The results of a little-publicized survey were released this week by Senator Richard Durbin, the Senate Majority Whip. The survey asked 83,954 participants which form of the public option they preferred: a 50-state public option, an opt-out public option, an opt-in public option, an option with a "trigger" or no public option at all.
Eighty percent favored a strong public option that covered uninsured Americans and provided the necessary competition to keep insurance company costs and premiums in check. A majority showed moderate to high support for a public option that includes a state "opt-out" provision; 75 percent voiced little or no support for a public option that requires states to "opt-in"; and only 12 percent showed moderate to full support for a "trigger", with 65 percent completely opposed to such a compromise.
If this most recent survey can be extrapolated nationwide, the American populace want a public option that covers those unable to be insured or who don't like what they have, and simultaneously offers necessary competition with effective choice in what health insurance plan they can select for themselves and their families. This could not be any simpler to say, so I will say it again. Of the 83, 954 Americans who responded to this survey, 67,163 want a strong and effective public option!
The House bill passed recently seems to suggest that of the 30 million or so eligible to participate in the insurance exchange, roughly 5 to 6 million participants would be in the public option. Surely, this is nowhere near enough to make a public health insurance plan effective enough to keep in check the costs and premiums the private insurance industry charges, and intends to charge, consumers. And an analysis with graphic presentation completed by Andrew Kurz, a former CFO for a Midwest Blue Cross and Blue Shield insurer, seem to bear this out.
A vibrant public option costs nothing. Health insurance costs under Medicare per person in 2009 totals $11,500 on average; under Medicaid it is $9,500. For an employee with a large employer, the 2009 estimated average is $7,100. There are 45 million people on Medicare, and an equal number on Medicaid. Given a current population of roughly 300+ million Americans, that leaves 215 million citizens with some sort of private plan or nothing at all. Of this amount, roughly 135 million are insured through large employers. The rest, 80 million or so, consist of either middle aged and older uninsureds/unemployed, or businesses with 100 employees or less. This latter group must be the immediate goal of who should be eligible for the public option. Hereafter, all Americans, even those with large employers, must be given the option to purchase or have their employers offer it as a choice, and these provisos must be set forth in any bill that reaches the President's desk.
Then there is the insurance exchange as set forth in the House bill. All insurers, including the government with its public plan, would compete by the same rules. All individuals and the smallest of businesses would have the ability to enroll in the first year of its creation, with larger populations being able to participate in each year thereafter. Each insurance carrier would offer one standard, basic benefits package policy so people need only compare service and price. The private market could also offer policies to supplement the basic package. Andrew Kurz states, "Only a strong public option with a broad enrollment base will compel insurers to compete". Moreover, no large enterprise may participate in an insurance exchange, or even the public option, until 2016. This leaves around 80 to 85 million folks who ultimately should - indeed, must - be eligible for the public option or participation in the insurance exchange in which the public option would be but one choice before 2016. However, seven years hence is too long of a period to wait for this to kick in.
Also of interest is Andrew Kurz's calculation that for every $100 in health care costs, $21 is spent on one person, $4.67 per person for a group of nine; $0.85 each for a group of 40; and $0.06 per person for 50 Americans. Consequently, it is easy to understand why those who spend so little have no real interest in changing a system about which they have no concern - that is, until they become the one in ten who becomes quite ill or diseased.
In summary, it is clear that Americans overwhelmingly want a public option with teeth in it. Such a public option does not cost Americans a dime. And the more Americans eligible to select a public option, the more the insurance risk is spread around, and thus the less health care reform will cost. (Without such a mechanism in place, it matters not whether we get new regulations, like pre-existing conditions not barring coverage - - - these regulations will cost insurers more money to be sure, but they will only pass along these costs to Americans in the form of higher premiums.) Without a strong and effective public option, any reform in our health care delivery system will only be one best described by thinking of a fox in sheep's clothing guarding the chicken coop.