One of the objections that opponents of the public option for health care is that "it will never get enough votes in the Senate." The definition of "enough votes" is certainly a malleable one. The Washington punditry informs us it's 60, but it has to be "bipartisan," e.g. half of those votes have to be Republicans. Chuck Grassley says 80.
I have a better proposal. President Obama could implement it with considerably less than 60 votes. He could do it with less than 51 votes in the Senate, less than 41 votes, less than 31 votes. Furthermore, if Obama is reluctant to do this (what I'm proposing is somewhat less than bipartisan), any state governor, the major of a large enough city, or even the CEO of a Fortune 500 company could do this without any advice or consent of the Senate, the House, the media, the insurance industry, or anyone else.
Just what the hell is he talking about, you ask? Read on and be enlightened.
The federal government is the country's largest employer, with something on the order of 1.9 million civilian employees. These employees, like any other employees of a large company (well, most of them, this isn't a diary about WalMart or other revivals of Charles Dickens), have health insurance as a benefit. An employer as large as Uncle Sam funds its own health insurance (the break-even point for a self-funded plan is in the hundreds, not millions of employees). The employee's "insurance carrier" does claims processing, puts you in their network (if it's a PPO or HMO), and otherwise does the paperwork. But they don't do the top plan design -- obviously they have IT-driven limits on what can be done and most employers don't attempt line by line plan design -- and they pay the claims using the employer's dollars.
The mechanics of running this benefit program are part of the executive branch. Therefore, many strategic decisions about Federal health benefits are under President Obama's control -- he can issue an executive order, unless forbidden to do so by statutory law. (Thus, a Federal employee in a same-sex relationship cannot obtain the benefits that my employer and many others would grant to them, thanks to the Defense of Marriage Act and other mindless acts of legislative bigotry. But I digress.)
Like Medicare, Federal employee benefits (the same ones Chuck Grassley and Max Baucus and Kent Conrad get) have an existing infrastructure in place. Unlike Medicate, there is nothing that statutorily prevents the President from extending them.
So President Obama has, available to him without the need for 80, or 60, or 51, or 41, or 31 votes in the Senate, a public option that doesn't require any legislative involvement at all. He simply signs an executive order that allows anyone to buy into Federal health benefits at 102% of the cost for a Federal employee (this is the amount that would be owing to an ex-employee under COBRA). Small businesses and individuals simply sign up and pay their premiums and they're insured. Voila. One executive order that would take a week to draft and the public option is up and running.
He doesn't justify it to anyone. Not to Kent Conrad, not to Tom Daschle (who is on the take from the industry and has no business advising anyone), not Chuck Grassley and Olympia Snowe (who are right wing stooges and have nothing to contribute), not Kent Conrad or Max Baucus (who are on the take from the industry, pure and simple).
But, you ask, what if Obama isn't willing to go the DIY route? Well, there's 50 state governors. Every state employee health plan is large enough to be self-insured and is under the control of the state executive. Once again, one executive order and it's done. It's actually a better deal for a cash-strapped state government. Perhaps 110% of cost instead of COBRA's 102%, and once virtually every private insurance plan in the state is wiped out, some of that income stream is going to augment what is in most states a very precarious revenue situation. Imagine if Jon Corzine did that here in New Jersey: since he'd pick up the NYC metro and Philadelphia markets (at least until NY and PA got wise and implemented their own DIY public option) he'd have a showcase accomplishment to take into his re-election campaign and a much more stable state budget. (UPDATE: when I say 102% I mean 102% of what is paid for a Federal employee, and I mean that before any subsidies that the current debacle of a debate might actually produce. That's a lot less than many private-sector COBRA policies, where COBRA passes on whatever the insurance company ripped off the employer for. For a large group, the typical cost per employee is much smaller than for a small company that can't do a self-funded plan. This isn't clear from my original version of this.)
We don't even need to find one governor to find enough cojones to do this. A large city government or a large corporation could do that, with even fewer controls. Does General Motors want to make a huge step toward fixing their own problems with retiree health insurance? Their CEO doesn't even need to sign an executive order -- they already have a billing infrastructure in place for their COBRA and they could have it up and running in weeks. They don't need to ask anyone's permission.
So Kent Conrad wants to kill the public option by proposing his silly (and self serving) co-op idea? All we need is a President, or if not that, a state governor, or if not that, a big city mayor or Fortune 500 CEO to step up and do it themselves without the help of the Senate Finance Committee or the Washington punditocracy or the health insurance political machine or anyone else.
I know it will never happen, of course. But if the idea even starts getting passed around as a serious possibility, it might scare some Democrats into not caving on the public option.