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The Public Option

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by Faiz Shakir, Amanda Terkel, Matt Corley, Benjamin Armbruster, Ali Frick, Ryan Powers, and Ian Millhiser

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Few issues are more pressing to President Obama right now than health care reform. As the New York Times recently reported, Obama has decided to "exert greater control over the health care debate," with an "intense push for legislation" that includes "speeches, town-hall-style meetings and much deeper engagement with lawmakers." Yesterday's speech to the American Medical Association (AMA) was a major part of this effort, since the group recently registered its opposition to the creation of a public insurance plan -- a key plank of Obama's health reform efforts. "The public option is not your enemy, it is your friend," Obama told the nearly 500 attendees at the address. Indeed, as The Wonk Room's Igor Volsky has explained, the public option remains the best way to "restore competition into the consolidated health insurance market, lower health care premiums, lead the way in innovation, and improve health quality." (The Wonk Room has put together a document debunking the top myths about the public option here, and the Center for American Progress Action Fund has a new analysis showing how few health insurance choices most Americans currently have.)

DOCTORS SUPPORT A PUBLIC PLAN: The AMA is opposed to the creation of a public health insurance option, claiming that it "threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans." While the organization has tried to walk back its criticism, it still seems to oppose the essential aims of a public plan: the ability to negotiate cheaper rates with providers and push private insurers to do the same. Obama's speech yesterday before the AMA's House of Delegates -- "the burial ground of health overhaul efforts past" -- was thus widely anticipated. In fact, he is the first president to address the group since Ronald Reagan in 1983. In the speech, Obama stayed firm in his commitment to a robust public option. "Insurance companies have expressed support for the idea of covering the uninsured -- and I welcome their willingness to engage constructively in the reform debate. I'm glad they're at the table," Obama said. "But what I refuse to do is simply create a system where insurance companies suddenly have a whole bunch more customers on Uncle Sam's dime but still fail to meet their responsibilities." Not all doctors are on the AMA's side. Although the group still calls itself the "house of medicine," only about half its members are actually practicing physicians and the group "represents maybe 20% of physicians in this country." Indeed, doctors nationwide have begun to distance themselves from the AMA. Doctors For America -- a grassroots organization representing doctors in all fifty states -- recently issued a statement and hosted a conference call in support of a robust public option.

THE GHOSTS OF 1993: Part of the drive behind Obama's recent "push" on health care legislation, according to the New York Times, is the memory of President Clinton's failure to pass reform. Yesterday, The Progress Report joined other progressive bloggers for a small meeting with Clinton at his office in Harlem. He said that Obama has a far better chance of passing health care legislation than he himself did in 1993, when Clinton faced a hostile political environment and severe budget constraints. "I had just passed a budget in which we raised taxes on the wealthy, cut taxes on the working poor, and were on track to reducing the deficit, and...we couldn't raise taxes again," explained Clinton. "So when I had an employer-mandate that in effect, guaranteed that the health insurance companies would be joined by the small business community -- at least the organized small business community -- which made it harder to pass." Clinton said that he believes Obama will work with the Senate to achieve the 60 votes needed to break a filibuster. But he urged Obama to be ready to use the budget reconciliation process if necessary -- which would require just 51 votes to pass health care -- to achieve a bill that would ensure universal coverage, cut costs, improve the delivery system, and boost preventive care. "If he can't get a good bill, I wouldn't give away the store on that," he said.

CO-OPTING THE DEBATE:
Although the AMA opposes the robust public option that Obama is proposing, it has said that it is "willing to consider other variations of the public plan that are currently under discussion in Congress." One of the alternatives that has received the most attention is Sen. Kent Conrad's (D-ND) idea of consumer-owned health cooperatives that would "be subject to the same standards [as private plans]." But co-opts, however defined, are not a substitute for a public plan with the capacity to "improve health quality by championing payment innovations or other delivery system reforms." As Volsky writes, "After all, one of the advantages of a truly national public plan is its ability to improve care quality by spearheading reforms and innovations."