There's good news and bad news today.
First the bad, let's get it over with. That politically smart Rockefeller amendment? The one that would have put Senators on the records as to whether they were willing to limit the profits that the insurance companies could get out of the $465 billion in subsidies this bill is giving to them?
He withdrew it. He said that it was being withdrawn because the CBO hadn't scored it. I suspect the fact that Bingaman spoke in opposition to it, on the grounds that the underlying bill already prohibits the most egregious industry abuses, had more to do with his withdrawing the amendment than the CBO score. So we don't know who on the committee is looking out more for the profits of the health insurance companies than the people they insure. All we know is that Bingaman was willing to be the one to shield his colleagues from having to demonstrate their positions with a vote.
So let's get to the good news, huh? It lies in the plethora of public option "alternatives" that have been bubbling up in the last few days, as Jon at FDL explains:
The fact that White House surrogates keep trying to sell these new "compromises" demonstrates that progressives have successfully entrenched the demand for a public option. Before the fight is finally over, there will be a dozen "compromises" like this from those who are trying to water down the public option and bring it into compliance with White House stakeholder deals. [emphasis mine]
Thanks to the House Progressives, and to an organized and loud external progressive community, the message has finally seemingly gotten through: the bill has to have a public option. Witness today's statement from Harry Reid, that there will be a public option in the bill that goes to the Senate floor. The devil is always in the details when they start talking about the definition of a public option being "relative," but at least we've gotten to the point where they recognize it has to be there. Progress.
Now for the variety of non public option "alternatives" being floated. First there's the one that the quote from Jon is referring to, something that Andy Stern has been pushing with Schumer and Wyden:
"I'm in the fourth way option," Stern said. "If Alabama doesn’t want a public option, they should consider that question. I don’t think the citizens of Alabama will want out. . . . I think we need a public option. I don’t think it needs to be triggered. The question is if there are certain state legislators who think it’s not appropriate for their state, they should have a right in some fashion to deal with it."
That's potentially the "Blue State" option, that would have states opt out of the public option rather than Carper's idea of them opting in. Now, Carper's idea
[I]n its current form, each state would have the option to:
- Participate as grantees in the CO-OP program and apply for seed funding.
- Open up that state’s employee benefits plan.
- Create a state administered health insurance plan with the option of banding together with other states to create a regional insurance compact.
So states could create public options and band together. The problem from Conrad's co-ops still exists--how do you get a pool large enough to effectively compete? Conceivably, you could pull together a region, but that's still going to present a challenge. There are other problems, like putting the onus on state legislatures to act. Jon calls it a trigger for co-ops, and I think he's right in that. It's hard to envision further fragmentation of an already confusing as hell and all over the place system by adding in potentially 50 more as a solution.
Why isn't Carper behind a regular public option (though he did vote for Schumer's level-playing field)? It's a familiar answer: there aren't enough moderate Democratic votes supporting it so I can't be a moderate Democrat voting for it.
Finally, there's the Cantwell amendment that did pass, narrowly.
The amendment creates a "federally funded, non-Medicaid, state plan which combines the innovation and quality of private sector competition with the purchasing power of the states," according to an overview.
It would be available to people with incomes above Medicaid eligibility but below 200 percent of the federal poverty level -- a very narrow window. However, Republicans fear -- and progressives hope -- that once the plan becomes law there will be pressure to expand it.
The plan would not be free. It is based on Washington state's Basic Health plan, which costs roughly 60 dollars a month, with the remainder of the premium subsidized by the state.
This isn't a public option either. It's quite narrow, covering about 75 percent of the currently uninsured. Eleven million uninsured sounds better than 46 million uninsured, but this is incremental, nibbling away at the edges of the problem, not substantive reform. As Jon explains it's not a bad idea in and of itself. It would be an improvement on the current exchange idea, in which the "government defines the basic health care plan which must be covered, and companies mainly compete on price of premiums and provider network." That improvement on the exchange, say coupled with Wyden's Free Choice Act that would open the exchange to everyone, would be helpful.
But it's not a public option. It's not a government provided, managed, and overseen program. And it shouldn't be sold as a public option. We won't buy it.
Finally, there's another state development that made it into the chairman's mark before markup even started, that could be a stealthy Wyden amendment that Ezra calls a state single-payer option:
Essentially, states can ask the federal government for a waiver that allows them to keep the federal funds they're receiving and do pretty much anything they want with them, so long as the coverage they provide is "at least as comprehensive as required under the Chairman’s Mark" and will "lower health care spending growth, improve the delivery system performance, provide affordable choices for all its citizens, expand protections against excessive out-of-pocket spending, provides coverage to the same number of uninsured and not increase the Federal deficit."
That could be used for a public option. But it could also be used for single-payer. The potential problem, as Jon Cohn points out, is that a Republican statehouse could use it to ratchet back coverage in existing public programs. But since the amendment doesn't allow anything to drift beneath the levels envisioned in the bill itself, it's hard to imagine a conservative state using it to be any less generous than the state would otherwise be.
You know, Medicare for all would have been a helluva lot easier. Again, there's potential in this, but it's still giving us an even more fractured system. It and the Cantwell amendment are now in the SFC bill. They are as close to any kind of public option as we're going to get, but they cannot be confused for a true, robust, national public option. The best that we can get? Only if Dems don't accept the fact they have the majority, and if they choose to use it, can do much, much more.