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From the website of the San Francisco Chronicle
Health care: Most wouldn't have public option
Carolyn Lochhead, Chronicle Washington Bureau
Thursday, October 29, 2009
(10-29) 04:00 PDT Washington - --
Senate Majority Leader Harry Reid's gambit to include a government-run insurance option in health care legislation has given a fresh tailwind to the idea despite opposition from conservatives.
But lost amid the ideological battle for or against a public option is a key overlooked fact: The vast majority of Americans would have no access to a public option even under its most expansive versions.
House and Senate bills limit the option to the smallest businesses and to individuals who cannot get insurance, or whose health care costs exceed 12.5 percent of their income. Even seven years into an overhaul, an estimated 90 percent of Americans, including nearly everyone who has employer-based coverage now, would be shut out of a public option.
Those currently in other government programs, such as Medicare and the Veterans Administration, also would be excluded.
The public option under all bills would be offered through insurance exchanges, a Web-based market for health plans. But most people who are unhappy with the insurance they have now would be locked out of these exchanges, leaving many Americans who are watching the debate in for a big surprise.
Only a handful of senators, such as Ron Wyden, D-Ore., and Mary Landrieu, D-La., have focused on widening the exchanges where a public option might be available. Wyden wants everyone who now has employer-based coverage to have access to the exchange if they don't like their insurance companies, but his efforts have been lost amid the narrower fixation on the public option itself.
"When you ask people in a poll, 'Are you in favor of a public option that would be available to everybody,' they say, 'Yes,' " Wyden said. "I don't think they're going to feel the same way about a public option available to only 10 percent of the population."
Wyden, an iconoclastic liberal, questioned the basic assumption by his fellow Democrats that such a limited public option will provide adequate competition to private insurers.
"People are going to want choices, public choices and private choices, available to everybody, because that's how you're going to hold the insurance companies accountable," he said. "You can't expect that having 10 percent of the American people getting the public option will force major changes with the other 90 percent who aren't subjected to choices, public or private."
He pointed to another surprise that awaits the public: Even those who would have access to a public option may not be able to afford it.
Citing estimates that a family of four earning $66,000 could pay an estimated 19 percent of its income on health care under some bill versions, Wyden said, "I can tell you, Americans are not going to consider 19 percent of their income affordable coverage."
Many health care experts agree. "I'm afraid rude surprises could be around a lot of different corners in this debate," said Marian Mulkey, senior program officer for the California Health Care Foundation, an independent philanthropy group based in Oakland.
Mulkey said the public option has been "dominating the discussion to an extreme extent" and that its importance as a principle to liberals and conservatives may outweigh its actual effect, at least in the short run.
A public program might face the difficulties private insurers have in holding down costs. "It's not entirely clear that just because it's a public program, it will be able to negotiate lower payments to providers or somehow develop more efficient benefits in a way that will yield a more affordable plan," she said.
Health care consultant Robert Laszewski, head of Health Policy and Strategy Associates in Washington, said that even if a public option is 25 percent cheaper than a private plan, which averages $13,000 a year for a family of four, it still will cost $10,000 a year.
Under subsidies in the House bill, a family earning $55,000 would pay the first $5,500 of any premium, public or private, he said.
"How many families earning $55,000 a year do you know that have an extra $5,000 in their checking account?" he asked.
Sen. Sheldon Whitehouse, D-R.I., a big advocate of the public option, acknowledged that most people won't have access to it. The exchanges were kept very narrow, he said, because of the way the Congressional Budget Office analyzes budget costs.
"We have to live with CBO's numbers and that creates some constraints," Whitehouse said. "I hope that quickly the public option will begin to demonstrate that those concerns were not justified and those constraints can be lifted and we can extend the option to everybody, because that's what makes sense."
Ironically, the power of the exchanges to dismantle the current system of employer-based health care, which many economists cite as the root source of exploding costs, could raise budget costs if more people move onto the exchanges and possibly into a public option.
But whatever effect a public option may have on the government's costs, there is little disagreement that giving individuals more choices - public or private - through the exchanges would inject powerful competitive forces into the system that could lower costs for everyone.
House to reveal overhaul today
After months of tense negotiations and setbacks, House Speaker Nancy Pelosi, D-San Francisco, will unveil a sweeping health care overhaul plan today, with a vote possible in the House as early as next week.
Pelosi is in an all-out push to move the legislation, which will have a government-sponsored insurance plan available to some people but not the "robust" version tied to Medicare rates that Pelosi and liberals favored.
Instead, it will have rates negotiated by the secretary of Health and Human Services, as swing-state "Blue Dog" Democrats preferred. Leaders are also working furiously to assure moderate Democrats that no public funds would be used for abortion.
House and Senate leaders have cleared the calendar for a possible weekend session Nov. 7 and another possible House session just before Thanksgiving, and canceled a planned Veterans Day break.
House Democrats said Senate Majority Leader Harry Reid's move to include a public option in the Senate bill Monday made it easier for moderate House Democrats to vote for a public option.
- Carolyn Lochhead
posted by sonny chiba37 @ October 29th, 2009, 5:21 pm -
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