Will There Be a Public Option?

I have waited a long time to even bother writing much about the "Public Option" because,

a) it may not even make it into a bill
b) will have minimal impact on most of us
c) you wouldn't know a) or b) going on the amount of news coverage about it

There are many really good as well as potentially problematic items that made their way into at least 1 of the 4 measures that were reviewed by the House or Senate. The "Public Option" has gotten a disproportionate amount of the coverage and most of it (on both sides of the issue) is misleading at best. I really don't think most of the public really understands much about the "Public Option", but be that as it may, according to a Washington Post/ABC News poll this week they are starting to become more in favor of it (whatever they believe "it" is).

Assume just for a moment that some form of a Public Option winds up being in the final bill signed into law by President Obama.

IF it winds up being "live" rather than waiting for a "trigger event"

IF it winds up being nationwide, rather than voted in or out on a state by state basis

It is still very unlikely that MOST Americans will have the OPTION of selecting the "Public Option" for their Health Insurance. It is very, very likely, that it will only be made available to those who do not qualify for insurance through their work or their spouse's employer. These people have already been able to get "private insurance", but in most cases it is very expensive. It is most likely that "Public Option" insurance will still seem expensive to those considering it, just less expensive than their other options.

A "Public Option" will NOT:

Incent businesses to drop their Health Care offerings (although the total upheaval of acquiring health insurance and making it more like auto insurance would dramatically reduce the overall cost).

Be selected by more than 10-15% of the populace.

Dramatically reduce health care rates (but it will keep them somewhat in check in future years)

Lead to the government takeover of the Health Insurance Industry

Lead to Socialized Medicine (if you hear anyone say this, remind them that the "Public Option" is for Health INSURANCE not Health CARE, and that they need to change the channel on their TV to something other than Fox News).

So, getting back to my topic today...Will there be a Public Option?

YES.

How we get there and what it will look like has very little to do with what is best for the country and everything to do with Politics and Money (this may be true about most laws).

The bill that passes in the House OR the Senate needs to have some flavor of the "Public Option" in it in order for the final law to have it. They do NOT both need to have it. In the final sausage making process of this law, the passed bills from the House and Senate get reconciled and as long as one of them have some language on a "Public Option" it is likely that the final bill signed into law will have something. So Harry Reid in the Senate and Nancy Pelosi in the House don't both have to be successful finding votes for the "Public Option", just one of them needs to get the right number of votes.

The Senate needs 60 votes to prevent a filibuster. There are 58 Dems, 2 Independents and 1 Mountain of Republican Snowe. There are a few conservative Dem Senators like Ben Nelson (NE) and Kent Conrad (ND) who are holding out on supporting a public option, mostly for the benefit of their political future. Harry Reid just needs to find a way of helping them keep face with their constituents. Enabling states to "Opt Out" will probably be enough for one or both of them. Senator Joe Lieberman (CT) the Independent who votes all over the place, but mostly for self-preservation, may not be as easily swayed since the Insurance Companies are clustered in his state. Which is why Olympia Snowe (R-ME) gets to control the final huddle in the Senate. Reid will giver her what she needs to vote for cloture and prevent a filibuster. Only 50 votes are needed for the bill once it comes to a vote (Joe Biden would break a tie) and I am guessing that some Senators (probably including Snowe) may vote for cloture to allow the bill come to a vote, but would then vote against the bill.

Pelosi needs about a dozen Blue Dog House members to vote for their bill (no filibuster in the House). It seems that it may come down to money as many Blue Dogs represent states with lower than average Medicare reimbursement rates - the guideline for payments in the currently proposed "Public Option" plan. Tweaking this or enabling hospitals to negotiate with providers could be enough to let out the Blue Dogs and get to the magic number of 218 votes. This Medicare rate issue is also probably the main sticking point for Senator Kent Conrad.

It takes money to make sausages.

Why Health Care Reform will Definitely Pass

Two big things have happened in the last 24 hours that basically bushwhack the way to getting some sort of Health Care Legislation to sit on the Resolute Desk by the end of 2009.

First, PricewaterhouseCoopers, who created a report sponsored by the insurance industry saying health care insurance premiums would rise faster as the result of Democratic reforms, put out a statement (thanks Politico) that let on that they weren't directed to evaluate the effects of the entire bill, just part of it. More specifically, just the parts that cost money, not the revenue generating portions to offset the costs. Oops! The fact that they are throwing their customer under the bus on this one means they are getting some serious pressure to come clean by the White House. If even a big accounting firm can't make your numbers look the way you want, you are out of luck. This 11th hour report seemed like it was going to cause a major problem with the passage of the Senate bill, but now it looks more like a desperate attempt by people who know they are on the wrong side of history.

Second, earlier today, Senator Olympia Snowe (R - Maine) announced that she would support the passage of the Baucus bill coming out of the Senate:

"When history calls, history calls. I happen to think the consequences of inaction dictate the urgency of Congress."

She also added:

"My vote today, is my vote today. It doesn't forecast what it will be tomorrow."

Which may mean she would vote against the final bill if it includes the public option, but her support means the Dems are almost certain to avoid a filibuster. Now the Dems technically already have 60 votes (58 Dems, 2 Ind). However, Snowe's support provides coverage for the more conservative/Blue Dog senators (Lincoln, Nelson, Conrad) to support it, at least to get it to a final vote.

As for what the final bill will look like, well, surprisingly, a lot like the Baucus bill looks now, and I don't think I would have guessed that 2 weeks ago. However, it is likely it will include some sort of Public Option. The first option is that there will be a triggerpoint of premium increases that would set in motion a Public Option. That threat alone is probably sufficient to keep rates lower, which is one of the primary goals of the public option (eliminating pre-existing condition exclusion would be the other). The second option I just caught wind of yesterday which is to have a Public Option as the default in all states, but that states can choose to not offer them. There is a wonderfully perverse justice wrapped into this one. Conservatives that don't want the Public Option can work toward making sure their state doesn't have one and really shouldn't care what happens in other states. However, once states without a public option see benefits occurring in neighboring states with the Public Option, they will clamor for it. This also utilizes the Behavioral Econmics concept of the Status Quo Bias, whereby people are less likely to change something that is already in place.

What Health Care Changes will we Get?

There is a lot and I do mean a lot that still has to happen before any bill is passed and signed into law, but if I had to guess, I think we will see the following changes:

1) Increased insurance provider options for some or most people
- I can't see through the cloudy crystal ball to determine whether there will be a public option, co-opts or enable health care companies to compete with one another nationwide, but competition and choice (limited) is a good thing and will reduce costs

2) Coverage for pre-existing conditions in almost all situations
- I hesitate to say ALL situations, but that is the goal

3) Assistance determining what health care insurance options are the best fit
- a relatively low cost item that will make life a whole lot better for those who struggle with such decisions

4) Premiums effectively lowered (through subsidies) for lower income families and individuals
- questions now are how much, to whom, what is the sliding scale and how would this be administered

5) Increased opportunity to get prescriptions at lower costs
- this may happen from non-government entities like Walmart and perhaps Shoppers Clubs like BJs, Sam's and Costco getting in on the potential increased revenue and membership.

Again, I am not sure what the price tag will be (but it will be lower than any number currently mentioned), whether or not there will be a public option or just the THREAT of a public option is certain triggers are hit (most likely compromise), whether some plans are taxed (unlikely since the premium isn't dependent just on value but also the actuarial expected cost of the insured) or even if health care is mandatory (unlikely unless heavily subsidized and the minimum requirement is very small).

But, if we get the items in numbers 1 through 5 (and we may not get much more), that will be a significant improvement without negatively changing the way most covered Americans get their insurance.

Senator Michael Dukakis?

I can't take credit for starting this scoop, as I read it on The Political Wire, but I can provide some glimpses into what type of Senator Michael Dukakis might be.

First, let me get on with a full disclosure. Michael Dukakis went to my alma mater, Swarthmore College. Second, he also ran cross-country at Swarthmore, like I did. So, although he is definitely left of me on the political spectrum, (I have never found his views incompatible with mine), I can admit I am probably in the tank for him due to our common background.

That being said, he has some serious shortcomings, at least in the public eye.

He ran one of the worst presidential campaigns of the last 50 years.

* He ignored the Willie Horton ad smear campaign crafted by Lee Atwater and discounted the fact that, yeah, a lot of Americans really aren't smart enough to see through that trash.

* He is very smart and doesn't know how to consistently speak in language that is understandable by many of the people trying to listen to him.

* He allowed himself to be filmed in an army tank with a helmet on. The RNC didn't even have to add words (but they did) when they ran a commercial with those images.

But....and these are some big buts, a Senator and the Presidency are very, very different. Despite the fact that whenever a senator looks in the mirror they see a potential presidential candidate, the actual responsibilities and talents required to be good at the job are very different. Some people who probably would have failed miserably as President have gone on to be very, very good senators. In fact, I would say this is probably true of the person Dukakis would be replacing, the late Senator Ted Kennedy.

Dukakis would not be more liberal than Ted Kennedy (that is almost impossible).

Dukakis is smart and knowledgeable about both domestic and international issues.

Dukakis is a really good guy. I mean a really good, down to earth guy. The kind of guy that if you struck up a conversation with at a local coffee shop, you would find yourself still there fully engaged in the conversation an hour later not knowing what happened to the time. I think he could wind up working well within the halls of the Senate, trying to find common ground with the few moderates there.

Apparently, his selection would not be a boost to Massachusetts governor, Deval Patrick's re-election attempt, as Dukakis still has some serious negatives in his home state, mostly due to his inability to offset the impact of the 'soft landing' of the US economy on Massachusetts.

BTW, Dukakis would be the 2nd Swarthmore grad from the mid-50s in the senate as Michigan senator Carl Levin graduated in 1956, one year after Dukakis.

How Kanye West can help get a Health Care Bill Passed

What?

Yeah, even I said that after I typed the title, but give this a couple of seconds and you'll see where I am headed.

So we all know about Kanye West's latest outburst, this time at the VMA Awards this past Sunday grabbing the mike from Taylor Swift during her acceptance speech. Well, it turns out that on Monday, while President Obama was being 'miked' for an interview on CNBC, he was speaking with some folks and commented that Kanye was a "jackass" for doing it.

Rather than generating one more wave of un-pleasantries from his opponents, this comment seems to have united almost everyone behind President Obama. For example, read the comments posted under these articles:

USA Today
Politico
Fox News

You can also hear the actual audio at TMZ. Over 90% of those voting at the TMZ site supported Obama's remark.

So my thinking is, let Kanye rip away. Perhaps Obama's detractors will realize they may have more in common with him than they think and perhaps we can get a more rational conversation going on how to improve health care coverage in the US.

BTW, Kanye's interruption was to say he thought this video by Beyonce for "All the Single Girls" should have won.


But perhaps Justin Timberlake should have been equally upset that his version of the same video wasn't even nominated:

A Political Emmy

It has been said that politicians are overly dramatic and often acting. Yesterday, an Emmy was given to someone portraying a politician.

Tina Fey was appropriately rewarded for one of the best spot-on (and quickly created) impersonations ever with her portrayals of Sarah Palin on Saturday Night Live last Fall.


When Sarah Palin was named as John McCain's running mate, one of the first things that hit me was how much she looked like Tina Fey. An observation became a reality and rewarded us with one of the funniest Political seasons ever.

Many of the videos have been taken down by NBC, but here is one of my favorite skits with Tina Fey as Sarah Palin:



Yeah, you can't find those SNL videos listed anywhere. Which is why you have to come to The Voting Booth Blog, because we remember where they are located:



And Finally, the SNL Sarah Palin & Katie Couric interview skit, which unfortunately cannot be embedded so you'll just have to click on the link and go to YouTube.