Bipartisanship breaks down over "public option"
The Public Plan Option: Bipartisanship, Or Fear And Loathing?
by Rob Cunningham
Health Affairs Blog
February 5, 2009
The tea leaves say President Barack Obama will do more than pay lip service to bipartisanship, but they don’t say whether others will follow his example.
“I sense a genuine interest in working together on the part of key Republicans in the Congress,” Senate Finance Committee chairman Max Baucus (D-MT) said this week. “They all want to be in on this. There’s a lot of excitement.” To be sure, differences over how to promote effectiveness research or IT will test the commitment of the pragmatic center. But, arguably, where there’s a will there’s a way.
That may not be the case, however, with another critical feature of the Democrats’ reform vision. Jeanne Lambrew, of the White House office of Health Reform, said this week that the administration eventually wants… to create a structured market, or “exchange,” as it is called in the Massachusetts version of universal coverage… and also a “public option.”
The subject of the public option came up frequently in the course of the Feb. 2-3 National Health Policy Conference, sponsored by Health Affairs and AcademyHealth. Whenever it did, old wounds seemed ready to reopen. A Business Roundtable representative asked if administrative costs of the public plan would be subsidized with taxpayer funds, giving it an unfair advantage over private plans. If the market power of the public plan enabled it to force lean reimbursement on providers, as the Medicare and Medicaid programs do, would providers shift costs onto private payers? The public plan idea makes the private sector nervous, said a participant in a workshop on employers’ perspectives on reform. “There’s a lot of concern.”
Republican Hill staffers at the AcademyHealth conference also expressed deep reservations about the public plan option and the related idea of creating a National Health Board to oversee the national exchange and other health-system functions. Ryan Long, minority staffer on the House Energy and Commerce Committee, asked if the public option would mean that everyone in the exchange would end up on Medicaid. Dan Elling, from the House Ways and Means Committee, wondered if the Health Board would constitute “one big HMO.” But Democratic staffers insisted that the public plan option is a must for them.
Lambrew said that details of the administration’s plans aren’t likely to be available for weeks, because work on the stimulus package takes precedence. So the exact shape of this new animal is still somewhat obscure. But fear and loathing of public-sector solutions in health care remains powerful, as it has been for most of the past century. It may be the ultimate test of the new president’s dream of post-partisanship.
http://healthaffairs.org/blog/2009/02/05/the-public-plan-option-bipartisanship-or-fear-and-loathing/
Comment:
By Don McCanne, MD
Well, we are there now. The progressive community had decided that the political barriers that have prevented reform over the past century must be brought down. A solution that would appease the conservative community must leave in place a private market of financing options. The progressives have agreed, and have asked only for one more option - a plan administered by the government.
In this Health Affairs Blog, Rob Cunningham reports on the pulse of the cross section of attendees at the National Health Policy Conference this week. What is clear is that every single detail of The Great Compromise - the public Medicare-like option - will be challenged during the legislative process. It is a fantasy to think that a bipartisan or post-partisan process will ever lead to the enactment of public option that would have any resemblance to the progressive concept of a comprehensive, better-than-Medicare plan with a financing system that would make it affordable for anyone.
Rob Cunningham reports that the mere discussion of such an option created an atmosphere in which “old wounds seemed ready to reopen.” But those wounds have never healed! And they never will.
Removing politics from policy is an impossibility. So are we going to establish battle lines over an emasculated public option that will send us back to our corners to sulk because we failed again? Or are we going to establish those same battle lines over a bona fide single payer national health program? The alignment would be the same, but with the first option, we surrender before the battle has even begun.