Let's review the watered down House public option proposal. "A small and ineffectual option"

We all want a strong and viable public option that can provide people with public insurance with better benefits and at a lower price than policies offered by the private insurance industry. If public insurance can't provide better benefits with lower premiums than private health insurance why in the world would any employer or individual want it?

So does the "public option" as presently written provide that option to all employers and individuals who want it? No.

“Under pressure from industry and their lobbyists, the public plan has been watered down to a small and ineffectual option at best, if it ever survives to being enacted,” says John Geyman, professor emeritus of family medicine at the University of Washington.

The public option contained in the House bill has already been compromised to the point of being "small and ineffectual at best", however, conservative Democratic and Republican politicians in Congress won't even settle for that! They don't even want to give us a little crumb to pacify us!

So what should liberals/progressives do?

Supporters of both single payer Medicare for All and a strong public option that will be available for everyone should continue to press our demands and not let up for a moment.

Let's review the hard facts regarding the proposed "public option" health care legislation and why it needs to be strengthened and changed.

House Tri-Committee
America’s Affordable Health Choices Act of 2009
(H.B. 3200)

57 members of the House signed the following letter:

July 31, 2009

The Honorable Nancy Pelosi The Honorable Henry Waxman
Speaker Chairman
U.S. House of Representatives House Committee on
Energy and Commerce
H-232, The Capitol 2125
Rayburn House Office Building
Washington, DC 20515 Washington, DC 20515


The Honorable Charles Rangel The Honorable George Miller
Chair Chair
House Committee on Ways and Means House Committee on
Education and Labor
1102 Longworth House Office Building 2181 Rayburn House Office Building
Washington, DC 20515 Washington, DC
20515


Dear Madame Speaker, Chairman Waxman, Chairman Rangel, and Chairman Miller:


We write to voice our opposition to the negotiated health care reform agreement under consideration in the Energy and Commerce Committee.

We regard the agreement reached by Chairman Waxman and several Blue Dog members of the Committee as fundamentally unacceptable. This agreement is not a step forward toward a good health care bill, but a large step backwards. Any bill that does not provide, at a minimum, for a public option with reimbursement rates based on Medicare rates - not negotiated rates - is unacceptable. It would ensure higher costs for the public plan, and would do nothing to achieve the goal of "keeping insurance companies honest," and their rates down.

To offset the increased costs incurred by adopting the provisions advocated by the Blue Dog members of the Committee, the agreement would reduce subsidies to low- and middle-income families, requiring them to pay a larger portion of their income for insurance premiums, and would impose an unfunded mandate on the states to pay for what were to have been Federal costs.

In short, this agreement will result in the public, both as insurance purchasers and as taxpayers, paying ever higher rates to insurance companies.

We simply cannot vote for such a proposal.

Sincerely,

http://tpmdc.talkingpointsmemo.com/2009/07/in-letter-house-progressives-object-to-blue-dog-public-option-compromise.php?ref=fpa

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Health care debate: Will public option be viable?
Given choice in the past, most picked private health plan
By Noam N. Levey | Tribune Newspapers
July 26, 2009

For months, Republicans and business and health care industry groups have been warning that President Barack Obama's proposal to create a new public insurance program for Americans currently without coverage would quickly devour the nation's health care system and leave Americans dependent on Washington for their medical care.

But the government insurance program that is fueling so much alarm may end up being much less voracious than its critics claim.

By 2019, as few as 11 million people will likely be signed up for the government plan, according to preliminary estimates by the nonpartisan Congressional Budget Office, which is evaluating bills being developed by senior Democrats in the House of Representatives and the Senate.

At the same time, the CBO estimates that more than 160 million people will get health insurance through their employer.

Neither the estimates by the CBO nor the experiences of states have dampened the concerns of insurance companies, hospitals and business groups, many of whom believe that millions of Americans will abandon private insurance for a government option that charges less.

Hospitals, many already struggling in the economic downturn, worry that they could lose money if more patients move to a government plan that pays lower rates. And businesses are concerned that they will be forced to pay more for their insurance to offset the losses being sustained by hospitals and other health care providers.

To prevent that kind of disruption, senior Democrats in Congress have proposed restrictions on who can sign up for the new public plan.

Please read the complete article at:

http://www.chicagotribune.com/news/chi-tc-nw-healthcare-0725-0726jul26,0,4896799.story

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House of Representatives and the Senate "The Affordable Health Choices Act" health care proposals. Their plans DO NOT provide a public option where everyone is free to choose the best plan for themselves or their family. Severe restrictions exist on what employers and individuals can choose the public option. According to Congressional aides, only 9 million people will have qualified for the public option in 2019, a full decade from now! Everyone else will be covered by mandatory private insurance!

Once again, here's the hard facts about the current proposed legislation

For many workers, insurance choices may be limited after health care overhaul
BY MARY AGNES CAREY AND JULIE APPLEBY
17 July 2009

President Obama and leading Democrats have stressed that people who like their employer-sponsored insurance would be able to keep it, under a health care overhaul. But they haven't emphasized the flip side: That people who don't like their coverage might have to keep it.

Under the main health bills being debated in Congress, many people with job-based insurance could find it difficult to impossible to switch to health plans on a new insurance exchange, even if the plans there were cheaper or offered better coverage. The restrictions extend to any government-run plan, which would be offered on the exchange.

Democratic lawmakers and administration officials say the restrictions are critical to maintaining a strong employer-based insurance system, which covers 158 million Americans.

But critics argue that the rules run counter to suggestions from health care reform advocates that an overhaul could provide people with a broader choice of insurance options. The rules, they say, could be especially unfair to some lower-income workers who are enrolled in costly job-based insurance. Also, they argue, the restrictions would hurt the proposed public plan by limiting enrollment.

Jonathan Oberlander, associate professor at the University of North Carolina at Chapel Hill, said the restrictions create a "big gap between the rhetoric and the reality" of health reform. "The rhetoric is that Americans will gain new alternatives," he said. "But the reality is that they are putting up firewalls that are going to restrict the access of people with employer-sponsored insurance to the exchange."

One result, he said, is that any public plan would be substantially smaller than what many backers are envisioning. That would reduce the public plan's power to compete with private insurers and hold down costs, he said. The Congressional Budget Office estimates that nine million to 10 million people would enroll in the public plan by 2019.

Please read the complete article at:

http://www.newjerseynewsroom.com/healthquest/for-many-workers-insurance-choices-may-be-limited-after-health-care-overhaul

If the employer has 10 employees or fewer they may qualify for the public insurance option sometime in 2013.

If the employer has 20 employees or fewer they may qualify the public insurance option sometime in 2014.

If the employer has more than 20 employees they may be able to get the public insurance option sometime in 2015, if approved by "the Commissioner". However, there is nothing in the legislation mandating such approval or requiring the government to make the public insurance option available to all employers for their workers at any time in the future.

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"Public Option" Would Only Be Available To The Otherwise Uninsured
TPM Cafe
July 16, 2009

I'm not sure that people really understand how the "public option" would work, given the rhetoric of the administration that people could "keep" their current insurance if they want to or choose a public option.

Last night on The Daily Show, Secretary Sebelius, in response to a question, made things a bit clearer regarding just how the public option would work. She was asked "who would choose" whether or not to use the public option: the employee or the employer? The Secretary said essentially it would be the choice of the employer because if the employer provides health insurance then that is the insurance the employee would have to use. Only if the employer chose not to provide health insurance would the employee be able to enroll in the public option.

Most of the people I know that have employer provided health insurance are glad they have insurance as opposed to not having it, but they hate the plans they have because the expense is totally unreasonable and with each passing year, less and less coverage is provided while costs go up. So, leaving the choice to employers is not the same as providing choice to citizens at all.

http://tpmcafe.talkingpointsmemo.com/talk/blogs/oleeb/2009/07/public-option-would-only-be-av.php?ref=reccafe

And congressional aides say only about 9 million will be insured by public plan by 2019! 21 million will be insured by private companies in the exchange by 2019. Another 164 million would be insured with private insurance through their employers.


----------------------------------

The Health Insurance Exchange: It's run nationally, though states can opt out of the national structure and go it alone if they choose, and if they follow federal rules. In the first year, it accepts those without health insurance, those who are buying health insurance on their own, and small businesses with fewer than 10 people. In the second year, it accepts small businesses with fewer than 20 people. After that, "larger employers as permitted by the Commissioner." In other words, expansion is discretionary, not mandated. The only people able to access the public plan in the early years will be on the exchange, and the exchange will be, relative to the population, pretty limited. So the public plan will be limited, and so too will any anticipated savings.

http://voices.washingtonpost.com/ezra-klein/2009/07/the_house_releases_its_health-.html?hpid=news-col-blog

http://www.reuters.com/article/reutersComService_2_MOLT/idUSTRE56D7JX20090714

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by snaxattack
Daily Kos
July 16, 2009


I mentioned in a previous diary the importance of the insurance exchange as a tool for enacting real health care reform. Without access to the health insurance exchange, there is no access to the public option and no access to portable health insurance. The House and Senate approaches both restrict access to the insurance exchange through a process called "firewalling", forcing everyone who has employer-based health insurance to keep that insurance. Firewalling is an impediment to real reform and must be stopped!


The Senate committees are making it hard to even enter the exchange as an individual. In order to prevent insurance companies from seeing real competition and make it more difficult to receive government subsidies, they are creating a "firewall" that puts a barrier between the insurance exchange and employees of companies that offer their own group insurance plan.

We need to start lobbying our congressional representatives for a STRONG insurance exchange, with no firewall to prevent employees of large companies from accessing high quality, portable insurance through the insurance exchange. We need to ask our congresspeople to implement a plan that allows large employers to contract with the insurance exchange, just as small businesses will be able to do.

http://www.dailykos.com/storyonly/2009/7/16/754237/-New

http://www.dailykos.com/storyonly/2009/7/9/751637/-The

------------------------------

House Democrats make a healthcare deal
By Noam N. Levey and Janet Hook
Los Angeles Times
July 30, 2009

The deal, worked out between a group of fiscally conservative Democrats and Rep. Henry A. Waxman (D-Beverly Hills), chairman of the Energy and Commerce Committee, changes the way a proposed government-run insurance plan would operate in order to allay concerns that it could crowd out private insurers.

"I think they've had an inordinate amount of input," Rep. Pete Stark (D-Fremont) said of the more conservative "Blue Dog" Democrats. "And every time people have given them some consideration, they want more."

Under the agreement between Waxman and the Blue Dogs, House Democrats retained the idea of creating a government insurance program, which they believe will help drive down costs and give many consumers a new insurance option.

But the deal takes steps to ensure that the government plan would not gain advantages as a result of the federal management of Medicare, the insurance program for seniors that can negotiate low rates because of its massive size.

Originally, the government insurance plan would have paid doctors, hospitals and other providers a rate set slightly higher than Medicare's. Insurers and hospitals, as well as many lawmakers, feared that arrangement would mean the government plan would incur lower costs than private insurers and could charge low premiums -- driving companies out of the market. Consumers, critics said, ultimately could be left with only one choice for health coverage: the government.

Under the deal struck Wednesday, the government insurance plan would have to negotiate with hospitals and other providers apart from Medicare. That could make it harder for the federally run plan to charge very low premiums.

Rep. Mike Ross (D-Ark.), a leading Blue Dog who worked on the House deal, called the changes to the government insurance plan "a huge win."

But more-liberal members protested. Rep. Patrick J. Kennedy (D-R.I.) said that by limiting the government's ability to drive insurance rates lower, the deal "lets insurance companies off the hook" for savings they had already promised the White House.

"It's a sop to the insurance companies," he said.

Please read the complete article at:

http://www.latimes.com/news/nationworld/nation/la-na-healthcare-house30-2009jul30,0,4773886,full.story

---------------------------------------------

Deal with 'Blue Dogs' sets up health care vote
By DAVID ESPO
Associated Press
July 29, 2009

After weeks of turmoil, House Democrats reached a shaky peace with the party's rebellious rank-and-file conservatives Wednesday and cleared the way for a vote in September on sweeping health care legislation.

Across the Capitol, House Democratic leaders gave in to numerous demands from rank-and-file rebels, so-called Blue Dogs from the conservative wing of the party who had been blocking the bill's passage in the last of three committees.

The House changes, which drew immediate opposition from liberals in the chamber, would reduce the federal subsidies designed to help lower-income families afford insurance, exempt additional businesses from a requirement to offer insurance to their workers and change the terms of a government insurance option.

The White House issued a statement praising the development in the House, and with appearances in North Carolina and Virginia, the president sought to minimize the significance of the slippage in his timetable.

The House deal was worked out over hours of talks that involved not only the chamber's leaders but also White House officials eager to advance the bill. It was unclear, though, what commitments Speaker Nancy Pelosi or the administration may have made to support the agreement once the bill advances to the floor this fall.

As word of the agreement spread, liberals fired back. "We do not support this," said Rep. Lynn Woolsey, D-Calif., head of the Progressive Caucus. "I think they have no idea how many people are against this. They can't possibly be taking us seriously if they're going to bring this forward."

http://www.google.com/hostednews/ap/article/ALeqM5jlMpJGn28kqCcgU-aGcYE_ZHW-ywD99OEU7G0

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House and Senate healthcare bills put up firewalls to restrict access to public option.

New Wyden health care proposal could be crucial
by snaxattack
Daily Kos
July 16, 2009


I mentioned in a previous diary the importance of the insurance exchange as a tool for enacting real health care reform. Without access to the health insurance exchange, there is no access to the public option and no access to portable health insurance. The House and Senate approaches both restrict access to the insurance exchange through a process called "firewalling", forcing everyone who has employer-based health insurance to keep that insurance. Firewalling is an impediment to real reform and must be stopped!

Jonathan Cohn and Ezra Klein are now reporting that Ron Wyden has come out with a "Free Choice Proposal" that would not only eliminate firewalls; it would force employers to contribute to the cost of health care on the insurance exchange. Wyden, who sits on the Senate Finance Committee, seems to have drawn major ideas from his Healthy Americans Act in order to achieve a happy medium that balances letting people keep what they have with reorganizing the health care system.

The Senate committees are making it hard to even enter the exchange as an individual. In order to prevent insurance companies from seeing real competition and make it more difficult to receive government subsidies, they are creating a "firewall" that puts a barrier between the insurance exchange and employees of companies that offer their own group insurance plan.

We need to start lobbying our congressional representatives for a STRONG insurance exchange, with no firewall to prevent employees of large companies from accessing high quality, portable insurance through the insurance exchange. We need to ask our congresspeople to implement a plan that allows large employers to contract with the insurance exchange, just as small businesses will be able to do.

http://www.dailykos.com/storyonly/2009/7/16/754237/-New

http://www.dailykos.com/storyonly/2009/7/9/751637/-The

The Health Insurance Exchange: It's run nationally, though states can opt out of the national structure and go it alone if they choose, and if they follow federal rules. In the first year, it accepts those without health insurance, those who are buying health insurance on their own, and small businesses with fewer than 10 people. In the second year, it accepts small businesses with fewer than 20 people. After that, "larger employers as permitted by the Commissioner." In other words, expansion is discretionary, not mandated. The only people able to access the public plan in the early years will be on the exchange, and the exchange will be, relative to the population, pretty limited. So the public plan will be limited, and so too will any anticipated savings.

http://voices.washingtonpost.com/ezra-klein/2009/07/the_house_releases_its_health-.html?hpid=news-col-blog

http://www.reuters.com/article/reutersComService_2_MOLT/idUSTRE56D7JX20090714

The House "Public Option" won't kick in until sometime in 2013!!!! Let's diddle daddle around!
And after the Senate is finished weakening the bill, who knows, it might not kick in until 2020 or later or they may include a so-called trigger.

Read pages 117 and 14 of the House healthcare bill.

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Daily Kos writer knew this a month ago:

My Thoughts On The Public Option In House Draft
by slinkerwink
Daily Kos
June 21, 2009

Here's what Wonk Room had to say about the House bill below:

"Unlike the HELP bill and the draft (leaked) language of the Senate Finance Committee, the Tri-Committee proposal seems to contain a fairly robust public insurance option. While details are still being worked out, the proposal establishes a public plan in 2013 that will compete with private insurers, within the Exchange, on a level playing field. The public option will be required to abide by all marketing, operations, and rating rules and would initially be allowed to use Medicare plus rates. After some time, the plan would have to independently negotiate fees with providers."

And there it seems that it might be wrong about the public option in the Tri-Committee proposal being available everywhere on day one. How can it be available on day one if it's supposed to be available in 2013 and the National Exchange that's proposed to cut down on costs is established in 2013 as well? This is one of the sticking points for us to push back on starting tomorrow. We'll have to ask the House Education and Labor Committee if the private insurers will have to be regulated immediately after the passage of the legislation or if the regulation starts in 2013. The delay for this puzzles me.

Always remember, the devil is in the details.

Another sticking point for us to push back on is that the public option will have to stop using Medicare plus rates at a certain point in time. Here's more from Karen Tumulty at Time Magazine on what that means:

"In the early stage, the public plan would reimburse health care providers at rates that are "similar to those used in Medicare"--that is, significantly lower than most private insurers pay them. This is something that the insurance industry, doctors and hospitals will all hate."

According to the summary, this tie to Medicare rates would be "severed over time as more flexible payment systems are developed." In other words, this public plan would eventually evolve into something that looks--and competes--more like a private insurance company, albeit one that happens to be run by the government."

This is the biggest sticking point for us to push back on along with the one about the public option having to be self-sustaining only on premiums, and we'll need to ask the Congressional Progressive Caucus to push back on this as well. Basically, we'll have a strong public option at first, but over time, it'll be weakened. I don't think this is right.

Please read the complete article and what you can do to demand a strong public option at:

http://www.dailykos.com/storyonly/2009/6/21/745208/-My

So what should liberals/progressives do?

Like I said, we should continue to fight for both single payer Medicare for All and a strong public option that will be available for everyone.

A Strong Public Option: The Community Health Insurance Option (full bill)

HEALTH REFORM AT A GLANCE: THE HEALTH INSURANCE EXCHANGE (full bill)

If Obama Discards Public Option, What's Left of Reform?
by John Nichols
The Nation
August 17, 2009

The public option has already been so dumbed-down and neutered that it is little more than a sliver.

The problem is that it may be the only sliver of real reform in his program.

Even with a robust public option, the president's initiative looks a lot like a bailout for the insurance industry --in stark contrast to the a single-payer reform that would replace industry profiteering with a not-for-profit system like Medicare.

Without a public option, there is no real reform.

In fact, without the public option, the Obama approach -- and that of compromise-prone Democrats in Congress -- looks increasingly like a step in the wrong direction.

That's because the "reforms" currently under consideration threaten to undermine Medicare and Medicaid -- with radical cost-cutting schemes -- while steering hundreds of billions in federal dollars into the accounts of for-profit insurers and the pharmaceutical industry.


Please read the complete article at:

http://www.commondreams.org/view/2009/08/17-1

this: