THE TREATMENT OCTOBER 27, 2009
Click here to read Jonathan Cohn's take on the comments made by Nancy-Ann Deparle, director of the White House Office of Health Reform, about the public option at today's TNR health care conference.
What good can the public option do if not enough people can access it? That’s the question that Senator Ron Wyden has been raising a lot lately. And he did it again this morning, at TNR's health care reform event. It's part of his campaign to pass what he's called the "free choice" amendment, which would allow people with access to employer-sponsored insurance to reject those plans, redirect their employer contributions, and buy coverage instead through the new insurance exchanges.
The odds are still against the amendment's passage. But Wyden's crusade has been generating media attention and, more recently, generating some enthusiasm on the left--where Wyden has had some trouble over the last year. Why the sudden surge of interest? With some form of a public option seeming more likely, supporters are wondering why it shouldn't be available to everybody. A case in point is Representative Anthony Weiner, who sat to Wyden's left during the event. If the public option is available only to people without access to employer-sponsored coverage, Weiner warned, relatively few people could use it. It'd be, as he described it, "a sliver of a sliver."
And limiting the public plan's enrollment wouldn't just affect those who might wish to enroll. In the long run, it would affect everybody who might benefit from its influence on the marketplace. With only a limited number of participants, and with rates that are unlikely to be tied to Medicare, the public option is far less likely to drive down prices than both its supporters and opponents expect, as Ezra Klein explains.
Oh, and if the exchanges are state- rather than nationally based, that will mean even fewer people--and possibly more opportunities for the public plans to become dumping grounds for the old and sick. (The smaller the exchange, the thinking goes, the greater the danger it ends up with a risk pool tilted towards the sick.)
Politically, the trouble for Wyden has been the staunch opposition of business and labor alike. But he found at least limited support today from Dennis Rivera, of the Service Employees International Union, who said “I agree with Wyden that if we’re only going to have 10 percent who have access [to the exchange], we’re not going to be achieving our goals.” (SEIU supports making the exchanges open to businesses, although it hasn't formally endorsed Wyden's call to make the exchanges available to all individuals.)
To be sure, it may be too late--as, again, Ezra believes--to scale up the exchange proposal significantly. But modest changes, at least, aren't out of the question. After all, which senator said that stronger exchanges were a big priority, shortly after voting for the Finance bill? None other than Olympia Snowe.
For video of TNR's event, click here.