What the Heck Do the Senators Mean?

More clues about a public plan

Right before the holiday weekend, Ohio senator Sherrod Brown and twenty-seven other Democratic senators introduced a sense of the Senate resolution “expressing the sense of the Senate that reform of our Nation’s health care system should include the establishment of a federally-backed insurance pool.”

Nothing really unusual in that, since members of the House and Senate often join forces and issue non-binding resolutions expressing support or disapproval for this bill or that. The timing wasn’t the best for media pick-up, falling as it did before Memorial Day and at a time when Senate Finance Chairman Max Baucus, who has emerged as Mr. Health Reform, was grabbing reporters’ attention with more pronouncements about the direction legislation might take.

On the listservs, supporters of a public plan rejoiced, noting that many senators seem to be on board with their line-in-the sand demand. Jeffrey Young at The Hill reported that the show of strength from the senators “sends a clear signal to liberals that a public plan, one of the left’s top priorities and a component of President Obama’s healthcare platform, will be part of reform.” But there was more—much more—to the senators’ calls for “an affordable, federally-backed insurance pool.” Hey, when you start talking about insurance pools, you never know. A risk pool in insurance can mean a place to dump bad risks—those too sick to qualify for normal coverage.

Just what did the senators mean? The press release was not at all helpful in that respect. First, it said that the signers wanted to include a “federally-backed health insurance option in health care reform.” Two graphs later, the release built upon that claim, specifying that the senators wanted to establish a “federally-backed insurance pool to create options for American consumers.” There’s a big difference between a single option that would be a government-financed program like Medicare—with the government providing the benefits—and the several options offered by private insurers that provide benefits with the government’s blessing, as they do in Massachusetts. A little clarification, here, would have gone a long way.

The press release then featured comments by various senators, offering their ideas on what a public plan should be. New York senator Charles Schumer said he wanted a plan “that delivers all the benefits of increased competition without relying on unfair, built-in advantages.” That sounds like the compromise he touted earlier. But if a public plan plays by the same rules as private insurers, what’s the point? Where’s the potential to lower premiums? And how can more private plans under the umbrella of some public option really reduce costs, given the fact that they will likely add more to the billions in billing costs that are already built into private insurance?

Senator Jeff Merkley of Oregon seemed to define a public plan as a way to “keep private insurance companies honest and help improve service and lower health care costs for everyone.” But how does Merkley envision keeping them honest? And by “everyone,” did he mean consumers who buy their own coverage, small businesses, or hospitals that face higher bills for expensive medical technology? Most of the senators used the carefully crafted rhetoric recommended by Democratic pollster Celinda Lake: their statements were laced with the words “affordable” and “quality” health care, as well as references to letting consumers choose—how empowering!—to keep the coverage they have now.

Since the press release was so fuzzy, I checked with some of the contacts listed on the release hoping for clarity. I didn’t get it. Some didn’t call back; others referred me to Senator Brown’s office. A health aide for one senator spoke on background (which is customary these days). She said the press release language was “simply another way to talk about a government-sponsored health plan or what some people call a public plan.” So, then, what was meant by a pool? She struggled a bit with this one. “People who create plans are a pool of people,” she said. One communications staffer explained it this way: “If you don’t have health insurance, the government will provide options for you, but if you like what you have, you can keep it.”

One Senate aide finally offered something useful—and something that the press should pay close attention to. She said a pool was a group of people involved in some type of plan, but most importantly, she raised the prospect that not everyone would be eligible to join. So, who could? Just those who are ill and rejected by private insurers? Only those who don’t have insurance from their bosses? Only those with low incomes? The press release and Senate staffers had danced around that key question. The staffer explained that different senators and representatives had different ideas about who might be eligible for a public plan. It could be available to some people and not others, she said, adding that “all (signers) agree this should be available—but what it looks like is ongoing.”

So what was the point of the press release (not to mention the others that will surely follow)? “It’s enabling more senators to straddle,” says Merton Bernstein, a law professor emeritus from Washington University. “A pool is about as amorphous a description as you can muster.” It gives Senate staffers something to say to single-payer and public plan supporters, he says, who call wanting to be reassured that their senators are in sync with what they want.

Bernstein could have added that the release also gives the press something to write about. The final shape of a public option probably won’t be known until the eleventh hour. But the press can’t wait to report after the fact. They need to tell audiences beforehand what the real prospects are for them—and who, in the end, will really have a choice of such an option. While they’re doing that, they should avoid passing along the focus group-tested blather about “quality, affordable” health care that politicos are trying to palm off as quotable news.

Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.