally, she’s be open to having larger businesses purchase insurance plans through the Exchange – an important feature since the more people who can have access to the Exchange, the better the economies of scale. Currently, the House bill is somewhat limited but can expand, and the Senate HELP bill is very limited – individuals and microbusinesses (up to 20 employees) only.
