It’s rare that people arguing about health care reform come at me from the left. But more and more these days, that’s what’s happening. Today I was on the phone with a friend who was threatening to be done with the Democrats once and for all if they didn’t pass a public option. I told him he was over-reacting.
You heard me right. At this point, I can live without a public option.
Lest you doubt my progressive credentials on health care reform, I’ve never hidden my belief that a single-payer solution is the most cost-effective way to achieve universal coverage. I haven’t wavered. I still say that when asked, and I have no problem defending that position.
But too many, in politics and out, said that was never going to happen. We wanted to tinker and tweak, not revamp and rebuild. And now that we see the result, many are rallying around the public option like it’s a singular opportunity to save the world. It’s not; it’s not even close.
Be real. The House version of the bill contains perhaps the most robust version of a public option. The CBO estimates that maybe a third of people in the exchange will choose it. That’s fewer than 10 million people, maybe 3% of Americans.
The public option has never been about coverage. It’s about cost. No more people will obtain health insurance if we have a public option. Nor will the quality of care go up. Some very smart people think we also need it for political cover, but I don’t really care about providing politicians with extra protection right now. The public option is meant to increase competition and lower the cost of insurance.
How much lower? At best, maybe $110 billion over 10 years. I’m not scoffing at that amount. It’s real money. But remember that’s an average of $11 billion a year in savings in a country that’s spending at least $2.4 trillion for health care. I just can’t get worked up about a measure that might knock off less than one half of one percent of total costs. For this you’d kill health care reform? Are you kidding me?
Since we decided to “build on what works and fix what doesn't”, let’s be truthful about this. All of the bills, even the Senate Finance Committee’s, accomplish the following:
1) Increased Medicaid and CHIP coverage
2) Subsidies to help lower income families buy coverage
3) Universal guaranteed issue (no denials of coverage)
4) Universal community ratings (no penalties for pre-existing conditions)
5) Increased insurance company regulation (no recissions)
6) An insurance exchange for those buying on the individual market
7) Out-of-pocket caps (maximum amounts you can ever pay)
No one will be denied insurance because of pre-existing conditions, no one will be priced out of coverage because they are on the individual market, and no one will go bankrupt because of medical expenses. There’s still a lot of good in there.
Don’t get me wrong. I’d rather have a public option than not. I’m in favor of lower costs. I’m so enamored with lowering them I’m for a single-payer system. In fact, as I’ve said before, I’d be in favor of almost any other comparable country’s system. But we didn’t want that. And I do realize this is an awesome deal for the insurance companies. It's also an awesome deal for pharma, for hospitals, and for doctors. Since we chose a path that buys off industry, let's be honest that this may work out well for them, too.
It’s fine to push for a public option. It’s fine to push for even more. It’s even fine to negotiate from a position of strength. But, please, in your hearts, calm the rhetoric. Those of you on the left, don’t overestimate the importance of the public option to the overall goals of health care reform. If we don’t get it, yes, the cost of the bill will be higher. But we’re already pretty used to high health care costs. The public option isn’t a back door to a single-payer system either, so don’t make that mistake.
Those of you on the right, don’t go crazy either. The public option isn’t the devil. It’s not going to lead to a nationalized system or to the end of private insurance. It’s just a means to increase competition and try to reduce the cost of reform. There was a time when those craving fiscal sanity would have liked that.
So let’s have a debate. Maybe we will get the public option. Maybe we won’t. Either way, the reform we are going to get is not nearly enough. We’ll still have a significant number of Americans without insurance, a system that lacks sufficient quality, and costs even higher than before. We won’t be able to afford it for long, and we’ll need to do this again. Throwing a tantrum and running home will mean your voice will not be heard next time.
So fight for your goals, fight for what you believe is best. But don’t burn down the village over the public option. It’s not worth it.
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