I never liked the idea of having to settle for a public plan. Any system designer knows that a centralized, optimized resource controller with no outside inefficiencies (profit motive) will be the most efficient.
I don't like the fact that health insurance companies are being allowed to continue on without a minimum payout rate as a percentage of premiums collected.
I really don't like the idea that certain republican lies have had such an impact on the debate, even after being called out as lies, that they changed the policy discussion.
I don't like republicans who negotiate openly in bad faith consistently reinvited back to the table.
I don't like it, but I could swallow it, come over the fold to see why:
First, the finally revealed Obama plan is only three regulatory elements shy of being a true universal healthcare plan. Those 3 elements are:
- A minimum payout requirement for insurers (ie, 79% of all premiums collected must be paid out in benefits, or paid to escrow).
- Everyone pays the same for a given set of benefits (community rating)
- No one may be turned down from enrollment in any plan, even though enrollment rules may be set up to prevent abusing the system.
Second, I noticed Obama proposed two separate public options in his plan, not just one. There will inevitably be pundits talking about how 'Obama punted on the public plan', making it 'small' and 'four years out'.
Well what is this 'catastrophic high risk pool' except a public plan? Combine that with Obama's promise to use government subsidies to limit the financial impact of being in that pool and you have all of the essential elements of a public plan! And proposed and adopted by John McCain during the primary no less!
I also noticed that Obama referred to having a competetive market as a 'right'.
Third, it was just as interesting to note what little things were left out. I love reading the fine print of speeches like these, carefully calibrated never to lie.
- Obama asserted that the public plan would affect only ~5% of health insurance buyers, or 15 million people. Any health insurer can do the math and see 20 million+ new customers, but...
- Did you hear the careful parsing of the use of the exchange? "If you don't have health insurance through your employer, or don't want it". The exchange, and thus the public option, under the Obama plan, would be open to all Americans!
In short, I think Obama is taking a mulligan here. I'll only give his plan a C+ or a B, but I can still swallow it. What I find as better than the plan itself, is the presentation of the plan. 4 years will be after the next election, and let Obama work on other priorities until then. In 2013, he'll have a fresh legislative battle to fight, assuming he gets reelected, but 4 years is a long time, and if the catastrophic coverage plan is working, it will be so popular he'll be a shoo-in.