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Paragraphs That Should Worry Liberals

From Politico's interview with presidential adviser David Axelrod:

On health care, Obama’s willingness to forgo the public option is sure to anger his party’s liberal base. But some administration officials welcome a showdown with liberal lawmakers if they argue they would rather have no health care law than an incremental one. The confrontation would allow Obama to show he is willing to stare down his own party to get things done.

“We have been saying all along that the most important part of this debate is not the public option, but rather ensuring choice and competition,” an aide said. “There are lots of different ways to get there.”


By Ezra Klein  |  September 2, 2009; 11:45 AM ET
Categories:  Health Reform  
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Comments

Good lord, I can just see the commercials for 2010: "After giving away your tax money to big banks, Obama is now *making* you hand over money to insurance companies."

If nothing else, the public option makes a mandate go down a little easier. As a political concern, Axelrod should be a little less dismissive of its political importance...

Posted by: Chris_ | September 2, 2009 12:01 PM | Report abuse

Those paragraphs make me happy.

Posted by: ostap666 | September 2, 2009 12:04 PM | Report abuse

I think it's important to point out that the sexiest part of those 2 paragraphs are not quotes from Axelrod (a senior advisor and no "aide"). Politico has decided that Obama has a willingness to forgo the public option, and that "some administration officials" express this willingness to have a showdown with liberals.

Posted by: Emma6 | September 2, 2009 12:05 PM | Report abuse

It is still too early for Obama to be making these kinds of concessions--it smacks of Sister Souljahing the Left. This sounds like Rahm and his deputy the old Baucus staffer again.

That said, the public option is a means not an end, and it would be ok with me to have a non-profit like Kaiser do the option. If there were 3-4 non-profits like that around the country that would provide a not-for-profit option that had lower administrative costs and economies of scale like in-house effectiveness and prevention research like Kaiser does, that would go a long way. They would have to share their research results with the gov't so they could form the basis of cost saving measures, but they probably do anyway.

Posted by: Mimikatz | September 2, 2009 12:14 PM | Report abuse

I'm fine with the White House and Democrats dropping the public option as long as they have another mechanism in place to rein in escalating health insurance costs. The public insurance option is a surefire way to inject some downward pressure on rising insurance costs. As for regional co-ops, I haven't seen any evidence that they can reduce insurance costs. In fact, Sen. Conrad made that point clear when he said regional co-ops cannot rein in costs but are there to inject competition in the marketplace. http://thinkprogress.org/2009/08/18/conrad-co-op-costs/

On the other hand, if Conrad's idea is expanded to a national/federal scale co-op which by definition would have a huge purchasing pool, then I can see some potential for a federal co-op to eventually driving down costs.

If health insurance was affordable, a lot of uninsured folks would sign up for it. The problem is not the availability of insurance plans. Health insurance on the open marketplace for the average American is very expensive and for the most part is unaffordable. I hope the White House is looking at this from the price perspective and not the availability perspective.

Posted by: jasonr3 | September 2, 2009 12:14 PM | Report abuse

does this count in that "things I say before 25" comment from earlier? If we get to 96-97% covered, reduce insurers profits even futher, regulate insurers more, bring costs down then why is this a bad thing?

Did you not say we should learn from the Nixon/Kennedy situation in the early 70's?

Way to incite a riot Ezra.

Posted by: visionbrkr | September 2, 2009 12:15 PM | Report abuse

Democrats should be worried. No public option means the loss of a massive amount of liberal voters. We are the base and we're beyond tired of being taken for granted.

Posted by: DAinLA | September 2, 2009 12:18 PM | Report abuse

Actually, Emma6, i'm almost certain that Axelrod said it, and asked that it'll be present as some anonymous source. This is how it's usually works.

As for the issue itself, well, Obama always said the same thing: He's like to see a public option, but he won't kill a bill without it.
It's a shame that such a huge majority of Democrats can't do something really good for the people, when Bush didn't have such majority, it he managed to push whatever evil idea Cheney could fart.

Posted by: impikk | September 2, 2009 12:20 PM | Report abuse

I still don't understand why liberals think that the public plan will be able to hold down costs. The public plan being discussed woudl not be allowed to piggy back off of the size of medicare. It would be non-subsizided and have to sustain itself completely off of incoming premiums. There is no requirement that providers that accept medicare also accept the public plan. I just don't at all see where the savings are going to come from.

Posted by: spotatl | September 2, 2009 12:20 PM | Report abuse

impikk - why would Axelrod use the same article that he is quoted in, to say something this provocative, then ask them not to attribute his name or title to the quote, as if people won't figure that it was more than likely him saying the provocative stuff? Also, if the administration wants this "Sista Souljah" moment, why telegraph it, as opposed to just doing it?

It just makes no sense and sounds overly divisive at a time when the Democrats don't need it. This just seems fishy.

Posted by: Emma6 | September 2, 2009 12:26 PM | Report abuse

Currently, it looks like reform will have the following (given Cohn's post about the thoughts of Snowe):

-Subsidies at least up to 300%
-Exchanges that are potentially open to everyone.
-No denial due to pre-existing conditions
-Limiting older premiums to only 2x a younger person's premiums
-A set lower bound on percentage of insurance coverage (probably 65% to 75%)
-The death of Medicare Advantage
-Potentially a non-profit coop plan in the exchange
-Insurance coverage increasing to around 95% of the population
-All this being deficit-neutral

To me, that's a pretty incredible and effective bill. If the left is willing to give all of this up for a slightly different definition of the exchange's non-profit plan, then they have completely lost their mind.

Posted by: mayorm | September 2, 2009 12:31 PM | Report abuse


The people really supporting the public option have done a pretty good job of painting an insurance exchange without a public option as some sort of private insurance wild west. Looking at Medicare Advantage and Medicaid HMO's, this isn't the case as the government can do a pretty solid job of shackling private companies with regulations protecting patients (in Medicare Advantage you've got about 5 levels of appeal for any denial at no cost to you, in Medicaid HMO's, it's as many as 6 levels, up to the [state's] secretary of state) without compromising quality scores or profits (granted, Medicare Advantage is a flawed example of that, but Americhoice - United Healthcare's Medicaid HMO - is their most profitable line of business, and I doubt you'll find anywhere where Medicaid is putting Americhoice out of business).

What a public option does do is help health reform dodge the additional political bullet of getting in the way of plan cost (plan cost is a bit of a crap shoot with no one knowing for sure how the actuarial dust will settle after blending risk pools w/quasi-community rating, as they've seen in Massachusetts). Rather than effectively create a rate-setting structure that is redundnat to lots of state agencies (and probably in conflict with them), it's easier to control costs using market forces.

Posted by: ThomasEN | September 2, 2009 12:32 PM | Report abuse

Obama is claimed to want to avoid the mistakes of the Clinton health care debacle, but one of the worse aspects of the Clinton Fail was constant leaking of non-sourced but damaging crap from the WH staff.

If Obama/Axelrod/Rahm want a war with the progressives/liberals, bring it on.

I'm not aware that football quarterbacks and coaches think it is wise to advertise their game plan in advance of the contest.

Frankly, I'm disgusted with the WH playbook as it seems to be emerging.

Let Obama/Rahm/Axelrod try and win in 2012 with the liberals and independents sitting on their hands. Even Cheney is being rumored as the next GOP POTUS claimant, and if we are going down as a nation, I can't think of a better Captain to be chained to the helm than Cheney.

Posted by: JimPortlandOR | September 2, 2009 12:35 PM | Report abuse

"The confrontation would allow Obama to show he is willing to stare down his own party to get things done."

It would also show his failure to understand how important the government's involvement as a market competitor is. There's a damn good reason that so many are outraged at the prospect of no public option.

Posted by: slantedview | September 2, 2009 12:38 PM | Report abuse

@Jim: "Let Obama/Rahm/Axelrod try and win in 2012 with the liberals and independents sitting on their hands."

They better not be sitting on their hands - this is a once in a lifetime opportunity for a viable new third party to take root.

Posted by: BigTunaTim | September 2, 2009 12:44 PM | Report abuse

IF the Administration explains how they can hold down your insurance costs without a public option, AND they can fit it into one sentence, AND keep it simple simple simple, THEN most of his disaffected supporters plus the independents will jump right back on board, and the Democrats will have an ascendancy in politics lasting a generation or more.

The opinion polls are volatile and many or most respondents are confused. People just want a leader who isn't a liar.

The President should also put in his speech that the taxpayer has made a PROFIT on bailing out the banks, it's in the Wall Street Journal.

Posted by: Lee_A_Arnold | September 2, 2009 12:59 PM | Report abuse

spotatl,

actually HR 3200 that came out of the Energy and Commerce Committee states that the head of HHS would use a floor medicare rates and a ceiling the average of private insurers rates. Which do you think when the choice is up to her (Sebelius) she would do?

Here's directly from HR 3200 page 121.


10 (2) INITIAL PAYMENT RULES.—
11 (A) IN GENERAL.—Except as provided in
12 subparagraph (B) and subsection (b)(1), during
13 Y1, Y2, and Y3, the Secretary shall base the
14 payment rates under this section for services
15 and providers described in paragraph (1) on the
16 payment rates for similar services and providers
17 under parts A and B of Medicare.


Then they go on later to state on page 122:

18 (b) INCENTIVES FOR PARTICIPATING PROVIDERS.—
19 (1) INITIAL INCENTIVE PERIOD.—
20 (A) IN GENERAL.—The Secretary shall
21 provide, in the case of services described in sub22
paragraph (B) furnished during Y1, Y2, and
23 Y3, for payment rates that are 5 percent great24
er than the rates established under subsection
25 (a).

-------------------------

so basically for the first 3 years they'll give providers medicare +5% and then after that they get Medicare rates.

more to follow . . . providers are OPTED into this if they are already medicare particiapting.

Posted by: visionbrkr | September 2, 2009 1:03 PM | Report abuse

@Jim: "Let Obama/Rahm/Axelrod try and win in 2012 with the liberals and independents sitting on their hands."

They'll win in 2012, period. But they can't win in 2010 without the base.

Posted by: rt42 | September 2, 2009 1:04 PM | Report abuse

here's where providers are automatically enrolled in the public option and then have to opt out. I'm sure that'll be easy for them to do, ya right.

Page 124:

124
•HR 3200 IH
1 (3) ESTABLISHMENT OF A PROVIDER NET2
WORK.—Health care providers participating under
3 Medicare are participating providers in the public
4 health insurance option unless they opt out in a
5 process established by the Secretary.

Posted by: visionbrkr | September 2, 2009 1:05 PM | Report abuse


visionbrkr,

worth mentioning that probably 95% of the existing contracts out there between providers and private payers also opt providers into new products at existing rates. This would include future exchange plans and I'm inclined to think of that opt in mechanism, and medicare rate piggbackging, for the public option as a truer 'level playing field'.

Posted by: ThomasEN | September 2, 2009 1:17 PM | Report abuse

ThomasEN,

yes you are correct. many private insurers when they consolidate (ie Aetna with US Healthcare) go by that assumption due to the scale of work necessary to re-credentialize providers and many providers don't like it for just cause as they'd like to know what they're agreeing to before they agree to it. But also when provider's contracts are up with insurers they negotiate those. Medicare doesn't negotiate. That's the difference.

I'm also still searching for the section but in watching on cspan.org i remember seeing that the blue dog deal that was made was that floor/ceiling comparison that I made before and that's why Republicans were against it because it would almost never be the ceiling and always be the floor.


Also exactly how is that medicare rate piggybacking for the public option a truer "level playing field" as you call it? To me that's undercutting price.

Posted by: visionbrkr | September 2, 2009 1:24 PM | Report abuse

visionbrkr- but the point is that I think that providers will all opt out of the public plan- there is no requirement at all they stay in. They accept medicare because of the scale involved- they get paid below market rates but make up for it in volume. There is no similar reason for them to accept the public plan. Any insurance company can mirror medicare rates if they wanted to, its just that no providers would accept them.

Posted by: spotatl | September 2, 2009 1:26 PM | Report abuse

this is a once in a lifetime opportunity for a viable new third party to take root.
That's change I can believe in!

Posted by: obrier2 | September 2, 2009 1:41 PM | Report abuse

spotatl,

I agree and not only that but remember that Medicare is a captive market. Once you reach 65 that's your only option (medicare or medicare advantage). Providers that have patients would risk losing them all (at a time, looking just at cost, that their services cost the most, ie need the most care). So its not just scale but also the type of market medicare is in. Also it will take a good amount of time for providers to opt out and its very difficult and time consuming to opt out of both medciare and each private insurance carrier.

That being said I am fearful (and democrats should be too if they want to be re-elected) of putting together "too good" of a public plan as you say that cuts costs to levels that you get to say 50% provider participation so then what sense would be the public plan if it was unusable or "your doctor wasn't in it?"

Posted by: visionbrkr | September 2, 2009 1:50 PM | Report abuse

I predict 0% chance that things will get any better, and 100% chance that they will make things worse. Congressional libs don't care about the problem -- it's the solution they want: the public option.

They will only pass a non-public-option plan if it is guaranteed not to improve things and jeopardize demand for universal healthcare. No option that might actually fix the broken market has a proverbial snowball's chance.

Posted by: whoisjohngaltcom | September 2, 2009 2:31 PM | Report abuse

"The President should also put in his speech that the taxpayer has made a PROFIT on bailing out the banks, it's in the Wall Street Journal."

Atually, the profit was from just a few banks that have repaid. Most banks have not repaid yet...many billions of this handout will never be repaid....

Posted by: bfh1 | September 2, 2009 3:17 PM | Report abuse

I took time off work, drove to Nevada and walked the poorest neighborhoods in Reno for THIS? All those people in those neighborhoods that never, ever voted (5% turnout in 2004 vs. nearly full before *early* voting was finished? Voters like this turned that somewhat red state into a bluer state than Pennsylvania. And for what?

So that people can be forced to buy insurance policies like they do in Massachusettes from companies they don't even like?

What on earth has happened? I was the biggest apologist and defender of Obama but this is just mind-bogglingly tone deaf. They are betting everything on simply passing a bill that gets everyone covered and not thinking that when everyone still faces the same crap from their insurance companies there will be revolt.

Nobody should forget that catastrophic health care was repealed back in 1990 after initially passing. Different reasons yes --the point is, it's not enough to pass the bill...people are going to have expectations and if it passes, those expectations are going up.

But what will we actually be giving them in terms of improvement?

Please Mr. President, talk to the people you used to talk to when you were a rising star. Stop listening to DC idiots!

Posted by: jdgssf | September 2, 2009 3:26 PM | Report abuse

aaaah, so that's what blue astroturf looks like. nice!

people at some point need to realize that eventually THE BILL COMES DUE and must be paid.

Posted by: visionbrkr | September 2, 2009 4:15 PM | Report abuse

Visionbrkr, you're already paying the bill, that's the problem (apparently the one you're blind to). If you pay $8K/ year for your insurance, $2K is going to the uninsured already; additionally, you're paying tax money for Seniors, those on Medicaid, those at the VA, government employees, soldiers, and lower middle class children through SCHIP.

Posted by: ccs4756 | September 2, 2009 4:22 PM | Report abuse

This actually ties back to a post Ezra made a few days ago....if we got reform that included all the things that are being talked about but no public option, this would still be an incredible piece of legislation and a huge win for the uninsured, the currently uninsurable and a worry if the minds of those with coverage now but harboring the "what if" thoughts.

If the insurance industry can make this work and hold down costs, fine. Remember the bottom line coming in to this deal was universal coverage and cost control. If this does it, great.

If costs continue to behave as they have the last 25 years, then the industry will have failed and we will have to entertain a Plan B. The pressure of these costs on the budgets of families and the government will be too big to not take the next step.

I think we have to remember that reform is a lengthy process and not something that this one bill will fix.

Posted by: scott1959 | September 2, 2009 5:00 PM | Report abuse

*They will only pass a non-public-option plan if it is guaranteed not to improve things and jeopardize demand for universal healthcare.*

If universal health coverage is not achieved, then the issue of a public option is moot-- the bill simply becomes pointless. You seem to be unaware that universal health coverage is what this entire thing is all about.

Posted by: constans | September 2, 2009 5:07 PM | Report abuse

"You seem to be unaware that universal health coverage is what this entire thing is all about."

Considering that 85% already have excellent healthcare, you're going to need a better reason than that to sell it. I've been led to believe that it's going to be "cheaper," "more efficient," "more competitive."

The middle class does not want to give up its insurance just so you can give a big slice of their care to the currently uninsured. It is NOT being sold on universal access, but at least we all agree that that is exactly what it is -- and why real, effective, market-based reforms will not be permitted.

Posted by: whoisjohngaltcom | September 2, 2009 6:53 PM | Report abuse

"They'll win in 2012, period."

ROTFLMAO. You actually believe that??? With a period on it, huh?

Posted by: whoisjohngaltcom | September 2, 2009 6:57 PM | Report abuse

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