rssControversy Swirls on Hill Around Public Health Plan
Wednesday, June 03, 2009 at 3:09 pm
- 23 Comments
Sen. Max Baucus (D-Mont.) and Sen. Charles Grassley (D-Iowa) (WDCpix)
Liberals love it. Conservatives hate it. Moderates have proposed some compromises, and the Obama administration is weighing ways to appease all camps. Whatever battles are brewing in this year’s looming health care reform debate, none is likely to reach the intensity of that over a government-sponsored insurance plan.
Supporters of adopting a public plan, a national insurance program anyone could opt into, argue that it’s an indispensable component of the Democrats’ soon-to-be-unveiled health care overhaul proposals, providing an affordable option to patients and keeping private insurers honest through increased competition. But critics contend that a federal plan is the first step to a single-payer system, tipping the scales unfairly with government subsidies and threatening the very existence of the private insurance market.
Illustration by: Matt Mahurin
Aside from aligning Democrats against Republicans, the young debate is also threatening to put liberal Democrats at odds with moderates, incite another intra-party rift between Democratic leaders in the House and Senate, and leave President Barack Obama — who wants to pass reforms supported by all parties — struggling to find some middle ground.
The episode highlights the difficulties facing Democrats in Congress and the White House as they try this year to make good on one of their very highest legislative priorities: revamping the nation’s health care delivery system in an effort to cover the 46 million uninsured Americans and slow the skyrocketing growth in medical costs. The debate will be a test of the political skill and will of party leaders, who are trumpeting the urgency of health reforms at the same time they’re urging caution in enacting them; who are hoping to trim the fat in the health care system at the same time they don’t want to eliminate jobs in the middle of a recession; and who are proposing enormously expensive reforms at a time of record deficits.
Lawmakers will also have to contend with the powerful insurance industry, which opposes the adoption of a public plan — and is lobbying furiously to keep it out of the Democrats’ proposal.
On Friday, the debate over public plans was launched in full after news leaked that Sen. Edward Kennedy (D-Mass.), chairman of the Senate health committee, intends to include the government-sponsored option as part of his sweeping reform proposal, expected to be unveiled next week. The leak inspired thoughts that Kennedy’s bill would be much more liberal than that being drafted by Senate Finance Committee Chairman Max Baucus (D-Mont.), who works closely with Sen. Charles Grassley (R-Iowa), a fierce opponent of the public option.
Kennedy and Baucus insist they remain on the same page, issuing a rare Saturday statement vowing to craft “complementary legislation that can be quickly merged into one bill for consideration on the Senate floor before the August recess.”
Joseph Antos, a health-policy analyst at the conservative American Enterprise Institute, said the leak — probably intentional — was likely intended to send a message to liberal Democrats that Kennedy’s on their side. It might also have been a message to Baucus that he’d better be prepared to nudge his proposal left — a situation that puts the Senate Finance Committee chairman in a squeeze between an allegiance to party and the promise to find bipartisan consensus on health care reform.
“He wants to be left of the 50-yard line, but he doesn’t want to be too far left of the 50-yard line,” Antos said of Baucus. “It’s the sort of thing we’ve seen often out of the Finance Committee … There’s a lot of game-playing going on here.”
The same dilemma faces Obama, who appears torn between his support for a public plan and a desire to have a bipartisan bill. The White House did not return requests for comment Wednesday.
Supporters of the public plan option argue that it’s vital if Democrats hope to slow the growth of health care spending, which is skyrocketing at a rate well above that of the rest of the economy. A government-sponsored plan, they say, could provide cheaper coverage because it wouldn’t have to pay the marketing and outreach costs that burden private insurers; it would cater to more people, lowering costs for reasons of sheer volume, and it wouldn’t be bound to produce profits for shareholders.
There are other advantages to the public option. Ron Pollack, executive director of Families USA, a consumer health care group, pointed out that private insurers operating under Medicare have been known to alter the terms of coverage, leaving patients without necessary treatments. A public plan, Pollack argued, “provides some stability” to patients. The government option would also create an enormous database of health coverage information that could inform future policy decisions, Pollack said — information private insurers often won’t disclose for proprietary reasons.
Conservatives and the insurance industry have other thoughts. Summing up the criticisms of the public plan option, Senate Minority Leader Mitch McConnell (R-Ky.) on Tuesday argued that a federally subsidized plan could offer “artificially lower prices” that would quickly attract interest from individuals and businesses alike. The result, McConnell contended, would be the death of the private insurance market.
“The very concept of a government ‘option’ is itself misleading,” McConnell said on the Senate floor. “What starts out as an option could quickly become the only option.”
Sen. Judd Gregg (R-N.H.), who floated his own health reform proposal this week, said the public option would eventually lead to “delays and rationing” for patients.
“The first rule of health care is, do no harm,” Gregg told MSNBC Tuesday. “Well, one thing which would do serious harm would be if the federal government came in and stood between you and your doctor or created a system which led to delays and rationing, which is what a public plan would.”
Several proposals floated on Capitol Hill in recent weeks seek to satisfy both supporters and critics of the public plan option. Under one measure, sponsored by Sen. Charles Schumer (D-N.Y.), the government would administer, but not be permitted to subsidize, the public plan. Instead the plan would have to rely on premiums and co-payments to cover claims, like any other insurer. The Schumer plan would also force the public plan to pay health care providers at rates higher than Medicare pays.
Another proposal would offer private plans the opportunity to expand coverage and reduce rates on their own, with the public option kicking in only in regions of the country where the private market failed to meet certain minimum thresholds of coverage and cost. Opponents of that strategy, including Schumer, argue that the nation’s 46 million uninsured residents are evidence enough that those thresholds have already been met.
Antos, of AEI, said one of those compromises could work, but first the language surrounding the debate would have to change so that the Republicans who’ve so adamantly opposed the public option wouldn’t be seen going back on their word.
“You’ve got to find a face-saving way,” Antos said. “So the first thing you do, you don’t call it a public plan.”
Douglas Holtz-Eakin, former head of the Congressional Budget Office, said that, without any details, it’s still too early to speculate about the fate of public plans in the coming debate. “There are many different flavors of a public option,” said Holtz-Eakin, the chief economist for the 2008 presidential campaign of Sen. John McCain (R-Ariz.). “We’ve got to see a specific proposal.”
Robert Blendon, a professor of health policy at Harvard University, pointed out that, even if the Senate isn’t able to pass the public plan provision, House Democrats will almost certainly include that option in their version of the bill, which is currently being drafted by Reps. Henry Waxman (D-Calif.), Charles Rangel (D-N.Y.) and George Miller (D-Calif.). For all the controversy swirling around public plans, Blendon added, there’s a larger barrier to the Democrats’ push for health care reform this year.
“This is very contentious, but not as contentious as how they plan to pay for it,” said Blendon, an expert on the Clinton administration’s failed attempt to pass comprehensive health care reform in 1993. “If they can find savings someplace, they would not stop the train for this issue. They would find some Sen. Schumer-like compromise and push the thing on through.”
David Cutler, a health economist at Harvard University who’s advised the Obama administration, downplayed the significance of the partisan griping over public plans, arguing on Tuesday that overall support for health care reform this year remains as strong as ever.
“You see these sorts of splinters,” Cutler said, “but you don’t see anyone walking out yet … We are in so much better shape than 16 years ago.”
23 Comments
Comment posted June 3, 2009 @ 4:17 pm
Oh boy. Am I glad Gregg is not part of the admin. How do you equate his statement one the quote “First do no harm” with the fact that insurers make money by denying care. Hmmm… Do no harm means denying care that a DOCTOR thought was needed? And the bogeyman is that govt will get between you and your doctor? Please.
Comment posted June 3, 2009 @ 6:33 pm
Let's sort this garbage out: there are representatives reaping monetary rewards from the insures making sure that the insurance companies would not be short of change.
This is called the private right to your own doctor. Of course you do not have one, you have an HMO and you see whomever is available when you need help and you are lucky to get an appointment.
But your representatives have Blue Shield/Blue Cross, everything is paid and they do indeed have their own doctors.
They fight for their money and their comfort.
Both of which is killing you, the working American.
Public plan with higher co-payment than Medicare? Let's start with : Medicare cost on average as much as $275 as month plus extra for medications. Many of us cannot pay that.
That will help the insurance companies and nobody else.
Public plan, or government single payer? well, that sounds like what your representative has: we all pay the same to the government who than reimburses the providers, covering majority of needed treatment (I'd cut out Viagra for anyone over 63). You keep your doctor and he/she gets paid unless they are to greedy and will want to go “private” in which case you should dump them anyway because the only thing they care about is money.
How much will it cost you? About $50 to $100 a months plus some co-payment for the medications.
Do we have enough money in the system to cover everyone? Yes, we only spend about 30 cent out of each dollar on patients but the system cover 75% of people.
Should you push for it? Only if you want to be treated humanly when getting ill without going bankrupt or be told that since you cannot pay, you will be left to die.
Do I know hat am I talking about?
I covered health care changes for about 10 year in very different systems. Only one worked: single system payer. But that one works really well.
Comment posted June 3, 2009 @ 7:20 pm
So if the problem with the public option is that private plans won't be able to compete, why are we always told the private sector can handle everything better than the government? So apparently it can't. So since the public option would be the stronger competitor, stopping it would be solely to protect the health insurance industry. How much to we spend to subsidize (since that's what killing the public option amounts to) the health insurance industry?
And people complain about the cost of saving the auto industry!
Comment posted June 7, 2009 @ 7:01 am
Yesterday I hosted a kick-off meeting here in Iowa City for Obama's Health Care Initiative. Had also attended a large meeting yesterday morning with Sen. Harkin as the principal speaker. In that audience there was huge support for 1) single payor and 2) and public option plan. It is very clear that without one or the other, more and more people will be left without health insurance, which would become a catastrophic situation for our country. It is very interesting to me that the Conservatives, who generally seem to have good insurance, want to pull up the ladder behind them and let the rest suffer. That should NOT be what America is all about
Comment posted June 7, 2009 @ 2:01 pm
Yesterday I hosted a kick-off meeting here in Iowa City for Obama's Health Care Initiative. Had also attended a large meeting yesterday morning with Sen. Harkin as the principal speaker. In that audience there was huge support for 1) single payor and 2) and public option plan. It is very clear that without one or the other, more and more people will be left without health insurance, which would become a catastrophic situation for our country. It is very interesting to me that the Conservatives, who generally seem to have good insurance, want to pull up the ladder behind them and let the rest suffer. That should NOT be what America is all about
Comment posted June 26, 2009 @ 6:44 am
The public needs to come up with more money to pay off congress than they currently receive from the insurance and pharmaceutical lobby. You have to ask yourself why the insurance co have spent 6.4 million dollars to counter proposals to make health insurance more affordable to millions of americans. Pfizer, the worlds largest drugmaker spent more than 6.1 million lobbying against health care reform. As long as we have for profit insurance companies who are able to deny claims, deny coverage for preexisting conditions, and drop coverage on people who have the misfortune to get sick we will not be able to have true reform.
Comment posted July 7, 2009 @ 2:23 pm
Please give us the voluntary option to pick an insurance plan from the normal plans “for profit” or public plans “at cost”. As Obama says: “for us to be able to say, here's a public option that's not profit-driven, that can keep down administrative costs, and that provides you good, quality care for a reasonable price as one of the options for you to choose, I think that makes sense. “Why would it drive private insurance out of business? If — if private — if private insurers say that the marketplace provides the best quality health care; if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business? That's not logical.” Just one salary from the big insurance CEO could pay for health care for how many people. And what does he do to earn that money? He tells the insured what doctor to see, what procedure to pay for, how much to pay for that procedure and rewards those that deny the most claims. They say they spread the risk but they actually spread the cost and still make huge salaries. That's a lot of profit on the backs of the few they pick to insure. Those that they insure are generally young and healthy and do not usually need the benefits that they pay for. They are “cherry picked” for the low risk of out pay. When these folks get older they are dumped onto the Medicare/Social Security program. Then we all pay anyway. Please give us the option to voluntarily choose between the normal insurance plans and the new “at cost” public plan.
Comment posted July 29, 2009 @ 9:56 pm
The Senate and the House should get together and make a single health care system for all Americans.
Why can't our are representatives in Washington provide health care, like they have,with a single payer system, which is the U.S. government.
Congress can send the American people off to War,but they can't get together and pass health care for everyone.
They should be ashamed of themselves.
Pingback posted August 7, 2009 @ 4:56 pm
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Comment posted August 5, 2010 @ 7:52 am
Why can't our are representatives in Washington provide health care, like they have,with a single payer system, which is the U.S. government.
Comment posted May 31, 2011 @ 3:02 pm
Legacy Planning Group is a business-to-consumer insurance agency that delivers Web-based, insurance information to individuals, families and small businesses who are in need of insurance information.
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