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Ditching the Public Option Could Produce a Better Health Care Bill

5 years ago
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It may be too soon to write a requiem for the public option, but I'm going to do it anyway and hope that the Senate fallback is even better: A bunch of creative ideas topped by opening up Medicare to younger Americans.

The public option in the Senate was devolving into a shadow of what I and others had envisioned at the start of the health reform process -- that is, a publicly administered, non-profit insurance plan that would compete with private plans and pressure insurers to keep prices low.

Ezra Klein of The Washington Post lists five compromises under discussion as alternatives to the public option:
-- Allowing people between ages 55 and 65 to buy coverage through Medicare, the federal program for seniors.
-- Expanding Medicaid to cover more poor people.
-- Reviving President Obama's proposal to cap charitable deductions and using the money to expand subsidies to help low- and middle-income people buy health insurance policies.
-- Regulating insurers more tightly, in particular requiring them to use a certain amount of premium money for medical services as opposed to profits, advertising, salaries and administrative costs.
-- Opening up new insurance exchanges, or marketplaces, to more people (current proposals limit them to the uninsured, the self-employed or workers at small businesses).

I would hardly miss the public option if all of those ideas were adopted. They won't be, of course, but I'd settle for three out of five. The Medicare proposal is especially appealing. It is a public option, but people don't need a definition or an inoculation against claims that it's socialism. That's because it's simple and clear and it already exists. Those who have it tend to love it. And it's flexible -- it can always be opened up to include different groups of people if there is a pressing need.

This has been a long journey for me as well as many others. Ten days after the launch of Politics Daily, in one of my maiden columns, I wrote a piece entitled "Private Insurers Should Have To Perform or Perish." The gist was that a government-run alternative would be a moment of truth for insurers and if they couldn't or wouldn't measure up, so be it.

But the continued watering down of the public option proposal has essentially neutered it. People with insurance through their jobs would not have the choice of the public option. The way things have been going, with talk of opt-outs and opt-ins, it would not be available in some states. Rates would not be tied to Medicare, so there would be no price pressure. Still another compromise would involve a "trigger" -- though what exactly would trigger a public option is not clear, nor is what would be triggered. Some triggers involve a national program, but others are limited to state-run programs. The Congressional Budget Office, meanwhile, says only 6 million people would buy the public option currently in the Senate bill -- and they'd probably be among the sickest, so premiums would be higher than private premiums.

I've finally joined the camp of enough already. President Obama seems have been in that camp for a while, and didn't mention a public option in his pep talk to Democratic senators Sunday on Capitol Hill. "The president didn't get into individual amendments -- like he hasn't throughout this process," White House press secretary Robert Gibbs said Monday when asked why Obama didn't raise that issue or abortion.

Asked if the public option issue was too hard, Gibbs said "no" and mentioned the group of 10 Senate Democrats -- a mix of pro and con -- that has been seeking a compromise. "By all accounts those discussions are going well and they are making progress," he added. Should the Senate drop the public option, there will be outrage among many on the left and few ways to neutralize it. The trump card is the Medicare buy-in. So now we cross our fingers and wait.
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