For now, public opinion appears to be on Obama’s side. A New York Times/CBS News poll conducted in mid-June found that 72 per cent of those questioned supported a government-administered insurance plan that would compete for customers with private insurers. Twenty per cent said they were opposed. The public option also has strong support in the U.S. House of Representatives, where Democrats enjoy a healthy majority and Speaker Nancy Pelosi is committed to the cause. “I’m saying we will have a public option in the House that will be real,” she said on June 19. “If it’s not real, it’s no use doing. And if we don’t do a public option, I’m not sure that we have as effective a public health care reform as we wish.”
But the Senate is a different story. There is weaker support there for a public option, and anxiety about deficit spending and government’s ever-expanding role. The Congressional Budget Office sent chills through senators when it announced that one bill that would subsidize health insurance for poor people would cost US $1 trillion and still leave 37 million people uninsured, while another plan under consideration would cost US $1.6 trillion. Centrist Democrats have expressed doubts that a public option could pass in the Senate. There is a strong possibility that an eventual Senate bill would shun a public option in favour of a system of regional- or state-level health co-operatives owned by members. Critics say they would not have the same bargaining power or economies of scale as a public plan to bring down costs.
Obama has also identified a series of other reforms he wants to see in the health care legislation, among them a ban on insurance companies rejecting people based on pre-existing conditions. He has also called for a variety of new spending, for such initiatives as preventative care, as well as for a major effort to analyze the effectiveness of treatments and tests. As part of his budget passed a few months ago, the President also put aside $635 billion over 10 years into a Health Reserve Fund. More than half of that is supposed to come from limiting tax deductions for the wealthiest Americans. He is also looking for a variety of spending cuts in existing government health spending. However, he has not heeded calls to support capping malpractice awards in a country where litigation leads to expensive “defensive” medicine, such as the ordering of extra tests and treatments.
Whether the public option will survive the legislative sausage-making process—and how hard Obama will fight for it—will probably only become clear sometime in the fall when lawmakers begin the arduous task of reconciling House and Senate bills. “That is when we will see the administration get heavily involved to get a compromise they will be happy with,” said Davenport. But Obama remains confident that he can succeed in reducing health care costs and achieving universal health coverage, something that eluded Bill Clinton a decade ago. Already, the President has won an agreement from the pharmaceutical industry to reduce its draw on the health care system by $80 billion over the next 10 years by offering lower prices for seniors’ drugs. At a June 22 press conference announcing that deal, Obama was buoyant enough to revive an old saying from his presidential campaign. “Yes, we can!” he said. “We are going to get this done.”
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