Driving A Harder Bargain

The attention and effort spent on the public option in the progressive activist community meant that a package of deals would have to be offered in order to get rid of it. But actually, it goes a bit further than that. Nate Silver and some other poll-watchers paid a lot of attention to a poll showing that a lot of the opposition to the current health care bills is coming from the left. They spun this to show that the center-left position in health care is dominant relative to the right. And all of that is true, but it doesn’t make anyone who thinks that the bill is insufficient want to support it. You’re talking about people who wanted a single payer system, and they’re highly unlikely to fall in line because of ideological affinity.

Indeed, I believe more people would be comfortable with the bill if it took power from any stakeholder group whatsoever, rather than cutting deals with all of them which protect that power. We could see the first of those deals break down this week.

Byron Dorgan’s amendment to allow the safe re-importation of drugs from abroad, which already has four Republican co-sponsors, would ruin the Big PhRMa deal reached with the Senate Finance Committee and the White House. It will get a vote, perhaps as early as this week, and the CBO has estimated that it would save the federal government $19 billion over 10 years in bulk purchasing. That says nothing of the savings to individuals who would be allowed to purchase cheaper drugs, which could reach $100 billion over the same time period. There’s also Bill Nelson’s amendment to close the doughnut hole gap in Medicare Part D, at a savings of $106 billion over 10 years, all out of the hide of the drugmakers.

In addition, if private insurers are given a captive market without public competition, particularly in the under-55 market, then the individual mandate may need to be loosened or done away with. Paul Starr, the Clinton-era health care expert, has devised a compromise that lets people opt out of the mandate, while disallowing them from opting back in within five years and still being eligible for subsidies or immune from denial of coverage based on a pre-existing condition. That may not be the best solution – we want to encourage medical coverage, no? – but the mandate is problematic in what amounts to an all-private system.

The Washington Post detailed some of these efforts to overturn deals with stakeholders. I would say that it would be difficult to get progressive support for a public option-less bill unless some of the deals come down.

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