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Obama promises to pursue a public option later

Raul Grivalja, co-chair of the Progressive Caucus, made some waves the other day by suggesting he was leaning against voting for the health-care reform bill. I've stopped covering daily statements like that one, as it's too difficult to figure out whether they mean "I don't want to vote for this bill" or "I want something in exchange for voting for this bill." A statement just released by the Grivalja press office makes this look like a case of the latter:

“The meeting with President Obama today was productive and necessary, and I was glad to hear him speak frankly about where we stand on health care legislation. He said the public option – a well-known and long-standing progressive priority – lacks enough Senate support to be included in the final package. However, he personally committed to pursue a public option after passage of the current bill.

I remain concerned about elements of the bill, but was encouraged by the president’s outreach and interest in a substantive discussion. We agree that expanding health care access and quality, while bringing down costs, is a top priority this year, and I intend to continue playing a constructive role until Congress holds its final vote.”

I've long wondered why Obama didn't promise this a while ago. A bill offering a public option and Medicare buy-in to age 55 would be a popular bill, and a good bill, and could be done after health-care reform had passed. The administration and others like to say that the Senate legislation is just a start, and they should begin acting on that belief. Pass the start, and then begin trying to make it better with smaller, discrete bills that are easier to message and pass.

By Ezra Klein  |  March 4, 2010; 5:46 PM ET
 
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Comments

It is easy for Obama to make sounds about 'later' reforms, but they are just sounds.

Rahm and his 'opponent' policy wonks in the White House will not want to bring up healthcare before the 2012 election, and it won't be pushed by Congress because they are afraid and tired of this healthcare battle. Most of the current reform won't even be in force as activity until after the 2012 elections, although that's not talked about anymore.

It would be a true miracle if a second-term Obama has a stronger progressive Congress than now. Unemployment will still be high, everyone seems to agree, and without more jobs at reasonable living wages, the federal budget will still be in the ER - and Obama says he'll fix that. Fat chance of either the Dems or whiney Repubs agreeing to that.

Talking about things that won't politically be possible is fashionable, but very misleading. What you see (in what may pass this year) is what you get, probably for another generation.

Posted by: JimPortlandOR | March 4, 2010 6:14 PM | Report abuse

JimPortlandOR, I disagree. I think that once HCR passes and Obama isn't seen, throwing sick people out on the street, kicking canes from under seniors, or killing puppies and some of the benefits (end to rescission and preexisting condition exclusion), there will be a desire for more of that. Unfortunately it will be way too late for 2010, when there will be a realignment back to a more repiglican house and senate. Still, there are no repiglicans on the horizon who have a chance at Obama right now.

Posted by: srw3 | March 4, 2010 6:22 PM | Report abuse

I learned first-hand that Raul Grijalva doesn't know the first thing about health care financing when after Scott Brown's victory, the CPC co-chair suggested breaking the bill into pieces.

If Grijalva had half a brain, he could easily list fixes more important than the public option. Here are a few:

1. Subjecting the self-insured to the minimum benefit packages
2. Eliminating the age, smoker, and family structure rating, and move to a solely region-modified community rating
3. Subjecting all insurance markets to the community rating, and making it extremely difficult to self-insure
4. Eliminating the income exemption, and increasing the individual mandate penalty to 5-6 percent AGI (this has to be done for 2 and 3 to work, or too many young, healthy people will be exempt from the mandate and/or choose to go bare)
5. Dramatically increasing the subsidy levels so someone earning less than 200 percent FPL has a 2 percent premium cap for an 80 percent actuarial value policy, someone with a 200-400 percent FPL has a 5 percent premium cap at 80 percent actuarial value, someone earning 300-600 percent FPL has a 10 percent premium cap for an 80 percent actuarial value policy and someone earning 600-800 percent FPL has a 12 percent premium cap for an 80 percent actuarial value policy
6. Getting an employer mandate for all employers -- including those of small businesses -- and require them to contribute a greater percentage of the costs to their employees' health insurance
7. Having a federal Exchange that has the House's Prudent Purchaser language and forbids insurance to be sold outside the Exchange
8. Increasing the minimum actuarial value of the Bronze, Silver, and Gold tiers to 80, 87, and 93 percent, and eliminating the Platinum tiers and "young invincible" policies
9. Limiting cost-sharing by benefit category to +- 5 percent.
10. Eliminating services outside the minimum benefits package from being offered on the Exchange
11. Eliminating the "prevention and wellness" discounts, which unfairly penalize Americans because of their circumstances
12. Having a comparative effectiveness board that has the ability to base payments to providers on comparative effectiveness research
14. Eliminating the Wyden state innovation waiver
15. Getting a good end-of-life care provision

Can Grijalva honestly say that any of these items are more important than the inclusion of a public option?

Posted by: moronjim | March 4, 2010 6:29 PM | Report abuse

I guess now that there is no pressure to court any GOP votes, President can afford to be little bit free in sounding 'more Liberal / Left'.

But White House should be knowing that any such noise above a particular decibel level and then we will have GOP again running the town as 'look, look; we have been telling about the Socialist Agenda of this President'. Agreed that they have been already saying that all along, but giving fresh inputs to that subsided political attack is not needed at this point. Only recently President had a strong rebuttal about 'Socialism' charge and politically it is expensive to get on defensive all the time to refute certain charges. For a starter, time you spending in denying certain charges means time lost in telling people about your vision and so on.

To understand all this power of developing larger narrative, one should read Mark Ambinder's excellent commentary about why White House / President & Dems are in play about HCR. Politics is all about shaping the narrative and after MA lesson, surprise surprise, GOP lost the narrative about HCR despite a strong showing in the health summit.

So Admin would not like to disturb the developing conducive environment by giving a political opening by talking PO which can be ruthlessly exploited in Nov campaign. I would say, still possible, Admin / President stay away from talking PO.

Posted by: umesh409 | March 4, 2010 6:29 PM | Report abuse

Ezra,

Obama's promise will go down in history as the same as Clinton's promise for "side agreements with teeth" in the NAFTA and WTO.

What a crock.

The progressives in Congress need to fight this bill in the reconciliation process. Add the public option and go for it. Blanche Lincoln will even wilt as her challenger proves what people like me have noted all along--even in Arkansas the majority of people support the public option.

Posted by: mitchellfreedman | March 4, 2010 7:26 PM | Report abuse

moronjim,

I'm more sympathetic to the idea of universal healthcare than your average conservative Democrat or Republican, but there is no way most things on that list would ever fly (frankly, I don't think trying to bring back the public option would succeed either). The cost would probably be prohibitive too.


1. Self insured? Does this refer to employers or to people who choose not to buy insurance? Why should we prevent people from choosing what sort of coverage they want?
2. Most people don't want to subsidize people who've made poor choices (smokers).
4. Probably a fair point, if you want an individual mandate to work, it has to be more than a token amount, else you're giving people a cheap option.
5. I'm going to avoid the math to save time/space, but those subsidies at those levels suggest an expectation that cost control fails, and would probably nuke the federal budget. This also inflates the implicit marginal tax problem.
6. On the plus side, an employer mandate would prevent employers from unilaterally dropping health care coverage (since the subsidy for the exchanges far exceeds the tax deduction). On the negative side, this increases the cost of employment and will increase unemployment until inflation sharply reduces real wages.
8/9. Cost sharing isn't a bad thing. If having to pay a co-pay or deductible discourages effective health care purchases, why should I pay for what someone else wouldn't pay for with their own money? Another note, I like being the person paying sometimes. When I'm not paying, I'm not the customer and I'm not likely to get the service I want.
11. No wellness or prevention discounts? Shouldn't people who take care of themselves pay less? I'd be more concerned about people in 'bad circumstances' if they weren't already getting tons of subsidies from the system.
12. CER with ability to reduce payments based on studies? I'd be skeptical that this would get through. Remember the brouhaha over the breast cancer guidelines? Guidelines that didn't even take cost into account, IIRC? Right or wrong, people belief that health care decision making is very patient specific, and payment incentives proposed by the government aren't going to be popular.
14. Why is state innovation bad?
15. End of life care should be self insured. The vast majority of us will need it one day, so it isn't realy an 'insurable' event. If people saved for end of life care, the economy would have more savings to invest - if the government pays for it via pay as you go, those savings won't occur (worse, the government will probably finance it with debt, reducing private sector investment).

Isn't this plan basically single payer made difficult? If all of the above could pass, why not go with single payer?

Or maybe an employer mandate with an automatic enrollment in Medicaid for the unemployed, with those people allowed to buy private coverage as a supplement?

Posted by: justin84 | March 4, 2010 7:40 PM | Report abuse

Sure, Obama will support a public option later. People who believe this probably are naive enough to believe he has kept his promises about being against an individual mandate, taxes on health care benefits and no changes in anyone's current benefits.

Unfortunately Obama is so desperate for a health care bill, nearly any will suffice, he will say and promise almost anything, so he will have something to brag about when he seeks reelection, as well as especially boost his ego.

Posted by: Aprogressiveindependent | March 4, 2010 7:41 PM | Report abuse

And this will survive a filibuster how?

Posted by: bmull | March 4, 2010 8:12 PM | Report abuse

The public option is probably easier to accomplish in 2011 and later if there is a Democratic congress simply because it is popular, saves money and doesn't required either raising taxes or increasing spending.
Those kinds of programs will be gold if the economy recovers enough that we have to go into more full-tilt austerity. There won't be a lot of feel good laws to pass.

As to how to get through a filibuster, sure that won't be easy. On the other hand, medicare expansion to 60 and to other sympathetic groups (state high risk pools?) might quality for reconciliation stand alone, especially as a 2012 campaign plank. Not to be too naive, but I can imagine a grand bargain of managed care Medicare on the exchanges from 50-70 (!) as a deficit measure.

Posted by: windshouter | March 4, 2010 8:40 PM | Report abuse

He hasn't been able to promise a public option in this round because that was the deal to neuter some insurance-hospital-medical opposition. The White House decided that lying to its supporters was a better deal than fighting its enemies. And they've almost lost HCR and will lose in November worse than they would have otherwise because that was a dumb estimate.

It happens.

Posted by: janinsanfran | March 4, 2010 8:42 PM | Report abuse

He didn't do it a while ago because it would have pissed Joe Lieberman off.

Now Lieberman is disposable.

Posted by: pj_camp | March 4, 2010 8:55 PM | Report abuse

Why are these otherwise intelligent and independent adults acting as if they cannot blink without President Obama's help?

If the Democrats held the majorities in the House and the Senate, but not the White House, would these folks need handholding? I don't think so.

It's past time for these Representatives and Senators to take off the training wheels.

Posted by: jade_7243 | March 4, 2010 9:16 PM | Report abuse

Thee idea of adding the public option later actually makes a great deal of sense.

The major strengths of the bill as written now are insurance reforms (ending exclusions for pre-existing conditions, ending lifetime and annual caps on benefits, ending recission) and the increased access for the uninsured. Those reforms should be widely accepted and appreciated once passed (and once the Democrats begin to emphasize what a significant difference they will make to millions of people during their Fall campaigns).

Where the current bill is less strong is in the area of cost controls, so as insurance costs go up over the next year or so, there should be increasing support for enhanced competition. The public option tends to poll the best of all of the proposed reforms anyway, because everybody likes to have "options."

I would have preferred a "robust" public option in the bill already, but I think it also makes a perfectly sensible "phase two" for HCR, to come up after the 2010 elections, and after the public comes to fully understand the initial round of changes.

Posted by: Patrick_M | March 4, 2010 11:23 PM | Report abuse

After the carnage of the 2010 elections, nobody is going to touch healthcare. The Congress will be less D, all the arguments against the current bill will still be in play. Patrick_M, the public has had a long long time to understand what is going to be passed. I can hear it now. Next year, when health premiums and health care costs continue to rise, what will that be attributed too? HCR. True or not it will be an argument that will resonate. And the solution being proposed here is, to paraphrase the Rs, "Let the government run your control your health"? For those that really believe a public option will magically appear in the near future, I got some ocean front propery in Arizona for sale...

Posted by: amaranthpa | March 4, 2010 11:52 PM | Report abuse

I have a question:
Has SNL done a spoof on Nancy Pelosi and Mitch McConnell? and if not, why not?
Because those two are hillarious.

Posted by: phillycomment | March 5, 2010 12:10 AM | Report abuse

"For those that really believe a public option will magically appear in the near future, I got some ocean front propery in Arizona for sale..."

Yeah, that's fine, amaranthpa. I have heard many on your side declare HCR dead and buried at many different steps along the way, and yet somehow the bill keeps advancing.

Time will tell. Social progress on access to health care won't be delayed forever, and this society is decades overdue compared to virtually all other western industrialized nations.

Posted by: Patrick_M | March 5, 2010 12:35 AM | Report abuse

Translation: Once I have squashed the last remnants of free markets from the middle class's healthcare systems by heavy-handed federal regulations designed to eliminate any profit motive, I will push aside the dead caracses of the private insunce companies with the new federally run single-payer system....it'll be great, just like UK's NHS!

Posted by: FastEddieO007 | March 5, 2010 6:36 AM | Report abuse

Fast Eddie, if you had any interest in being honest, you wouldn't conflate the public option with NHS. In no world are they even remotely the same thing. If someone here was talking about single payer we could have a debate about what things the NHS does well and what it doesn't and whether we want to have an NHS-style system.

But nobody's talking about that except you. Stop lying.

Posted by: MosBen | March 5, 2010 7:40 AM | Report abuse

This is pure fantasy. They don't have the votes for a public option now, but somehow after Dems lose votes in the Senate and the House after Nov. (possibly even losing control of the House) they will have the votes for a public option??

Perhaps it's conceivable in Obama's second term. But very doubtful....

And the Medicare buy-in is even less likely. Docs and hospitals will go nuclear at even the hint that this idea is re-emerging. It would mean a significant cut in reimbursement for both group -- just about 0% chance of happening. In fact in the next 10-15 yrs we're more likely to see the Medicare eligibility age increased to make the funding situation better...

Posted by: mbp3 | March 5, 2010 8:27 AM | Report abuse

Obama will "pursue" the government option later. Uh huh. In a Congress with fewer Democrats? And Grivalja professes to believe this? Sure.

Posted by: ostap666 | March 5, 2010 8:33 AM | Report abuse

How would you distinguish a private insurance company that has its rates set by the government, its payouts set by the government, and its costs set by the government from a purely government entity.


The answer: their stationary won't have the "Obama" logo on it (yet).

"Nationalizing" the un-profitable private insurance companies in a few years from now is really just a formality!

This is a SINGLE-PAYER system from Day 1! The Democrats actually are passing a Single-Payer system, except they've managed to disguise the hugest tax increase EVER on the middle class in the form of a mandated premium payment to a private insurance company(which is just a federally-managed holding company for the federal government).

I've got to give Jacob Hacker a lot of credit!!! He really pulled off one of the greatest cons on the American people ever!

Posted by: FastEddieO007 | March 5, 2010 8:35 AM | Report abuse

Yeah right! Just like we'll be out of Iraq this summer, just like holding the banks accountable, just like no mandate and no excise tax. Who's going to believe this?

Posted by: obrier2 | March 5, 2010 8:49 AM | Report abuse

Ah, Ezra, ever the liberal optomist. The Democrats couldn't even get a public option passed when they had their largest majorities in congress in a generation what make you think that after the November elections when at the very least they'll probably barely have a majority that they'll be able to pass it? Obama is just telling liberals what they want to hear and will like most of his promises be thrown to curb when it's convienent for him.

Posted by: RobT1 | March 5, 2010 9:56 AM | Report abuse

FastEddie, you do realize that NHS is *actually* socialized, unlike single-payer. Right?

Here's the difference: when the government provides the service -- that is, employs the doctors, nurses, etc. (like the VA), that's socialized medicine.

When the government pays private organizations to provide the service (like Medicare), that's single payer.

This is neither, because the government option is in competition with private insurers on the same market.

Posted by: rpy1 | March 5, 2010 10:23 AM | Report abuse

Obama PROMISES to work on the public option later. Uh, huh. He already promised us no mandates, and yet forced public funding of the thieves who already bought off Congress is the basis of this “Insurance Industry Profit Protection and Enhancement Act.”

Face it folks, from the bankster bailouts to Obama’s faux health care reform, it’s clear whose side he and most of our Dems are on. Right now progressives are rallying to help Obama force the House to accept the crappy Senate version of the bill. Even MoveOn and other large progressive groups are blindly falling in step with this most recent of Obama’s corporate welfare scheme. The reason Obama wants the House to vote on the Senate bill first is because once it’s passed, progressives CAN’T demand the public option. This is a sneaky way to squash the left’s increasing demand for true reform instead of this wealth distribution corporate welfare scheme.

Our Democrats have given us a false choice. We don’t have to accept this version of the bill or nothing. The Senate bill is exactly what Obama, Republicans and ConservaDems want: No public option, mandates to ensure continued profitability for Big Pharma and the insurers that were already draining the financial life blood out of their current customer base and needed a larger host body, and subsidies from the middle class to the poor(er) to make people think their parasitic insurers are not all that bad.

But we don’t have to fall in line and support this corporatist takeover of healthcare. We can demand the public option right now, before Obama gets the House to give away it’s ability to fix this bill. But to do so we’ll have to demand that no health care bill be passed without the public option. Period.

Posted by: newtc | March 5, 2010 2:12 PM | Report abuse

Are you kidding this is the worst president
since Hoover.For the past year he has done nothing but Lied like Pelosi....can't wait till 2012.


ozziemesa

Posted by: rd62561 | March 5, 2010 3:20 PM | Report abuse

Obama promised to pursue Public Option later. Obama promises don't mean a thing. He has already broken most of his campaign promises so why believe this lie?

Posted by: bobgon3 | March 5, 2010 6:06 PM | Report abuse

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