To: Kenneth E. Phillipps who wrote (76088 ) 12/14/2009 4:10:33 PM From: TimF Read Replies (1) | Respond to of 224707 Health Care Deal in the Senate? 09 Dec 2009 10:51 am A lot of outlets are reporting a deal along the following lines: Medicare buy-in for those 55 or over, some sort of non-profit quasi-public option overseen by the Office of Personnel Management, and a trigger for the public option that is arguably very unlikely to ever kick in. With Ben Nelson's abortion amendment voted down, and Nelson saying he won't vote for a bill without very similar language, a workable compromise on a public option substitute is necessary to get the 60 votes they need. But Lieberman just sent out the following press release: -------------------- "I am encouraged by the progress toward a consensus on proposals to send to the Congressional Budget Office to review. I believe that it is important to pass legislation that expands access to the millions who do not have coverage, improves quality and lowers costs while not impeding our economic recovery or increasing the debt. "My opposition to a government-run insurance option, including any option with a trigger, has been clear for months and remains my position today. "Regarding the 'Medicare buy-in' proposal that is being discussed, we must remain vigilant about protecting and extending the solvency of the program, which is now in a perilous financial condition. "It is my understanding that at this point there is no legislative language so I look forward to analyzing the details of the plan and reviewing analysis from the Congressional Budget Office and the Office of the Actuary in the Centers for Medicare and Medicaid." ----------------------------------------- To me, that reads like nothing with a public option trigger is going to pass. But perhaps I am not understanding the exotic subtleties of Congress-speak. The meat of this proposal is obviously the Medicare expansion. Like the now-discarded "co-op" idea, the non-profits suffer from one obvious flaw: someone else has to decide to put capital into starting them up. Starting an insurance company is not something you do with a $500,000 grant from the Ford Foundation, especially not on a national scale. And it's not clear why you would want to--there's no profit opportunity, and I suspect that the onerous regulation is going to make it look relatively unattractive to philanthropists who would have to concentrate a really significant chunk of their charitable giving on making one of these things work. Is this enough to make a deal? It still looks to me like either Lieberman or the public option nuts have to blink. And for all their obsession with an increasingly watered down proposal, my money's on the public option afficionadoes. At the end of the day, they want these deals more than I think Lieberman does.meganmcardle.theatlantic.com Comments (14) Ravi Nagarajan December 9, 2009 11:19 AM This "deal" is mind boggling in terms of how it is being covered as a rollback of the public option. A massive expansion of Medicare to those between 55 and 64 years of age is obviously a "public option" for millions of Americans and, even if premiums are higher, I doubt they will be high enough to fully offset the cost. Therefore, we are taking an already teetering system and making matters worse. Furthermore, the proposal to have the Office of Personnel Management oversee a quasi-public option is just a public option in another form. The obvious flaw regarding start-up capital is a very valid one ... and I think it is more likely than not that a national plan would have to be offered once the non-profit route fails. It seems to me that a great deal of clarity could be achieved if the left simply admits that they would like to see a single payer system eventually and are moving towards that with Medicare expansion. Conservatives can then make the case for a regulated free market using today's system as the starting point. All of these half measures do nothing other than to muddy the waters. If the left wants a single payer national system, why are they unwilling to say so? Ann (Replying to: Ravi Nagarajan) December 9, 2009 11:38 AM "if the left simply admits that they would like to see a single payer system eventually and are moving towards that with Medicare expansion" Exactly! The arguments for the public option never make sense. If the public plan won't be subsidized, then it's not really adding anything. Far more could be achieved if the federal government stopped allowing restrictions on sales of health insurance plans across State lines, thus expanding competition. The public option only makes sense if the public plan will be subsidized, explicitly or implicitly (by imposing crippling regulations only on private plans), in order to move towards a government monopoly. It's frightening how often we hear liberal politicians talking about the importance of competition as justification for a public option, since the only true 'competition' is from a government entity with special privileges. A level playing field can never bring about the right kind of competition, since it's not rigged to guarantee the politician's preferred outcome. Fannie and Freddie worked so well that we're bringing the same approach to health care, but this time we'll make sure that Fannie Med eventually drives out all the others.meganmcardle.theatlantic.com