This week has seen a lot of forward movement on health care reform — from rumors that Pres. Obama was about to take the public option off the table, to yesterday’s reports that House Democrats have come together on a plan to impose a surtax on wealthy Americans to help pay for health care.
Earlier in the week, the Blue Dog Democrats’ anti-public option armor began to show some cracks. On Wednesday, Blanche Lincoln made a subtle but clear shift in favor of the public option (emphasis in original):
Lincoln, who’s getting hammered by ads demanding she commit to the public option, has now shifted towards supporting one, at least in rhetorical terms. In a piece for today’s Arkansas Democrat-Gazette, she says health care reform should include a public plan or a non-profit substitute.
Here’s the key graf from Lincoln (the piece is subscription only):
Health care reform must build upon what works and improve inefficiencies. Individuals should be able to choose from a range of quality health insurance plans. Options should include private plans as well as a quality, affordable public plan or non-profit plan that can accomplish the same goals as those of a public plan.
The assertion that reform “should” have a public plan or non-profit substitute is a shift from her previous position, which was only that she was “evaluating” a public plan or a substitute.
Much if not most of the credit for persuading Rep. Lincoln to change her thinking on a government-run plan goes to these folks.
Another Blue Dog Democrat — Loretta Sanchez from California — broke ranks with her centrist colleagues on Friday, after they presented House Democratic leaders with a letter that listed cost-cutting demands that forced the latter to delay the roll-out of the final health care reform package until Monday. In the same letter, however, the conservative Democrats also stated their opposition to any public health care component, on the grounds that the “below-market rates” of ” ‘[a] Medicare-like’ public option would negatively impact hospitals, doctors and patients. …” In other words, the BDDs were objecting to the lower costs of a public option!
Igor Volsky notes there’s “an inherent contradiction” in this letter: the Blue Dogs want to find more savings within the system, but they’re also asking that the bill spend more.
Fortunately, there is at least one “Blue Dog” member who understands this contradiction and is willing to break from her coalition to support a public plan. On MSNBC this afternoon, Rep. Loretta Sanchez (D-CA) said, “I am one of those people who believes that we should be required to have a public option because it will bring the costs of health care down.”
The Congressional Budget Office has released a preliminary score for the public plan, and it looks good — with caveats:
According to a pair of Capitol Hill sources, preliminary estimates from the Congressional Budget Office suggest that a strong public option–the kind that the House of Representatives is putting in its reform bill–should net somewhere in the neighborhood of $150 billion in savings over ten years.
The sources cautioned that these were only the preliminary estimates, based on previous discussions–that CBO had not yet issued final scoring on language in the actual bill. But the sources felt the final estimate would likely be close.
Exactly how the plan produces those savings is, obviously, a key question. The reason–well, a reason–centrists and conservatives don’t like a public plan is that they fear it will use the government’s bargaining leverage to force doctors, hospitals, and drugmakers to accept unfairly low reimbursements. Private insurance would go out of business, since they couldn’t compete; meanwhile, providers and producers of medical care would struggle to stay afloat.
Advocates of a public plan (myself included) think those fears are overblown–and that there are ways to make sure a public plan doesn’t have that effect. But if the CBO is scoring significant savings, then chances are the House version gives the public plan the kinds of power conservatives and centrists fear.
But, for now, the bigger story is the number. At a time when finding the $1 trillion it will take to finance coverage expansions remains the major challenge of reform, the discovery of $150 billion in potential savings is an important–and encouraging–piece of news.
TheHill.com reports that support among conservative Democrats for a ” ‘robust’ public health insurance plan” is broader than one might think:
A band of 22 New Democrat and Blue Dog lawmakers say they support a “robust” government-run health plan, boosting chances of moving healthcare reform with a public insurance plan through the House.
Democratic centrists remain the biggest obstacle to House Speaker Nancy Pelosi’s (D-Calif.) ability to pass a healthcare bill with a public plan, and many conservative Democrats oppose a public option as unfair to private insurers.
But the letter from the 22 New Dems and Blue Dogs indicates opposition from this group is far from universal.
“We have a broader coalition to pass this than what was assumed before,” said Rep. Lois Capps (Calif.), a New Democrat who circulated the letter supporting a public option with Rep. Chris Murphy (D-Conn.). “While we may belong to a more moderate branch, we want it known that we support the public option.”
The 20 New Democrats on the letter represent nearly one-third of the 68-member caucus. It is signed by two Blue Dogs and three members who are both New Dems and Blue Dogs.
Charlie Rangel (D-N.Y.) will unveil the House’s health care plan on Monday.
All, via Memeorandum River.
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