On Saturday, the New York Times reported that a “significant split has developed between the two Democratic senators leading efforts to remake the nation’s health care system. They disagree over the contours of a public health insurance plan, the most explosive issue in the debate”:

As a starting point for his bill, Mr. Kennedy favors a public plan that looks like Medicare, the government-run program for older Americans created in 1965, when he was a young senator. By contrast … Democrats on the Finance Committee said Mr. Baucus was exploring a possible compromise. Under this proposal, the public plan would be created only if private insurance companies had not made meaningful, affordable coverage available to all Americans within several years.

Sen. Max Baucus (D-MT) is arguing that the threat of a public plan would motivate private insurers to lower premiums. So what would a trigger proposal look like? The legislation could establish certain benchmarks: if premiums do not decrease by X% over Y years, then a public plan would enter the Exchange. The key is to develop the proposal before hand, to ensure a speedy implementation process and convince private insurers that a public option is not just a theoretical threat.

But what would the public option look like? The new public option could start using Medicare-based rates and Medicare leverage to negotiate better prices (this is what Kennedy is considering). Or, beyond the public option, Congress could establish Medicare-based rates throughout the market, allow all private insurers to pay Medicare rates and require all providers serving Medicare patients to accept those rates as full payments. Or Congress could task a commission with the task of adjusting health spending to achieve fiscal balance.

But it’s unclear why we’re bending over backwards to give private insurers the benefit of the doubt…yet again. Why shouldn’t we require private industry to deliver on their promise to contain costs? Health reform isn’t about protecting private industry; it’s about adopting policies that are most likely to lower health care costs. A robust public option — the Kennedy proposal — is likely to score well even with a conservative CBO because it will be able to use its inherent advantages (lower administrative spending) and Medicare leverage to negotiate lower prices with providers and lower health care spending.

Over at the Washington Post, Ezra Klein argues that I overstated my (ongoing) case against the Congressional Budget Office. On Friday, after the CBO released its decision to exclude the federal mandate to purchase health insurance from the federal budget, I argued that we should not allow the CBO to hold health reform hostage. “Why exactly are [reformers] jumping through hoops to satisfy the CBO?,” I asked.

Klein writes that I went “a couple of steps too far“:

This is, I think, going a couple of steps too far. There’s no doubt that the Congressional Budget Office is a pain in the neck for health reformers. But that’s not the fault of the Congressional Budget Office. It’s because the cost of health reform — at least in the plans under consideration — is a pain in the neck for health reformers. Attacking the CBO is like attacking the guy who writes the numbers on the price tag…. Reformers fear CBO’s honest estimates, however, because they recognize that the opponents of reform will use them dishonestly.

I fully recognize that the cost of reform is the “real pain in the neck for health care reformers.” $1.5 trillion over 10 years ain’t chump change and my post was not intended to obfuscate the fact that comprehensive health care reform would require a serious upfront investment. Nor was it prompted by my “fear of CBO’s honest estimates.” Rather, I was highlighting the deficiencies within CBO’s accounting process. I’m not attacking “the guy who writes the numbers on the price tag,” I’m questioning how “the guy” comes up with the numbers in the first place.

As CBO chief Doug Elmendorf admitted during a recent Senate Budget Committee hearing, “we have very little evidence about interlocking changes in the complex health-care system, and I don’t think that our numbers should be the ultimate determinant of the policies that you and your colleagues will vote for and against”:

WHITEHOUSE: And I have two concerns about your actuarial science. One, there is a limited amount of evidence, and so you’re very limited in what you can sign off on in terms of scoring. And two, areas that we’ve been talking about like health information infrastructure and investment in quality reform that saves money and reimbursement reform end up being dynamically inter-engaged. [...]

ELMENDORF: I agree entirely with your concerns, Senator. CBO is going to draw on existing evidence about the effects of changes. And that evidence will be weak in many cases, and it will be particularly weak in cases that involve the interactions of several policy changes. We have a fair amount of evidence related to incremental changes that, on policies that have been in place for a long time, because almost everything has been moved up and down, and you can see how the world has responded to that. We have very little evidence about interlocking changes in the complex health-care system, and I don’t think that our numbers should be the ultimate determinant of the policies that you and your colleagues will vote for and against.

WHITEHOUSE: We’ll have to make some leaps of faith based on our best judgments.

ELMENDORF: Yes. Now, however, let me say I think we can be of great service to you in judging what leaps are worth taking.

Put simply, the fear is that the CBO understimates the savings from health care reform. It has a hard time identifying long-term savings, doesn’t consider the ledgers of businesses or families — who would benefit from progressive prescriptions — and has some serious scoring problems. For instance, health care reform would improve the health of the population, increase workers’ productivity and in turn yield greater revenue. The CBO does not score these savings. Klein is correct to note that this isn’t the CBO’s fault — Congress demands exact numbers and so the CBO tries to come up with ballpark estimates.

As Robert Reischauer — the CBO head from 1989 to 1995 — put it after one member of Congress wished to know if the CBO’s estimates about President Clinton’s health care reform plan were “in the ballpark,” “Congressman, I believe that we are in the town the ballpark is in. ”

Yesterday, NBC broadcast End of Patient Rights: The Human Consequences of Government Run Healthcare, a 30-minute ‘documentary’ produced by Rick Scott’s Conservatives For Patients Rights. The ad, which felt like a poorly designed infomercial slated for the witching hour, followed Rick Scott and former CNN producer Gene Randall as they traveled to Great Britain and Canada, interviewing patients, medical professionals, and academics about the deficiencies of single-payer health care.

Scott himself is a poor spokesperson for the consequences of health care rationing. As Lee Fang explains, Scott started the Hospital Corporation of America/Columbia Hospital Corporation, with the goal of doing for hospitals “what McDonald’s has done in the food business.” Through an aggressive strategy of rapid acquisitions and consolidation, Scott turned his business into one of the largest health care companies in the world. But by the time Scott resigned and the company reached a $1.7 billion fraud settlement with the federal government for systematically over-billing Medicare and stealing from taxpayers, HCA/Columbia had become infamous for doing what Scott now so loudly decries: rationing care. (Watch a short video about Scott here.)

Still, in 1993 and 1994, Scott successfully opposed President Clinton’s health reform efforts. Since then, the cost per person of American health care has more than doubled, with an annual growth rate regularly more than twice that of inflation. A growing number of Americans are struggling to afford health insurance, but Rick Scott is using the very same hollow rhetoric to oppose reform now, as he did then. Lee Fang has compiled this video:

Watch it:

Certain nefarious Democrats — we won’t tell you who — want to import British and Canadian health care into the United States, the infomercial argued. Should they succeed, Americans will lose access to their doctors and spend years on a government list, awaiting surgery.

But despite the “journalistic feel” and clear messaging, Rick Scott is no Billy Mays. For no matter how loud his message was, his point was still unconvincing. The documentary conflated deficiencies of the foreign health care systems with American reform efforts but failed to cite a single Democrat who advocates copy-and-pasting the British or Canadian examples; Scott didn’t explain which Democratic proposals would lead to rationed care or engage in the substance of the President’s principles. He presented the Democrats’ reforms not as they are, but as conservatives wish for them to be.