Thursday, December 10, 2009

Public Option as a symbol

Politico has a report on the death of a liberal dream in public option going out. The public option as it was included in both the House and Senate bills was no liberal dream, and was very weak, and would likely have been inconsequential. The point of public option as a cost saving tool would be to impose Medicare payment rates on a larger slice of the nation. This would have slowed cost inflation as CBO and others said. However, the public option provisions had a new entity being created by HHS, which would then have to set up networks andn negotiate rates. This wouldn't have likely worked very well, and CBO said it basically wouldn't do much one way or another. In the end, the phrase public option became something that Democrats/progressives were for, and that Republicans/conservatives/mod-conservatives were against.

The real questions are: (1) is the system as is sustainable? (2) we willing to undertake a major change to cover more [notion of everyone has been given up]? (3) Can we do this in a way that slows cost inflation? (4) If the answer to (3) is yes [and it is], are we willing to make the hard choices to do this? [answer is mostly no, but some steps in Senate bill, maybe getting better not worse at the end] . Ezra Klein has report of Collins and Wyden teaming up in a good sign...not so much the amendments per se, but if Collins and Snowe are on board then Nelson is superflous and that is good for good policy.

Public Option gave Democrats and Republicans something to fight noisily about while not talking more clearly about these bigger questions. And Republicans just blocking has harmed their interests if they can't actually kill the bill is one Republican lamenting.

As I wrote about a few weeks ago, public option 'light' as I called it was much ado about nothing in actual health policy terms. It is interesting to see Senators who have been professing worry about 'govt involvement in health care' and using that to be against 'public option' now embracing a Medicare expansion. On health policy grounds, I think the Medicare expansion makes more sense, and I think the bill has probably gotten a little better, and especially with the frosh Dem Senators talking about adding in some more cost saving provisions I might get quite a bit better right at the end--I am surprised by that, but glad for it. I guess you can say that alot of time has been wasted haggling over public option, but the thought of missed Christmas vacations may have been the only thing that would finally get the Senate rolling.

Most intersting to see is whether the President really backs whatever Senate may pass and asks the House to take it up as is.

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