All year, the biggest fault line in the health care debate has been the public option—a proposed government-run insurance plan that Americans without access to group coverage would be eligible to sign up for.
To liberals, it has been the reason for doing health care reform, an innovative tool that will break up private insurers’ monopolies and improve the cost and quality of care for everyone. To the right, it’s just socialism.
But on Tuesday night, faced with filibuster threats from Joe Lieberman and a handful of conservative Democrats, Senate Majority Leader Harry Reid and his gang of 10 negotiators seemed to compromise the public option away. And more than a few liberals seem ready to go along with it. Bernie Sanders said the compromise “may be stronger” than the public option, and Howard Dean said it’s “what should have been done in the first place.”
Jerry Nadler isn’t so sure, though—and since the Senate’s bill will eventually have to be merged with the House’s bill, his opinion counts for a lot.
“The public option has certain purposes,” he said on Wednesday afternoon. “If those purposes are all satisfied somehow, some other way, we’d have to take a look at. If they weren’t, that would be a problem.”
It was just a few months ago that Nadler, a long-serving West Side Democrat, drafted a letter to House Speaker Nancy Pelosi threatening to oppose any legislation that didn’t include a “robust” public plan. Sixty of his fellow House Democrats signed it. Eventually, they compromised—a little—by voting for a final House bill that included a public option that didn’t link provider reimbursement rates to Medicare’s low levels.
But the new Senate compromise would throw the public option on the back burner; it would only be “triggered” if private insurers failed to create nonprofit plans (which would be administered by the same agency that runs the Federal Employees Health Benefits Program) for those who don’t qualify for group coverage. The other major feature is an expansion of Medicare—allowing some Americans to buy in at 55, instead of 65. It’s the Medicare part that has liberals like Sanders and Dean excited.
“The basic idea of allowing Medicare to go to people under 55 is a wonderful idea,” Nadler said. “Some of us have thought we ought to do that for a long time. But—and I hate to use this term—the devil is in the details.
“I mean, I gather that people are going to have to pay a premium for it. And the question is, how big is the premium, how affordable is it? There’ll have to be a Medigap plan, too, presumably. What’s the affordability? What are the subsidies? We have to look at all of that stuff before we can really talk intelligently about it.”
Nadler’s skepticism does seem warranted. The enthusiasm that some liberals are showing for the Medicare buy-in does seem to have a too-good-to-be-true element. On one level, expanding eligibility to 55-year-olds is a major step toward what the left has always wanted—a single-payer system, or “Medicare for all.” But if conservatives like Lieberman were ready to filibuster a public option (which, after all, would only have affected about 15 million Americans—at best), are they really about to sit back and let the country take a giant step toward universal Medicare?
When it comes to the nonprofit idea, Nadler is just confused. After all, both the Senate and House have always envisioned creating a health care exchange where private insurers—assuming they met basic standards established by the government—would be able to compete for business from individuals. The House wants one national exchange; the Senate wants 50 state exchanges.
Reid’s gang of 10, Nadler said, “seems to be saying, from what I’ve read, that where there isn’t enough competition, they’re going to the nonprofits on a national exchange within a state exchange. I’m not sure how that works. It’s not at all clear to me how that works.”
The idea of a trigger—which allows Reid to claim that he hasn’t actually dealt away the public option—isn’t fooling Nadler, either. “If you have the votes to stop the public option, then presumably you’re not setting up a trigger that’s on a hairspring that’ll trigger right away,” he said. “You’re setting up a trigger that will never trigger, or that will trigger only due to unusual circumstances.”
The House passed its health care bill last month with just two votes to spare. The 39 Democrats who voted “no” were mainly moderates and conservatives; Nadler and his progressive colleagues almost all supported it. But that could change in Round Two—especially without a public option.
This helps explain why some on the Senate side (and maybe even in the White House) are floating the idea of bypassing the usual House-Senate conference committee and forcing the House to vote up or down on the Senate’s plan. Essentially, a Democrat like Nadler would be forced to choose between a bill he played no role in crafting and killing health care altogether.
Nadler called that “totally unacceptable.”
“Have we all been wasting our time and energy for the last eight months?” he asked. “We should just wait for the Senate to do what they want?”
Still, he’s optimistic that a deal with the Senate can be struck and that a bill can be on President Obama’s desk soon.
“If [the Senate] can actually pass a bill before Christmas, we can conference it and pass it before the end of January—assuming that the houses weren’t totally at loggerheads for some reason,” he said. “Hopefully, we wouldn’t be.”