Sen. Ben Nelson (D-Neb.) called the Huffington Post on Wednesday, following our latest story about his stance on a public health care option, to clarify where he stands.
"I was reading your blog again," Nelson said. "It says, 'Nelson Again Open To Public Health Care Option.' I've always been open to any idea that floated out there, all except one."
Which one? Universal, single-payer health care.
"I just want to get it cleared up." he said.
To that end, here's the extent of Nelson's thoughts about how a public option fits into an overhaul of the American health care system. The debate, as it is unfolding in Washington, is between two competing plans: One would include a public option that would compete with private plans in an attempt to lower costs and expand coverage. The second would not include a public plan at the start, but would establish certain criteria for private insurers to meet. If they failed to meet the criteria within a specific time period, a public option would be "triggered."
The latter is backed by the insurance industry and seen by advocates of a public option as a way to kill reform before it even gets started. The trigger will be designed, they say, so that nothing is ever triggered. That is what has happened with Medicare Part D's prescription drug plan, they say; it included a trigger that has yet to be pulled.
Nelson supports the trigger, he said, but is not has entirely against considering a public option if it could be done in a way that would not erode the current system.
"A trigger kills the public option. It should be up to people in Nebraska and America to choose their health insurance plan, private or public, and Sen. Nelson shouldn't deny them that choice," said Richard Kirsch, national campaign manager for the reform coalition Health Care for America Now.
Nelson said that when he initially said he opposed a public option, he was referring to universal, single-payer health care.
"First of all, I did say that I'd drawn a line in the sand and that I would oppose a public option. At that point in time, the kind of public option that was really being discussed was single payer, and single payer in competition with current insurance programs that 200 million Americans have. And that's unacceptable," Nelson said. "It was then and it is now and it will be if it comes out [of the committee process]. And based on the fact that that was sort of the discussion of the moment, [I said] that I would be organizing a group of Democratic senators to develop a coalition to oppose that kind of public plan...I do not believe I've been inconsistent here. I believe the language has changed a bit as discussions have gone on."
Adam Green, whose group, Change Congress, has been pounding Nelson in Nebraska for not embracing the public option, and for taking too much money from the insurance industry, dismissed Nelson's explanation as unsatisfactory.
"When Ben Nelson first opposed the public option in May, 'public option' solely meant competition in the marketplace and giving consumers a choice. Anything else is an outright lie," Green said.
Nelson responded that they were attacking him because they support a single-payer system. "They're for a single-payer plan and they don't like the fact that I'm not," he said. "I represent an obstacle to their success and I plan to be an obstacle to their success."
Green rejected that charge. "Change Congress's petition clearly says the public option 'would force private health insurers to compete -- driving health care costs down for families across Nebraska' and calls on him to side with those families over his special-interest contributors. Nelson saying anything else is yet another lie. To quote Change.org, 'Uh... Ben Nelson Knows We Can See Him, Right?' Senator Nelson, stop digging," said Green.
Regardless, Nelson says that he is now persuaded that 'public option' doesn't currently mean 'single-payer,' saying that "...it appears that the public-plan option is not the single-payer plan, but it could be used as a backup, as in the case of prescription drug Part D of Medicare."
"I haven't changed my mind. I'll look at anything that anybody gives me. That doesn't mean that I'll sign on to it or accept it. But I've said what I can't accept for sure," he said. "I think it's important to say that anything that would destabilize the insurance that people already have -- that 200 million Americans have -- is objectionable. We're trying to find a way to insure people that don't have insurance, not change the whole idea of insurance here. And the 200 million Americans that have insurance, I think the satisfactory ratio is something like 87 percent."
He added, "To the extent that there's a public option out there that doesn't [erode the private system], I will look at it and I might look at it favorably as in the case of prescription drug benefit."
The Huffington Post asked, to clarify, if he supported a public option that wasn't subsidized and had to compete fairly.
"Well, it's not about that. It's about a backup," he said. "There are a lot of people trying to find a way to describe a public option in less ominous terms and I see it for what it is, if it's in a position to compete with and take away people's -- 200 million Americans -- current insurance plans. I'll take a look at what somebody offers in the way of a public option, but I think now we're probably moving away even from discussion of public plan/private competition. I think we're looking at it as a backup in case somehow the current market structure doesn't work."
So you mean a trigger?
"Right, exactly, the trigger," he said. "There's a substantial difference between a public option, a public plan, that is triggered in the event of the failure of the private market to succeed, and one where the public option is put in place, and the intent and/or the result is that you have an erosion of the current private plans that people currently have."
"So," we asked, "what I'm understanding is that you would support a public option as a backup/trigger, but not as something that is put in immediately?"
Well, almost.
"Let me put it this way," he said. "I will automatically look at that and see what it is, but if it's something like -- because I'm talking about plans that don't exist yet. Ryan, this is part of the problem. I was attacked for opposing the president's plan but the president doesn't have a plan. There's not a plan out there. These are just ideas that are being floated around to see what constituency might develop for them. It's the same thing for the trigger and the same thing for the public option that might be behind [the trigger]. I have to see the actual plan before I can say what I will or won't support. But what I have said, an idea that I cannot support is a plan that comes in place -- a public option that would erode current insurance that 200 million Americans happen to enjoy right now."
For Green, Kirsch and other advocates of the public option, backing only a trigger doesn't go far enough. "The public option is about one simple concept -- competition -- giving people a choice between privately-run insurance and a publicly run health insurance option. If Ben Nelson says he's 'open' to all proposals, but continues to side with his special-interest backers who fear competition and giving consumers a choice, that's the exception that swallows the openness rule. It would mean he's not open -- instead deceiving his constituents and choosing to be in the pocket of the health and insurance interests who gave him over $2 million in campaign contributions," said Green.
It's premature, Nelson said, to know where the Democratic caucus stands. "I think it's probably just too early to do a head count. But I've said it, and I mean it: if the plan that comes out is single payer, I'll do everything I can to organize a group to be against it," he said, defining single-payer as "a government-run, one-size-fits-all, CMS-driven plan like Medicare, Medicaid, in effect.
Nelson also dealt with a few counter options, one of which is that the public plan won't be government-subsidized, but will be forced to compete fairly. "They'll come along and say, 'Well, it won't be subsidized.' Well, then it wont be sustainable because things won't be based on sound actuarial science and it will engulf the market. And the plan here is to insure 45 million Americans, not take away the private plans that 200 million Americans currently enjoy. Now, some want to do that and those are the ones that are attacking me," said Nelson.
Those who focus on the uninsured see the glass half-full, he said. "They're pointing to the lesser and saying that that's the problem. The greater is the 200 million who do have it and the 50 million that currently do have public plans currently," he said, referring to patients with access to Medicare, Medicaid and veterans benefits.
But more importantly, he said, proponents of a public option should first give the industry time to reform. "They're objecting to the system the way that it was. They're not responding to the way that it will be," he said. "Now they can [object] all they want, but as the industry will be taking away the prohibitions on preexisting conditions, and the rating based on health conditions, you level out the field of underwriting and you solve the problem that has in effect occurred because of people who have diabetes or who have some health conditions. When those obstacles are removed from the present environment then the system will succeed."
Nelson, a former insurance executive, is often looked to for his knowledge of the industry in the Senate, where many members are less than expert when it comes to health care. How much less?
"I had one of my colleagues ask me on the [Senate] floor what a private plan was," said Nelson. "I said, 'Well you have it. It's Blue Cross/Blue shield.'"
Ryan Grim is the author of This Is Your Country On Drugs: The Secret History of Getting High in America, due out later this month