For an adminstration whose campaign was famous for being good at strategic jujitsu and the verbal pivot, both HHS Secretary Sebelius and President Obama have been giving the kneejerk, simplistic and wrong answer when asked if "public options" is just a trojan horse to get to "single payer."
Here is an exchange on NPR yesterday:
Can you say flat out it's just never going to be single-payer health insurance, and we're going to try to write it, if we can, so that it won't ever be?
Sebelius: Oh I think that's very much the case, and, again, if you want anybody to convince people of that, talk to the single-payer proponents who are furious that the single-payer idea is not part of the discussion.
Why the onus on public option and single payer? Those are popular with 55-75% support! Meanwhile support insurance companies or Republicans is nil.
Whether you support a strong public options (as President Obama still says he does) or single payer, a stronger rhetorical and negotiating pivot for the administration would be:
"Of course not single payer. Unless of course the private insurance companies fail us all, again!"
PNHP’s Don McCanne suspects that:
The proposal to provide a government-run Medicare-like program as an option for purchase within an insurance exchange of private health plans is vehemently opposed by the insurance industry, the U.S. Chamber of Commerce, the AMA, all Republicans, a large bloc of conservative Democrats, and many others. No amount of negotiation can resuscitate a Medicare-like option. It's dead.
To avoid losing the support of the progressives and many of the moderates in Congress, efforts are being made to create a new private program that has distinguishing features, primarily cosmetic, that will allow them to mislabel it as a public option. The fear of opponents is that this pseudo-public option could later be transformed into a government-run program. Thus it is imperative that the design of the option would lock it up as a private sector model with no possibility of transformation. Without that assurance, the pseudo-public option will have to be eliminated during markup in order to salvage other reform policies. The opponents will never ever sign on to single-payer-in-waiting.
Those in the progressive community who abandoned single payer to support a public Medicare-like option, believing that this was the politically feasible strategy for success, simply haven't been paying attention if they still really believe that a government-run public option can survive. They can keep on wishing, but they would be wise to back up their position by signing Sen. Bernie Sanders' Petition to Congress
Meanwhile, conservative Democrats are selling us out with Republicans in the House and Baucus is doing so in the Senate:
As Mr. Baucus worked to lower the cost, he huddled in his office on Tuesday evening with Senator Charles E. Grassley of Iowa, the senior Republican on the committee, and Senator Michael B. Enzi of Wyoming, the senior Republican on the health panel.
What possible good cam come of DINO Baucus crafting a proposal with Repugs Grassley and Enzie? Is that what we were electing in November 2008?
As Robert Kuttner points out, the devil is in the details and if the proposal does not include at least the strong Medicare-like version of public option, then it will neither control costs nor insure everybody. Kuttner is concerned that a bad reform really would be worse than nothing.
[sinp]
A crucial question is whether the law will include a public, Medicare-style plan. This public plan could be used by people who otherwise lack good insurance, or by employers who conclude that the public plan is a better deal for themselves and their workers.
The public plan would be the gold standard of both good coverage and cost-containment. Without the public option, a system to cover everyone by relying on the existing private insurance industry will realize few cost savings. The result would be increased pressures over time to cut care and shift out-of-pocket costs from insurers to consumers.
The administration's projections have relied heavily on the supposed savings of better use of computerized medical records and an end to the extreme variation on treatment patterns and costs. However, absent a single unified system, or a strong public option, neither better computerization nor voluntary pledges to cuts costs will realize major savings.
In a meeting with Democratic senators midweek, Obama pledged his support for the public option. But given his desire to work with the insurance companies and get some Republican support as well, the real question is whether he will put his prestige on the line to keep the public option in the bill. He pointedly did not say that he'd veto a bill without a public option.
[snip]
The U.S. health care system is the most expensive and least cost-effective in the advanced world mainly because private insurance companies waste about 25 cents on the premium dollar on claims, profits, administration, and marketing. They have no serious financial incentives to emphasize prevention, and every possible incentive to avoid sick people. Doctors and hospitals, meanwhile, make their money from increasing costs.
Other countries get getter results at lower cost because a universal system naturally emphasizes wellness and prevention, and spends its money on the most cost-effective treatments, not the most expensive ones. Every nation faces similar inflationary pressures because of advances in technology and an aging population; but other advanced countries, using single-payer systems, do a fine job of covering everyone for ten percent of GDP or less, while we spend upwards of 15 percent and leave out nearly fifty million souls and under-insure tens of millions more.
[snip]
Not surprisingly, the industry's stance is that any public plan must compete on disadvantageous terms. And most Republicans oppose a public plan outright.
President Obama, the great conciliator, has chosen to work with the private insurance industry rather than targeting it as the primary obstacle to meaningful health reform. Periodic leaks from the White House suggest that if push came to shove, Obama would ditch the public plan in order to get a bill through Congress.
[snip]
However, in the push to get legislation in the face of fierce industry and Republican opposition, a good public plan could well be tossed overboard. That would leave a legacy of expanded coverage, but a time bomb of exploding costs resulting in underinsurance and a squeeze on actual care.
Personally, I would much rather see President Obama going to the country, making clear that the obstacle to real reform is the private health insurance industry, and battling for public health insurance. That, however, is not the president we have. We'll see what kind of public plan, if any, survives.
Meanwhile, whether you see it as the model for a not completely phony public option, or better yet for single payer as an expanded and improved upon version, why don't you join the us in Washington, DC on July 30th for Medicare's 44th Birthday Rally and Lobby Day for Single-Payer Healthcare!