Progressive Reactions To The Senate’s Public-Option Compromise
While the Congressional Budget Office reviews the Senate’s new health care reform proposal, the key players are remaining tight-lipped about its details. But news organizations are piecing together from their sources what this public option compromise is beginning to look like.
Dylan Ratigan of MSNBC’s “Morning Meeting” outlined some key components he’s uncovered of the new Senate proposal:
1. Private Health Insurers Offer Non-Profit Plans On Government Exchange:
“It encourages private ensurers to offer non-profit plans that will be negotiated by the federal government, and sold on exchanges that are regulated and run out of Washington. So imagine you’re a for-profit insurance company, now you’re going to be told to run a non-profit insurance plan to compete with yourself.”
2. Trigger Option For Public Plan
“The threat to get them to do this [administer non-profit plans] would be the creation of a government plan which would be a greater threat to obliterate them if they don’t do it, because obviously you don’t want to open a non-profit to compete with yourself unless your only alternative is obliteration.”
3. Expands Medicare / Allows Buy-In
“The deal also lets the uninsured in this country buy into Medicare once they turn 55. […] Reid says there is a public option in there, but many Progressives may disagree with this.”
Here’s some of the initial feedback, thus far, by pro-public option progressives:
THUMBS UP: Howard Dean spoke to the Huffington Post about the new proposal:
The former Vermont governor called the decision to allow consumers between the ages of 55 and 64 to buy Medicare coverage “a big step forward.”
“It opens up Medicare and gives people a real choice,” he said. “And secondly it does something that should have been done the whole way along: instead of creating a new bureaucracy it just uses the one we already have.”
“I’m not a fan of the private market, as you know. However, the private market does work in two countries, Switzerland and the Netherlands, and the way it works is by substantial regulation… If, in fact, this is basically going to be run as if it were the federally employee benefit plan, than this can work. The [Office of Personnel Management] knows how to run this plan and I’ve almost never heard anything bad of the federal employee benefit program.”
“There doesn’t have to be a public option in the bill because I’m some sort of ideological socialist,” he said of his support for a government-run insurance provider. “There had to be a public option because the private sector doesn’t work. And if they can make it work [without a public option], then let’s see.”
“The criteria that I use to evaluate the various proposals is; ‘Is it reform?'” Dean concluded. “And this is reform.”
“I’m disposed towards this,” he said. “It was part of my platform when I ran for president. But look at this. It makes sense. Why have two bureaucracies, including one who hasn’t run this before [the Department of Health and Human Services]… when you can use Medicare?”
THUMBS UP on many aspects of proposal: Senator Bernie Sanders stated last night:
“What you’re looking at is tradeoffs which, in fact, at the end of the day, may be stronger than the very weak public options,” Sen. Bernie Sanders told Rachel Maddow on MSNBC. “The other part of the tradeoff…may also be an expansion of Medicaid. And if you add to Medicaid the development of many new community health centers, you will be providing a lot more health care access to lower income people. If you do an opt-in for people 55 years of age through Medicare, you’re also providing a significant benefit,” Sanders added.
THUMBS DOWN: Senator Russell Feingold issued a statement immediately following the meeting last night:
“While I appreciate the willingness of all parties to engage in good-faith discussions, I do not support proposals that would replace the public option in the bill with a purely private approach,” he said. He added, however, that he will base his vote “on the entirety of what is in the bill, and whether I think the bill is good for Wisconsin.”
THUMBS UP: Senator Rep. Anthony Weiner issued a statement:
“Last night, my Democratic colleagues in the Senate struck a deal that will help us move health care reform forward in the Senate. The details are still sketchy, but there is one remarkable element of the emerging plan: the expansion of the smart single-payer health care plan that serves over 43 million Americans—Medicare.
Extending this successful program to those between 55 and 64, a plan I proposed in July, would be the largest expansion of Medicare in 44 years and would perhaps get us on the path to a single payer model. Medicare provides health care to all Americans over 65 and has an overhead of barely 1 percent. In a debate that hasn’t focused enough on how to genuinely contain costs and deliver affordable health care, this is one idea I like a lot.”
THUMBS UP: Sen. Jay Rockefeller said:
“I’ve got a smile on my face. I don’t smile naturally.”
THUMBS DOWN: Sen. Roland Burris is threatening a filibuster from the left:
“If we have to get 60 and it comes back and it does not have a public option in it, I will not vote for it. It will still take 60 votes to pass it. If we don’t pass a meaningful health care reform bill in this session, we are all going to hang separately,” Burris said. “I’ve listened to my constituents.” He added, “Understand that I have drawn a line in the sand. I’m not much of a dealmaker in this regard.”
Here’s some of the noise emanating from the progressive blogosphere:
THUMBS DOWN: Jame Hamsher of FireDogLake doesn’t like it.
THUMBS DOWN: Markos Moulitsas of Daily Kos doesn’t like it. In responding to an email from Obama, Markos says:
Really? All we have to do is send the DNC $5 and we get ponies? The same DNC that is enabling corporatist Democrats to water down and destroy any hope for health care reform? That DNC?
This is so freakin’ obnoxious I can hardly stand it. We are about to get a turd of a “reform” package, potentially worse than the status quo. We have the insurance industry declaring victory, Republicans cackling with glee, and the administration is using that piece of shit to raise money?
Obama spent all year enabling Max Baucus and Olympia Snowe, and he thinks we’re supposed to get excited about whatever end result we’re about to get, so much so that we’re going to fork over money? Well, it might work with some of you guys, but I’m certainly not biting. In fact, this is insulting, betraying a lack of understanding of just how pissed the base is at this so-called reform. The administration may be happy to declare victory with a mandate that enriches insurance companies, yet creates little incentive to control costs or change the very business practices that have screwed so many people. But I’ll pass.
Democrats are demoralized, and have little incentive to turn out next year. The teabaggers will turn out. If this is how the Obama camp thinks we can energize the base — by promising them a health care pony for $5 to the same Democratic Party that is home to the likes of Baucus, Nelson, Lincoln, Lieberman, and the rest of the obstructionist gang — then we’re in for a world of hurt in 2010.
THUMBS SOMEWHAT UP (over the long haul): Matthew Yglesias writes:
… what the Senate has been negotiating over is the availability of a not-so-hot public option. Still better than nothing, but not transformative, not a game-changer. The Senate’s deal has watered this down even further, involving a sort-of co-op idea plus a triggered public option under circumstances where it’ll be very difficult to ever pull the trigger. Disappointing.
But there’s an important ray of hope here: The compromise will allow people to buy into Medicare. This, in essence, is a version of the original public option idea from before it got watered-down—a nationwide program linked to Medicare. The bad news is that the availability of the buy-in will be limited. People under the age of 55 won’t be able to buy in. And buy-ins will be limited to people on the exchange. As Chris Bowers points out this means the expansion won’t impact very many people “this public option ‘compromise’ would only cover 1.08 million Americans, or only about 25-33% of what the opt-out public option would have done.”
That’s correct. But there’s an important caveat to that. Anything limited to the exchange won’t impact most Americans very much even when reform goes online in 2014. But the exchanges will get much bigger over time. Part of what’s going on in the United States is that the employer-based health insurance system is slowly unraveling. Both the House and Senate versions of reform consist not only of using exchanges to cover the currently uninsured, but also using exchanges to construct a kind of safety net so that as employer-based insurance continues to unravel, people will land softly in exchangeland rather than crashing into the rough ground of the current individual insurance market. The Senate bill will slightly accelerate the decline of employer-based insurance by slowly phasing out the tax subsidy for such insurance. […]
So in addition to pushing for expansion of the buy-in to people outside the exchange, it’s also worth pushing for accelerated opening of the exchange to more-and-more people. In the long run, of course, it’ll also be necessary to fight for further lowering of the age threshold.
RESERVING JUDGMENT FOR NOW: Digby writes:
I believe that had Obama and Reid really been committed to the public option they probably could have found a way to finesse Lieberman long before now. There is no doubt that the only reason Lieberman did this was to fuck the liberals. Hard. It’s obviously become his life’s purpose.
We’ll know details soon. Right now it sounds like everyone is still confused, so there’s no need to get too excited or angry or anything else. Rockefeller’s attitude bodes well. And I saw Bernie Sanders on Maddow and he seemed quite jolly, although he reiterated his pledge to not vote for any bill that didn’t have a public option. So, we’ll see.
THUMBS UP: Ezra Klein writes:
The national non-profits are not exactly like, but not that far from, the compromised public plan in the House version of the bill. They won’t be publicly run, but with the OPM regulating them tightly and carefully choosing which offerings are accepted into the market, the impact might not be that different in practice. They have the advantages of offering a single product nationally and being freed from the profit motive, both of which were key to the theory of the weaker public option. Indeed, they’re like publicly-regulated utilities more than private plans. These look a lot like the semi-private insurers that function well in Germany, Sweden and the Netherlands, among others.
Meanwhile, the Medicare buy-in lets people in the broader insurance market see what national bargaining power can do for individual premiums. Right now, Medicare’s rates are largely hidden, as no one pays the full premiums, and so no one can really compare it to private offerings. But if the premiums become visible, and Medicare’s superior bargaining power is capable of offering rates 20 to 30 percent lower than its private competitors can muster, we’ll see how long it is before representatives begin getting calls from 50-year-olds who’d like the opportunity to exchange money in return for insurance as good as what 55-year-olds can get.
My personal take:
Call me cynical, but the idea of placing perhaps the single most corrupt and immoral industry on the planet — the health insurance industry — in charge of administering non-profit plans is like hiring Pol Pot as bus driver at a private, elite, prep school. And if the Blue Dogs go along with this and sign on, then I’ll have to assume that the health insurance industry has found a way to work around it (i.e. there will be something in the bill that will allow them to base non-profit — probably subsidized — premiums on costs which the industry will be allowed to arbitrarily inflate).
The question that should be getting asked is this: If there are to be non-profit plans on a government exchange (for those who can’t afford health insurance) then wouldn’t Medicare be the most logical choice for administering them, since they are already administering non-profit plans? Since Medicare’s administrative expenses tend to be lower than the health insurance industry’s, it would be cheaper to allow Medicare to administer the plans. It makes no sense to put the corrupt and inefficient health insurance industry in charge of this function, which leads me to believe there’s some kind of fix in the works.
At some point, this cancerous industry wedged between patient and doctor will have to be surgically removed, and the longer it takes for our representatives to confront this reality, the more pain I fear is ahead of us.
THUMBS DOWN: Ed Schultz of MSNBC’s “The Ed Show” is adamantly against this new compromise.
Ed’s guests both give THUMBS DOWN: Editor of The Nation Katrina Vanden Heuvel and former Cigna VP Wendell Potter. See the clip here:
THUMBS UP: Rep. Alan Grayson seems to like the compromise:
Technorati Claim: GRR82NPHT8BW
Breaking News: Sen. Reid On Public Option Negotiations: “We have a broad agreement”
Senate Majority Leader Harry Reid gave a news conference tonight indicating that a compromise of sorts has been reached on the public option between the ten Liberal and Conservative Democrats who’ve been meeting for days to hash something out. He and the ten Senators are for now keeping the details of their agreement under wraps. They first will be submitting the proposals to the Congressional Budget Office to be scored (tomorrow morning).
Here’s are Reid’s remarks, as transcribed by the New York Times:
Thanks everyone, for being patient and waiting for us. It goes without saying that this has been kind of a long journey. We have confronted many hurdles and had to take some big steps and a lot of little steps. But tonight we have overcome a real problem that we have had. I think it’s fair to say that the debate at this stage has been portrayed as a very divisive one and many have assumed that people of different perspectives can’t come together. But I think what we were able to work out the last few days, which culminated tonight belays that fact. We have a broad agreement. Now I know that people are going to ask to be given every detail of this.
I have talked 20 minutes ago to Doug Elmendorf. I told the head of the CBO that we were going to send him something tomorrow that he would have to score and the reason I mention that to you, I also went over in some detail about what we were authorized to say about we are going to send him. We know what we are going to send him, we have to write it up in legislative language. And he said the same as when you sent over your merged bill. We have had a rule here for 40 years or however long we have been in existence, if you start talking about the plan and start shipping it around, it will be made public. And we want that not to be the case because we want to know the score before we start giving all the details even to our own members.
So you are not going to get answers to those questions. I asked Senators Schumer and Pryor to work together with a group of moderates and progressives. Everyone thought it’s an impossible job. But these two fine senators have done an outstanding job of leading these two groups of people. Everyone knows who the 10 are, they have worked very hard for days now. This is a consensus that will help ensure the American people win in a couple of different ways. One, insurance companies will certainly have more competition and two, the American people will certainly have more choices. I already know all 60 senators in my caucus don’t agree on every piece of the merger. I know that we have sent over there to CBO, or will send to them tomorrow, not everyone is going to agree to every piece that we have sent over there. But that doesn’t mean that we disagree on what we sent there.
I applaud and congratulate the 10 senators led by Schumer and Pryor. I think it’s important to mention their names, Brown, Carper, Feingold, Carper, Harkin, Landrieu, Lincoln, Nelson, Rockefeller. As I have indicated, we can’t disclose the details of what we have done, but believe me we have got something that is good and I think is very, for us, it moves this bill way down the road.
Let me just say, we have seen all kinds of articles in newspapers that Senator Schumer, Senator Pryor, I have said things, other parts of the tent, as Elmendorf and I talked tonight, all the things you have read in the newspapers, all the things you have read in the newspapers. The public option is gone. It’s not true. Ok. Everyone understand that. So we are not going into detail. But you have heard to this point, you could be surprised what we’ve sent to CBO.
Here’s an official written statement that Reid’s office released later on the compromise:
I asked Senators Schumer and Pryor to work with some of the most moderate and most progressive members of our diverse caucus, and tonight they have come to a consensus.
It is a consensus that includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices.
I know not all 10 Senators in the room agree on every single detail of this, nor will all 60 members of my caucus. But I know we all appreciate the hard work that these progressives and moderates have done to move this historic debate forward.
I want to thank Senators Schumer, Pryor, Brown, Carper, Feingold, Harkin, Landrieu, Lincoln, Nelson and Rockefeller for working together for the greater good and never losing sight of our shared goal: making it possible for every American to afford to live a healthy life.
As is long-standing practice, we do not disclose details of any proposal before the Congressional Budget Office has a chance to evaluate it. We will wait for that to happen, but in the meantime, tonight we are confident.”
Nancy Pelosi: The Lone Democratic Leader Fighting For Health Care Reform
New estimates from the nonpartisan Congressional Budget Office showed a healthcare overhaul drafted by Democrats would reduce the U.S. budget deficit over 10 years and cost less than $900 billion. Reuters reports that:
[Pelosi] asked CBO to provide estimates on three versions of the [public] option — one based on reimbursement rates paid to healthcare providers under Medicare and two that would rely on reimbursement rates negotiated with the providers.
All three were shown to reduce the annual budget deficit and come in under The President’s goal of $900 billion. Speaker Pelosi is reported to be pushing the Medicare-based public option for passage:
Pelosi (D-Calif.) made it clear in a leadership meeting Tuesday night that she intends for the Medicare-based public option to be included in the final House bill.
She added that passing a strong public option will give the House negotiating leverage in conference negotiations with the Senate.
The Medicare-based plan, called the “robust” option or “Medicare Plus 5” in the jargon that has emerged on Capitol Hill, ties provider reimbursement rates to Medicare, adding 5 percent. That option saves the most money, according to congressional analysts, by competing with those companies and driving down premiums.
Pelosi still hasn’t pulled together the essential 218 votes needed for passage, though she revealed they are close.
So, while President Obama and Senate Majority Leader Reid continue to waffle around on the public option — and, in doing so, display a serious lack of fortitude — their counterpart in the House, Speaker Nancy Pelosi, continues to demonstrate both courage and tenacity. Pelosi has effectively become the lone ‘change agent’ within the Democratic Leadership.
The American people spoke loud and clear in the 2008 elections: they granted the new Democratic President and the two Democratic-controlled Houses of Congress a mandate for change, and it appears that ONLY Nancy Pelosi got their message.
Should a robust public option get passed in a final bill — thereby ensuring real health care reform — Americans will have Nancy Pelosi to thank for it; not “with the help of” the White House, but “in spite of” the White House — who effectively undermined the public option at every turn.
Thank You, Nancy Pelosi, for taking the lead as a real ‘change agent’ when both your male counterparts appear to lack the courage, the conviction — the balls! — to stick out their own necks.
Watch: Nancy Pelosi tells Bloomberg today that she has the 218 necessary votes for a strong public option. She explains why it is essential to any reform bill: