The not-a-public-option compromise, and beyond
There's a lot left to be decided in health-care reform, or at least there should be. The subsidies could use some help, and the Medicare Commission should be strengthened. The House and Senate need to figure out their revenue measures, and Ken Thorpe is right that more could be done on the delivery side. But whatever issues are left to resolve in the policy, the politics have come down to hammering out a compromise on the public option.
Last week, Harry Reid convened a working group to develop a compromise. Five liberals and five conservatives would attend. Chuck Schumer, Jay Rockefeller, Tom Harkin, Sherrod Brown and Russ Feingold would represent the left. Mark Pryor, Blanche Lincoln, Mary Landrieu, Ben Nelson and Joe Lieberman would speak for the moderates. But Lieberman didn't show up.
With Lieberman's message received (though his staff still attending the meetings), Tom Carper stepped into the process. Lieberman, meanwhile, began attending talks with another group of moderates. This group included Mark Warner, Kay Hagan, Mark Udall, Jeanne Shaheen, Ron Wyden and, over the weekend, Olympia Snowe. Some of these folks support a public option, some don't. The importance was really Snowe and Lieberman in a room together. The bill will need at least one of them in order to pass, and both have stated their firm opposition to a public option of any sort. So the compromise being developed by Reid's group is not a public option.
Currently, insurance plans are regulated by the states, which means they're different in every state. That makes it hard for them to achieve certain efficiencies of scale or maximize their leverage against providers. But back in September, I noticed a promising provision in Max Baucus's draft that would allow for national insurance plans, so long as they met a minimum level of federal regulation. That seemed like a potentially huge change, but I never heard another word about it, so I let it go.
The compromise being discussed is built atop that provision. The idea is that the Office of Personnel Management would choose nonprofit plans that met national standards and offer them on every state exchange (unless states opted out). These plans would be private, but the OPM would act as an aggressive purchaser, ensuring that they met high standards and conducted themselves properly. It's a private option with a public filter, essentially. But more importantly, it's a menu of national, nonprofit plans, which would be much more interesting from a competitive standpoint than state-based, public plans.
But the fact remains that private plans are not public options, no matter how much extra scrutiny they're subjected to. Though the liberals in the room are listening to this compromise, sources close to the discussion tell me that the conversation is opening up beyond the insurance offerings. In other words, the compromise on the public option might end up being more than a compromised public option. This is, in my view, an extremely promising development, and I'll say a bit more on that later today.
Photo credit: William B. Plowman/Associated Press.
December 7, 2009; 8:15 AM ET
Categories: Health Reform
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