How many public option compromises can dance on the head of a pin?
To add a bit of context to the post below, the public option has already gone through two major sets of compromises. They were:
Separating the public option from Medicare: The Congressional Budget Office projected that pairing the public option with Medicare would save the government more than $100 billion over 10 years. Independent analysts had forecast premiums reductions of 20 to 30 percent for the public option's customers. But Republicans partnered with conservative Democrats to kill this advantage, even in the more-liberal House version of the public option.
Limiting the public option to the exchanges: This happened with somewhat less fanfare, but was similarly significant: It meant the public option would be unavailable to 90 percent of Americans. Over time, it's possible the exchanges could expand, and if they expand, it's possible that individuals will be able to choose the public option (though it's not assured -- the expansion could give employers the power to choose which insurance their employees get from the exchange). But for now, the public option will only be available to a sliver of the market.
And though that brings us up to date on the House bill, the Senate's public option was saddled with an opt-out clause for individual states. But that's not all! Senate leadership is searching around for a public option compromise that can get to 60. For those keeping count, this will be a compromise atop a compromise atop a compromise. Here are the areas being examined:
National or state? A national public option is likely to be a lot stronger than a public option that is run by individual states or triggered into individual states. So there are ongoing discussions about whether the public option will be national or broken up. This gets even trickier in the case of a trigger, as you have to answer whether the trigger calls a national public option or a state public option into existence.
Implementation. Is it available on day one? Or triggered? Can states opt in or opt out? Or do they simply offer the public option, no questions asked?
Funding: In all the public option proposals I know of, the public option is self-funding (i.e., it works off of premium payments). But some conservative Democrats aren't content with that, so they're looking to build a stronger firewall between the public option and federal funds. I don't really understand how this will work.
Governance: In theory, the public option is the "public option" because it's run by the public sector. That is to say, it's run by the government. But the problem some conservative Democrats has is that, well, it's run by the government. Kent Conrad attempted to handle this by founding co-ops. That idea didn't go very far, but now there's talk of something like a national nonprofit that would be founded to run the public option.
It's hard to say, at this point, which of these compromises will enter into the final legislation. Tom Carper, Chuck Schumer, and others are working to figure it out. But the war is being waged on increasingly narrow ground that's getting carved up in increasingly peculiar ways. I don't know if you can get 60 votes for a non-Medicare, exchange-limited, state-based, opt-in, firewalled public option, and it's hard to say whether you should prefer that to a non-Medicare, exchange-limited, national, firewalled nonprofit option. But those are the choices that will dominate the debate for the next few weeks.
December 1, 2009; 6:39 PM ET
Categories: Health Reform
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