On Friday, Jack Beatty, appearing on Tom Ashbrook's WBUR program On Point, honestly revealed all about the President's hope for a public insurance plan. Listen here starting at minute 23:50 for the introduction, and at minute 25:00 for Jack's own comments after President Obama's remarks in New Hampshire:
"It is disingenuous of the President."
"The fact is that the public plan opens to the door over time to Medicare for all."
"But the Democrats can't say that, and yet that is the fact."
"A robust public plan ... over time, is going to take more and more business from private insurers."
"This is backdoor single payer."
I made some of these points several weeks ago.
Whether you, dear reader, want a single payer or not, the issue now is Presidential credibility. Put aside the recent craziness about end-of-life care and other manipulated public outcry at town meetings. As I noted in July, real people have real concerns about the legislation and the legislative process. This showed up recently, too, in a recent New York Times poll. The President and his folks have wanted to hurry through a bill that affects one-sixth of the national economy, and when they hide their underlying philosophical intent, it undermines their chances. It deserves more time and consideration and honesty than that.
We will, however, get legislation. It will include new requirements for insurers to abandon nasty practices like denying coverage for pre-existing conditions and the like; it will create a national exchange like the Massachusetts Connector to allow individuals and small groups to shop around for better insurance products; and it will include subsidies for some low income people. It will not include the public plan, although there will be permission to establish local co-ops, like those that provide electricity to rural areas.
The House of Representatives will wait for the Senate to act first, because they want to be sure that a bill can pass the Senate. The need to get at least 60 votes in the Senate is critical. Why? Actually, not so much to avoid a filibuster, as to bring in conservative Democrats and moderate Republicans to get 50 votes. Yes, 50. For as things stand now, the Democrats can't even get a simple majority, much less a filibuster-proof majority.
The points to be worked out are the significant details:
How many people will get a subsidized plan? The numbers seen in the House are unreachable if the cost is borne solely by the wealthy. And since a broad-based tax increase is unlikely, the Senate will compromise with a lower number of families included.
How will the national exchange work? Will it be regulated by the states subject to national guidelines? Likely, given the prerogatives of the Governors. But this will mean a lack of uniform standards and plan designs. Will private insurers be allowed to participate in all 50 states? Will they have to?
Will there be a body that rules on efficacy and cost-effectiveness of new diagnoses, treatments, and medical equipment and supplies? Probably not, as manufacturers fear discouragement of new products and services.
The result will look a bit like Massachusetts: New rules for insurers to protect consumers; substantially greater, but not universal coverage; and some public subsidies paid for by progressive tax increases. I'd say this isn't too bad. It is not everything everybody would want, including myself, but the President will be able to sign a bill and claim victory. Given the amount of effort and political capital expended, though, it will be the last step for many years to come.