Co-op proposal continues to draw White House defensiveness, Liberals' ire

The Hill reports on Health and Human Services Secretary Kathleen Sebelius' backpedaling on comments she made Sunday that a public option "isn't essential" to a reform package: "'Here's the bottom line. Absolutely nothing has changed. We continue to support the public option that will help lower costs, give American consumers more choice and keep private insurers honest,' Sebelius said. 'The public option is a very good way to do this,' she added" (Youngman, 8/18).

White House press secretary Robert Gibbs said the administration continues its support for the public option, Roll Call reports: "Obama's position is 'unchanged,' said White House Press Secretary Robert Gibbs, who reiterated a previously stated position that the public insurance option is a preferred strategy but not a necessary precondition for Obama to accept a bill" (Koffler, 8/18).

CongressDaily: "White House Press Secretary Robert Gibbs said this morning that reports of a shift in administration policy were exaggerated, and the White House did not intend to signal a new position. 'If it was a signal, it was a dog whistle we started blowing weeks ago'" Gibbs said today" (Hunt, 8/18).

Liberal Democrats are expressing displeasure over the White House's apparent abandonment of the public plan option as part of sweeping health overhaul proposals, NPR reports.

"In a letter Monday to Health and Human Services Secretary Kathleen Sebelius, the co-chairs of the Congressional Progressive Caucus and the head of the Congressional Black Caucus said a public option is pivotal in any overhaul of the nation's health care system. Some 60 lawmakers signed the letter." The lawmakers see the public option as key to controlling cost in a Medicare-like system.

"But the public option has run into opposition from moderate Democrats in the Senate. Sen. Kent Conrad (D-ND) told (NPR's Robert) Siegel on Monday that for any health care measure to pass the Senate, it cannot include a government-run, public insurance plan" (All Things Considered, 8/18).

Obama and his administration officials were unprepared for the flak over the public option, The Washington Post reports: "at a time when the president had hoped to be selling middle-class voters on how insurance reforms would benefit them, the White House instead finds itself mired in a Democratic Party feud over an issue it never intended to spotlight."

"The president has maneuvered gingerly around the issue of a public plan, largely maintaining that he prefers to include the public option in a new insurance marketplace. He often argues that competition from a government plan -- without high executive salaries and the need to post profits -- could keep big insurance companies 'honest.' But Obama and White House Chief of Staff Rahm Emanuel have also signaled a willingness to consider other avenues" (Shear and Connolly, 8/19).

The Washington Post also has a timeline of Obama's comments on the public option.

In a "Fact Check" article, The Associated Press reports the White House did shift insistence on a public plan, even though it says it did not: "During the 2008 presidential campaign, Obama said a new public plan should offer comprehensive insurance similar to that available to federal employees. In the first half of the year, Obama said repeatedly in speeches, weekly radio and Internet addresses and town halls that he wants a health care overhaul that has a taxpayer-funded public health insurance option. He has said the plan would compete with private insurance to keep costs down."

Liberals cried foul "when Obama hedged this weekend in Colorado (on inclusion of a public option)" and other administration officials followed his lead. But the White House insists "that the rhetoric hadn't shifted. 'Must include' became 'whether we have it or don't have it'" (Elliot, 8/19).

The Philadelphia Inquirer explains the differences of opinion on the public option and notes: "Both parties in Congress agree on about 80 percent of the health-care agenda - such as getting rid of preexisting-condition exclusions, and requiring individuals to buy insurance while offering subsidies to people who can't afford it" but disagree on how to do it. (Vitez, 8/18).

Some physicians are fans of co-ops, The Boston Globe reports: "Specialists, including advocates for cooperatives, said in interviews that their patient-controlled structure and nonprofit status are not what will ultimately prove most useful. Rather, it is the way they pay doctors and care for patients that holds the most potential for savings."

"There are only a few large health cooperatives in the country. They typically combine a health insurance plan with networks of doctors and hospitals. Unlike most private insurance plans or HMOs, they are mutual plans, owned and overseen by patients through a board of trustees. They maintain slim margins, using leftover funds to expand treatment or lower premiums" (Kranish, 8/19).

ABC News features health policy experts weighing in on the merits between the public option and co-ops (Cox, 8/18).

www.kaiserhealthnews.org