So if we get a coop instead of a public option, what do we need in it?
GUARANTEED ACCESS: Any coop plan must immediately provide access to quality, affordable care that can never be taken away, even if you switch or lose jobs, start small business, early retirees, the uninsured, everybody.
COST: costs must be kept down, and with growth rates within shouting distance of inflation. And the buy-in must be significantly less than 13 percent of annual income.
COMPETITION: Having individual mandates without competition is a gigantic giveaway to the same insurers who are ripping us off – no dice. Also, regional coops must be able to bargain collectively or services, and states must allow interstate policy sales.
ACCOUNTABILITY: We must account for all the ways the insurers will game the system: we must have accountability to consumers, provide a “basic services” platform including prescription drugs, prevent price spikes, prevent adverse selection, prevent lifetime caps and gigantic deductibles, prevent insurers from denying you or dropping you…and in 2011 we will probably need a new law to address all the new ways insurers will try to cheat the system.
NATIONAL COVERAGE: Having state coops will be impractical, since the insurers, with effective monopolies in 38 states, will be able to crush small coops. Also, the insurers have sweetheart deals with local powerbrokers which would need to be changed – a huge issue. Also, idiots like Pawlenty want to play the bogus Tenth Amendment card, which must be dealt with.
ADMINISTRATION: To placate the conservatives, the plan would not be government-sponsored; it will be given its policy by the HHS, governed by members paid from coop’s own funds, financially guaranteed by the government in perpetuity (a must), and administered by private firms.
So it must always be there, it must always be affordable, it must always provide a minimum level of services.
Obama’s speech got Democrats to talk to each other, and won over independents and seniors; his meeting with the Blue Dogs reassured a lot of them on cost issues. Momentum is in his favor.
But there is still some confusion. Liberals think Obama backed the public option, the ever-changing Hoyer now expects some sort of public option (at least in the House), some Blue Dogs look for the public option to be “circumscribed” in favor of regional coops, Baucus thinks Obama backed the Baucus plan, and Republicans are either flipflopping or rejecting all compromise including coops. Schumer pointed out that the Baucus plan should be moved back to the left since Republicans won’t vote for it anyway. Some think the speech left room for a Conrad-like nonprofit coop along with a Snowe-like trigger for a public option if the private sector doesn’t enroll enough new people. Rangel wants to hold off on House action until the ever-sluggish Senate acts – possibly a dangerous recipe for delay, or possibly a way to get the two chambers synched up better.
So Obama still needs to herd the cats.
The one thing almost everyone agrees on, is writing off the Republicans. One GOP official said flat-out: “The image of a bunch of white guys booing an African-American president is about as bad as it gets.”
Friday, 11 September 2009
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