The phrase "public option" has become toxic. Obama could say he wants all the components of a P.O.

[jenmito]

but not use those words. It seems that's what he's BEEN doing, but was criticized for not saying he WANTS a public option. Listen to what he DOES say-sounds an awful lot like he wants a public option without using that term.

[Davis_X_Machina]

1. If he asks for it...

...the Blue Dogs and Senate Dinos dig in their heels.

If he doesn't ask for it, the House Progressive Caucus digs in its heels.

If he asks for it, and doesn't get it, he's been defeated, which is bad enough, but of necessity defeated by members of his own party.

I'd tap-dance around the topic like mad if I were in his shoes.

[jenmito]

4. I agree...

but if he asks for it without using the PHRASE "public option," that could give the Blue Dogs and DINOS cover to vote for it.

[DrToast]

2. I don't agree. The public option is only toxic to those who believe Obama was born in Kenya

The public option is still one of the most popular aspects of reform.

[jenmito]

3. It's also toxic to the blue dogs. Theyre chickening out even though the P.O. IS popular. A little

re-branding, or just not using that term, wouldn't change the fact that it still is what it is.

[DrToast]

11. It's toxic to them because they're protecting insurance companies

I'm not sure changing the name is going to satisfy them.

[sui generis]

5. BAD LEADERSHIP

why is he so bad at this?

Obama, lead goddammit, or get out of the way. Own it, own the term, demand it. Quit pussying around with nuance which you're really bad at anyway, and get to the core of the health care debate.

Start with the vision of the outcome and the pain points it addresses. Describe where we are today. Lay out a strategy for getting from here to there. Restate the outcome of the pain points if no action is taken. Then pick up the plan, start at the beginning, proceed through the middle, and when you come to the end, then stop.

[jenmito]

7. He's going to start leading NOW. He wanted congress to take the lead to

form a bill (to do the opposite of the Clintons who failed at this). But now that it's crunch time, he's going to step up and take control. Why does he have to use the term if he describes what he must have in the bill and it's all the components of a public option?

[sui generis]

14. because he started using it. The absence will be perceived as

"hiding something", or at least used that way by detractors.

Obama cannot be successful if he tries to make everyone happy. The people who need this are the people he needs to make happy, not people who already have health coverage and access to healthcare.

Once he clarifies that, what he needs to avoid is backing down. If Kennedy was the lion in the senate, Obama needs to be the lionking in the executive office.

That means pointedly NOT considering input from anyone who stands to profit from some nuance in his strategy. I think we need this paid as a TAX, or opted out if you have insurance by selecting an extra deduction. If you forget to opt out, you can leverage your annual premiums against the withholding so that it is not a tax on anyone who has private insurance, if they so choose.

The taxable amount is therefore not a "premium" and is not subject to risk pool pricing. If services are used without paying or having private insurance, the entire cost of services is applied directly to your federal tax burden and subject to collection through federal paycheck lien.

We WILL take in more money on the public option than will actually be used the first year, that way. It will force private insurers to compete on premiums with a public option uniform income-scaled paycheck withholding.

Secondly, Obama MUST allow the OMB to negotiate formulary and costs.

On to "managing healthcare costs":

We should guaranty liability insurance for doctors who have a predominantly public-option clientele. We should be willing to forgive guaranteed medical school student loan debt if a doctor goes into primary care and contractually establishes and maintains a predominantly public-option practice for 7 years. (or some number).

We do collective bargaining agreements on clinical supplies and lab work costs. We make medical school accessible to more future doctors. We encourage nurses and PA's to "finish" as MDs, even years into their careers. We use peer review to address costly lab-padding protocols - finding continued billing for unjustified lab procedures to have costs re-assigned to the ordering physician. Peer review makes this fair - and we create those peer reviews the same way we empower jury duty; it's required.

This is what he needs to innovate with.

[liberalpragmatist]

13. Well, Clinton presented a plan

And it got torn apart, so the advice Obama has gotten is to let Congress take the lead.

It may prove to be a mistake, but it's not crazy.

[valerief]

6. Most of America WANTS a public option. Teevee only shows the insurance company marionettes. nt

[jenmito]

8. I know. So Obama gives it to them. But since apparently, 60% of Americans don't understand

what HCR entails, why shouldn't Obama make clear what he wants it to include if it includes all the components of a public option?

[valerief]

10. I thought he was waiting for Congress to give him a bill first. nt

[jenmito]

12. He waited for Congress to draft a bill. They've come up with 3 or 4. Now he will see

what Congress has the votes for or is close to having the votes for. He did the opposite of what the Clintons did.

[kjackson227]

9. I think he alluded to this in one of his town halls...

[flpoljunkie]

15. A national Health Insurance Exchange with at least 20 million participants could 'bend cost curve'

and be a vehicle to insure the tens of millions who have no insurance.

Ezra Klein has written that Obama would need to get major concessions in order to drop the public option--including more money for subsidies and a much stronger health insurance exchange--but that the public option should only be dropped--if it is truly needed to 'secure passage of the final bill.'

If the public option needs to be dropped to secure passage of the final bill, then that may be the unfortunate reality of the situation. But that's the context in which you drop something like the public option: A context in which you get something significant for the concession, like passage of everything else, or much more money in subsidies and much stronger exchanges. You don't drop it in the hopes that the compromise will be seen by opponents as reasonableness rather than weakness. The public option is good policy and, if it comes down to it, the largest bargaining chip. You don't give it away lightly. But you do have to keep it in perspective.

http://voices.washingtonpost.com/ezra-klein/2009/08/against_giving_up_on_the_publi.html

Klein's column about Health Insurance Exchanges: http://www.washingtonpost.com/wp-dyn/content/article/2009/07/28/AR2009072802114.html?hpid=opinionsbox1

And, this from Klein on the public option...

The public option is one of them, to be sure, and I think there's a substantial chance it will be present in the final legislation. But what about the expansion of Medicaid to 133 percent of the poverty line? That's a solid 20 million poor Americans who don't have coverage now, and will soon. What about the out-of-pocket caps, so no one goes medically bankrupt ever again? Or the assurance that no insurer can ever discriminate based on a preexisting condition? Or the subsidies for working Americans who can't quite afford coverage? Or the requirements that insurers spend more money on medical care and less money on premiums? Or the guarantee that the gruesome practice of rescission will finally end?

http://voices.washingtonpost.com/ezra-klein/2009/08/be_excited.html

I would wholeheartedly agree on the regulation of the 'medical loss ratio'--the percentage of premiums spent on paying claims. It is about 80 cents today--compared to the early 90's figure of 94 cents paid out in claims (Wendell Potter gave these figures when he appeared on Bill Moyers several weeks ago).

That said, I have no doubt most Republicans would not support a 'national' Health Insurance Exchange. Of course, we do not need all their votes.

[nc4bo]

16. Whatever he calls(or doesn't call it) it, the components better be there....

sooooo much is riding on true health care reform, the most important being the health of millions of people.

President Obama, just do it for Christ's sake. Just get it done.

[RememberWellstone]

17. Call it Kennedy's fantastic time machine

Or how about Sweet candy coated care?

This is getting silly to watch.:eyes:

[Better BeLIEve Bull]

18. when he signs it into law, it will be called the Public option