I'm feeling frustrated with people who insist that the health care bill has to have a public option or a single payer, and that we should reject it if it doesn't. In my opinion, they couldn't be more wrong. People who say this are confusing the goal of universal health care with the means of getting there and possibly putting that goal at risk. And we really shouldn't care whose ideas get used. It doesn't matter whether they come from Dennis Kucinich or John Boehner. What is important is having affordable universal health care as quickly as we can. That's likely to mean that we're going to have to compromise, but let's get behind our President and the members of Congress who do support universal health care and drive something that works through, whatever it looks like.
A public option is simply one part of one approach to universal health care. But it isn't the only one, and by itself it isn't going to solve the problem. Not only that, but there are a lot of different possible public options, and not all of them will work well. Even a good idea won't work well if it's poorly executed. We have to get beyond focusing on the means and keep our eyes on the goal -- Sen. Kennedy's life's work.
More below the jump.
If you haven't already done so, I suggest reading this piece by NPR about health care systems in Europe. Of the five it reviews -- France, Britain, Switzerland, Germany, and Holland -- only Britain's is a single payer system. The others all have universal private -- not necessarily for-profit -- health care coverage, combined with policies driving effectiveness in various ways. Insisting that we cannot have true reform without single payer or a public option is every bit as false as "death panels -- and while I believe single payer proponents advocate it in the best of faith, the claim that we cannot have universal health care without a public system has been disproven.
I want to be clear here that we should not compromise on the goals of access to quality health care for everyone, that nobody should be denied treatment because of their financial situation, and that nobody should be impoverished because of medical bills. Nor should we compromise on having this expeditiously. We shouldn't "kick the can down the road" because of the current recession (indeed, I think the recession makes it all the more important to pass universal health care, both in terms of mitigating its effect and in terms of getting us out of the recession), and we shouldn't keep studying it forever. A lot of people really are hurting, and as President Obama said, it's a lot harder for someone to start a company if they're going to have to go without health insurance to do so. That argument should appeal to free market conservatives at least as much as to progressives! Nor am I going to shed crocodile tears if it does turn out to cost something in the short run. Compromise on the timeline, if necessary, should be on the order of weeks or at most months; just enough to get something up and running. As the President said, having a safety net in place while we get a permanent system built and debugged is a really good idea -- that John McCain came up with it is irrelevant.
I also don't think we particularly need to negotiate with people who aren't negotiating in good faith. But disagreement isn't in and of itself bad faith. I do know people who are conservative in their outlook and believe that the US has an excellent health care system, but I don't believe that their intent is bad simply because of that. I've had a lot of discussions on Facebook with some of these people, and I believe that they genuinely want to improve the health care system, but they make different assumptions than I do and maybe don't fully share my goals. But that's not true of everyone in the opposition. People who go around talking about "death panels" are either really stupid or misinformed (and no, I don't think Sarah Palin is that unintelligent) or they really are talking in bad faith. Likewise, the teabaggers who simply try to disrupt meetings, or who make absurd claims that "the bill contains provision X, it's right here on page 421", aren't acting in good faith. Some people may also pretend to negotiate in good faith but make it clear in other ways that that's a facade. Some people's goals are also so far removed from ours that it may be hard to find common ground. But people who honestly believe that the government should have as little role as possible and that health care should be improved by focusing on the private delivery system should be presumed to be negotiating in good faith until proven otherwise.
But it really rubs me the wrong way when I see comments from progressives that there should be no compromise on a public option, or that public option is at most a step toward single payer, or even that we should not compromise on single payer. That's every bit as doctrinaire and doctrinaire as conservatives who say that government should have no role in health care and that it should be left to the free market. It's putting ideology (or in some cases politics) ahead of meeting people's needs. We are all progressives here on Daily Kos; we believe that the government should be promoting the common welfare. Well, if the best way to do so turns out to be through private means in a given case, so what? If Sen. Kennedy, the liberal lion of the Senate, could work with Orrin Hatch -- and yes, George W. Bush -- to advance incremental causes important to him, surely we can honor his legacy by doing everything we can, regardless of whom we're working with or ideological differences, to finally achieve his life's work? Read or reread his letter to President Obama and decide for yourself -- again, if necessary -- whether you're really willing to let his dream die over a detail.
I personally believe that a robust public option should be part of the overall plan. But that's because I think it will be the least disruptive means to achieve the goal. In essence, it's simply another competitor in the marketplace, one with much lower overhead than any of the current insurers have; the fact that it's public doesn't make it any less of a participant in a (theoretically) free market. We have public options currently available for some groups of people (Medicare, Medicaid, VA) and we understand the model. I personally don't care one way or the other whether the current insurance companies survive or not; they can either learn how to compete more efficiently (and Wall Street can learn to accept less profit) or go out of business, just as any other company that can't compete does. So, I think a good public option will work well in our framework. But is it the only possibility? Hardly.
It's possible that allowing companies to sell insurance across state lines will increase competition. As long as the regulatory regime is sufficiently rigorous to ensure that everyone is guaranteed non-discriminatory access, and people are making medical decisions with their doctors rather than having insurers butting in, maybe it will work -- and I'm sure this will come up for discussion in the coming weeks. But again, rather than focusing on the means, let's ensure as progressives that as the legislation is developed that it meets our goals.
Suppose it turns out that there simply aren't the votes for a public option plan, and health reform scuttled as a result, while some other option that does meet the critical goals could have passed. Do you want to be the one looking the person who can't receive treatment for cancer in the eye and tell them that no, we didn't pass universal health care, but we're better off anyway because we wouldn't have had a public option? I know that I don't.
As long as the means are ethical -- and we're certainly not going to be torturing people! -- we really shouldn't care what those means are. Let's honor Kennedy -- and help the President that he believed in -- by fulfilling the dream.