“The Public Option is not your Enemy”

Finally, if we are to win the battle that is now going on around the world between freedom and tyranny, the dramatic achievements in space which occurred in recent weeks should have made clear to us all, as did the Sputnik in 1957, the impact of this adventure on the minds of men everywhere, who are attempting to make a determination of which road they should take. Since early in my term,our efforts in space have been under review. With the advice of the Vice President, who is Chairman of the National Space Council, we have examined where we are strong and where we are not, where we may succeed and where we may not. Now it is time to take longer strides-time for a great new American enterprise-time for this nation to take a clearly leading role in space achievement, which in many ways may hold the key to our future on earth.

President John F. Kennedy, May 25, 1961

Why can’t we put the same determination that put a man on the moon into finding a solution for affordable health care for all?   What are the sticking points?

Some of the first efforts toward that goal were put into play yesterday.  We had the usual Presidential teleprompter read before the American Medical Association yesterday.  It was characterized this way by Sam Stein.

“The public option is not your enemy, it is your friend,” Obama declared at one point.

His prepared remarks were a bit more detailed:

If you don’t like your health coverage or don’t have any insurance, you will have a chance to take part in what we’re calling a Health Insurance Exchange…. You will have your choice of a number of plans that offer a few different packages, but every plan would offer an affordable, basic package. And one of these options needs to be a public option that will give people a broader range of choices and inject competition into the health care market so that force waste out of the system and keep the insurance companies honest.

Back in the world of where the rubber hits the road, the Congressional Budget Office (CBO) returned an estimate of the Affordable Health Choices Act that was proposed by Dodd and Kennedy.  Ezra Klein of WaPo used the adjective “devastating”.

According to the agency, the bill would cost a hefty trillion dollars over 10 years and extend insurance to a mere 16 million people. That’s a lot of money to spend if you’re only going to achieve a third of your goal. Frankly, I was pretty surprised by the results.

And so, it turns out, were the people writing the bill.

A couple of months ago, the Health, Education, Labor, and Pensions Committee sent the CBO a sketch of a draft of its legislation. And the CBO sent the members back a stab at an outline of an estimate. It was all very early, and very rough. But CBO’s response was encouraging. The total cost was a bit higher, but the number covered was much higher. More like what you’d expect. More like what health reform is trying to achieve.

The draft the CBO examined last week, however, was in certain respects even less complete than the outline they were given months ago. In an effort to buy some extra time to negotiate with Republicans on the committee, the Democrats on HELP left out some of the more controversial policies in the hopes of reaching a bipartisan agreement sometime this week. The public plan, the employer mandate and the individual mandate were all absent from the proposal the CBO examined. The employer and individual mandates — the first of which pushes employers to offer coverage and the second of which force individuals to purchase coverage — are particularly key to increasing the number of Americans with health insurance.

You might ask what the HELP Committee was thinking, sending Swiss cheese legislation to CBO. Well, the HELP Committee’s expectation was that the CBO, in crafting its preliminary score, would assume something similar to the outline it had seen months before. The CBO didn’t. In fact, it did the opposite. CBO ran its estimates with no employer mandate and an individual mandate with a laughably small penalty.

“Swiss cheese legislation”, is this what the American people deserve?

The announcement of the plan was made to the AMA and the plan itself appears crafted to appease them.  Again, from the Stein article.

There is some confusion over just what kind of public plan AMA could support, but for those intricately involved in the health care fight, it seems likely to that the plan would have to be vastly watered-down.

“If a public plan is designed so as to satisfy the AMA, it is very unlikely to be able to serve the general aims of long-term cost containment,” said Paul Starr, a Professor of Sociology and Public Affairs at Princeton University. “The AMA won’t just want guarantees of higher rates than Medicare in the short run; it will want protection against the potential that a large public plan could enroll the great majority of people and exercise the kind of countervailing power in the market that would greatly restrain physician fees in the future.”

That said, there is a bit more optimism today than last week that the White House could eventually win over the group’s support.

I understand the need to seek consensus on such a big proposal, but again I ask, is the consent and approval of the AMA lobby the essential to the task at hand?  Their job is to deliver health care.  Their goal is to do it profitably and perhaps efficiently.  Should this stake be enough to give them veto over public health policy?

Here’s more on the estimated costs and the presidential marketing plan from the NY Times.

Senator Orrin G. Hatch of Utah, a senior Republican on both committees drafting health legislation, said he found the office’s numbers stunning. He calculated that the Kennedy bill would cost taxpayers $62,500 per uninsured person over the 10 years.

Mr. Obama took the cost issue head on in Chicago. “The cost of inaction is greater,” he told the doctors, because rising health care prices are “an escalating burden on our families and businesses” and “a ticking time bomb for the federal budget.”

Opening a week in which health care will dominate attention in Congress, the president’s speech on Monday was the latest example of an oft-used ploy to press his case: appearing before skeptical audiences, confident of his powers of persuasion but willing as well to say what his listeners do not want to hear.

“The public option is not your enemy,” Mr. Obama said. “It is your friend, I believe.” Saying it would “keep the insurance companies honest,” the president dismissed as “illegitimate” the claims of critics that a public insurance option amounts to “a Trojan horse for a single-payer system” run by the government.

You have to read a little further down the article for this astute analysis of past democratic goals for health care.  This is again, a rubber hits the road moment.

The president’s emphasis on reducing health care costs over expanding insurance coverage, which dates to his campaign, reverses Democrats’ priorities of recent years. Obama advisers say the focus on cost savings has appeal for all Americans, not just the uninsured. Some advisers, including veterans of the Clinton administration, say President Bill Clinton’s emphasis on covering the uninsured helped doom his health care plan in 1994.

I keep thinking about that Clinton Plan.  That plan faced an uphill battle in congress because of the numbers.  The Congress and Senate were not in President Clinton’s back pocket.  Let’s revisit, however, the Democratic Majority sitting in Washington DC right now, frittering away their power playing to that one Republican out there in right field. Why play to lobbies traditional in the Republican column when the Republican Column is bereft of assets right now?  Furthermore, how can you sell a plan on cost savings when even the press that should be on your side characterize the plan as “devastating”?  Oops, there I go, thinking again.

We need to frame this issue in terms of the devastation it has on people’s lives.  Where are the faces of those 1 out of 3 people that file bankruptcy because just getting well sends them into a financial deathbed?  Let’s talk about the personal toll as outlined in Businessweek where the healdine screams  Study Links Medical Costs and Personal Bankruptcy.

Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid.

Medically related bankruptcies have been rising steadily for decades. In 1981, only 8% of families filing for bankruptcy cited a serious medical problem as the reason, while a 2001 study of bankruptcies in five states by the same researchers found that illness or medical bills contributed to 50% of all filings. This newest, nationwide study, conducted before the start of the current recession by Drs. David Himmelstein and Steffie Woolhandler of Harvard Medical School, Elizabeth Warren of Harvard Law School, and Deborah Thorne, a sociology professor at Ohio University, found that the filers were for the most part solidly middle class before medical disaster hit. Two-thirds owned their home and three-fifths had gone to college.

But medically bankrupt families with private insurance reported average out-of pocket medical bills of $17,749, while the uninsured’s bills averaged $26,971. Of the families who started out with insurance but lost it during the course of their illness, medical bills averaged $22,658. “For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments, and deductibles that illness can put you in the poorhouse,” said lead author Himmelstein. “Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy.”

Now there is a punchline.  Let’s talk about health care reform in terms of the costs to American people and then start the discussion on this:

I believe we possess all the resources and talents necessary. But the facts of the matter are that we have never made the national decisions or marshaled the national resources required for such leadership. We have never specified long-range goals on an urgent time schedule,or managed our resources and our time so as to insure their fulfillment.

(Same speech from JFK, very next paragraph after the one quoted above.)