Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.
When Senate Majority Leader Reid held a press conference announcing the inclusion of a version of a public health insurance option in the merged Senate health reform bill, he didn’t mention the outcome of another major difference between the two Senate committee proposals--what would be responsibility of employers with regard to on-the-job coverage. And not a single reporter asked.
It’s strange that on-the-job coverage gets relatively little attention in the debate, even though more than half of Americans have health coverage through their employers. That's more than the Americans in programs like Medicaid and Medicare (around a third of the population) and much more than the Americans who buy coverage as individuals (less than a tenth of the population).
For all its flaws, employer-based coverage generally provides good benefits to workers and their families. It pools together shared contributions by employer and employees, leveraging group purchasing power for better premiums and/or a better level of benefits. Among other things, employers use their purchasing power to prevent any of their workers from being denied for pre-existing conditions. The workplace provides an easy place to sign up for coverage--and sometimes a useful ombudsman to deal with the insurer. It is also efficient way for insurers to get multiple customers at once, rather than incurring the expense of marketing and selling policies one at a time. That helps keep premiums down.
But despite its dominance, employer-sponsored insurance doesn’t extend to all workers. More than 80 percent of the uninsured are workers, or family members of workers. And without reform, on-the-job benefits are eroding. The percentage of Americans who get coverage through employers shrank by over 5 percent in the past decade. And in some states, like California, it’s about to go under the half-way mark--which is why the state has been exploring setting some minimum standard for health benefits. With the overall cost of health care rising, employers are scaling back coverage or in some cases dropping it altogether.
After a weekend of furious activity, Democratic leaders in the Senate think they are close to getting the votes they need in order to pass an "opt-out" version of the public option.
But they feel like President Obama could be doing more to help them, with one senior staffer telling TNR on Sunday that the leadership would like, but has yet to receive, a clear "signal" of support for their effort.
The White House, for its part, says President Obama supports a strong public option, as he always has--and that, as one senior administration official puts it, the president will support the Senate leadership in "whichever way" it chooses to go on this particular question.
Read those statements carefully and you'll see they don't actually contradict each other. Instead, they offer a pretty good picture of where the public option debate is at the beginning of a week that could quite possibly decide its fate.
For those just tuning in, the underlying issue here is whether to create a government-run insurance program into which people could enroll voluntarily and that might, ideally, provide more affordable coverage while providing the private insurance industry with much-needed competition. As recently as two or three weeks ago, many observers (this writer included) thought the idea was more or less dead politically.
By now you've heard the news: Senate Majority Leader Harry Reid will be including an "opt-out" variation on the public plan in the health care bill he brings to the Senate floor.
It is not a full public option. It will not use reimbursements pegged to Medicare. As Ezra Klein says, it is still a major compromise for liberals. And yet it's also a lot more than liberals seemed likely to get, as recently as a few weeks ago.
Indeed, it is hard to overstate what a turnaround this is--or how quickly it happened. By late summer, passing any reform at all looked like a fifty-fifty proposition at best. And even as the political environment shifted, the public option looked doomed. It was going to take sixty votes to get a public option through the Senate. The votes just weren't there.
To be clear, they still aren't there.
Is it curtains for the strong public option? Over the past week, the White House has taken a lot of heat for not going to bat for it, and Senate Majority Leader Harry Reid has reportedly just decided that the Senate bill will include a watered-down proposal that would allow states to opt out of a national public plan. And, in a speech today, Christina Romer, head of the president’s Council of Economic Advisers, expressed only circumspect support for a strong public option, instead calling the excise tax on high-cost plans the “number one item” that would curb health care costs.
Speaking at the Center for American Progress today, Romer said that President Obama believes the public option is a “potentially important source of cost-containment … especially in rural states,” where insurance markets are heavily concentrated and don’t face much competition. Yet her remarks framed the proposal as a possibility rather than a prerequisite. “Personally, I have been quite persuaded that the public option can be an important source to cost-containment,” Romer said, citing an example from California’s experience contracting with HMOs to provide care for Medicaid patients:
In some counties, we have two private plans, [in] some counties we have one public and one private. … The interesting thing is that cost growth in the counties where there is a public and a private is indeed slower than in counties with two privately run plans.
In other words, the inclusion of a public insurance plan increased competition and drove down costs--exactly what liberal advocates for the strong public option are arguing now in Congress. However, Romer admitted that the California case was “a small sample” and that her support for a strong option remains preliminary. “It’s one of the things that’s given me a sense that it could be something that could ultimately slow the growth rate of costs,” she said.
Many liberals are hailing Senate Majority leader Harry Reid’s decision to pick the opt-out version of the public option over the trigger as a progressive victory. Representative Lynn Woolsey, co-chair of the House Progressive Caucus agrees--and thinks there’s no reason the House shouldn’t go even farther, and include a strong public option in its bill.
And I thought yesterday was crazy.
Brian Beutler has sources telling him that Senate Majority Leader Harry Reid is close to rounding up 60 votes for an "opt-out" public option, but that the White House is trying to slam on the brakes. The main reason? Republican Senator Olympia Snowe, whose support the White House covets, is against the idea and prefers some sort of trigger. One source tells Beutler:
They're skeptical of opt out and are generally deferential to the Snowe strategy that involves the trigger... they're certainly not calming moderate's concerns on opt out.
Ezra Klein has a longer, extremely well-reported take that includes a fascinating back-story of how Reid came to embrace the opt-out. It culminates with a description of Reid's meeting at the White House last night:
On Thursday night, Reid went over to the White House for a talk with the president. The conversation centered on Reid's desire to put Schumer's national opt-out plan into the base bill. White House officials were not necessarily pleased, and they made that known. Everyone agrees that they didn't embrace Reid's new strategy. Everyone agrees that the White House wants Snowe on the bill, feels the trigger offers a safer endgame, and isn't convinced by Reid's math. But whether officials expressed a clear preference for the trigger, or were just worried about the potential for 60 votes, is less clear. One staffer briefed on the conversation says "the White House basically told us, 'We hope you guys know what you're doing.'"
Notwithstanding the differences in emphasis, the two items are twists on the same basic theme--a theme consistent with what other sources, in the administration and on Capitol Hill, have been saying for the last few days.
WASHINGTON--Is there room in the Republican Party for genuine moderates? Truth to tell, the GOP can't decide. More precisely, it's deeply divided over whether it should allow any divisions in the party at all.
That's why the brawl in a single congressional district in far upstate New York is drawing the eyes of the nation. Conservatives are determined to use the race to prove that there is no place in the party for heretics, dissidents or independents.
The Senate Finance Committee has been the focus of so much attention, for so long a time, that it's easy to forget another committee in the Senate passed its own version of reform several months ago.
The Health, Education, Labor, and Pensions (HELP) Committee had only partial jurisdiction, of course. It couldn't touch Medicare or Medicaid and it couldn't call for new revenue. But it had the opportunity to design a coverage system, including insurance exchanges, plus it had the chance to introduce some quality incentives.
So how good a job did the committee do? And, in an ideal world, how much of HELP's work would Majority Leader Harry Reid incorporate into the final measure that goes to the Senate Floor? To get some guidance on those questions, we've decided to publish the second installment of the Truman Scale.
For readers who missed it the first time, the Truman Scale is TNR's own rating system for health care reform measures. Named for the first president who tried seriously to pass universal health insurance, the Truman scale--which goes from 1 (worst) to 10 (best)--is a composite of scores on three separate criteria:
Security Will it expand insurance coverage substantially--and make sure the insurance people have is good insurance?
Cost Will it pay for itself--and will it reduce costs over the long run?
Quality Will it actually make medical care better?
Bill Frist, the heart transplant surgeon turned senator, didn't always distinguish himself as a man of principle when serving as Majority Leader from 2003 to 2007. Yes, that was him diagnosing Terry Schiavo's medical condition from the close proximity of the Senate floor.
But, like so many politicians, Frist was a complicated figure who also had what seemed (at least to me) like a genuine interest in public service--an interest that occasionally led him to stand up for what he thought was right.
Perhaps because he's out of politics again, that streak has shown itself again, in an interview about health care reform with Karen Tumulty.
The Hill has a piece about the upcoming Senate race in Nevada. It seems Danny Tarkanian, son of coaching legend Jerry, is looking to unseat the Senate majority leader with the help of some of daddy's old players and other NBA notables the family has become chummy with over the years.
One striking thing to me is the extreme confidence conservatives have that health care reform will fail. The Weekly Standard has been at the forefront of this triumphalism. Fred Barnes, writing in the Weekly Standard, flatly declares reform won't even make it out of the House:
Harry Reid's polling numbers continue to sink, with the latest survey from the Daily Kos/Research 2000 finding that 52 percent of Nevadans view him unfavorably. He's also trailing two of his GOP contenders. What will that mean for the Senate majority leader? Eve Fairbanks wrote a piece last December arguing that despite Reid's disapproval rating, his seat may be a hard win for Republicans:
Just days after Barack Obama’s election victory last November, Elaine Kamarck and I published an essay with a somewhat downbeat title--“Change You Can Believe In Needs a Government You Can Trust.” We began this way:
“As Barack Obama takes office in 2009, he will confront a paradox. On the one hand, the American people are demanding action in many areas—to improve the economy, to increase access to health care while restraining costs, and to reduce energy costs and our dependence on oil, among others. On the other hand, people are deeply mistrustful of the federal government as an honest and capable agent for achieving these goals. There is nothing new about this ambivalence, but how the next president deals with it may make the difference between success and failure, measured in sustainable public support as well as legislative accomplishment.”
We went on to trace the history and causes of declining trust in government and to recommend a series of steps—including a government reform agenda and modest, confidence-building domestic policy measures—that the new administration could take to nurture public trust in the federal government as an effective and honorable instrument of national purpose. And we warned that “the new administration cannot afford to assume that because the people grudgingly support a massive rescue plan for the financial sector, they will embrace a major expansion of government in other sectors of our society.”
Nothing that has happened in the ensuing ten months has changed my mind about the importance of trust in government. In October 2008, at the end of the Bush administration, just 17 percent of Americans trusted the federal government to do the right thing all or most of the time. Barack Obama’s inauguration has made remarkably little difference: The latest CBS survey reports that the trust level now stands at 23 percent. By contrast, it stood at 47 percent in 2004, 44 percent in 2000, and 40 percent in 1988. (From the late 1950s through the early 1970s, it averaged more than 60 percent.)
Some people keep talismans in their wallets to remind them of those they love: a romantic letter, a set of dog tags, a family picture. Senate Majority Leader Harry Reid has such a token--but it's to remind him of the people he hates.
With many, including us, focused on the likelihood of Barack Obama naming James Steinberg as his national security adviser, word comes today that the job may go to Marine General James L. Jones, who retired last year after serving as Supreme Allied Commander of NATO and Commander of U.S. European Command.
On Monday, Nancy Pelosi made an announcement that was buried amid the tumult over the Steny Hoyer-Jack Murtha battle for House majority leader. It was the appointment of Representative Michael Capuano, a Massachusetts Democrat, to be the head of Pelosi's "transition team" as she assumes the job of House speaker.
The splotch that appeared on satellite photos of North Korea two weeks ago was like a Rorschach blot for foreign policy wonks. A cloud of smoke that would have been considered benign in almost any other country (it being in actuality just a cloud) was immediately feared the result of a nuclear explosion, showing just how anxious national security types have become about Pyongyang's weapons program. Colin Powell and Condoleezza Rice had to reassure the Sunday morning talk shows that the North had not, in fact, tested a nuclear bomb.
Last month a band of lawmakers led by John McCain drafted a letter to President Bush insisting that "Saddam Hussein must be removed from power." There was only one problem: With the exception of Joe Lieberman and McCain's friend Congressman Harold Ford, they couldn't find any Democrats willing to sign it. And so the letter went out with only two Democrats committed to the Iraqi dictator's ouster.
