Tuesday, October 27, 2009

Wyden's Free Choice Amendment, Generic Drugs and the Exchange

During an appearance on Rachel Maddow's program, Senator Ron Wyden said that he would fight all the way to floor to open the public option to everyone, not just the 10% who cannot get private insurance as is the case now. He says this is the time for progressives to demand that the rhetoric of choice matches reality in policy. As Wyden says,

The bottom line is that the public option can’t really hold private insurers accountable if it is only competing for 10 percent of the insurance market, because private insurance companies aren’t going to change their business practices if 90 percent of their customers can’t take their business elsewhere.

Real reform means empowering Americans to choose insurance that works well for them and their family, while rejecting plans that don’t. Including a public option is a step in the right direction, now let’s remove the firewalls in this bill that prevent Americans from choosing it,'' Wyden said in a statement.

Currently the Public Options being discussed would be open to 10% who have no other access to health insurance. This population would be disproportionately filled with very medically high risk people, and the cost of insuring them, even under a government sponsored public plan, could quickly skyrocket. Dumping by the big insurers during the first couple of years while reforms were still "kicking in" could further exacerbate this, effectively bankrupting the public plan (which must be law be self-sustaining) before it ever has the chance of succeeding.

Employee based coverage, Mandates and Opt-Outs:

Some additional thoughts I want to make sure you understand. Right now, only small businesses, those who can't get insurance and those who buy insurance on the individual market will be eligible to purchase insurance on the exchange. If you work for a large employer who offers bad insurance coverage, you can't purchase something better for yourself through the exchange or public option.

Most citizens no longer count on remaining with the same employer for 5 years, much less 20 and in the last few years, we've seen that it is not uncommon to have to change jobs multiple times within a few years. Should you also have to be switching insurance companies and doctors every time you change jobs? An individual able to buy their own insurance on an exchange or through the Public Option would not be burdened with that constant change - which frequently depending on the insurance plan, may require changing healthcare providers.

If states are allowed to opt-out of the Public Option, then shouldn't the citizens of those states who do want and need a public option have access to it on their own? Especially if there are mandates that everyone must have insurance.

The entire health care exchange along with the Public Option should be open to all citizens. Wyden's Free Choice amendment is not mere icing; it is essential. We should definitely rally to support this.

The New Republic had a forum in Washington, D.C. this morning and Representative Anthony Weiner shared his thoughts on this issue. Ezra Klein reports:

Can you reform the health-care system if you can't change it?
The exchanges are closed to 90 percent of the population for the same reason that the public option is weakened and limited only to the exchanges, and even then, limited to the states that want to offer it, at least in the Senate's version. These rules exist for a simple reason: to stop people from fleeing employer-based insurance. Rep. Anthony Weiner, speaking at The New Republic's heath-care reform panel this morning, is a bit confused.
What are we trying to protect when we're trying to protect against the destabilization of a system we all agree isn't working and that we think people are trying to leave?

He's right, of course. Among the many implicit precepts directing health-care reform are the following:

  1. The employer-based system doesn't work, either to assure coverage or control cost.
  2. The employer-based system must be preserved.
  3. A strong public option would offer consumers lower premiums and attract a lot of customers.
  4. A strong public option cannot be included because private insurers cannot effectively compete with it.
  5. Among the worst economic distortions of the system is the fact that employers choose insurance for their employees, and thus employees don't really understand the cost of coverage.
  6. The exchange cannot initially be open to employees, and may never be opened to employees, because they might leave employer-based insurance in order to shop for their own policies more aggressively.
You can go on in this vein, of course. It's a bit of a problem. Underlying it is the political insight that people want the system changed but are afraid of rapid changes to their personal situation, and so reformers are trying to build out their reforms such that people can transition to new and better options gradually. The problem with that, of course, is that the reforms won't necessarily have the size or scale to show their power, and many people will be legally prevented from changing over even if they would like to. It's a bit like rolling out a new television, but refusing to sell it to people who own televisions larger than 25 inches. You've lost a big pool of early adopters, which means you might also lose the people who would otherwise follow them.
So what do we need to be doing now?

We still have a LOT of work to do. From today’s Los Angeles Times:
As President Obama’s push for a healthcare overhaul moves toward its final act, the oft-vilified health insurance industry is on the verge of seeing a plan enacted that largely protects its financial interests.

In the House:
  1. Continue to urge Reps for Yes votes on the Weiner Amendment and to retain the Kucinich Amendment in the final bill.
  2. Urge House members to make the Public Option they adapt Open to All citizens and to be based on Medicare +5%
  3. Remind your Representative and House leaders that the employment market has changed and there is no reason for healthcare benefits to be tied to employers any longer.
  4. Urge House members to remove the the Eshoo/Barton amendment that blocks generic competition by granting 12 years of monopoly protection along with the patent protection that biologic drugs already receive. More Info.

In the Senate:
  1. Urge Support for the Wyden Free Choice Amendment and an open exchange so all citizens can benefit from reform
  2. Remind your Senators that the employment market has changed and there is no reason for healthcare benefits to be tied to employers any longer.
  3. Tell Your Senators and Senate leaders that we need affordable medicines in the hands of patients and they should not pass any law that blocks generic competition.
Letters to the Editor:
Letters to the Editor are still one of the most effective ways of swaying political opinion despite how many of us are spreading information on-line. I would guess they are still as important as your personal phone calls to Congress because politicians know that many more people will read your opinion when printed in regional and national papers and that local papers are read by voters in their districts who may not be active on the Internet.

On the right side of this blog, you will see the widget for Contact Congress from Congress.org. You can use that to find contact information for your Reps and Senators as well as local media if needed. Make a pledge to yourself to do at least one thing every day to try and see that we have the absolute best health care reform bill possible. We - and your kids and grandkids will live with it for a long time, so let's all pitch in and try to make sure it is done right.

1 comment:

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