The subtitle of this diary is "We Must Come Together On This Now"
The decision by liberal activist organizations and blogs to bypass the Medicare for All endeavor, would be slightly less troubling if it weren't dumped in favor of redirecting focus and energy on an undefined/mythical "strong public option."
No such strong public option exists in any version of the current bills, nor has one been offered by any member through amendment.
Indeed the only "strong/robust public option" is a plan that allows everyone to buy into Medicare. Yet no organization or top blog has demanded this be defined as the "robust public option."
For activists to fail to demand any one, including even the Progressive Caucus, to define buying into Medicare as the "public option" is terrible mistake that has, in part, led to our current predicament where even the best possible bill being debated in Congress is in reality a health insurance industry bailout and Big PhRMA giveaway.
WE MUST ACT NOW TO FIX THIS PROBLEM.
Directing activist energy towards an undefined endeavor is always bad, but when it is the follow-up to burning a large contingent of the activist base it's even worse. For some this decision is deliberate. They justify it by claiming that if Congress passes a small and weak public option it will be beefed up later. Once the program really takes off sometime in the future, so the logic goes, the very same corporate politicians who today are bought and paid for by Big Insurance and Big PhRMA will suddenly be ready to ram a nail into the heart of the industry, which then would be emboldened with hundreds of billions of dollars more in taxpayer dollars and a mandate for all Americans to buy their product. I think you can sense how I view that argument, but in case there's any doubt, allow me to say ditto to Kip Sullivan.
A "robust public option" can no longer afford to go without definition. There needs to be a commitment RIGHT NOW for all of us to define the elements of a robust public option, based not on vague phrases, or outcomes that are subject to interpretation, but on concrete measurable and specific terms. Otherwise we all, every single one of us from the "Single-Payer or Bust" crowd to the "YAY any Public Option" crowd, will lose this crucial political battle and fight for descent affordable health care.
WHAT DOES A "STRONG, ROBUST PUBLIC OPTION" LOOK LIKE?
In my opinion it would have five crucial elements:
- It would expand an existing government program.
- It would be truly "public" - accessible to any person or business, including local and state agencies. (THE KENNEDY PLAN)
- It would be big and consolidate the various federal health insurance programs.
- It would auto-enroll those who don't have health insurance into the Kennedy Plan.
- It would require all prescription drug prices to be negotiated.
(1) IT WOULD EXPAND AN EXISTING GOVERNMENT PROGRAM.
All of the "uniquely American" "public options" being discussed require a new bureaucracy (or non-profit insurance companies) to go out and create a provider network and negotiate fees with thousand of doctors across the U.S. to compete with established private insurers. It's a system that could be set up to fail, and as of right now it is set up to fail, let alone deliver any type of real cost savings.
It is illogical to build a whole new house when it's easier and cheaper to simply add a new wing and slightly remodel; it is a waste of government time and a waste of taxpayer dollars. It is much wiser politically and cheaper to simply expand Medicare, the government health insurance program that has been up and running for 44 years and already proven to be successful.
In addition to being ready to go on day one, the primary advantage of expanding Medicare, instead of creating a new "public option," is that the American people are familiar with it, and it is very popular among voters. Just ask yourself, which is easier to explain to Joe Public: "expanding Medicare" or "a new government program that's going to operate on a health insurance exchange." Now ask yourself, which is harder to demonize, and which is easier to defend? The answer to all three questions is "expanding Medicare."
Furthermore, doctors, health care advocates, bureaucrats and politicians alike are all familiar with the Medicare program, and it's needs, strengths and weaknesses.
(2) IT WOULD BE TRULY "PUBLIC" - ACCESSIBLE TO ANY PERSON OR BUSINESS, INCLUDING LOCAL AND STATE AGENCIES. ("THE KENNEDY PLAN")
A real public plan wouldn't have a firewall to prevent the vast majority of people from enrolling, or require the few eligible Americans to wait until 2013 to enroll (after 100,000 citizens have died from a lack of health insurance). Expanded Medicare would be open to any person, business or local/state agency without limitation on day one. We'd call this the Medicare "Kennedy Plan", a health care reform program that actually befits the decades of work our fallen leader did championing health care as a right and not a privilege. (I am firmly in the camp of people who believe healthcare reform named after Ted Kennedy must not suck, and accordingly, none of the current versions of the public option or bills floating around should bare his name.)
In a real public health insurance plan that provides "decent quality health care, north and south, east and west for all Americans as a matter of right and not of privilege" there would be no deductibles, and the premium would be a percentage of payroll, split between the employer and employee. Figures vary regarding the percentage of payroll tax necessary for single payer, with the highest estimates being 7%, so maybe the Kennedy Plan is around that much, or maybe because it's not single-payer it is slightly more. How the premium is split is open for debate, but employees should pay no more than 50%, which if the cost is 7% of wages would be 3.5%. A 3.5% payroll tax would be just $70/month for an individual who makes just $12/hour, and $175/month for an individual who makes $60,000 a year. Give the American people that public option and we'll need bouncers at the front door of every Medicare/Social Security office in the country to control the huge crowds of people eager to dump their private parasite health insurance company.
The 2.9% shared Medicare tax (split 1.45% employer-employee) would still be applied to everyone regardless of whether they enroll in the Kennedy Plan or private insurance. And as proposed in H.R. 676 any additional costs not covered can be financed through taxes levied on the country's most affluent and investor class (possibly a 0.25% tax on stock transactions, tax on the top 5% of Americans, etc.).
To sorta kinda steal a page out of Ron Wyden's playbook, any worker who doesn't want their employer's private health insurance plan would be allowed to enroll in the Kennedy Plan and the employer would be required to provide the payroll tax match. Additionally, the Kennedy Plan would be portable, so people could keep it when they switch jobs.
For those who are self-employed they'd be required to pay the entire 7%. Subsidies would be provided for those who can't afford the premiums, are unemployed, and possibly for small business. (For the latter group it may simply take the form of a tax-deduction, which one would hope would attract the support of Blue Dogs and the Maine girls, but nothing has so far, so I wouldn't rely on it.)
(3) IT WOULD BE BIG AND CONSOLIDATE THE VARIOUS FEDERAL HEALTH INSURANCE PROGRAMS.
Since Medicare is being expanded, and insurance is being subsidized for those who can't afford it, it would be more efficient to consolidate our many publicly-financed health insurance programs under Medicare. Consolidation would put all federal workers (I'd argue we should start with Congress, but I realize that's asking for a lot unfortunately), SCHIP and Medicaid patients under the Medicare roof, with the able-bodied workers enrolled in the Kennedy Plan.
Shifting the SCHIP and Medicaid patients to Medicare would be the most politically favorable aspect of the plan, as overnight 50 state legislatures (almost all of which are having difficulty balancing their budgets) would see a windfall of resources. Over $140 billion in revenue would be freed up at the state level, about $19 billion in California alone. (This is the exact opposite of current proposals that threaten to further strain state budgets with yet another unfunded mandate.) Perhaps states could be required to spend at least 33-50% of their new resources opening new/reopening closed health clinics, hospitals and convalescent homes in poor urban and rural communities for the next 10 years.
To ensure that all federal employee's health insurance labor agreements continue to be met, any service that is not delivered through the Kennedy Plan can be allowed to be provided by a supplemental non-profit insurance company that would have national jurisdiction.
(4) IT WOULD AUTO-ENROLL THOSE WHO DON'T HAVE HEALTH INSURANCE INTO THE KENNEDY PLAN.
Add me to the chorus of people who think mandating citizens buy private insurance, with the IRS as the collection agency, is just plain political suicide. It's a plan so corrupt and stupid that only a person as crocked and two-faced as a corporate Democratic politician could propose it. It's wiser to replace the "tax penalty" for those who don't enroll, with a Medicare Kennedy Plan card.
By mandating all citizens have health insurance and automatically enrolling anyone who has yet to purchase it by a specified date into the Kennedy Plan our health care system could begin producing some of the cost savings/health improvements of universal health care. (Imagine that as a talking point: "Within 100 days of passage all Americans will have access to the finest health care in the world.") Yes, the debate over the mandate will be heated (as I type this I can hear Limbaugh's voice: "Even from the grave Ted Kennedy is taxing American citizens"), but mandated private insurance is very different than mandated insurance with a public plan. All Americans will have the choice of going with the for-profits or the Medicare Kennedy Plan.
Defending this system is much easier than defending a firewalled public option, coupled with a mandate that in essence would require all Americans buy a phony product from a corrupt industry.
(5) IT WOULD REQUIRE ALL PRESCRIPTION DRUG PRICES TO BE NEGOTIATED.
This is self explanatory. There'd be no backroom deal with PhRMA to give away $220 billion in taxpayer dollars. All prescription drug prices would be negotiated just like the VA and along with the VA. Subsidies would be provided for those who can't afford them, including the ill who are need of expensive drugs. (This is another area where possible supplemental non-profit insurance might have a market).
EXPANDING FROM A MINIMUM 143 MILLION AMERICANS ON MEDICARE
By combining the:
43 million on Medicare,
53 million on Medicaid/SCHIP,
47 million without health insurance, and
9 million federal employees (and their families)
(minus 9 million who are on both Medicare & Medicaid)
we'd have a MINIMUM of 143 million Americans on Medicare. This is before one single employee, business, or public agency dumps the for-profits and signs-up for the Kennedy Plan, something that would be encouraged by simultaneously implementing the private health insurance reform measures proposed like no more pre-existing conditions, no caps, no rescission, basic requirement of services that are the same as the public plan, etc. (Incidentally, all of the private health insurance reforms sounds good on paper, but they're predictably filled with loopholes, just like previous health insurance reform bills.) Therefore, it's very reasonable to think a vast majority of Americans would be on Medicare. But, if we really want to strengthen the public plan, we'd take three more steps, which may be more politically controversial:
(6) IT WOULD ELIMINATE ALL FEDERAL TAX-DEDUCTIONS AND SUBSIDIES FOR PRIVATE INSURANCE.
Using taxpayer dollars to finance health insurance plans provided by companies that spend 20-27 cents more of every health care dollar on administration than Medicare is not reform, it is corporate welfare and wasteful government spending. All subsidies should go to the government plan, so if people need public assistance they belong on the public plan: Medicare/the Kennedy Plan. (By the way this includes eliminating that wasteful program Medicare Advantage).
(7) IT WOULD MANDATE ALL PUBLIC LOCAL/STATE AGENCIES THAT RECEIVE FEDERAL FUNDS ENROLL THEIR EMPLOYEES IN THE KENNEDY PLAN.
Which arguably would be done through #6, and for the same reasons. Just as with the federal employees, supplemental non-profit health insurance can be provided to ensure all labor agreements remain in tact.
(8) DOCTORS WOULD BE REQUIRED TO ACCEPT IT.
Every doctor would be required to accept Medicare and prohibited from providing preferential treatment to any private insurance patient. With a robust Medicare program featuring the Kennedy Plan, the only real way private insurance companies could rig the system is by offering doctors higher rates in exchange for exclusive access or front-of-the-line service. (The latter is what currently occurs in Germany, where the upper class are allowed to opt-out of the public health insurance plan.) Don't let that horse out of the gate. However, this also likely requires increasing Medicare's reimbursement rates. The amount of increase is largely dependent on the amount of savings, which could be generated from other reform measures.
HOW MUCH WOULD IT COST?
Get Charlie Rangel on the phone and make him tell CBO to score it! One (of many) reasons single payer is cheaper is because the system is populated with the young, rich and the healthy, who pay for the elderly, poor and the sick. Plus, there are significant savings from the preventative care that would come from universal health care coverage and eliminating deductibles for all Americans on Medicare. (There should be small co-pays, only to prevent moral hazard.)
Given that previous CBO studies have concluded that cost plummets when young people are added to Medicare, it is reasonable to believe that expanding Medicare is a magnitude cheaper than all of the alternatives, if not deficit neutral. With those who make $12/hour only seeing a monthly premium of $70, the number of people who would actually need assistance and the overall cost of the subsidies is not going to break the bank by any stretch of the imagination. (Let Kent Conrad argue against a plan that would make Medicare solvent AND provide universal health care coverage!) And if #6 is implemented, which would prohibit subsidies and tax deductions for private insurance, tax dollars would only be spent on the most efficient forms of health care.
WHAT WE'RE UP AGAINST
All of this begs the question:
If unlike all of the current versions of the public option that are firewalled, only cover 11-12 million at best, and won't go into effect until 2013, an expanded Medicare version with the Kennedy Plan is available to anyone on day one, preserves "choice," costs a mere fraction of the current bills, and is an instant economic stimulus for states that could really use it, who could possibly argue against it? Why is this plan in a DK diary and not in an amendment on the House of Reps and Senate?
I hate to end this diary on a defeatist note, but the stark reality is, as said by Ian Welsh:
Since a real public option properly created to not be constrained from doing so WILL drive private insurers out of business, it will not be allowed to happen. It may be called a "public option", but it won't actually be allowed to operate as a public option should. A public option which won't destroy the insurers in time, is also a public option which can't drive down prices effectively.
All else is shadow play.
In this entire health care/insurance reform debate, truer words have never been spoken.
SO WHAT'S THE USE?
The point is we need to own up to what Ian says, and as a movement we should not allow ourselves to be used. Furthermore, when we can come together we should. We all should support HR676 and the debate that it creates. And we should not allow those on the Hill who claim they're with us off the hook. Otherwise, even the strongest supporters will vote for HR 676, and after it fails to pass, they'll vote for a weak bill (with or without a watered-down public option) touting that they voted for single-payer, they wanted single-payer but there weren't the votes, so they had to vote for the weak bill.
With the political landscape as it is, the fight for the undefined public option to date has simply given Democratic politicians the political cover to support a bill that will result in record profits for one of America's most despised and abusive industries. They could not and would not be able to do it without us.
So there needs to be a shift - right now. WE NEED TO BE DEMANDING OF OUR PRESIDENT AND OUR REPRESENTATIVES:
MEDICARE FOR ALL
or at least
MEDICARE FOR ANYONE WHO WANTS IT.
Nothing less should be acceptable.
Make the Progressive Caucus push the debate, put an amendment on the floor, start whipping votes and touting Medicare for Anyone Who Wants It on MSNBC, CNN and in their Town Halls. Rhetorical red meat ain't enough. Make them do the job they were elected to do as politicians to get the most while surrendering the least.
Be clear, be concise, confront your representatives and bring it home for Teddy: