WaPo health columnist counters: 'no Plan B, everyone knows it'


President Barack Obama and his aides have prepared a scaled-back healthcare reform proposal should they not have the votes in Congress to pass a broader measure, according to a report Thursday.

The new proposal would help insure roughly 15 million, about half the 31 million Senate Democrats' original plan would aim to insure. Children would be allowed to stay on their parents' health plan until they were 26, and the bill would expand Medicaid and the Children's Health Insurance program.

The Wall Street Journal said the new proposal would "modestly" expand existing federal programs.

Unlike the Democrats' House and Senate proposal, it would not fine those who decline insurance and wouldn't require all Americans to carry it.

It is, however, a huge step backward from Democrats' earlier promise to close a massive insurance gap that has left nearly 40 million Americans without health insurance coverage. It's a far cry from earlier proposals for a public option, under which the government would have created a competitor to private insurance firms, and seems to spare insurers and pharmaceutical companies from multi-billion dollar fines that Democrats had considered to help fund their proposal. News of its consideration comes even before President Obama meets with Republicans for a health care summit Thursday.

"Officials cautioned that no final decisions had been made," wrote Laura Meckler for the Wall Street Journal, "but said the smaller plan's outlines are in place in case the larger plan fails."

According to Meckler:

As he was weighing his choices, Mr. Obama asked his staff to show him what a more modest policy might look like, and the plan to cover about 15 million people was the most promising, a senior White House official said. "He wanted people to look at what effect you could have on the overall problem if you have to go smaller," the official said.

White House Chief of Staff Rahm Emanuel didn't devise the smaller policy, the official said. But Mr. Emanuel argued that it wasn't feasible to pass a comprehensive bill and counseled a lesser version, according to several people familiar with the conversations. Others argued that Democrats were going to take a political hit by voting for a health-care bill no matter what, and they should opt for a sweeping measure whose benefits would be easier to highlight.

Another argument made by those pushing for major change: Why run for office if not to address big problems such as health care?

Mr. Obama decided to renew his push for a comprehensive bill, and Thursday's televised summit was designed to lay the groundwork for that approach.

But the Washington Post's Ezra Klein, who covers health care, claims the Journal story considerably exaggerates its thesis and the White House is "furious" about it. The supposed plan isn't really under consideration, he writes.

In August, discussions raged in the White House over whether to pare back the bill. The comprehensive folks won the argument, but people also drew up plans for how you could pare back the bill, if it came to that. More thinking was done on this in the aftermath of the Massachusetts election, when Rahm Emanuel and some of the political folks again argued for retreating to a more modest bill. As you'd expect, these conversations included proposals for how that smaller bill would look.

I could quote some White House sources swearing up and down that that's all this is. A vestigial document that's being blown out of proportion by a conservative paper interested in an agenda-setting story. They're furious over this story. None of the quotes are sourced to the White House -- not even anonymously -- raising questions that the whole thing is sabotage. But it hardly matters. There's no Plan B at this point in the game, and most everyone knows it.

On Wednesday, the House overwhelmingly passed a bill that would end an anti-trust exemption enjoyed by major insurance firms. The Senate has rejected several of the House's more liberal measures -- including the public option -- so its unclear whether the anti-trust reversal would survive a Senate vote.