By James Pethokoukis
WASHINGTON, Oct 28 (Reuters) - The Senate will likely vote on a government-run health insurance option that would let individual states 'opt out' from participating. Liberals like this approach because they believe few if any states would actually exit.
Proponents are aware that when Medicaid was introduced in 1965, it also had an opt-out provision. Currently all 50 states are in the program.
At least that's the dream. But in reality the Senate will be unable to pass such a plan without resorting to extreme parliamentary maneuvers.
Centrist Democrats like Joe Lieberman, Ben Nelson and Blanche Lincoln appear unlikely to vote for it, nor moderate Republican Olympia Snowe. The necessary 60 votes don't seem to be materializing.
Yet Majority Leader Harry Reid, facing a close election in Nevada, feels the need to at least have a vote so as not to alienate his Democratic base.
The more likely scenario: Democrats will have to settle for a plan that incorporates a 'trigger' for a public plan in the future based on the state of insurance premium costs. And that probably means no public option any time soon.
An analysis of previous healthcare-related triggers by Timothy Stoltzfus Jost, a law professor at Washington and Lee University, found such mechanisms are 'difficult to implement, too narrow in their focus, and can too easily be reversed if the political landscape changes.'
Political scientist Jacob Hacker of Yale University is more direct, calling triggers 'a backdoor way of killing the public health insurance option.'
And that is a problem if America is going to pursue a government-centered path to healthcare reform that is fiscally sustainable. Other advanced economies have reduced costs while also achieving universal coverage by some combination of heavy price regulation, a reliance on non-profit insurers and complete government takeover.
Currently, the Democratic plan has none of these features. At least with the existence of an operational public option that reimbursed providers at low Medicare rates, one could envision how American healthcare could eventually transition to one that would seem familiar to the average German or Canadian.
Instead, the result could be the all-carrot, no-stick approach of Massachusetts, where healthcare reform expanded coverage without controlling costs.
That approach, while politically easier in the short run, actually creates longer-term political and financial issues, since eventually costs must be contained by rationing care.
-- For previous columns, Reuters customers can click on
(Editing by Martin Langfield) http://blogs.reuters.com/james-pethokoukis/ Keywords: COLUMN HEALTHCARE/ (james.pethokoukis@thomsonreuters.com) COPYRIGHT Copyright Thomson Reuters 2009. All rights reserved. The copying, republication or redistribution of Reuters News Content, including by framing or similar means, is expressly prohibited without the prior written consent of Thomson Reuters.
WASHINGTON, Oct 28 (Reuters) - The Senate will likely vote on a government-run health insurance option that would let individual states 'opt out' from participating. Liberals like this approach because they believe few if any states would actually exit.
Proponents are aware that when Medicaid was introduced in 1965, it also had an opt-out provision. Currently all 50 states are in the program.
At least that's the dream. But in reality the Senate will be unable to pass such a plan without resorting to extreme parliamentary maneuvers.
Centrist Democrats like Joe Lieberman, Ben Nelson and Blanche Lincoln appear unlikely to vote for it, nor moderate Republican Olympia Snowe. The necessary 60 votes don't seem to be materializing.
Yet Majority Leader Harry Reid, facing a close election in Nevada, feels the need to at least have a vote so as not to alienate his Democratic base.
The more likely scenario: Democrats will have to settle for a plan that incorporates a 'trigger' for a public plan in the future based on the state of insurance premium costs. And that probably means no public option any time soon.
An analysis of previous healthcare-related triggers by Timothy Stoltzfus Jost, a law professor at Washington and Lee University, found such mechanisms are 'difficult to implement, too narrow in their focus, and can too easily be reversed if the political landscape changes.'
Political scientist Jacob Hacker of Yale University is more direct, calling triggers 'a backdoor way of killing the public health insurance option.'
And that is a problem if America is going to pursue a government-centered path to healthcare reform that is fiscally sustainable. Other advanced economies have reduced costs while also achieving universal coverage by some combination of heavy price regulation, a reliance on non-profit insurers and complete government takeover.
Currently, the Democratic plan has none of these features. At least with the existence of an operational public option that reimbursed providers at low Medicare rates, one could envision how American healthcare could eventually transition to one that would seem familiar to the average German or Canadian.
Instead, the result could be the all-carrot, no-stick approach of Massachusetts, where healthcare reform expanded coverage without controlling costs.
That approach, while politically easier in the short run, actually creates longer-term political and financial issues, since eventually costs must be contained by rationing care.
-- For previous columns, Reuters customers can click on
(Editing by Martin Langfield) http://blogs.reuters.com/james-pethokoukis/ Keywords: COLUMN HEALTHCARE/ (james.pethokoukis@thomsonreuters.com) COPYRIGHT Copyright Thomson Reuters 2009. All rights reserved. The copying, republication or redistribution of Reuters News Content, including by framing or similar means, is expressly prohibited without the prior written consent of Thomson Reuters.
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