Cross-posted at the Examiner.
It´s crunch time in the United States Senate on health care reform. If health care reform has any chance of passing by the end of the year, or more importantly, before Obama delivers the State of the Union address in January, this is the week that perhaps the final compromises will be struck. A lot of deals are on the table as I write, and perhaps the best way to determine the viability and policy merits of the newest ideas being presented is to examine the leverage that progressives ought to have given the trajectory of this protracted health care fight. One compromise in particular presented in recent days should be particularly appealing to progressives and might just finally break the logjam.
Moderate and conservative Democrats pride themselves on being great compromisers, but the truth is that their version of compromise usually means that progressive should compromise until they reach the moderate position. That approach won´t cut it in health care reform. The conservatives would be wise to remember that progressives have already compromised many times over. The original concept of a public option was a compromise, as most progressives and Democrats honestly favor a single-payer, Medicare-for-all, health care system. But as always, the right wing started negotiations over health care from their principled position, while the left started with a compromise. The original concept was that in order to attract moderates and perhaps even a few conservatives, the Democrats ought to present not a single national public plan, but rather a public plan option, one that each individual citizen could choose to join, and one that would provide a not for profit alternative to keep private companies honest.
On the merits it ought to be an idea that appeals to free-market conservatives and moderates. If the private companies really are more efficient at providing health care than the government, as they claim, there should be no reason the public option would be a threat to private insurers. On the other hand, if the public plan proved more efficient by keeping administrative costs down, people would choose the plan. That´s exactly how the free market is supposed to work. And once Congress made it clear that the public plan wouldn´t receive constant government subsidies, but would have to operate only from its own premium dollars, conservatives could no longer honestly argue the government was creating an ¨unfair competition.¨
As these disingenuous conservative arguments against the public option mounted, progressives gave ground. First, the public option wouldn´t be available to every American, only those currently uninsured. Second, instead of the public option being able to offer lower cost services to patients by basing their reimbursement rates on Medicare plus 5 %, the House progressives gave in by allowing the public option reimbursement rates to be privately negotiated like all private insurers do, thus losing the tremendous bargaining power of a Medicare-like program. Third, in order to appease a small group of anti-choice Democrats, the House accepted an amendment by Rep. Bart Stupak to dramatically change the status quo by not allowing insurance plans under the new health care exchange to cover abortion. On the Senate side, in order to appease a small group of 4 or 5 moderate Democrats who do not support a stronger public option, Harry Reid decided to present to the Senate a weaker version of the public option in which states could choose individually to opt-out. And lastly, in order to get the vote of Senator Ben Nelson to simply allow a debate on the legislation, Democrats had to drop the provision to strip insurance companies of their anti-trust exemption, one of the few progressive provisions left in the bill.
All of this means that the public option that is left in the bill is incredibly weak, and even if it passed would have a very difficult time serving the purpose that progressives hoped it would- keeping the insurance companies honest and offering a real not-for-profit alternative to consumers. As it stand the CBO estimates that only 3 or 4 million people would end up in the public option under the Senate bill. That´s hardly enough to make it a true competitor. And this is exactly why progressives ought to strongly consider the most recent compromise being floated.
The compromise would drop the public option. In it´s place the government would allow uninsured Americans to access the Federal Employees Health Benefits Plan, the one that insures members of Congress and all federal employees. All options in this exchange would be non-profit. The alone is hardly a decent compromise since even Blue Cross operates as a non-profit and private insurers could easily game the system. This might however be a strong substitute for the health exchange the Senate and House have proposed creating. Instead of re-inventing the wheel, just allow Americans to access the same choice of plans members of congress give to themselves.
But it’s the second part of the proposed compromise that deserves very careful consideration. There are talks to allow Americans over 55 years old to buy in to Medicare. The most recent Census estimate indicates that nearly 11 % of Americans are between the age of 55 and 65. This amounts to over 30 million Americans. Under this proposal 30 million Americans would now have access to a truly public option, one much stronger than the current Senate version of the public plan. Remember that under the current Senate plan as low as 3 or 4 million people would probably take advantage of the public option. Expanding Medicare would not serve as great competitor to the private industry however, so if this compromise was made, progressive would have to insist that this change was accompanied by tighter insurance regulations, better cost-controls, and an insistence in the bill that insurance companies could not charge patients more based on pre-existing conditions and income.
With all of the compromises that progressives have made during this process, these demands would be perfectly fair. And progressives should remember that all along we have wanted Medicare to be the model for a new public option, and ultimately believe a Medicare-for-all plan would be the far most efficient. This is big step in that direction. It´s not a perfect deal, but at this stage, it may be our last shot at some real progressive reform.