In the Washington Post today, Ezra Klein wonders if the existence of a public plan alone is the right benchmark to measure health care success.
Discusses the five most important aspects of the debate that aren't related to the public plan, Erza leads with the Health Insurance Exchange:
1) The Health Insurance Exchange: I know. I'm a broken record on this point. But if the fundamental fact driving health-care reform is that our system is broken, then the central question is whether we're building something to replace it. If the Health Insurance Exchange is strong enough, it can serve as that something. If it is weak, and it is limited to the unemployed and the self-employed and small businesses, then it isn't likely to emerge as a viable alternative. And if you're still not convinced that you should care about the Exchange, then consider this: The Exchange is the body that offers the public plan. You could have the strongest public plan in the world, but if the Exchange is only open to 20 percent of the country, then only 20 percent of the country will be able to purchase public insurance coverage.
Read Ezra's take on the key issues that "deserve a lot more attention than they're getting" -- Medicaid, subsidies, minimum benefits, and choice -- here.
The debate closer to home has, of course, largely been dominated by the public option and the senator at the center of national health reform, Ron Wyden. Last week saw President Obama praise Wyden's leadership and approach, while taking issue with parts of Wyden's plan. From the Oregonian:
President Barack Obama praised Oregon Sen. Ron Wyden on Wednesday as a "real thought leader" and ally on health care reform but said he could not support Wyden's controversial plan for providing medical insurance to virtually every American.
"There are a lot of good concepts to what Ron's proposing," Obama said. But despite his professed agreement with "90 percent" of Wyden's thinking, he said parts of the plan are too "radical" for the country.
Wyden has worked on health issues for years and has developed a plan, the Healthy Americans Act, that the Congressional Budget Office has said would be "revenue neutral." While Wyden has support from Democrats and Republicans, his support from Democratic leadership has been lukewarm.
Under Wyden's plan, workers would be responsible for choosing their health insurance. In return, employers would give workers a raise equivalent to the cost of the health care that was previously offered. That pay would be taxable, but Wyden stresses that new federal tax deductions would shield all but the highest earners from additional taxes.
Wyden argues that linking health care costs to individuals will promote competition and drive down costs.
Responding in Willamette Week, Wyden had this to say:
“Whenever the president of the United States says he agrees with 90 percent of what you’re doing, I say with a smile, ‘Mr. President, that sounds pretty good. Let’s go get the other 10 percent,”‘ said Wyden, a former colleague in the Senate with Obama.
Following the Obama interview, an Oregonian editorial praised Wyden's transparency on financing reform:
In all of the national debate, Wyden's bill is the only proposal that has an actual financing plan. When Obama gets around to announcing his own financing plan, it too will be labeled "radical" by those favoring other ideas.
It's true, of course, that Wyden's plan sounds radical. It calls for a fundamental shift in the way employers support health coverage for workers.
Under the Healthy Americans Act, employees would be responsible for selecting the health insurance that best meets their needs. For example, older workers would not need a plan that provides obstetrical services and could buy a more tailored plan.
Happily, Obama said he agrees with 90 percent of Wyden's thinking, such as the idea that health insurance must be portable between jobs. That's good to hear, because no matter what you think of Wyden's plan, he at least understands that the real question isn't so much who pays for health coverage but how it's paid for.
For Obama, it's too easy to dismiss Wyden's financing plan as radical. The president will find it much harder to unveil a plan of his own that doesn't sound equally radical.
Soon, however, he'll have to show his hand. We hope he will be as forthright about its financing mechanism as Oregon's senior senator has been in promoting his own plan, radical or otherwise.