Pelosi's Not-So-Public Option

John Nichols: In The Healthcare Reform Bill, The Compromise Was Even More Than Expected

(The Nation)  John Nichols writes about politics for The Nation magazine as its Washington correspondent.

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The public option was always a compromise for serious supporters of health-care reform, who -- like Barack Obama when he was running for the Senate in 2003 -- knew that a single-payer "Medicare for All" system was what America needed to provide health care to everyone while controlling costs.

But, in the in reform legislation debuted Thursday by House Speaker Nancy Pelosi, the compromise was even more compromised than had been expected.

Pelosi says the legislation is "historic," and celebrates the fact that is does still include a public option -- a component many pundits had said was destined for abandonment. But, while there is a public option, it is anything but robust. Progressives believe Pelosi has bent to far to the right.

And The New York Times suggests as much in its analysis, which declares that:

Under pressure from moderate-to-conservative members of the House Democratic caucus, Speaker Nancy Pelosi has decided to propose a government-run insurance plan that would negotiate rates with doctors and hospitals, rather than using prices set by the government...

Ms. Pelosi said the public plan, which she prefers to call a "consumer option," would compete with private insurers. But the speaker was apparently unable to muster the votes needed for the 'robust' liberal version of a public plan, which she has repeatedly said would save more money for consumers and the government.

Translation: The "public option" Pelosi and her team have proposed a plan that would not make payments for care based on Medicare rates, as the Congressional Progressive Caucus and key Senate Democrats have proposed.
Rather, under the Pelosi plan, the rates be tied to those of the big insurance companies. That's a big, big victory for the insurance industry, as it will undermine the ability of the public option to compete -- and to create pressure for reduced costs."

Pelosi's plan also drops a number of provisions that had been advanced at the committee level to promote consideration of "Medicare for All" models and to allow states to experiment with single-payer plans. That's an especially bitter pill for House progressives, who has won support for state-based experimentation in committee votes.

Groups such as Progressive Democrats of America were quick to raised alarm bells because some of the most innovative responses to the health-care crisis are being forged at the state level. While single-payer proposals are being blocked at the federal level, PDA national director Tim Carpenter says the single-payer fight is ramping up in the states.

Last week, members of the PDA national team traveled to Pennsylvania for a rally at the capital rotunda in Harrisburg, in support of Healthcare for All Pennsylvania and their single-payer bill," notes Carpenter. "The momentum for single-payer healthcare grows daily. It appears Congress will have to be forced to follow the lead of states like Pennsylvania, California, Illinois, Ohio and Massachusetts --- all working to implement single-payer healthcare at the state level.

House progressives were quick to express disappointment, as they were counting on the House to advance a strong alternative to the Senate Democratic leadership's very weak public option proposal -- which would allow states to opt out of the plan.

Reviewing the details of Pelosi's plan in a passionate speech on the House floor, Ohio Congressman Dennis Kucinich, one of the chamber's most ardent advocates for reform asked: "Is this the best we can do? Forcing people to buy private health insurance, guaranteeing at least $50 billion in new business for the insurance companies?

Kucinich continued:

Is this the best we can do? Government negotiates rates which will drive up insurance costs, but the government won't negotiate with the pharmaceutical companies which will drive up pharmaceutical costs.

Is this the best we can do? Only 3 percent of Americans will go to a new public plan, while currently 33 percent of Americans are either uninsured or underinsured?

Is this the best we can do? Eliminating the state single payer option, while forcing most people to buy private insurance.

If this is the best we can do, then our best isn't good enough and we have to ask some hard questions about our political system: such as Health Care or Insurance Care? Government of the people or a government of the corporations.

Congressional Progressive Caucus co-chair Lynn Woolsey, D-California, said she and her allies would continue to battle to muscle-up the public option.
"It's not even the fourth quarter,'' said Woolsey, who noted the public option had only recently been dismissed as dead by many pundits. "We will be insisting on (the option) being as strong as it possibly can be.''

"He needs to hear from us that he needs to support the public option,'' Woolsey told the Los Angeles Times. "He's not saying it loud enough. We want to make sure he lets the Senate know he wants a public option in the bill."
The focus on Obama is appropriate. He has the authority, as a man with a bully pulpit and a veto pen, to tell Pelosi that a soft public option is insufficient. At the same time, he can and should be more involved in challenging the absurd proposals -- advanced by conservative Democrats and moderate Republicans -- for "opt-outs" and "triggers," which threaten to weaken the public option to the point of meaninglessness.

[Ferrell-2]

Medocare for us oldsters is working just fine paying 85% of approved costs with our co-insurance paying most of what Medicare doesn't pay. That works out pretty good for the majority of us seniors and we don't want extreme changes. Bear in mind, I'm not speaking for those not yet eligible for Medicare because they certainly don't consider us in their clamor for single payer health coverage. I, nor any member of Congress, know how all of this is going to play out but the writing is on the wall that senior citizens will be shafted along with our co-insurance companies regardless of what public options are put forth. How else can we feel about this?

[askagain]

Health care reform that doesn't make anyone completely happy. Those who want no change get a watered down public option. Those who want a completely overhauled system get a watered down public option. Sounds like a good compromise to me. Does anyone know how the public option will work? Will it be administered by the government or insurance companies? Will everyone be able to enroll in it or will it be for low income people only? And what will premiums look like? By mandating health coverage for everyone, we will again be spending other people's money whether they want it or not. And will our coverage be improved or weakened when the government determines what our policies will look like. It is Halloween and we have been tricked again.

[rational_1]

"celebrates the fact that is does still include..."

Do these authors even read their own words? Surely CBS can afford a copy editor to read through these articles before they are posted to their website. They seem to be relying on a spell checker. Completely unprofessional and I'm seeing a lot more of this lately.

[askagain]

Here is a tidbit for those who think government does a better job. The State of Virginia announced it is getting rid of its pharmacy for the mentally ill. The pharmacy employs nine people with a payroll of 800,000. It distributes $13,000,000 of medicine per year through various health departments around the state. The state belongs to a consortium which purchases medicines at discounts.

Here is the kicker. Walmart pharmacies and other pharmacies can supply the medicines for less money. So, the state can save $800,000 in payroll and purchase the drugs for less through commercial pharmacies. The only difference is that patients will have to go to pharmacies like the rest of us. This is another example of private enterprise getting the job done for less money.

[rightbehind]

I would rather a good bill fail than have a bad one pass. Tank this weak bill. Give us the robust strong public option or a list of politicians to send packing. I'm happy with either. Too many people have sacrificed to put them back in office. They try to pass garbage and I'll be protesting myself. Might even join the teabaggers. I at least agree with them I don't want my money wasted.

[rightbehind]

Tank it and we get all good democrats to commit to single payer before the 2010 elections. We clean the house and senate and do it right. Get rid of the worthless republican created HMOs. I would prefer the people that provide service to the patient get the good pay rather than an insurance company that provides no service to the patient.

[amc7150]

Pelosi, Reid and Obama have all lied about this health care bill. LIARS, LIARS AND MORE LIARS. Do they think the American people are totally stupid? I hope they all get sick and all the doctor's turn their backs on them. I'm with Wilson, LIAR - LIARS - LIARS. Keep telling everyone you're a Democrat and that you support Pelosi, Reid and Obama - The Dems are from our gifted program - they are very, very educated LIARS.

[bann65]

This SNOB Pelosi has NO IDEA what the American people are about.

[doc_holliday76]

by noloyalisti:
"This watered down junk is a joke and they will have to face the music from the voters."
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While this is definitely "watered down junk," I doubt the corporate America stronghold on the system will endanger any politicians, and only set the health care debacle on its final cruise to failure.

This will change absolutely nothing, costs will continue to rise much faster than the inflation rate, the for-profit insurance industry will continue to cut a fat hog, and the unfunded future liabilities of America like Medicare/Medicaid will eventually make this system fail, in order to create TRUE health care reform down the road!

[rightbehind]

Tank the weak garbage. Get the democrats to commit to single payer and we clean out the rest in 2010. All republicans need to be sent packing along with any yellow dogs that we can find good replacements for.

[doc_holliday76]

Kucinich continued:

Is this the best we can do? Government negotiates rates which will drive up insurance costs, but the government won't negotiate with the pharmaceutical companies which will drive up pharmaceutical costs.

Is this the best we can do? Only 3 percent of Americans will go to a new public plan, while currently 33 percent of Americans are either uninsured or underinsured?

Is this the best we can do? Eliminating the state single payer option, while forcing most people to buy private insurance.

If this is the best we can do, then our best isn't good enough and we have to ask some hard questions about our political system: such as Health Care or Insurance Care? Government of the people or a government of the corporations.
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This is definitely not the best we can do, since $800 Billion in waste, fraud and abuse in a $2.5 Trillion yearly health care debacle, should have been targeted in the first place.

This weak health care "reform" bill will only allow our health care debacle to limp along for a few more years until it completely fails, and then we will see TRUE health care reform.

[brian1920]

Here is a sample of what is in this: Section 2531, entitled ?Medical Liability Alternatives,? establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]?? a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys? fees or imposes caps on damages.

The people writing this bill are criminals including Pelosi.

[noloyalisti]

We see again who actually runs America: big money and big corporation. The rest of us are just their slaves to rape and pillage and steal from. Let's face it.

[rightbehind]

Looks like your right

[noloyalisti]

The Democrats have a clear mandate to dismantle the current failed and corrupt Medicare system. This watered down junk is a joke and they will have to face the music from the voters.

There obviously are not enough liberals and progressive in the party and the big corporations can too easily bribe Congress. We need to change BOTH of those systems ASAP.

[nojoy01]

by noloyalisti October 30, 2009 2:26 PM EDT
The Democrats have a clear mandate to dismantle the current failed and corrupt Medicare system. This watered down junk is a joke and they will have to face the music from the voters.

There obviously are not enough liberals and progressive in the party and the big corporations can too easily bribe Congress. We need to change BOTH of those systems ASAP.
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I'm sorry noloyalisti, but if the "Democrats have a clear mandate to dismantle the current failed and corrupt Medicare system." then obviously you are privy to inside information that the rest of us aren't. Also, you are apparently using a different definition of the political term "mandate" than is generally accepted. During the campaign the President spoke of providing "affordable health care" for all of us. I don't recall one word about dismantling the Medicare system. As for a mandate, winning an election that included a record number of voters going to the poles (125,181,481) by 3.4% (66,862,039 to
58,319,442) does not, as used in political terms, constitute a mandate for anything. It just means that Barack Obama won the election & now gets to TRY and keep his campaign pledges. If it were truly a mandate the thing would have been done & over with months ago. So please stop deluding yourself and/or trying to mislead others by the misuse of the term "mandate" as it applies to political elections. Yours for better, and saner, health care. Nojoy01