THE BLOG
11/08/2009 05:12 am ET | Updated May 25, 2011

Affordability and the Public Option

As the nation looks forward to President Obama's Wednesday address on health care, progressives need to be concerned about reports that some in the White House are pushing to scale back proposals in two areas: making health care affordable and the public health insurance option. We should be equally concerned about both.

In a column this week, David Brooks argued that Obama was losing support with independents because of being seen as big spender. The implication was that spending on health care should be scaled back. But doing so would result in fewer people getting subsidies for affordable health care or a reduction in the level of guaranteed benefits. And that's the last thing that voters, including independents, want.

In a poll taken by Joel Benenson, the president's pollster, and commissioned by AFSCME, SEIU, and Health Care for America Now (HCAN), voters were asked to choose between limiting federal spending or assuring affordability for families and small businesses. The results were strikingly clear.
  • 66% agreed that, "As long as we don't increase the federal deficit, we should invest enough in health care to make sure that health coverage is really affordable to middle-class families and small businesses."
  • 18% agreed that, "It is important that we put a spending cap on health care reform at one trillion dollars so the cost doesn't spiral out of control, increasing our deficit and weakening our economy overall."
HCAN asked pollster John Anzalone to ask a similar question to voters in Blue Dog districts where people were slightly more likely to have voted for McCain than Obama. Here are the results from that question:
  • 66% of voters and 63% of independents agreed that "The key to health insurance reform is making coverage affordable to families and small business. As long as we don't increase the federal deficit, we should invest enough to make sure that health coverage is really affordable to middle-class families and small businesses."
  • 21% of voters and 20% of independents agreed that, "It is important that we put a spending cap on health care reform at one trillion dollars so the cost doesn't spiral out of control, increasing our deficit and weakening our economy overall."
This makes sense. At the end of the day, the way that most Americans will measure reform is by asking, "Do I have good health care that I can afford?"

The health care reform bill in the House includes several key provisions designed to make health care affordable to families: a requirement that health insurance policies offered by employers and through the new health insurance "exchange" include decent benefits with limits on out of pocket costs; a requirement that employers pay a reasonable share of premiums for employees and their dependents; subsidies for families that earn up to $88,000 to purchase coverage; and the creation of a public health insurance option that will lower costs both directly and by forcing private insurers to compete.

The public option is a key structural change to affordability because without it, the same private insurers that have driven costs through the roof will be getting a gift from the government. If reform mandates everyone buy insurance but there is no public health insurance option in the mix, then we are just delivering millions of new customers - and billions more in profits - to the private health insurance industry. And as an example of how a public option could lower costs all around, Medicare actually has a lower rate of health care inflation - 4.4% from 1997-2007, compared to private insurance's increase of 7.4%.

Affordability and the choice of a public health insurance option are both essential to legislation that will achieve the president's goals of making good health care affordable to everyone. We have come too far not to get it right.

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