11/23/2009 05:12 am ET Updated May 25, 2011

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., 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