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For months now, I've had a question I was afraid to ask:  Can't we achieve significant health care reform WITHOUT Congress?  Specifically, can't the president begin offering a public option under the Department of Health and Human Services?
Surely people who are much more plugged in than me have thought of this.  But in light of Scott Brown's election and the infuriating mishandling of HCR and the public option in the Senate, I'd really like to know.  Who needs Congress?  Let me spell out the idea below the fold, then please educate me why it is, or is not, feasible.

So here's how you get Health Care Reform without Congress:
DHHS takes bids on a contract for an insurance provider to administer a public health insurance option.  This would be similar to a large corporation letting bids for insurance carriers who want to provide coverage for their employees.  The winning company would need to follow strict guidelines spelled out by DHHS in the contract.  Personally, I'd recommend Rep. Weiner write those guidelines.  Two biggies, of course:
A) All who apply are accepted regardless of health history. No "pre-existing conditions".
B) Subsidies are available for low income applicants.

In essence, DHHS would say "We have a contract worth $100-billion a year for a company to insure up to 50-million Americans.  Who wants it?"  

Americans who sign up would be expected to pay their own premiums, so ideally the $100-billion wouldn't come from the DHHS budget at all.  But of course, subsidies for low income applicants would be available.

Using the numbers I threw out, it comes to $2,000 a year per person insured.  For a family of four, that's $8K a year or $666 a month.  I currently pay $1,500 a month for my family of four on the private market, so that would attract my business, or pressure my existing carrier to lower their rates for folks like me.  You know.  By God competition.  

Rather than a mandate, I'd suggest a long term buy-in, say, two years to manage costs by preventing someone from buying in the day before surgery and cancelling the day after.

I know there's considerable distrust in this community of health insurance providers, and don't I know it's well-founded.  At the same time, these are the people who know how to run a health plan successfully.  Having DHHS as the controlling entity who sets the rules means we can set public policy AND take advantage of the expertise of those in the industry.  And, it would be quicker to implement.

You could argue that the program would only exist as long as Dems hold the White House.  Okay.  Let's watch as Republicans take health care away from 50-million Americans-- most of whom are paying for it out of their own pocket.  They may as well abolish Medicare while they're at it.

I'd love to hear someone with the expertise of a Lawrence O'Donnell explain why this wouldn't work.  We are currently fighting two wars using contractors.  Why can't we fight the health care crisis the same way?

Originally posted to back2you on Wed Jan 20, 2010 at 08:15 PM PST.


This idea is...

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