Over the last few weeks Jay Rockefeller has emerged as the Senate's most visible spokesman for a public insurance option. And, purely from a public relations standpoint, this is something of a mixed blessing. He comes from West Virginia and is pretty popular there, so that certainly helps bring non-coastal credibility to the cause. But Rockefeller speaks in a plodding, rambling style that doesn't always make for great television. He's also pretty stubborn, which makes him a loud advocate but not necessarily an effective one, at least given the way the U.S. Senate works.
But Rockefeller gets something better than almost anybody I've seen--something he's expressed in interviews and, most recently, during this weeks hearings of the Senate Finance Committee. It's how everyday people, particularly those without a lot of money, interact with the health care system. It's easy to treat health care as an abstraction--to make it all about economic theories and Congressional Budget Office projections. (I'm surely guilty of this myself.) Rockefeller sees it through the eyes of West Virginians making $30,000 a year--people who just want to know they can pay their premiums and that, if they do, the insurance they get will protect them when they get sick.
Rockefeller's ability to channel these feelings may seem odd, given his privileged pedigree. But it makes sense given what he's done with his career. Remember, West Virginia didn't choose him. He chose West Virginia, starting with his service as a VISTA volunteer. He knows his constituents very well. And he acts that way.
You see this in his advocacy for the public plan. The arguments you hear in the debate are mostly about costs, payment rates, and how best to make a market function. But for Rockefeller, it really boils down to a simple proposition: A public plan is good because you know it will always be there for you.
The government isn't going to point to an obscure provision on page 152 of your manual and deny you essential services. The government isn't going to comb through your medical records and decide that, having taken your premiums for several months, you're not eligible for coverage after all. The government isn't going to stop offering coverage next year because it can't make a profit big enough to satisfy Wall Street.
Reform without a public option can still remedy a lot of these ills, as long as there's enough regulation. But it's not clear there will be, which is why Rockefeller is speaking out--and why he should be.
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COMMENTS (3)
I am conservative, I've studied the issues, Democrats still need to explain the public plan.
First, of the 30 million Americans Obama and Baucus wish to cover, 10 million are Medicaid citizens-that leaves 20 million.
Second, after regulation, insurance companies can no longer exclude pre-existing conditions, establish premiums to cover risk or offer policies which are less than the established minimum
Third, the exchanges will exist-this is one area which needs further edification. HR3200, and common understanding, is simple: it will be an Internet based menu of choices-sign in/sign on. Obama is, I think, saying it should also be a mechanism to pool citizens. If that is tr ... view full comment
I am conservative, I've studied the issues, Democrats still need to explain the public plan.
First, of the 30 million Americans Obama and Baucus wish to cover, 10 million are Medicaid citizens-that leaves 20 million.
Second, after regulation, insurance companies can no longer exclude pre-existing conditions, establish premiums to cover risk or offer policies which are less than the established minimum
Third, the exchanges will exist-this is one area which needs further edification. HR3200, and common understanding, is simple: it will be an Internet based menu of choices-sign in/sign on. Obama is, I think, saying it should also be a mechanism to pool citizens. If that is true, then you'll have 20 million people ready to buy (some subsidized, some subject to mandate). Why not just offer them the same choices as Fed Insurance Pool? They have 8 million customers, that buying power earns strong discounts and senators/congressmen are happy with it. Establishing that pool-28 million-then gets some extra discounts to the Fed Gov't (as they pay 75% of the premiums for fed workers).
Fourth, the public plan-idea is, to force insurance companies to compete-but with what? It cannot be fair to seed the public plan with Medicare rates-which are 25% lower reimbursement to doctors and hospitals than private insurance-no company can compete with a built-in cost advantage as that. Criticize you will health insurance companies-but there is no way they can lower premuims to match. Fine, you might say, then, all 20 million will be on public plan with Medicare rates (Medicare plus 5% results in same thing).
Fifth, then it gets interesting..........if public plan is available to only companies with 20 or fewer workers (first two years under HR3200), then, it's still 20 million. But, after first 2 years, HR3200 allows some agency to permit any company to join public plan. So, if public plan rates are lower due to Medicare payment levels, and you get to 21 employees-you're out. Or if you have 25 employees your competitor at 18 employees saves some big money on health insurance. Not fair.
Sixth, the reform will add 12% to physician and hospital loads-maybe more as they probably are sicker than average. But another 30 million people are reimbursing those doctors and hospitals at 25% off the going rate. Will the doctors work at that level? Can the hospitals make money at that level?
Seventh, if you want to kill private insurance, and get everyone on Medicare, fine..........but then, as the Commonwealth Fund has reported, doctor incomes fall (even with the new busiiness) by 20% and similar with hospitals (wiping out all hospital profits and surpluses for the non-profits).
Is that your public plan?
Thank you lobo for the one cogent, remotely sincere set of questions about the public plan that I have ever read or heard of so far.
I will comment on the one I am familiar with. Most health insurance rackets (I won't call anything a "business" that isn't one by any definition: a company in competition with others to provide the best service possible and accountable to their customers for it) can quite easily cut rates by 25%.
They are almost all notoriously bloated, inefficient, wasteful with profit rates sometimes reaching in to the thousands of percent (I am a big fan of the Kaiser paradigm however). Profits are fine, but not if you abuse people and profit from terrible service. As it st ... view full comment
Thank you lobo for the one cogent, remotely sincere set of questions about the public plan that I have ever read or heard of so far.
I will comment on the one I am familiar with. Most health insurance rackets (I won't call anything a "business" that isn't one by any definition: a company in competition with others to provide the best service possible and accountable to their customers for it) can quite easily cut rates by 25%.
They are almost all notoriously bloated, inefficient, wasteful with profit rates sometimes reaching in to the thousands of percent (I am a big fan of the Kaiser paradigm however). Profits are fine, but not if you abuse people and profit from terrible service. As it stands now, they are a menace profiting from sorrow and most of us have zero sympathy for them being held accountable for that. I still don't see what's wrong with Medicare for all (aka single payer) and simple anti-govt rhetoric doesn't mean much to me as a response.
Do you think anything needs to change or that the way health care and health insurance are delivered in this country right now is sustainable (my rates went up by 20% this year - and I have supposedly good insurance, whatever that means anymore). Can you name a way to contain exploding health care costs without a public option? Seriously, I'd love to hear an alternative.
BTW Lobo - front page of the NYT, Swiss System Thrives Wthout Public Option - what do you think?
http://www.nytimes.com/2009/10/01/health/policy/01swiss.html?_r=1&hp
BTW - Jonathon, great piece. As I wrote yesterday - Rockefeller is my all time favorite Senator and the real hero of health care.
BTW Lobo - front page of the NYT, Swiss System Thrives Wthout Public Option - what do you think?
http://www.nytimes.com/2009/10/01/health/policy/01swiss.html?_r=1&hp
BTW - Jonathon, great piece. As I wrote yesterday - Rockefeller is my all time favorite Senator and the real hero of health care.