Yogi Berra is regarded as one of the greatest catchers in the history of baseball. One of the most storied players in the history of the game, Yogi was a 15-time All Star and won the AL MVP three times, in 1951, '54 and '55. He played in 14 World Series and holds numerous World Series records including most games by a catcher (63), hits (71), and times on a winning team (10). He is also first in World Series at-bats, first in doubles, second in RBIs, third in home runs and walks. Yogi also hit the first pinch hit home run in World Series history in 1947.
Many know Yogi's exploits on the field and his accomplishments as a manager, but today most people know him for his famous "Yogi-isms," such as, "If the people don't want to come out to the ballpark, nobody's going to stop them," and, "The future ain't what it used to be." Lately, I've been thinking about another of Yogi's utterances: "It ain't over till it's over."
During the (nearly) year-long siege of health care "reform," there were numerous examples of the Progressive's mindset that whatever passed the Congress this year was just a beginning. The end game, that which is seen as the ultimate goal by many in that camp, is nothing less than "single payer" -- a scheme in which the government is the de facto insurance company. The problem is that accomplishing that single payer goal in today's political climate is like trying to eat an elephant in one bite -- it simply cannot be done.
Many in the opposition believed that as things shaped up and were ultimately enacted, additional attempts at moving closer to that goal would come slowly and incrementally -- if at all. Yet just four months after President Obama signed the Patient Protection and Affordable Care Act (PPACA), Congress is attempting to reintroduce the so-called "Public Option."
Representative Lynn Woolsey (D-CA) is the co-chair of the progressive caucus. On July 22, Woolsey announced a bill that she contends would offer consumers a choice between private plans and a "robust" public plan once the health exchanges become activated in 2014. Woolsey believes that, "A robust public option offers lower-cost competition to private insurance companies. This will make insurance more affordable for those who do not have it, and keep insurance affordable for those who do."
Woolsey opined that introducing the public option now is key, "so it will be available as a ready-made offset or deficit reducer in this or the next Congress." She went on to contend that it would, "rein in the spiraling costs of premiums and save billions of dollars and improve health care while doing it."
At the time of this writing, the bill has 121 co-sponsors in the House and has won unsurprising praise from Sen. Bernie Sanders (I-Vt.). "I am very pleased that Congresswoman Woolsey and 120 of her colleagues in the House are introducing a bill to create a strong public option operating in every state exchange," said Sanders. He went on to note that, "I have long been in favor of a Medicare-for-all, single-payer health care system, but in the post-Affordable Care Act world I think the very least we can do is to offer every person the option of choosing a government-run health insurance plan over a private one."
It's that "very least" part that is instructive and a bit frightening. If the Republicans succeed in wresting control of one or both houses of Congress in the midterm elections, a lame duck session of the 111th Congress could attempt to do much more than the "very least."
Senate Majority Leader Harry Reid told an audience in Las Vegas on July 24 that, "We're going to have a public option. It's just a question of when." In recent days we've heard similar messages from President Obama and Speaker of the House Nancy Pelosi.
E. Neil Trautwein, VP of the Employee Benefits Council for the National Retail Federation, believes that, "this is more likely about rallying her party's faithful -- the D[emocrat] base -- by waiving the public option banner." Trautwein's opinion is that, "True believers were disappointed in Congress and the Administration for 'abandoning' the public option." He asks, "Haven't we already heard that debate settled in the negative?"
Whether you view this new attempt at a public option as a certainty or just as political posturing is less important than understanding that there are forces in play that will not stop pushing until we have a single-payer system. The difference between most in Congress and Senator Sanders is that he is willing to be completely honest and upfront about his intentions. With Sanders, it is more a question of ideology than of politics.
The political calculus behind a single-payer system was summed up most succinctly by Rep. John Dingell (D-Mich.) when he said, "Health care reform is a political exercise to first of all work our own program, and second to screw the Republicans" -- a refreshing bit of honesty from an elected representative. For those who may be finding the "it ain't over" theme a bit hard to fathom, you should know that this quote from Mr. Dingell is from the Clinton Health Care plan days -- 17 years ago.
Whether politics or policy, the proponents of the public option have been spurred on by analysis from the Congressional Budget Office (CBO), which has now re-scored this aspect of health care reform. Based on the reasoning that the current legislation is different from that which was enacted in March, the CBO believes the provision could save $68 billion through 2020.
We've written about this before, but it bears repeating: The CBO can only score that which is put in front of them. Outside analysis -- which takes into account a wider range of real-market conditions and situations -- often varies substantially from CBO analysis. One such set of variables are the 159 boards, commissions, bureaus, programs and offices of the federal government to carry out new tasks under the health care law.
The Center for Health Transformation (www.healthtransformation.net) has published a wall chart of the immense organizational structure to be created as a result of PPACA. As they point out, "Most of these ideas are undefined and will be determined in the coming years under agencies such as the Centers for Disease Control or the Centers for Medicare and Medicaid." It is impossible for the CBO to determine the overhead burden of this new bureaucracy -- much less to include it in the analysis. It's hard to believe that this much government won't cost a substantial chunk of the savings CBO estimates.
Every government program -- especially those we label as "entitlements" -- ends up creating a larger footprint than originally intended. Health care, with or without a public option, will suffer the same fate. An old friend once opined that bad ideas in the private sector go out of business, but bad ideas in the public sector get more funding. Sadly, this whole discussion reminds me of yet another Yogi-ism: "It's like d?j? vu all over again."
David A. Saltzman, RHU, DIA, is national marketing director of Chicago-based Disability Resource Group Inc. The South Carolina resident is a past president of NAHU and has been a health, disability, life and employee benefits broker for more than 25 years. Readers may contact him at dsaltzman@drgdi.com.
