A Health Care Post With A Bunch Of Pretty Pictures Of Presidents Past Preaching To Politicians Past (Say That Three Times Fast)

So what is Barack Obama going to say tonight? Will there be a public option or no?

Jonathan Weiseman and Janet Adamy in WSJ:

President Barack Obama, in a high-stakes speech Wednesday to Congress and the nation, will press for a government-run insurance option in a proposed overhaul of the U.S. health-care system that has divided lawmakers and voters for months.

White House officials say the president will detail what he wants in the health-care overhaul, as well as say he is open to better ideas on a government plan if lawmakers have them.

Democratic plans call for requiring most Americans to carry health insurance. Failure to comply could cost families as much as $3,800 a year, according to a new Senate proposal.

The president is likely to say that a government-run insurance plan, known as the “public option,” will not provide a level of subsidies that give it an unfair advantage over private insurers, according to aides familiar with the speech preparations.

Matthew Yglesias:

Something I’m not entirely certain public option supporters really understand this, but the President’s not lying when he offers those reassurances to the insurance industry. As I’m watching Senator Ron Wyden explain on television right now, under the House and HELP bills something like 80 to 90 percent of the population wouldn’t actually have the option of enrolling in the public option. And of the minority of people who could enroll in the public option, most won’t, since the public option has been crafted specifically so as to avoid giving it an “unfair” advantage over private health insurance.

Jennifer Rubin at Commentary:

Now perhaps the report has it wrong, and Obama is going to avoid appearing utterly out of touch with the groundswell of opposition to a government takeover of health care. Maybe he’ll not embrace the Left but instead show a hint of recognition that he understands the concerns — and yes, fears — of average Americans who don’t really want the health-care system ripped up by the roots. But then again, Obama is a very arrogant man, convinced that he knows best and that, through the sheer brilliance of his words, can turn public opinion around. So a very arrogant speech may be just what he has in mind.

Carol Platt Liebau in Townhall:

Unfortunately for the President, the government option is nothing but trouble for him.  Republicans say they won’t support a bill with one, liberals say they won’t support a bill without one.  By invoking it tonight, he’ll lose his best opportunity truly to hit the “reset” button in the healthcare debate as far as the GOP goes; by signalling his willingness to bargain it away, he’ll lose the good will of his far-left base (which will no doubt go along with whatever he wants anyway).

Tonight, expect to hear plenty of sad stories about people who are being treated “unfairly” by the current system.  Get ready for the righteous denunciations of “insurance companies.”  And then remember:

More than 80% of Americans are satisfied with both their health care and their health insurance.

However, Mike Allen in Politico:

President Barack Obama plans to give a strong endorsement of a public option – or government health-insurance plan – in his remarks to Congress on Wednesday night but will stop short of an ultimatum, leaving wiggle room for negotiation as the bill moves through Congress, according to sources familiar with his remarks.

Rubin again:

Now we hear that in his great moment of presidential leadership, when he is to tell people where he really stands on health care, Obama is going to hedge on the public option.

Karl at Hot Air:

Obama will endorse a government-run insurance plan (as usual), but will not demand one (as usual). Off the record, the White House admits the “public option” is off the table, as House Maj. Ldr. Steny Hoyer and Maj. Whip Jim Clyburn start tiptoeing for the exit. The leaders of the progressive caucus’s reputation continue to demand a “robust” government plan, but the rank and file aren’t necessarily following. In the Senate, even Olympia Snowe seems to be drifting away from the project. Obama may offer a few more details in his speech, but has put off offering his own draft legislation (most likely to extend the news cycle). The legislative process has been headed toward health insurance reforms and an individual mandate for a while, which is why progressives have been preparing to be disappointed with this speech since last week. The Right has little motivation to watch, beyond the prospect of playing Obama Health-Care Speech Bingo.

Mark Impomeni at Redstate:

Mark it down.  President Obama’s “make or break” speech, as the media is portraying it, will be widely viewed as a success among the chattering class.  It will be groundbreaking, visionary, full of clarity, and a “game changer,” as CNN has already labeled it.

But sit tight, that’s just for a while.  Patrick Rufini had it right on Twitter last night.

Tmrw’s speech will be widely praised for resetting the debate on #hcr. And then everything will go back to exactly how it was within 96 hrs

Exactly.  What Patrick realizes, that the MSM does not, is that short term gain is all the president’s speech is intended to do.  If the speech was to be anything like what the media is previewing, the White House would not be making it known that Obama does not plan to offer any real specifics, and plans to be “non-committal” on the central question of the whole debate, the so-called “public option.”

But does the public option really matter?

Ezra Klein:

The end result is that the public plan is unlikely to have a very large customer base, which means it will be unable to use market share to bargain prices far lower than private insurers. That might not matter if the plan could attach itself to the rates that Medicare uses. In the first draft of the House bill, the plan could do that, at least for its first three or four years of existence, after which point it was cut loose from Medicare. But the deal Henry Waxman cut with the Blue Dogs erased that advantage, and now the public plan, even in the House bill, is on its own. That is to say, the plan has neither Medicare bargaining power nor the sort of customer base that gave Medicare its bargaining power.

Is that an argument against the public plan? Nope. There are real advantages to the presence of a public alternative. Competition matters, for one thing, and there are a lot of states where one or two private insurers essentially control the market. Experimentation matters, too, and the public plan could be used alongside Medicare to test payment reforms and disease management programs that could pay off in the long run. The public plan could also usher in a fairly radical level of transparency in pricing and behavior, forcing private insurers to follow suit. And lastly, the public plan is something of a corporate accountability measure. Its presence in the market ensures that health-care reform won’t simply be a large reward to the insurance companies absent any serious changes in their behavior.

These were the original arguments for the public plan, and they’re as strong today as they were then. But they are not the same as cost control. Cost control happens when we use less treatment, need less treatment, or pay less for treatment, and the public plans under consideration don’t really do any of those things. In fact, the bills under consideration don’t do any of those things, though I think they’re a useful first step. This step in health-care reform is largely about expanding coverage and creating a structure — with universality and the exchanges and so forth — that will make cost control easier down the road. None of the bills, on their own, really do all that much to control costs.

Joe Klein in Swampland:

Again, there are two reasons why someone–like me, for example–who supports universal health insurance might oppose a public option:

1. that it sets up an unfair competition with private insurers, leading to a government-provided, rather than just a government-funded insurance system. (I don’t think it’s very likely–it’s the domino theory of health care–but I would be opposed to a system where every doctor and nurse was employed by the government. I do favor a single-payer system where the government uses tax credits to give people the money to buy health insurance.)

2. the right-wing smear campaign has succeeded and moderate Democrats, and a few stray Republicans, who might otherwise vote for health care reform won’t do so…perhaps enough to kill legislation that would make health care more available and affordable for Americans, while prohibiting insurance companies from denying you access because of pre-existing conditions or an increased need for care.

Paul Krugman:

Most arguments against the public option are based either on deliberate misrepresentation of what that option would mean, or on remarkably thorough misunderstanding of the concept, which persists to a frustrating degree: I was really surprised to see Joe Klein worrying about the creation of a system in which doctors work directly for the government, British-style, when that has nothing whatsoever to do with the public option as proposed. (Forty years of Medicare haven’t turned the US into that kind of system — why would having a public plan change that?)

But what is one to make of the practical, political argument from the likes of Ezra Klein, who argue that any public plan actually included in legislation probably wouldn’t make that much difference, and that reform is worth having even without such a plan?

There are three reasons to be suspicious of that argument.

The first is that I suspect that Ezra and others understate the extent to which even a public plan with limited bargaining power will help hold down overall costs. Private insurers do pay providers more than Medicare does — but that’s only part of the reason Medicare has lower costs. There’s also the huge overhead of the private insurers, much of which involves marketing and attempts to cherry-pick clients — and even with community rating, some of that will still go on. A public plan would probably be able to attract clients with much less of that.

Second, a public plan would probably provide the only real competition in many markets.

Mark Thompson at The League:

First, in terms of the overhead issue, Krugman is ignoring that any public option is going to wind up investing pretty heavily in advertising itself if it’s going to be successful.  It has to provide the public with information by which it can let the public know that it’s out there and how to sign up, and how it’s so well-worth signing up for, pretty much like the Post Office, Amtrak, and public universities do.  So it’s difficult to see how the public option would meaningfully result in a reduction of marketing overhead costs.  Meanwhile, although I have no illusions about the bureaucracy that is the health insurance industry, it’s difficult to see how the federal government would be significantly less of a bureaucracy.  The only way I can see this happening is if the public option is set up in a way where it will deny fewer claims; the problem with this is that paying more claims has its own costs associated with it.  This makes it highly likely that any reduction in bureacracy (and I’m skeptical that there would be any reduction) would only have the effect of shifting costs, not reducing them.  To be sure, there may be a strong normative argument for such a cost shift, but I don’t see how it would actually reduce costs overall.

On the second issue – competition, the argument appears to miss some realities about the health insurance industry.  Specifically, the health insurance industry’s relative profitability is surprisingly low – only about 2.2%.  So introducing more competition would seem to have an overall price reduction ceiling of only 2.2% unless you really believe that the government can do exactly what existing insurance companies do in a less bureacratic, more streamlined fashion.

What are the odds of health reform?  Jonathan Cohn at TNR and Marc Ambinder say good, or at least it survived August. Ed Morrissey notes public option backtracking. Nate Silver says the public option is likely popular in Blue Dog districts.

And Sarah Palin in WSJ:

Now look at one way Mr. Obama wants to eliminate inefficiency and waste: He’s asked Congress to create an Independent Medicare Advisory Council—an unelected, largely unaccountable group of experts charged with containing Medicare costs. In an interview with the New York Times in April, the president suggested that such a group, working outside of “normal political channels,” should guide decisions regarding that “huge driver of cost . . . the chronically ill and those toward the end of their lives . . . .”

Given such statements, is it any wonder that many of the sick and elderly are concerned that the Democrats’ proposals will ultimately lead to rationing of their health care by—dare I say it—death panels? Establishment voices dismissed that phrase, but it rang true for many Americans. Working through “normal political channels,” they made themselves heard, and as a result Congress will likely reject a wrong-headed proposal to authorize end-of-life counseling in this cost-cutting context. But the fact remains that the Democrats’ proposals would still empower unelected bureaucrats to make decisions affecting life or death health-care matters. Such government overreaching is what we’ve come to expect from this administration.

Speaking of government overreaching, how will the Democrats’ proposals affect the deficit? The CBO estimates that the current House proposal not only won’t reduce the deficit but will actually increase it by $239 billion over 10 years. Only in Washington could a plan that adds hundreds of billions to the deficit be hailed as a cost-cutting measure.

Flopping Aces:

With each article former Gov. Palin is rapidly rebuilding her reputation (which suffered from one of the worst smear campaigns by Democrats in history) for common sense and sound judgement that so many of us recognized from her first introduction onto the national stage at the GOP convention last year.

Whether that means she will have rebuilt her reputation sufficiently to run for president in 2012 remains to be seen. But I look forward to her becoming a growing presence in future policy debates over the coming years. She’s already suffered the worst of what Dems can throw at her and has no place to go but up!

Karen Tumulty at Swampland:

It’s still a lie.

Sarah Palin is back on “death panels” in the Wall Street Journal.

UPDATE: Worth reading her circular logic in this justification for making things up. Apparently, it was okay to spread a falsehood, because people actually believed it: Establishment voices dismissed that phrase, but it rang true for many Americans.

Moe Lane:

Former governor and VP candidate Sarah Palin wrote a pretty good op-ed for the Wall Street Journal on the health care situation – one where she points out, repeatedly, that we’re being asked to blindly fund a government program that will affect every aspect of our life and will not save us money in either the short or long term.  As Ace of Spades notes, this is not going to cover new ground for the people already intimately familiar with the debate – but for those who aren’t, it will give a good idea of conservative objections to Obamacare, not to mention providing the alternatives that the Democrats are pretending that the Republicans aren’t providing.  All in all, useful and timely.

I’m sure there will be more on any one of this topics later.