Senate Deal Does NOT Eliminate the Public Option

As you may have heard by now, it looks like a deal has been reached on health care reform proposals from the US Senate. The basic shape of the deal is that the final vestige of the original public option proposed in the legislation has been removed.

But wait! All my fellow public option proponents, before you begin to decry the compromise that surrenders the thing you had been hanging your hat upon, I ask you to take a gander at what we are getting in exchange. Not all compromises are bad compromises - the question should be: did we get somethinge of value in exchange for what surrendered.

Q: So, what did we get?

A: Well, for starters, we got something called Medicare buy-in.

Q: What's that?

A: Basically it means that if you do not have or cannot afford insurance, you can purchase cover under the existing medicare program. This way you benefit from the government's negotiated rate for services, and a national not for profit plan that is administerd by the government, and is trusted and popular.

Q: But wait... That sounds a lot like... A public plan.

A: Yes, it is. In fact, it's a version of something Ted Kennedy was advocating for early on in this process - something he called "Medicare for All". It's simple, cost effective and absolutely a public option.

Q: There's a catch, right?

A: Yes. Medicare buy in is only offered to those over the age of 55 - people within 10 years of qualifying for medicare anyway.

Q: So what about the rest?

A: People under the age of 55, without insurance, can buy a range of options from the health exchange. Some of those options, according to this compromise plan, would be plans administerd by the Office of Personnel and Management. These OPM plans are very similar to what the government offers its own federal employees. It has very tight restrictions and it can't make a profit. Any organisation that wants to could create such a plan but they would have to get OPM approval and closely monitored by them.

Q: Gee. That sounds kind of... similar to a public option.

A: Yes it is, a bit. The only difference is that the day to day management would be administered by an outside company, but it's very closely government controlled in order to reduce costs.

Q: But what if they don't reduce costs?

A: Apparently, the current plan would allow for a trigger under which a directly government managed public option would be created if these plans fail to achieve their objectives. Realistically, though, the terms under which that would happen are so stringent that it is unlikely to ever take place.

Q: Hmmm....

A: Yes. It bears thinking about, doesn't it?

Q: Anything else?

A: YES! One other thing I think is nifty is the notion, rumored to now be included in the bill, that insurers on the exchange will be limited to spending at least 90% of their income on actual health care. If true, that would make me really, really happy.

There's lots more to learn, think, talk about in the days and months to come. But at the moment I am feeling cautiously optimistic that what we have done is compromise the way it SHOULD work: we've gotten something near to or equal what we traded away and in the process allowed our opponents (in this case, conservative Democrats. And Joe Lieberman) the opportunity to save face and come on board.

Whether they will or not remains to be seen. But I got hope. And, apparently, so does Howard Dean!

So glad that me and Governor Dean are back on the same side of this.