How (and Why) Obama Should Kill the Public Option
First of all, let's be clear on one thing. The public option has the same level of support from the Obama administration that it did a month ago. The president has consistently said that he believes a health care reform bill should have a non-profit option to keep insurance companies honest, but has insisted that the public option isn't the most important part of health care reform. This is a focus on the destination, not the road taken to get there, yet the media loves their "Democrats divided" storyline so much, every conditional statement becomes a tempest in a teapot.
Even worse, I keep seeing well-meaning liberals take the bait and insist that there is "no reform without the public option." It's ridiculous, short-sighted, and doesn't take account for the full depth of the reforms being considered. Checking out the White House's checklist of health insurance consumer protections or Families USA's 10 Reasons to Support the Health Care Reform Bills or even the Washington Post's Health Care Cheat Sheet, multiple reforms strike me as more important than the public option.
- An individual mandate that gets us close to universal coverage and includes subsidies for those earning up to 400% of the poverty level.
- A health care exchange that enables people to more easily compare and buy health care plans while giving them the power to collectively bargain for lower rates.- A bevy of new insurance company regulations that will limit out-of-pocket expenses, keep insurance companies from refusing or limiting coverage if you get sick, and stop discrimination based on gender or pre-existing conditions.
If every other part of the eventual bill is as robust as it needs to be, as Kevin Drum and Joe Klein have pointed out, a public option won't even be necessary. Or to put it another way, if you've already bought into the idea that magical free market fairies are going to help the public option compete with insurance companies and keep health care costs down, then strict regulations and an working health care exchange should already do the trick. The danger isn't health care reform minus a public option, it's health care reform that has had other aspects watered down in order to bargain for a public option.
I shed no tears for the insurance industry. The billions of dollars they've made by denying care to sick customers is dirty money. Trying to reform health care while being concerned about their bottom line would be like London police having second thoughts about arresting Sweeney Todd because the delivery boy at the pie shop downstairs might get laid off. You don't get to profit off the suffering of others anymore? Tough shit. This alone is why I support the inclusion of non-profit health care providers in health care reform. Any industry that's willing to let people die to protect their profits isn't above price fixing.
Yet, at risk of sounding like a weak-kneed, centrist Democrat, the public option is a really dumb idea. It is to single payer what civil unions are to gay marriage, an idea that looks good on paper to the elites who aren't affected by it directly but just reeks of beltway compromise. I'm dismayed by the obsession with the public option that has taken the left by storm. This is what progressives are drawing a line in the sand for?
The problem isn't that a public option won't accomplish what its proponents say it will, but that the whole concept of a "public option" is so fuzzy that it almost invites suspicion. Conservatives imagine it as government-run takeover of health care that will put insurance industries out of business, while liberals are convinced it's the closest thing to single-payer they're likely to get and hope it will strike a serious blow to the murder-by-spreadsheet industry. Yet many activists on both sides seem unaware that there are multiple versions of the public plan and that in even the most liberal healthcare bills, the public option is limited to heath care exchanges which in turn are limited to the unemployed, the self-employed, and small businesses. In short, the promise of a public plan isn't great enough to justify liberal glee or conservative paranoia.
If I had my way, I'd dump the public option immediately and banish the words "public" and "option" from the vocabularies of any Democratic leaders trying to drum up support for reform. The public option may be uniting the liberal base (which is a very, very good thing), but it has proven toxic for the centrist Democrats whose support is needed to block a Republican filibuster in the Senate (which is a very, very bad thing). In its place, the Democrats should announce a Medicare Consumer Plan will be available on the health care exchanges. The beauty of this approach is that it would seem like a great compromise on the part of progressive Democrats (since most aren't fully aware of the limitations of the public option), but it's much stronger policy-wise and politically :
- Medicare's existing bargaining power could ensure lower costs for consumers while eliminating much of the haggling within Congress about what form a public option would take.
- Expanding Medicare would likely have much lower administrative costs than setting up a whole new public insurance plan from scratch.- By demonstrating a renewed commitment to Medicare, reformers would help tamp down opposition from seniors
- Conservatives have a much harder time making "devil's in the details" arguments. People don't know what a public option is, but we've had Medicare long enough to know it isn't the second coming of Hitler.
Ultimately, I don't like having free market fundamentalism determine the shape of our health care system, but liberals already lost that battle. (I guess that's what you get when you share a democracy with people who think the Devil buried the dinosaur bones to trick us into not believing in Jesus.) If we're going to go with a market-based solution to our health care woes, let's go with one that's cheaper, already works, and is harder to reform opponents to criticize. Since we can't have Medicare-for-All, can we at least get Medicare-for-Those-Who-Want-It?
Follow Greg Saunders on Twitter: www.twitter.com/waltisfrozen
Loading comments…
Want to reply to a comment? Hint: Click "Reply" at the bottom of the comment; after being approved your comment will appear directly underneath the comment you replied to
medicare for all!
that's what we call it, that's what we want.
I am opposed to the current health care reform plan and the public option specifically. The public option is supposed to be designed to compete fairly and equally with private insurance companies. This is not possible because the public option will never be allowed to go bankrupt. It would be politically impossible to close this program. It can function inefficiently, provide poor service and lose money without the threat of going bankrupt unlike private insurance companies. It will reimburse at an unreasonably low rate and provide limited coverage to compete with the private insurance companies. There will be no incentive for the program to be run well and it will drive private insurance companies out of business resulting in a single payer system. This is like the government telling me to live on a budget, but if I spend excessive money on cars, boats and houses I will not lose any of my possessions and the government will give me more money. I can tell you I would start spending money right away without any regard for the consequences.
How is Medicare for anyone who wants it not a public option?
We should fix Medicare by eliminating Medicare Advantage, making one comprehensive plan for all, closing the doughnut hole in Part D, changing Part D so we can aggressively negotiate drug prices, and make Medicare open to any private individual or to any employer (of whatever size) who wishes to buy in. Also, require every employer to offer it as an insurance option to their workers.
If we do that, it won't make any difference what is in the rest of the bill, because if the insurance companies continue their rapacious practices, people will be able to vote with their feet.
What is there in any of the current proposals that will keep the insurance companies from tripling their rates to make up for having to accept people with "pre-existing conditions?" None that I've heard about. People would flock to a reasonably-priced public option, unless there isn't one because of arguments like this. Give me cost controls and I'll drop my demand for a public option (which "Medicare for anyone who wants it" would be).
no mandates without a single-payer system! , and who cares about 'exchanges'?
Supporters of the public option like to say that it will keep the private insurance
companies honest. Who will keep the public option honest?
The voters.
Every single one of those consumer protections are good and noble but what they will NOT do is LOWER COSTS. In fact, they will INCREASE COSTS, because insurance companies will have to pay more to cover the people they would otherwise deny, pay for the procedures for people they would otherwise reciss, pay above figures they would otherwise cap, etc. etc. Aside from actual *medical* reform and in the absence of price controls, the only hope we have to lower insurance prices is for a managed-price competitor to compete directly with the health insurance establishment.
No, without the public option meaningful health care reform will collapse. The public option was proposed as a compromise because Congress would never pass price controls and more regulation on the health insurance industry. The Republicans are opposed to price controls even more than they are opposed to the public option.
What the insurance industry wants is an individual mandate without a public option and/or additional regulations and price controls. That way, they can force insurance premiums even higher when people are forced to buy insurance from them. It's simply a matter of supply and demand.
No, it isn't OK to kill the public option. Stop compromising with people who have no intention of ever supporting anything you do. It doesn't matter what's in the final bill, the Republicans will all vote against it. So stop compromising with them. Just stop it.
You said it better and more politely than I probably would have.
I personally prefer Coke over Pepsi.
Stop being so negative and partisan. Stop it. Stop it RIGHT NOW.
First of all, "Medicare for whoever wants it" IS a "public option". Proponents would be delighted with something that looked like Medicare.
Second, the notion that it would somehow be easy to "extend Medicare" ignores a lot of killer details, the most obvious of which is: how would it be paid for? Medicare proper is paid for by a payroll tax.on ALL workers, on the reasoning that they will eventually all be covered. Obviously, "optional" Medicare would require premiums to be paid by those choosing the option. Would you commingle the premiums and the taxes? I think that would be a hard sell. On the other hand, if you keep them separate, you will effectively have Medicare and a Medicare-like public option.
Also, some providers will not accept Medicare patients because they disagree with the reimbursement amounts. This is already going to become a bigger problem as boomers hit 65 , but it would be exacerbated further by adding under-65s to the same system.
Finally, you appear to miss the main point of a public option -- to provide a benchmark of how health insurance can respond to that "bevy of new regulations". If you rely entirely on regulation, you leave the system vulnerable to future piecemeal weakening of regulations. A public entity is much harder to mess around without voters noticing, because the participants are voters.
"Also, some providers will not accept Medicare patients because they disagree with the reimbursement amounts."
There are greedy schmucks everywhere, fortunately their are hundreds of thousands of doctors in the US and the world who uphold the Hippocrates oath and are more than willing to take a cut in reimbursement fees in order to stabilize our health care system and assure health care to every human being.
Simple solution, license to practice requires accepting medicare reimbursement as payment in full.
There are Republicans on record making the same proposals as this blogger.
This isn't news to me at all, and I would also like to point out there are states such as Colorado who refuse to accept their full amount of federal health care dollars, which in turn would make Medicare more accessible to a larger portion of their citizens; based on their suspicions that making Medicare more accessible would draw more people to their state just to solely take advantage of those services, as some do in California.
It's a truism that once a government program is in place and operational for a while, it is next to impossible to get rid of it and that is not always a bad thing. Has it ever been a bad thing for medical care? That is precisely why we need a legitimate public option in place. Regulations are way too easy to ignore, not enforce, or dilute. Our system doesn't need fine tuning. It needs a major rebuild, even if it takes years to accomplish. New plugs aren't going to help much if the rings are shot or the block is cracked. The new plug approach will ultimately only discredit the mechanic(g
"but liberals already lost that battle"
There was no such "battle." The only battle was a public relations strategy, to make it seem as if Obama and his folks were for government insurance, but had to give it up pursuant to some kind of settlement.
This was a pre-planned strategy. The president didn't try very hard to fake it either. Just a few words "public option" here and there, no supporting details, as he did with lectures about elective surgeries. I hope the American public is not so gullible.
On the bright side for the administration, the liberal denial-mindset about the public option, and the right wing panic about this ghost, has distracted the conversation from the sell-out to drug cos., meetings with lobbyists, and even larger, discussion about what is left in the bill itself.
It's too bad that Greg's policy prescription (which is perfectly valid -- Medicare for Those Who Want It; Medicare for Purchase, Medicare Buy-In Option; call it whatever you want) is buried in Paragraphs 8-10 of an 10-paragraph post. The option to buy in to Medicare is what the "public option" should have been all along, and it's a far better "public option" than the current incarnation in all its hazy fuzziness. Commenters, please read all the way to the end of the article before posting your thoughts. And Greg, it's generally considered best to put the most important part of your article at the top rather than at the bottom. Not everyone will erad the whole thing.
I think people are missing the brilliance of this post. He's saying "Let's dump the public option and let everyone buy into Medicare" (it's at the bottom of the post). Yes! That's exactly what we need to do. It's just semantics, but the whole idea is to hit the reset button with better framing. See, the Democrats made a mistake with the term "Public Option". It has no definition, so opponents are able to label it as whatever scares people and frame the debate around their misleading view. Medicare, however, is defined. Opponents can't attack Medicare, the seniors who are quite happy with their own Medicare won't buy the scare tactics.
I think this is a great strategy. Democrats can say that they've compromised, but they've really pushed Republicans into a corner AND inserted a public option that CAN'T be watered down or redifined.
You're right, but by the time he gets around to it, he's already lost most readers (including me) with the spineless B.S. "cave now" arguments against the public option offered by the DINO likes of Klein and Drum.
Hello...
There are Republicans on record making the same proposals.
This isn't news to me at all, and I would also like to point out their are states like Colorado who refuse to accept their full amount of federal health care dollars, which in turn would make Medicare more accessible to a larger portion of their citizens, based on their belief that making Medicare more accessible would draw more people to their state to take advantage of those services, as they do in California.
You really need to set aside your revenge fantasies against Republicans and focus on getting the best bill possible. Some Republicans would sign on to a compromise.
You must be logged in to comment. Log in or connect with
