As anyone who has
read this blog knows, I am a huge proponent of the inclusion of a public
insurance option in any health reform moving through Congress. I keep wracking my
brain, and I simply cannot figure out how to keep the private insurance
companies in the game without a government option to keep the risk
manageable. In a perfect world, I'd love to see a single-payer government plan, but we can't honestly afford the transition at this point, so a "perfect world" will have to wait. In the meantime, a government health insurance option is a necessity. But we cannot afford an obsession.
I was around in
1994, and let me assure you; Harry and Louise didn't kill the Clinton health care plan,
Yes, folks; the
reason we are no closer to a universal health plan now than we were in 1994 is
because of US. And I'm starting to see signs that it might be happening again. I'm starting to get nervous again,
for the first time since this process began.We simply cannot blow it this time.
For those with short memories, let me remind you that Bill Clinton was not a favorite of
progressives back then. A lot of people, including yours truly, were only
moderate supporters, and only supportive because he wasn't a Republican. After
12 years of ReaganBush, he was better than nothing. So, when Hillary Clinton
presented her health reform plan, it was panned and criticized by the
progressive community as "not enough."
The Clinton plan
attempted to bring universal coverage to
the system through employer mandates and a health insurance exchange. Sound
familiar? And if one wanted complete reform in one fell swoop, it fell short.
But it would have started the reform ball rolling, and it would have made
future reforms easier. But progressives
stayed silent. The right had Harry and Louise, and we had crickets. Now, 15
years later, we see the results of that wonderful move, and now, we're facing a desperate situation, needing a health insurance reform plan just to survive as
a nation, and we're on the verge of doing the same thing again with our obsession with a "robust public option" over everything else. Seriously,
folks; this is life and death now; we need as much reform as we can muster at this
time; do not get so hung up on the phrase "robust public option" that
we end up screwing ourselves in the end.
Don't get me wrong;
the public option is necessary for complete health care reform. There is no
question of that. But there are a lot of other reforms in the bills currently before
Congress that are just as important. In fact, combined, they are MORE important
than the "magical" public option. Think about what the current
proposed reform does, apart from creating a public insurance system:
- You will have a choice of
insurance companies, all competing for your business;
- You can go to any doctor,
without having to secure insurance company approval beforehand;
- Private insurance contracts
will no longer be between you and your employer; you will contract
directly with the insurance company;
- You will know what is covered
because, for the first time ever, insurance companies will have to cover
all medically necessary procedures;
- Insurance companies will have to cover everyone who applies, offer three plan levels and not jack up premiums for "high risk" customers;
- Insurance companies will only be able to drop policyholders for non-payment; no more dropping the sick in favor of the healthy;
- Insurance companies will no
longer be able to deny valid claims for health care procedures deemed
necessary by your doctor, unless they can prove fraud;
- All employers, except those
of REALLY small companies, will have a mandate to provide health insurance
under the Exchange;
- Premiums have to be
affordable to employers and employees;
- Employers pay 76% of premiums;
- Those who are under a certain
income level will get assistance to pay their premiums.
In other words, if
the public option was stripped out of the plan today, there would still be a
LOT of reform in these bills, and it would solve about 70% or more of the
problems with the current health care system. Our system is so broken that we
can't afford to lose a 70% improvement in the system.Therefore, the progressives'
current obsession with the phrase "robust public option" worries me
to death, for a very basic reason;
Which of the above
reforms are we willing to give up in order to keep the public health insurance
option on the table? Do we give up the employer mandate? If we do that, then
what meaning does a public insurance option have? If employers don't have to offer insurance, then we'll have another insurance available that we quite possibly won't be able to afford.
Do we give up
the insurance company mandates on coverage, and allow private insurance to continue their current
practices? They already don't give a damn about covering 47 million people, and they don't give a damn about covering those people who are paying them. Why would the mere presence of public insurance "scare" them into doing the right thing?
Do we give up on the Exchange, and allow private insurance to
dominate a region or state, as they do now, and simply add a "government
option," if you want it? Surely you've been to the grocery store and seen
the looks of derision shown to people who dare pull out a government debit
card; do we want to see that happening with health care?
We need the full
spectrum of health insurance reform that is offered in these bills. Without all
or most of the components, we won't see much reform. But a lot of
people are nervous about a public health insurance system, some of them
rightfully so. And if we allow any or
all of the other reforms to be tossed out in favor of a public insurance
option, then we will have demonstrated that we haven't grown up since 1994, and
we might end up doomed to the same system we have now, and that we stuck
ourselves with 15 years ago.
The public option is
an important component to this, and I'm not saying it isn't. But the thing is, if we pass all
of the rest of the reforms Congress is considering, private insurance will be
begging for a public insurance system within a few years, anyway. Employers will be mandated to provide
coverage and pay for most of it; private insurance companies will have to
compete in an insurance exchange, they will be limited in what they can charge, they will no
longer be able to turn anyone down or cancel anyone except for non-payment, and they will have to cover
everything short of fraud. I don't know about anyone else, but I can't imagine
a for-profit insurance company operating under such conditions without crying uncle at some point. Given the increased risk they would have to bear, at
some point the insurance companies themselves will be begging for a public
plan. At that point, all we would have to do is expand Medicare and make it
available to everyone under 65, as Thom Hartmann suggested a few weeks back,
and there will be very little controversy over it at that point.
The point I'm trying
to make is this; be careful not to throw the baby out with the bath water.
Fight for ALL of the reform, and don't get bogged down in a "robust public
option" obsession, and let much of the rest of the bill go down in flames in order
to get it. It's estimated that upwards of 25 million of the current 47 million
people currently uninsured would be covered on day one, even if HR 3200 passes
without the public option. On the other hand, how many of the 47 million would
be covered if a public insurance option is added to the status quo, without
most of the other reforms? I haven't seen that study, but I would suspect it
wouldn't be any more, and might even be less, as "government
insurance" takes on the same stigma as "welfare" and "food
stamps" has now. And let's get real; if all we have is a public insurance plan, and
neocons ever find themselves in the majority again, you know what'll happen. They would just "starve the beast" and bring the public insurance plan to its knees, thus demonstrating that nothing the government does works out.
Fight hard for a
public insurance option, but realize that all of the other reforms are just as
important, and together actually constitute much greater reform than the public
option. Don't make the same mistakes progressives made in 1994.The country can't afford it.