Promising Words from Wyden

I find this extremely encouraging.  While I've worried about Wyden's position in the health care debate, specifically whether he would support a public option, I find the tone of support he takes here to be a big relief, though he doesn't actually talk about the public option, the fact that he talks in optimistic terms (both from a policy perspective and in terms of momentum in Congress) about the principles outlined in Obama's speech that are enshrined in the bills that have been passed out of committee so far, and offers criticism of particular parts without bringing up the public option, I consider a major relief.  I would still like to see him make a stronger statement in support of the public option, but after this I'm a lot less worried about where Wyden will come down in all this.  Wyden did however have some concerns that should be explored.

Wyden says, "the area that i would like to be bolder in is in this area of creating a market through choice and competition."

Wyden believes the proposal wouldn't allow nearly as many people as it should to choose to enter so-called health insurance exchanges, if they're unhappy with the insurance their employers provide.
"Only people who are unemployed and uninsured and work at very small businesses would be allowed choice and competition in the exchanges," Wyden noted "Anybody who works at a mid-size business who doesn't like what they have, a government bureaucrat steps in and says you don't have choices.

As long as we're on this topic, I'm highly skeptical of the "choice and competition" talking point that Obama and Democrats have picked up on.  Many employers offer multiple plans to their employees, and employees then choose the plan they wish to buy into.  Employers who do this are effectively creating on a very small scale something we can call an "insurance exchange," as has been proposed in every bill on a much larger scale.  Personally I have never met someone who, when given such a choice has any clue what they're choosing.  People will get a choice, and businesses purchasing plans off the exchange will have a choice, but there's no reason to believe that they will make an economically rational one given the way insurance plans are presented.  In High School my mom once changed plans at Washington State University because one of them offered better coverage for the asthma medication Advair, which our original insurance plan didn't want to cover, but was doing an incredible job of controlling my asthma.  That was an awfully narrow consideration, that if you're able to do an in depth cost benefit analysis of the two plans, might not actually be worth it.  However, since health care plans are unreadable for most people, consumers will make choices like the one my mom made rather than really figuring out which plan offers the better deal holistically.  I think we need reform badly enough that I'm willing to get behind a strong health insurance exchange, but I'm pretty skeptical that it can actually work, even educated and informed consumers are going to be unable to distinguish between plans and will choose based on pretty narrow criteria.  Wyden's other concern was related to the tax on health care companies that forms a central part of the Baucus cop out plan, and was endorsed by Obama the other night.

But Wyden was perhaps most critical of the financing scheme--enshrined in the Baucus plan, and endorsed by Obama--to raise the funds needed to pay for the bill by taxing high-end private insurance plans. That measure sells politically--who doesn't like the idea of taxing insurance companies?--but the incidence of the tax is likely to befall insurance consumers, including middle class Americans who Obama vowed not to increase taxes on.
"This financing system is not my first choice," Wyden said. "We're going to be working in the finance committee to address the concerns you describe."

Everything I've read on the topic of this type of a financing scheme agrees that the costs will just be passed on to consumers.  Given the realities of American health care that's just not a productive outcome.  I think Wyden is spot on here, and hopefully we can come up with a better way to finance this.

I was really relieved at the tone that Wyden seems to take here, he's not playing games with whether he'll support something like what Obama laid out the other night, but he is engaging seriously with the policy and looking for ways to work towards a better bill.  As far as the two points I highlighted here, I think Wyden is wrong on the first, but so is Obama, absent a single payer approach however, it makes a lot of sense.  And on the second he's spot on.  Hopefully Wyden can help improve the Senate bill (whichever one becomes the Senate bill) and cast his vote for universal health care.  Now he better not make me regret this post by working against a public option.

Wyden's game on the Public Option

Most accounts I've seen have Oregon Senior Senator Ron Wyden playing coy on the public option, suggesting that he might or might not support it.  I've had a difficult time figuring out what exactly Wyden's position is on the matter, but he did seem to take a small step towards, "standing in the way [of the public option]," as he said he wouldn't when he signed a letter along with major health care reform roadblocks such as Ben Nelson, Mary Landrieu, Susan Collins, and Olympia Snowe urging a delay in the reform effort.  That letter allowed for the push to slow to a halt leading into the August recesses, that allowed the anti-reform brigades time to organize and present their fake populist outcry against health care reform.

I'm not sure what Wyden's position is precisely here, beyond that he understandably likes his own bill.  When it was first drafted a couple of years ago Wyden's bill was an excellent roadmap for what passable health care reform might look like given the slim Democratic majority of 2006, with of all people Robert Bennett of Utah as its cosponsor.  The thing that's odd about this whole thing, however, is that Wyden won the argument before it began, his Healthy Americans Act was the first coherent presentation that I'm aware of, of the "health care exchange" model that forms the basis of the Senate HELP Committee bill, the House Education and Labor Committee bill, and the Obama outline plan.  There are only two major differences that I'm aware of:

1) to Wyden's credit, his bill seems to advance insurance portability a little bit more effectively than the health care exchanges presented in the House and;
2) Wyden's bill contains no public option

Clearly the second is the more contentious issue, oddly given that a public option advances the goal of health care portability more effectively than anything else in the insurance exchanges that are presented in the bills that have been passed out of committee.  This is very strange, given that its the first difference that Wyden's bill is more effective on, there may also be some very specific cost-containment measures in Wyden's bill that don't exist in other bills, but many of those could easily be added in by amendment.  That the public option has become the point of contention with Wyden is very strange, since a well organized public option that assumes Medicare providers will participate in the public plan, ties reimbursement rates to Medicare rates, and allows for drug price bargaining by Medicare and the Public Option would provide tremendous downward pressure on private health care costs.

Back when he introduced it, Wyden's plan was a good outline for bipartison, effective health care reform that promoted universal coverage.  Since that time however, it has become obvious that the goal of the Republican Party on many issues is to block the Democratic majority from any accomplishments, this was apparent from the stimulus debate and from Republican repositioning on the once bipartison Employee Free Choice Act, as well as to block any health care reform.  This is part of why the debate has had nothing to do with the actual proposals, with half the debate being about Canada and Britain (solutions that are not being proposed by anyone with power) and the other half being about blatant lies and distortions.  While Wyden's proposal could pick up Republican support in 2007 I seriously doubt that it could today.  Nonetheless I'm not opposed to having a vote on Wyden's plan, but his waffling on a public option is just plain bizzarre, as Jacob Hacker (linked in previous paragraph) argues compellingly, Wyden's plan too would benefit from a public option.  Its time for Wyden to stop playing whatever game he's playing here and get on board with the public option, its hard enough to pass health care reform over the objections of conservative Republicans, they don't need help from progressive Democrats.

Patience My Friends

The health care debate seems to have picked up steam since Ron Wyden introduced a plan for universal health care a few weeks ago. Today, Paul Krugman wayed in on what needs to be done in the short term.

Universal health care, much as we need it, won't happen until there's a change of management in the White House. In the meantime, however, Congress can take an important step toward making our health care system less wasteful, by fixing the Medicare Middleman Multiplication Act of 2003.
...
What should Congress do? The new Democratic majority is poised to reduce drug prices by allowing -- and, probably, requiring -- Medicare to negotiate prices on behalf of the private drug plans. But it should go further, and force Medicare to offer direct drug coverage that competes on a financially fair basis with the private plans. And it should end the subsidy to Medicare Advantage, forcing H.M.O.'s to engage in fair competition with traditional Medicare.

Conservatives will fight fiercely against these moves. They say they believe in competition -- but they're against competition that might show the public sector doing a better job than the private sector. Progressives should support these moves for the same reason. Ending the subsidies to middlemen, in addition to saving a lot of money, would point the way to broader health care reform.

It seems to me that the calls for a national single payer health care program have been getting much louder the last few weeks, which is good. I agree with Krugman however, and have articulated this before (though perhaps not on this blog). In terms of necessity the time for this is absolutely now, today in a perfect world we should institute national health insurance. However, the institutional standing of our country at this moment does not lend itself to this possibility. Before we can institute such a program, Democrats absolutely have to control the executive branch. If we push too hard, too fast for national health insurance without controlling the executive branch we risk losing the argument at a time when there was never any possibility of passage. Bush cannot hold the veto pen when we pass such a program. That's why I believe Krugman is correct here, ultimately we need national health insurance, but in the meantime we cannot possibly get it signed into law today, so we should chip arround the edges of American health care to make some good positive changes for people that we can get passed into law.