News about healthcare negotiations



To understand what will ultimately be the progressive position that has a 50 percent chance of being adopted, take a close look at my column "Public option" from The Hill newspaper on Tuesday. Let me be clear: I suggested exactly this approach at extremely high levels during the recess.

Under the formula I suggested, private insurers and insurance co-ops would have two to three years to meet specific standards about the number of people covered, the cost of healthcare, the amount customers are charged in premiums and other key issues.

In this formula, the public option would be passed in the bill but would not go into effect unless the standards are not met by private companies and co-ops. The standards would be specific and publicly announced, with quarterly reports by the president.

If the president certifies in writing that the standards have not been met, by the end of 2012, the public option automatically goes into effect without any further legislative action no later than January 2013. We would know much earlier, from the quarterly presidential reports, what the result will ultimately be. In the meantime, the pressure would be on private insurers to best serve customers by meeting the standards.

When you hear the phrase "trigger," this is a hard trigger with a loaded gun that would give the private sector every opportunity to keep the promises being made today. If targets are not met in this formula, the public option happens. If targets are met, the public option would not be necessary, or triggered.

The contrary, weaker form of trigger under discussion would suggest that if standards are not met by 2012 or 2013, nothing happens except another vote in Congress that would begin the process from scratch years from now. This is a soft trigger without a gun. If this is enacted, the public option would be effectively dead.

What is happening behind the scenes today is that several forms of a co-op-public option trigger are under discussion. One group favors a hard trigger with a loaded gun, as I suggest; another favors a soft trigger with no gun. This is the unresolved issue now under negotiation.

Trust me, I have been involved on this issue at high levels with multiple sources for some time, both as a columnist writing about healthcare and a former aide to Democratic leaders in Congress. I offer advice based on years of cutting deals on major issues. Based on everything I know, which is far more than has been publicly reported, my conclusion is that the president NEVER intended for the public option to pass and ALWAYS intended the public option be dropped in return for Republican votes.

This explains the convoluted presidential positions in direct statements by the president and strange background comments in multiple media by various senior aides.

The president and his aides made two major miscalculations. First, they assumed that by giving up the public option they would win substantial Republican votes, which, as of now, they have radically overestimated.

Second, they assumed the Democratic majorities in the House and Senate would quietly accept giving up the public option. They underestimated the strength of opinion among a majority of Democrats in the House and in the Senate.

As I write these words on Wednesday morning, the outcome is uncertain, but this is the most important issue under discussion today.

Ignore statements about the president fighting for the public option, which in my view are untrue because in truth, he is not, whatever the rhetoric.

Ignore stories about the public option being dead, which in my view miss the point of what is actually being negotiated, which is whether or not there will be a credible threat, in real time, at a time certain, of a public option if abuses continue by private insurers.

This what I share with readers, based on my reporting. What is happening is not about focus groups, not about polls, not about the Kabuki drama of Washington positioning, and not about the opinings of many who are not in the real loop and who do not understand exactly what is happening.

This is about writing real legislation in the real world, the way real legislation is written. This may be pretty, or not, but this is my report on what is happening behind the scenes as you read these words.

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