Very little about American health care is logical.
I didn’t watch today’s press conference, but reading back over the transcript I liked this discourse on the public plan, in which Obama was letting his Vulcan side show:
OBAMA: Now, the public plan, I think, is an important tool to discipline insurance companies. What we’ve said is, under our proposal, let’s have a system, the same way that federal employees do, same way that members of Congress do, where we call it an exchange, but you can call it a marketplace, where, essentially, you’ve got a whole bunch of different plans….As one of those options, for us to be able to say, here’s a public option that’s not profit-driven, that can keep down administrative costs, and that provides you good, quality care for a reasonable price as one of the options for you to choose, I think that makes sense.
QUESTION: Wouldn’t that drive private insurance out of business?
OBAMA: Why would it drive private insurance out of business? If private insurers say that the marketplace provides the best quality health care; if they tell us that they’re offering a good deal, then why is it that the government, which they say can’t run anything, suddenly is going to drive them out of business? That’s not logical.
Now, the — I think that there’s going to be some healthy debates in Congress about the shape that this takes. I think there can be some legitimate concerns on the part of private insurers that if any public plan is simply being subsidized by taxpayers endlessly that over time they can’t compete with the government just printing money, so there are going to be some I think legitimate debates to be had about how this private plan takes shape. But just conceptually, the notion that all these insurance companies who say they’re giving consumers the best possible deal, if they can’t compete against a public plan as one option, with consumers making the decision what’s the best deal, that defies logic, which is why I think you’ve seen in the polling data overwhelming support for a public plan.
Meanwhile, Ryan Grim reports that Chuck Schumer and Kent Conrad are working to blur the differences between a “public option” and a “co-op.” Ezra Klein says the compromise they’re looking at would basically amount to a public option. Under the circumstances, I think this would be a good moment for the President and leaders in the House of Representatives to step up their advocacy of a public option and criticism of the co-op concept. The way the Senate works, at least as I understand it, is that a certain number of Senators there are very in love with a “centrist” self-presentation and will insist on acquiring some kind of “major concession” from liberals before voting for a bill. The question then become, what kind of “major concession” is, in fact, minor.
Unfortunately, during the stimulus debate the Senate “centrists” actually did enormous harm to the country by curtailing aid to state government. But if these Schumer-Conrad talks progress, the “concession” they wring could more-or-less amount to just relabeling the public option as a “co-op” that would nonetheless have the essential characteristics of a public plan. On the policy merits, the issue is all buried in the details of exactly how the public plan or co-op or whatever operates. But in the political logic of the Senate, perceptions and labels matter much more. It’s not logic, but it’s life.