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, progressives did.
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.