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The public option is on life support, and the prognosis is poor

In Washington, it’s what between the lines that counts.
Today is a prime example. The NYTimes’ article on the latest from the White House today was entitled “Obama Overrides Aide on Health Insurance ‘Public Option”.
But reading the article, and talking with folks inside the Beltway reveals a different angle.
President Obama did NOT override his Chief of Staff, but rather reinforced Rahm Emanuel’s Monday statement, where Emanuel stated “‘The goal [of health care legislation] is to have a means and a mechanism to keep the private insurers honest. … The goal is non-negotiable; the path is’ negotiable,” (as reported by The Wall Street Journal)
“Mr. Emanuel said one of several ways to meet Mr. Obama’s goals is a mechanism under which a public plan is introduced only if the marketplace fails to provide sufficient competition on its own”. In his ‘override’, Obama said:
“I am pleased by the progress we’re making on health care reform and still believe, as I’ve said before, that one of the best ways to bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete and keep them honest…[I] look forward to a final product that achieves these very important goals.”
Note the careful parsing of words – the President wants a final product that achieves those goals (cost reduction, choice, quality); Obama does not say the public option is the only way to get us there, but rather “one of the best ways”.
Which means there are other ‘best ways’.
I’m hearing that the public option does not have enough traction in the Senate, and Sen Conrad’s co-op plan is not going anywhere.
The moderate Democrats (Ben Nelson (Neb.), Mary Landrieu (La.) Evan Bayh (Ind.), Blanche Lincoln (Ark.) and Mark Pryor (Ark.)) may be supportive of health reform, but are not enthusiastic about the public plan, and neither is Joe Lieberman (I CT). According to a source familiar with the situation, “[the] Blue dogs have specifically written a letter against a Medicare-like plan. Big issue for them. With everyone focusing on the Senate people are missing the opposition in the House. Pelosi plans to strong-arm. We’ll see…”
But without their support, reform’s chances drop from solid to slim. While some may think the reconciliation process can be used to ram through reform, that may well be a false hope. Again, according to someone knowledgeable about the process; “Reconciliation is not the issue it would seem to be. A Senator can object to any non-budget item in a bill under reconciliation rules as not a budget item. Insurance exchanges, underwriting rules, mandates etc [which are critical to reform] get tossed. This will take at least 60 votes. Moderate Dems are not onside on many of these items.”
While the White House’s plan is to stay out of the public fray, draw no lines in the sand, and do the serious arm-twisting once a bill is on the floor, it’s anyone’s guess as to how a mammoth thousand-page bill will fare. Harry and Louise clones will come out by the dozens, the various interest groups will ramp up their donations, and the longer this takes, the less likely it succeeds.
That leaves us with no health reform, unless Congress decides there is another ‘best way’.
I’ll suggest that Laszewski’s Affordability Model is entering the discussion at the right time.
Because as things look now, without it, or some other mechanism that will address the cost issue while avoiding ideological non-starters, we aren’t going to have reform.

One thought on “The public option is on life support, and the prognosis is poor”

  1. There are moderates in the Senate. Kay Hagan is probably one, even if she is owned by the Blues. Mary Landrieu would be more properly labeled conservative.

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Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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