Mitch McConnell: One Step Ahead of AHIP and PhRMA

In advance of today's White House summit on Health Care Reform (which you'll be able to watch live on C-SPAN and, if rumors are true, live-streamed from whitehouse.gov), Senate Minority Leader laid down a marker in the health care debate.  But in standing up for private insurance, he's way ahead of AHIP and PhRMA, who thus far have mostly had nice things to say about the President's plan.  What's going on here?

In a letter sent to the president on the eve of the health care summit, McConnell and four (only four?) other conservative senators give lip service to the normal bipartisan rhetoric but, unlike our friend Sen. Max Baucus, they don't even try to say everything's on the table.  There's one idea that they'd like to kick out of the discussion - the public competitor.  "Forcing free market plans to compete with these government-run programs would create an unlevel playing field and inevitably doom true competition.  Ultimately, we would be left with a single government-run program controlling all of the market. This would take health care decisions out of doctors and patients and place them in the hands of another Washington bureaucracy."  Basically, this means they're prepared to take a competitive, market-based solution and turn it into single-payer, whether it actually is or not.  That McConnell wants to do so is not surprising - the big businesses of insurance and pharmaceuticals that would most lose out from being forced to be more efficient through competition have been constituencies that Republicans have nurtured and protected for decades now.

What's surprising is that in order to do so, he actually has to admit that the health insurance we have today is non-competitive and would not survive being "forced" to compete!  That doesn't sound very free-market to me!

This is perhaps the most intriguing part about Obama's public competitor plan:  it takes the Republican talking points and uses them in the service of progressive principles.  As we've mentioned before, the whitehouse.gov page on health care begins this way:  "On health care reform, the American people are too often offered two extremes -- government-run health care with higher taxes or letting the insurance companies operate without rules."  The Obama plan is positioned to be between those two extremes.  You're going to hear that line a lot today - it even made it into the press release.  Can McConnell be successful standing up to government-run health care when Obama is also standing up to government-run health care, and proposing what he's sure to refer to as a market-based solution with true competition between public and private coverage?  We'll see.

But in taking such a hard stand, McConnell and company are actually out ahead of AHIP and PhRMA, who you would expect to be the aggrieved party.  They're still playing nice.  PhRMA's Billy Tauzin (perhaps best known as the House member most responsible for Medicare Part D's giveaways), who once promised an ad campaign against the Obama health care plan, is still very much at the table.  "This is a great start.  There are things we don't like about it. But there's time to discuss all that."  AHIP has focused mostly on the plans to stop overpayments for Medicare Advantage (roughly the same health benefits, 12-13% additional cost?  Yeah, y'all need to fix that), but did so in the second paragraph of their release, after praising the president's budget.  Others, like Nancy Chockley, of the National Institute for Health Care Management which represents not-for-profit insurance, will note that every stakeholder will receive "flesh-wounds" but none of them seem mortal.  Why are some Senate Republicans (only five of them signed the letter?  Seriously?) so far ahead of the industry?

Simply put, the senators have nothing to lose.  Until the bill appears in Congress, the insurance industry and Big Pharma very much have something to lose by acting out and laying markers in the sand.  While they're still at the table, they have to be civil.  Obama has occasionally been knocked for not confirming the details of his plan more vociferously, instead giving vague, general principles.  But if doing so means the only people speaking out against health care reform are ignorable wackos like Richard Scott and five Republican senators, nullifying the head start that the opponents of reform got in 1993, it's a smart, smart strategy.