Via the indispensible Don McCanne, from the cat food commission report-out and discussion on CSPAN yesterday:
Sen Dick Durbin (D-IL): We are hastening the day when the only option left will be a public option.
Rep. Paul Ryan (R-WI): I think Sen. Durbin probably said it right. We are hastening the day when the only option is the public option. I think you're right (directed to Sen. Durbin), and I think that this advances that possibility and likelihood.
Rep. Jeb Hensarling (R-TX): I would agree with Sen. Durbin... you are hastening more people into the public option.
Rep. Jan Schakowsky (D-IL): To say that we're going to reduce our deficit and our debt by asking Medicare beneficiaries to pay more for their health care, I think is absolutely unconscionable. ...already 30 percent of their income going to health care costs, I think is absolutely the wrong way to go when we do have other options. I put on the table, not as an if-all-else fails, a public option to reduce health care costs.
As we know, a strong version of the public option would reduce costs. The official beltway wise men at the CBO said so. As it turns out, even Republicans will on occasion admit this.
As various plans to weaken Medicare continue to get promoted by the right wing bipartisan rich people/corporate consensus in Washington and by way too much of the media, there is some bipartisan recognition that as people lose their health insurance benefits... well, they may need to get health insurance benefits.
As Don says:
The commission members understand that health care is the greatest contributor to our federal budget deficit. Most of them recognize that the health spending recommendations in their final report are inadequate to control continuing cost escalation.
Some would reduce government spending by shifting more costs to Medicare beneficiaries, even though they understand that current out-of-pocket costs are already excessively burdensome. To others, that would be unconscionable.
There seemed to be an understanding by both Democratic and Republican commission members that the failure to control Medicare spending will hasten the day when the public option will be the only option.
Why a public option? Apparently there is bipartisan agreement that a government insurance program would be more effective in slowing future health care spending. They understand that government systems have worked well in other nations.
One interesting tidbit in the original "chairmans" version cat food commission report (.pdf page 36) was a more or less throw-away suggestion for both Public Option and/or All Payer. All Payer is a requirement that all insurers -- public and private, for-profit and non-profit -- have to reimburse on the same fee schedule. This is a very positive and useful reform, already in place in Maryland, that is of course opposed by the insurance and hospital industry, and by some physician groups. I will have more on All Payer another day.
Although a strong public option would probably be much better then what we have now, and I will take even Paul Ryan's backhanded endorsement of it, the limitation of public option compared to single payer remain as they were before:
A government plan offered within our market of private plans is incapable of instituting most of the changes that make single payer systems work and save the really big bucks. As simply another player in our fragmented, dysfunctional system, it would be a very feeble force for efficiency.
Furthermore there remains the reality of adverse selection. You can't make money insuring sick people. Health insurance companies compete solely on the basis of adverse selection. They seek to insure the healthy. They avoid insuring the sick and dump those who do get sick by any means necessary.
The dirty little secret is that currently insurance companies have no problem with Medicare taking care of the elderly and disabled, so they don't have to; those people are expensive. They have don't have a problem with Medicaid taking care of the very poor; those people get sick more and can't afford premiums anyway. They are happy to dump the non-profitable onto the public system. And so it would be with a public option. Given a pool of people with the option for private or public insurance, the private insurance companies will find ways to attract the healthy into their plans, steer the sick into the public plans, and dump people who get sick in their plans into the public plans. This make their costs less and the public plans costs more. Not due to the inefficiency of government, as they would then claim, but solely due to adverse selection. So "everybody-in and nobody-out" is part of what make single payer more efficient. And dumping the sick on the public system, while profiteering on the healthy (so long as they stay health), is not a good plan.
How do we know this? Because that is exactly what they have been doing all along. From Nobel Prize winning economist Kenneth Arrow's seminal paper way back in 1963 (.pdf) to what the insurance companies did with so-called "Managed" Medicare and "Managed" Medicaid.
Obviously given our current politics we are not getting expanded and improved Medicare for All in the next congress. But we will continue to fight for it, and it will come someday. Not only because it is the right thing to do for the people, but because it is the only policy that can cover everybody, provide quality care, and control both total costs and individual costs.