The Curve Has To Want to Bend: Like Steven Pearlstein , Robert Samuelson more or less assumes the purpose of a "public option" is to control costs (as opposed to providing the security of a guaranteed fall-back plan). In an Un-Samuelsonesque fashion, he also assumes that there is some solution that will control costs in a manner agreeable to patients.
It's not insurers that cause high health costs; they're simply the middlemen. It's the fragmented delivery system and open-ended reimbursement. Would strict regulation of doctors, hospitals and patients under a single-payer system provide control? Or would genuine competition among health plans over price and quality work better?
That's the debate we need, but in truth, doctors, hospitals and patients don't want to be limited, whether by government or markets. Congress reflects public opinion. Fearing a real debate, we fake it.
a) Maybe none of these options--single payer, competition among health plans--will significantly lower costs, and we'll simply have to pay the increasing bill. Just a thought. b) If, as Samuelson says, "doctors, hospitals and patients don't want to be limited," it sounds like the debate over our system of "open-ended reimbursement" isn't a "debate we need." It's a debate we've had. Samuelson's side lost. Nobody wants to bend the curve.
Maybe it won't be bent. 8:38 P.M.
Give Him a Fifth Chance! After completely misreading the zeitgeist and-- in a series of self-servingly ostentatious steps ("storytelling," emo)-- leading his network into a ditch , is CNN's Jon Klein really going to keep his job? He doesn't seem even to be "embattled." ... 8:34 P.M.
The Federalist Capers: A federalism compromise on the "public option" always seemed more promising to me than a "trigger" based compromise. But I'd been viewing the issue through a welfare-reform prism, in which states would either be in or out as discrete statewide units. Josh Marshall points out that the virtue of Harry Reid's plan is it allows states to join a single nationwide federal plan rather than set up their own plans . That lets you create a big--or big enough--pool of insured. It's like letting states opt out of (or in to) Medicare. ... That said, the federalist approach still offers a giant menu of possible compromises, from 1 to 50. You can have opt-out, opt-in, opt-in with a numerical limit, opt-out with incentives not to opt-out, opt-in with incentives to opt-in if regional distribution isn't achieved, even opt-out with a trigger that offers the incentives only if too few states stay "in." ... Update: Sam Stein has more . ...
Note also that the federalist solution means at least one "juice" vote in every state legislature
, as health insurance lobbyists seek to use campaign contributions to
gain access and thereby influence the "opt out" or "opt in" vote. Another source of federalism's appeal! And bipartisan appeal at that. ... 8:34 P.M.