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Sunday, August 23, 2009

How to break the impasse AND WIN

Instead of the legislative machinations being bandied about, Obama can win this by splitting the public option into a separate bill and having it passed out of a House committee immediately, and meanwhile getting the up vote, at least from all the Democrats and probably a few Republicans, on the less–volatile parts of the bill. Those remaining elements are namely (1) the end of the insurance company's right to deny or rescind coverage (before or after the claim) or discriminate with outrageous pricing based on pre-existing conditions; (2) the universal mandate; (3) the insurance “exchange” where insurers will have to compete on established parameters of coverage; and (4) assistance with premiums for people who can't afford them, such as a family with an income less than $88,000 as in the current House bill.

Even without the public option, those are serious changes that bring the U.S. close to at least some of the European systems that are significantly less costly than the current mish-mash of a system we have (if you can call it a system). (Several of the Continental European systems do rely to a great extent on private insurance.)

There will be huge cost-savings simply from insurance companies no longer deploying armies to dig for and do battle over pre-existing conditions, from doctors and hospitals knowing exactly when the patient shows up at the door that they will be paid in full, by whom and when, and probably to some extent by somewhat improved competitive environment through the exchanges.

But Obama cannot give up on the public option. First, he must acknowledge that when they understand the “public option” correctly – that it is a choice entirely in the hands of the individual between a public non-profit policy and private policies -- Americans overwhelmingly support being given that choice. Accordingly, he must put the burden of persuasion against this public option on the opponents: why in the world would they deny the American people something they want which will help control insurance costs? By promoting a separate bill on the public option, he can promote debate on that issue alone by allowing people to focus on what it really means, and in the process put even more pressure on the opponents to explain themselves. This they are unlikely to be able to do, since they are protecting the highest possible profits of the insurance companies -- reducing their incentive to improve efficiency -- and gigantic salaries in the tens of millions for their top executives.

The best chance of actually getting the valuable public option is to stop allowing opponents to hide behind all the ridiculous flak the rest of the bill is receiving. Cut it out but keep it alive (and well).

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