When Can A Public Option Not Be A Public Option?

03/18/2010 05:12 am ET | Updated May 25, 2011

The public option is the most contentious issue the Senate will debate about in its health care reform bill. Viewpoints go the length of the spectrum, from Roland Burris (D-Il) declaring he won't vote for a bill that does not include a strong public option, to Blanche Lincoln (D-AR), vowing not to vote favorably on reform that includes any form of a public option. In between we have suggestions for opt-out, opt-in, or "triggered" public options. What are Americans to think or to do? Let's get back to basics.

The sine qua non of a public option is affordability of health care.

A public option means competition for the private sector that offers health care policies.

A public option provides choice to consumers, so that every one can pick the most cost-effective product for themselves and their loved ones.

In both the Senate and House bills, the public option would be part of an insurance exchange that would not be up and running for 3-4 years after passage of health care reform.

Now, there are those who do not want the government to run a health plan for fear that the private sector will go the way of dinosaurs, or that the government will take over health care completely, or because of some other ill-founded and made-up reason. But, let's take the Blanche Lincolns of our Senate as all-knowing folks who see things that others of us cannot comprehend or fathom.

Now, Senator Lincoln would (or should) have to agree that Arkansans want to have quality benefits for as low a price as possible through competition in the marketplace. After all, that is the American way--it is capitalism in its truest form. Due to its present exemption from antitrust laws, the insurance industry would not necessarily agree nor have to agree. As Wendall Potter, the noted former CIGNA executive turned whistleblower tells us, insurance companies know how to make money by finding loopholes in what regulates them; they are good at that.

So, we don't want a public option because we don't want the government putting its nose where it does not belong, but we want to prevent the insurance company from ever after gouging us citizens with outrageous premium costs. We want a public option that is not a public option.

So here goes; call it the No Public Option Plan.

1. For each year that the insurance exchange in health care reform is not up and running, premium prices will be rolled back an equal number of years. In other words, if we have to wait three years for an insurance exchange to start, then what we are charged by insurers during this three-year time frame will be what we paid for premiums three years ago. This has the effect of eliminating cost and premium increases that the insurance industry will start charging now and until health care reform takes effect in order to offset the new regulations that will be set up to reduce their profits. Freezing premium prices in this manner will also provide consumers with a "credit" of sorts for being overcharged premium costs to unnecessarily increase insurance company revenues that then bolstered their bottom lines.

2. There will be a mandate that all insurers who write health care insurance policies must participate in the insurance exchange. This seems only fair since there will be a mandate on all Americans to buy health insurance or face a penalty. The amount of their annual insurance premium based on benefits to those eligible to participate in the exchange will be no more than a certain percentage tied to an index, like the consumer price index, revisited once a calendar year. There will be a cap per year on any increases.

3. Those eligible to initially participate in the exchange will be those either not covered through a health plan provided by employers with greater than 100 employees, or who are covered or who are eligible for government-run programs, notably Medicare and Medicaid. A recent analysis pegs the number who should initially be eligible to participate in a public option, or no public option plan, at 80 million Americans.

Thus, with lifting the antitrust exemption, and implementing the new insurance regulations, what is proposed in this post is a public option that is no longer a public option. What is proposed serves the same purpose as a government-run public insurance plan without the government running one: making health insurance affordable for every single American.

To all the Blanche Lincolns or the Roland Burrises of the Senate, what would you say now?

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