Senate Health Care Reform Debate Starts Today

The debate on the health care reform deal starts today in the U.S. Senate at 3 p.m. There is still one major sticking point in the negotiations: the fate of the public option. Don’t worry though, Compromisin’ Carper is on the case:

There is one idea that supporters hope could rally the centrists: Call it the nonpublic “public option.” It’s an idea from Sen. Tom Carper (D-Del.) for a national insurance program that is neither run nor financed by the government. It could win over moderates because it wouldn’t be a direct government expansion, but it would also satisfy liberals because it would be a national health insurance program designed to compete with private insurers from Day One.

It’s possible that the public option will be dealt with through a manager’s amendment, offered near the end of the debate, that ties up loose ends on the bill. It could include tweaks to the public option, ways to toughen up abortion restrictions in the bill (another concern of Nelson) and any other targeted attempts to secure a single senator’s vote.

Reid will get backing from war rooms on Capitol Hill and in the White House, where operatives with a coordinated strategy stand ready to amplify the floor debate. “Our focus is to get the bill off the floor as soon as possible in a form that is most consistent with the president,” said a senior administration official. Crafting a public option compromise “is largely what is taking up the time.”

Wherever there’s an attempt to weaken the public option, we see Carper. Coincidence? I don’t see how creating a private middleman will help. The point of the public option was to get rid of the layers of bureaucracy and cut down expense for people.

Something else to chew on: a report from the Urban Institute concludes that a trigger for a strong public option may be better than the current weak version of the public option.

We argue that a strong version is necessary because there is little else in health reform that can be counted on to contribute
significantly to cost containment in the short term. Capping tax-exempt employer contributions to health insurance has great
support among many analysts (including us), but it faces considerable political opposition. Proposals such as comparative effectiveness research, new payment approaches, medical homes and accountable care organizations, all offer promise but could take years to provide savings. Thus, the use of a strong public option to reduce government subsidy costs and as a cost containment device should be an essential part of the health reform debate.

[…]

The Senate has proposed a public option with an opt-out provision. This has the advantage of recognizing regional diversity in political philosophy by allowing states to pass legislation to keep it from being offered in their states. A disadvantage of this proposal is that it would exclude many who would potentially benefit from a public option. The states likely to opt out are likely to be those with high shares of low-income people and many uninsured.

The other alternative is to establish a strong public option but not implement it unless a triggering event occurred. The goal would be to allow the private insurance system to prove that it can control costs with a new set of insurance rules and state exchanges. The triggering events could be the level of premiums exceeding a certain percentage of family incomes or the growth in health care spending exceeding certain benchmarks. Since the public option would only be triggered because of excessive costs, however measured, we assume that a relatively strong version of a public option would come into play.

We recognize that taking a strong public option off the table may be necessary to enact reform legislation. But this will mean, at a minimum, higher government subsidy costs by not permitting a payer with substantial market power to bring cost containment pressure on the system. The outcome is likely to be that costs will continue to spiral upward. In effect, the nation would be relying on the range of promising pilot approaches to cost containment that would take some time to be successful. If they are not, we may be left with increasingly regulatory approaches, such as rate setting or utilization controls that apply to all payers. This would mean much more government involvement than giving people a choice of a low-cost public option that would be required to compete with private insurers.

What do you think? Would you be willing to accept a triggered P.O. if it triggered a strong public option? I’m intrigued by the idea but the opponents of the public option don’t want any kind of public option and they say they’re willing to blow up reform if they don’t get their way. Do you really think they would agree to a real trigger and a strong public option?

One last thing to think about, the CBO says that premiums will decrease for most people but increase for some:

A new CBO report, requested by Sen. Evan Bayh (D-IN) contains some helpful, though not unexpected information about the impact of Senate health care legislation on insurance premiums, particularly in the individual market.

According to CBO, average premiums in the individual market would increase 10 to 13 percent because of provisions in the Senate health care bill, but, crucially, most people (about 57 percent) would actually find themselves paying significantly less money for insurance, thanks to federal subsidies for low- and middle-class consumers.

Like all changes, there will be winners and losers. We have to make the decision that benefits the greatest number of Americans.