Bait and switch: How the “public option” was sold

[IndianaGreen]

Sebelius story is now in LBN. Here is an article that another DUer posted there.

Bait and switch: How the “public option” was sold

Posted by Andrew Coates MD on Monday, Jul 20, 2009
by Kip Sullivan

The people who brought us the “public option” began their campaign promising one thing but now promote something entirely different. To make matters worse, they have not told the public they have backpedalled. The campaign for the “public option” resembles the classic bait-and-switch scam: tell your customers you’ve got one thing for sale when in fact you’re selling something very different.

When the “public option” campaign began, its leaders promoted a huge “Medicare-like” program that would enroll about 130 million people. Such a program would dwarf even Medicare, which, with its 45 million enrollees, is the nation’s largest health insurer, public or private. But today “public option” advocates sing the praises of tiny “public options” contained in congressional legislation sponsored by leading Democrats that bear no resemblance to the original model.

According to the Congressional Budget Office, the “public options” described in the Democrats’ legislation might enroll 10 million people and will have virtually no effect on health care costs, which means the “public options” cannot, by themselves, have any effect on the number of uninsured. But the leaders of the “public option” movement haven’t told the public they have abandoned their original vision. It’s high time they did.

<snip>

To see why the “public option” proposed by congressional Democrats remains at great risk of stillbirth, let’s engage in a frustrating thought experiment. Let’s imagine Congress has enacted the House version (it is not quite as weak as the HELP Committee model and thus gives us the greatest opportunity in our thought experiment to imagine a scenario in which the “public option” actually survives its start-up phase). Let us imagine furthermore that you have been foolish enough to apply for the job of executive director of the new “public option,” and the Secretary of the Department of Health and Human Services (the federal agency within which the program will be housed) decided to hire you. It’s your first day on the job.

You know the House bill did not create a ready-made pool of enrollees for you to work with the way the 1965 Medicare law created a ready-made pool of seniors prior to the day Medicare commenced operations. You realize, in other words, that you represent not a single soul, much less tens of millions of enrollees. You will have to build a pool of enrollees from scratch. You also know the House bill authorized some start-up money for you, so you’ll be able to hire some staff, including sales people if you choose. You can also open offices around the country, and advertise if you think it necessary. But you know you can’t pay out too much money getting the “public option” started because the House bill requires that you pay back whatever start-up costs you incur within ten years. In other words, you may hire enough people and open enough offices and buy enough advertising to create a critical mass of enrollees nationwide, but you must do it quickly so that your start-up costs don’t sink the “public option” during its first decade.

The only other feature in the House bill that appears to give you any advantage over the insurance industry is the provision requiring you to use Medicare’s rates plus 5 percent, which essentially means you are authorized to pay providers 15 percent less than the insurance industry pays on average. But the House bill also says providers are free to refuse to participate in the plan you run.

http://pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%e2%80%9cpublic-option%e2%80%9d-was-sold/

[ProSense]

1. There has been no bait an switch. Conrad has been selling his co-op idea from the beginning

A piece critical of a public option most people are fighting to preserve is not going to advance single payer.

[slipslidingaway]

4. We are not even talking about Conrad, the public option being

sold is nothing like the original plan.

Maybe you should read both articles and then read his analysis of the proposed "public option" in the Senate HELP bill.


The Senate HELP Committee “public option” will be multiple “options,” and these will be run by insurance companies

http://pnhp.org/blog/2009/08/14/the-senate-help-committee-%e2%80%9cpublic-option%e2%80%9d-will-be-multiple-%e2%80%9coptions%e2%80%9d-and-these-will-be-run-by-insurance-companies/

"...Summary of Section 3106 in semi-plain English

Section 3106 is difficult to read. It fails to offer clear definitions of critical terms, it uses different terms to describe the same thing, and it contains unnecessarily abstract language. Because it is poorly written, it requires at least two readings to understand it. I will tell you first what I derive from it in the plainest language possible, and then discuss some of its provisions so you can judge for yourself whether I got it right.

...The corporations that contract with the Secretary to create these “community” health insurance companies will be required to meet the same standards insurance companies currently must meet in order to serve as “Medicare Administrative Contractors” (MACs) to administer Medicare’s traditional program. These corporations must, in other words, be insurance companies.


...Now that I’ve tried to explain Section 3106 in the Mother Tongue, it is time to immerse ourselves in the actual bill language. In the next section I review the language that indicates Section 3106 is proposing multiple “options,” not a single Medicare-like program. In the section after that I review the language that indicates the multiple “options” will be created by nonprofit insurance companies like Blue Cross Blue Shield..."

...Section 3106 is a mess, but its meaning becomes clear after several readings. Section 3106 does not create the “Medicare-like” program promised by Jacob Hacker, HCAN, Howard Dean, and other “option” advocates. Instead it proposes a program that authorizes DHHS to create numerous health insurance companies tied to geographic areas, and to contract with members of the existing insurance industry to create and possibly run those companies. Leaders of the “public option” movement have an obligation to advertise the HELP Committee bill truthfully. It is not accurate to say the HELP Committee bill creates a “robust” or “strong” public option. It is not even accurate to say the HELP Committee bill creates one “option.” The truth is the “option” is balkanized and very weak. In fact, HCAN, Andy Stern, Howard Dean and other “option” advocates who have praised the HELP Committee bill should do more than cease to praise it. They should tell Congress they oppose it..."

[ProSense]

6. Oh please,

the public option in the bill hasn't changed. When people were asking for specifics, they got them. Nothing has changed in the HELP bill.

[slipslidingaway]

7. Oh please, you need to read the articles. nt

[slipslidingaway]

2. And here is the follow up article...

http://pnhp.org/blog/2009/08/08/reply-to-critics-of-%e2%80%9cbait-and-switch-how-the-%e2%80%98public-option%e2%80%99-was-sold%e2%80%9d/

"...I stated that a “public option” with zero to 10 million enrollees might not survive and, if it did, it would have little effect on health care costs and the number of uninsured and underinsured. I criticized the leaders of the “public option” movement for failing to notify the public that the mousey “options” in the Democrats’ bills bear no resemblance to the huge “public option” originally proposed by Hacker and celebrated by HCAN.


...The cycle we’re in now bears many similarities with the last two cycles. When this cycle began (2007 is as good a year to pick as the first year of this cycle, although that is somewhat arbitrary), single-payer legislation was better positioned than ever before to be taken seriously by Democrats.


...But once again an articulate policy entrepreneur appeared on the scene to sell a market-based alternative to single-payer that would leave the insurance industry at the top of the health care food chain, and once again the Democratic leadership fell for it. This time the entrepreneur was not Paul Ellwood. This time the policy entrepreneur was Jacob Hacker, a professor of political science at Berkeley. Just as Ellwood and the Jackson Hole Group had before him, Hacker said enhanced “competition” among insurance companies was the solution to the health care crisis. (The name of Hacker’s latest paper is “Healthy competition.”) This time enhanced competition would not come from “managing” competition, but from the creation of a “public option.” This time the coalition that promoted the alternative to single-payer was not the Jackson Hole Group, but HCAN, assisted by a sister coalition called the Herndon Alliance.

The Herndon Alliance was founded in 2005 by many of the same groups that would create HCAN in 2008. The Herndon Alliance paved the way for HCAN’s promotion of the “public option” with some laughable “research” claiming to find that Americans want a “public-private-plan choice” approach and don’t want a single-payer system. I have written elsewhere about the bogus “research” conducted by the Herndon Alliance. Suffice it to say here the Herndon Alliance cooked up a new and more insidious version of the “political feasibility” argument..."

[IndianaGreen]

3. 'Single payer is not within the realm of possibility this term'

Hit the nail on the head!

Naivete about social change

As the remarks by critics of “Bait and switch” quoted above suggest, some “political yes buts” have a superficial understanding of how social change happens. They think it happens quickly or not at all, and they think it begins and ends in Congress.

This view of social change is often expressed in the mantra quoted above, “Single payer is not within the realm of possibility this term.” The implication is that if single-payer advocates cannot demonstrate that they have at least 51 percent of the votes lined up, they should retreat to the sidelines and watch the “political yes buts” do their thing. It implies that social change must occur within a single session of Congress rather than over the course of many sessions. It implies that movements for social change should, in the event that they do not have a majority vote locked up at the beginning of any given session of Congress, put their campaign in moth balls and forgo the opportunity to educate the public and build their movement through lobbying, testimony, rallies and all the other tools associated with campaigns to move bills in Congress.

In short, it implies an absurd Catch-22. To get the “political yes buts” to join them, single-payer advocates must show proof of having a majority of Congress on their side; but to get a majority of Congress on their side, the single-payer movement must build and wage a campaign relentlessly over many years in the face of active discouragement from the “yes buts” – and without pestering Congress with ideas unfairly characterized as utopian.

These demands, when they are spelled out, are obviously irrational. Universal coverage under a single-payer system is going to be difficult to achieve. The difficulty may be on the order of the difficulty of ensuring voting rights for women and civil rights for black people, to name just two examples of movements that took decades to accomplish their goals. If the leaders and supporters of these movements had accepted the Alice-in-Wonderland rules recommended by the “yes buts,” the women’s suffrage and civil rights movements would never have happened.

http://pnhp.org/blog/2009/08/08/reply-to-critics-of-%e2%80%9cbait-and-switch-how-the-%e2%80%98public-option%e2%80%99-was-sold%e2%80%9d/

[slipslidingaway]

5. Yes and see his analysis of the "public option" in the Senate Help

bill, just posted it above.

Link...

http://pnhp.org/blog/2009/08/14/the-senate-help-committee-%e2%80%9cpublic-option%e2%80%9d-will-be-multiple-%e2%80%9coptions%e2%80%9d-and-these-will-be-run-by-insurance-companies/

[slipslidingaway]

8. Uniquely American Solution - What is it ? Why is it being pushed?

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6289091&mesg_id=6289091

Is the goal of the "uniquely American solution" to keep the private health care companies in business and protect their profits?

It is not just the Democrats that are using the phrase, Karen Ignagni of AHIP wrote an article in April.

Some talking points from the Herndon Alliance and published on the Third Way site...
(see above thread for links to this and other articles)



What Journalists Can Learn from Celinda Lake

http://www.cjr.org/campaign_desk/what_journalists_can_learn_fro_1.php

"First there was Frank Luntz. Now, Celinda Lake is trying to do for the Dems what Luntz did for the GOP. Lake, a longtime Democratic strategist, has been hard at work crafting the right words and phrases to persuade the public that Dems really do have their best health care interests in mind. For months, politicians, advocates, and especially the president have talked about “affordable, quality” health care—a Lake-fashioned phrase that has caught on big time. Reporters have repeated these words without providing any context about what they mean—that is, if they mean anything...

In early June, a memo circulated from the Herndon Alliance and Lake Research Partners telling advocacy groups and other interested parties precisely what words they should use to counter Republican messages as health reform’s verbal war begins. The Herndon Alliance, which calls itself a non-partisan coalition, has partnered with some 200 organizations, including former single-payer advocates, think tanks, foundations, advocacy groups, businesses, and health care providers. The Alliance claims to “provide value-added services to partner organizations”—i.e., helping them develop communications strategies. Lake has worked closely with the Alliance in crafting messages its partners can use. She has counseled the Alliance’s partners against using the term “universal coverage.” Maybe that’s why it’s not talked about much anymore. Similarly, she tells activists never to say “Medicare for all.” Instead, they should say “choice of public and private plans.”

...Lake says that frame is “so effective” because it taps into the public’s key expectations for health reform, such as the choice of keeping your current plan and doctor—the president uses that one; affordability (paying less and getting more)—lots of groups are using that one; and finding a uniquely American solution—insurance companies and Sen. Max Baucus have used that one. But wait a minute. Didn’t the phrase “uniquely American solution” surface with Bill Clinton? In the early 1990s, as Clinton began to craft his plan based on managed competition, he framed it as his “uniquely American plan.” How many uniquely American plans can there be? ..."

[slipslidingaway]

9. kick nt

[slipslidingaway]

10. Original estimate - 130 million people in public option, save 1 Trillion in next decade

the current estimates of the public option would have 10 million people and Cost 1 Trillion over the next decade.

That is quite a shift!

:(


Lewin Analysis of Health Plan: Good News for Obama and Clinton

Posted: February 18, 2008 01:02 AM

http://www.huffingtonpost.com/roger-hickey/lewin-analysis-of-hackere_b_87125.html

"...A year ago, just as EPI was publishing Hacker's HCFA plan, CAF had already gone to work, engaging everyone who would listen in public and private educational discussions about the Hacker-EPI approach -- including presidential candidates from both parties. After a year-long dialogue, we can see how Hacker's work has become the template for both Barack Obama's and Hillary Clinton's health care plans. And just as importantly, our allies in the labor movement, public interest and community action networks are coming together around basic health care principles that are based on Hacker's model for health care for all. More on this soon - here at this website and at the Take Back America conference March 17, 18 and 19."


CAF Blog Chronicles Impact of Hacker Health Care for America Plan on the Evolution of the Edwards and Obama Health Proposals
Health Care for America

By Roger Hickey on January 11, 2007 - 4:14pm.

http://www.ourfuture.org/files/documents/evolution-of-the-healthcare-debate.pdf

"The great debate over how to fundamentally fix our broken health care system just got a lot more interesting.
Today, the Economic Policy Institute released the Health Care for America plan – a simple yet sophisticated approach crafted by Jacob Hacker, author of “The Great Risk Shift.” Health Care for America, which you can find at www.sharedprosperity.org, comprehensively tackles the major health care problems holding back our society and economy: the 46 million uninsured, the skyrocketing costs and the uneven quality.
My organization, Campaign for America’s Future, will be launching a nationwide effort to discuss and debate how to get good healthcare coverage for all Americans while controlling spiraling health care costs. The best way to start that debate is to put a simple, clear and progressive health care plan on the table. Health Care for America is that plan, and it will be a benchmark by which all other plans can be judged...


...But if the rules for public-private competition are poorly thought out, an inefficient private system will simply suck subsidies from the public sector, sullying the promise of universal coverage.

Again, the details matter. The initial Edwards plan has room to add in crucial details. And Hacker is urging Edwards to enhance his proposal by ensuring the public plan would “offer the broader benefits necessary to attract younger workers and compete on a level playing field with private insurance plans.”



HEALTH CARE FOR AMERICA WOULD SAVE BILLIONS

Lewin Analysis Shows Immediate Savings, Rein on Costs

http://www.sharedprosperity.org/hcfa/news_release.pdf

"...Lewin estimates the proposal would cover 99.6 percent of all Americans without raising
total national health spending. It would also save hundreds of billions over time – more
than $1 trillion over the next 10 years – in national health spending, according to Lewin.


...The 38 million Medicaid and State Children’s Health Insurance Program enrollees would
be folded into the new insurance pool, with current levels of coverage guaranteed. Lewin
estimates that, of the 260 million Americans not enrolled in Medicare, half would be in
the new Health Care for America program and the other half would continue to be
covered by private employer-based coverage..."

[slipslidingaway]

11. A few more snips...

"...In public comments about the Democrats’ “public option” provisions, the leading lights of the “public option” movement imply that Hacker’s model is what Congress is debating. Sometimes they come right out and praise the Democrats’ version as “robust” and “strong.” But I cannot find a single example of a a statement by a “public option” advocate warning the public of the vast difference between Hacker’s original elephantine, “Medicare-like” program and the Democrats’ mouse version.

...Ditto for Hacker’s allies. Representatives of Health Care for America Now (HCAN), the organization most responsible for popularizing the “public option,” repeatedly describe the House and Senate HELP committee bills as “strong” or “robust,” always without any justification for this claim, and have repeatedly failed to warn the public that the “public options” they promote today are mere shadows of the “public options” they endorsed in the past.

...Searching the websites of the organizations that serve on HCAN’s steering committee – AFSCME, Democracy for America, Moveon.org and SEIU, for example – one will find not a shred of information that would help the reader comprehend how small and ineffective the “public options” proposed in the Democrats’ bills are, nor how different these are from the one Hacker originally proposed. Yet these groups continue to urge their members and the public to “tell Congress to support a public option.”

...Now let us compare Hacker’s original model with the mousey “public options” proposed by the Senate HELP Committee and the House. Of Hacker’s five criteria, only one is met by these bills! Both proposals require the insurance industry to cover the same benefits the “public option” must cover. None of the other four criteria are met. The “public option” is not pre-populated, the subsidies to employers and to individuals go to the “public option” and the insurance industry, employees of large employers cannot buy insurance from the “public option” in the first few years after the plan opens for business and maybe never (that decision will be made by whoever is President around 2015), and the “public option” is not authorized to use Medicare’s provider payment rates. (The House bill comes the closest to authorizing use of Medicare’s rates; it authorizes Medicare’s rates plus 5 percent).

Is it any wonder the CBO concluded the Democrats’ “public option” will be a tiny little creature incapable of doing much of anything? More curious is that CBO gave the House “public option” any credit at all (you will recall CBO said it would enroll maybe 10 million people). The CBO should have asked, Can the “public option” – as presented in either bill – survive?..."