Dominating the whole [health care] debate is the question of whether to include a government-run insurance plan on the exchange. Proponents say such a measure — included in the House bill and the Senate health committee bill — would provide the uninsured with a guaranteed high-quality plan, in case insurers still try to game the rules to deny coverage or payments. They say it would also restrain the overall growth in costs. A low-priced competitor, the logic goes, would drive insurers to pressure doctors to deliver the most cost-effective care.
In today's newspaper, "Debate's Path Caught Obama by Surprise: Public Option Wasn't Intended as Major Focus" appears on the front page. It quotes "a senior White House adviser, who spoke on the condition of anonymity," who said:
"We've gotten to this point where health care on the left is determined by the breadth of the public option. I don't understand how that has become the measure of whether what we achieve is health-care reform."
Let me, then, summarize the whole pro-public plan position: I'd say there are two main reasons why the public option is indeed "the measure of ... health-care reform." One, it will keep private insurers from gaming the system. Two, it will "restrain the overall growth in costs."
I consider the second reason even more important than the first. To "drive insurers to pressure doctors to deliver the most cost-effective care" is to compel the restructuring of how health care is delivered in this country. Not how it is insured, necessarily, but how it is delivered. Today, doctors and other sources of health care charge for services rendered. Another MRI, another charge. What needs to happen is for providers to work together, avoid unnecessary, duplicative procedures, and get paid for results, not for services.
President Obama has said he won't insist on a public option, i.e., a nonprofit, government-run health insurer. He isn't "drawing a line in the sand" about a public option. He favors it but he has also said, "If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I'd be happy to do it that way."
Fine, but without a public option or a close substitute, driving down costs is problematic. So what might be a close substitute? MacGillis, in the Post:
To get Republican votes, the Senate Finance Committee's bill is likely to include member-owned cooperatives instead of a public option, though critics say those would lack competitive clout.
And, according to today's front-page story:
Republicans signaled Tuesday that dropping the public option would not garner additional GOP backing. Jon Kyl (Ariz.), the second-ranking Senate Republican leader, criticized an alternative idea of creating a private insurance cooperative, calling it a "Trojan horse" that was effectively the same as the public option.
"It doesn't matter what you call it, they want it to accomplish something Republicans are opposed to," he said.
Kyl's comments came as other conservative Republicans joined in to bash the co-ops idea. Rep. Tom Price (Ga.) said, "A co-op that is simply another name for a public option, or government-run plan, will be rejected by the American people."
Yesterday morning's Post juxtaposed these two articles: "Some Key Democrats Say Public Option is Essential to Health-Care Reform" and "Health Cooperatives Gain Backing as Alternative to Public Option." According to the latter, health co-ops might not even make it off the ground, assuming the eventual reform legislation authorizes them.
That's important, but what's truly key is that co-ops, if passed, might lack enough marketplace clout to drive health care into a more efficient delivery mode. The public option would do just that. My continuing attitude is that the public option amounts to the Reggie Jackson of health insurance reform: it's the straw that stirs the drink.
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