The Health Care Cave-In
May 18, 2009, 10:15AM

"Don't make the perfect the enemy of the better" is a favorite slogan in Washington because compromise is necessary to get anything done. But the way things are going with health care, a better admonition would be: "Don't give away the store."

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On the campaign trail, Barack Obama pushed a compromise -- a universal health plan that would include a "public insurance option" resembling Medicare, which individual members of the public and their families could choose if they wished. This Medicare-like option would at least be able to negotiate low rates and impose some discipline on private insurers.

But now the Medicare-like option is being taken off the table. Insurance and drug companies have thrown their weight around the Senate. And, sadly, the White House -- eager to get a bill enacted in 2009 rather than risk it during the mid-term election year of 2010 -- is signaling it's open to other approaches. What other approaches? One would create a public insurance plan run by multiple regional third-party administrators. In other words, the putative "public plan" would be broken into little pieces, none of which could exert much bargaining leverage on Big Pharma and Big Insurance. These pieces would also be so decentralized that the drug companies and private insurers could easily bully (or bribe) regional third-party administrators.

Another approach now being considered in the Senate would have states create their own insurance plans. That's even worse: Big Pharma and Big Insurance are used to buying off state legislators and officials. They'd just continue their current practices.

A third option is to create a public plan that pays for itself and, according to the office of Senator Charles Schumer, who came up with it, "adheres to private-insurance rules." But adhering to private insurance rules is exactly what the public plan is not supposed to do. How can it possibly discipline private insurers and get good deals from drug companies and medical providers if it adheres to the same rules that private insurers have wangled?
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