Public Option Nears Finance Committee Vote

The public option debate in the Senate Finance Committee was originally scheduled for a vote today, but it was pushed back to Tuesday. While the chief cheerleaders on the committee are not entirely hopeful about its prospects in the committee, they certainly sounded confident about it overall.

"The health care bill that is signed into law by the President will have a good, strong, robust public option," (Chuck) Schumer said.

How that will happen remains an open question. But the Senators assured reporters on the call that we're all going to get a taste of their passion and persuasiveness on this issue at the ongoing Senate Finance Committee hearings on Friday.

"I think it's a great idea," (Jay) Rockefeller said of the public option. "Chuck Schumer thinks it's a great idea. And we're going to be all over it tomorrow." [...]

Schumer said that "a large majority of Democrats are for a public option" -- but that the ratio is higher in the House than the Senate, and higher in the Senate than in the Senate Finance Committee.

"I think we have a real good chance on the Senate floor," he said.

Schumer and Rockefeller have a lot of weapons at their disposal. First off, there's the pure popularity of the measure, which has ticked up in recent weeks, at 65/26 in the latest New York Times poll. This is also true in the case of swing district Democratic seats, who not only express a fundamental desire for health care reform this year, but support a public option and reject a trigger. This is also a crucially important piece from that polling:

It's wrong to think about the public option in isolation from other elements of reform. Forcing an individual mandate without a public option is a clear political loser (34% Favor / 60% Oppose), and only becomes more palatable when a public option is offered in competition with the private sector (50% Favor / 46% Oppose)

And swing district voters have already decided the private sector has failed to keep healthcare affordable, and want a public option now (48%) instead of waiting for a trigger (36%).

A mandate without a public option will be extremely unpopular because people can sense that the idea of a forced market for private insurers is designed in the interests of those insurers, not them. This is really elementary stuff.

I don't know if whether this report about Blue Dogs fading in their opposition to the public option relative to other health care goals is a sign that they're learning from these reports or not. They seem to be more interested in the regional disparities in Medicare reimbursement rates, which is really a payoff, but if those rates were adjusted, opposition to a public option tied to Medicare rates in some fashion would probably fade away. Especially considering that it's the fiscally responsible thing to do, per the CBO.

The original House bill required the public plan to pay providers 5 percent more than Medicare reimbursement rates. But as part of a package of concessions to Blue Dogs, the House Energy and Commerce Committee accepted an amendment that requires the HHS Secretary to negotiate rates with providers. That version of the plan will save only $25 billion.

In total, a public plan based on Medicare rates would save $110 billion over 10 years. That is $20 billion more than earlier estimates, a spokesman for House Speaker Pelosi said.

We'll see if this arsenal of evidence can convince Senators who really just want to protect the status quo, and more important, protect industry profits. We're finally going to see where they stand when the Finance Committee votes. We'll be watching.

Amendment Day

The Senate Finance Committee began marking up the Baucus health care bill this morning, and Part II of that hearing begins in just an hour or so. While the markup session is more a theater show than an actual horse trading session, lots of what has been going on behind the scenes will be revealed publicly over the next few days, in front of the White House and all the industry big hitters.

We know that the Republicans on the committee have given up trying to govern and are solely interested in scoring political points. Among their amendments are measures to reduce the excise tax “for any state with a name that begins with the letter ‘U’”. They have compiled 27 amendments designed to reduce affordability for regular Americans, dozens of amendments to protect industry from fees, one to change every instance of the word "fee" in the bill to "tax", and added the usual amendments around ACORN and czars. They are thoroughly unserious and have marginalized themselves from this debate.

That's proven by the fact that, based on the leaks so far, the movement is toward making the bill better from a liberal perspective than a conservative one. The affordability credits are expanding, new financing schemes are being debated, and Ron Wyden's Free Choice Act is picking up support amidst a decent CBO score:

Relative to the Chairman’s mark, the amendment as modeled would reduce the net impact on federal deficits by about $1 billion over 10 years. There would not be substantial effects on the total number of people with insurance coverage or the sources of that coverage, relative to the Chairman’s mark.

The CBO doesn't think lots of people would use Wyden's alternative, which would allow anyone to go into the exchange even if their employer offered health care. But this gives people an option, and sets the stage for an eventual move away from the employer system without a firewall propping it up. If it can show itself to be able to survive, it can prosper. If not, if the premiums go up and the employer-offered insurance gets worse, people have a safety valve. Max Baucus said this morning to Wyden, "I especially appreciate your comments about choice and competition if you don't want to be stuck with what your employer gives you. We're going to get into some ideas for how to do that."

I would like to see more counter-attacks along the lines of removing the anti-trust exemption for health insurers, to keep them in line with the policy. Dallasdoc has some great ideas. But the cantankerous nature of Republicans has actually moved the ball toward the only ones on the playing field, and Baucus-care is slowly, but surely, improving. Hopefully that will continue down the line.