Last year I voted for Barack Obama, who proposed a health care plan that had a public option and no individual mandate nad no tax on premiums. He looked like he won the election. But last night, a guy who gave a speech with the skill of Obama laid out Mitt Romney's health care plan, slighly modified with aspects of John McCain's. It's a windfall for the death-by-spreadsheet industry. Maybe the guy on TV was one of those pod people; the Body Snatchers may have taken away Obama. Since the pod person sounded so much like Mitt Romney, I'll call him ORomney. And it was a neat touch of the Rethugs to heckle him, just to make the ruse more credible.
When you boil down what Obama, or whoever that guy was, pushed for last night, it is only bipartisan in the sense that Dorgan and Nelson should like it; otherwise it is comes almost directly from Romney. The lipstick on the pig is very thick but the snout is still a snout. Let's look at the details.
Under Romneycare, which is now in effect in Massachusetts, insurance is sold by private companies. Their price is not regulated. "Competition" is supposed to hold rates down. This doesn't work when demand is forced and the supply is limited. Providers hike prices with reckless abandon and insurance companies either pass it along or don't provide coverage. (That's why rates were hiked 28% this year, the first year after it took full effect.) The good news is to the construction industry: Mass. General Hospital continues to build new towers, as lower-cost community hospitals go out of business.
Check!
Under Romneycare, insurance is still tied to employment. The largest employers negotiate rates and coverage with insurance companies, who negotiate discounts with providers and pass them along to prime accounts like, say, federal employees. Small business either finds a broker to create a group for them, doesn't participate, or goes to the "Connector".
Check!
Under Romneycare, insurance companies give up the right to Just Say No in exchange for the Individual Mandate. You pay a fine if you don't buy private insurance. So sales of policies are up.
Check!
Under Romneycare, the truly poor are still on Medicaid, while the working poor and lower middle class get subsidies via the Commonwealth Care program. That is a separate pool of private insurance where the state pays part of the bill, based on income.
Check!
Under Romneycare, an exchange ("Health Connector") acts as an assigned risk pool, providing insurance to those not covered by group plans and otherwise not offered coverage. This pool is not allowed to deny coverage based on pre-existing conditions, so it's better than what most states have, but the price is set by the insurance companies. Since it is where the high-cost customers go, along with individuals with no other option, prices are 20-40% higher than the already-high rates paid by typical groups.
Half-Check.` ORomneyCare has key differences. The exchange doesn't go into effect for four years. In the interim, it adopts McCain's plan: Ask insurance companies to pretty please create high-deductible "catastrophic" coverage plans (aka Junk Insurance) and ask them to allow everyone to sign up. And it apparently takes one of McCain's other horrible ideas for the long term. It divides the exchange between "normal" customers and a separate "high risk pool". So the normal providers in the exchange can presumably turn you down, but then you can go to the high risk pool and pay maybe $50-100k/year for some kind of coverage. Or pay the $3800 fine, or go to jail. So in this sense, ORomneyCare is well to the right of Romney. Hence the plan is bipartisan: It splits the difference between rival factions of the Rethuglican party.
The Speech that some pod person gave last night talked about a public option, but it was nothing like a Democratic plan, or the one that Barack Obama ran on last year. For one thing, it was set up as a sort of wistful dream, not a necessary part of the plan. For another, it is targeted to reach only 5% of the population, only available through the exchange. The exchange doesn't start up until after the next presidential election. (The Rethugs are already drooling over their obvious ticket: Palin-Wilson.) And then it's only available to the uninsured, so those paying too much today, or small businesses getting raped, are apparently not eligible. And then it isn't based on Medicare, so it will have to "negotiate" rates, but as a small-market-share plan, it won't have much clout. And then it will have to be totally self-financing, keeping rates high. So its main purpose seems to be to distract Democrats who might think that ORomneyCare has something to do with Democratic positions.
But they would be wrong.