In the Arena

Senate Health Care Vote

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There are a couple of aspects of this historic vote that deserve notice here:

1. My favorite provision requires that all members of Congress give up their federally-funded health care benefits and join the health care exchanges that will be set up by this bill. This is brilliant politics, addressing the tide of populist anger and fears of incipient socialism. But it also makes an important substantive point. The future of health care reform in this country will depend on how effectively the exchanges–health insurance super-stores–are working. If members of Congress have to participate in this system, you can bet they’ll insist on a array of choices, similar to the system they currently use, the Federal Employees Health Benefits Plan.

2. One of the ways that choice can be enhanced in those exchanges is a public option. I watched Joe Lieberman, the Senator from Aetna, slag the public option on Meet the Press this morning. He was armed with a new CBO score that has public option policies costing more than private policies in the proposed new system (I’d love to know more about that one, given the add-on private costs of corporate profits and advertising). The question David Gregory should have asked next was: So if you want more competition, as you say, are you in favor of lifting the anti-trust exemption that health insurers now enjoy? If Lieberman wants to be philosophically consistent, if he really wants to offer more choice and greater competition, he should announce that he will filibuster any bill that doesn’t end the anti-trust exemption. Right now, because of Ben Nelson, the Senator from Omaha Mutual, the Senate bill doesn’t contain such a provision. It should. (By the way, I still consider the public option a relatively small bit of business–certainly nothing that would cause me to vote for or against the bill. There are other far more important provisions.)

3. Thanks to Oregon’s Ron Wyden, the Senate bill contains a provision that will allow employees of companies that offer health care plans to go to a public exchange, if the exchange offers a plan they like better than the benefits they’re getting on the job. That’s an excellent idea…and it should be expanded. Any company that wants to offer its employees health benefits via the Exchange route should be allowed to do so. The more people involved in the Exchange system, the better the rates are likely to be and the more choices offered.

This, most health insurance experts believe, is the best way to rebuild the U.S. health care system–through regional public exchanges or one big national exchange that will offer a range of health insurance options. Such a system will make it easier to regulate the health insurers and monitor the system. I’d like to see an Exchange system that includes all Medicaid and Medicare recipients as well. True fairness demands that every American receives the same choice of benefits at the same choice of rates.