Some have claimed lately that we must keep the public option in HR 3200 or the bill is worthless. Regardless of whether that is true, many seem clueless as to how small the public option in this bill actually is.
The CBO projected that it would only enroll about one third of people in the Exchange by 2019, or about 10 million people. That is close to the number of new entrants in Medicaid over the same period due to eligibility changes. See the chart below for the complete projections.
The facts are pretty sobering.
Of course, the CBO has stated that the public option enrollment estimate is "subject to an unusually high degree of uncertainty" because of "all of the factors in play." But to my knowledge it is the only credible one in existence.
Several things should hence be clear. First, the public option is about as important as the Medicaid eligibility change. They're both "public plans" and will insure a comparable number of people. It does probably make sense to advocate more for the public option at this time simply because it is in greater danger of being axed.
On the other hand the surtax that provides funding for half this bill is comparable to the public option and may well also be axed: the Senate is not friendly to it. Hence the surtax seems like an unjustly neglected part of this bill. If it gets removed, then the middle class will be forced to pay for more of the subsidies as opposed to those making over $350,000 a year. That is a big deal.
We should also realize that whether or not the public option gets included in the final bill, the approach here will rely mostly on mandates that force people to buy from the private insurance industry. So this bill will be a bonanza to the insurance industry either way.
There are some in the media right now who say that the public option will somehow push down overall costs where they otherwise would stay high. But this is nonsense. It's obvious that whatever premiums are under this plan, they will stay fairly constant regardless of whether a public option insures 10 million, slightly more or zero.
It seems like many people (exhibits one, two, three) may be under the impression that at least one of the proposals in Congress would bring down costs substantially. Unfortunately none of them will: not HR 3200 in the House and certainly not the Baucus plan in the Senate. They will cover most of the uninsured, but they are not going to bring down costs much if for no other reason than that any public plans will be far too small. And claiming otherwise will just lose us credibility with the public.
The real question we should be asking is not "Will there be a public option like the one in HR 3200?" but rather "Why is the public option in HR 3200 so small?" and especially "What about Medicare-for-All?"
These issues are hard to raise because they do not involve simply favoring one of the proposals in Congress. It is much easier to be taken seriously if you can simply point to a proposal by someone in power and say, "Let's do it." Unfortunately many here apparently feel so pressured to take the easy route that they are throwing the facts out the window. Don't defenestrate the facts!
The main proposal that would actually lower costs is national health insurance, or Medicare-for-All. It has been favored near 50-60% in most polls, though whether last month's rapid changes in public opinion due to right wing lying have damaged it as well is open to question. This is clearly what we should be aiming for.
It's preferable to just advocating a much bigger public plan like the one mcjoan cites here partly because we would have already moved far off the political "table" anyhow.
The public option isn't just some kind of political litmus test. It's the last stand for affordable health care in the future.
Unfortunately Congress is not considering a public plan remotely near this size. In fact, the number in Congress favoring Medicare-for-All probably exceeds those who have thought through a huge public option.
Medicare-for-All is more conducive. It's simple and makes sense and is capable of sustaining a movement. The public option is ill suited for movement building--it's the kind of compromise you tolerate in the legislature if necessary, not make the main goal. The lack of focus on an easily recognizable goal is crippling to attempts to engage the public.
For a specific example of how this works, consider that almost all other industrialized nations have national health insurance. Are we going to cite international comparisons (cost, infant mortality, wait times) and then forget the actual system being compared to? That will totally muddle the argument and we can rule out it ever making sense.
To sum up: the public option is something we should fight for, but in this bill it's only one reform of many. We should stop thinking that it is big enough to systematically reduce costs or build a movement, because it just isn't. For that we need to advocate national health insurance.