P.U.B.L.I.C. O.P.T.I.O.N.

11/10/2009 05:12 am ET | Updated May 25, 2011

The title to this piece is spelled using the words, "public" and "option," but after each letter there is a period--and for good reason. One might say the letters with periods behind them must be an acronym for something, that each letter stands for another word. Well, this is not quite right. You see, when the president spoke of the public option in his recent speech to a joint session of Congress, he was to be sure talking about a public health insurance plan; more likely, though, he was talking about a concept to keep the insurance industry in check concomitant with his proposed plans to place further regulations upon health insurance companies. While it does have to be a self-funded plan that must pay for itself, Obama made clear that he would take nothing less than something that would compete with the private market and force it to reduce costs, i.e., premiums to consumers for health care coverage. Listen up to know why.

The president was right on target, with much aplomb and determination, that the following must be in any reform:

1. Barring coverage due to pre-existing conditions shall be unlawful.
2. Rescinding an insurance policy following treatment and absent fraud will be
3. There will be a cap on out-of-pocket expenses.
4. There will not be a ceiling on coverage for care and treatment on an annual basis.

I address these four items as an example of a point, although there are many items within the President's proposed reforms. Why do I do this? To show the American public that the insurance industry will not care how many new regulations are foisted upon them, so long as there is no "p.u.b.l.i.c. o.p.t.i.o.n.". After all, new regulations mean additional exposures to insurers. Additional exposures mean more expenses and payouts of insurance reserves (what is kept on hand to pay claims), which means less revenues that can go to the bottom line, as well as for bonuses to executives. The only way to increase revenues with added exposures is to . . . you got it--INCREASE PREMIUMS. And that means (can you guess?) that we are all back at ground zero, because if millions of Americans cannot now neither afford nor access our health care system, just wait a year or two following the adoption of these new regulations to see how high the private market will jack up insurance costs. Heaven help us if we don't have a "p.u.b.l.i.c. o.p.t.i.o.n." to control these new premiums!

Another point about the "p.u.b.l.i.c. o.p.t.i.o.n". Those who oppose it (mostly if not all Republicans since they no doubt have shown themselves to have the collective intellectual capacity of an amoeba) keep telling Americans that with it the government will interfere with the doctor-patient relationship. To this I would say that at least three United States Supreme Court cases decided since 2000 (two in the Bush era) have recognized that the private market already interjects itself into that relationship; ask any patient or doctor if this is not so. And if you do not believe me, ask your neighborhood lawyer to look up the cases of Pegram v. Herdrich, Aetna v. Davila, and Cigna v. Calad. An alternative that forces down premiums and keeps the private market in check also has the advantage of not interfering with the doctor-patient relationship.

As for the "trigger" (what a poor choice of words) idea, forget it. This is, as Obama made reference to in his speech, just symptomatic of "kicking the can" to the next president, to the next election, etc. He means what he says: he is going to be the last president to ensure that true health care reform comes about, and, to be sure, that has to, indeed, must, include a "p.u.b.l.i.c. o.p.t.i.o.n.". Maybe this will sink into all those amoebas, huh?

Having true competition that lowers costs can be called by whatever name the president wants. Sure, a public health insurance plan is the most desirable and should be demanded by all those in the majority in Congress. But, if those in Congress are only inclined to ensure competition to drive down costs and premiums while wanting regulations without the creation of a public insurance company, then speak up now, or forever hold your peace. Betcha, however, that since no one has come up with a solid, will-work-from-day-one alternative to a public health insurance company that achieves the same goals as it would, no one will.

In the end, the president's determination, strength of character, and leadership on health care reform--mixed with a dose of moral imperative and the memory of Senator Kennedy--is an exceedingly powerful elixir from which no voter should neither run nor be in fear. At the same time, the buffoons on the other side, like a Sarah Palin or, now, a Joe Wilson, will not know what to do except create more lies about reform and show more disrespect to an individual who could rank among the best chief executives this nation has ever had.

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