Democrats seek compromise on health care plan
By Ricardo Alonso-Zaldivar
The Washington Post
April 2, 2009
Democrats are seeking a compromise on a bigger government role in insurance coverage as part of President Barack Obama’s proposed health care overhaul.
At issue is whether middle-class workers and families should have the option of a government-sponsored plan that would compete with private insurers.
Sen. Charles Schumer, who is working on the issue for the Senate Finance Committee, said Thursday one potential compromise is based on insurance plans that most states already offer their employees. Obama’s health secretary nominee, Kansas Gov. Kathleen Sebelius, likes the idea.
Schumer, D-N.Y., said such a plan would avoid expanding a federal program like Medicare and that a private insurer possibly could run it. Sebelius already administers that type of plan in Kansas.
The insurance lobby fears that a federally backed plan could drive companies out of business.
“We are taking a look at the different state employee plans to get a better understanding of how they operate,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.
GOP lawmakers “are going to need to know what’s in the fine print,” said Craig Orfield, a spokesman for Sen. Mike Enzi, R-Wyo., a leading lawmaker in the debate.
“My goal is to find a plan that would be acceptable to large numbers of senators,” Schumer said in an interview. “Right now, the private insurers are totally opposed, but maybe there’s room.”
In California, the state sponsors three medical network plans for employees and retirees. These plans are offered alongside traditional insurance plans. The state-sponsored plans, administered by Anthem Blue Cross, account for about one-fourth of the 1.3 million people in the state employee health program, said Karen Perkins, a spokeswoman for the California Public Employees Retirement System, known as CalPERS.
The idea of using the state employee plans as a model came last month from two policy experts, Len Nichols and John Bertko.
“We were just trying to avoid nuclear war,” said Nichols, director of health policy for the nonpartisan New America Foundation. “We saw advocates of Medicare for all pushing to put the country into Medicare. And we saw the right using that to push the moderates out of engagement in the health reform debate.”
Schumer said he is looking at Nichols’ idea as a possible compromise and is beginning to sound out other Democrats and policy experts. He has room to maneuver because Obama and many Democrats did not spell out what they mean by a “public” insurance option.
But Schumer said other Democrats insist that option should look like Medicare, in which the government directly sets benefits and payment rates.
Mark McClellan, a health policy expert who ran Medicare under President George W. Bush, said Nichols’ proposal was “well meaning,” but that the government is much bigger than any state, so the effects of a federally backed plan on the insurance market would be far greater.
“At this point, I don’t know many Republicans who are confident a public option could work without making it look like another private sector choice,” said McClellan. “And then what would be the point?”
http://www.washingtonpost.com/wp-dyn/content/article/2009/04/02/AR2009040202804.html
Comment:
By Don McCanne, MD
The progressives in the House of Representatives have stated that they “will only support comprehensive health care reform legislation which includes a public plan option on a level playing field with private health insurance plans.” (http://cpc.grijalva.house.gov/index.cfm?ContentID=351&ParentID=0&SectionID=66&SectionTree=66&lnk=b&ItemID=349)
The Republicans will not support a government-run plan that competes “unfairly” with the private health plans. Specifically, they will not support a Medicare-like option.
But look at the wording of the statement from the Progressive Caucus. The public plan option must be “on a level playing field with the private plans.” The model that meets that definition is a PPO that is sponsored by the government but administered by private insurers, with a firewall separating the PPO from the government. Thus the government option will be simply another PPO, with all of its perverseness, competing in a market of private plans. The line in the sand drawn by the Progressive Caucus was washed away by their carefully worded release.
Mark McClellan has it right. The only hope for gaining the support of Republicans is to make the government option “look like another private sector choice, and then what would be the point?”
With the concession of the progressives, the strategy for a Medicare-like public option has already failed. Moving forward with what amounts to another private PPO with a government seal of approval means that the private insurance industry will maintain control of health care financing for the majority of Americans.
We have in the making yet one more example of where the Republicans will extract enough concessions from the Democrats to ruin the legislation, and then when it comes time to vote, the Republicans will vote against it anyway.
The Democrats have to give up the fantasy of a bipartisan solution since Congressional bipartisanship is a total fiction. The Democrats have to move forward with honest health care reform that works for everyone. They shouldn’t look for help from the party of NO.
