This article is published in partnership with the Media Consortium, of which RH Reality Check is a member organization.
A plan to reform health care that includes a robust public option
would actually cut the deficit, according to preliminary estimates by
the Congressional Budget Office (CBO). For the purposes of this
analysis, a robust public option was defined as one that reimburses
doctors at Medicare rates plus five percent. The latest CBO estimate is
critical for Democrats because President Barack Obama said he wouldn’t
sign a health care bill that adds to the deficit. (There’s a double
standard at work. Health care has to pay for itself or save money. But
as Jo Comerford notes for Democracy Now!, the president has no
compunction about bloating the budget with defense spending.)
As health care reform moves into the closed-door, intra-party
negotiation phase, House of Representatives Speaker Nancy Pelosi is
emerging as a champion of a public option. Pelosi has always said that
she can’t pass a bill without some kind of public plan, though she has
wavered about how tough that plan should be on payouts to providers.
But according to Brian Beutler of TPMDC, yesterday’s “favorable CBO
report seems to have settled all that, and Pelosi’s decided to go all in for a public option.”
And why not? A clear majority of Americans now favor a public option, as John Byrne reports in Raw Story. According to a Washington Post/ABC
News poll published on Tuesday, 57 percent of respondents favor a
public health insurance option to compete with private insurers. That’s
an increase of five percentage points in two months.
Two bills made it out of committee in the Senate, one with a public
option (the Health Education Labor and Pensions Committee’s effort) and
one without (the Senate Finance bill). So, proponents of the public
option are putting pressure on Senate Majority Leader Harry Reid to
include one in the final bill. The Progressive Change Campaign
Committee is running ads in Reid’s district that ask if he’s strong
enough to back a public option. Reid might be more susceptible than
usual to progressive pressure because he’s up for reelection and facing
dismal poll numbers, according to Alex Koppelman in Salon.
The public option has come back from the abyss several times, thanks
to a combination of popular appeal, political courage and determined
progressive activism. But Mike Lillis of the Colorado Independent
argues that Democrats shot themselves in the foot
by taking single payer off the table early on. Single payer health care
would abolish private health insurance and cover everyone through a
Medicare-like system. It would be an easier and cheaper way to achieve
universal coverage than any of the options Congress is considering now,
but it’s an anathema to the insurance industry.
As Lillis observes, a basic principle of negotiation is to ask for
more than you think you’re going to get and negotiate down from there.
But the White House made a point of shooting down single payer in May
and Congressional Democrats held but one hearing on the prospect. Talk
about lousy business skills.
By choosing the public option — not single payer — as
the left-most negotiating point, Democrats left themselves with few
places to go but toward more conservative proposals for insurance
reform, experts say, including the co-op model and a system of
triggering public plans only if private insurers fail to meet certain
cost and coverage targets. In the blood sport of congressional
negotiating — which dictates that you over-ask, and then move
toward your goal during the subsequent bartering — Democrats were
asking merely for the public plan they wanted in the final bill.
While we’re on the subject of preemptive concessions to unreasonable
political parties, Amanda Marcotte of RH Reality Check describes how
Democrats have bent over backwards to accommodate the anti-choice lobby
on funding abortions under a public plan. Democrats have proposed
elaborate bureaucratic workarounds to make sure that abortions are only
covered by private money. Still, anti-choice militants like Michelle
Bachmann (R-MN) are accusing them of backing abortion fieldtrips
for school kids. Speaking of starting high and negotiating downward,
Democrats should threaten to overturn the Hyde Amendment, which bans
the use of federal funds for most abortions. Let’s see what the
anti-choicers are prepared to give up in exchange.
In a sense, it’s reassuring that legislators are taking the public
option seriously enough to argue about how it might pay for abortions.
If they didn’t think we were going to get a public option, it would be
a moot point.
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