Two stories on Senate discussions about health care reform suggest that the Senate may not yet be focused on defining the essential components of a public health plan option. They haven’t even publicly defined the relevant goals, so that we can hold them accountable.
First, Ezra Klein reports on Senator Schumer’s comments on Sen. Kent Conrad’s proposal for state/regional cooperatives, which Conrad had proposed as an alternative to a public plan option.
Schumer said Finance Republicans had rejected several proposals designed to beef up the suggested nonprofit insurance co-ops. These included setting up a national structure for the co-ops, $10 billion in government seed money, power to negotiate payment rates to medical providers nationwide and creation of a presidentially appointed board of directors.
Apparently, even these minor adjustments to Conrad’s weak proposal aren’t getting any Republican commitments of support, confirming Krugman’s view (and many others’) that Republicans won’t accept anything that remotely poses a competitive threat to private insurance companies. Is there any point in further discussions with them?
Second, HuffPo’s Ryan Grimm quotes Conrad on whether he’d be amenable to strengthening his co-op concept to accommodate Schumer’s desire for more national presence.
"National structure: I believe to be effective there has to a national entity with state affiliates and those affiliates have to have the ability to regionalize. I think his concern there can be addressed," said Conrad. "Second, he believes there needs to be national purchasing power. I think that’s a good point that the national entity would be able to do purchasing on behalf of the state and regional affiliates and on behalf of the national entity itself."
It seems the two sides are still not even talking about the same concept. Schumer claims to support a national public insurance option that would be subject to the same rules as private plans and thus compete on a "level playing field" with private insurance plans. Conrad hasn’t accepted anything that would pose a significant threat to private plans, but he hints he’s willing to consider giving his co-ops some limited national backing and more funding during start-up.
Recall from my post last week Ezra Klein’s observation that Schumer’s level-field public plan was not just a major compromise from the widely supported single-payer system but a further compromise from a "robust" public plan that would pose a serious challenge to the private insurers.
So when Schumer negotiates with Conrad, we still have a less-than-robust public plan concept being compromised against a non-public plan concept, with the bargaining foundering on the easiest questions of national start-up support. Now that they’ve explored that boundary and determined there’s no there there, it’s time to get back in the right ballpark.
With over 70 percent supporting a public plan, such Senate discussions are now a waste of time. The Republican’s refusal to accept even a strong national co-op concept means they aren’t even in the same ballpark as Democrats pushing genuine reform. Let that be the Republicans’ problem, not ours. (More from Yglesias on related points.)
And Schumer is still trying to define "competition" as something that doesn’t seriously, unduly frighten the private insurance industry. But that was Obama’s point about "keep them honest."
Shielding the highly un-competitive private industry from robust transformative competition should never be the goal of the reform effort. The central point of the competition is to force the private companies to radically alter their egregious behavior towards consumers and health care providers and lower their costs, while giving consumers a better choice if they do not.
Instead, the goal should be to create a public option that is as attractive to consumers, efficient in its operations, and fair to providers, as Congress can make it. Congress should be designing a plan that consumers and providers will actually want to use, and then let the private plans respond if they can to retain their market share.
After decades without meaningful competition or effective oversight, the private sector has become ossified and strongly resistent to reforms, and it’s getting worse. It has become profoundly anti-consumer, at war with both the consumers it works diligently not to cover and the providers it constantly hassles over compensation.
Shaking up that system, forcing it to compete against something better, and keeping it honest, should be the minimum reform conditions Congress imposes on an industry that has simply failed in its primary functions.
If a well designed, efficient and sustainable public plan succeeds in attracting consumers and providers away from the dysfunction private system, the country will be better off. If the private system is capable of responding positively, by substantially improving its services and practices, that too will be progress. But if they can’t improve and thus steadily lose market share to the more attractive public option, then that’s fine too.
Congress’ job is to authorize, fund and create the most attractive, sustainable public plan this country can produce, and then put in place the funding and oversight mechanisms to hold it accountable for doing its job. Then let Americans choose it if they don’t like what they have.
Update: Private insurers oppose public plan competition: Giving Americans a genuine choice is the last thing they’ll agree to, because they think they’ll lose the competition. Their statement reads like a self indictment.



39 Comments







I’m willing to accept a “public Option” although it is distasteful to me.
But if they can’t even come up with THAT after all of our $$$$$$$ they’ve thrown into the bottomless maws of the banks and AIG and foreign banks, I wish they’d just leave the whole thing alone and let what happens, happen.
Even 1-2 trillion for the people over TEN YEARS is NOT that big a deal, the way they throw money to their pals.
After that abortion of the “credit card reform” bill, they better prove they’re fit to drive this cart and pony.
bernie sanders is doing a good job on health care reform. he’s introduced a single payer universal healthcare bill and also a bill to permit 5 states to try single payer based reform.
There was a link to this on Atrios this morning, so maybe the White House is gearing up for a grassroots push. A girl can hope, can’t she?
Mornin’ Scarecrow and Firedogs -
Marion – a friend and co worker was asked to provide her and her family’s healthcare story for that effort. wonder how they got her name ? she hadn’t participated in Obama Campaign or had not commented over at .gov post election site. was it from list of those initially rejected by SS/disability ???
p.s. interesting they seek a two fer from it in that she was queried about and then asked to endorse Sotomayor
Yeah, I was willing to reluctantly get behind Obama’s plan, but if we’re only getting a severely diluted version of an already watered-down plan, it’s just not worth it. Why put all this energy into a seriously flawed plan that’s getting more and more flawed with each passing day?
I think I’m going to start putting my efforts into REAL reform like Bernie Sanders’ proposals.
i wish there had actually been a plan. not that obama should have done it, but someone in congress should have, imo, introduced a plan after consultation with the whitehouse (to make sure it was something like what they were looking for). that way we could have it as a focal point for analysis and organizing (as we have hr 676 for single payer organizing). that doesn’t mean it has to be the final bill, or even a starting point for legislation. but it gives us something concrete to think about.
asking people to get enthusiastic about a plan that doesn’t exist, about analysis that doesn’t exist, etc. is asking too much.
ymmv.
fyi house energy and commerce (waxman’s committee) hearing now in progress: Comprehensive Health Reform Discussion Draft, Day 1
not enough advil in the world….
the more cynical among us would see this as commencement of See-How-Much-$$$-We-Can-Scare-Out-of-the Extractionists Season
lol!
i don’t doubt that’s the case for a few congress critters. i just thought (and keep hoping) that evidence based analysis and looking for the best possible policy would also play a role.
turns out once again, i am not cynical enough — and that scares even me!
i should also say, this is another great post scarecrow. i’d draw a different conclusion re what congress should be working on (single payer v multi payer with public plan), but i’m open to anything that works.
With health care and so many other issues, until we get:
1] New well designed, efficient and sustainable rules for the US Senate to operate by; and,
2] New well designed, efficient and sustainable rules for financing Senate campaigns,
we should expect half-assed half measures that favor the well connected and well heeled.
i can’t listen to the hearing. someone is talking about how we have to deny health care to 80 year olds (just give them hospice) because that’s the way to save money.
damn it. let’s protect people not the insurance industry.
Scarecrow, seriously, you should publish a short book on this. You have it just about written.
Gee, anyone want to venture a guess as to why there is this crap going on.
Hint: Camp Baucus
http://news.yahoo.com/s/cq/200…..ics3147708
wow. see cbl2 @7
JEBUS!
They don’t even CARE that their whoredom is out and obvious!
WAKE THE FUCK UP, AMERICA!!!
This is ridiculous! We all know these people are in the pockets of the insurance cos and that they are greedy (like YOU DiFi)!!! These people need to be eliminated of their health care …
Sen Massa has volunteered to remove himself from this sterling health care, after retiring from the Navy AND battling cancer, what about the rest of you squirming maggots who call yourself “for the People,” huh? Huh?
I have waited for over 5 years trying to get SSD and now I have been informed since all that waiting, appeals, etc., I am past the 8 year limit for people who have worked (I have over 30 years of paying into the System). “Well too bad Lady, now all you would qualify for is SSI, which will bring you 1/2 the income ~ IF we even allow you to collect THAT, which we are fighting like a banchee…”
Sometimes I hate these people!
Cat In Seattle
The Republicans are not the problem; they made this mess, which the Democrats were elected to fix. The problem is the center-right Democrats, starting with Barack Obama, who has not yet entered the fight. He only needs 51 votes in the Senate this time, and if he would fight for good healthcare as hard as he fought to continue funding his escalation in Afghanistan, he’d have no problem getting 51 votes.
What we have here is a senate who is unabashedly, unashamedly working against the majority of American people.
I’m thinkin’ what we NEED to address this situation is some form of a #AmericanElection movement……………….
Take it to the streets if we have to, and definitely continue to move progressives into both congressional houses.
I guess we can all figure out now WHY the 2006 election mandates never happened. It was a perfect set up to blame it all on the rethugs, but democRATS weren’t doing us any good either.
i turned the hearing on again (yes i’m a masochist). stupid congress people don’t know the difference between single payer and single employer.
my head hurts.
It’s impossible to get a senator to understand something when his campaign funding depends on not understanding.
SELISE, if you’re going to do that to yourself, I recommend MORE ALCOHOL.
I don’t drink during the day, but I would if I followed your “routine”….
po thing!
i just used the mute button again. *g*
Protecting corporations’ wealth, not Americans’ health. (The best senate money can buy.)
Is there any point in further discussions with them?
A resounding NO!
Why should the very Corporations that fucked up Health Care have any say in what the people ,70%, want? No the Repukes and their moneyed masters should be just shut out of the system, after all they had their 60 years to get it right but no they let greed guide their business model and look at what we have 47 million with no coverage and no health care until it is so late that the costs hit the ceiling!!
I NO to the Repukes We don’t need them. Let them piss and moan and vote against Single payer and then we pound that fact in every race that the Repukes don’t want you to have good affordable Health care like they get and why MONEY!!
Reccomended!!
We need to create a perception of serious downside risk in opposing the will of the people on this matter. Ads should be going out now, and they should be focused on Democrats only. And we should make it clear that they will be primaried if they oppose the will of the people.
and I’m LOVIN’ mntleo2’s idea!!!
REMOVE THEIR HEALTHCARE, let them fly blind and get routinely ripped off by their good buddies in the insurance industry, LIKE THE REST OF US, and see if THAT produces any results.
meanwhile, they need badly to be fired!
Jane and other progressive bloggers announced the formation of a coalition several months ago. I would encourage her et al to come out now and announce that we are going to be going after these corporatist dems as well as rethugs.
You betcha!!!
They’re ALL THE SAME ANIMAL anyway.
There’s no reason not to go after “rethugs,” but there is no way we are going to get them to change. So, if resources are finite, it’s best to focus them on the centrist Dems who are showing signs of caving. They were elected to fix things. They have to face a primary. And if they last the primary, progressives are not above punishing them by voting for a (shudder) rethug.
i don’t disagree — i just don’t see the resources to do it. i remember how much effort went into challenging joe lieberman in 2006. a national effort and a small state.
I think we have learned a great deal about putting together grass roots organizations.
PUBLIC things are BAD things. Think about them. Public Housing. Public Transit. Public Schools. Do YOU trust your Health Care to PUBLIC DOCTORS? Socialism is socialism no matter how you spell it. It MUST be defeated.
Public schools, public health/CDC, libraries, courts, police, fire departments, sanitation districts, water/electric public utilities, army/navy/marines/air force, coast guard, social security/medicare/medicaid admin/workers; highway/road maintenance; street lighting; uemployment comp, workers’ comp; emergency systems, enviromental standards setting/enforcment/cleanup; food and drug safety inspection/enforement; etc, etc.
If you can go from your home to your supermarket without using the services/things all these public works bring you, you live in another country, or you simply don’t appreciate what all these folks do for you, every day.
Of those, the only things I trust are the Defense systems and police powers of the individual States. Anything else the Federal government does doesn’t work and should be abolished as unconstitutional and violative of the 10th Amendment.
Streets/highways.
Rest areas (God love ‘em!)
Police.
Firemen.
Airports.
Universities.
Libraries.
Plenty of public things are good.
Still, I don’t see “public doctors” on the horizon. Who’s talking about that? The House bill just mentions public insurance and community health clinics. No big takeover of the health industry.
How to make a case for the robust public option the way Paulson did for TARP at cost that is 20% of the Pentagon official annual budget. If the Pentagon were to lose that amount each year, they still wouldn’t drown in a bathtub, I’ll be bound.
Haven’t read the thread above, so don’t know if the principles list is growing, but the Feinstein Nay Saying post today directs us to the Healthcareforamericansnow.org site and at /site/content/what_comprehensive… there is an interesting list of principles for your What Should Public Health Plan Opton Include.
Thanks for continuing the coverage.
Blessings to all,
Isn’t it ironic that the ’small government’ crowd goes on about a lot of things, but never ever criticizes the size of the military, except to say it is too small?