Public Option Would Have Little Impact     Permalink

Ruth Marcus has a good column on the public option today discussing Sen. Ron Wyden (D-OR), someone we have brought up repeatedly here. People are starting to catch on. While the discussion of the public option in the health care bill has caused a huge uproar, it is just one of those symbolic issues that gets everyone's dander up, but would have little practical effect. Some people want it because they see it as a first step towards a single-payer plan that would eliminate the private insurance companies. Other people oppose it because they see it as a first step towards a single-payer plan that would eliminate the private insurance companies. But as currently formulated, the idea that everyone would be forced into a government-run plan is not true. Only people not eligible for employer-sponsored health care and some very small businesses would even have the option of choosing the public plan. As Marcus points out, even for a person whose employer chooses a plan with high copays and deductibles, the public option is no option at all. He or she must use the employer's plan.

This is where Wyden comes in. His plan, written jointly with arch-conservative Sen. Bob Bennett (R-UT), scraps the employer-based insurance altogether and instead has all the health-insurance companies compete nationally (something not currently the case) to force real competition and thus lower prices. What would also be needed is to remove the health-insurance industry's current exemption from antitrust law.

All the plans currently floating around Congress have as their real goal to get more people covered, in most cases by giving them government subsidies. This approach does not rock the boat because the insurance companies like it--it gives them 40 or 50 million new customers without creating any real competition to speak of. That the government is paying the premiums for many of their new customers is of little interest to the companies.

The Wyden-Bennett plan is not the only way to force competition. Another way is to allow anyone--including the already insured--to buy into either Medicare or the plan that federal employees have. Short of something like this, even if a health care plan passes and even if it has a public option, a lot of people will be very, very surprised to discover that absolutely nothing has changed for them except that they can quit their jobs and still get insurance, even with a pre-existing condition.

But even the pre-existing condition part may be illusory. In 1996, Congress passed the Kennedy-Kassebaum (also called HIPAA) bill by a vote of 98 to 0 in the Senate and 421 to 2 in the House. It was supposed to allow workers to keep their insurance when they left their jobs and prevent insurance companies from denying coverage to people with preexisting conditions. But it had no teeth, which is why it passed both chambers almost unanimously. Things that sound good on paper but don't actually change the status quo or have any economic impact on the industries supposedly being regulated are always winners in Congress. Here is more on Kennedy-Kassebaum.

Consider the following. Recently, a Texas woman, Robin Beaton, was scheduled to have surgery for breast cancer but three days before the operation her insurance company said they wouldn't pay for it because she had failed to disclose that she was once treated for acne. The insurance company didn't cancel her policy, a practice called rescission, due to a pre-existing condition, but due to her failing to disclose complete information about her health history. Of course, the company can make the disclosure form so complex and detailed that nobody could ever get it perfect making rescission easy. Eventually, her congressman intervened and she got her surgery, but only after her tumor had doubled in diameter. The point here is that the devil is in the details and that merely saying that companies can't discriminate based on pre-existing conditions doesn't mean a lot. The only thing that will keep them honest is genuine competition--and competition from the private sector is probably a bigger threat than a weak public plan or co-ops.

The bottom line is that when all the screaming and yelling is finished, Congress will pass a bill--with or without a public option--and half the country will cheer and half the country will be dismayed but nothing will change for most people. Whether this is a bug or a feature is in the eye (or wallet) of the beholder.

Republicans Lead in Gubernatorial Races     Permalink

New polls in the Virginia and New Jersey races for governor show the Republican candidates still leading in both states, albeit by smaller margins than in the past. In Virginia, Bob McDonnell (R) leads Criegh Deeds (D) 42% to 37% according to a new nonpartisan poll. He had been leading by over 10% before his masters' thesis, which advocated very conservative political views, was in the news. In New Jersey, challenger Chris Christie (R) leads incumbent Jon Corzine (D) 44% to 35%. An independent candidate, Chris Daggett, gets 13%. The elections will be held in just 6 weeks.

Republicans Lead in Key Senate Races     Permalink

Republicans also have good news in two Senate races. Embattled Sen. Chris Dodd (D-CT) still trails former representative Rob Simmons (R) 42% to 46% in a Research 2000 poll. However, Simmons will have to beat two or three challengers in a primary to become the candidate.

Majority leader Sen. Harry Reid (D-NV) is also in trouble. Polls show that Reid trails Danny Tarkanian (R), son of a former UNLV basketball coach, 40% to 50%. Against former Republican state chairwoman Sue Lowden, he fares just as badly.

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