I'm a primary care doctor. Even though Medicare pays me poorly, I'm comfortable taking care of patients on Medicare because I know I can recruit the patient's Congressperson as an ombudsman. With patients who have private insurance I get paid a bit better but I see irrational denials of coverage and there's no decent way to appeal those decisions. I'm opposed to any substitute for the 'public option' that doesn't make the patient's Congressman or Congresswoman as powerful an ombudsman as in Medicare.
And that's pretty powerful. I haven't seen the reaction when a Congressional office telephones Medicare, but years ago I did see how a VA hospital reacted when a Senator contacted them. Even though the Senator's letter simply inquired blandly if the constituent 'was eligible for any more VA benefits', the hospital administrator seemed to jump first, and then ask, "Was that high enough?" When a Congressperson's office calls, federal agencies JUMP.
A Congressional representative has a unique combination of attributes that make him or her an ideal ombudsman: power, accountability, and availability. The power comes from the ability to tinker with or even cut off a given agency's funding. The accountability comes from having to be re-elected every two years, and I'm convinced even the representatives with the 'safest' seats don't forget there's another election coming. And the availability comes, if from nothing else, the fear that somebody will write a letter to the editor that "Congressman Jack S. Phogbound's office won't even answer their phone."
"Co-ops" and mandates to buy private insurance would probably insulate the insurance carriers from oversight by Congress. I doubt that any alternative to a 'public option' offers as strong a patient advocate, and I will oppose any alternative that doesn't clearly measure up.
I hope to go to town hall meetings of my own Congressman and the Congressman who represents most of my patients on Monday. I hope to ask a question along the lines of, "Has your office been successful in helping constituents who've had trouble with Medicare, and do you have as much success with private insurance problems?" I urge everybody to do the same. It's a 'public education' question.