rssPublic Option Still a Sticking Point in Health Care Debate
Wednesday, July 29, 2009 at 4:11 pm
- 19 Comments
Rep. Jim Cooper (D-Tenn.) (cooper.house.gov)
It’s become a predictable sticking point surrounding the Democrats’ hopes to revamp the nation’s health care system: The creation of a government-backed insurance plan as an affordable alternative to private coverage.
Liberal Democrats have insisted the option be included to keep private companies honest, while Republicans have insisted that it be scrapped to ensure the viability of the private marketplace. Yet as liberal Democratic leaders continue to haggle with their conservative colleagues over the public-plan strategy, the entrenchment of black-and-white ideology has slowed the process to a crawl. In the eyes of an increasing number of health care experts and key lawmakers, agreeing to some tint of gray will be the only way to break the stalemate.
Illustration by: Matt Mahurin
“There are different ways to do this,” Rep. Jim Cooper (D-Tenn.), a member of the conservative-leaning Blue Dog Democrats, told CNN Tuesday. “So many advocates of public option don’t really know specifically what they’re advocating and so many opponents don’t really know what they’re opposing. So it’s important that we get the definition right.”
On its surface the concept is simple: A government-backed insurance plan offered alongside the private options would pressure those companies to keep coverage comprehensive, denials to a minimum and costs low. Supporters point out that the federal plan wouldn’t have to buy expensive advertising like other insurers, nor would it have to earn the profits expected by shareholders of private companies — money that could be used instead to reduce premiums.
On Tuesday, President Obama reiterated his support for the public plan as one option on a proposed menu of insurance plans which patients could choose from. “That helps keep the insurance companies honest, because now they have somebody to compete with,” Obama said during an online health care forum sponsored by AARP.
Two Democratic proposals already moving through Congress — one crafted by House leaders and the other by Democrats on the Senate health committee — include such an option.
But critics maintain that the public option would have an unfair, taxpayer-backed advantage over private plans that could eventually lead to the demise of private insurers altogether. The issue has pitted Democrats against Republicans, turned moderate Democrats against their liberal colleagues, and left the Obama administration straddling the chasm in search of a compromise capable of winning bipartisan support.
There are several proposals floating around Capitol Hill that could represent the compromise needed to push the Democrats’ sweeping health reform plans through the Senate, where 60 votes will be required to defeat a likely Republican filibuster. One would allow for the creation of a public plan only in areas where private insurers failed, after a set time period, to meet certain coverage and cost targets. The strategy has been blasted from the right for proposing a public option at all, while the left has criticized it for relying on the efficiencies of the same private model that’s left more than 45 million Americans uninsured.
Republicans are fond of citing a study by the Lewin Group indicating that the public plan, depending on how it’s modeled, could entice 119 million people to drop their private coverage. On Monday, however, the Congressional Budget Office released estimates indicating that only between 11 million and 12 million people would choose the public option under the Democrats’ proposals.
Another compromise proposal would create regional co-operative plans to be managed by the same people buying into them. But that strategy, too, has been attacked from both sides of the ideological divide. Liberals point out that the patient pools would be much smaller in regional co-ops, eliminating the advantage of a nationwide plan to lower costs by virtue of its sheer size. Conservatives, meanwhile, argue that it would take an enormous government effort to get the co-ops up and running.
Cooper, for his part, has broken with many of the Blue Dogs to come out in support of the public-plan option — if it’s shown to cut the long-term health spending projections that are largely the inspiration for health reform to begin with. The Tennessee Democrat says he’s outlined 18 separate public-plan models that could serve that purpose.**
“There are types of a public plan that can work as long as it’s on a level playing field,” he told CNN.
The comments arrive as the Democrats’ plans to pass health care reform before the August recess seem increasingly out of reach. In the House, Democratic leaders of the Energy and Commerce Committee met with the Blue Dogs Tuesday to iron out their differences over a plan to link public-option rates to Medicare payments — a model that many moderates contend could restrict health care treatments in rural, already under-served parts of the country. But those negotiations, thus far, have led only to promises of more negotiations.
Meanwhile, all eyes remain trained on the Senate Finance Committee, where Chairman Max Baucus (D-Mont) has been huddled with five other members from both parties in search of the elusive health reform blueprint capable of bipartisan support. Early reports on those negotiations indicate that the group is leaning toward scrapping the public option in favor of the co-op model.
On Tuesday, House Majority Leader Steny Hoyer (D-Md.) floated the possibility that House Democrats would accept the co-op strategy if it were structured to accomplish the same goals of covering the uninsured and lowering costs that the public plan is designed to tackle. “After all, a co-op will be a competitor,” Hoyer told reporters.
That, however, would be sure to incite a backlash from liberals, who had something different in mind when they went to the polls last November.
All sides of the debate agree that inaction on health care reform is no option. Under current models, health care spending nationwide is projected to rise by at least 6.2 percent annually over the next decade — more than 2 percentage points faster than the rest of the economy, according to the latest estimates from the Health and Human Services Department.
It’s an unsustainable trend. As a share of the economy, health care spending stood at 16.2 percent in 2007, but is projected to reach 17.6 percent this year, topping 20 percent by 2018. Despite all the spending, roughly one in six Americans lacks health coverage.
“We spend a lot of money in our health care system that doesn’t do a thing to improve people’s health, and that has to stop,” Obama said at the AARP forum. “We’ve got to get a better bang for our health care dollar.”
**Update: Cooper’s office has declined to release this list, saying that it’s “outdated.”
19 Comments
Comment posted July 29, 2009 @ 8:42 pm
Nobody mentions the fact that the new senior health care plans lets others besided their doctors approve of many medical procedures that may be neede as one gets into their 70's and older.
Comment posted July 29, 2009 @ 9:23 pm
Apparently, House and Senate Republican and Blue Dog Dems do not think that the average working American should have an access option to the same government funded health care plan they currently enjoy. Expect more lies and deceptions as this issue moves forward.
Comment posted July 29, 2009 @ 9:35 pm
Thank goodness one of the so called blue dog dems – Rep. Cooper – is coming around to a public health care option. It makes no sense to talk about health care reform is a public plan isn't one of the options – period.
The insurance companies have had their way with all US insurance customers for way too long – asserting that the industry deserves more time to fix their greedy ways is fool hardy. Someone tell that to Sen. Snow from Maine – she's either naive or stupid to believe insurance companies have any intention of losing any fat profits – profits needed to cover their losses in the stock market.
Answer this: Several of our smaller states had as many as 3 & 4 malpractice insurance carriers in 2001. Today, Montana, North Dakota, South Dakota, Idaho, Wyoming, and Utah have either just ONE (no competition) or TWO malpractice underwriters. Since 2001, most surgeries have increased in cost by over 110% – and large explanation for that is the 150% to 200% increase in malpractice fees. The insurance companies have actually taken things in the direction of increasing fees in collusion – because there's also no anti-trust enforcement. We must have a public plan to keep the insurance firms honest – otherwise, whenever we have an extremely business friendly republican president, the insurance rates will sky rocket once again….as they did under President Bush & Cheney.
Over 200 Million Americans believe we need a public health care option – a public choice. That should be even enough for blue dog dems to come around – and several Republicans as well.
Comment posted July 29, 2009 @ 9:38 pm
Mike,
You think our Senators are going to use the health plan they are trying to foist on us and give up their own cushy government plan? Seriously?
Comment posted July 29, 2009 @ 9:50 pm
martinspiegle – you really have to stop listening to the GOP lies. They're just trying to scare you.
Right now, it's the profit-driven Insurance Companies that are between you & your Doctor.
With a Public Option, there is no profit motive, advertising, etc, thus, costs will be less.
Doctors will just be able to give the care you need.
How many Seniors now, would trade their Medicare for a *Private* option, choosing a profit-driven Corporation over Medicare?
Why aren't people in Canada, Britiain, Germany, etc, if their systems are so bad, calling for a system like ours? Answer: Because their systems work, and ours doesn't.
I have health insurance. Recently, I called them to see what I was covered for regarding going to an eye doctor. I was told they wouldn't even pay for a checkup, unless I had cataracts.
With a Public Option, I'll be able to get regular eye checkups, and not have to wait until something is seriously wrong.
Comment posted July 29, 2009 @ 9:51 pm
We get these promises that a public plan would only be paid by premiums and never by tax payer dollars. With bank bailouts followed by auto bailouts, who can believe such drivel? Republicans are offering the compromise of Co-ops. If the Democrats want to trash Obama's promise of bipartisanship, then they can explain themselves whenever anyone complains about healthcare in the future.
Comment posted July 29, 2009 @ 9:53 pm
Is that why people in Canada and Britain buy private health insurance if they have the money? Because their plans are so good? Seems like that would be a waste. And how exactly do you know that with a public option you'd be able to get regular eye checkups? The plan isn't even written yet you “know” what you will be able to do. Must be Nostradamus or something
Comment posted July 29, 2009 @ 9:58 pm
The dems cannot be serious about health reform without seriously supporting significant
tort reform. Defensive medicine whereby doctors have their patients undergo numerous tests,
to avoid being sued, is a national disgrace. So the piety and indignation echoed by obama and
the dems really is disegenuous in the extreme. Where are the statesmen like Moynahan when
you need them. Until serious medical tort reform is enacted this entire excercise is nothing more than a big government grab for control of another major sector of our private economy.
Comment posted July 29, 2009 @ 10:06 pm
Over 200 million americans don't know what they are talking about. Having previously lived in the U.K. for many years I lived under the public option. It was nothing short of disastrous,
average wait for non terminal hospital visits or specialist appointments, 5 months. Do you know anything about healthcare or are you just another pushover for the dems whose only answer to
any problem is more government. More government has given europe an average over the last ten years of approx. 10% unemployment, much lower growth than the US and much higher taxes. However with Obama you will get your wish, much higher taxes, higher unemployment, a shrinking private sector, a lack of incentives for innovation and entrepeneurship, a much bigger and more intrusive government and of course what every honest liberal wants, a guaranteed
equality of outcome and resultant national mediocrity.
Comment posted July 29, 2009 @ 10:07 pm
The US health care system is in such bad shape that any reform at all will be an improvement. I'd personally like to see Congress adopt Obama's whole package, but the important thing is that Congress should do *something* now and break the ice. If there is some progress this time, there will be more next time, and we can hope it won't take another 50 years.
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Comment posted July 30, 2009 @ 3:15 pm
The problem with “Obama's plan” is he hasn't outlined any plan at all. He left it to congress to do the dirty work.
Comment posted July 30, 2009 @ 7:23 pm
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Comment posted July 31, 2009 @ 12:11 am
What is there to stop employers from passing more and more of the cost of private insurance on to the employee thus driving people off of the private plan and onto the gov't plan. So eventually the insurance companies will be run out of business and the entire country will be on the govt plan whether you want to be or not. And Dems point to the need to make a profit doesn't exist for the public plan, that is just going to increase the deficit even more. If I wanted to live in France I would move there.
Comment posted August 6, 2009 @ 1:38 pm
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Comment posted August 4, 2010 @ 3:16 pm
And Dems point to the need to make a profit doesn't exist for the public plan, that is just going to increase the deficit even more. If I wanted to live in France I would move there.
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