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Debate in D.C. turns to shape of public option
So far: Lots of ideas, little agreement on government plan
Mona Shield Payne / Special to the Sun
Mary Venable, who is uninsurable because of a pre-existing condition, joins Rudi Kraft in holding signs and candles in support of health care reform during a candlelight vigil Sept. 2 in Boulder City.
Sunday, Oct. 18, 2009 | 2 a.m.
Sun Archives
- Tax on 'Cadillac' insurance plans could snare hotel maids (10-11-2009)
- Is Harry Reid moderate on health care, or keeping powder dry for final fight? (10-4-2009)
- What cuts in Medicare would mean for seniors (10-4-2009)
- John Ensign: Public option would be popular, so let's not do it (9-20-2009)
- Protesters decry GOP stance on health care reform (9-29-2009)
- Harry Reid: Public option trigger 'pretty doggone good idea' (9-25-2009)
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Shelley Berkley
Dina Titus
Harry Reid
Washington — As congressional leaders work behind closed doors to craft the final health care bills for House and Senate votes, one of the key undecided questions remains the fate of the public option.
The conversation appears to have shifted from whether there will be a government-run health insurance option to what exactly a public option might look like. The House bills include a public plan component, though differences remain, while the Senate bills being melded in Majority Leader Harry Reid’s ornate offices are split on the issue.
This crucial element in the health care discussion is now morphing into its own debate as various versions of the public option are offered as possibilities.
“Decisions about a public option remain central to achieving an agreement on getting affordable health care,” said Judy Feder, a senior fellow at the centrist Center for American Progress. “Finding a way to treat it that everybody can live with is essential to making a final deal.”
First, a primer. A public option is not a government-run doctor’s office or clinic or hospital, and it’s not for poor people. As Reid once put it — “it’s not a program set up for people who are losers.”
The public option would essentially be an insurance plan run by the government, which would pay doctors, hospitals and other providers to furnish care — much the way the government now pays providers under Medicare.
With the new requirement that everyone carry health insurance — the way drivers in most states are required to have auto insurance — the government-run plan would be an option for workers who don’t get insurance through their employers. Employees could choose this plan as an alternative to buying insurance from a private company.
Supporters like the public option as a way to force insurance companies to compete for more 30 million new customers — those uninsured Americans, including nearly 500,000 in Nevada, who would be required to obtain health insurance.
Insurance premiums have skyrocketed over the past decade, rising 131 percent, according to a September report from the Kaiser Family Foundation.
And insurance companies are recording large profits.
Feder calls the public option an insurance plan “that’s accountable to us as voters and taxpayers, not to Wall Street.”
Detractors call it socialism or Obamacare.
Those wary of the government plan, including many conservative-leaning Democrats, worry that its lower premiums would force insurance companies out of business.
“A new government run plan would dismantle employer coverage, bankrupt hospitals and increase the federal deficit,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the lobby representing 1,300 of the nation’s health insurance companies.
The nonpartisan Congressional Budget Office has estimated a fraction of the uninsured, about 5 million, would choose the government public option plan.
But as with so much of the health care issue, there are details to be worked out.
Reid gave a hint of the immensity of the coming debate several weeks back when he said: “A public option is a relative term.”
In the House bills, the hang-up is over whether doctors and hospitals would be paid at flat rates as under Medicare or whether the government would negotiate rates with each provider.
Two of the House bills call for reimbursement at Medicare rates plus 5 percent. But an amendment won by conservative House Democrats to a third bill allows doctors and hospitals to negotiate rates with the government.
A flat rate is expected to save the government more money than a negotiated one, supporters argue, by setting a lower price and forcing the private insurers to compete with that price. It would also make it easier for the government plan to get off the ground, because negotiating the rates would require an administrative undertaking, according to Elise Gould, director of health policy research at the liberal-leaning Economic Policy Institute.
Nevada’s Democrats in the House are split on this issue, with both saying they are siding with what Nevada’s doctors want.
Rep. Shelley Berkley said even though her husband, a kidney doctor, would prefer the Medicare-plus-five rate she approved as a member of the Ways and Means Committee, other doctors in Nevada tell her differently.
“In speaking with my doctors at home, most doctors prefer the negotiated rate,” she said. That is now her preference. “That’s what I’m going on.”
But Rep. Dina Titus believes doctors in her Southern Nevada district would prefer the Medicare-plus-five rate and is leaning in that direction.
“Congresswoman Titus has heard from a number of doctors in Southern Nevada who are in favor of reimbursement rates of Medicare plus 5 percent and she is continuing to look into the benefits of going in that direction,” her spokesman, Andrew Stoddard said.
Nevada’s Republican members of Congress, like most Republicans on the Hill, are against the health care proposals.
In the Senate, where the health committee bill includes a public option but the Finance Committee bill does not, the questions are more existential as Reid and top senators and White House officials are negotiating the bill that will be brought to the floor.
Bringing forward a bill with a public option would make it easier to retain — it would likely require 60 votes to remove it, which would be potentially hard to find. Or Reid could draft a bill that does not include the public option, but would allow one to be voted on as an amendment during the floor debate — a potentially steep climb.
Reid warmed recently to the suggestion from Republican Sen. Olympia Snowe of Maine for a trigger — if 5 percent of the residents of the state could not find affordable health plans from private insurers, then a government-run public option would be offered.
Reid called it a “pretty doggone good idea” during a September tele-town hall with Nevada voters.
Titus, who is increasingly supporting the public option, is cool to the trigger proposal. “But if a public option with a trigger is what can get passed, she does not want the perfect to be the enemy of the good,” her spokesman said.
Berkley was less enthused by the trigger, saying insurance companies have had plenty of opportunities to lower their prices.
“We’re either doing this or we’re not,” she said. “What more evidence do we need?”
More recently, Democratic Sen. Thomas Carper of Delaware has suggested having states decide whether or not to create state-run government options. Supporters say that would leave the decision in the hands of locals but critics worry it would be too daunting a task for states. Nevada’s state government, for example, offers only a bare-bones government Medicaid program.
Democratic Sen. Charles Schumer of New York has suggested creating a nationally run public option, but allowing states to decide whether they want to opt in or out.
The debate over the public option took up the bulk of a closed-door meeting of Democratic senators last week as they discuss what Reid should — and should not — include in the bill coming to the floor.
Sen. Ben Nelson of Nebraska, perhaps the most conservative Democrat in the Senate, emerged from the meeting to report that the debate, though “less raucous than a town-hall meeting,” was robust.
Discussion: 21 comments so far…
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How can you all do anything working three days a week and a new fat pay raise..... Keep your your dam_n nose's out of my wallet and heath care.... One question if you do get this and would force insurance companies out of business.how any many more people will Obamacare be responsible for underemployment is he the Senate the Congress going for a record 15-25% in 10-11 months ? Reid I will be voting this year as all years and I even get a twofer your son is running also ..................
This is not a news article.
It is an opinion piece.
"And insurance companies are recording large profits."
Insurance companies have marginal profit rates.
I think that Lisa believes that any profit is a LARGE profit.
If she is a reporter...doubtful....she would have cited a study that insurance companies has large profits but she did not.
She injected her personal (not an expert) opinion into the article.
The Las Vegas Sun is notorious for lifting its editorial pieces directly from the New York Times. It is also known for writing "news" articles that are in fact editorials by Greenspun and company.
But the Sun does make excellent toilet paper.
A public option is not a government-run... As Reid once put it -- "it's not a program set up for people who are losers."
This is our senior senator too big to fail Harry Reid in action.
As an illiterate unwashed redneck white trash tea-bagger I realize that I have no right to question the spin that the Democrats are putting out.
Obama in addressing the Nation from Congress was right to call my opposition positions "a lie, plain and simple.
I know that Obama must be true to his need to "call out people who misrepresent his positions. Obviously because we have "phony claims" and I am unable to understand what is good for me.
We welcome "Harvard graduate" Obama's snarling smack down public rebuke of opposition who do not trust him or believe him. This is the kind of leadership change we can believe in.
It is an ill conceived notion that the unwashed public should view a congressional bill and believe they could understand it.
The fact that the Health Insurance bill will be done in secret and the Democrats will continue to spin that the unwashed have no right to view the Health Insurance bill because they are illiterates with "phony claims" and are unable to understand what is good for them.
Obama, Reid, and Pelosi are tone deaf. They do not respond to our phone calls, e-mails, townhalls, or rallies. They refuse to listen to us because we are lairs to them, but mostly because we do not believe them or trust them.
Harry called us evilmonger and Nancy called us un-American.
The rising cost of health insurance is NOT the problem, it's the rising cost of health care. Insurance just pays the bills and passes on the costs. Nothing in any of these plans help make health care cost less.
The largest increases in health costs are directly related to the last reform of Medicare. When hospitals are required to treat patients and the government lowers the payments for the government paid clients, the only option is to raise the cost to the privately insured patients.
When everyone is on a government mandate "lesser pay" program the only option will be less care.
They should just open Medicare up to anybody who wants to buy it.
The for-profit health insurance "industry" just sucks money out of healthcare like some large gaping 35% wound on the system.
Oh hell; why don't we just resurrect Mao, Marx's Manifesto and everyone sing, "This new upcoming Socialist Republic is mmm mmm mmm good."
It's morally wrong to leave 100 million Americans un or underinsured, 1 illness away from financial ruin. And it's wrong to burden small business with the outrageous insurance costs also -- saw a cool site; Balkingpoints ; incredible satellite view of earth
Future, a lot of people have been spreading complete lies about the bill. Death panels don't exist, the public option will save huge amounts of cash in the long term and I see the far right wing of the Republicans party spouting a lot of lies. Our president is going to save a lot of lives with this.
steve7952, Oh sure, America will go down in history as being a hardcore communist nation...like Canada, Denmark and England. You sound incredibly ridiculous.
You nailed it, SgtRock. This is an opinion piece. Either this writer, Harry Reid's Lapdog, is sloppy with words, or extremely sly, as evidenced in this sentence from the article:
"Detractors call it socialism or Obamacare."
The use of "detractors" is prejorative, defined as "to take away from in quality, value or reputation" or to "divert or distract."
In other words, Mascaro is dismissing out of hand those who label it socialism or Obamacase, as if they can't possibly have legitimate concerns. By labeling them detractors, she automatically belittles their point of view, as if there's only one noble side of the argument, and all others only serve to "take away from in quality, value or reputation."
I love how the Sun thinks all of their readers are too stupid to see through their tactics. No, just most of them, but you can rest assured I'll be around to hold your feet to the fire.
I see the Faux news drones are weighing in here. Well I got news for you, right now you so called tea baggers are no longer in charge, and I think you can count on a public option. But nice try at disruption, I am especially amused at the drone who calls himself the future, when he really represents the past ! How odd a person this is...
Hey cpo... You need to watch FOX NEWS and you would discover the the Democrats are in charge.
Democrats control the White House, the Senate and the House of Representatives. The Democrats can pass any piece of legislation that they desire.
Fox News is not a news network. It is the propaganda arm of the right wing and a specious source at best. Citing Fox News as a source for unbiased news is like citing Marlboro as a source for an unbiased list of the causes of lung cancer.
LarryVegas, Obama wants a strong majority to vote for it (60+ votes). He is being overly nice by not using the simple majority. He should abandon being non-partisan and pass what the majority of Americans want, which is a public option.
The current health care plans winding their way toward Obama do nothing about controlling costs or insuring everyone. At best they cut the number of uninsured in half and drive us into budget oblivion.
This is a bad idea.
Krases... You are as full of crap as a Christmas goose.
Both of your comments are lacking in substance and reasoning...
But, I must give you this... Your comment about Obama being overly nice is rather humorous.
Under the watches of Sens. Reid and Ensign and Reps. Berkley and Titus, the US DHHS is ordering children, under the "Family Reunification Plan", into domestically violent environments where they are suffering wrongful deaths, abuse and neglect. YOUR RIGHT!
"In other words, Mascaro is dismissing out of hand those who label it socialism or Obamacase, as if they can't possibly have legitimate concerns."
---
If the detractors of health care reform had any legitimate concerns they'd articulate those concerns instead of mindlessly dismissing efforts at reforming health care as "socialism" and particularly "Obamacare."
Really, why take fools seriously when they parade around with signs that say "Obamacare" over an inflammatory depiction of our president as an African witchdoctor with a bone through his nose?
Is that what you call a "legitimate concern"?
Those are 3 GOOD MUGSHOTS of 3 CROOKS
Per the Celeb-in-Chief's own mouthpieces yesterday, the "public option" is dead...ain't a-gonna happen....forget it.
http://texex-xpress.blogspot.com/2009/10...
Of course, this piece was written BEFORE that was announced but "UPDATES" are permissable, are they not?
What the real tragedy here is that no one really understands the healthcare issue. I know I don't, what I do know is that I lost my job and have no health coverage at present, and don't really feel it's the employer's responsibility to pay for everyone's health care. I say this issue must start at the source of the inflationary timeline which is that of the need to get governmental regulation on all of the out of control liability insurance costs that doctor's are forced to pay against frivolous lawsuits(this coverage numbers in the hundreds of thousands per year folks) Next the drug companies inflationary costs for drugs needs to be brought back down to earth from the 300 % mark up stratosphere by again governmental regulation. Look at these sources early on in this process, and there we find the seeds of the entire health care quagmire...