Monday, August 17, 2009

Public Option: the White House's Ping-Pong Ball

Depending on who you listened to on Sunday, you might've gotten the impression that President Obama was willing to forgo the public option as part of his health care reform package.

... Or not. Who really knows?

It actually started on Saturday, when Obama was speaking at a town hall meeting in Grand Junction, Colo. He told the crowd, "All I'm saying is, though, that the public option, whether we have it or we don't have it, is not the entirety of health care reform. This is just one sliver of it, one aspect of it."

Not a condemnation, but not exactly a ringing endorsement, either.

Then on Sunday, the firestorm of confusion began when Health and Human Services Secretary Kathleen Sebelius -- who would presumably be responsible for the implementation of the public option -- told CNN's John King that the public option was "not the essential part" of Obama's reform plan. She also said the White House would be open to health insurance co-ops as an alternative ... even though that does little in terms of keeping costs down and insurance companies honest.

Meanwhile, on CBS' Face the Nation, White House press secretary Robert Gibbs reiterated the President's support for the plan, hammering home the idea of creating competition among the insurance companies and offering potential consumers choice. Under the current system, some people who live in certain areas of the country and don't get coverage through their employer might only have one choice in terms of coverage.

Kinda hard to compete when you're the only team on the field.

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Fast-forward to Sunday afternoon, when Linda Douglass, communications director for the White House Office of Health Care Reform, sent an email to Politico that read, in part, "Nothing has changed. The President has always said that what is essential is that health insurance reform must lower costs, ensure that there are affordable options for all Americans and it must increase choice and competition in the health insurance market. He believes the public option is the best way to achieve those goals."

Sunday night, an unnamed administration official told The Atlantic that Sebelius "misspoke" regarding the public option. Another one quoted in that same story said Sebelius didn't misspeak, but that the media misplayed the quote.

Anyone confused yet?

This isn't the first time the Obama administration has lost control of the health care message; in June, Rahm Emanuel hinted that the White House might be willing to forgo the public option, which left the White House scrambling to prove otherwise. And we all know about Vice President Joe Biden's habit of running off at the mouth.

Say what you want about the Bush administration -- and there is plenty to say -- but this sort of thing never happened to them. If the administration wanted something done, it gathered up everyone within the party and hammered it home. There were no conflicting messages from within the White House, and Republicans within both houses of Congress didn't argue over what to do about the bill -- they just drafted it and passed it.

The Democrats? Not so much.

While Obama isn't wrong when he says the public option isn't the entirety of reform, I happen to agree with Howard Dean when he said it's likely impossible to do true health care reform without a public option. To Dean, the public option is the entirety, because there's really no way to keep costs down among the insurance company without the public option to keep them honest.

Sure, the President can make it illegal for insurance companies to rescind policies and deny coverage based on pre-existing conditions -- and while those are good things and worth adding to the bill, without the public option there's really no way to keep down costs. Without the public option, insurance companies could accept people with pre-existing conditions, but they could also charge higher premiums. Without the public option, insurance companies wouldn't drop breast cancer patients, but they could theoretically raise that person's premiums.

Unless the administration figures out a way to intensely regulate these companies -- and considering how many of them are funneling money to the White House and members of Congress, that's doubtful -- there can be no cost-cutting and true consumer choice without the public option.

Maybe Rep. Anthony Weiner (D-N.Y.) put it best on Monday, when he said, "Leaving private insurance companies the job of controlling the costs of health care is like making a pyromaniac the fire chief."

Will there still be a public option if and when health care reform is passed? It remains to be seen, but it seems Obama still supports one. Seem isn't good enough, though; Obama needs to be more forceful in his beliefs. If he wants a public option, he needs to say so in no uncertain terms. The time for compromise and bipartisanship is over; the Republicans have made it clear time and again they want no part of this, so stop coddling them.

Fact is, without the public option, health care reform will amount to nothing more than a bandaid applied to a severed arm. Without that option to keep insurance companies honest and help bring down costs, reform will do little for those already with insurance and even less for the 47 million without.

Taking single-payer off the table was a mistake, and so would removing the public option. Even if the White House doesn't, though, the mistake of perception has already been made. If there's one way in which Obama needs to mirror Bush, it's in the consistency of the message and ensuring everyone within the administration is on the same page.

If Sunday proves nothing else, we now see the Obama White House is sorely lacking cohesion.

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