UPDATE: The AMA Says No. Maybe. Yes. Whatever.

The problem is that a public plan really can't "mean many things." There's only one thing it can mean, if we're going to have a clear debate: a nationwide, taxpayer financed, government run health insurance plan that any American can opt into and that, if it offers cheaper more generous coverage than private insurance would be immensely popular and would reduce costs both by having the largest risk pool and the most purchasing power.

These variants that the AMA is talking about don't satisfy anyone who wants a big, robust public plan. This isn't about compromise, either. If the private industry doesn't have to step up to compete with the public plan, then what they're calling a "public plan" isn't what those of us who advocate one mean by the term.

Karen, you shouldn't accept their nomenclature. You should just call it something else because it is something else.

Shorter AMA:
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"We do not oppose a 'public plan', if by 'public' one means 'better than private in some way'."

KT:
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When Barack Obama says he is for a "public insurance option," people need to ask what that means.
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Amen, sister.
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Perhaps when some people say they are for "Change We Can Believe In", people ought to ask what that means, too.

KT:
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Thanks so much for trying to get an answer out of the AMA.
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I suspect that providing clarity on their position is not at the top of their spokespeoples' priority list at the moment, but I trust you perhaps more than any other political reporter to get whatever truth can be had out into the light of day.

Karen, I see what you're saying but there's a real risk here that the bill could wind up containing, something called a "public plan" that really has nothing to do with what most of us mean when we use the words. Like, say it has a publicly run option for small business employees and the self-employed that's administered by the states and subcontracted to private insurers. You could call that a "public plan" and in this "anything goes" dialogue, some would. Then people like me have to spend the next few years arguing "no, we never got a real public plan" and it's going to be very annoying.

I seem to understand less with each "update".

"Also, I think what the AMA mostly objects to is the idea that doctors would be told that if they want to be part of Medicare, they also have to agree to take patients from this public plan."
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If true, in my opinion this means the AMA cares more about themselves than their patients.

OT ... or is it?
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Ernest Mandel speaking of what feudal lords do:
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"He partially delegates his powers to others - but not to free men, since the latter belong to a social class in opposition to the seignorial class. The feudal lord delegates part of his power to people completely under his control: serfs who are part of his domestic staff. Their servile origin is reflected in many present-day titles: 'constable' comes from comes stabuli, head serf of the stables; 'minister' is the serf ministrable, i.e., the serf assigned by the lord to minister to his needs - to act as his attendant, servant, assistant, agent etc.; 'marshal' is the serf who takes care of the carriages, the horses, etc....
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Coming back to feudal society, it should be noted that state functions exercised by the ruling class do not only concern the most immediate areas of power, such as the army, justice, finances. Also under the seigneur's thumb are ideology, law, philosophy, science, art. Those who exercise these functions are poor people who, in order to live, have to sell their talents to a feudal lord who can take care of their needs. (Heads of the church have to be included in the class of feudal lords, inasmuch as the church was the proprietor of vast landed estates.) Under such conditions, at least as long as dependence is total, the development of ideology is controlled entirely by the ruling class: it alone orders 'ideological production'; it alone is capable of subsidising the 'ideologues'."
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Ernest Mandel

I thought it was interesting that the AMA mentions the Cooperative Plan that Conrad came up with as an alternative requested by Baucus.
Politico just happened to mention this on the second page of this link. Dems vs Dems
http://www.politico.com/news/stories/0609/23616.html
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The article said that a spokesperson from a major liberal advocacy organization Health Care for America Now that it will not support Conrads alternative plan as it would not seem to have the bargaining clout to control costs or keep insurers honest.
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But KT, I keep getting the impression that because opponents and skeptics inject vagueries in the term "public health care" lawmakers and journalists (not you, of course) are excused for ignoring the proposal. This is the very reason why the public health care option should be openly debated and covered and not swept away under the rug because nobody thinks it'll happen anyway. The argument that "it just won't happen" is not a good excuse for ignoring the public health insurance issue. To give an example, it seems just a year ago nobody in the press (and DC?) expected a 1st term African-American senator from Illinois to defeat Clinton and McCain to become the next president..."it just wouldn't happen." Yes, a public insurance plan can come in many forms which is why it is important to explore those forms and ideas. And as much as the politicians and the press try to laugh away the idea, the public has shown it is very open to the idea...probably since every other idea in the past has failed. So I think you and your colleagues should use this opportunity to open up the debate further and truly cover the ideas behind a public health insurance option and what it would mean. At least then the idea wouldn't fall victim to MSM & political mudslinging as well as distortion.

As I recall, a few million people voted for someone who made a fairly specific and often repeated commitment on health care coverage. I can't find the exact quote from the stump speech, but generally it was this:

"If you like your current coverage, you'll be able to keep it. We'll also give you the choice of getting the same coverage provided to members of Congress, and we'll help you afford it."

Anyone who has the exact campaign quote, feel free to provide it. Shouldn't that specific commitment be the starting point for analyzing any proposal and its effects – whether it satisfies the promise so many of us voted for? Whatever a "public plan" might mean, does it meet the promised criteria?

A note re: the AMA reaction – I remember an observation by a physician of my acquaintance, who likes to recall the initial and eventual views his predecessor in GP had to Medicare. The senior doc's reaction to the program was that it would destroy the practice of medicine; his analysis of the program in operation was that it was the best thing that ever happened to his practice and to those of most of his colleagues.

LOL, Karen. But see... I'd kind of like you NOT TO LET them use the words "public plan" to describe those other things. Would make my life a lot easier.

Indeed you have, KT, and thank you for that. The follow-up, which is admittedly far easier to suggest than to execute, would be "how would (Plan X) affect a member of the public if adopted?" Maybe a comparative chart assessing alternatives, for those who want to go beyond an overview.

KT,
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OT

Listened to you on Diane Rehm NPR show this morning. Very interesting and informative.

Karen:

You're my kind of reporter – thorough and responsible. May your SwampTribe increase.

Yes, a healthcare option matrix would be awesome. Thanks FO and KT!

You're my kind of reporter – thorough and responsible. May your SwampTribe increase.
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Is that a wish for more Swampkids? Would KT blog while on maternity leave?

[...] UPDATE: Two posts from Karen Tumulty, here and here. [...]