UPDATE: What’s really going on?

Posted by AzBlueMeanie:

Good to know that others are asking the right question… mcjoan at Daily Kos, who used to work for Sen. Ron Wyden (D-OR), and still has contacts with his office, asked what was behind his participation in the "gang of six" letter on Friday. What's with Wyden? This is the e-mailed response:

Majority Leader Reid and Chairmen Baucus have asked Ron to bridge the gap between progressives and the moderates to find enough votes for them to pass health reform this year. That is what he is attempting to do.  Contrary to a popular fairy tale, there is no passing comprehensive health reform without 60 votes. Two of our Democrats have had lengthy absences due to health, and other Democrats have voiced serious concerns about the current leading bills in the House and the Senate.  Ron is trying to make certain that their voices, critical to the success of health reform, are heard now so as to avert the failure of health reform later.

Far from advocating delay that would jeopardize passage of health reform this year, Ron specifically rejected any suggestion in the letter that the committee and the senate should wait until after the August recess. Ron trusts Chairman Baucus and Majority Leader Reid to be able to tell the difference between good faith progress with Republicans like Sen. Snowe and Sen. Collins, and DeMint-like obstruction. Ron aligns himself with President Obama's comments today and is fully prepared to work well into the August recess if that is what it takes to make progress on a bill that can pass the Senate. He is absolutely committed to the President's timetable of enacting health reform this year.

Bottom line, in Wyden's mind, this could still happen by August recess or in August, if that's necessary. The "fairy tale" referred to are the limitations which currently exist in Senate rule on what actually can be included in the budget reconciliation process. Quoting resident expert David Waldman:

Are there any potential problems with this? You bet. For one thing, there's the Byrd Rule, the main purpose of which is to prevent Senators from cheating by using the protections of the reconciliation process to shoehorn in all sorts of policy changes that would otherwise be threatened by the filibuster, but which aren't sufficiently related to the budget. Remember, reconciliation is supposed to be a budgeting procedure, not a free pass for just anything you want to put in the bill. Republicans are already complaining that health care reforms shouldn't count as budgeting issues. But anybody with half a brain can see that major reforms would absolutely have a budgetary impact, and a considerable one at that. The trick will be relating the policy changes closely enough to budgetary changes to pass muster with the Senate parliamentarian, whose job it will be to rule on the propriety of the language and whether it fits under the definition of what's proper for reconciliation. The parliamentarian's word isn't necessarily final, but appeals to overturn decisions made under the Byrd Rule require… 60 votes.

This could happen with budget reconciliation, but it wouldn't be easy and not optimal. So Wyden's been tasked with trying to find a way around having to resort to reconciliation. Because his Healthy Americans Act, introduced in 2007, did provide a bridge to moderates and even Republicans, he's a good vehicle for that effort.

But there's another element to this in play for Wyden. He has introduced the "Free Choice Act," a bill that Ezra Klein says is the "idea that could save health-care reform and that dday calls the healthcare "killer app." Is the bill that good? Yeah, it really does seem to be, adding an element that has been missing from the health insurance exchange–real choice. Here's Ezra:

Under the bills being considered right now, the exchange will be limited to the uninsured, the self-employed and small businesses. Maybe it will be expanded over time. Maybe not. In addition, it is barricaded by what's called a "firewall." The firewall essentially bars individuals from entering the exchange so long as their employers offer them a basic level of health-care coverage.

The Free Choice Act starts by setting the rules for the exchange: Within five years the exchange is open to all employers. More importantly, it's open to all people. The firewall is extinguished. But as the late, great, Billy Mays would say, that's not all!

The key component of the Free Choice Act is called "cash-out." Under the Free Choice Act, if I decide that I don't like any of the health-care coverage options being offered by my employer and would prefer to choose from the many options being offered on the Health Insurance Exchange, my employer has to give me a voucher that covers 65 to 70 percent of the cost of the lowest level of exchange plan. (That is the average portion that an employer pays of his employee's health insurance premiums.) I can take that voucher and, along with whatever money I want to throw in, choose a plan on the exchange.

This does a couple of things. First, it changes the health-care system for the currently insured. It doesn't take what they have. But it gives them a choice. If the political yin of health-care reform is that you can keep what you have if you like it, the policy yang should be that you can choose something different if you don't. The Free Choice Act gives the insured something concrete: autonomy. If they don't like what they have, they are assured options….

Second, it gives people an incentive to choose cost-effective plans. If your employer is paying 70 percent of your $10,000 health insurance premium, and you find a $9,000 plan on the Exchange — maybe it's an HMO rather than a PPO — you pocket $1,000. Currently, since I pay only 30 percent of my health-care premiums, making the same choice within the HMO and PPO offerings that The Washington Post gives me would only net me $333 dollars. Wyden's plan would put 300 percent as much money in my pocket. That changes behavior. And even the CBO thinks so. This is one of the main reasons the Congressional Budget Office scored Wyden's Healthy Americans Act — which had a similar provision — as saving, rather than costing, money.

Third, it begins to build a viable alternative to the employer-based health-care system. Experts think that the exchange will need at least 20 million participants to really start seeing advantages of scale. This will ensure it has much more than that. And if the exchange works? If direct competition between insurers lowers costs and increases quality, if standardized billing and administrative efficiencies save money, if the massive pool of customers helps insurers bargain for discounts with providers, then the exchange will become a progressively better deal, and more people will choose — there's that word again — to enter it. And if more people choose to enter it, then that cycle happens again, more people enter, and so forth. Soon, you've built the system we want rather than the one we have.

This, as dday says, actually would ensure competition between the private insurers and the public option. It could help prevent the public option from becoming the ghetto of the uninsured and the previously uninsurable–the sickest people.

All of this could actually change the dynamic in the insurance market and force competition on price and quality, rather than the current competition among insurers, which is "who can pay for the least amount of health care." It gives individuals the freedom to choose without stripping them of their bargaining power – in fact, it empowers them more. And it strengthens the public option, by opening the market to potentially tens of millions more consumers.

This is an excellent approach, and one that actually does expand what Democrats and the President keep touting–choice. It is, as dday says, a concept that progressives should embrace. The problem is, by signing on to that letter with Nelson and Lieberman, will Wyden be able to rally the progressives behind this effort?

The real question is whether the media villagers and Beltway bloviators will give any media coverage to Sen. Ron Wyden's Free Choice Act alternative so that Americans can learn more about it and make an informed decision on which health care reform option will work best to achieve the desired results.

I am willing to consider Wyden's proposal, but I need the senator to describe in detail his Free Choice Act and explain to me why it really is the best alternative. I would question that if it is the "siver bullet" that some of the writers above seem to think, then why was the Free Choice Act not the platform bill used in the Senate to develop health care reform? And why was it not considered (or rejected) by the HELP committee in the House? It is a failure of the media that we are only learning of Wyden's alternative now at this late date. Why has his bill not been part of the national discussion since January?