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How Pharma and Insurance Intend to Kill the Public Option
Source Dave Anderson
Date 09/06/06/18:31

Robert Reich's Blog
How Pharma and Insurance Intend to Kill the Public Option, And What
Obama and the Rest of Us Must Do
by Robert Reich

I'VE POKED around Washington today, talking with friends on the Hill
who confirm the worst: Big Pharma and Big Insurance are gaining ground
in their campaign to kill the public option in the emerging health
care bill.

You know why, of course. They don't want a public option that would
compete with private insurers and use its bargaining power to
negotiate better rates with drug companies. They argue that would be
unfair. Unfair? Unfair to give more people better health care at lower
cost? To Pharma and Insurance, "unfair" is anything that undermines
their profits.

So they're pulling out all the stops -- pushing Democrats and a
handful of so-called "moderate" Republicans who say they're in favor
of a public option to support legislation that would include it in
name only. One of their proposals is to break up the public option
into small pieces under multiple regional third-party administrators
that would have little or no bargaining leverage. A second is to give
the public option to the states where Big Pharma and Big Insurance can
easily buy off legislators and officials, as they've been doing for
years. A third is bind the public plan to the same rules private
insurers have already wangled, thereby making it impossible for the
public plan to put competitive pressure on the insurers.

Max Baucus, Chair of Senate Finance (now exactly why does the Senate
Finance Committee have so much say over health care?) hasn't shown his
cards but staffers tell me he's more than happy to sign on to any one
of these. But Baucus is waiting for more support from his colleagues,
and none of the three proposals has emerged as the leading candidate
for those who want to kill the public option without showing they're
killing it. Meanwhile, Ted Kennedy and his staff are still pushing for
a full public option, but with Kennedy ailing, he might not be able to
round up the votes. (Kennedy's health committee released a draft of a
bill today, which contains the full public option.)

Enter Olympia Snowe. Her move is important, not because she's
Republican (the Senate needs only 51 votes to pass this) but because
she's well-respected and considered non-partisan, and therefore offers
some cover to Democrats who may need it. Last night Snowe hosted a
private meeting between members and staffers about a new proposal
Pharma and Insurance are floating, and apparently she's already gained
the tentative support of several Democrats (including Ron Wyden and
Thomas Carper). Under Snowe's proposal, the public option would kick
in years from now, but it would be triggered only if insurance
companies fail to bring down healthcare costs and expand coverage in
he meantime.

What's the catch? First, these conditions are likely to be achieved by
other pieces of the emerging legislation; for example, computerized
records will bring down costs a tad, and a mandate requiring everyone
to have coverage will automatically expand coverage. If it ever comes
to it, Pharma and Insurance can argue that their mere participation
fulfills their part of the bargain, so no public option will need to
be triggered. Second, as Pharma and Insurance well know, "years from
now" in legislative terms means never. There will never be a better
time than now to enact a public option. If it's not included, in a few
years the public's attention will be elsewhere.

Much the same dynamic is occurring in the House. Two members who had
originally supported single payer told me that Pharma and Insurance
have launched the same strategy there, and many House members are
looking to see what happens in the Senate. Snowe's "trigger" is
already buzzing among members.

All this will be decided within days or weeks. And once those who want
to kill the public option without their fingerprints on the murder
weapon begin to agree on a proposal -- Snowe's "trigger" or any other
-- the public option will be very hard to revive. The White House must
now insist on a genuine public option. And you, dear reader, must
insist as well.

This is it, folks. The concrete is being mixed and about to be poured.
And after it's poured and hardens, universal health care will be with
us for years to come in whatever form it now takes. Let your
representative and senators know you want a public option without
conditions or triggers -- one that gives the public insurer bargaining
leverage over drug companies, and pushes insurers to do what they've
promised to do. Don't wait until the concrete hardens and we've lost
this battle.

2009 Robert Reich

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