Wednesday, August 19

Why Obama is so Squishy on The Public Option

In June, this is what President Obama said in a Letter to Senators Kennedy and Baucus.

The plans you are discussing embody my core belief that Americans should have better choices for health insurance, building on the principle that if they like the coverage they have now, they can keep it, while seeing their costs lowered as our reforms take hold. But for those who don't have such options, I agree that we should create a health insurance exchange -- a market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for them, in the same way that Members of Congress and their families can.


If many of you remember, this is *always* what's he's said - that he would offer the American people the same Benefits options that Congress and Federal Employees already have - and that wasn't the Public Option (which even they don't have - yet), it was the Exchange which they do.

It may seem weird to many, but no Obama has NOT backtracked or changed positions. People have failed to HEAR him above the din, instead they've heard what they wanted to hear as shown by the contensious back and forth in this Presser with Gibbs from Yesterday.




Q What's been the response so far, what kind of feedback to the suggestion in recent days that a public option might not be part of the health care reform?

MR. GIBBS: Well, as I've said, now, yesterday and earlier today, the President -- his position, the administration's position is unchanged; that we have a goal of fostering choice and competition in a private health insurance market. The President prefers the public option as a way of doing that. If others have ideas, we're open to those ideas and willing to listen to those details. That's what the President has said for months. Coincidentally that's what the Secretary of Health and Human Services has said for months. It's what I've said for months. I think the suggestion somehow that anything that was said Saturday or Sunday as being new administration policy is just not something that I would agree with.


Gibb's is right, there wasn't a change - going back to Obama's June Letter to the Senate.

None of these plans should deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs. I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.


Note the order and priority shown in the President's statement. Health Exchange First, Public Option Second.

The fact is that the Key issue in Health Care Reform to The White House and to Obama isn't the Public Option and never has been the Public Option, it's the Health Care Exchange (which is exactly what's he's been saying all along) - under it individuals and small business will be able to get bulk rate discount pricing for Health Care Services from a Menu of available options - ONE of those options might be a public/non-profit plan.

Those who can't afford to buy a plan, up to 400% of the Federal Poverty Level, will get subsidies which means that the poor people will no longer by trapped in either Medicaid or having to use the Emergency Room as their doctor. If they want to, they would have the choice of using the subsidy to buy Blue Cross/Blue Shield or Wellpoint (which would also *HAVE* to take them!)

That alone is HUGE.

Having the ability to apply that subsidy, or your own purchasing power to Medicare or a Medicare-like plan is a bonus. A nice bonus, but still a bonus.

People forget now because they either don't remember, or never fully understood it - but this was THE key tenent for bringing down costs in Hillary Clinton's Original Plan. In her system they were called "Associations" which would be non-profit pools for providing low cost care options. Any insurance provider working with an Association would have to meet standards established at the national level, but also by a State level Medical board which would provide a consumer score-card on the quality and price of each plan within an association in order to provide better information to consumers. HR 3200 which is the most Obama-ish of the plans has simplified much of this down and eliminated the state-level boards as well as ended the Clinton requirement for a minimum of 2 Associations per state to ensure competition. One Federal Board plus 50 State Boards plus 2 Associations per state was the source of the claim that Hillary care included "A Government Health Care TAKE OVER WITH 151 New Federal Agencies!" - which it didn't. Opponents were lying then and they're lying now.

If we get the Exchange Now, which again was the primary pole in Hillary's plan for bringing down costs and improved risk sharing, we can add a public option, non-profit Co-ops or a modification allowing people to Buy-in to Medicare (The Weiner Plan) later.

Just as the Right Wing is getting it all completely wrong over imaginary "Death Panels" - the Left is going a bit overboard over the be-all-end-all of the Public Option. An even though I'm glad to finally see progressive get in the ring for the battle - I'm glad the Weiner Caucus is willing to say "Public Option or Bust" - I'm not exactly sure they realize which battle they're really in.

Like the President, I happen to strongly support the Public Option (as described in John Dingel's HR 3200) in the form of a replacement to Medicaid, modeled on the Medicare system funded by Premiums with it's own independent Trust Fund unburdened by the demographic and structural problems that currently plague both of our tax funded systems Medicaid and Medicare. I think that's better than Medicare-for-All and Not-for-Profits Co-Ops that won't (initially) have the volume to make a difference in the market that is currently dominated by Big Insurance.

This isn't to preclude the possibility that an even better idea might not come about in the next few weeks - we should all, always be wary of the hubris of believing we already know the answer, before we've fully understood the question - and I think that's essentially been the President's point. He'll go with the best idea available - right now Public Option is it, but we have to realize that the thing he absolutely Won't give up on - the Line he WON'T CROSS - is the Health Exchange.

Frankly, we've been very poorly served by the media in all of this, including Keith and Rachel - although they've tried valiantly. The only person I've seen or heard who has the background and research to fully understand this point, because he closely covered the Hillary Health Care Story in 1994, has been Time's Joe Klein - From the Ed Show Yesterday.



Klein: There's a 80-90% Chance that we'll have Insurance Reform this year, which will ban Pre-existing conditions, and you'll have Health Care Exchanges - which will lower the prices for small business and individuals.

Klein: The Public Option is peripheral to the really important stuff here.

Ed: It's not.

Klein: I've been covering this 20 years, you can have Universal Coverage without a Public Option. What does the Public Option do? It's give bargaining power to the public against the insurance companies - that is precisely what the Health Exchange Does!


All of this is why the White House is reacting the way they are and why they don't feel the Public Option Alone is the biggest pole in the tent, it's not. It's essentially useless without the Exchange.

I'm not saying that people shouldn't fight, and fight hard, for the Public Option, but even if we can't implement Howard Dean's Backdoor Conference Committee Re-Insert we'll still have pre-existing conditions off the table, we'll still have coverage rationing off the table, will have fixed the ability of Medicare to negotiate for better drug prices and have Health Exchanges guaranteed (and in every version of this bill, even in the Senate - I believe WE DO) we should take "YES" for an answer and work on enhancing and improving things later once people see how well the Exchanges work. Just remember that FDR didn't implement every facet of Social Security on the first try, but he did get the basics in place.

The Public Option is *NOT* the last line in the sand, Health Exchanges are.

Just Sayin'...

Vyan

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