Felicia Muftic – Obama gets a grip on health care reform
September 13, 2009
Last Wednesday the president seized the reins of a runaway wagon pulled by a horse team, kicking and nipping one another, and drove it straight down the road just to the left of the median stripe. He was blunt, direct, plain spoken, specific, and passionate in his address to Congress. He successfully appealed to many on the left and middle who voted for him last November. While he did not veer to the left to make the public option the bottom line, he made a strong case for it. He proposed his own plan to provide accessible and affordable insurance to more than 95 percent of Americans, built on top of the chassis of employer-based privately supplied insurance, and he charged Congress to conform their legislation to his preferences.
The government-controlled public option he prefers would be offered alongside private plans in an exchange to provide competition, making private insurers contain costs for a viable appeal to exchange customers. Obama left the door open to alternatives , though they have to provide a better way to contain costs and to provide affordable premiums.
The exchange, similar to what is offered to members of Congress, is the mechanism that would give the currently uninsured and 95 percent of small businesses a menu of affordable insurance policies. Unless a better idea emerges, a public option in some form will remain in his plan.
He promised to veto legislation that would increase the deficit. His price tag: $900 billion over the next 10 years, which costs less than either G.W. Bush’s tax cut to the rich or the Iraq war. Most would be paid for by record-keeping efficiencies, elimination of high administrative costs for Medicare, lower cost drugs for seniors, reduced reliance on expensive emergency room use by the uninsured, premiums paid by exchange customers, penalties for non-participation, and taxes on Cadillac insurance plans. The remainder would require tax increases on the non-middle class.
Obama embraced George W. Bush’s proposal for malpractice tort reform, though “it was no silver bullet,” co-opting one of the Republican’s proposals to contain costs. Another Republican alternative to the public option, improving competition by allowing consumers to buy insurance in other states, is a sound-good idea with severe limitations. A non-competitive oligopoly exists within most states, giving consumers limited choice and high insurance premiums. The reality is that the oligopoly exists nationwide, too. Most of those state insurers are affiliates of or owned by the same few national companies.
Most Republicans now agree with the president about the need for some “market place” reforms of all health insurance, protecting consumers from coverage denial because of pre-existing conditions, dropping insurance on sick patients, lifetime or annual caps and high deductibles and co-pays.
Details of the public option will still be sticking points. The president minimized its impact in four ways:
• Per the Congressional Budget Office, less than 5 percent of the U.S. population would ever choose the public option. • It would not be free: Participants would have to pay premiums similar to the private insurer participants, though low-income consumers would receive subsidies to afford the premiums.
• The public option choice would only be available to those individuals and small businesses who do not have employer insurance or were unemployed.
• Tax credits would be given to businesses to provide employees’ insurance, reducing use of the exchange.
This downplaying of the scope of the public option was Obama’s answer to the “government takeover” fear hype and “socialism” hysteria fomented by the irrational right that was beginning to erode his support in the middle.
However, he has risked ticking off the left by limiting access to the public option.
The President also was open to the “trigger,” another bone for blue dogs and a couple of Republicans to chew on. It is emerging as the most likely compromise. Private insurers who wanted to participate in the exchange and were salivating for access to its 37 million new customers would be given three years to come up with cost-containing insurance plans, or else have to compete with a public option. As John McCain proposed in 2008, pending full implementation of legislation, immediate insurance would be given to the uninsured.
The left may have to swallow the trigger to get blue dog moderate Democrats from purple states on board or they may both face political blowback in the 2010 midterms if their inflexibility kills health reform legislation.
Wednesday night it was obvious that Obama believes he can throw all but a few of the Republicans under the wagon and still get his plan passed and he can give blue dog Democrats confidence they will have enough support from those who voted for him last November to “to shape the future” not to fear it.
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