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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Two Views On a Non-Public “National Option”

The big development on health care reform that began to emerge from Senate negotiations over the weekend was the idea of replacing the (relatively weak) public option in the bill pending for floor action with a national menu of private plans that would be made available though the federal Office of Personnel Management or perhaps the Federal Health Benefit Plan. This would, as the popular slogan goes, give Americans (at least those eligible for the exchanges, and who live in those states that didn’t “opt out” of such an option) the same kind of health insurance available to members of Congress, without, of course, any prior guarantees about the price or the quality of coverage.
The initial reactions to this idea are interesting and illustrative of many of the underlying dynamics of the health care reform debate among progressives. The “father of the public option,” Yale’s Jacob Hacker, has rejected any “public option” that isn’t actually public in its insurance offering:

A bill that forces people to take private insurance but doesn’t create competition or a public benchmark is a prescription for unaffordable coverage, runaway costs, and political backlash. The “middle ground” is nowhere to stand if it’s going to crumble beneath you.

Hacker’s piece is a reminder of the irony that many supposedly tight-fisted moderates and conservatives are opposed to the one element of health reform–a publicly run insurance plan that could force down premiums for private plans–most likely to reduce public and private costs. For Hacker, it’s the use of Medicare’s structure for operating a “fallback” or “guaranteed issue” plan that represents a new line in the sand now that the use of Medicare rates has been dropped (even in the House).
Meanwhile, Ezra Klein of the Washington Post explains the genesis of the non-public national option in a progressive-centrist negotiating team put together by Harry Reid, and suggests it may be a first step towards deal-making that extends beyond the public option issue and encompasses other goals important to progressives (e.g., subsidy levels, degree of insurance regulation, and phase-in periods for the whole system).
Looks like another wild and confusing week on the health care front.

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