Editore"s Note
Tilting at Windmills

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August 20, 2009

CHOICE AND A PUBLIC OPTION.... It seems some of the opposition to a public option in health care reform has to do with a misconception: that it would be mandatory.

Rep. Mike Ross (D-Ark.), the Blue Dog point-man on health care, said yesterday he would not vote for a plan that would "force government-run healthcare on anyone. Period." But he added that the House contained a public plan that is "strictly ... an option."

Given the name -- "public option" has the word "option" in it -- I'd hoped that was obvious. It's not. When pollsters ask about a public option, lately, there's been a lot of opposition. When pollsters ask about the policy and ask if people want the choice, the results are far more encouraging.

More than three out of every four Americans feel it is important to have a "choice" between a government-run health care insurance option and private coverage, according to a public opinion poll released on Thursday.

A new study by SurveyUSA puts support for a public option at a robust 77 percent, one percentage point higher than where it stood in June.

This comes on the heels of an NBC poll. In June, the poll asked respondents if they thought it was important to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance." A total of 76% thought it was important. When NBC changed the wording, and dropped the concept of choice, support for the public option plummeted to 43%.

This should offer reformers a pretty big hint about how to frame the pitch: reform would offer Americans a choice between private insurers or a voluntary public option, which would compete to help lower costs.

Dems should also be prepared to press opponents on this. "I think consumers should have a choice between competing private and public plans. Why don't you want American families to have a chioce?"

Steve Benen 3:55 PM Permalink | Trackbacks | Comments (24)

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Comments

Republicans don't like choice, remember??

Posted by: Matt on August 20, 2009 at 3:58 PM | PERMALINK

seeing as how obama just called it "suspenders" -- with a belt of other reforms (the supposed goodybag to appease progressives if we dont get the suspenders) --

perhaps "option" can be better understood now by the thicker and more emotionally differently-abled...

Posted by: neill on August 20, 2009 at 3:58 PM | PERMALINK

It would also be nice if everyone had the option of joining the public plan, which is not the case. So there is some coercion (of the Republican-preferred kind).

Posted by: elbrucce on August 20, 2009 at 4:07 PM | PERMALINK

I remember when the Nazis gave Jews the option of moving to concentration camps or not. There was the same confusion then.

Which proves Obama is a Nazi. From Kenya.

Posted by: chrenson on August 20, 2009 at 4:25 PM | PERMALINK

I have written the White House healthcare website about this very issue. As a former teacher, I am crestfallen to realize that the word "option" is too complicated for legislators and our fellow Americans to understand. The language must be explicit, able to be understood by the average 5 year old. Better to use the word "choice." How pathetic is that???

Posted by: Carol A. on August 20, 2009 at 4:27 PM | PERMALINK

Some of my acquaintances are reading "choice" as not having a choice about "having" insurance at all -- if it's mandated that all have (and pay for in some way) insurance, then the only choice becomes who gets the dollars. They see mandated insurance as a net outflow of money from their current status.

Perhaps this is an area where some clarification could occur.

.
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Posted by: ROF on August 20, 2009 at 4:30 PM | PERMALINK

Well as long as progressives are honest among ourselves about what some of us really want and expect.

Advocates of Single-Payer generally believe that that on a level playing field it would provide better service at a lower cost and so would be perfectly willing to line up behind a Medicare for All program that would indeed allow no real choice. (No one forces people over 65 to participate in Medicare Parts A, B or D, you can opt out of B and D and if you draw your income solely from capital can avoid paying for A, but but 95+% of us we pay for Part A (Hospital) whether we want to our not.)

I believe the combination of a Public Option and the profit control provisions of Sec 116 of the House bill combined will first kill the market for individual health insurance and then the market for what the bill calls 'smallest employers' (who mostly don't supply good coverage now) and severely impact the market for what the bill calls 'smaller employers'. The privates simply won't be able to compete on price and employers will simply pay the 8% of payroll fee as the cheaper alternative to facing the uncertainty of future rate increases in case of a spike in claims. (Under the current system you are under the mercy of any new hire, they have no legal obligation to tell you that they have a chronically sick spouse or a special needs kids and unless they are total idiots who want that spouse or kid to starve because Mom got turned down for a job they won't. And the result for the employer may well be a rate increase at plan renewal.)

The end result will be more and more employers deciding to drop coverage leaving employees no real choice beyond turning to the Public Option. For sales purposes it may be necessary to maintain the front of 'Choice' but the path to Single-Payer that runs through the Public Option starts looking more mandatory the farther down it you go.

The President's promise that you will be able to keep the coverage you have assumes that employers will not force your hand by dropping coverage unilaterally. Not only do I expect that to happen, as a supporter of Single Payer/Medicare for All I welcome its advent. And so should other progressives, the elimination of choice is a feature and not a bug if you truly believe in Single Payer.

Posted by: Bruce Webb on August 20, 2009 at 4:37 PM | PERMALINK

Dems should also be prepared to press opponents on this. "I think consumers should have a choice between competing private and public plans. Why don't you want American families to have a chioce?"

Dems? Why not the President?

Posted by: Econobuzz on August 20, 2009 at 4:42 PM | PERMALINK
Dems? Why not the President?

Unless there has been a coup or Presidential party-switch when I wasn't looking, "Dems" includes the President.

Posted by: cmdicely on August 20, 2009 at 4:44 PM | PERMALINK

Given the name -- "public option" has the word "option" in it -- I'd hoped that was obvious.

Not at all. Political English is far too ambiguous and malleable for nearly any word to have an obvious meaning especially taken out of context.

Don't forget that for the last several years, the word "option" has been primarily used in VERY threatening contexts. As in, "Republicans are considering using the "nuclear option." Or, "we don't want war, but if Saddam doesn't come clean about WMD, we'll need to pursue other options."

See? It's not so hard to understand how people might be confused.

Nothing is as simple as it looks when it comes to language and meaning.

Posted by: lobbygow on August 20, 2009 at 4:48 PM | PERMALINK

You were referenced and quoted by Glenn Greenmwald in yesterday's post Mr. Benen. It was an insightful article showing how the public option was always just a bargaining chip for the WH who could have controlled the message all along but allowed detractors to push it out while rallying progressives to defend it so it would have more bargaining power. Here's just a piece from the article where Glenn begins to sum up before explaining what can be done about it if we are to save a "Public option" (Single payer was never allowed into the debate because ti was too much of a problem solver):

"...The attempt to attract GOP support was the pretext which Democrats used to compromise continuously and water down the bill.  But -- given the impossibility of achieving that goal -- isn't it fairly obvious that a desire for GOP support wasn't really the reason the Democrats were constantly watering down their own bill?  Given the White House's central role in negotiating a secret deal with the pharmaceutical industry, its betrayal of Obama's clear promise to conduct negotiations out in the open (on C-SPAN no less), Rahm's protection of Blue Dogs and accompanying attacks on progressives, and the complete lack of any pressure exerted on allegedly obstructionists "centrists," it seems rather clear that the bill has been watered down, and the "public option" jettisoned, because that's the bill they want -- this was the plan all along.  

The Obama White House isn't sitting impotently by while Democratic Senators shove a bad bill down its throat.  This is the bill because this is the bill which Democratic leaders are happy to have.  It's the bill they believe in.  As important, by giving the insurance and pharmaceutical industries most everything they want, it ensures that the GOP doesn't become the repository for the largesse of those industries (and, converesly, that the Democratic Party retains that status).
This is how things always work.  The industry interests which own and control our government always get their way.  When is the last time they didn't?  The "public option" was something that was designed to excite and placate progressives (who gave up from the start on a single-payer approach) -- and the vast, vast majority of progressives (all but the most loyal Obama supporters) who are invested in this issue have been emphatic about how central a public option is to their support for health care reform.  But it seems clear that the White House and key Democrats were always planning on negotiating it away in exchange for industry support.  Isn't that how it always works in Washington?  No matter how many Democrats are elected, no matter which party controls the levers of government, the same set of narrow monied interests and right-wing values dictate outcomes, even if it means running roughshod over the interests of ordinary citizens (securing lower costs and expanding coverage) and/or what large majorities want..."
* * * * *
Go read the whole argument as the next paragraphs tell what is being done about this and how we can help.

Posted by: bjobotts on August 20, 2009 at 4:49 PM | PERMALINK

It's like years we had to go through years of calling it a 'PIN number' after calling it a 'personal identification number (PIN)'. Gotta make things double clear for the heartland.

Posted by: Crissa on August 20, 2009 at 4:52 PM | PERMALINK

Bruce Webb: The President's promise that you will be able to keep the coverage you have assumes that employers will not force your hand by dropping coverage unilaterally. Not only do I expect that to happen, as a supporter of Single Payer/Medicare for All I welcome its advent. And so should other progressives, the elimination of choice is a feature and not a bug if you truly believe in Single Payer.

That argument has been made by opponents of the "public option" and disputed by proponents. It is one of the supposed "actual details" Steve Benen referred to yesterday that the proponents do not agree on.

The government itself (i.e. "bureaucrats" and "experts") would write the regulations covering the public option and other eligible plans, and would most likely write them so as to protect the public plan from competition, thereby (as you wrote) driving the private plans out of business, and eliminating "choice".

Proponents who (contrary to your post) say that this can't happen -- are they naive? uninformed? disingenuous? misleading their constituents?

Posted by: marketeer on August 20, 2009 at 4:53 PM | PERMALINK

Given the name -- "public option" has the word "option" in it -- I'd hoped that was obvious.

Hmmm... so the public option means choice! Never thought of it. So far, when hearing 'public option', I actually heard 'fascist government takeover', because that's how Hannity programmed me.

Yours, Random E. Teabagger

Posted by: Ohioan on August 20, 2009 at 4:54 PM | PERMALINK

You quote: "More than three out of every four Americans feel it is important to have a "choice" between a government-run health care insurance option and private coverage..."

From your previous post: "You'll have choices, regardless of what the detractors tell you," Hill said. "They are lying. That's a strong word, but it's true." (And then you write) Thank you, Baron Hill. When Blue Dogs get sick of conservative misinformation, you know it's getting out of hand.

I hope a few more of you out there are beginning to appreciate Obama's strategy now. As the issues are clarified, support rises. The Repubs have been driven to expose themselves not just as liars, but as, to use Joe Klein's word, "nihilists," and the Blue Dogs have been given the opportunity to be, well, Blue.

Posted by: CMcC on August 20, 2009 at 5:31 PM | PERMALINK

You could have a public option without a mandate.
I don't think you can have a mandate without a public option.
It wouldn't pass a Constitutional smell test.

Posted by: thebewilderness on August 20, 2009 at 5:32 PM | PERMALINK

The government itself (i.e. "bureaucrats" and "experts") would write the regulations covering the public option and other eligible plans, and would most likely write them so as to protect the public plan from competition, thereby (as you wrote) driving the private plans out of business, and eliminating "choice".

Once again "marketeer" insists that private industry -- those Titans of the Free Market with all their Profit Motive and Efficiency -- can't compete with government. It's a fascinating admission!

Posted by: Gregory on August 20, 2009 at 5:51 PM | PERMALINK

Devil's advocate: As various committees have worked on the bill, there's been much discussion of lawmakers' options in crafting the plan and paying for it. I suppose "public option" may subconsciously strike some ears as "option to include a mandatory public system in the bill".

At least we're talking about it directly now. For weeks running, on shows like Face the Nation, you had McConnell or Sessions and some ConservaDem agreeing with each other, and Bob Schieffer hyperventilating about whether taxes would be raised, or "Cadillac plans" taxed. 100% GOP f-u-d talking points, and not a peep about the public option & the overwhelming popular support for it.

Posted by: Lionel E. Hutz, attorney-at-law on August 20, 2009 at 6:24 PM | PERMALINK

NO CO-OP'S! A Little History Lesson

Young People. America needs your help.

More than two thirds of the American people want a single payer health care system. And if they cant have a single payer system 77% of all Americans want a strong government-run public option on day one (85% of democrats, 71% of independents, and 60% republicans). Basically everyone.

Our last great economic catastrophe was called the Great Depression. Then as now it was caused by a reckless, and corrupt Republican administration and republican congress. FDR a Democrat, was then elected to save the nation and the American people from the unbridled GREED and profiteering, of the unregulated predatory self-interest of the banking industry and Wallstreet. Just like now.

FDR proposed a Government-run health insurance plan to go with Social Security. To assure all Americans high quality, easily accessible, affordable, National Healthcare security. Regardless of where you lived, worked, or your ability to pay. But the AMA riled against it. Using all manor of scare tactics, like Calling it SOCIALIZED MEDICINE!! :-0

So FDR established thousands of co-op's around the country in rural America. And all of them failed. The biggest of these co-op organizations would become the grandfather of the predatory monster that all of you know today as the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT health insurance industry. And the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT healthcare industry.

This former co-op would grow so powerful that it would corrupt every aspect of healthcare delivery in America. Even corrupting the Government of the United States.

This former co-op's name is BLUE CROSS/BLUE SHIELD.

Do you see now why even the suggestion of co-op's is ridiculous. It makes me so ANGRY! Co-op's are not a substitute for a government-run public option.

They are trying to pull the wool over our eye's again. Senator Conrad, if you don't have the votes now, GET THEM! Or turn them over to us. WE WILL! DEAL WITH THEM. Why do you think we gave your party Control of the House, Control of the Senate, Control of the Whitehouse. The only option on the table that has any chance of fixing our healthcare crisis is a STRONG GOVERNMENT-RUN PUBLIC OPTION.

An insurance mandate and subsidies without a strong government-run public option choice available on day one would be worse than the healthcare catastrophe we have now. The insurance, and healthcare industry have been very successful at exploiting the good hearts of the American people. But Congress and the president must not let that happen this time. House Progressives and members of the Tri-caucus must continue to hold firm on their demand for a strong Government-run public option.

A healthcare reform bill with mandates and subsidies but without a STRONG government-run public option choice on day one, would be much worse than NO healthcare reform at all. So you must be strong and KILL IT! if you have too. And let the chips fall where they may. You can do insurance reform without mandates, subsidies, or taxpayer expense.

Actually, no tax payer funds should be use to subsidize any private for profit insurance plans. Tax payer funds should only be used to subsidize the public plans. Healthcare reform should be 100% for the American people. Not another taxpayer bailout of the private for profit insurance industry, disguised as healthcare reform for the people.

God Bless You

Jacksmith Working Class

Twitter search #welovetheNHS #NHS Check it out

(http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/)

(http://www.youtube.com/watch?v=IbWw23XwO5o) CYBER WARRIORS!! - TAKE THIS VIRAL

Posted by: jacksmith on August 20, 2009 at 8:35 PM | PERMALINK

Monkey Insurance.

I was taught in Asia how to catch a monkey.

Get a hard coconut shell and put a hole in it about 1 inch in diameter.

Connect the coconut shell to a 20 ft string.

Place a ball of sticky rice inside the coconut shell.

The monkey will put his hand into the coconut shell to get the rice.

When he/she tries to pull out the hand, it will not fit through the hole with the fist around the rice.

Due to greed, the monkey will NOT release the rice to get his/her hand out and you have thus caught the monkey.

I caught every single monkey I tried to catch this way and released him/her by spraying water into the coconut so the rice was no longer in a sticky ball.

Insurance companies are greedy monkeys refusing to give up anything for the common good.

Posted by: Ken on August 20, 2009 at 9:40 PM | PERMALINK

[sockpuppeting deleted --mod.]

Posted by: gary on August 21, 2009 at 12:39 AM | PERMALINK

[sockpuppeting deleted - mod.>

Posted by: sam on August 21, 2009 at 12:54 AM | PERMALINK

One thing about this choice business: Remember it's a myth that Americans have a choice in health policies (beyond the choice my granddad offered his kids for dinner: you can take it, or you can leave it).

Only the largest companies offer employees a choice between even two policies, and there the decision often comes down to which includes your doctor on the list. Or, when neither does, which one your doc would rather go through the red tape to sign up with.

Posted by: Suzii on August 21, 2009 at 3:28 AM | PERMALINK

Republican opposition to health care reform is entirely ideological not programmatic. Therefore no compromise plan is possible. Republicans have staked their political recovery on a return to neo-Reaganite government-bashing -- which liberals need to point out again and again is really democracy-bashing. So, the passage of any government program that actually benefits average Americans is, from the Republican point of view, a disaster because it undoes 30 years of conservatives progaganda that tries to convince Americans that government is inherently inefficient, corrupt and oppressive.

That's really all there is too it, and it doesn't stop even when Republicans control the government. The Bush administration was more than willing to pass the huge and hugely expensive prescription drug benefit for Medicare because they saw it as giving them a two-fer: First, it gave huge benefits to the drug companies that pay Republican bills. And second -- and even though this was a Republican bill -- its runaway costs gave Republicans another opportunity to beat up on the profligate waste of government-run programs once Republicans were thrown out of office and looking for an agenda that would get them back in the door.

You have to be willing to check your reason and morals at the door, and accept a lot of outrageous nonsense, if you want to understand how Republicans think these days.

Posted by: Ted Frier on August 21, 2009 at 6:45 AM | PERMALINK




 

 

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