This Week In Health Care

The Progressive Caucus has a PR problem, but they also have an institutional muscle problem. The Blue Dogs frequently vote as a block, or at least threaten to do so if certain elements of legislation are not met. The Progressive Caucus rarely does that. But on health care reform, they are asserting themselves.

Dear Madam Speaker and Majority Leader,

Regarding the upcoming health care reform debate, we believe it is important for you to know that virtually the entire 77-Member Congressional Progressive Caucus (CPC) prefers a single-payer approach to healthcare reform. Therefore, it will come as no surprise as you work to craft comprehensive health care reform legislation, that we urge the inclusion of a public plan option, at a minimum, in the final legislation. We have polled CPC Members and a strong majority will not support legislation that does not include a public plan option that is supported on a level playing field with private health insurance plans.

We look forward to working with you to ensure inclusion of a public plan option and the successful passage of healthcare legislation that will provide a choice of quality healthcare for all Americans

Sincerely,

Lynn Woolsey, Co-Chair, Congressional Progressive Caucus
Raul Grijalva, Co-Chair, Congressional Progressive Caucus

Now, I mentioned a couple weeks ago what "a level playing field" actually means, and I don't think progressives are really going to like it.

The Level Playing Field Plan. Insurers, predictably, howled that a public insurer with access to Medicare's market power would put them out of business. (Generally speaking, liberals agreed with that.) The messaging they settled on was conceptually odd but has proven pretty effective. A public insurer, they argued, would not be competing on a "level playing field." This might have caused someone to wonder when, exactly, the market had ever cared about "fair." But instead, this frame has been widely adopted, with Obama telling Chuck Grassley, "I recognize that there's that concern. I think it's a serious one and a real one. And we'll make sure that it gets addressed." In answer to this, Len Nichols proposed a public insurance plan that doesn't have access to Medicare's bargaining power, and this is the policy that CAP's paper advocates. This is not single-payer lite. It's just an insurer without shareholders or highly-paid executives. (I should note that some, like Harold Pollack, believe you could begin with this plan and end with the single-payer lite plan. I'm not convinced, but its possible.)

As I said then, "such a public option would not achieve the kind of bargaining power to make it cost-effective."

Now, public option supporters got a boost with an endorsement from Kathleen Sebelius, who explained similar plans in the states:

In response to questions about a federal public-insurance option, Ms. Sebelius pointed to a government-run health plan for state employees in Kansas, as well as a public plan in California for Medicaid recipients. Such plans help create competition in insurance markets where there is little, Ms. Sebelius said.

"Often when you have 60% to 70% of market share, you have a monopoly, and it's really not a competitive environment," said Ms. Sebelius, who previously served as Kansas' insurance commissioner. "We have examples throughout the country of very competitive, very effective strategies."

But if those strategies are neutered and turned into something called a "public option" without the monopsony bargaining power that a public option could provide, it's not quite a revolution.

I do think that this new liberal pro-business group will be a major help in the health care debate. Already we're seeing Walgreens offering free health care for the unemployed and the uninsured at its in-store clinics. Businesses that are friendly to reform and have some resemblance of a heart can really move the debate.

Meanwhile, the leading voice on the opposite side of the debate has a past:

Richard L. Scott is unusual in these tough economic times: a rich, conservative investor willing to spend freely on a political cause.

He visited with lawmakers on Capitol Hill this week, and his new group, Conservatives for Patients’ Rights, has hired a leading conservative public relations firm, CRC, well known for its work with Swift Boat Veterans for Truth, the group that attacked Senator John Kerry, Democrat of Massachusetts, during his presidential campaign.

Mr. Scott’s emergence this spring as the most visible conservative opponent to Mr. Obama’s not-fully-defined health care effort has former friends and foes alike doing double takes, given Mr. Scott’s history.

Once lauded for building Columbia/HCA into the largest health care company in the world, Mr. Scott was ousted by his own board of directors in 1997 amid the nation’s biggest health care fraud scandal. The company’s guilty plea and payment of $1.7 billion to settle charges including the overbilling of state and federal health programs was taken as a repudiation of Mr. Scott’s relentless bottom-line approach.

“He hopes people don’t Google his name,” said John E. Hartwig, a former deputy inspector general at the Department of Health and Human Services, one of various state and federal agencies that investigated Columbia/HCA when Mr. Scott was its chief executive.

If this ends up being the best conservatives can do, we're going to be fine.