For quite a while now Ron Wyden has been quietly expressing a pretty fundamental philosophical difference with the White House, the House leadership, the Senate HELP leadership, and the Senate Finance leadership about health reform. The crux of the matter is that Wyden doesn’t want the health insurance exchange (and thus any public plan that may or may not be included in the exchange) to be closed to small businesses and the uninsured. He points out that the current closed-exchange versions of reform mean that for most people this huge, complicated, expensive health overhaul will mostly just leave everything the same. Those of us who get insurance from our employers would get peace of mind, but nothing else. By contrast, if you adopt Wyden’s proposed amendment we’d all get an array of new health insurance options.
Personally, I think this is a good idea. On the other hand, there’s a totally non-mysterious reason why it’s not included in any of the health reform packages approved by five different congressional committees—it’s totally at odds with Barack Obama’s repeated promise to avoid forcing anyone who currently has insurance to change their coverage. You just can’t square Wyden’s idea with Obama’s promise. And though Obama’s promise is substantively not a great concession to make, it’s absolutely central to the White House’s political strategy. There’s basically no way to get from where we are now in the legislative process to where Wyden wants us to get.
And this, I take it, is why Wyden spent most of the summer being pretty restrained in making this point. It’s a good point, but it’s irrelevant to the process that’s unfolding. Over the past 12 hours, however, that’s been changing and I’ve repeatedly seen Wyden on cable doing tough hits on the status quo orientation of the bill. I think he’s right about this, but I have serious doubts about the game he’s playing. It’s much easier for me to see the current process collapse in favor of nothing than it is for me to see the current process turning in the direction Wyden wants it to turn. Max Baucus has treated a lot of the Finance Committee Democrats very shabbily as this process unfolds, and some of them are pissed off at him. But while it’s all to the good for bloggers to just vent about the frustrations of the process, I think it’s pretty clear at this point that the most feasible way to get what Wyden wants is to enact something that falls within the broad Obama/Waxman/Baucus/Dodd family of relatively cautious reform and then have the debate about opening the exchange at some point in the future when people are less freaked out.
The public opinion research indicating that it’s important to promise the insured they can keep their insurance is pretty overwhelming. Ron Wyden is right and the public is wrong, but this is one of these situations in which being right isn’t going to help you very much and tilting at this particular windmill at this moment in time doesn’t strike me as very productive.
To clarify, the reason opening the Exchange will violate the pledge to prevent anyone from losing their current coverage is that existing employer-based pools will be destabilized if people are allowed to leave them. A lot of companies that currently offer group insurance would find themselves unable to continue to do so if half their employees left the plan to join and Exchange plan. They would find themselves with no choice but to stop offering insurance coverage, start offering higher wages, and send all their employees into the Exchange.
This isn’t a “problem” with Wyden’s idea. It’s a good idea. Severing the link between employment and insurance would be a good idea. Giving people more choice between insurance plans would be a good idea. Giving people more control over what proportion of their total compensation comes in the form of health insurance would be a good idea. But even though it’s a good idea, it’s a good idea precisely because it would destabilize current arrangements and there’s very little political support for doing that.