A little-noticed tidbit in Saturday's Washington Post is sure to raise eyebrows among liberal supporters of a gorvernment-run healthcare plan: the plan is likely to be administered by a private insurance company, the very companies that progressive activists are trying to unseat.
The public-option debate is frustrating some Democrats, who have come to believe that a government-run plan is neither as radical as its conservative critics have portrayed, nor as important as its liberal supporters contend. Any public plan is likely to have a relatively narrow scope, as it would be offered only to people who don't have access to coverage through an employer.
The public option would effectively be just another insurance plan offered on the open market. It would likely be administered by a private insurance provider, charging premiums and copayments like any other policy. In an early estimate of the House bill, the Congressional Budget Office forecast that fewer than 12 million people would buy insurance through the government plan.
Supporters of the public plan contend that it will help to trim healthcare costs, as a public insurer wouldn't need to generate profits. Health insurance companies typically earn profits of around two to four percent, which amounts to billions of dollars for some firms.
A physicians' group notes that the bills authorize the government to contract with "corporations" that will create a "public option."
"Both bills authorize the Secretary to contract with corporations to conduct unspecified activities that will somehow lead to the creation of an “option” program throughout the country," Kip Sullivan at Physicians for a National Health Program writes.
Advocates of a “public option” claim that the “option” will look like Medicare. They say this about the “option” in both bills that have been introduced to date – the House “reform” bill, HR 3200, and the bill written by the Senate Health, Education, Labor and Pensions (HELP) committee. But this statement is not true.
Medicare is larger than any private insurance company; the “option” in both bills will be small. The traditional Medicare program is a single program with uniform benefits; the “option” in both bills will be a balkanized program that may not be available in all parts of the country. Medicare is administered by public employees; the “options” in both bills will be administered by private-sector corporations, some or all of which will be insurance companies. The “option” in neither bill resembles Medicare....
As the preceding rather convoluted description of MACs and contracting administrators suggests, neither the HELP bill nor HR 3200 makes it easy for readers to grasp that corporations, not public employees, will create, and probably run, the “option” program. Neither bill comes right out and says, “The Secretary shall hire private-sector corporations to create and run as many health insurance companies as is necessary to make health insurance available for sale to the non-elderly in each health insurance market in America.” Nor is that fact being ballyhooed by the bills’ authors and proponents. But it’s an important feature for “option” supporters to understand because it undermines the claim “option” advocates make over and over that the “option” will look like Medicare.
The Senate Health Committee bill includes a public option; the Senate Finance Committee bill does not. Senate Democrats are pushing to include an "opt-out" or "trigger" public health option in their final bill, which would unsettle some Democratic moderates but not to the point where they'd join a Republican filibuster.
In the House, Speaker Nancy Pelosi (D-CA) is whipping votes for a "robust" public option, to give negotiators between the two chambers leverage in order to have some form of the public option be included in a final bill.