Is it Time to Bid Adieu to the Public Option Mirage?
I joined in the health care fight in May… sending out email alerts to all I knew telling them to support the public option, and to tell everyone they knew… called my reps asking for the same thing. Joined with nycve, Jane and slinkerwink in their appeals for a strong (robust was the phrase used at the time… long ago abandoned as it became clear that it was not and never would be)….
I even organized a very successful rally at Senator Bingaman’s office in July… I spoke with his legislative healthcare aides personally… they assured me he "supported" the public option.
I pointed out to them that it’s easy to say you "support" something, but to really mean it, you have to fight for it. Perhaps Bingaman fought for it behind closed doors, but he never showed in his one town hall or his appearance on Charlie Rose or publicly.
I began to get suspicious of the "public option" in August, as I know many others here did as well. I asked Howard Dean in his live blog here at FDL a couple of months ago how he could support a public option that would essentially exclude those covered by employer insurance because of the unrealistically high premium percentages that had to be exceeded… Dean’s response was along the lines of "well, we’ll get our foot in the door and build on it from there."
So I went along with that… usually I take what Dean says as gospel… he is the one voice I know I can trust.
But as time has gone on, and the House version came out and the Senate version came out and as even Obama said in his speech to both houses of Congress… "The public option ONLY will cover about 5% of Americans…" I really began to wonder why progressive were still fighting for something that had become a mere shadow of its former self… or as I had said before on FDL… a public option with barely a pulse.
So I wondered if others in the progressive community were feeling as I … that the health care bills as they presently exist are really almost laughable in their handouts to the insurance companies and big PhRMA.
Wendell Potter, another voice that I imminently respect, told O’Donnell last week that "Yes, if we keep the public option in, the Senate bill is still worth passing." He said the insurance companies were really fighting to exclue the public option clause… so that meant that it really does threaten them… hmmmm…. I remain skeptical.
So today in the NYT… Paul Starr (former healthcare aide for Clinton … I know not his true conmpass… is he a corporate shill like Begala and Carville and Emanuel?) makes what is to me a pretty compelling argument for jettisoning the weak and near death PO for other concessions such as implementing some major changes before 2014, etc.
I began reading his OpEd with suspicion… after all, we’ve been so indoctrinated that we MUST support the public option at all costs… but as I read what he said, it began to make more and more sense. As I think Dave Dayden pointed out here at the Lake a day or so ago, the PO will receive the denied dregs of individual and small business
policies (I myself could easily be among them if I became seriously ill as I have junk individual insurance….)… therefore the premiums will be higher, and no one will want to switch to higher premuims (I’m sure this was all elegantly orchestrated by the insurance powers that be… see recent logs of WH visitors).
If so, the PO will be an abysmal failure out of the gate… and why not fight for stronger concessions that take effect before 2014?
AS the health care debate enters its decisive stage, liberals in Congress should be ready to trade the public option for provisions that will actually make the reforms succeed.
Discussion of the public option — a government insurance plan that would be offered to individuals and small businesses buying coverage through new insurance exchanges — has been dominated by ideological politics. Conservatives claim it would amount to a government takeover, while liberals imagine that it would radically alter the insurance market by providing better protection at lower cost.
As it now stands in Congress, however, the public option would do neither. According to the Congressional Budget Office, it would enroll less than 2 percent of the population and probably have higher premiums than private plans. For progressives to say they will block reform without a public option is not just foolish, but potentially tragic if it results in legislative deadlock.
An earlier version of the public option, available to the entire public, might have realized progressive hopes and conservative fears. By paying doctors and hospitals at Medicare rates (which are 20 percent to 30 percent below those paid by private insurers), the public option would have had a distinct price advantage. But by severely cutting revenue to health-care providers, it would also have set off such a political crisis that Congress would never have passed it.
Instead, the bills in Congress now call for the government plan to negotiate rates with providers, as private insurers do. That limitation exposes a defect in the idea. The government plan may well have to charge higher premiums because it is likely to attract more than its share of the chronically ill and other high-cost subscribers. It could go into a death spiral of mounting costs.
….. Strengthening that authority and accelerating the timetable for reform are what liberals in Congress should be looking for in a deal.
The basic aim of reform is to create a more efficient and equitable system for health insurance and health care and to provide subsidies so everyone can afford coverage.* Those who obtain insurance individually or through small businesses now get a rotten deal in the market. Out of every dollar in premiums they pay, nearly 30 cents goes for administrative overhead (as opposed to about 7 cents in large-employer plans). And those in poor health may be denied coverage for pre-existing conditions or be charged astronomical rates for insurance.
By creating a single, large “risk pool” for individuals and employees of small businesses, the exchanges should give those vulnerable groups the advantages of large-employer plans. The bill would also ban pre-existing condition exclusions and require insurers to offer coverage to everyone in the exchange at the same rate regardless of health (albeit with some adjustment according to age).
For these reforms to succeed, there needs to be effective regulatory authority to prevent insurers from engaging in abusive practices and subverting the new rules. The bill passed by the House would provide for that authority and lodges it in the federal government, though states could take over the exchanges if they met federal requirements. The Senate bill would leave most of the enforcement as well as the running of the exchanges to the states.
Yet many states have a poor record of regulating health insurance, and some would resist passing legislation to conform with the new federal law. ……
Accelerating the timetable of reform ought to be a priority. Although the legislation calls for some important interim measures, the Senate bill defers opening the exchanges and extending coverage until 2014. …..
For Congress to put off expanding coverage to 2014 would be asking for a lot of patience from voters. It would also give the opponents of reform two elections to undo it. President Obama would have to run for re-election in 2012 defending a program from which people would have seen little benefit.
To speed the process, the legislation ought to give states financial incentives to adopt the reforms on their own as early as mid-2011. A state like Massachusetts, which already has a working exchange, could move expeditiously to qualify for federal money. The final deadline for the federal government’s expansion of coverage should be no later than Jan. 1, 2012.
Let the moderate Democrats who oppose the public option say they stopped a government takeover. Liberals should be prepared to give up what is now a mere symbol for changes in the bill that would deliver affordable insurance more effectively and quickly to the millions of Americans who desperately need it.
* "The basic aim of reform is to create a more efficient and equitable system for health insurance and health care and to provide subsidies so everyone can afford coverage."
If this is Starr’s polite way of saying "stop the murder-by-spreadsheet" and "rape and pillaging of Amercans by the healthcare industry… then I agree with him… cus that is certainly my reason for wanting healthcare reform.
My reason for wanting healthcare is also to get the for-profit insurance company out of healthcare decisions in American…
So what do you guys think?
Would we be better off:
1) With no "healthcare" reform bill at all?
2) With a combined Senate/House bill similar to both bills at this time?
3) With a "healthcare" bill sans the weak PO but with other provisions that are stregthened?
Of course No. 3 begs the question of what is the likely success of strengthened provisions being granted? We could lose all the way around…
Or perhaps, as Potter and Dean have said, having any public option is better than no public option, even tho as presently construed it will like fail.
My thoughts are that some bill will pass… it will favor the healthcare industry as Obama/Emanuel set it up from the beginning… people will be required to buy private insurance and their profits will only increase. We must make it effective before 2014… and really, it probably doesn’t matter if there is a public option or not… having it in would be a pyrrhic victory at best.
And finally… what a fine mess Obama’s White House has created.