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House Democrats Renew Push for Public Option in Overhaul

By Jane Norman, CQ HealthBeat Associate Editor

September 15, 2009 -- Democratic supporters of the public option in the health overhaul bill mounted a vigorous defense in the House on Tuesday, summoning a panel of health experts who said it's essential for cutting costs. The friendly witnesses sharply criticized a Senate proposal to instead establish a system of consumer-run co-operatives, as well as any "trigger" mechanism that would delay the public option.

Additional firepower came later in the day from Sen. John D. Rockefeller IV, D-W.V., who told reporters he can't back in its current form a bill under development by the Senate Finance Committee that likely will leave out a public option in order to draw more votes from moderate Democrats and Republicans. Rockefeller, a member of the committee who's not been involved in bipartisan negotiations, vowed "many, many, many amendments" to the bill when it is taken up by the full committee.

He said he has sat alongside Chairman Max Baucus for 22 years on the Finance panel but "I can't agree with him on this bill." Rockefeller also cited the bill's possible shift of low-income children into private health insurance plans, and a possible tax on insurance companies that he said would rebound on West Virginia coal miners who receive generous health benefits due to the dangerous nature of their work.

The three-hour meeting of the House Democratic Steering and Policy Committee, which drew House Speaker Nancy Pelosi as well as leaders of the three committees that have approved versions of the House bill (HR 3200), came as the Finance Committee neared the end of months of talks. The release of a draft plan by Baucus, D-Mont., could come as soon as Wednesday, with markup sometime next week.

Jacob Hacker, a Yale University professor who developed the concept of the public option, said a government-sponsored plan will have a "superior ability" to control costs within the health exchange system, while maintaining broad access for people who need health insurance. He told members of the Democratic panel that it would be a "great mistake" to opt instead for some kind of "trigger" mechanism that would institute a public plan if private insurers don't live up to specified benchmarks.

"For most who support it, a trigger is just a way of saying "no" to a public plan choice," said Hacker, and a way to "gain political cover." Co-ops, he said, "are not a serious means of achieving any of the public plan goals."

House members erupted in applause when Hacker finished speaking.

But there were also expressions of dismay and amazement from lawmakers about the heated opposition that the overhaul debate has generated in town hall meetings and elsewhere, including from seniors, veterans and others who take part in government-financed programs.

Rep. David Obey, D-Wis., asked Hacker and the other panelists to "amuse me" and inquired, "Is Medicare a public program?" He then asked the same about Medicaid and veterans' and children's health care and received answers of "yes" to all.

"Could you explain to me why there are so many people who are on those programs who seem to be highly concerned about the dangers of government programs?" asked Obey. "Could it be they have been misled by special interests with a lot of money?"

Hacker said many people are happy with Medicare yet still "may not fully believe the government can do things right, but it can."

Asked Ways and Means Committee Chairman Charles B. Rangel: "What can you do to overcome the fears, the unfounded fears, that people have on this issue?"

Karen Davis, president of the Commonwealth Fund, said that "change is always threatening," and lawmakers need to drive home the message that health costs can't continue on their current trajectory. Davis said health care consumes 17 percent of the nation's economy, up to 21 percent by 2020, and contributes to stagnating or declining incomes for workers and their families.

"We have 72 million people that can't pay their medical bills," she said "I think you have to educate the public, educate each other about where we're going."

Rangel, a New York Democrat, said protestors have "no idea of the extreme costs of doing nothing—that just doesn't make sense." There is an "emotional feeling out there that defies common sense," he said.

"Unless we get a handle on it," said Rangel, "I don't see how we can move further."

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