Fixing Health Care Does Not Require a "Bi-Partisan" Bill -- It Does Require a Public Health Insurance Option

The private insurance industry and its spokespeople in Congress are frantically making the argument that for health care reform to last and have the support of the American people, Congress must pass a "bi-partisan" health care reform plan.

Of course you never heard a word about "bi-partisanship" from the insurance industry or Republicans when they passed the notorious "Medicare Part D" prescription drug plan in 2003. Back then, they froze Democrats out of all negotiations, and passed the bill on a 220 to 215 vote in the House (with only 16 Democrats voting yes). In fact, Medicare Part D would be their idea of a "good" health care "reform": taxpayer subsidies for private insurers with no competition from a public plan. And if we went that route, the results of health care reform would look pretty much like the results of Part D as well - no cost control, giant gaps in coverage, and confusing options for consumers.

Now that the political tide has turned, and last year's economic collapse has given voters a fresh lesson in the consequences of turning public policy over to corporate CEOs and insurance giants like AIG, the Republicans and insurance companies have had an eleventh-hour conversion to the benefits of "bipartisanship" when it comes to health care reform.

It's no surprise then that in the current debate, the advocates of this position have made it clear that, to them, "bi-partisanship" means one thing: Americans should be denied the choice of a public health insurance option like Medicare. Their problem is that while a public health insurance option may not have bi-partisan support in Congress, it has big time bi-partisan support among the voters.

In fact, of course, it won't matter one whit to average Americans whether the bill passed by Congress is "bi-partisan." What will matter is that:

• Something gets passed.
• It provides health care for everyone.
• It puts the brakes on skyrocketing health care costs.

In the current context, there is no way to provide these things without also providing us with the choice of a public health insurance plan that would compete with private insurance companies, and keep them honest.

Average Americans know that they have been at the mercy of private health insurers for too long. After the health care mess that they have created, insurance companies can hardly expect everyday voters would be real keen about handing them the exclusive right to provide health insurance to everyone in America who is ineligible for Medicare, Medicaid or Veteran's benefits.

A poll conducted earlier this year by the highly respected Lake Research Partners found that voters overwhelmingly want everyone to have a choice of private health insurance or a public health insurance plan (73%), while just 15% prefer everyone having private health insurance.

And the preference for a choice between public and private health insurance plans extends across all demographic and partisan groups, including Democrats (77%), Independents (79%) and Republicans (63%). So in fact, President Obama's proposal that creates a choice of a public health insurance option is a bi-partisan plan - whether is has "bi-partisan" support in Congress or not.

Because of the budget rules passed by Congress, Obama doesn't actually need any Republicans to pass a health care reform bill. The rules allow passage without a filibuster, by a simple majority - which in the Senate means 50 votes and a vice-presidential tie breaker. That would allow passage of a truly effective health care reform plan even while losing all Republicans and 10 Democratic Senators.

Of course in this political environment that won't happen. They may squeal on their way to the vote, but in the end most Democrats and some Republicans will almost certainly feel the heat of public opinion and vote for health care reform when the chips are down.

The president's principles - which were outlined in a letter to the Senate last week - have broad support among most Democrats in both houses, notwithstanding adamant insurance industry opposition to a public health insurance plan.

The few isolated Democratic opponents in both Houses have never advanced solid policy arguments in opposition to giving Americans the choice of a public health insurance plan. The closest they've come is a frail argument that many private insurers couldn't compete. That line of argument ignores two facts:

• The point of health reform is to provide health care to all Americans, and to cut costs - not to benefit wasteful, inefficient private insurance companies that have become fat by gouging consumers and denying claims.
• If private insurers can't compete with an efficient public health insurance plan, they have no business being in the market place. After all, they would be the first to argue that the "private sector" is always more "efficient" than government.

What they're really worried about is that in order to compete they would have to cut massive CEO salaries like the $26 million Cigna paid last year to its CEO - a figure that is 65 times higher than the salary paid to the CEO of the Federal Government - President Obama. Insurance companies are worried that they would have to become more efficient and cut their profit margins in order to compete. Of course from the point of view of the taxpayer, that is one of the major goals of health care reform: to control skyrocketing costs and incentivize efficiency instead of waste.

The other argument advanced by the few Democrats who oppose a public health insurance option is the fallacious notion that it is not popular in their districts. In fact, Republicans and Independent voters are almost as sick of being at the mercy of private insurance companies as Democrats. The idea of providing consumers with a choice of a public health insurance option is popular in Arkansas and Kansas - as it's popular in Illinois and New York. It's popular in rural areas and urban areas.

The Obama plan for health care reform has massive bi-partisan support throughout the United States. Let's get busy making sure that it becomes the law of the land whether the insurance companies and the Republicans in Congress support it or not.

Robert Creamer is a long-time political organizer and strategist, and author of the recent book: "Stand Up Straight: How Progressives Can Win," available on amazon.com

Comments

[jonbw]

Grassley and the rest of the GOP is currently spreading lies about the public plan. They have not plan to be honest brokers in a honest debate about the issue. We need health insurance reform, we need a public option open to all, and we need it now. No trigger. this is a fight for the progressive caucus. Stand your ground and we will win the day.

Grassley lying about the public option
http://jwalkerreport.blogspot.com/2009/06/senator-grassley-lies-about-public.html

[Kaelieh]

Here's something to think about with a public option. Yes, it rids the system or atleast for whomever buys the public plan, of the insurance companies we all love to hate; but, what about doctor's getting just compensation. Very few take medicad and the number of doctors dropping out of medicare has been going up and up for awhile now.

A drop in doctor's compensation could be a problem with a public option. Doctor's graduate from medical school with a lot of debt and it takes a long time and thousands in interest to pay it back. My cousin is in his 4th year of med school at a public university no less and already owes 90,000 dollars and that's not counting the interest already accrued. That's hard to payback, especially because residents make a shockingly low amount. If doctors can't afford to repay their loans, you'll see less go to medical school which would in turn drive up costs further because professionals will be in shorter supply.

[live by the golden rule]

So we need to restore the Public Health Service scholarships, which disappeared under Reagan. These paid the full cost of medical school for students who pledged to give back by serving in under-served communities. Students could choose family practice and needed specialties, rather than paying their debts by wasting their lives and education injecting botox into vain people.

[lurban]

I can't resist. There's a very simple answer. Forgive all student debt still outstanding, make a part of the health plan pay for worthy med students, (in lieu of taking profit) Require in exchange community practice including Departments of public health, (already in place until recently) --given expanded practice and facilities (creating a building boom! -of stuff way more useful than explosives)) --You get the idea! a system for people, not profit.

[ntmessage]

Most of the wasted cost and eroding quality of the system emanates from the huge cost centers within the industry away from practicing physicians, nurses and patients. Let us assume that Obama will not repeat the mistake of the Clinton administration regarding Health Care. However, this leads to potential mistake number 2. Ignoring the fiscal implications of not lowering the overall COST and, at the same time increase the QUALITY, the tax increases and economic issues moving forward may well be intractable.

We pay too much (twice other large countries and our outcomes are worse) and growing. If Obama simply leaves the systemically flawed cost structure alone (i.e. excessive profits and irresponsible price increases for the worst private players in the industry),
Indeed one of the reasons people do not want their taxes raised is that there is so much waste in the entire system today, more in the private system. Why should people have their taxes increased to enable private insurers to make more profit or simply more revenues!

A COST and QUALITY debate must happen now and use 7-8% of GDP overall cost limits along with Quality benchmarks. Otherwise, we are just throwing more money into the most inefficient industry on the planet. Not Financial System, and not the auto companies, not the US postal service, but the Health Care System we have right now.

We cannot make the system even bigger and allow the existing private companies continue to cherry pick profits on our nickel.

[jeffrey678]

The public healthcare plan only scares the companies that are ripping off the American people. The public plan will weed the crooked companies and save the taxpayer a lot of money. If private companies are more efficient that Government, THEN PROVE IT. This is your chance. Stop whining.

[mikebythesun]

They want a bill to make the Obama adminsitration look good, be bi-partisan as much as possible, and set up the 2010 elections. And they're not willing to rock the boat too much to do that. We can all blame insurers and the GOP, but the fact is that we're in the driver's seat now and the politics of yesterday still set the course for the Obama adminstration. You want to blame someone? Blame the White House and Congress for being so stupid as to not follow such obvious waves of public opinion as evidenced by the "respected Lake" poll. I wonder how the poll would have fared if it included an honest assessment of what the costs for real reform would be. The honest answer is that people want great, reliable services but don't want to pay for them. You don't need a poll to verify that.

One last thought on the bi-partisan point. If the public plan is really bi-partisan as Bob says, then where the hell are the Repubs? They're all hammering against it, as far as I can tell. I have to agree that whatever hc reform is passed it should be bipartisan. Imagine having a pubilc plan and then the next Repub in the White House gets to appoint a HHS Secretary to dismantle it or run it into the ground. That's why you need consensus from the start. Otherwise, it will be run like the Bushies ran FEMA.

[CherokeeGirl]

Don't let them get away with it, I've bothered my congresspeople and I hope you will too.

Public Option is A MUST. Don't let the NO party water down our Bill.

Medicare FOR ALL PERIOD!

[stuporman]

sadly, instead of one man, one vote, we have one ceo, all the votes.

[gfs5541]

Yes, to Single Payer. I'm going to be honest: When I working at my last job, I constantly opted out of a health insurance plan that my employers had. Why? Not because I couldn't afford it, but I didn't want to give my money to a private health insurance provider I perceived as "ripping off" their customers. The provider had a previous CEO that had to resign and he got a "fat" severance package.

This is why having a public insurance option is so vital. When you get sick or hurt, you want to know that health care providers "got your back". I can care less about folks who have private health insurance. In fact, they should keep their insurance. I can only hope when these people get sick or hurt, they get treated instead of having to fight their providers for insurance money they paid for. And if these folks rant about single payer being "socialized health care," tell them the military runs a single payer system http://en.wikipedia.org/wiki//TRICARE). If a single payer health care system is good enough for our folks in uniform and their families, then why it is not good for us? Let the government set up a single payer system.

To the politicians who take money from these private providers: Its time to decide who do you work for, not who pays the checks and funds your election campaigns.

[hearsyoursign]

Well, I can see why someone of your "intellect" would vote YES for a single payer plan. "I chose not to buy my own insurance because - blah, blah, blah - so I need everyone to foot the bill for a single payer so that I can, like, be taken care of forever and ever without an ounce of responsibility to myself or others!"

I cannot stand it when people use TRICARE as the premier example of single payer plan. I would remind everyone that TRICARE services the military and their families only. Yes, that is still in the millions of people, however it is not 300 million. TRICARE is so efficient because it serves one demographic and serves them well (by all accounts of the military personell I know). Further, it is often military medical servicing their own so, of course that relationship is going to be superior.

A single payer system under government control and that wonderful, efficient, cost effective government service we have all come to know so well in other aspects of life, is inviting nothing but catastrophy. Further, if, as in Canada, the US government makes it illegal for private industry to offer or supply alternate forms of insurance - well, that pretty much makes you a slave, whose value to the state is based solely on what use the government has for you at any time. And then, one day, government decides your expense outweighs your productivity, and, well . . . . .

[jjasonham]

Paying taxes into a single payer qualifies as taking a responsibility for a program. You fund it as a taxpayer, you reap the benefits. Don't even go there about an inefficient government running healthcare. We cannot prove how inefficient the government is with regards to healthcare when it happens. Private insurance has already proven how inefficient it is. 47 million are uninsured right now and you woefully lament what MAY happen....

[ChelseaC]

And your sources for your fearmonegering are.......­..........­..........­?
Don't even pick on France--they have the NUMBER ONE health care system in the world.
Go and tell lies to those dumb enought to believe them.

[ChelseaC]

gfs5541,
Well said.
You're fanned.

[philochs76]

Unfortunately, the issue with US healthcare is not "Who pays". If that were the issue, we could go single payer and all our problems would be solved. The issue is WHAT we pay.

We pay claims generated by doctors and hospitals. Those skyrocketing claims costs are what have created a mess. A public insurance option would make government mandated, fixed discounts available to everyone, and would be "competing" with private insurance options that offer private discounts instead. That is not a level playing field. In offering a public insurance option, private insurance is setup to fail. Maybe that's ok, but don't represent that it's about making CEOs accountable. There is no way that private plan discounts can compete with government fixed discounts, especially since most private plans are making up the difference between shortfalls in government payments and the actual cost of care.

There is also no way that a public plan will fix the cost problem. There may be a temporary administrative cost decrease, but the claims costs will still increase. It is incredibly disappointing that this vital debate has been reduced to public vs private solutions, when the real conversation needs to be about reforming patient care in America. If this is the road we're going down and we make no effort to effect the root of health costs, we will continue to see ever-declining care, increased hospital closings, and a greater tax burden on us.

[stuporman]

34% of health insurance premiums go to pay off insurance company ceo's, not doctors and hospitals.

[Jacobadle]

Stuporman,

Thanks for this statistic. Can you tell me where you saw this? I'd like to cite it in a paper.

[kendraro]

Single payer Universal Health care - we don't care about the profits for those CEOs - they don't care about care about us- and we will vote out all those who forget who they are working for in DC

[blueken]

Keeping the present health care system is like not curing the plague because it would put grave diggers out of work. We have 45 million people un-insured in the US. If they show up at an ER they will recieve treatment, even though they contribute nothing to the health care system. Meanwhile 60% of bankruptcy in this country are due to catastrophic health problems. If you think it won't happen to you, consider 70% of those that went bankrupt due to catastrophic health problems were insured when the health problems started. If those 45 million people who are un-insured contributed $10 a week, that would be an additonal 450 million dollars a week. We already spend twice as much as the next nearest country on health care. Add in uniform billing and negotiated drug prices, and we could get a lot more health care, for the same amount of money. SIngle payer, universal health care, everything else is a scam!

[Pablo175]

http://www.nytimes.com/2009/06/07/health/policy/07plan.html?hpw

[DIdaho]

"If private insurers can't compete with an efficient public health insurance plan, they have no business being in the market place. After all, they would be the first to argue that the "private sector" is always more "efficient" than government­."

Absolutely the best line here. It should be repeated as talking point by every public option supporter, every time, just like the right-wing drums the same line. Except this isn't the big lie, this is the big truth.

The "level playing field" public option opponents keep squawking about is a strawman and a lie. "Leveling" service so that the government's required to overcharge in order to hide the fees private companies put in their back pocket by denying claims is an outrage.

If the alleged horrors of government-run programs: limited service, long waits, denial of services; are true, then private insurance will have no problem competing. If they are not true, there's no reason not to have government insurance.

I agree the best option is to also have public clinics as well, along the British NHS model. But first things first.

[Gdebs]

Do you ever hear people who talk about "waiting" and "rationing" health care
consider the waiting and rationing endured by the people who have no health care? This health care system we have makes as much sense as having a fire department or a police force that serve only the wealthy part of town.

[BlueTide]

This is where Obama can prove me wrong when I voted for Hillary in the primaries. I voted for Hillary because I thought she would be more committed to meaningful health care reform. I hope Obama will fight hard for universal health care with a public option. I hope that Congress says no to individual mandates (But I suspect that in the end that's the route Congress will take). The insurance companies would scream with joy if Congress subsidizes them, drops the public option and forces everyone to buy private health insurance.

[DustyMills]

If Congress were to turn their backs on the American people by siding with the insurance industry, I bet you that they would then be counting the days they had left in office. EVERY American should call their congressmen/women and demand that they stand with us. Remember, they work for us, and if they can't give American's that which they have thru our tax dollars, then they need to be voted out of office. We need to stand togeather on the issue of healthcare, if we don't then the insurance companies will continue to make enough profits to pay their CEO's 26 million a year.

As American's, we can do this. It is our right to be healthy and make sure our children stay healthy. We cannot afford to allow Congress to take away this basic human right. We want a public healthcare system we can afford, now let's make sure every elected offical heeds the call.