After going to ground following his calamitous prime-time response to President Obama's address to Congress in February, Louisiana Governor Bobby Jindal has stepped back onto the national stage to insert himself in the health care debate. But while his Wall Street Journal op-ed claims to show "how to make health care reform bipartisan," Jindal's simply took a page from Karl Rove's playbook. That includes regurgitating Rove's charge that a public option will lead 100 million Americans to change health plans, a claim Politifact simply deemed, "false."
In his op-ed, Jindal the stimulus foe turned cheerleader recycles all the usual Republican obstructionist health care canards. Despite his untimely past criticism of federal volcano monitoring, Jindal disingenuously compares "government involvement in the delivery of that health care" not to Medicare but to FEMA.) And at the center of his fear-mongering is the specter that Americans will see their health plans change as employer shift to the public option in droves:
"If a so-called public option is part of health-care reform, the Lewin Group study estimates over 100 million Americans may leave private plans for government-run health care. Any government plan will benefit from taxpayer subsidies and be able to operate at a financial loss--competing unfairly in the marketplace until private plans are driven out of business. The government plan will become so large that it will set, rather than negotiate, prices. This will inevitably lead to monopoly, with a resulting threat to the quality of our health care."
"The Lewin Group estimates 70% of people with private insurance -- 120 million Americans -- will quickly lose what they now get from private companies and be forced onto the government-run rolls as businesses decide it is more cost-effective for them to drop coverage. They'd be happy to shift some of the expense -- and all of the administration headaches -- to Washington. And once the private insurance market has been dismantled it will be gone."
Of course, omitted by Jindal and Rove alike are some inconvenient truths about that April analysis by the Lewin Group. First, its study looked at several scenarios for the design of a public option for health. These projected as many as 120 million and as few as 10 million Americans switching plans given the availability of a lower cost government alternative. Importantly, not only did the Lewin scenarios not correspond to any of the legislation supported by either the Obama White House or Democrats in Congress, that 70% figure is based on the public plan enrolling everyone and offering the same fees to providers as Medicare; a proposal being advanced by no one at this time. As Politifact noted:
But there are other ways to set up a public option health care plan. Under the Lewin Group's estimates, if you restrict a Medicare-style public option only to individuals and small businesses, only 32 million would leave private coverage. And if the public option is less like Medicare and competes more like a private insurer, the number drops further.
As Ezra Klein suggested in the Washington Post, the structure of the public option will be a political, economic and policy balancing act. But pointing to a piece at Kaiser Health News, he notes that the various Democratic proposals already envision restrictions on the new insurance exchanges precisely to limit switching from existing plans.
Politically, discouraging switching is important not just because most people likw "what they have, or are at least scared of what they don't know," but because Obama seems committed to building on the current employer-based system. Economically, a structure which creates incentives for significant switching will swell the rolls - and budget - of the taxpayer-subsidized government option, a tricky result to be sure. All of which leads to a policy outcome which, as Klein notes, "preserves the current system." As he concludes:
"From a political perspective, that concession was probably an important, and maybe even an essential, one. But from a policy standpoint, it was a huge concession nevertheless."
While Jindal today claimed tens of millions of Americans "may leave private plans," Rove insisted they would be "forced onto the government-run rolls." And that, PolitiFact concluded, is "wrong."
That's wrong. The report said that people would choose to leave private insurance if given a cheaper option, but the report provided smaller numbers for other options.
The debate in Congress over what a public option will look like is fierce and ongoing. So Rove is picking the worst-case scenario and then distorting the cause and effects. We rate Rove's statement False.
(Interestingly, a variant of this same discussion came up in my recent back-and-forth with ABC's Jake Tapper. I took exception to his article, "President Obama continues questionable 'you can keep your health care' promise," which omitted any data on the current accelerating trend of employers passing costs onto or dropping coverage altogether for their workers. While noting that Obama clarified, "what I'm saying is the government is not going to make you change plans under health reform," Tapper nevertheless concluded by mentioning the Lewin Group's John Sheils, "who estimated that up to 70 percent of those with private insurance would end up on the public plan." For more on our apparent agreement to disagree, here's my original piece, our respective follow up comments at DailyKos and the exchange on Twitter.)
UPDATE: It is worth noting that Lewin Group is a subsidiary of private insurer UnitedHealth. As mysticlaker comments below, the Washington Post today detailed some of UnitedHealth's dubious business practices, including "in January, UnitedHealth agreed to a $50 million settlement with the New York attorney general and a $350 million settlement with the AMA, covering conduct going back as far as 1994." WaPo also notes (as tegrat pointed out) about the Lewin Group forecast for health plan switching that:
The Congressional Budget Office came to a different conclusion, saying that enrollment in the House Democrats' proposed public plan would total about 11 million to 12 million people.