Slate's Timothy Noah provides a thoughtful overview of the intellectual origins and political evolution of the public option's place in health reform.
It's a complicated case, the public option. Lotta ins. Lotta outs. But Timothy Noah is the Big Lebowski of health writers, and is the man for the job to keep all these strands together. (Yes, we know we've made that joke before, but like our living room rug it really ties the blog together.)
Noah's goal was to understand why the CBO and others estimated that premiums for a so-called level playing field public option would cost more than private plans. Noah spoke with New America's Len Nichols, whose paper with John Bertko helped outline how a public option with negotiated payment rates could compete on a level playing field with private plans.
First, thank you to all our veterans for their service and sacrifice.
This Veteran's day we're a bit caught up in the upkeep of grant reports, so he's a quick run down of the news and issues that caught our attention:
Tuesdays with Harry: Politico reports that Senate Majority Leader Harry Reid took procedural steps yesterday that would allow him to open debate on a bill Tuesday next week. Of course there a lot that needs to happen before then, including the release of bill with CBO scores, but still, it's a good sign that things are moving in the Senate.
My Life, Your Work: Former President Bill Clinton spoke to Senate Democrats at their weekly meeting Tuesday. His message? Git'er Done. "The worst thing to do is nothing," Clinton told reporters.
This post appears on the National Journal's Health Care Experts Blog where you can also see what other health policy analysts have to say about allowing states to opt out of a public health insurance option.
The public plan debate marches on this week as we discuss whether or not states should be allowed to “opt-out” of the public health insurance plan. Allowing states to choose not to provide the public health insurance plan as an option in their markets has its virtues. It establishes the infrastructure necessary to create a public health insurance plan nationwide, but it also makes the decision ultimately a state judgment. This may be a safer way to go for those who worry about government expansion.
While we do not know the details of what kind of public plan states would be able to “opt-out” of, we suspect the center of gravity is closer to a level playing field approach, such as that proposed by Senator Schumer (where the plan would have to negotiate payment rates with providers) as opposed to the version supported by progressive Democrats in the House (where the plan would administer prices based at least in part on Medicare rates). If the level-playing field approach is in fact adopted, assertions that the plan would simply “underpay providers” rather than “driving real reforms that bring down costs and improve quality” are unfounded.
We were tempted to say that providing all Americans with affordable health care is not as hard as landing on the moon... but then we remembered that we have landed on the moon...
Sen. Joe Lieberman (I-CT) may not be, to use Harry Reid's own words, "the least of Harry Reid's problems."
After all, Reid does have to worry about a couple of other guys and gals (from Roland '"no-leverage-point" Burris to Blanche "tough race in 2010" Lincoln). But Lieberman's comments about possibly joining a Republican filibuster of health reform with a public plan certainly got everyone talking today, and he's been on our minds too. Earlier this month, while all eyes were on Maine Republican Olympia Snowe, who cast her ambivalent "aye" vote for the Senate Finance bill, anyone listening to the radio might have noticed that Joe Lieberman was making a lot of worrisome noises.
Senate Majority Leader Harry Reid (D-NV) said the merged health reform Senate bill will contain a public plan option but states can opt out until 2014. He said the "public option" is not a silver bullet but will boost competition, keep insurers honest, and give people more choices. He said it will add "meaningful reform" to a broken health care system.
Reid is sending his proposed bill to CBO for scoring "in a few hours." At a news conference he stopped short of saying he was positive he had 60 votes, but expressed quite a bit of confidence about health reform. He said he had the support of the White House, and key Democratic negotiators Max Baucus and Chris Dodd.
UPDATE: Statement from Chairman Baucus:
Friday, the Kaiser Family Foundation released the latest results of the monthly Kaiser Health Tracking Poll. Public opinion is holding fairly steady from last month's poll, starting a gradual rebound after support for reform dipped during the raucous August congressional recess.
A majority of respondents (55 percent) believe it is more important than ever to tackle health reform right now. By party, that's 73 percent of Democrats and 55 percent of Independents, but only 30 percent of Republicans. A majority of Republicans believe they would be worse off if health reform passes, while only 29 percent of Independents and only seven percent of Democrats believe health reform would hurt them. According to the Kaiser Family Foundation's Mollyann Brodie, 8 out of 10 Americans are in favor of eliminating insurance denials based on pre-existing conditions, making it the most popular of all the reform provisions currently under consideration. The poll also found a majority of Americans are confused about the timetable of reform, thinking insurance market reforms and help for the uninsured will occur immediately after the bill is passed -- in reality, changes will be phased in over the course of several years.
In the odyssey of health reform, the public plan is the Proteus of our wonkish mythology -- constantly shifting, capable of divining the future, but never willing to give you a straight answer. Sorry, Politico's Pulse already took the soap opera metaphor, "As the Public Option Turns" so we had to get Homeric.
Still, trying to get a handle on where the public plan stands is like wrestling a wet seal.
Earlier in the week, Democratic House leadership felt confident they had the votes to pass a "robust public option" tied to Medicare payment rates, but the latest whip counts suggest the leadership still has some work to get 218 votes in the House.
Meanwhile, in the Senate, Majority Leader Harry Reid (D-NV) is leaning toward including a public insurance option that would allow the states to opt out. The White House is said to favor a trigger option, hoping to keep the Republican Penelope from Maine weaving at her loom.
All this is subject to change, and next week, it will no doubt change again. And the week after that, too. However, lawmakers should not let the protean politics of the public plan obscure other key aspects of reform. Insurance market reforms like guaranteed issue and community rating, may not have the same siren call of public plan debate, but they are critical in making health reform work.
A new issue brief from the Robert Wood Johnson Foundation and Health Affairs provides a thorough overview of the issue, looking at why insurance market regulation is needed, what's proposed in the various bills, and the possible objections and barriers to proposed solutions.
As health reform draws closer to the goal line, efforts to influence the debate have never been fiercer. Lobbying from health care groups is proceeding at a record pace, and everyday seems bring a new crop of ads. In fact, the most recent Kaiser Health tracking poll showed that over half of all Americans (54 percent) had seen, heard, or read an ad in the past week having to do with health reform -- up more than 30 points from June. Of those who’d seen an ad in the past week, 35 percent saw ads in favor of passing reform, 29 percent saw ads opposed, and 29 saw both.
While it’s hard to keep track of the ad wars, two recent productions caught our attention.
The first comes from Americans for Stable Quality Care, a diverse coalition of health care industries and providers, “who share the common belief that all Americans deserve access to stable quality health care.” The ad is titled "House."
The Nationals may have never had a shot at the playoffs, but Washington's senators are still playing hardball in October.
Much of the action centers on the public plan, which has reemerged as one of the central issues in merging the Senate's HELP and Finance bills.
Senate Finance Chairman Max Baucus told reporters on Monday that he believed a "pure public option" did not have the votes to pass the Senate, but that there were many options on the table that could form the basis of a compromise.
The public plan option, in the Senate at least, is beginning to remind us of one of those really really convoluted word problems back in sixth grade math.
"If there are 60 Democratic senators, and 50-something (maybe) back the public plan and none really want to kill health care reform but 15 want to make the playing field more level and four want to leave it to the states, and two are named Nelson and twenty are up for re-election and 9 come from red states... and one is named Reid" how many cookies did Johnny eat?
And would Johnny have eaten all those cookies if he had better primary care?