If you weren’t completely depressed by the Afghanistan debate, let’s switch over to health care!

It appears that Tom Carper’s 39th attempt to arrive at some compromise for the “Gang of Four” to accept on the public option will be revealed next week.

Carper has been working on variations of the public option for months. Recently, he has touted a so-called hammer public option that he believes answers centrists’ criticisms that the public option in Reid’s bill is government-run and government-funded. The public option would kick in for states where insurance companies fail to meet standards of availability and affordability of plans. Unlike Snowe’s trigger proposal, which would give insurers at least one year to satisfy those requirements, Carper’s public option would start the first year the bill goes into effect. States might be permitted to opt into the public option even if the benchmarks are met.

Under Carper’s proposal, the bill would establish a national public insurance program founded by the government but managed by a non-governmental board. In addition, the plan would be unable to access any taxpayer dollars beyond its initial seed money. This public option would operate alongside private insurance and, potentially, the nonprofit healthcare cooperatives and state-based public plans authorized by Reid’s bill.

This plan is fluid and final details are expected to be ironed out in the coming days.

Fluid is one way of putting it. Another way is water vapor, because that’s about how valuable it would be as a tool to challenge insurance companies to compete. Jon Walker’s characterization of a non-public, triggered co-op non-option sounds about right. To serve the needs of four recalcitrant Senators at the expense of 56, Carper has devised a Frankenstein’s monster of a plan that probably won’t even make sense to those administering it, let alone the public. Even the White House doesn’t really want to talk about this at the risk of saying something coherent.

As for the idea that liberals should scrap this gobbledygook of a public option and move on to some other part of the bill to extract something, the bottom line is that the public option scored well as a savings, and practically everything else liberals would like to do would cost money, and the President set an arbitrary spending limit at $900 billion dollars over ten years that doesn’t look to be changing even though the Senate bill reduces the deficit enough to accommodate some more money. Maybe there are some ideas that don’t involve cost, like changing the rating requirements (making insurers not charge so much more for older customers) or putting violators of insurance regulations in jail. But they’re few and far between, and they don’t substitute for enacting something into law that can be built upon as a means to change the incentives in the insurance industry to force competition on price and quality instead of avoiding the sick. There’s just nothing else in the bill that would do that.

But this Rube Goldberg, designed to cater to the likes of Presidents Snowe and Collins, is just nonsense, and basically would put in Blue Cross/Blue Shields in select spots of the country. Notice that lots of them got co-opted by bigger insurers and stopped being non-profit long ago, even if some of them pretend to be. So the obviously better solution would be to pass the public option through reconciliation as a deficit reduction play. Pundits and Republicans would whine about it and that would matter for approximately two minutes. Then everyone would get on with their lives.

David Dayen

David Dayen

2 Comments