Monday, August 17, 2009

Losing the Public Option

Having a healthcare bill pass without a public option inspires a valid question, what's the point? Or, in more detail, how do you inspire the changes and efficiencies you need in the current health insurance market without introducing a robust competitor whose focus is on providing care and not on profit? But perhaps losing the public option, at least the hobbled option that would pass under the current reform bill, isn't as bad as you think.

The number of compromises that were being injected into the public option to keep it from being effective, or even competing on a level playing field with for-profit competitors, were worrying. It may in fact be more productive to walk away from those demands and side deals, passing a cleaner version of a public plan in future years. The public plan was to be entirely separate from Medicare (why?), was to be forbidden from negotiating drug prices (why?).... Rhetorical questions - to make it less effective, more costly, and less able to price compete with private insurers who don't face similar restrictions.

I acknowledge the retort that if it doesn't happen now, we can't count on it happening in the future. True. But we can count on the trends in private insurance continuing - the dropping of high cost patients (sometimes in flagrant violation of contract), rapidly increasing premiums, employers finding themselves unable to offer quality plans or perhaps any plan at all, people being made more and more responsible for their own medical expenses - whether or not they can afford them. Stripping out the public option is meant by the insurance companies and their captive congressmen to maintain the status quo - but the status quo is not sustainable.

Don't get me wrong. Killing the public option is cowardly and backward-thinking, the type of thing you would expect from a Member of Congress whose primary concern is the size of his campaign coffers. Those who stood in the way, or might stand in the way in the future, should be rewarded with primary challenges. But it may be more important to end the hysterics, let Obama move on to other parts of his agenda, and figure out how this issue can be more successfully addressed in the future.

If a public plan is postponed, the Democrats should evaluate what can be done through reconciliation. Can Medicare be expanded to let older workers buy in, at an unsubsidized rate, for a full or partial set of benefits? Could it be expanded to provide an administrative framework and national care provider network for insurance companies organized at the state level? Could it at least be rebranded with in-your-face tagline, such as "Medicare: Government Health Insurance That Works For You!"

Meanwhile, where's the Issa-Kingston "Federal Cafeteria Plan for Everyone" bill?


  1. Why can't just those why pay taxes get health b'out that Obama and the rest of the health care reform starters??? NO seriously, this I could be in favor of, but not just letting any old person that comes to America, even the illegal’s to get health care and our taxes go up the roof???? No, sure, I will cont. to fight this...

  2. You do know that the proposed reforms do nothing to extend health insurance to illegals, don't you? Who's trying to get you worked up over a non-issue?

  3. Actually, it is currently a ubiquitous issue, not a "non-issue."

    Health care reform that aimed to reduce cost could always include provisions to reduce the number of people covered . . . of course that would seem to fly in the face of "universal" coverage and of much public health theory . . . but hey, it would cut costs short term at a minimum . . . and if you incorporated laws that prevented hospitals from providing e-room care to people who can't pay for it you could generate great cost savings.

    You would probably go to hell for doing it (great cost savings come at the low, low cost of someone else's pain and suffering . . .), but hey, if you don't believe in that . . . : )


  4. It's a non-issue in relation to the legislation under discussion, let alone in relation to the "public option" that may or may not follow from that legislation. Maybe the legislation should address care for illegals, or whether EMTALA should be revisited, but it does not.

    Is it an issue in other contexts? Sure.


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