“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?

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