Public Option Is Not Essential
If health reform legislation does not guarantee a public option, could progressives support it, in good conscience?
I hear this question a lot. My answer is yes -- so long as the bill provides millions of low-income uninsured with affordable, comprehensive health coverage.
To be clear, giving consumers the choice of a public option could be a critically important check on high prices charged by private insurers as well as discrimination frequently encountered by people with health problems. If proposed insurance regulations that are part of health reform legislation fail to curb these practices, a public plan could offer consumers a relatively humane and efficient alternative. Most people support such a public option, and the main arguments against it involve absurd fantasies about a government takeover of American health care.
But what happens if the public option falls to the cutting room floor as health reform moves forward? Should Congress "kill off any legislation that doesn't have a public-insurance option"?
That depends on the legislation. Nearly 50 million people in this country lack health insurance. Many are people of color. Most are low-income workers and their families. These Americans work hard, sometimes holding down multiple jobs. Yet they are cheated out of the dignity and security of knowing that they and their families can see a doctor or fill a prescription when they get sick.
Of course, the consequences of uninsurance go beyond indignity and insecurity. All too often, uninsured women with breast cancer have their disease diagnosed too late for effective treatment, because they can't afford to go to the doctor. Uninsured adults with diabetes and high blood pressure can't afford to fill their prescriptions, with grim and sometimes fatal results. In 2006 more than 22,000 preventable deaths were estimated to result from a lack of health insurance; that number is doubtless higher today.
So suppose health reform legislation provides health coverage to tens of millions of low-income people -- but it fails to guarantee a public option. Maybe the legislation contains a "trigger" that creates a public plan if the insurance industry fails to perform. Maybe it offers consumer-owned health insurance cooperatives rather than a Medicare-like public option. Should progressives oppose such a bill?
Two thought experiments may shed light on this question. First, imagine that Congress is considering a major expansion of the food stamp program. The bill could greatly reduce hunger in America. Would progressives nevertheless fight to defeat the legislation, since, in buying the products of major corporations, food stamps merely line the pockets of industry? Not very likely. MoveOn.org, for example, has campaigned to stop food stamp cutbacks, despite increasing criticism of the food industry for a range of troubling practices.
Here's a second thought experiment. Imagine you're with dozens of your uninsured neighbors, low-wage workers with chronic illness. Maybe they clean your office building, care for your children, or help with your dry cleaning. Facing you are two buttons, green and red.
Push the green one, and your friends and neighbors get health insurance. Chronically ill parents survive and get to know their grandchildren.
Push the red one, and these low-wage workers remain uninsured. Some needlessly suffer severe illness. Others die, and some of their children grow up without a parent. Either way -- whether you choose red or green -- there's no public option.
Which button do you push?
The answer is clear. Legislation that provides affordable access to essential health care for millions of low-income, uninsured Americans deserves strong progressive support -- even if that means the fight for a public option continues into the future.
Cross-posted from The New Health Dialogue Blog
Dawn Teo: Humana Mailer Targets Elderly, Claims Medicare Benefits To Be Cut
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Permit me to baldly state, forgo the public option and you doom any motion toward a single-payer plan for the rest of our lifetimes. Given the the current proposed laws wouldn't cut in for four years in any case, long enough for them to be burnt to the ground by a hostile Administration, I'd rather put off a vote on Mr. Dorn's substandard insurance bills and try again next year or in the next Administration. The law he supports would do precious little for anyone save the insurance companies, believe me. The upside he offers is minimal and the downside immense.
See Stan Dorn's Profile
If the legislation does nothing more than force people to buy insurance, I agree that it would not be worth supporting. Fortunately, the proposals under consideration provide subsidies to help low-income people afford coverage. This includes a major expansion of the Medicaid program to cover adults with incomes up to 133 percent of the federal poverty level, millions of whom are ineligible for Medicaid today. These are the very poorest uninsured, who, under pending proposals, would receive comprehensive coverage, without premiums, deductibles, or copayments above the nominal level. Low-income people with incomes above this income threshold would receive subsidies, but it remains to be seen whether they will be sufficient.
At this juncture, progressives should be advocating, not just for a public option, but also for very strong subsidies for low-income people. But the legislative process will not give us everything we want. What do we do then? I think it is far too facile to say, without considering other aspects of the bill, that without a public plan, progressives need to oppose reform legislation.
Throwing money at bad insurance componanies by way of the poor is hardly reform.
I had a heart attack two years ago - I had a bare minimum of (employer provided) health insurance. I got stuck with a bill for $20,000 - my annual income. According to Medicaid standards in the state of New York, BTW, on my income (>200% the poverty level) I should be able to provide for a family of 12 - so I'm not eligible.
What do I want? Health care. What does your plan give me? Nothing.
There's much more to be addressed in this situation than simply providing a low cost public option; but without that, you have a recipe for disaster in a mandate.
What you're saying amounts to this:
"The poor are not covered by health insurance - so let us at least force them to buy health inusrance from private insurers who will cut them off as soon as they get sick, hunt them down and expell them for pre-existing conditions, and raise their premiums far beyond their capacity to pay. Then they will be covered by health isurasnce, right.?"
NO.
NO MANDATE, NO REFORM WITHOUt PUBLIC OPTION.
Address the real world please, not your insider's blue dog fantasy.
(You don't get it - if you don't insist on public option (single payer preferred, but that's the compromise) then you're not on my side, and I owe you nothing.)
OH MY!!!!
Let's settle down and think this through. The art of politics is not pretty and includes working with people you cannot stand. So what to do? Democrats have not cooperated and worked together on this health initiative. They are all over the place. Do you want nothing? Do you want uninsured and under insured to go without? Do you want our Nation's health care to continue to slide to the bottom? Yes, continue to lobby for a public option. Yes, put the squeeze on congress by making calls. BUT, let's not leave the playing field if it does not go entirely our way.
NO.
Without a public option, a mandate to buy insurance is essentially corporate slavery -- AND guarantees maximum expense to the taxpayer.
Without a public option, I do not call it "reform." I call it a DISASTER.
I completely agree with the article.
We all want a public option. We all want universal healthcare. How do we get there? By give and take. That's how our political system works.
This is a once in a generation chance to cover a huge percentage more uninsured and set the nation's course towards more...a public option and then single payer.
If we lose this chance because we stick to our guns and say all or nothing, then shame on us.
I completely agree with the article.
We all want a public option. We all want universal healthcare. How do we get there? By give and take. That's how our political system works.
This is a once in a generation chance to cover a huge percentage more uninsured and set the nation's course towards more...a public option and then single payer.
If we lose this chance because we stick to our guns and say all or nothing, then shame on us.
We all want a public option. We all want single payer. How do we get there? In steps! That's how politics works. You give, you take, and you make progress over time.
If we blow this once in a generation opportunity to cover a huge percentage more uninsured because we said all or nothing, then shame on us.
I totally agree with the article.
> Should Progressives in Congress kill any health care
> legislation that doesn't have public insurance option?
Yes, definitely.
Unless they stand up for the Public Option, the weak-willed Dems will cave on it, and give the Republican minority literally everything they are demanding.
So, as the House is proving by standing firm on the Public Option, if the White House wants to play chicken and risk having their limp compromise bill defeated, they are going to have to include a public option. Not a trigger, not a cop-out co-op plan, not a do-nothing insurance reform/mandate bill.
The problem is we should have been pushing full-on Single Payer the entire time. That way, the "compromise" would have been the Public Option. Instead, they gave up on Single Payer without even trying, and the "compromise" is another do-nothing giveaway to the insurance companies conservatives are so desperate to accomplish.
OK. I'll be flexible. If I can't have the public option, I'll take single payer. Medicare for all would be fine by me.
Otherwise any plan that requires individual mandates without competitive pressure is going to lead to skyrocketing costs for consumers. Rates may be pushed down, only to have out of pocket costs and denials of coverage go up. If the middle class isn't to benefit at all, why not just raise the income ceiling on Medicaid?
Individual mandates must exist on the condition that a plan that is available to everyone, from the day the mandate goes into effect, that is strong enough to go toe-to-toe with insurers exists.
But I'll take the Medicare for All option as well. Because I'm flexible.
See Stan Dorn's Profile
It’s fascinating that people see no shades of grey here. Massachusetts passed legislation in 2006 along the general lines now proposed in Congress – subsidies to help low-income people buy insurance, an individual mandate for people to buy coverage unless it’s unaffordable, a health insurance exchange in which people could choose from a number of different plans, etc.
Less than 2 years after the law passed, the proportion of uninsured residents dropped to 2.6 percent – the lowest percentage ever recorded in an American state. Among low-income residents, the proportion without any usual source of health care dropped by a third. The percentage forced to go without necessary health care because of cost dropped by 10 percent.
The percentage of state residents who support the law rose from 68 percent when the law passed to 72 percent in 2008.
The Massachusetts law does not have a public option. The only choices are private. Does that mean they did the wrong thing to pass this law?
I want to see your donor list. Somehow everyone who comes out for captive consumers (individual mandates) without competitive pressure (the public option) receives a substantial portion of their funding from the pharmaceutical and health insurance industries.
So where's the link that says where the Urban Institute gets it's funding?
See Stan Dorn's Profile
I'm doing this on my own time, not on Urban's nickle. But since you asked, most of Urban's money comes from foundations like Robert Wood Johnson, Commonwealth, etc., or from federal government contracts. My colleagues at Urban have written and spoken ardently in favor of the public option, as you can see from one of the links in my original post. I favor the public option as well. But I know that the final version of the legislation will fall short of our hopes. The question we need to think about is - what then? Do we really think we'll get something better after the 2010 elections?
Have you ever wondered why it's so damned difficult for congress to pass legislation that the public wants? By polling, 77% of us want, at the very least, a public option. I know why and so do you, we may own their butts, we do pay their salaries, but their souls belong to the highest bidder. (I had another word in mind for butts, but I wanted this to post.) Right now, the highest bidder is the health insurance industry. If we allow a "compromise?" that sends billions of tax dollars to these crooks who have spent their lifetimes stealing from us, that would be a capitulation instead. We would no longer be customers; captives would be a more accurate description of our state.
If the legislation were to establish a public option that the public could freely select, the gig would be up for the private health insurance industry, and they know it. They are keenly aware how unfair they’ve been with their customers and they seek to escape the consequences of their past actions. They also know that the wheels are falling off their bus. As health insurance becomes even more expensive the drop off of their customers will become significant, affecting the bottom lines of their companies. Those, who like me demand a public option or nothing, are counting on it.
OK! It feels very good to rant about the corrupt system and the money that buys votes, but let's be practical. ALL or NOTHING? I don't think so. Stan is absolutely right. This is the world we live in. A legitimate question to ask is: how can we cap the amount insurance companies and public option/coo
The public option, as well as this insurance reform in general, is not there to get people to buy insurance. It's there to control costs.
The public option will allow the government to offer a plan, just like it does with the already highly successful Medicare, which will compete with the for-profit options.
Conservatives have been saying for decades that government can't do anything right, and that the "free market" is ALWAYS better. So then, why are they so desperate to avoid putting that to the test?
"Public option" IS the shade of grey. We've surrendered as much as we can and still have a viable health CARE reform (and not just a juggling of the market place).
Keep telling yourself that.
I for one am disgusted with how lobbyists and corporate America have are trying to take over our party.
And how there are those that are bowing their heads to that in our party is beyond me.
No PO, kill the bill, we can't let the DLC and Blue Dog Democrats get away with selling our party to the highest bidder.
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Might I add that Republicans, having enough sense to see that they aren't going to be able to stop the passage of some kind of "reform," now require for their political purposes only that it is guaranteed to fail.
"Reform" which preserves virtually all of the structures causing the failure of our present system while merely adding mandated coverage for the hated poor? The Republicans would thank you for hedging their bets with your money.
Remember Obama asking that we "make" him accomplish those reforms we elected him to put in place? Make means make. He has to see the blood in our eyes. He has to understand he dare not call bluff. Tell him you'll accept less and you will certainly get less.
Your food industry vs. insurance industry argument is bogus! Food industry at least fdoes some real vslue-add. Also, food stamps can be used to purchase fresh items and seeds and plants to grow one's own food. There is no option like that in the insurance industry.
Value-add like what, salmonella? E. Coli?
That's right. As long as something that appears vaguely rabbit-like emerges from the top hat, we should infer that magic has happened--even if the "magic wand" looks suspiciously like a pencil topped by the nub of an eraser.
All that's really necessary is to make health insurance affordable by fiat. We don't need no stinkin' mechanisms.
With single-payer conceded at the outset and the public option being diddled to death, the idea that 46 million Americans are going to obtain insurance--EVEN IN NAME ONLY, let alone that which both usable and affordable, is not just naive. It's TERMINALLY naive (and that's as charitable as I can be). What we'll end up with is a bill that encompasses those basic reforms (pre-existing conditons, etc.) over which no one has been arguing and makes insurance purchasable for entrepreneurs. We'll achieve coverage for 20-25 million, leaving the poor holding a flaming colostomy bag.
If a true and functioning public option is left out of this bill, most Americans will lose nothing by insuring its defeat--and the Democratic Party will deserve its fate.
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