Carper Pushes Public Option Opt-in, Lieberman Open to State-Based Public Plans

Politico is reporting that Thomas Carper (D-DE) is working on an alternative to the public option opt-out, which would be the public option opt-in. This is would a “national” public option where states must pass a law to join. Joe Lieberman (I-CT) told the AP he was against any federal public option, but might open to the possibility plans set up and run by the states.

As I wrote earlier today, the public option opt-in is a federal public option that would likely be denied in a majority of states. I suspect, at least for the first several years, only a dozen or so of the bluest states would opt-in. The much smaller customer base should seriously limit the ability of the public option to drive down premiums. A public option opt-in would likely produce a technically viable insurance entity, but one with almost no real impact on our health care system, and one only available to few individuals in a handful of states.

As weak and worthless as the public option opt-in idea is, the state-based public plan idea is an even bigger joke. As Sen. Jeff Bingaman (D-NM) pointed out states currently have the power to set up public plans right now. There is nothing legally stopping them. Saying you want to “allow” states to set up state-based public plans is the equivalent to saying you want to do nothing at all. The other big problem with this idea is that the public plans would likely only be available to the roughly 10% of people using the exchanges. Most states have a populations below 3 million and therefore would be unlikely to create state-based public plans with sufficient costumer bases to be truly viable.

Carper's national public option opt-in is a nearly useless “compromise.” While Lieberman's state-based public plans is a complete joke and by definition can't even be called a "compromise" because it is the status quo. If someone tells you they believe state-based public plans are a “compromise,” they are either ignorant, a liar, or likely both.

Carper Public Defends Secret PhRMA Deal In Exchange For Support Ads

In a stunning moment during the Senate Finance Committee markup Sen. Tom Carper defended a secret deal that the White House, Baucus, and PhRMA had reached. The White House has long denied the deal. Carper publicly acknowledges that part of the deal was that PhRMA would run millions of dollars worth of campaign ads in support of health care reform.

According to Carper the “golden rule” in Congress is that secret back room deals in exchange for advertising buys must be honored. Carper's statement below,

I was not involved in negotiations with PhRMA but I believe that the administration was, obviously PhRMA was, and I presume this committee was involved in some way in those negotiations.

And what PhRMA agreed to do through those negotiations is to pay about
80 billion dollars over 10 years to help fill up half the donut hole. That's my understanding. And they are prepared to go forward and to honor that commitment. As I understand it, the commitment from our colleague Senator Nelson would basically double what was negotiated with PhRMA.

And whether you like PhRMA or not -- remember I talked earlier today in our opening statements, I talked about four core values, and one of those is the golden rule, treat other people the way I want to be treated?

I'll tell you -- if someone negotiated a deal with me and I agreed to put up say, 80 dollars or 80 million dollars or 80 billion dollars and then you came back and said to me a couple of weeks later -- no no, I know you agreed to do 80 billion and I know you were willing to help support through an advertising campaign this particular -- not even this particular bill, just the idea of generic health care reform? No, we're going to double -- we're going to double what you agreed in those negotiations to do. That's not the way -- that's not what I consider treating people the way I'd want to be treated.

That just doesn't seem right to me.

Carper was speaking in opposition to an amendment from Sen. Bill Nelson and Sen. Jay Rockefeller. The amendment mirrors what Henry Waxman did in the House to close the Medicare Part D doughnut hole by requiring drug manufactures to provide rebates for the overcharging of dual eligible Medicare/Medicaid recipients. Recently a group of House Democratic freshmen sent a letter to Waxman to asking him a rewrite the bill to reflect the Medicare Part D language in the Baucus bill.

PhRMA's board approved the $80 billion in price reductions on June 19. On June 30, the Hill reported that PhRMA began running ads in the districts of vulnerable Democratic House freshmen.

Senator Carper Supports Trigger - Updated

Today on MSNBC, Senator Carper (D-DE) said that he does not want their to be a national public option available on day one. He said, he along with Senator Snowe (R-ME) supports a “trigger” mechanism. The American people will only get to choose a public option years from now if the insurance companies continue to fail. He said it should be like the “trigger” in Medicare part D.

It should be noted that criteria for “triggering” a public plan in Medicare part D is insurmountably high and useless. It deals only with the number of plans offered and not price or quality. It has yet to be triggered.