It's been an wierd time around DKos lately, at least for me. The apparent capitulation of the veto power to Joe Lieberman left me demoralized and questioning whether our still young President was really tough enough to govern. I have always considered myself a realist and a supporter of the President, most of the time, but I have indulged in emotion for a few days now. Well, enough of that. It's time to ask, rationally and substantively . . .
Is the Senate compromise worth passing on its merits, or not?
I'll get over my disappointment in President Obama, warranted or not, just as I am sure that progressives will get over their schism over health care reform. The irony in all of this is that last year a lot of people wondered if Obama was tough enough to deal with the Republicans, but the Republicans are irrelevant - made so by a combination of ineptitude and lunacy - and so it has turned out that it is really the hydra-headed progressive movement and the various Democratic caucuses that the President must deal with to get anything done. Combine that with the fishbowl that is DC and we get, well we get the current mess. Okay, governing is tough and the President isn't perfect. Some of the shine had to come off the halo at some point, and in any event, I've had all the navel gazing I can stand, so the substantive question is:
Is the Senate compromise worth passing, or not?
Of course getting to the answer begs a second question, is there anyone still willing to ask that first question or have all minds been made up? I suppose at this point I should say this:
If you aren't at least willing to be open-minded about it, either way, then this diary is a waste of time for you. Reading any further will not satisfy any emotional desire to see someone else bash or laud the President. From this point further the diary will discuss only the substance of the Senate compromise on the various and sundry public option alternatives, such as it is. Really. I feel kind of like Grover in The Monster At The End Of The Book, trying to keep you from turning the page. So, seriously, if you're just going for the emotional high at this point, please don't read any further, don't tip, don't rec, and don't comment.
Okay, what do we know about the Senate compromise. Well, the Washington Post has been pretty good at keeping up with developments. On December 7th Ezra Klein blogged about the discussions of a possible compromise between the pro- and anti-public option senators that turned out to be pretty damn accurate. Said Klein:
With Lieberman's message received (though his staff still attending the meetings), Tom Carper stepped into the process. Lieberman, meanwhile, began attending talks with another group of moderates. This group included Mark Warner, Kay Hagan, Mark Udall, Jeanne Shaheen, Ron Wyden and, over the weekend, Olympia Snowe. Some of these folks support a public option, some don't. The importance was really Snowe and Lieberman in a room together. The bill will need at least one of them in order to pass, and both have stated their firm opposition to a public option of any sort. So the compromise being developed by Reid's group is not a public option.
Currently, insurance plans are regulated by the states, which means they're different in every state. That makes it hard for them to achieve certain efficiencies of scale or maximize their leverage against providers. But back in September, I noticed a promising provision in Max Baucus's draft that would allow for national insurance plans, so long as they met a minimum level of federal regulation. That seemed like a potentially huge change, but I never heard another word about it, so I let it go.
The compromise being discussed is built atop that provision. The idea is that the Office of Personnel Management would choose nonprofit plans that met national standards and offer them on every state exchange (unless states opted out). These plans would be private, but the OPM would act as an aggressive purchaser, ensuring that they met high standards and conducted themselves properly. It's a private option with a public filter, essentially. But more importantly, it's a menu of national, nonprofit plans, which would be much more interesting from a competitive standpoint than state-based, public plans.
Two days later, Decemebr 9th, Shailagh Murray and Lori MOntgomery reported for the Post that:
Democratic Senate negotiators struck a tentative agreement Tuesday night to drop the controversial government-run insurance plan from their overhaul of the health-care system, hoping to remove a last major roadblock preventing the bill from moving to a final vote in the chamber.
Under the deal, the government plan preferred by liberals would be replaced with a program that would create several national insurance policies administered by private companies but negotiated by the Office of Personnel Management, which oversees health policies for federal workers. If private firms were unable to deliver acceptable national policies, a government plan would be created.
In addition, people as young as 55 would be permitted to buy into Medicare, the popular federal health program for retirees. And private insurance companies would face stringent new regulations, including a requirement that they spend at least 90 cents of every dollar they collect in premiums on medical services for their customers.
And that was the first compromise, where the Senate bill would drop the public option in favor of the Medicare Buy-In and national insurance plans negotiated by the OPM. Strangely, the blogoshere seemed to focus on the first element, the Medicare Buy-In, and completely ignore the second. But in any event, the idea first noticed by Klein back in September pops up again as part of a compromise to secure passage. (A cynic might wonder if the entire episode were orchestrated by Reid and Baucus, but this diary is intensely focused on the merits of the issue and not the personalities of the key players.)
But the Medicare Buy-In did not please the Party of Joe, with its all-powerful caucus of one, and so a second round of concessions occurred at the behest of President Obama. The Medicare Buy-In was dumped in a shallow grave alongside the Public Option abandoned and victory was declared on December 15th. Said the President after this further compromise:
I am absolutely confident that if the American people know what's in this bill and the Senate knows what's in this bill, it will pass, because it's right for America [...] the final bill won't include everything that everybody wants, [but we] simply cannot allow differences over specific elements of the bill to derail reform. [...] Any fair reading of the bill will show that all the criteria I laid out, before a joint session of Congress, have been met.
The compromise contains all of the elements that the President called for, it is claimed, in his September 9th address to the Joint Session of Congress. Well with respect to public options, Medicare expansions, et cetera, does it? In that address, press coverage of which was dominated by Joe "You LIe" Wilson, President Obama said the following(pay attention to the italics):
So let me set the record straight here. My guiding principle is, and always has been, that consumers do better when there is choice and competition. That's how the market works. [...] And without competition, the price of insurance goes up and quality goes down. And it makes it easier for insurance companies to treat their customers badly -- by cherry-picking the healthiest individuals and trying to drop the sickest, by overcharging small businesses who have no leverage, and by jacking up rates.
[...]
[A]n additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Now, let me be clear. Let me be clear. It would only be an option for those who don't have insurance.
[...]
Now, it is -- it's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight. But its impact shouldn't be exaggerated -- by the left or the right or the media. It is only one part of my plan, and shouldn't be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage available for those without it. The public option -- the public option is only a means to that end -- and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, [Ed.: blech, blargh, puke puke puke] I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.
For example -- for example, some have suggested that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others have proposed a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice.
Well, there's lot there, but a fair reading of that passage of the President's address to Congress basically boils down to the last sentence: "I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice." That choice could be a public option, or a co-op, or "another non-profit entity to adminster the plan". Back in July Presient Obama sent a letter to Senator Baucus and the late-Senator Kennedy outlining his views on how the Senate should progress on debating the various health care reform proposals. That letter included the following passage:
The plans you are discussing embody my core belief that Americans should have better choices for health insurance, building on the principle that if they like the coverage they have now, they can keep it, while seeing their costs lowered as our reforms take hold. But for those who don't have such options, I agree that we should create a health insurance exchange -- a market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for them, in the same way that Members of Congress and their families can. None of these plans should deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs. I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.
President Obama clearly supported the concept of "a public option operating alongside private plans" as integral to creating competition and keeping donward pressure on premiums. (Note that what is referred to is "a" public option, not "the" public option that exists in NoVa Boy's head). Results, however, are what should count. Whether one is disappointed in the President for supporting the compromises that first scuttled any public option, and then the Medicare Buy-In proposal, or whether you saw it coming all along, or whether you think Obama is a really cool dude or a corporate shill, all of that is irrelevant. The question is: Will the OPM negotiated and managed public-private national insurance plan function to create the level of competition needed to achieve the goals of health care reform?
It's hard to tell, actually, because there is damned little to no serious analysis of the proposal. [Admit it, you didn't even know it was in the compromise did you?] Certainly, the Democratic leadership will spin it as being Just As Good AS The Real Thing(tm), but that doesn't make it so. Turning to the Washington Post again, Ed O'Keefe raises some questions, but provides no answers. OPM certainly has a great deal of experience administering such a program for federal employees, but alhough the federal government seems monstrous (in size), it pales in comparison to the tens of millions that might access the new national health insurance plan program. Joe Davidson provides a little more detail but no more answers. Other news reports are less than sanguine, worrying that a vast expansion of its duties would overwhelm the agency. By all accounts, however, OPM is fairly good at what it does. But can it do more?
Frankly, I must admit to being somewhat shocked that there is apparently no objective analysis of whether OPM will be capable of managing the massive effort it will take to administer such a vast new program. On that score the compromise is irresponsible at best. Of course OPM will have until 2014 to work it out, and we know now probably about as much about what this will entail as we did about how the Public Option would have functioned in actuality. On balance I doubt there is a satisfactory answer to the question posed by this diary. We simply have no data, no objective analysis, and indeed no concrete plans on which to base such an analysis. Looking at the state of the senate negotiations dispassionately, it is impossible to tell at this point whether the public-private National Insurance Plan Program will function as effectively as the Public Option or the Medicare Buy-In to engender competition, reduce premiums and help end insurer abuses. The most fair and objective position to take, at this point, therefore, is to pass the bill and see if OPM is up to the job. If not, the Public Option will have to be revisted; of course, it would have been most wise to get committments to do just that before agreeing to the compromise.
So, what do you think? Does anyone have any insight or additional information on the National Insurance Plan Program?