Tuesday, July 07, 2009

Obama Hasn't Compromised on the Public Plan. Yet.

by Jonathan Cohn

The White House just put out a statement, making clear that President Obama still supports including a voluntary public option as part of health reform:

I am pleased by the progress we're making on health care reform and still believe, as I've said before, that one of the best ways to bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete and keep them honest. I look forward to a final product that achieves these very important goals.

Separately, a high-ranking administration official privy to recent negotiations with the hospital industry told me that the administration in no way backed down from a public option in exchange for the industry's agreement to sign off on $155 billion in reduced Medicare and Medicaid fees.

(On the other hand, according to the Washington Post, the White House did promise not to let the public plan use the relatively low reimbursement rates of Medicare and/or Medicaid. But those two things aren't mutually inconsistent)

The main impetus for this push, I gather, is a new Wall Street Journal story:

By Laura Meckler and Janet Adamy

It is more important that health-care legislation inject stiff competition among insurance plans than it is for Congress to create a pure government-run option, White House Chief of Staff Rahm Emanuel said Monday.

"The goal is to have a means and a mechanism to keep the private insurers honest," he said in an interview. "The goal is non-negotiable; the path is" negotiable.

Mr. Emanuel said one of several ways to meet President Barack Obama's goals is a mechanism under which a public plan is introduced only if the marketplace fails to provide sufficient competition on its own. He noted that congressional Republicans crafted a similar trigger mechanism when they created a prescription-drug benefit for Medicare in 2003. In that case, private competition has been judged sufficient and the public option has never gone into effect.

Notwithstanding the White House statement and private assurances administration officials are giving reporters, I assume Emanuel's statement is an accurate reflection of the administration's thinking on the matter. Remember, this isn't Joe Biden talking as he's walking to his car, with a bunch of microphones stuck in his face. This is Emanuel, who always chooses his words carefully, speaking in a sit-down interview with reporters from one of the nation's most influential media organizations.

Besides, it's not as if the White House push actually contradicts what Emanuel said to the Journal. In other words, that fact that Obama supports a public plan and hasn't bargained it away yet doesn't mean that, at the end of the day, he wouldn't embrace a compromise on it.

Obama has said as much himself, by making clear he wouldn't draw a "line in the sand" on the public plan. Since Obama has in fact drawn a line in the sand on at least two other issues--a plan must not inflate the deficit, he's said, and it must make progress on reducing costs over the long run--it's fair to assume he and his advisers don't feel as strongly about the public insurance option.

Update: Karen Tumulty notes that notes that the trigger option Emanuel describes sounds a lot like the idea that Republican Senator Olympia Snowe, among others, has floated.

Source: The Treatment

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