The public option has taken on a mythical status. For many people, health care reform will be deemed a failure if the President signs legislation without a public option. That's problematic.
The public option was never a coherent, well-defined policy tool. Instead, it was an amorphous concept that stood as a symbol of reform and as a perceived antidote to the greed and callousness of the insurance industry. However, deputizing the public option as a health care reform litmus test ignores the other policy-changes that need to be enacted for health care reform to succeed. Right now, health care reform in the US needs substance, not symbolism. A robust public option is important, but it is not the only ingredient necessary for health care reform to succeed.
It's understandable why the public option has become the focal point of health care reform. The health care reform bill that came out of the House was 2,074 pages long! A public option is an easy reference for anyone who doesn't have three spare days to read the bill in full. A public option is easy to identify, it has a nifty title and it's intuitively likable. And, the public option was a gesture of good faith from policy-makers that paid homage to those who wanted a single-payer system like the British National Health Service.
The problem with elevating the public option to mythic proportions is that we are putting stock in a symbolic policy that never had a stable definition or a clear purpose. A public option became everything to everyone. At various points in the last year, the public option ranged from being defined as a choice of Medicare for all, to a non-profit insurer that was steered by the health secretary, to limited government run insurance plans that were to be run by each state.
Commentators highlighted polling that said that the majority of Americans favored a public option, but the polls never defined what the public option that they were referring to actually was. Because politicians knew having a public option was important to voters, they sought out ways that they could honestly say they had a public option in their bill, even if it meant overlooking other necessary aspects of reform. As a result, we got watered down public options, we got talk of triggers, we got state opt outs and we haven't seen enough progress on the issues that matter like reforming the way health care is delivered, making the insurance industry more competitive and putting in place tough regulations on insurers.
In health care reform, there are a number of ways to achieve the same goals. The public option was touted a vehicle increase competition, but we forgot that another way to do it was to repeal the 1945 McCarran-Ferguson Act that provides federal antitrust exemption for insurance companies. The public option was talked about as a tool to reduce costs. However, another (and a possibly more effective) way to reduce costs is to create a tax on high-cost insurance plans and to establish a non-political body that sets Medicare reimbursement prices. The public option was supposed to be a way to guarantee access for everyone to some form of insurance, but another option for guaranteeing access is to ban insurance companies from denying coverage based on pre-existing conditions, mandating insurance coverage for every American and regulating the insurance market much more heavily like they do in Switzerland and the Netherlands (including regulating prices for medical procedures). Finally, perhaps the most effective way to improve health care in the US is by changing the incentives in the system from providing more care to providing better care and promoting preventive medicine. A watered down public option would be a symbolic victory, but it wouldn't prompt the kind of changes we need.
Health care reform is too important to fail. We need health care reform for the tens of millions of Americans who are uninsured, for the hundreds of millions of Americans who have seen their insurance premiums go up while their incomes have gone down and for the plethora of others who need better access to high quality, safe medical care. Finally, we need health care reform for the larger economy. Commentators have said that President Obama should focus on the economy, not health care, but, in reality, health care is the economy. We need health care reform to get the budget back in order, to allow Americans to have the freedom to change jobs and so that insurance premiums don't continue to eat a higher proportion of wages year after year.
Right now, we've got a choice to make. We're coming down to the wire on passing health care reform and unfortunately, policy-making means compromise. The questions we need to be asking ourselves in the policy push for the goal line are: 1) whether getting a public option is a symbolic victory or is instead vital to health care reform?; 2) what constitutes successful health care reform?; and 3) if achieving moderate, but significant progress reforming the US health care system trumps going down in flames in the name of crafting the perfect piece of legislation? In my opinion, the perfect can't be the enemy of the good.
We'll get a Public Option alright and a lot of people, projecting their idea of what a PO is, will be mighty pleased..
But, when the finally figure out just what it is and just what it doesn't do, they are gonna be mightily ticked and looking for someone to blame.
That's when it became clear that the concept of the PO had indeed been clearly known since probably March, to a great deal of people in DC, who had been lobbying against the concept since probably before Obama's inauguration. Only since the Sept. speech has the PO become some kind of mythical circus.
the public option is not a "sideshow" ~
it is a critical part of the equation.
and it's kind of a red herring that it's not yet clearly defined.
of course it's not yet clearly defined ~ the proposals are still being refined.
but regardless, calling it a "sideshow" is simply dead wrong.
What the #$@% IS a public option?
So far, you'd stand a better chance of nailing jello to the wall than getting a definitive answer to that.
I suspect it's nothing more than a buzzword meant to pacify us long enough for the for-profit insurance companies to fleece us yet again.
Exactly. The "public option" was a device to misdirect attention while Obama killed health care reform. That's all it ever was. However, by not clearly defining it, merely defining what it would magically do, he allowed everyone to imagine it differently. And since there was certainly no reform in anything ELSE he was proposing the "public option" (never designed to be either) became the repository of the magical and mythical "reform".
Folks, the "public option" was, is, and forever will be, a lie. That's all. It's something shiny to distract the public while Obama and the DLC Democrats killed single payer.
It was a con. That's all it was.
Single Payer was and is the real deal health care reform. And until someone comes up with another idea that makes as much sense as single payer it will remain the real deal.
It's simply dishonest to the debate implying that rooting out Medicare corruption today can't happen and that it has to come in the form of a mega bill. If you don't understand this then you're being hoodwinked. If you do understand it then what you're saying is that it's okay for the government to be corrupt (not root out corruption) as long as I get what I want in the form of a bill for the near term. Or one is simply conceding that it's impossible to root out Medicare fraud on any meaningful level (before or after a bill), but including this as a factor in order to pass a government option is...well, it's okay to do
that! Corruption and lack of weeding out corruption is the biggest health care killer of all (this is true if you really think about the consequences of where these lost billions could have been put to use).
So, about the bill, caveat emptor, a bill isn't necessary to weed out corruption.
Real health care reform is simple: Expand Medicare to cover all Americans. It's easy to understand, it's cost-effective, and it would provide better access to health CARE (as very much opposed to health "insurance") for a lower cost than what we're getting, which is a mandate to purchase overpriced under-coverage. However, Medicare For All will not be passed because it does not benefit private insurance companies--at least, not as much as delivering up millions more captive customers will swell their coffers.
As for "the perfect being the enemy of the good," how does that apply when the current legislation is not good in the first place?
Oh, if only there was some example of a universal health care system to be found in the world. Some other countries who have had different types of single payer systems in place for decades we could study.
Oh, if only we had our own type of government run example in the US. Something millions of Americans have used and given top marks for, oh say, 40 years? We just can't figure out how this universal health care stuff is supposed to work.
Ugh! It just makes you want to weep.
However, I believe it was used exactly as those who promoted it intended. They wanted to take real reform off the table, substitute it with this vague notion which would have the dual effect of forcing reform proponents to rally round false reform while the Right attacked the Public option as if it were single payer type reform.
So essentially, negotiations started Center-Right and have moved further Right without having had any debate on the real reform agenda (mostly Left). The Public Option was and is a classic Red Herring.
It is possible for there to be "reform" that is worse than nothing. And that appears to be what we're going to get.
(And now the Federal Reserve chairman is proposing raiding Social Security in his confirmation hearings - is there any doubt the base of the Democratic Party will not be supporting Democrats in the 2010 election without a major course correction?)