Monday, September 7, 2009

Is President Obama's Position on Public Plan Really "Unclear"?

MSNBC reports that President Obama's position on having a "public plan" option compete with private insurance remains unclear two days before his speech on healthcare reform. White House political advisor David Axelrod addressed the issue during an interview with the Associated Press (reported by MSNBC):

The president "believes it should be in the plan, and he expects to be in the plan, and that's our position," Axelrod told The Associated Press.

Asked if that means a public plan has to be in the bill for Obama to sign it, Axelrod responded: "I'm not going to deal in hypotheticals. ... He believes it's important."

The president "believes the public option is a good tool," said Axelrod. "It shouldn't define the whole health care debate, however."
White House Press Secretary Robert Gibbs also recently addressed the issue:
[]Gibbs . . . said the president believes a government plan would be "a valuable tool." But Gibbs danced around the question of whether it has to be in the final legislation.

Asked if Obama would sign legislation that lacked a government plan, Gibbs responded: "We're not going to prejudge what the process will be when we sign a bill, which the president expects to do this year."

Asked if Obama would say in his speech that he'd veto a bill without a government plan, Gibbs responded: "Well, I doubt that we're going to get into heavy veto threats on Wednesday."
I am not sure that this position is ambiguous. I think Axelrod and Gibbs are saying that Obama will "support" a public plan option, but that he will sacrifice it in order to pass other components of the legislation.

What Voters Need to Hear About a Public Plan
Voters need an honest discussion of the public plan -- not sensational discourse about socialized medicine and death panels. They need to know how the public plan relates to overall reform objectives (cost savings, expanding access to medicine, etc.). They also need to consider whether and how it will impact the delivery of medicine and whether these changes, if any, are good or bad for patients.

Voters also need to hear realistic opinions regarding the cost of the public option. Although the government certainly would have to fund it initially, the White House says that the plan would become self-sustaining due to premiums paid by policyholders. Republicans actually buttress this assertion when they argue that private insurers cannot compete with a public plan. If the public plan attracts millions of insured individuals from private insurance, then there is a greater chance that premium payments can sustain it.

If the public option does not win support, voters needs to consider whether other aspects of healthcare reform should advance without it. I wonder, for example, whether it is wise or fair to mandate coverage without a viable alternative that reduces the overall cost of health insurance.

What Voters Need to Hear About the Status Quo
If voters are truly worried about fiscal policy, they need to consider the budgetary impact of the status quo. Federal and state governments heavily subsidize "private" employer-sponsored health plans by not treating the benefits to employees as income and allowing employers to deduct contributions as business expenses.

The subsidization of employer health plans, which is the largest of all federal "tax expenditures," substantially reduces tax revenue collected by federal and state governments. The "tax break" is also regressive because a greater percentage of higher income earners have employer-sponsored health plans than low-income workers.

Presently, universal, public plans are available for the elderly (Medicare), the extremely poor (Medicaid), and children in certain households (SCHIP). The government also substantially funds healthcare for workers -- largely those in big companies. I would love to hear a justification for covering or assisting these groups but denying coverage for the 47 million uninsured Americans, who include millions of workers and their children.


Sue said...

Darren I'm trying real hard to not predict what Obama will say Wednesday, but when I listen to all the back and forth I get nervous. I heard this morning that even if there is a public option in the bill it won't come into affect for 3 years. Thats obsurd, I need insurance now and I cannot afford COBRA!

LawMomLaura said...

I attended a town hall meeting organized by a group called "Mad As Hell Doctors". They say that the public option will not come into being for a few years but, more importantly, that it will be a failed-from-its-inception program that will cover only the most ill and will therefore be an experiment that no one will like because it will cost a great deal. Their preferred approach is called "Single Payer" national insurance that covers everyone, private hospitals and clinics and providers, but everyone is in and no one is out. The benefit is that the cost to insure the most ill is offset by the cost to insure the most healthy and youngest, so it is a program that will sustain over the long term.
Unless people go seek out this type of discussion, go with open minds and hear from people in the industry, we will never see meaningful reform in this country.

Sue said...

I agree Laura but isn't single payer a taboo subject and would NEVER get approval from the right?

Aeneas said...

Laura, Sue--I am independant/conservative but I like the single payer system. The trouble is that all trust has been lost both in the ability to create something that is not some kind of lega and legislative monstruosity; and in the motives of the legislature and administration. Now, if a single payer could be created that taps into the private system and keeps the government out of it other than as a regulator (without $$$$$ and a government mega department) and it covers all equally (do away with the gut reaction that seniors will be cut out); and restore trust (silence the fear that if you are a registered Republican, the 'panel' will refuse you treatment; I know, crazy, but that narrative is out there), then you would have the support of the reasonable right and right of the center. You'll never have the support of the fringe, of course. And that goes for both fringes. A tall order? I don't think so. The trouble is the incredible incompetence to deal with such a very important and grave issue. Status quo is not an option. But, the reform proposed now, as it is, it's to tattered and has too many fingerprints on it and too many lies, obfuscation and smoke and mirrors have been used to save it.

We need fresh, simple, understandable and effective. But not until trust is restored.

Aeneas said...

Ooops... end of post I meant to say: both to kill it and save it. Guilty on both sides.

Darren Lenard Hutchinson said...

Sue/LawMomLaura/Aeneas: Single payer is "DOA." Even if it is the best thing (I would love to hear more debate on this), it would never fly. Not now. Not in the near future. The health care system would have to be in a catastrophic state of near-collapse before people would even take the initiative to ignore the fever pitched screams of "socialized medicine."

Darren Lenard Hutchinson said...

Sue: I didn't know it would take three years to launch the public plan -- but I did know it would take more than a year. Sorry about your health insurance situation.

I remember the first time I learned how much health insurance was. I really loved my health plan when I was a clerk for a federal judge. I wanted to keep it when I went into private practice. Under COBRA, I could do this. I asked for the price and it was almost 400 bucks a month -- and this was in the 90s. Plus, I had to answer all of these medical questions, etc. Life is very different with public plans and employer-sponsored, government subsidized plans. As an attorney, I could have afforded it -- but it was not worth the cost. I feel sorry for people who have no other option!

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