Before the hate starts, let me say that I am a single payer supporter although I acknowledge that it currently has a snow balls chance in the Senate right now. BUT
I think several people here are conflating very important healthcare reforms with the public plan. The public plan is not a panacea. A public plan does not expand coverage or make sure that private insurance companies don't screw you over.
First, let's start off with Axelrod's e-mail which lays out what is going to be in the bill no matter what (strong, weak, or no public plan):
- Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
- Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
- Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
- Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
- Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
- Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
- Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
- Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.
Second, there is what I think the most important fulcrum of the debate. How much to subsidize health insurance (this will largely effect how many people actually get covered).
- House - up to 400% of poverty level
- Senate (HELP) - up to 400% of poverty level
- Senate (Finance) - up to 300% of poverty level
And expanding Medicaid
- House - up to 133% of poverty level
- Senate (HELP) - up to 150% of poverty level
- Senate (Finance) - up to 133% of poverty level
ALL THIS IS DONE WITHOUT A PUBLIC PLAN.
Before you destroy me, I want you to re-read all of the above and think about how many more people will get health insurance (around 30 million), how many people will not get dropped from their health insurance and how many people will avoid bankruptcy--with the bill I just laid out above and without a public plan.
A strong public plan which anyone (including those whose employer's offer coverage) could join and which would combine with Medicare to negotiate rates would be great. It would have a significant effect on bending the cost curve down in the long run and make expanding coverage easier. That plan is not in any of the bills.
The public plans run from pretty good in the Senate (HELP) to what's the point (i.e., Senate (Finance) coops). We are more likely to get co-ops or AT BEST a public plan that only covers those who do not have access to insurance through their employer, that will have to negotiate its own prices (without Medicare) and that will have to sustain itself from its own premiums.
I think rather than going to mattresses over such a weak plan, we go to the mattresses about increasing the subsidies to the poor and the middle class so we get as close to 100% as possible. The Senate (Finance) only gets to 95% from the one estimate I saw while the others are closer to 97-98%. That is a big difference right now.