Fox News personalities and other conservative media figures have recently claimed or suggested either that a public health insurance option is unpopular among the American public, that it is costly, or both. But they ignored that numerous major public opinion polls contradict their claims; that both the House and Senate health care reform bills require the public plan to be self-sustaining; that the Congressional Budget Office (CBO) concluded that a public option did "not have a substantial effect on the cost" of the Senate health committee bill; and that numerous experts agree that a public plan is important to help control the cost of health care.
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Conservative media figures falsely suggest public option is unpopular, costly
Clyne: Public option is "wildly expensive and unpopular with doctors and the general public." In an October 13 New York Post op-ed, former Bush speechwriter Meghan Clyne wrote that "the 'public option' is wildly expensive and unpopular with doctors and the general public. So the Baucus bill -- which for now seems like the White House's favorite version of reform -- ditches it." Clyne provided no evidence to support these claims. [New York Post, 10/13/09]
O'Reilly, Rove mock notion that people want public option included in reform. After Bill O'Reilly aired a clip of House Speaker Nancy Pelosi stating that the American people "like universal quality health insurance and reform if it has a public option," O'Reilly stated, "[T]hat's not what the polls show," and, "I haven't seen one tea party demanding that the government run" health care." Fox News contributor Karl Rove said that "[b]y a better than two-to-one margin, people want to get their health insurance from a private company as opposed to the government. Where she comes up with that people are out there protesting in the streets and going, please ... I want the post office to be in charge of health care." [Fox News' The O'Reilly Factor, 10/13/09]
Dobbs: "[T]here is the matter as to whether or not the money will be there" for public option. CNN correspondent Ed Henry stated that congressional Democrats are "going to have to probably face reality that the votes are probably not there for a public option, and it's likely that a final bill is going to have to have something less aggressive." Without providing evidence supporting his concern, CNN host Lou Dobbs stated, "And also there is the matter as to whether or not the money will be there as well." [CNN's Lou Dobbs Tonight, 10/13/09]
Recent polls find continued support for public option
CBS News: 62 percent favor government offering "a government administered health insurance plan." When respondents were asked in an October 5-8 CBS News poll whether they would "favor or oppose the government offering everyone a government administered health insurance plan -- something like the Medicare coverage that people 65 and older get -- that would compete with private health insurance plans," 62 percent said they would support the plan.
Ipsos/McClatchy: 53 percent said "public health insurance plan" is necessary to ensure access to health care. In an October 1-5 Ipsos/McClatchy poll, 53 percent of respondents said that the statement, "It is necessary to create a public health insurance plan to make sure that all Americans have access to quality healthcare" was "closest to your opinion," rather than the statement that "[a]ccess to quality healthcare for all Americans can be achieved without having to create a public health insurance plan."
Rasmussen Reports: 46 percent favor creation of "government-sponsored non-profit health insurance option." When respondents were asked in an October 2-3 Rasmussen poll whether they would "favor or oppose the creation of a government-sponsored non-profit health insurance option that people could choose instead of a private health insurance plan," 46 percent said they would favor the plan, and 37 percent were opposed.
Quinnipiac University: 61 percent support option of "government health insurance plan." When asked in a September 29-October 5 Quinnipiac University poll, "Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans," 61 percent said they would support the plan.
Pew Research Center: 55 percent favor "government health insurance plan." When respondents were asked in a September 30-October 4 Pew Research Center poll if they would favor or oppose "[a] government health insurance plan to compete with private health insurance plans," 55 percent said they would favor the plan.
Survey finds majority support for public option among doctors
Mount Sinai School of Medicine poll: 63 percent favor option of public or private insurance. A survey conducted by Dr. Salomeh Keyhani and Dr. Alex Federman of the Mount Sinai School of Medicine found that 63 percent of the 2,130 physicians surveyed randomly said they "support a health reform proposal that includes both a public option and traditional private insurance. An additional 10 percent of doctors support an entirely public health system."
Evidence undermines claim that a public option would be costly
CBO: Senate bill's public plan does "not have a substantial effect on the cost or enrollment projections." In its July 2 preliminary analysis of the Senate HELP Committee's bill, CBO found that, in the words of CBO director Douglas Elmendorf, the public option "did not have a substantial effect on the cost or enrollment projections largely because the public plan would pay providers of health care at rates comparable to privately negotiated rates -- and thus was not projected to have premiums lower than those charged by private insurance plans in the exchanges."
House, Senate bills require premiums to cover costs of public plan. Both the House tri-committee bill and the Senate HELP Committee's bill require the public plan to charge premiums sufficient to cover administrative costs as well as the cost of enrollees' benefits.
From the America's Affordable Health Choices Act of 2009, as introduced in the U.S. House of Representatives:
SEC. 222. PREMIUMS AND FINANCING.
(a) ESTABLISHMENT OF PREMIUMS. --
(1) IN GENERAL. -- The Secretary shall establish geographically-adjusted premium rates for the public health insurance option in a manner --
(A) that complies with the premium rules established by the Commissioner under section 113 for Exchange-participating health benefit plans; and
(B) at a level sufficient to fully finance the costs of --
(i) health benefits provided by the public health insurance option; and
(ii) administrative costs related to operating the public health insurance option.
From the Affordable Health Choices Act as passed by the Senate Health, Education, Labor, and Pensions Committee:
''(5) PREMIUMS. --
''(A) PREMIUMS SUFFICIENT TO COVER COSTS. -- The Secretary shall set premium rates in an amount sufficient to cover expected costs (including claims and administrative costs) using methods in general use by qualified health plans.
CBO reportedly found original House public plan saves $110 billion. Congress Daily reported that House leaders "released CBO estimates for liberals' preferred version of the public option that show $85 billion more in savings than for the version the Blue Dogs prefer." Congress Daily further reported:
The original House bill required the public plan to pay providers 5 percent more than Medicare reimbursement rates. But as part of a package of concessions to Blue Dogs, the House Energy and Commerce Committee accepted an amendment that requires the HHS Secretary to negotiate rates with providers. That version of the plan will save only $25 billion.
In total, a public plan based on Medicare rates would save $110 billion over 10 years. That is $20 billion more than earlier estimates, a spokesman for House Speaker Pelosi said.
The numbers are based on oral communications between CBO staff and Pelosi's office, a Pelosi spokesman said. They do not represent an official CBO estimate.
House leaders are pushing the Blue Dogs to accept the additional savings from the Medicare-tied public plan. But Herseth Sandlin said Blue Dogs see it as a "false choice," and said House leaders recognize that Blue Dogs continue to have some concerns about that.
The public plan saves money because it pushes down premium prices. Lower premium prices across the country would mean the government would have to pay less in subsidies to low-income people who buy insurance through the exchange, according to CBO. Medicare rates are typically lower than those paid by private insurers, so using that formula would allow the public plan to charge considerably lower premiums to stay solvent. If the government has to negotiate the same way insurance companies do, public plan premiums likely won't be as low -- hence less savings. [Congress Daily, 9/25/09]
Experts stress importance of public option for cost control
Urban Institute: A public plan could save $224 billion over 10 years. Urban Institute economists John Holahan and Linda Blumberg estimated that a public plan paying Medicare rates plus 20 percent could save the government $224 billion over 10 years. The report stated that "[t]he public plan would have lower administrative costs than private plans and could establish or negotiate provider payment rates at lower levels than private payers are able or willing to do today." [Urban Institute, 6/26/09]
Krugman: Public plan would "probably provide the only real competition in many markets." In a September 8 blog post, Nobel laureate Paul Krugman wrote that "even a public plan with limited bargaining power" could "help hold down overall costs," citing "the huge overhead of the private insurers, much of which involves marketing and attempts to cherry-pick clients." Krugman further wrote that "a public plan would probably provide the only real competition in many markets." [The New York Times, 9/8/09]
Reich: "[T]here's no way to get overall healthcare costs down without a public option." Former Clinton Labor Secretary Robert Reich wrote: "Without a public, Medicare-like option, healthcare reform is a bandaid for a system in critical condition. There's no way to push private insurers to become more efficient and provide better value to Americans without being forced to compete with a public option. And there's no way to get overall healthcare costs down without a public option that has the authority and scale to negotiate lower costs with pharmaceutical companies, doctors, hospitals, and other providers -- thereby opening the way for private insurers to do the same." [Salon.com, 8/17/09]
Jacob Hacker: Public plan would be "one of the levers for bringing down costs over time." In an interview with NewsHour correspondent Jeffrey Brown, Hacker, a Yale political scientist, stated that a public option is "going to be a cost-controlled backstop. That means that it's going to be able to be one of the levers for bringing down costs over time, both by creating a check on private insurers and by innovating in the delivery of and -- and payment for care." Hacker added, "When the Congressional Budget Office first looked at a public health insurance plan, when it was estimating the cost of the competing proposals in the House, it estimated that the public health insurance plan could save on the order of $150 billion over 10 years, relative to not having that public health insurance plan in the mix." [NewsHour, 9/1/09]
Johnson and Kwak: Reform without public option provides no pressure on insurers to reduce cost. Writing in The Washington Post, economists Simon Johnson and James Kwak stated, "Imagine health-care reform without a public option: Insurers have to charge the same price regardless of customers' medical history; everyone has to buy insurance; and poor people get subsidies to help them afford it. From the insurers' perspective, they get more than 40 million new customers, they subsidize the old and sick by overcharging the young and healthy (who have to overpay because of the mandate), and the government even pays people to buy their product. There are no new competitors (additional choices for customers), and there is no pressure to reduce costs. What could be better?" [The Washington Post, 8/25/09]
From the October 13 edition of Fox News' The O'Reilly Factor:
O'REILLY: Now, as you mentioned, this is not going to be the bill, because they're going to sort it out, and they have to reconcile with the House. Nancy Pelosi is still fighting for the public option. Roll the tape.
PELOSI [video clip]: We in Congress are saying to the American people, you are mandated to have health insurance. But unless we have a public option, we are putting them at the mercy of the health insurance industry, and they know it. So they like universal quality health insurance and reform if it has a public option.
O'REILLY: Well, that's not what the polls show, but Ms. Pelosi is --
ROVE: Yeah. No, no, look, nearly nine, you know, nine out of 10 Americans think they have health care coverage. It's actually 83 percent have health care coverage, but nine out of 10 they think do. And they're overwhelmingly happy with what they got. By a better than two-to-one margin, people want to get their health insurance from a private company as opposed to the government. Where she comes up with that people are out there protesting in the streets and going, please --
O'REILLY: Right, I haven't seen one tea party demanding --
O'REILLY: -- that the government run --
ROVE: I want the post office to be in charge of health care.
O'REILLY: I would like Nancy Pelosi to organize a tea party that we demand that the government run the health care, because it would be mess.
But look, the -- I can't get real excited about this, what happened today. You're not opposed to this. You know that the health care costs have got to come down. They got to get it under control. You know that. We would prefer to have it in competition.
O'REILLY: You know, with all the insurance companies competing across state lines. I think that would -- savings plans for individual Americans. I would prefer to have the private sector do it.
ROVE: Right, be able to save taxes --
ROVE: -- for your out-of-pocket medical expenses.
From the October 13 edition of CNN's Lou Dobbs Tonight:
HENRY: Now, as [CNN correspondent] Candy [Crowley] was pointing out, for the first time now, the White House will be getting their hands a bit dirtier in this process than they had before, leaving most of the work to members of Congress, letting the process play out. The president's faced criticism from some fellow Democrats for not being more assertive in this debate, and starting tomorrow the White House chief of staff, Rahm Emanuel, will be among the negotiators on the Hill, meeting with Senate leaders to merge all these various bills. But I can tell you, I'm already picking up from some Democrats on Capitol Hill more frustration.
They think that in the last five, six hours in the reaction to the Baucus bill passing that the White House has been, in the words of one top Democratic aide, sort of tepid, that the president is still not stepping out there and clearly defining whether he's going to push hard for a public option, for example. So we'll see how long they're able to celebrate here at the White House, Lou.
DOBBS: Well, if the president is not doing that and there's any confusion on the part of the Democratic leadership, why is it then that both the House and Senate leadership are saying there will be a public option in conference?
HENRY: Well, they continue to say that in part because a lot of their constituency groups are demanding it. I mean, the labor unions, for example -- very important to the Democratic Party -- are now saying that starting tomorrow, they're going to be running newspaper ads across the country coming out against the Baucus bill.
They're partly doing that because the public option is not in the Baucus bill, and they're frustrated by that. And so, as Candy was suggesting, they're going to try to pressure these negotiators to include it in there. So in part, the Democratic leaders on the Hill want to sort of fight the good fight for some of their constituent groups.
But whether this really has the votes -- I have talked to some top Democrats on the Hill, insist the votes are not there for a public option. They're kind of going through the motions on that, but at some point, they're going to have to probably face reality that the votes are probably not there for a public option, and it's likely that a final bill is going to have to have something less aggressive, Lou.
DOBBS: And also there is the matter as to whether or not the money will be there as well. Ed, thank you very much.
HENRY: Big question.
DOBBS: Ed Henry from the White House.