by Bill Kavanagh: As you no doubt know already, the
public option as an essential element of healthcare reform has been under
sustained attack. Not only did the town hall Astroturf commandos decry
the public option as part of a “government takeover” of healthcare, but soon
afterward, the insider oddsmakers in Washington declared the public option
dead-on-arrival, even as a substantial majority of the House of Representatives
supported it, along with most Americans polled on the subject.
While
the public option would provide competition the private health insurance market
currently lacks, it’s become clear that passage of it will be a monumental task
in the Senate. One way to do it would be by the same method President
George W. Bush got both of his huge tax cuts for the super rich: by using
“reconciliation,” a parliamentary procedure that bypasses the promised
filibuster by the Republican minority. While the reconciliation process
has been used by both Democrats and Republicans, the current Senate majority
and the President are reluctant to push through a monumental healthcare bill
without any Republican support.
Other
options to pass healthcare with either no public option or a severely hobbled
version of it are viewed as a cop-out on the promise to truly reform the
system. With all the momentum gathered to pass a healthcare bill this
year, it would leave tremendous disenchantment among supporters to end up with
a bill that didn’t actually make the health insurance market more competitive
and affordable for most Americans. It would be particularly hard to
explain to those who now lack affordable insurance and the easier access to
care it provides.
There
are those who argue that any substantial reform that includes the nationwide
elimination of “pre-existing conditions” and moves towards full participation
will eventually lead to a better system… over time. They posit that what
isn’t passed now will be easier to obtain once healthcare is viewed as a right
by most Americans and the reform process continues over the coming years.
This position doesn’t address all those whose health is endangered today by a
lack of healthcare or by poverty produced by a bankrupting experience with
illness.
Now,
there appears to be another option to pass a reform bill with a public option,
but without the highest level of conflict— a public option with a
state-by-state opt-out provision. Nate Silver at fivethirtyeight.com has
posted some reasons to consider a public option with an opt-out for states that
choose not to offer the choice to their citizens. I’ll be honest, I
haven’t explored comments on the proposal outside of Silver’s on the subject,
but at first glance, it sounds like the best compromise short of a “clean”
public option bill. It has the beauty of leaving the workings of the
public option alone (not hobbling it as other compromises would do) yet making
it more politically palatable to Senators who fear voting for its inclusion
universally.
As
Silver notes, making the public option the ‘default choice’ would be a powerful
way to encourage most states to remain opted-in. The presence of the
public option in most areas would encourage even conservative states to offer
this alternative that would be available to residents of nearby states.
And the power of the public option where is would actually be in effect would
be undiluted. No hobbled plan to make the insurance companies
happy. The main attraction of the public option—the negotiating power to
offer care at low rates— would remain.
Perhaps
this is the “magic bullet” necessary to pass a true reform bill. Maybe
not. But meanwhile, outspoken progressive support for the public option
remains the only bulwark between the insurance lobby and a Senate cave-in to
their demands.
I have no doubt that there are millions of Americans who support healthcare reform of some kind. In fairness, Republicans have been trying to chip away at Medicare for generations with plans for Health savings accounts and efforts in the private sector. Democrats have been pushing for a government-run plan for generations. Conservatives have been calling for tort reform for decades. Liberals have been insisting that we move toward a single-payer model since the Great Depression. Americans clearly want something to be done in regards to healthcare reform, but does this mean that they want an entirely new system or to hand over the current system to the federal government? Of course not.
Americans want the best value for their healthcare dollar; they want competition, they want choices; they want to know that their doctors and health professionals have their best interest in mind; they want affordable healthcare coverage; and they want to be able to refrain from purchasing it if they so choose. The truth is we do genuinely need healthcare reform on some level, but assuming that the public option is the something that all Americans are asking for is simply misguided and deceptive. Just because Americans want something does not for a second mean that they want Everything.
http://republicanredefined.com/2009/10/19/something-start-meaning-public/
Posted by: tchristopher | October 19, 2009 at 01:24 PM
If we can look to the polls for what Americans say they want, they DO want a public option, which is competition for the private insurers. It's useful for those who would like to derail reform to say that it's all murky and that we don't know what Americans want, but it's also, as tchristopher puts it, "simply misguided and deceptive." A public option is consistently supported by majorities in polling on the issue.
As for "handing the system over to the government," that's simply not what a public option is. Reform that includes a public option would not force anyone happy with their current private insurer to change their provider. I agree that we want the best value for our healthcare dollar. Why not let us choose?
Posted by: Bill | October 19, 2009 at 02:31 PM