Thank You, Mr. President: The Public Option is Alive and Well

If I was more
arrogant and self-absorbed, I might think President Obama is reading this
blog.  Just about everything I asked for
in my open letter was covered in his speech. And make no mistake; President Obama even made the best case for a public option that I've seen so far.

I know there's a lot of consternation on the part of many progressives about the speech last night. I've seen and heard more hand-wringing in the hours since this speech ended than I could ever have imagined. I even heard an argument that the current reform would "preserve the private insurance system intact," and simply give them 31 million extra customers, which is simply not true. For-profit health insurers don't make money through volume. They make money by NOT covering those who might cost them money, and by NOT covering as many procedures as they can get away with. If 31 million extra customers would make them more money, ask yourself the obvious question;

Why aren't the covering those 31 million customers now? And if those 31 million customers will represent such an incredible windfall, then why are insurance companies fighting reform tooth and nail?

A lot of the trepidation on the part of some progressives is somewhat misplaced. There was a full-blown endorsement of the public option in last night's speech, and an acknowledgment,from a very popular sitting president, that nothing less than full health insurance coverage will be acceptable. He not only insisted that access to health care is a right, but that everyone had a responsibility to buy coverage. Imagine a democracy in which rights and responsibilities are both important. Dare we dream?

President Obama decided to make the public option aspect of his speech more "mission" than "method." I know we're not used to this anymore, but this is how good politics is done. The president doesn't make law, for the most part; he is the executive; he executes the laws that Congress makes. Now, I know "executing" laws took on new meaning during the Bush years, but President Obama is getting back to basics here.

The president distilled it down to one short line:

But I will not back down on the basic principle that if Americans can't
find affordable coverage, we will provide you with a choice. And I will
make sure that no government bureaucrat or insurance company bureaucrat
gets between you and the care that you need.

That, my friends, is a public insurance option. Yes, he left
the door open a crack to possible solutions other than a government-run insurance plan, but he did so because he had to, politically speaking. By stressing the mission, which is to provide an insurance choice to people who slip through the cracks in the rest of the plan, he gave Congress the mission, without dictating the method. Congress does not react well to being backed into a corner and being told what to do.

If anyone can come up with a plan other than a public insurance option
that fulfills the above mission, I'd like to see it. Co-ops come close, but to be quite honest,
the co-ops proposed by Blue Dogs are pretty much the public option with a
"private insurance" veneer; it makes no sense to have private
companies provide low-cost, non-profit insurance options, when the government
is already set up to do that and has the track record. If i know this, so does the much-smarter President Obama.


He did exactly what
he should have done in his speech. As a speech to guide legislation
through Congress, it was an absolute gem. 
He's right that 80% of necessary reforms are pretty well settled; a fact that is absolutely stunning, by the way. It's unusual to see so much reform  contained in one bill.
Whether they like it or not, Republicans will have to learn to live with the

  • Private insurance companies
    will have to accept everyone at the same price, regardless of risk. 
  • Private insurance companies
    will have to provide specific minimal coverage, and can't weasel out under
    any circumstances.
  • Private insurance companies
    will only be able to deny claims if they can prove fraud. If a you and your doctor decide a method of treatment is what you need to improve your health, your insurance carrier will have to pay for it.
  • Cost controls will be
    instituted that will keep a lid on costs within the system.
  • Private insurance companies
    will have to participate in an exchange, and compete in an open, free and
    fair market.
  • Employers will have to
    provide insurance options for their employees, or they will have to pay to
    mitigate the cost of not providing coverage.
  • And lots more…

Therefore, it is quite the miracle that the only
element of health care reform still in play is the method by which the system
picks up the slack and provides an option for those who don't want private
insurance, or those who don't have an affordable option available to them. And
that will require a public option, quite possibly in the form of an extension
of Medicare. There is just no other way to make
sure coverage is available to everyone.


Keep something in mind here. The public insurance option is the only part of the current reform package that could possibly end up costing the federal government money directly.  Every other part of the reform package impacts insurance companies only. Given our level of debt and the depth of the recession, Blue Dog Democrats, all of whom represent "fiscally conservative" states and districts, have to be able to go back to their constituents and show that they "did the right thing," to a certain extent. If the president was
to come out absolutely in favor of the public option to the exclusion of
everything else, then he might actually force those Democrats to side against him, and that could end up dooming him on the entire reform package. By opening up the possibility of compromise, President Obama is actually giving these legislators political cover back home. Now, they can propose something other than a public option first, and then support the public option later, when their proposal is defeated. This is how legislation is made, folks. You have 535 legislators, all trying to please their diverse constituencies, while also doing the right thing for the country.

President Obama made sure he expressed himself on fiscal conservatism, as well. One of the greatest lines in the whole speech was the following:

Add it all up, and the plan I'm proposing will cost around $900 billion
over ten years – less than we have spent on the Iraq and Afghanistan
wars, and less than the tax cuts for the wealthiest few Americans that
Congress passed at the beginning of the previous administration. Most
of these costs will be paid for with money already being spent – but
spent badly – in the existing health care system. The plan will not add
to our deficit. The middle-class will realize greater security, not
higher taxes. And if we are able to slow the growth of health care
costs by just one-tenth of one percent each year, it will actually
reduce the deficit by $4 trillion over the long term.

That says it all. Clearly, concisely, it makes the case that the public insurance option is not only affordable, but that it will save us money in the long run. And it's true. I've already laid out some of the math in another post a few weeks ago. But the president laid it out simply and clearly last night, in a few simple sentences, in a way that just about every middle of the road voter will be able to understand.

But the speech went beyond laying out the specific details of the plan. President Obama also laid out the moral component of health insurance reform in stark detail:


collective failure to meet this challenge – year after year, decade after
decade – has led us to a breaking point. Everyone understands the extraordinary
hardships that are placed on the uninsured, who live every day just one
accident or illness away from bankruptcy. These are not primarily people on
welfare. These are middle-class Americans. Some can't get insurance on the job.
Others are self-employed, and can't afford it, since buying insurance on your
own costs you three times as much as the coverage you get from your employer.
Many other Americans who are willing and able to pay are still denied insurance
due to previous illnesses or conditions that insurance companies decide are too
risky or expensive to cover.


are the only advanced democracy on Earth – the only wealthy nation – that
allows such hardships for millions of its people. There are now more than
thirty million American citizens who cannot get coverage. In just a two year
period, one in every three Americans goes without health care coverage at some
point. And every day, 14,000 Americans lose their coverage. In other words, it
can happen to anyone.


the problem that plagues the health care system is not just a problem of the
uninsured. Those who do have insurance have never had less security and
stability than they do today. More and more Americans worry that if you move,
lose your job, or change your job, you'll lose your health insurance too. More
and more Americans pay their premiums, only to discover that their insurance
company has dropped their coverage when they get sick, or won't pay the full
cost of care. It happens every day.


This laid out the
moral imperative that every American should feel when it comes to health
insurance reform, and he did so in a way that middle America will be able to relate to, and that's important. As I have said repeatedly on this blog, ours is the only
nation in the world that doesn't seem to care about people who are dying or
being ruined because they don't have insurance. I know that can't possibly be
true, but that's what it looks like.


We have a moral
obligation to fix this because of the human toll. People are dying and lives
are being ruined, and this is supposed to be the United States of America. When
things like that happen, we're supposed to fix it.  Not only that, but it's costing us money;
more money than any other country on earth, even though about one-fifth of our
nation has no medical coverage at all. None.

What President Obama did last night was to make his case to the average working American, who don't have the time or the energy to study this issue to a great extent. These are the people we have to reach in order to get real reform through, whether it's health care, or banking reform, or anything else. Getting health care reform through has always been something of an uphill battle, but it's especially difficult during a deep recession. What the president did was assure people that he wasn't going to go full-bore into a plan that will raise their taxes and put the country into greater debt. He assured them that their coverage would not be lost, and that it would actually get better under his plan. In other words, he assured the 80% of Americans  who have health insurance coverage that things would only get better under this reform plan.

The public insurance option got more of a boost last night than it's had in a couple of months, but you have to open your eyes to see it. The president did a masterful job last night, and re-energized the reform movement in a very profound way. Kudos to him, and thank you, Mr. President. 



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