March 12, 2010

House Speaker Nancy Pelosi was firm today: A public option will not be included in the reconciliation package. After reminding reporters that she has been for single payer health care since "before most of [them] were born", she explained there would be no public option in the reconciliation bill. Expanding that answer, she pointed the finger at the Senate, saying,"[the Senate] does not have the votes."

We can argue about whether the Senate has the votes or not, but as TPM reports, Senate support has diluted as more Senators make qualified commitments. Of those making some sort of commitment, only 24 have actually signed the Bennet letter. The rest have given only qualified nods.

But the latest support rests on increasingly unstable grounds, with recent additions to the list naming multiple caveats. Sen. John Tester (D-MT), for example, said, "It depends on how it was designed." Sen. Byron Dorgan (D-ND) said he wouldn't vote for a public option that reimburses doctors at the Medicare rate. Sen. Russ Feingold's office told TPM he'd only support a public option that lowers the deficit by $25 billion.

Despite the lack of a public option, some little-recognized provisions in the Senate bill do actually serve the purpose of offering lower-cost insurance. Policies negotiated by the OPM which cannot be operated or priced for profit is one way to force competition, particularly when it requires companies to spend 95% of the premium paid on actual benefits. I have issues with the state opt-in provisions the Senate attached, but I still expect rates to be lower than ordinary commercial policies in states where they're offered.

If the effort put into the public option was redirected into pushing Congress to remove the opt-in provisions and make the insurance exchange national as part of future legislation it would be a better use of energy. Or alternatively, push toward Grayson's solution of offering at-cost buy-in option to Medicare to everyone. Either idea has a better chance than beating a horse that's died, been laid to rest and had the coffin nailed shut by none other than Speaker Pelosi.

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