US House of Representative speaker Nancy Pelosi finally unveiled the democratic proposal for health care reform today.
Beside the expected prohibitions against insurance companies refusing to cover pre-existing conditions and canceling coverage when a person needs it the most, it contained language for a public health option, i.e., a government-payer plan similar to Medicare.
However, the “public option” is not the robust plan the most liberal members wanted, i.e., Medicare pay plan plus 5%, in which providers’ only options are to take it or leave it. Nor was it what conservative wanted to see, which is no public option of any kind under any circumstances for any reason. Instead, it was a compromise that is intended to bring the more conservative “blue dog” democrats into the larger democratic fold.
Of course, it is somewhat baffling to consider that most of the folks who hate the mere idea of a public option, where the government is the payer instead of a private, Wall Street listed, for-profit insurance company, are also extremely satisfied with their Medicare coverage. One is reminded of the woman who attended one of the health care reform “town hall meetings” held last August. She shouted out at the congressman at the podium in front of reporters and television cameras that she wanted the government stay out of any health care reform because she absolutely didn’t want the government interfering in any way with her Medicare!
On the other side of the issue, the most liberal of the democrats will be lamenting the demise of the so-called “robust” public option, i.e., Medicare for all. Ostensibly, this “robust” plan would at least be available to those who do not have health insurance, and later possibly to anyone who wanted it. Doctors and other providers would be paid Medicare fees plus 5% for services, period. That would keep the public option costs low and consistent, with no possibility of unusual cost growth.
Well, neither side got their first choice. Instead, a “watered-down” version of the public option, wherein negotiations over pay with providers would be a critical part of the plan, is the way the house leadership intends to go.
The “blue dog” democrats are expected to at least accept this plan because the government would no longer unilaterally control the fees to the providers. Thus, private insurance companies would more easily be able to compete. By requiring negotiations with providers, the plan now starts to look more like the private insurance plans which are currently available to federal employees and retirees under the Federal Employees Health Benefits (FEHB) program, as well as many union-provided plans.
In these plans, premiums go up each year after the government negotiates with the private insurance companies for premium rates. This, in effect, neuters the ability to keep costs low, consistent, and within the rate of inflation because recurring negotiations with providers easily allows for large yearly increases. This year, for instance, premiums are rising as much as 15%, depending upon the plan. And for comparison, the rate of inflation for the past year was negative 1.3 %!
What speaker Pelosi and the house democratic leadership have done is craft a compromise that should bring in the votes necessary to pass health care reform in the House of Representatives. If both the extreme right and the extreme left are dissatisfied, then it must be the most balanced plan that could be achieved. And that’s important, because if the democrats can’t remain united behind the plan, it will fail to pass the house. In that case, the disaster will probably eat up everyone, democrats and republicans alike, and President Obama as well.
If you’re a conservative, you still have a shot having the public option stopped when a similar bill is debated on the senate floor. The senate is much more volatile then the house because the democrats normally only have a tenuous 60-40 margin to stop the promised republican filibuster, and that includes Joe Lieberman, (I-CT), who has already said he will actually join the republican filibuster if a public option is included in the senate bill. That would bring the tally to 59-41, insufficient to stop a filibuster. So it is by no means certain that a public option will survive in the senate’s final version of the bill.
On the other hand, if you’re a liberal, the watered-down version of public option in the house bill may be strengthened during floor debate, and even it isn’t, the separate final bills that pass both the house and the senate have to be reconciled and then re-voted upon before the final version go to the president for signature. So, at this point, it’s still a crap shoot.
As a wise man once said, there are two things most people will never want to watch: How a sausage is made, and how a bill becomes law. Both will disgust and turn your stomach.
C-SPAN, anyone? 🙂