President Obama: “I strongly believe that Americans should have the choice of a public health insurance option”

In a letter to Senators Ted Kennedy and Max Baucus that the White House just released this afternoon, President Obama spelled out his vision for health care reform, making it clear that he wants a public sector alternative to private insurance: “operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.”  (Hat Tip to Jonathan Cohn, over at The Treatment  for calling attention to this letter.

So much for speculation that the administration would back down on this issue.

The President also is “putting another $200 to $300 billion on the table,” Cohn notes, “proposing to extract that money from savings in Medicare and Medicaid.” He pairs the offer with a proposal he talked about yesterday that would give the Medicare Payment Advisory Commission (MedPac) the power to implement its recommendations for Medicare reform. (MedPac is an independent panel that advises Congress on Medicare Spending and under legislation sponsored by Senator Jay Rockefeller, MedPac would have authority to set fee schedules for both hospitals and doctors.)

I have written extensively about MedPac’s recommendations on HealthBeat and I’m now writing a post fleshing our precisely how MedPac would squeeze waste out of Medicare spending, while lifting the quality of care.  ) 

In his letter, the President also stressed that “reform cannot mean focusing on expanded coverage alone. Indeed, without a serious, sustained effort to reduce the growth rate of health care costs, affordable health care coverage will remain out of reach.  So we must attack the root causes of the inflation in health care.”  He then points to the large multi-specialty medical centers, where doctors work on salary, that HealthBeat has pointed to as models for learning how to provide more effective care at a lower cost: “ That means promoting the best practices, not simply the most expensive. We should ask why places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio, and other institutions can offer the highest quality care at costs well below the national norm. We need to learn from their successes and replicate those best practices across our country. That's how we can achieve reform that preserves and strengthens what's best about our health care system, while fixing what is broken.”

I’ll post more about the role MedPac would play in reform later this evening.

8 thoughts on “President Obama: “I strongly believe that Americans should have the choice of a public health insurance option”

  1. As Pacino might say, “HOO-Waaaah!!”
    This is great news. After witnessing the casual manner by which the president tossed a few other things into the pile, then pulled back and let Washington politics have its way, I was afraid he might do the same with health care reform. Maybe not.
    When I studied the actual proposals in the pipeline at the Kaiser comparison site I came away with the impression that the insurance industry had everyone in Washington by the family jewels. Proposals to “insure” every citizen, no matter how poor or currently ineligible, with tax money underwriting the whole enterprise, has the insurance companies salivating. Why should they care who they insure as long as Uncle Sugar picks up the tab? Actuarial tables don’t lie, and the more public they are the better insurance companies look. (“Hey, all we’re doing is figuring out a financially reasonable way to cover everybody. We don’t make the charges. All we do is manage this grand new risk pool. Don’t pick on US!”)
    I imagine a well-run, cost effective public plan, operated out of community clinics, VA hospitals and military dispensaries with paid professionals (yes, even PCP’s and specialists). Such a system could still outsource lab tests, imaging, even CT’s, and still deliver top-quality health care at a fraction of the costs of the current health care land yacht version of a gas hog.
    The professionals would be in the loop for any new best practices as they develop and the drug companies could be brought to heel at the same time.
    Compared to most community health care non-systems, the VA and military systems are models of fiscal excellence. It’s been forty-five years since I was drafted to become an x-ray tech in the Army Medical Service Corps and I saw how that worked from the inside. I’m sure today’s system is radically different and far better, but the basic idea was excellent: professionals were paid according to grade (officer ranks) but that was only the base. Added to that might be “professional” pay + “overseas duty” pay + “hazardous duty” pay + whatever it might take to recruit and retain needed services. No, it wasn’t fee for service because that doesn’t make any sense when patients have no means or “private insurance” for fees.
    This is all a flight of fancy on my part. I expect nothing of the sort will come to pass, but I had to get it out of my system. It comes from seeing too many Michael Moore films. Now back to your regular scheduled programs.

  2. Damn.
    Human spam-bots already.
    Awkward syntax.
    Business must be off in call centers where English is not the mother tongue.

  3. I agree that “we must attack the root causes of inflation in health care” as you quote President Obama. To me, the root cause is the fact that more people are ill each year with life-long diseases; even children now have TypeII Diabetes which used to be an illness only with adults. Keeping people in good health starts with individuals. The health care system definitely needs health care professionals; and it needs informed individuals even more.
    A book I have recently written may help in this direction and I want to draw it to your attention, as you may be interested in it. The title is “Soul Talk With Cells: What We Really Want Is To Play” and information is available at If you have any questions, I am most willing to offer my views on this topic.
    Flora Sue Gardner

  4. Hootsbuddy–
    I am as thrilled as you are.
    Obama is good at standing back, keeping quiet, and letting people flail about.
    Then, in a quite, calm voice he says: “I feel strongly about the public sector option.”
    What he is thinking is this: “We won.” We don’t have to compromise on something I feel strongly about.
    He is not going to buckle to please lobbyists.
    And I don’t think that he will let Congress water down the public option so that it isn’t “too competitive.”

    Who’s going to keep the GOVERNMENT honest?
    Oh. Blag-o never happened? A figment of the media’s imagination?
    What a sick joke — more government bureaucrats who can’t be held accountable.

  6. The President’s direct engagement on health care reform now is imperative. This president was elected on and,I believe, is still committed to a change agenda.
    US Health Care is terribly broken and unsustainable. Besides its moral failures of not providing some coverage to all US citizens, not reforming it now threatens our entire US economy. Tinkering with this very broken system is not enough and Obama and his team know that.We need the level of bold change in health care as we are applying to energy policy and to the environment. Nothing less will carry the day.
    Join our president over the next several weeks and months as he puts forth more details. Congress alone regrettably will not do the job it should on this issue.
    So this popular President and the people who elected him must.
    Dr. Rick Lippin