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Obama: I Will Not Back Down from Public Option...Or Something Like It

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As expected, President Obama's speech contains a clear defense of the public option--noting for the first time that the public option has popular with voters. But it also leaves him plenty of wiggle room to accept compromises.

"[A]n additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange," Obama will say. "Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up."




It's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight. But its impact shouldn't be exaggerated - by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end - and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

For example, some have suggested that that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others propose a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.

This is a pretty clear explication of the public option proposals on offer in both the House and the Senate. It's also a fairly clear sign that Obama's quite willing to sign off on something that falls short of the public option progressives are demanding. Loosely translated, it suggests that Obama is demanding that health care reform include...something: a public option, a triggered public option, or a co-op. But he'll draw the line if it doesn't call for some sort of alternative option, triggered or otherwise.

You can read the entire public-option excerpt below the fold.

Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. The insurance reforms that I've already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.

Despite all this, the insurance companies and their allies don't like this idea. They argue that these private companies can't fairly compete with the government. And they'd be right if taxpayers were subsidizing this public insurance option. But they won't be. I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers. It would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.

It's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight. But its impact shouldn't be exaggerated - by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end - and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

For example, some have suggested that that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others propose a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.

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29 comments

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September 9, 2009 8:21 PM   

"for decades, driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it."

oh well, in that case....

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September 9, 2009 8:27 PM   

Just take a stand. This endless wavering is pathetic.

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AJM

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September 9, 2009 9:36 PM   

As expected -- I'm all for it, just don't expect me to fight for it. Weasel.

Most of the rest of the speech was good to great -- much better than I expected.

Obama needs to read the audit of Blue Cross in Iowa which shows how and why co-ops would fail.

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September 9, 2009 9:42 PM   

".... "Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance....."

Correct me if I'm wrong, but didn't that just take away choice from those who have )terribly expensive or poor)coverage and would like to switch to the public option?

Also, did you see how he ditched payment covering abortions?

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September 9, 2009 9:44 PM    in reply to chigger

Crap, public option, except if you're a woman who has been raped or are a minor female who has been sexually abused and become pregnant. Those must pay their own way. Right.

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September 9, 2009 11:45 PM    in reply to chigger

I was wondering about that as well. Was he hinting of a Public Option for those who can't afford private insurance in lieu of subsidy (that would line the pockets of private insurers)?

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September 9, 2009 9:51 PM   

Also, he made the point in the beginning about how our current system makes it difficult for companies such as our auto makers to compete with auto makers from other countries with government-paid healthcare, instead of employer-paid healthcare such as ours have. Explain to me how his proposals help our auto makers to be more competitive.

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September 9, 2009 10:17 PM    in reply to chigger

I think hes referring to slowing the growth of insurance costs.

The problem is costs are ALREADY HIGH.

Thats why something radical is the best solution. If we went single payer and removed employer mandates, that would free up small buisnesse s and companies.

Insurance companies could still exist, as long as we regulate hospitals, so that they wont be encouraged by the insurance companmies to raise premiums, and therefore create the need for "supplemental" insurance

The public option Obama talked about was a weak one and not the one we want. We want a plan available to ALL americans, not kjust the poorest. We want something that everyone can buy into if they chose too. thats the only wa this makes sense and competes against big insurance.

As for the companies, I think the exchange will be whats helps them.He should create two exchanges one of r businesses and one for individuals.

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September 9, 2009 10:09 PM   

The president laid out the facts and specifics. However, he failed to champion for the public option and he was too, too reconciliatory to republicans like Grassley. He did little to sway me, but i guess i wasn't his intended audience. The speech was mediocre at best.

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September 9, 2009 10:13 PM   

Also....I can understand the need for mandatory insurance coverage under single payer, but it sounds like a total cave to the insurance lobby under anything less than single payer. I just don't see these suggested policies bringing down prices, quite the opposite, so mandating something that is likely to be unaffordable is ridiculous.

I don't know, I'm still chewing on it, but it just seems to me he failed the simplicity test.

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September 9, 2009 10:17 PM   

It's true. If there is a better way to get there then do it. Wait.........THERE ISN'T.

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September 9, 2009 10:45 PM    in reply to theone718

Bingo!

That's the point and the back door way of demanding the PO. Anything else simply won't do the job.

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September 9, 2009 10:29 PM   

I give it a B or B-. It was a far cry from some of his campaign speeches, in particular his Election Night victory speech and his nomination speech. And I still wanted to see more specifics on how he'll pay for this and how his goals can be accomplished without a government-run option, if they can at all.

But it was a step back in the right direction and was more powerful and clear than anything he has said since getting sworn in. It won't win over any Republicans, but it should re-assure people in his own party.

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ESK

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September 9, 2009 10:42 PM   

Arm chair activists drive me nuts. Absolutely unrealistically skewed perspectives here in many of the first 11 comments. Name calling and sour grapes. When will the extremes, both left and right, understand that when you can't have exactly what you want disparaging comments won't get it for you either. Infantile.

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September 9, 2009 11:14 PM    in reply to ESK

I tend to agree. Health care is incredibly complex, with lots and lots of moving parts. We have a 1,100 page bill just out of one committee! Add to that the fact that there are disparate parts of the Democratic Party ranging from Dennis Kucinich to Mary Landrieu, and any plan will have to thread several political needles in a way that makes Cold War diplomacy look like playground problems. I don't pretend to understand all of it, or even great portions of it.

Yet there are so many people who are so convinced that they have the answer. "Obama should just" fill in your own opinion.

I think the public option has become a Shibboleth for progressives. Even if a lot of commenters have no idea exactly what they mean by public option.

But, hey, Obama has pissed off a lot of progressives. That I get. But Jesus, call it what it is: disappointment with a President you do not perceive as fighting for you. That's fair, and earned. But to let that cloud real critical policy thinking...well, that's the GOP way.

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September 10, 2009 1:48 AM    in reply to LarsThorwald

You mean that universal health care won't come complete and wrapped with cool wrapping paper and a bow?

What annoys me is that people want everything immediately. It's rare that things in life ever work that way. You make steps, see how they work out, fix the problems, and work for something better than you had before.

I'm guilty of the occasional sour grape with how Obama is handling things--but there's a road and there are mile markers. This is reality and there's no warp drive in politics. My fear is that the people who want everything now will contribute to nothing getting done. Which would be a waste since I think that the next big thing after universal human health care is universal pet insurance....

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September 10, 2009 4:59 AM    in reply to LarsThorwald

In all fairness though, it is on pages with 4" margins and a *maximum* of 24 lines per page .... not to mention the 2" headers every few pages and table of contents at the start of each section. On a GOOD page you're lucky to get over 120 words (ran a few through an online word counter). Can we HONESTLY call that 1100 pages? I'd give it about 250 tops.

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September 9, 2009 10:43 PM   

Watching Axelrod on Maddow, I saw Humpty Dumpty, still sitting on a wall. Everything is negotiable; trust us.

No, I don't.

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September 9, 2009 11:29 PM   

I worked for a long time in the building industry, sometimes writing specifications for building construction. There are basically two approaches to writing specifications. One is to write a "performance-based" specification, which lays out what level of performance must be reached by the product or work. With a performance-based spec, there are often many possible products that can meet the criteria established by the specification. The other approach is to write a "prescriptive" specification, which indicates a specific product (and sometimes even the vendor or contractor). With a prescriptive spec, generally only one product is acceptable.

So, as I see it, we liberals have been calling for a "prescriptive" specification in regard to the public option. We've been saying that the public option is the one measure that can be used to satisfy the goals we need to achieve. But I think that what Obama is did in his speech tonight is to propose a "performance-based" specification for health care reform. He is spelling out the level of performance that must be provided in any law he signs. It seems to me that as long as we can ensure that the level of performance is greater or equal to that of a public option, we should be OK with his plan.

I probably should add that there are some additional risks in going the "performance-based" specification route. There needs to be extra time and effort extended in order to ensure that the product actually does meet the criteria established by the specification. So it's absolutely crucial that any alternative to the public option actually does meet the same performance goals of the public option itself. Congress better come through on that.

It may indeed be, as I think Obama was saying, that the public option *is* the best way of achieving those goals. But no matter what, as Obama said, it's the achieving of the ultimate goal itself that's important, not how it's achieved.

I'm one of those progressives who's been clammoring for the public option. The President convinced me tonight. I think it was a great speech. I'm fired up!

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September 10, 2009 3:45 AM    in reply to Wordie

Yes, apparently, countries like Switzerland have affordable universal coverage without a public plan. In their case, they do it by strict regulation of the insurance industry. I think there are many misinformed "progressives" out there who think all countries with universal coverage have public plans. Some do, some don't. Another option is to control costs by how reimbursement is provided (outcomes or salaries vs. fee for service). Personally, I think the evidence suggests that altering reimbursement would have the single largest effect on health costs. All those cost-effective clinics that have been touted lately (like Mayo) cut costs 50-70% in that way. Makes me think Obama got in bed with the wrong interests and vilified the ones who could have helped the most. The AMA and big pharma do NOT want to see reimbursement based on outcomes but big insurance does. If you traded them a system that controlled costs on the user end, moved tort reform to special expert courts instead of juries, and mandated universal buy-in in return for the regulation necessary to prevent abuse, it could have been win-win.

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September 10, 2009 8:05 AM    in reply to Heretic

How big is Switzerland?

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September 10, 2009 12:04 AM   

Can someone explain the trigger option?

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September 10, 2009 1:03 AM   

Great take on the speech by Chris Weigant from the Huffington Post:

The Left is going to be seriously disillusioned by "what might have been," and what was jettisoned for political expediency (which is also known as "getting enough votes to pass it"). The Right is going to be seriously disillusioned because whatever passes will likely (at the very least) be a good thing which in no way resembles the terrifying caricature they've been using to scare people for decades.

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September 10, 2009 1:11 AM   

will anyone ever ask Obama the one question that for some unknown reason isn't being asked. WE NEED TO KNOW.
Here's the question;

1.If I were just an average joe out there who maybe did or did not have insurance coverage. And I just happened to NOT WANT any coverage at the time the public option became available. Would I be fined?

I've read in many places that this plan includes hefty fines for those refusing to be covered. Why isn't that very important question being asked on national television? The question needs to be asked and answered for all Americans to see and hear. straight from the president's mouth.

don't you agree?

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September 10, 2009 2:08 AM   

It was a terrific speech.

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September 10, 2009 5:09 AM   

So do mandates kick in after 4 years too?

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September 10, 2009 5:18 AM   

Good Speech.

My bottom line has always been, let's make sure we get something in the damn bill, that we can build on toward single-payer medicare for all for the future (since its obvious we're not going to get it right now).

The only thing in the 5 committee bills that resembles that is the PO. Watered down or not.

As long as that's in there, I'm all thumbs up.

Its in his plan that he presented to congress in writing:

http://i.cdn.turner.com/cnn/2009/images/09/09/obama.plan.pdf

So I'm cool for now.

Let's just keep fighting. And we'll get it.

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sbv

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September 10, 2009 11:58 AM   

good point willia451! president obama made clear in his speech last night, once again i might add, what is essential in health care reform is unjeopardized and secure quality, affordable health care for all and a means for cost containment.

these will be in whatever bill president obama signs; and it will be, lordie this is what the republicans and some democrats and their corporate sponsors fear the most, a good beginning for universal, single payer health care.

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September 10, 2009 12:37 PM   

Maybe some people were listening to a different speech than I was.

Here's what I heard: "I still like the idea of a public option, because I think it's the easiest and most obvious mechanism for keeping the private insurers honest, by providing comparable coverage with lower overhead costs - forcing the insurers to rein in their unrestrained pursuit of ever greatest profits to compete." He specifically called out "Wall Street's expectations" as one of the primary root causes for the explosion in costs for medical coverage. The corollary root cause for the explosion in costs for medical care is the large pool of uninsured. He covered that too.

He was telling Congress, "you don't have to do a public option - but if you don't, you're going to have to come up with another way to enforce limits on the profit margins of private insurers." That's really the whole crux of the thing. The choice is between a quasi-government takeover of private insurers via very intrusive regulation, as they do in Switzerland, or you can create some market force that requires them to self-regulate via competition. He indicated that he thinks the latter is the simplest course, but if he's presented with a plan which accomplishes the desired objective that doesn't include a public option, that would be ok.

W/R/T all of those above who think he said you won't be able to buy into the public option unless you're currently uninsured, I don't think he said that. Because he isn't proposing a dismantling of the current system, he's acknowledging that most folks who are already receiving employer-subsidized coverage will want to stick with that. But the public option will be available from the beginning for the uninsured, the unemployed, the self-employed - people who currently can't afford or have been denied insurance from the private insurers. People move in and out of the above categories all the time - from employed to unemployed to self-employed...in any given 2-year period about a third of us change jobs. So while he didn't explicitly say "anyone can buy into public option if they choose to", if you can't imagine how guidelines could be written to exclude some who want to buy in but not others - and I can't imagine how that would be done - my implicit understanding is that what he was getting at was this: anyone can choose it, but for those who already get employer-subsidized health coverage, it probably won't make financial sense to turn down employer coverage and pay for public option entirely out of their own pocket. In practice, a public option initially will serve mostly those in-between jobs or self-employed. What he didn't say was that over time a public option, if it provides a better value, would probably pick up a lot of small businesses or their employees, and I think he was underselling with his 5% estimate. 5% is a pretty average rate for unemployment, so it doesn't account for all the low-income workers without coverage or the self-employed - plus a lot of those folks have families, so the overall population served by the public option initially would probably be closer to 10%. Perhaps they're operating on the assumption that a significant portion of those folks would opt for a private insurer priced competitively with the public option, either with or without a government voucher to help pay the premium.

And yes, he did say everyone's going to be required to get coverage. The penalties that will incur if you don't have coverage will go to cover the costs you add to the system when you show up at the emergency room needing care and have no insurance to cover the costs. It's liability insurance for the costs you would otherwise pass on to others through your negligence in not obtaining coverage. Nothing wrong with that in tandem with economic assistance for those who otherwise wouldn't be able to afford insurance.

That's what I heard, anyway.

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