Four Reasons Why Giving Consumers the Choice of a Public Health Insurance Plan Is Great Politics for Democrats

The private health insurance industry and its voices in Congress have begun to spin the narrative that offering consumers a choice of a public health insurance plan is:

a) Never going to pass Congress;
b) A fringe proposal by the Democratic Party's "left wing;"
c) Is generally bad politics for Democrats.

This narrative is flat wrong. In fact, offering consumers the choice of a public health insurance plan as part of health care reform is great politics for Democrats of all stripes, and is absolutely capable of passing Congress. Here are four reasons why:

1) It is very popular. In a poll taken earlier this year by Lake Research, 73% of respondents favored a health plan that gives them the choice between a private plan or a public health insurance plan. Only 15% preferred to have only the choice of a private plan. 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%).

In fact, this is one of the most popular parts of President Obama's health care reform proposal -- which a Diageo/Hot Line poll found last week had overall support of 62% of the voters.

What's more, private health insurance companies are very unpopular. Only 7% of Americans say they trust private health insurance companies.

Democrats have the high political ground on the issue of health care reform in general, and the choice of a public health care plan in particular -- with support from the Democratic base, crucial independent voters -- and even Republicans voters. In the coming debate, we need to act like it.

2) Democrats Need the Choice of a Public Plan to mobilize the base to fight for reform. The prospect of escaping from the tyranny of private health insurance firms is enormously motivational to core Democratic voters.

In order for Democrats to maintain a motivated, united front in defense of health care reform, the health care proposal must include the choice of a public health insurance plan. If it does not, elements of the base will oppose the plan and much of the balance will be tepid in their support.

We desperately need that united base of progressive organizations and voters to do battle with the massive number of special interests that will do everything in their power to oppose, disrupt and cripple a serious health reform proposal, as they did in 1993.

The fact is that any health care reform that actually controls cost will gore the oxen of many of the health industry's special interests; they will be very motivated. In order for us to be successful in the face of that motivation, we must mobilize a unified, equally-motivated group of voters to demand change.

We not only need the broad base of support -- which we have -- we will also need intensity to carry the day.

The presence of a public health insurance option in the plan is critical to maintain that unity and motivation.

3) A proposal containing a provision that gives consumers the choice of a public health insurance plan can pass Congress. The rules contained in the budget resolution that passed Congress protect health care reform from a filibuster in the Senate. That means it can pass with just 50 votes. We will have 50 votes in the Senate to pass a provision giving us a choice of a public health insurance plan.

The talking heads keep intoning: "But we won't have any Republican votes." We don't need Republican votes to pass the Senate. In fact we could loose all Republicans and 10 Democrats and still pass a bill. It would be great to pass a bill with bi-partisan Congressional support, but the choice of a public option already has massive bi-partisan support among the voters. Once it's passed, the special interests won't have any more luck taking it away than they had privatizing Social Security or eliminating Medicare.

In fact, there is a real question whether a bill that does not contain the choice of a public plan can pass Congress. Eighty House Democrats have signed a letter saying they won't vote for a bill without a public option.

There is simply no appetite among most Democrats in Congress to pass a new version of the disastrous "Medicare Part D" that provided some pharmaceutical coverage to those on Medicare. It has huge gaps in coverage (a "donut hole"), it gives private health insurers a monopoly on providing coverage, and it prohibits the government from negotiating with pharmaceutical companies to get cheaper prices. It would have been simple and elegant for Congress to extend traditional Medicare coverage to include drugs, but the Republicans that then controlled Congress and the White House -- and the health care and pharmaceutical firms -- would have none of it. Their goal was not to provide a critical, needed service to consumers. It was to make lots of money. The result is a much more expensive approach than coverage through Medicare.

Yesterday in his speech to the AMA, President Obama was dead on when he said, "But what I refuse to do is simply create a system where insurance companies suddenly have a whole bunch more customers on Uncle Sam's dime but still fail to meet their responsibilities." That brings us to point four.

4) The choice of a public option is critical to assure that health care reform actually delivers universal coverage and controls costs.

That is why President Obama says he has included it in his proposal for health care reform.

Those who argue that a public option is not necessary ignore both history and everything we know about structuring incentives for human behavior.

For middle class Americans who don't qualify for Medicare, we have just lived through a private-health-insurance-only world. It has been a disaster. Why do we spend 50% more per person than any other country on earth for health care, yet are 37th in health care outcomes? The only thing that completely differentiates America from every other industrial country on earth is that we are the only country whose health care system is dominated by private health insurance companies.

This is not a speculative question. The jury is in. They had their shot and blew it. And it is no wonder. Do you think any insurance executive spends a minute trying to figure out how to assure universal insurance coverage and control system-wide costs? They spend all of their time figuring out how to maximize their market share, their profit margins and executive salaries. That's why they want to insure healthy people, not sick people. It's why they employ armies of people to decline claims, and why they waste tens of millions on advertising. It's why companies like Cigna spend $26 million on their CEO's salary. It's why the amount they spend on marketing and administrative cost is so much greater as a percentage of the total spent on health care than it is under Medicare.

They don't do these things because they are bad people. They do them because those are the rules of the game in the private insurance market. That's how their success and failure are measured. That will not change unless they are forced to compete with a plan that has different incentives -- one that is in business to assure universal coverage and to control health care costs.

The bottom line for Democrats is that when it comes to health care reform, it's not just the sizzle, it's the steak. Democrats are going to get one shot at reforming health care, and that reform has to actually work to provide universal coverage and control costs. Congress may be able to live off of the optics of a plan that won't work for a while, but it won't be long before it will be obvious that the plan either worked as advertised or not.

We can't afford to screw this one up. Democrats need to pass a health care reform bill this year, and we need to be sure that it will really work. Giving people the choice of a public health insurance plan will do more to assure that the system works as advertised than anything else we can do.

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

[MSGH]

Aw c'mon; do you really think the Republicans are willing to take a pro-choice position on anything?

[ChelseaC]

There are three reasons individuals would be against a public option or single payer:
1. They're just plain stupid
2. They're rich/out of touch
3. They work for health insurance medical complex

[kart125]

There are three reason why someone would be for a public option or single payer:
1. They lack the most basic rudimentary understanding of economics
2. They simply don't understand that government is incapable of providing goods and services more effectively and efficiently than private enterprise (even China figured that out)
3. They fail to see the the dichotomy when they complain about government failures, bloat, waste and corruption but then think that same government is going to somehow manage to provide inexpensive, effective, and efficient health care

[neckozihp]

Yes I agree! What Obama proposes for healthcare would do what all his other plans for the economy have done. Ruin it!!!

[quiviran]

That's why the US has the least expensive healthcare in the world for all citizens with the best outcomes. The 36 countries ranked above the US are lying.

[jmpurser]

Yes, the "public option" was a great ruse for the Democratic party. Really stinks for America of course but you can't have everything. First things first and the glory of the party over all!

[robbep]

I suggest if you dont think the government will handle handle care well that you dont select it as your option. That is fine with me but dont try and prevent me from having a choice of the public option. If the private insurance plans are so much better for the country then they shld have no prblms driving the putlic option out of business. I thought free market competition was good for the country.

[quiviran]

Go back to school and post again after you have an actual grasp of the terms you are trying to use. And post in english, not thumb-speak.

[kart125]

If you'd been paying attention, the problem is not the "option" or the " competition." The problem is that government being government, when the government option fails, and it will, it will not simply declare bankruptcy as any other private company would have to, it will simply subsidize that failure with tax dollars, or to regulate it to a point where it becomes even more dysfunctional on a governmental level. This not fair "competition" but taxpayer subsidized failure. And then people then say "I'm ok with using tax payer money to subsidize that failure." Then the question comes back to, again, well if we're going to use taxpayer money why not use it to subsidize successful private enterprise rather than failed government programs. After all, it the goal is to get the best bang for the buck providing health care, shouldn't that buck go to achieving success rather than wasated on government failutre?

[larryinjax]

When we start taxing the employer benefit, the public will choose the least expensive insurance. Are the major health insurance companies be too big to fail

[LarBear]

NEED TO KNOW....

http://www.scientificamerican.com/blog/60-second-science/post.cfm?id=health-insurers-want-you-to-keep-sm-2009-06-03&sc=WR_20090609

Health and life insurance companies in the U.S. and abroad have nearly $4.5 billion invested in tobacco stocks, according to Harvard doctors.
The largest tobacco investor on the list, the 160-year old Prudential company with branches in the U.S. and the U.K., has more than $1.5 billion invested in tobacco stocks.

[capitaldysfunction]

Why all the arguments? Anyone who has used their private health insurance knows that these multi-million dollar CEO salary led organizations make money by denying legitimate claims. Do the Republicans really think I want a health care system run by the same insurance companies that have screwed me on multiple occasions? Meet me at the next election and I'll tell ya how certain I am that I don't.

[blazerlove]

Down with Bipartinsanship! What have the Republicans ever done for the poor of this nation? Why do I care if they like a bill or not? If they hate it: then it must be GOOD!

I say Single Payer or a Public Option with no "triggers" and then crush the rebuplicans, industry reps, and conservative and blue-dog democrats like the sell-outs they are.

I get soooooo tired of conservatives being so mean all the time, and then expect to be at the table. Send them to bed with no supper!

[zukervati]

I can't understand why our POTUS is being so magnanimous with his outreach to the very Rethugs who have their constituency riled up enough to vote against their own interests? It's time to cash in some of the political capital, take some risks and sh0ve the Rethuglican horde aside through decisive action. Screw the blue-dogs, they only care about their seat and not public/POTUS' desire for an equitable healthcare solution for all.

[Carpevinum]

Hey Bob there are 46 Million or so reasons why this option is a good one. And 250 million reasons why it sucks. I don't care what the polls say either. This government couldn't get water to the Superdome for 5 days after Hurricane Katrina and we are supposed to trust them to run our health care system? I also watched Joe Biden on "Meet the Press last Sunday say, in response to the question about why the Obama-Pelosi $1 Trillion Spending Bill that was supposed to create all these jobs and energize the economy, and was actually not doing a damn thing, he said, "We guessed wrong." Hey Bob....get a clue. The American people are nat as stupid as you think they are. Well, at least everyone but the 46 million. They would follow Obama over a cliff if it means free milk money. The rest of us disagree.

[SpiralUp]

actually, it seems like it's just REPUBLICAN government that is inefficient and ineffective.

[Mildmannered]

good point -- republicans don't respect government so why should they be good at governing

[cvwilson]

The Republicans could not get water to the Superdome. When you have people in charge who have a contempt for government and have no desire to have it succeed at anything that is what you get. Read Thomas Frank's "The Wrecking Crew: How Conservatives Govern" for a full examination of Republican incompetence and the reasons behind it. As for the Simulus Bill, you obviously were not paying attention that it is a Two Year stimulus. Even when projects are all approved once local governments get the money for them, they still have to put them out for competitive bidding (please no more no-bid contracts like Halliburton received). Furthermore, employment is always a lagging indicator when coming out of a recession. I am sure you credit Reagan's tax cuts in 1981 for reviving the economy in the eighties. However, the fact is, unemployment kept rising for 16 months after those tax cuts were passed.

[Carpevinum]

When I said "government" could not get water to the Superdome, I did not say or imply ANY party. The government is loaded with people from both sides Wilson. The G-Man is inept. period. I am conservative but not so blind that I cannot see corruption and malfeasance in the Republican party as well as the Democratic party. All people like you see is failure on the right and the left is A-OK. This is very foolish and ignorant. And for every book like "Wrecking Crew." which I read too. there are books that denigrate the efforts of democrats as well. Have you read any of them? And it soulnds as though you know MUCH BETTER than Joe Biden, because those were HIS words on 'Meet the Press' not mine. Maybe you ought ot give Joe boy a call and set him straight. Apparently he is more out of touch than I am. So call him please and share your insighful wisdom with him too. And tell him to read that book. And then we can all hold our breath for 2 years.

[leftjab]

So, you've spoken personally to the 250 mil people that are in love with the current system? I recommend having your head examined by your doctor as I suspect that you have a screw loose. Wait! I guess the lombotamy worked after all. Oh and by the way, we won the election and have one hell of a leader in our president. We will finally get this passed and that must really burn your ass. Trollboy! er Carpevinum.

[Carpevinum]

Actually, I would like to see health care reform passed and then the people will see just how the inept G-man runs the show. I make a very good living and will always have my own insurance and/or money for the best care for my wife and children regardless of how badly Obama gacks it. And he WILL gack it. Oh and by the way, you won the election and have one hell of a Vice President too who last Sunday said, and I quote, "We guessed wrong." Sounds to me like you voted wrong lefty and that must really burn your brain. "We guessed wrong." WOW, what a brilliant man. 3 years and 7 more months of "guessing." I am brimming with confidence.

[gypsy508]

Interestingly the 46 million are the ones who don't have health care now. I'm not sure where the 250 million number comes from.

[SpiralUp]

Join us on Thursday, June 25, 2009 for The Great American Sickout, a National Rally for Health Care For All Now. Congress is acting. They haven't been listening to us.

http://www­.1payer.ne­t/action-a­lerts/313-­national-r­ally.html

I will be there, hopefully with a million other people. They need to see that we're serious, and that our numbers are as significant as their bribe money. The bribe money will do them no good if they DON'T GET OUR VOTES.

[RightsGuy]

There are two main arguments for single payer health care.

THE MORAL ETHICAL ARGUMENT

Health insurance companies make their profit by denying health care to sick people. That is immoral and unethical.

THE ECONOMIC ARGUMENT

The second compelling argument is economic. Our current system of for-profit corporate health insurance has created an unbearable economic burden on the nation.
There are over 1500 separate health insurance companies operating under different sets of rules creating a huge 30 % administrative overhead. For comparison, administrative overhead for Medicare is only 2%.

By converting to a single payer system, we immediately save 300 billion dollars in administrative overhead.

As a nation, we are now paying twice what other countries pay for health care, yet we do not have universal health coverage here in the US. 50 million Americans are without healthcare and 87 million Americans without health insurance at some point in the past 2 years. Almost half the bankruptcies currently filed in the United States are because of medical bills.

Despite the costs we pay, the United States ranks LAST on a list of 19 industrialized nations in preventable deaths, and 29th of 37 in infant mortality. The World Health Organization ranks the US at 72nd for healthcare accessibility and efficiency. We can no longer maintain the status quo for the ways we currently provide and pay for health care.

Tell your Senators that SINGLE-PAYER MUST BE ON THE TABLE AND GIVEN FULL EVALUATION BY THE CONGRESSIONAL BUDGET OFFICE.

[Mildmannered]

good posting. thanks for the facts.

[kart125]

"There are over 1500 separate health insurance companies" - wait, what? I thought the claim was there wasn't competition. 1500 sounds like an whole lot of comptition. And of those 1500 companies, none can find a more inexpensive efficient way?

"By converting to a single payer system, we immediately save 300 billion dollars in administrative overhead."

And add 500 billion dollars in buraucratic overhead, graft, waste, and incompetance.

[RightsGuy]

BAUCUS HAS MADE A DEAL WITH THE INDUSTRY.

Here’s part of the transcript from the video (at 8:33):

BAUCUS: I think everything is going to stay on the table, but big portions will be modified and sculpt. One example is the public option. You know, that's a hot button. And I do suspect a version will be there. NOW, BY SAYING THAT, I DON'T WANT TO FRIGHTEN PEOPLE, PARTICULARLY ON THE INDUSTRY INDUSTRY SIDE, SAY, "OH-OH, HERE THEY GO. BAUCUS HAS SAID PUBLIC OPTIONS," AND, YOU KNOW, THE DEAL IS OFF. All I'm saying is there are ways to skin a cat, there are ways to find solutions, there are ways . . .

RITTER: Politicians have to stop taking money from the insurance companies, and right now they're saying it's not politically feasible because they're still taking money from that big industrial-medical complex, from pharmaceuticals and insurance companies.’



LINDA ALLISON: My name's Linda Allison. I work for one of the large corporations here. But I talk to a lot of people about health care. My question is: so many people go bankrupt using their credit cards to pay for healthcare. Why have they taken single-payer off the plate? And why is Senator Baucus on the Finance Committee discussing health care when he has received so much money from the pharmaceutical companies? Isn't it a conflict of interest? http://therealnews.com/t/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=3719&updaterx=2009-05-28+11%3A55%3A13

[cvwilson]

It is making me angry when I hear senators saying that the votes do not exist to pass a public option. The polls indicate that the support for single-payer is in the low 50 percentile and, as the above article states, support for the public option is in the 70 percentile. Who do these people think they are to tell the American people that they can not have the policy option that they want? Who do these people work for? That I think is the real question here. Whether the issue is health care, Employee Free Choice Act, green economy, banking reform, etc, the real issue behind all of these is Who runs the country? Is it "We the People", as it states at the very beginning of the Constitution, or is it a cabal of corporate interests? Have we become a country like Iran where our elections are just democratic window dressing? Where in Iran's case, behind their window is a theocracy run by mullahs. In our case, a corporate state run by CEOs. I think we are about to find out.

[NPAlliance]

Are you a healthcare professional who is committed to a robust public health plan option? Please join us in petitioning Congress!

www.docsforapublicplanoption.org

We are a diverse group of healthcare professionals and students of the health professions that support the choice of a public health insurance plan as an essential component of comprehensive health care reform this year.

[SpiralUp]

I'm an RN, and I signed the petition. Also:

Join us on Thursday, June 25, 2009 for The Great American Sickout, a National Rally for Health Care For All Now. Congress is acting. They haven't been listening to us.

http://www­.1payer.ne­t/action-a­lerts/313-­national-r­ally.html

I will be there, hopefully with a million other people. They need to see that we're serious, and that our numbers are as significant as their bribe money. The bribe money will do them no good if they DON'T GET OUR VOTES.

[neckozihp]

I am a healthcare professional and I would NOT sign such a petition. I do NOT agree that a public health insurance plan would be good idea. Medicare, Medicaid and the VA hospitals are examples of how poorly the government has done so far in this area. You will probably find the majority of medical/healthcare professionals agree with me.

The following article reveals a very important issue in regards to affordable healthcare:

www.americanthinker.com/2009/06/medical_tort_reform.html

[droftim]

Do you know anything at all about the VA Hospitals or are you just parroting the ideologues in Congress? The VA system gets the highest possible marks for quality and its patients are more satisfied than any private plan.

"The Best Care Anywhere " http://www.washingtonmonthly.com/features/2005/0501.longman.html

The AMA refused to participate in the design of Medicare and Medicaid and now doctors are complaining about its structure. If they don't watch out, the same thing will happen in this round of reform.

[friskee1]

stupid question..out of the 22 debates he had with hillary, most of it on healthcare, when did he ever support single payer? hands anyone??

[gypsy508]

Never. Although several years ago he said it would take a Democrat president and a Democrat congress to enact it.

[droftim]

Obama never did. What he said was that people would be able to keep their existing plans (which is kinda hard when the plan goes away because your company is cutting costs or you lose your job) and that everyone would have the option of buying coverage comparable to that available to Congress.

The only way that he can deliver that in any fiscally responsible way is...Single-payer.

[observer151]

It would also be worthwhile to read this article http://www.huffingtonpost.com/bill-mann/americans-whove-used-cana_b_215256.html and all the reader comments there, after reading Mr. Creamer's post.