For several months, the White House had handed off the public debate over health care reform to Congress, and mostly to one of the most conservative and corporatist Senate Democrats at that. Just as bad, they had been talking about the desire for a bi-partisan bill, rather than the best bill we can get. But now Obama and the White House are taking a more public role in the fight for some form of health reform.
For those fighting for public option as a way to further the cause of providing access to care that is universal (all people), comprehensive (all needed care) and affordable (controls costs for both individuals and the country as a whole), may I commend you to three recent blog posting by some other folks who know their stuff...
Below are some tips if you are trying to make sense of "public option" versus PUBLIC OPTION.
First up is the great Trudy Lieberman, who has been following health care issues for years, previously with Consumer Reports and currently with the Columbia Journalism Review. Their "Campaign Desk" blogging should be considered indispensible reading; among her series has been the self-descriptive "Baucus Watch" and "Who will be at the Table" tracking the lobbyists.
Here are her suggestions for policy items to follow:
• Who will really be able to join a public plan—everyone, or just those who don’t have other coverage or are too ill for insurers to take them on as customers?
• Can workers with coverage from their employers go to a public plan if it’s cheaper? In other words, is there a real choice for everyone?
• How will coverage be financed—by taxpayer dollars, or by premiums from people needing insurance?
• Will the government provide the coverage, as it does for Medicare’s hospital and doctor benefits, or will private insurers provide it, as they do for Medicare’s prescription drug benefit? There’s a big difference here.
• What will the benefit package look like? Which special interests are working to make sure that their latest gee-whiz technology gets covered?
• Will doctors and hospitals be paid the Medicare rates, or something higher?
• If they get the higher rates, then where will the cost-savings come from?
• If private carriers provide the benefits with more of the same inefficient billing costs, where will the administrative savings come from?
Robert Reich has also been tracking the actual policy details of whatever is being called public option on any given day. He has pointed out that details matter, not the label of just being called "public option" and that many versions of "public option" are essentially phony smokescreens and how we fight against them; wondered how hard the White House will push for the better policy and details, and helps us track each new phony bamboozle and how recognize the real thing.
The underlying point is that the proposed "compromises", by conservative Democrats and "moderate" Republicans have the goal of satisfying AHIP and Pharma. The purpose to make sure that whatever is called public option has no chance to actually compete, cannot actually drive costs down, and are actually designed to be costly failures so that in a few years they can frame the debate for Health Reform 2.0 as a failure of Democrats, liberals and big government.
Most pessimistic is Miles Mogulescu over at Huffingoton Post on June 9, who seems to channeling what I wrote back in July 2008 and again last week on June 6.
There is a version of health care reform that would be very much to the liking of the for-profit health insurance industry and is very much in line with proposals being discussed by health insurance shills in Congress like Baucus and Grassley who have received huge campaign contributions from the for-profit health care industry.
- First, it would mandate that every uninsured American buy private health insurance or be fined by the IRS. This would provide the health insurance industry with 40-50 million new paying customers. (Obama argued against Hillary Clinton's proposals for such individual mandates in the Presidential debates, but now appears to be prepared to accept them as part of the price for insurance industry support for a health reform bill.)
- Second, it would provide partial subsidies to families who make less than two to three times the poverty level to buy private insurance, money that would go straight into the pockets of the for-profit insurance companies.
- Third, it would pay for this government subsidy by making workers pay income tax on their employer-provided health benefits. (John McCain supported this approach and Obama opposed it during the campaign, but Congressional opposition to other taxes to pay for health care reform may leave it as the last available option to Obama.) As Obama pointed out in his debates with McCain, this would lead many employers to drop health coverage for their employees and force them into the individual insurance market which is the most profitable sector for the insurance industry.
- Fourth, it would jettison the implementation of a public non-profit insurance option that might cut costs and provide serious competition to the private insurance industry, or more likely, include a neutered public insurance option that would be barred from seriously negotiating with providers for lower prices, and that might well benefit private insurers by offering a dumping ground for older and less healthy consumers whom private insurers don't want to insure, anyway.
If, as Rahm Emanuel says, "everything is negotiable", and if, as Obama says, he'd rather get part of what he wants with more than 60 votes--including some Republicans--than all of what he wants with 51 votes--all Democrats--then this is what health care "reform" may well end up looking like--a federal bailout of the private health insurance industry at the expense of the taxpayers.
Supporters of compromise are fond of chastising supporters of more robust health care reform, particularly single payer advocates, by repeating that "we can't let the perfect be the enemy of the good." The problem is that an overly compromised health reform bill that satisfies the health insurance lobby and its Democratic and Republican supporters in Congress may not be "good" at all, and may even make things worse. Health care costs would not be reduced, putting increasing strains on individual and government budgets. Uninsured individuals would be forced by the government to buy private insurance they can't afford, taking a big hit out of family income and reducing demand in other sectors of the economy. Workers would be forced to pay for it by being taxed on their employer-provided health benefits. And as a result, increasing numbers of employers would drop health benefits for their employees.
In a few years, this could lead to a huge political backlash against Obama and Congressional Democrats who voted for this "reform." Just as the Clinton's flawed health care proposals in 1994, which never came to a Congressional vote, lead to the revival of the Republican party in the 1996 mid-term elections, the enactment of a flawed health care reform plan by Obama, which results in greater financial burdens being placed on American families, could lead to the revival of the Republican Party and its calls to let the "free market" rule.
I am a single payer advocate because as a matter of policy and economically it is the best way to go. But I am not a nihilist. I too, really, want the best reform that we can get now. But I also want think strategically for what likely effects of that reform really will be. That means asking
the "Who Wins "I Told You So" After this reform fails to provide coverage that is universal, comprehensive and controls costs? We want to be sure that the next step, be it in 2012 or whenever, is forward to single-payer, based on the argument of "this is what happens when you leave the private for-profit insurance companies in place as wasteful, cheating, unneeded, pool-splitting, adverse selecting, intermediaries". What I fear is that if we are not careful, the next step may be backwards, based on the usual right wing corporatist argument of "Democrats, liberals and big government tries to reform things and it went badly".
Part of the fight is for the best possible bill, and while one frame is to talk about what form so-called public option will be, another frame is to count votes: There is little question that the Senate could and should go the reconciliation/budget route and bypass the filibuster 60 problem. Fighting for the best bill we can get now means fighting for a 50-senator vote + Biden version. It means pushing the Kennedy/Dodd Senate HELP committee to hold firm. It means pushing the progressive caucus in the House to beat back the already overly pre-compromised House Tri-Committee version.
Frankly I'd prefer a bill that is good enough to have no Republican support and that the more corporatist Democrats are also unhappy with.
It is going to be viewed as "our" bill regardless. Why not make it half decent.
And, above all else, make it clear that this is not single payer, not national health insurance, and merely a mediocre compromise, the best we can get... for now.
P.S.: To our public option and others "for any health reform that we can get" realists... how mediocre is too mediocre? How much of just a prop-up for the insurance companies (mandates without a real public option), is too much? When do we get to say, "No!" ?