To Dick Durbin: Before Surrendering the Public Plan, Just Make It Optional
The public health care plan is the major lightening rod of the health care reform "debate" (which, thus far, has not been about health care or reform!). It provides the radical right "evidence" to engineer fear of "socialism" and "a government takeover" that make seemingly rational people scream for the government to "stay out of Medicare (!)." It allows irrational people, e.g., Sarah, with apparent backing from Newtie, to proclaim that the government is setting up "death panels." [Whereas tobacco companies, whose business is, literally, selling death -- needing to recruit 15,000 children per month to become nicotine addicts -- seem not to be objects of Sarah-Newtie's outrage].
By making the public plan optional for each state, the hot air is let out of the disinformation balloon. "The public plan is socialism." Okay, if that's what people in your state believe, disallow it in your state. The wingnuts could even declare victory. Who cares?
If Alaska believes their quitter's twitters that the public plan establishes "death panels", then they can refuse to allow that plan to be offered in that state as one of the competing health plans. If Kentucky believes that its people "win" on health care by defeating a public plan, then let them defeat it, for Kentucky.
My state (Washington) would certainly adopt it. If Montana (our neighbor and home of Max Baucus) does not want it, then several years later we can see what the health care is like in Montana compared to Washington. And, if it is better in Montana without the public plan, why should the rest of us get exercised about it?
Consider this: suppose Medicare had been, similarly, optional. In states that did not adopt it, insurance premiums would have to skyrocket to account for the very high costs of seniors' medical care. Business would have suffered a competitive disadvantage, and many families would have to go into massive debt to pay for Granny's care -- something Granny would have felt terrible about. Who would want to live in that state, and how long before the political forces in the state decided, however reluctantly, to adopt Medicare?
Adoption of the public plan, if optional, will become a major campaign issue in most states. I suspect that it will be nearly universally adopted -- or the private insurers, in an effort to prove it is unnecessary, will keep their premiums from rising at such drastic rates.
I will go a step further. This was first suggested ("An Offer on a 'Public Option' Republicans Can't Refuse: Let States Determine Whether to Adopt It", June 25, 2009) purely as a political strategy. But, making the public plan optional is not only better political strategy, it is better public policy in our federal system. Federal authority really should be exercised only when necessary, and the burden of proof ought to be on those who assert its necessity. Those states not wishing to partake of the public plan ought not to be provided any additional benefits as compensation, but ought not be treated as pariahs.
The optional public plan can pass. There will no longer be any excuse for a member of the Democratic caucus to vote against cloture (and, if they do, they should be stripped of their seniority). We now know that Senator Byrd can make it to the Senate to cast a vote. That provides 59 votes for cloture. If Senator Kennedy cannot make it for the cloture vote, making the public plan optional ought to attract the Maine Senators to vote to allow a vote on health care reform.
Deference to federalism is also good 21st century progressive politics. One does not have to subscribe to the Republicans' nonsense of government-as-ogre to prefer individual control over one's life choices. Progressives who assume that millennials, who shun the rightwing because of their lies and divisiveness, are naturally attuned to federal power do so at their electoral peril. Today's progressivism is not yesterday's.
Progressives make a fundamental error, therefore, when they do not take advantage of opportunities to create policies that do not require the assertion of federal authority. On energy and the environment, for example, no such opportunity exists -- indeed, even federal authority is inadequate, world action is required.
Health care reform, however, is different. It provides an opportunity for accomplishing the goals of reform, while enjoying the benefits of federalism. And, in so doing, enabling the reform to be enacted in the first place.
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Let's be frank. There was never any real intent of offering a public option, since that is precisely what scares the health insurance companies most. The Republican town hall mobs are just providing a smoke screen for doing what was always the plan anyway -- making sure robust health care reform does not pass.
The minute I see a writer use words like "wingnuts," "trolls," "left loonies," I can not take them seriously. Intelligent discussions should not include namecalling. It also shows a lack of imagination. The simple solution to health insurance is that everyone (including Senators, Congressmen, Governors, etc. ) MUST all have the same coverage (no exceptions). If so, you would see reform immediately.
Make it voluntary. Make it simple. Make it clear.
Single-payer.
Its a pity that politicians are still afraid of being labeled as socialists for something like this public option. Why cant they see the long term benefit? I am sure that all the people who benefit from this option will be looking to vote for those legislators who supported it. The people who fall for the socialist fear mongering will probably not vote for democratic politicians anyway.
That said, I think MR. Abrams makes an excellent point and hope that this idea is considered by people such as Mr. Durbin.
I want mr. durban to put his health care plan on the same table and if single payer or the option goes SO does his and ALL the rest of Congress.
No public option? Big mistake.
Without the public option, with respect to calling this health care REFORM, there's no there there.
Why doesn't Congress authorize the states to levy a sales tax if they opt in to a federal single-payer system?
This way the states that want it, can have it, and pay for it, and the states that don't, won't. Of course there would need to be some guarantee that the system was paid for only from this plan (and perhaps with whatever premiums might be charged to people under the Plan), so that it would not add to the deficit.
I know that a sales tax hits the lowest income people the hardest, but free healthcare benefits them the most, so again, it sounds fair to me. Plus, we would all be able to see exactly how much of a societal cost healthcare has, by the annual adjustment of the sales tax rate.
This appeals to conservatives because it respects states' rights, independents and conservatives because it's cost-transparent and deficit-neutral, and bleeding-heart types (literally and figuratively) appreciate the free healthcare, so what's not to like?
Why are some people so wedded to the idea that the private industry must survive? It has demonstrated for decades massive failure as the central mechanism to deliver health care. Why do people want something so egregiously awful to survive?
I say install the pubic plan and let the private industry rise or fall on its own merits. Isnt that free market principals at work?
It is not a free market if the private industry must compete with a government run plan that can set its own prices as they see fit. At first people will think it is great. Soon, though, the private companies will not be able to compete, govt. will dictate to doctors and drug companies how much it will pay, and people will deal with rationed care. Ask any Canadian, Italian, or Brit. how they like waiting 8 weeks to see an oncologist or 12 weeks to see an ortho. We currently have the absolute best health care system in the world. The only thing "egregiously awful" about it is that not everyone can afford it. Make it cheaper by creating competition and eliminating frivolous lawsuits. Make it part of the welfare system for people who still can't afford it. But do not allow government to run it because we will not like what we get in the long run.
There is no such thing as a free market in any form of insurance. Yet all modern market economies benefit from pooling personal financial risks using insurance systems to minimize the economic disruptions that otherwise occur when people suffer catastrophic losses, often due to no fault of their own. All forms of insurance (private or public) operate like public goods: they require broad participation, cooperative behavior, and trust. It also helps if those insured exercise prudence to reduce unnecessary risk (e.g., not smoking). If not carefully regulated by government, private for-profit insurance (risk) pools are vulnerable to perverse incentives: cherry-picking the risk pool to exclude certain groups who might be at higher risk (e.g., people with pre-existing conditions), cost shifting to those outside the risk pool (e.g., denying as many legitimate claims as possible), and free-riding by people who try to enjoy the benefits of pooling risk without participating financially (e.g., the voluntarily uninsured who put off getting insurance until they encounter health problems). Our current patchwork of public and private insurance greatly amplify these problems and make US healthcare the most inefficient and expensive system in the world while delivering inferior results compared to other industrialized nations with universal healthcare. The only way to solve these problems is to create a universal risk pool regulated by the government. We don’t believe in markets for kidneys, why allow price to be the primary means for allocating essential healthcare?
Yeah. We're not talking about televisions, cellphones and wristwatches here... we're talking about HEALTH CARE.
Do we have to profit off of EVERYTHING? Should we be capitalizing off of basic human needs?
Maybe there should be a few areas in life where we just do what's best for everybody... like treating the sick and educating the young... i.e. things people need in order to survive.
Save all the free market competition for luxuries.
I totaly agree.
Complicate it as much as you want,,,,but we are talking about INSURANCE. Actually insurance reform.But, for those who don't have any or can't afford it should be given consideration.Let"s get a public option and make it fit everyone not just a few.
Everything doesn't have to be left or right .We should care enough about each other to find common ground and make our country more fit for the world market. As it is we are not able to.
Thirty seven countries have a head start on us.
In 10 years when the system is completely broke and the youth no longer want to fund the elderly, they will need to "tighten" the provisions on many treatments. And, the DEA will cut back on prescriptions for pain relievers. You wouldn't want those dieing to be addicted to narcotics. However, you will receive counseling on your "duty to die".
I don't understand how anyone could want our government to control something as huge and complicated as the health care system. Wouldn't it be an easier thing to control if people that cannot afford healthcare get a voucher? Reform of healthcare is the goal, not to fundamentally change it. Open state borders so that people can purchase their insurance from another state. Change laws regarding malpractice so that doctors can pass on their insurance savings to patients. These should be the goals of reforming healthcare as they would lower the cost and allow more people to afford coverage, and as I said before, government can provide help to those who need it. I am convinced that even if a public option passes just as way to compete with private companies, eventually those private companies will die and we will only be left with our public option. I do not want going to the doctor to be like going to the DMV or post office.
I really wish everyone was able to put aside partisan differences and look at the big picture. Do not blame the other party, work with them to bring about a change that will make the greatest country in the world even greater. We are all Americans and need to use our heads to make the best decisions.
"Reform of healthcare is the goal, not to fundamentally change it."
Thank you for your paid endorsement.
I'm all for states being able to choose their own fate when it comes to a public option. What is stopping them now? Is there something in the federal code that won't allow a state to provide its own public option?
I often ask this same question about single payer. I don't believe there is anything stopping a state from adopting (contrary to the popular progressive belief that Kucinich put in an amendment that made it legal. He only put in language that would exempt single payer from possible federal intervention under another law.)
I applaud your attempt to get progressives to try some of these things at the state level. (I agree with medicare example, except I think it would have had just the opposite affect). Let states decide for themselves. I'd even go a little further and have the federal government make sure that residents of one state could purchase the public option from another state. This would lesson the probability of states subsidizing the option, since residents may not want their tax dollars used to benefit residents of other states.
Optional means we are still paying for the uninsured when we go to the hospital. They are why it costs a well over $1k to get a stitch in the emergency room. You are paying for your own treatment, as well as the treatment for people who are not paying. Optional means we will still pay, and Republicans can point to the climbing price of that optional plan (because you are paying for others' bills too) as money they prevented the government from spending.
No, I would rather the crisis comes into being and we tar and feather Republicans for their utter stupidity at that time so we can get what we need then. Better that than to let them gain face and blame us for the crisis too.
Right on!
Sigh. If this were the Civil Rights movement, would we be talking about a 'states rights' approach to the Voting Rights Act?
Abrams argues that this would take the 'government takeover' argument away from the right, and that states that those that do approve a public option will have a competitive advantage over states that don't, thus putting pressure on those states to adopt it, or to pressure private insurers to lower their costs.
This is sort of the Gay Marriage approach. It forces not one unified political decision, but 50 state-by-state contests from now until who-knows-when. That approach might make sense for Gay marriage, as the general population is fairly divided on that issue. But nationally most Americans want a public option. And in addition to 50 political fights, what's to prevent different states from adopting or rejecting different plans? Talk about a confusing patchwork. And where is the most widespread poverty? The South. Where is the least amount of unionization that might negotiate for private insurance? The South.
Abrams says "Deference to federalism is also good 21st century progressive politics."
It seems to me that it is more divisive than progressive.
GREAT post.
See Paul Abrams's Profile
If people want it, then their states will adopt it. If they do not, and their premiums are higher, or their employers cannot offer it because of costs, they will throw out those who do not vote for it.
You are quite right about civil rights. But, e.g., the Voting Rights Act's triggering mechanism applies only to states in the South with a history of discrimination. Here's the analogy: both the triggering mechanism in the Voting Rights Act, and the public plan, are mechanisms to achieve a certain end. They are not the end in themselves.
A healthcare reform bill that achieves the desired end (which, IMO, ought to be improved health outcomes, at lower costs with universal coverage) is what we should be about. Allowing states different mechanisms to make that happen is good policy.
OH, but socialism is so very scary!!! What a bunch of cowards. And Americans think they are so brave and courgeous yet the word "socialism" will having them wetting their pants. The corporate media has trained brained dead Americans well. Oh, the horror.
Socialism? Are you nuts? We are talking about health care reform, not setting up any kind of government.
Good luck getting the teabagger cretin class to believe it.
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