Public Plan Consensus Possible? Daschle Offers A “Qualified Yes”

A "common ground" solution is possible for the most controversial issue in the health care reform debate - whether to establish a government-run insurance plan that would compete with private plans - according to former Sen. Tom Daschle.

In an appearance at the National Press Club June 2, Daschle, who favors a public plan option, described his view on prospects for health care reform this year and offered a "qualified yes" to the question of whether there could be agreement on the public plan.

However, he emphasized the only way to resolve the issue is to seek a solution "that recognizes the concerns of those that oppose but also the concerns of those who think strongly this is the right thing to do."

Sen. Ted Kennedy, D-Mass., is one of the key Congressional leaders endorsing a public option. Opponents of the concept associate a public plan, especially one modeled on Medicare, with stringent government price controls.

Daschle suggested policymakers should focus on alternatives to a plan that is both funded and operated by the federal government, He pointed to "something like the TRICARE" insurance system for members of the military and their families, where the "government assumes the risk" of insurance and "private plans administer the benefits."

Other approaches could include a state-based system, or one that ensure states have "maximum flexibility" in forming insurance risk pools, he said.

Former HHS Secretary Mike Leavitt, who also spoke at the National Press Club event, was skeptical about whether sharing responsibility with private insurers or states would address price control concerns.

"Tom has just described three versions of government-run health care," Leavitt said. "Believe me, as a guy who oversaw the biggest payer system in the world, if you're paying for it, you're controlling it."

Public Plan As Fallback

Another idea being floated in Congress is that the public plan be available only as a fallback if adequate competition and cost containment from private insurers fail to materialize. The concept is endorsed by the House Blue Dogs in a position paper released June 4.

The coalition of centrist Democrats does not support a public plan. However, the paper outlines a number of conditions that should be met if such an option is included in comprehensive health care reform. Another condition is that Medicare rates should not be used as the basis for reimbursement.

Though the public plan is the most contentious issue in the health reform debate, Daschle noted "there are a lot of very close seconds."

They include taxing health benefits, medical malpractice reform, establishing an independent federal health care board modeled on the federal reserve, requiring all individuals to purchase insurance and requiring employers to provide health insurance to employees.

Given the number of unresolved issues - though he suggested a compromise is achievable on the tax question - Daschle predicted "there is really only a 50/50 chance that [health care reform] is going to pass" this year.

He emphasized that President Obama's continued involvement in the process will be a key factor in moving legislation, pointing to the president's June 2 meeting with Senate Democrats as a positive sign.

Although Daschle does not have a formal public role in health care reform since he withdrew from his post as director of the White House office on the initiative, he continues to work behind the scenes.

For example, Daschle is involved in developing health reform proposals along with two other former Senate majority leaders, Republicans Robert Dole and Howard Baker, at the Washington-based Bipartisan Policy Center. A report is expected shortly.

- Cathy Kelly ([email protected])