It looks to me like the popular objections to a health care bill being expressed by voters this month are concentrated in two primary areas:
- A concern about “government control of the health care system”—mostly around the public plan option.
- The trillion-dollar cost of a health care bill at a time deficits are swelling and worries about who will really end up paying for it.
As a result of the first concern, we are getting the first indications that some Democratic leaders are ready to ditch the robust Medicare-like public option and are beginning the process of talking the party out of demanding it be included in a health care bill.
This from Politico today:
After the toughest week yet for health reform, leading Democrats are warning that the party likely will have to accept major compromises to get a bill passed this year – perhaps even dropping a proposal to create a government-run plan that is almost an article of faith among some liberals…"Trying to hold the president's feet to the fire is fine, but first we have to win the big argument," former President Bill Clinton said Thursday at the Netroots Nation convention, a gathering of liberal activists and bloggers who will prove most difficult to convince. "I am pleading with you. It is OK with me if you want to keep everybody honest. . . .But try to keep this thing in the lane of getting something done. We need to pass a bill and move this thing forward."
It has been clear to me for months, and I have been saying so on this blog, that the public option has not had the votes even among Democrats to make the finals. With all the heat “a government takeover” of health care has attracted from those at the town hall meetings either the Democrats ditch it or get used to the idea they have no chance of passing health care reform.
Given all of the stridency we have heard from liberals in recent weeks making inclusion of a public plan a litmus test for the minimum health bill they will vote for, it will be interesting to see just how this rolls out.But getting rid of the public option doesn’t make health care reform easy.While there are lots of other issues to sort through, I will suggest that the public’s unease with health care goes beyond the public plan. Voters seem every bit as uncomfortable with the trillion-dollar cost of reform and just how it would be paid for. They just don’t seem to buy the argument that savings from the current system and a tax on someone else will save them from eventually having to pay for it—and I think they are justified in believing that.
With talk about abandoning the public option also comes a discussion about a smaller health care bill that would cost less and just make a down payment on reform—focusing on insurance rules and the insurance exchange.
That is a possibility. However, even that will not be easy.In order to craft an insurance system where pre-existing conditions limits and medial underwriting could be largely or entirely done away with, it would also have to be a fix that got lots of the healthy people to buy coverage. To do that, get a good mix of the sick and the healthy to maintain a viable insurance pool, the subsidies for those now uninsured and unable to afford the thousands of dollars health insurance costs would have to be robust.Those insurance subsidies are what costs so much and make up the better part of the trillion dollar price tag the currentDemocratic health care plans have.So, we can theoretically get rid of the robust Medicare-like public plan option with a stroke of the pen but not the trillion dollar price tag—and with it the voters’ concern about how much a bill costs and who will pay for it.
Robert Laszweski has been a fixture in Washington health policy
circles for the better part of three decades. He currently serves as
the president of Health Policy and Strategy Associates of Alexandria,
Virginia. Before forming HPSA in 1992, Robert served as the COO, Group
Markets, for the Liberty Mutual Insurance Company. You can read more of
his thoughtful analysis of healthcare industry trends at The Health
Policy and Marketplace Blog, where this post first appeared.
More by this author:
- Health Care Reform Coming Out of Senate Finance?
- The Affordability Model
- The Dumbest Thing I Have Ever Seen An Insurance Company Do
- The Biggest Health Care Controversy on the Hill
- Sustainable Health Care Reform
Filed Under: Uncategorized
Tagged: Policy/Politics, Public Option, Reform, Robert Laszewski Aug 18, 2009
Public Option is Competition!!! Cooperatives do not work. Failed in Florida over ten years ago. Public Option will increase competition and price pressure. Come on capitalists — are you afraid it will reduce greed in insurance companies?
Dear President Obama,
Please do not accept a bill that excludes a public option for health care. It is essential that we have a public option to keep the private insurance companies honest and competitive.
Melodie Miller
Voter
It has been interesting listening to the news, US congress, and public outrage about a government run health plan. Knowing most people have known a family member who has been out of work for an extended period of time, denied a needed surgery’s , or just needed comfort care to finish living their last day’s only to be denied. Medical plans help people who have them, and they are not perfect, what is even worse is hearing how people who don’t have medical shouldn’t be covered; everyone could go into a story of how someone they know can’t get treatment. It is also public knowledge on how much Emergency rooms are costing the average tax payer in America because they are being used as doctor’s offices due to the fact they are not allowed to turn anyone away. Yet healthcare is become such a political issue, it is almost as if everyone is scared they are not going to get credit for coming up with the solution; however, they also don’t want to take credit for backing one that isn’t 100% perfect. If congressmen and women would stop putting out false claims on what could happen and trying to scare people into thinking how evil this plan is, a solution could be reached.
It is despicable that anyone on Capitol Hill was voted for; hearing that a public option would ruin private health care was almost laughable if it wasn’t such a dangerous claim. Workers have been told that if there is a public option companies would not get the same discounts and healthcare would go up for both the company and the workers. Here’s a fact if a public option was available and it was so good that the majority a company’s employees switched over, it could save major companies millions, offering a higher net income and possibly higher wages to its employees. Now look at the fact of all the people that get an injury that with proper medical treatment they could go back to work, instead they spend month’s applying for disability, they appealing the initial denial, before finally losing almost everything they own running up countless emergency room visits, and living on welfare before finally getting the treatment they needed to return to work. Of course that doesn’t hurt other American’s right, or is that even more costly than if someone was off work for 6mths got the medical coverage they needed and then became a productive member agian. This also has to make you wonder would it also help social security if so many young Americans did not need to be on disability because they were able to get the medical help, or if people would not need to lose or quit their jobs because they were able to take the time off for medical coverage.
The next point all the fear messages that are being sent out by the media, first the companies are not going to lose money if insurance rates have to go down to compete. Less people will be on disability if they have the medical coverage that will get them treated before they qualify, remember under the current rules you have to be off work for one year before you can even qualify of disability. Also the dreaded public option again if it is cheaper than what you are paying now or the coverage is better, would that really be a bad idea. Many people have lost their own retirement funding because of the 80/20 plans. People would abuse the system, yes in the beginning many people would probably go to the doctor frequently to take care of several issues they have neglected for years, due to not having any coverage. The same is happening at companies that are offering insurance to its employees, those that have had it for a long time don’t need it as often and tend to be healthier because they have used when they needed to, although the ones who have not had it run to the doctors several times a month for the first couple years taking care of everything while it last. That is an all too common factor for people who care about medical, if you have it and it is good coverage eventually you don’t think about it and just use it when you have too. If you have not had it and are grateful for having it you may use it in excess for a while, that does calm down, unless you are a hypochondriac. They are going to be exceptions to every rule that does not mean that the exceptions are the rules and that is what Americans are being told, by employers, and others that thrive on people fears.
In conclusion, while a government run anything may not be the best possible solution, having no solution is even worse, at least with a government run health care system it would open the door for private run insurance companies to relieve some of its burdens and come up with some new innovated ways of doing business. It is often when you see something else done that a new idea may come up, and possibly much better solutions. I have found stats both ways supporting universal health care and against universal health care, I guess it just depends on which opinion I want to have that day. What is pathetic is how American’s continue to die or be out of work because people in the Media and Government can’t come together on what needs to be done and that is getting more people healthcare. I will leave you with one thought, I have an Aunt who has worked for the same place for the last 37 years and does not get health coverage, if she ever retires she will lose her home, not to mention she has now developed a lump on her throat, question is it cancerous or isn’t it? Does it even matter she will worry herself to death wondering because of the lack of treatment and if it is cancerous it will spread too far to be treatable by the time she does get coverage. So she will lose her home, and everything she has spent her life working for all because she can’t afford insurance. Who is going to have to pay for all the medical bills she leaves behind and the foreclosed home, you are that’s who. Makes you wonder if getting people in her situation medical coverage should be a concern, of course she will probably one of them that has to get on disability early and take an even bigger chunk from social security and still we argue and put fear into people just because you have the power to do so. The fact is when this next election happens the public will speak again and let everyone know if health care was an important issue, that is unless of course it gets pushed through now and then the tied can be turned onto a different subject, but make no mistake those that listen to the media and didn’t listen to their own states will not be there for the next health care debate.