Public option
Ezra gets his hands on the outline of the Obama administration's principles for health reform as enumerated in their budget. Stealing from him:
• Guarantee Choice. The plan should provide Americans a choice of health plans and physicians. People will be allowed to keep their own doctor and their employer-based health plan.• Make Health Coverage Affordable. The plan must reduce waste and fraud, high administrative costs, unnecessary tests and services, and other inefficiencies that drive up costs with no added health benefits.
• Protect Families’ Financial Health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness.
• Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking—as well as guarantee access to proven preventive treatments.
• Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions.
• Aim for Universality. The plan must put the United States on a clear path to cover all Americans.
• Improve Patient Safety and Quality Care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology with rigorous privacy protections and the development of data on the effectiveness of medical interventions to improve the quality of care delivered.
• Maintain Long-Term Fiscal Sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue.
Recall that during the campaign, Obama's plan differed from Clinton's and Edwards' in one key way: Though all three plans would have allowed for individuals to buy into Medicare or a similar public option, Obama's lacked a mandate. Like Matt, I think that, on the politics, that was the right way to go. Now, though, Obama's switched his preferences. These principles call for universality, but not for a public option. That seems pretty backwards to me. The mandate should in theory be popular with insurance companies (in fact, it should be non-negotiable for them) and it ought to be used as a bargaining chip so that they can't just put all their efforts into fighting other truly progressive measures like the public option. Handing over the mandate gift at the outset and then hoping they agree to a public option down the line, or after the legislation's been introduced makes things much, much harder.
On this very point, Howard Dean said, "If they are allowed to choose Medicare as an option, this bill will be real health care reform. If they’re not, we will be back fighting about it for another 20 years before somebody tries again. "
Comments
Baucus's plan announced a couple months ago did include a Medicare premium purchase option for everyone 55 and over. Has it been dropped out of the Baucus plan now?
http://healthcare.nationaljournal.com/2008/12/baucus-medicare-proposals.php
It's killing me how they're so willing to throw over the public insurance plan option. It polls brilliantly so there's no political reason. It provides competition for the private insurance companies, who have participated in a clear market failure in its absence, so it makes economic sense. It strengthens "the clear path" to universal coverage. But it makes big donors upset and so it looks like it's being trashed out of the gate. If this were a conversation with one of my activist friends, s/he would be saying that nothing is going to happen without real campaign finance reform and we'd shake our heads sadly, while taking a minute to consider work in other fields.
Democrats have been waiting since Truman to have public health care. The public option is this type of reform. It would create a whole generation of Democratic voters. Without it, Obama is merely setting up a huge regulatory framework that will be a big fun thing for Republicans to tear down. WE NEED PUBLIC BUY IN; THE PUBLIC OPTION DOES THIS.
WHERE IS THE PROGRESSIVE OUTRAGE OVER THIS?
Thanks a lot.
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