To understand the opposition of so many of us to the health care bill as it's currently constituted, it might be helpful to review for a moment the concept of regulatory capture.
In my opinion, the design of the Public Option as a means of health care reform was to keep the private health insurance companies somewhat honest and in control through the creation of an alternative that would operate with a different set of values and objectives other than maximizing profit at every opportunity.
Yes, it's possible to attempt to achieve that same objectives through regulation of the private health insurance companies, but IMHO, regulatory capture is likely to prevent that from happening.
Here's wikipedia's definition:
Regulatory capture is a term used to refer to situations in which a state regulatory agency created to act in the public interest instead acts in favor of the commercial or special interests that dominate in the industry or sector it is charged with regulating. Regulatory capture is a form of government failure, as it can act as an encouragement for large firms to produce negative externalities.
http://en.wikipedia.org/...
Few of us would doubt, as we enter the second decade of the 21st century, that regulatory capture is an accurate description of the current state of affairs in basically every single industry that is regulated by the federal government.
There are thousands of lawyers and lobbyists in Washington making millions (billions?) of dollars working on behalf of large, private corporations. The people working at these firms are some of the smartest, most hard-working, highly-educated and well-compensated people in our society. They play in instrumental role in writing and interpreting the thousands of pages of legislation and literally millions of pages of federal regulations that are generated each year.
Against this industry, it is simply not possible for the public to have much influence over anything more than a few big picture items. It's just too much and too complicated.
By way of example, this community is one of the most educated and politically active groups of people anywhere. The health care bill is often called the most important progressive legislation of our generation, and the nation has been debating the various versions of it for months. But I ask you to consider what percentage of people here at Daily Kos have read it in its entirety? I'd venture less than 1%, way less.
For every page of legislation, there will be created exponentially more pages of implementing regulations. What percentage of us will be reading and commenting on those? How much attention will be paid to the details of that once the nation's focus moves on to immigration reform, or cap and trade, or the wars in Afghanistan and Iraq?
It just ain't gonna happen, at least at a scale that can have much impact. As a public interest lawyer myself, I can tell you that keeping the public's attention and marshalling the resources to wage battles in Congress, in the courts, in federal agencies is very tough for all but that most compelling of issues.
But rest assured, every major health insurance corporation will have major lobbying and law firms on retainer poring over every detail, calling in favors, making contributions to the right people, etc. The vast majority of "us" (the public) will have moved on, but they will redouble their efforts, their focus sharpened and sustained by the billions of dollars at stake.
The theory of regulatory capture explains this:
For public choice theorists, regulatory capture occurs because groups or individuals with a high-stakes interest in the outcome of policy or regulatory decisions can be expected to focus their resources and energies in attempting to gain the policy outcomes they prefer, while members of the public, each with only a tiny individual stake in the outcome, will ignore it altogether.
http://en.wikipedia.org/...
The Public Option was IMHO, the one "big picture" item that might have provided a counterweight to all of that. While never perfect, once a federal agency is created and tasked with providing affordable, quality health insurance, then there would be an army of people whose sole objective is to achieve that goal, and at the same time, nobody in particular with a direct financial interest in thwarting it. Indirect, sure, but that's a different ball of wax entirely.
Instead of having a diffuse public interested in affordable, quality health care and a specific set of corporations whose profits and losses would be directly impacted by the decisions of the federal agencies that will be attempting to regulate them, you would have a specific group of civil servants charged with delivering affordable, quality health insurance and a diffuse group of corporations with an indirect interest in preventing that from happening. The latter scenario is far more likely, IMHO, to result in the outcomes that we desire.
I do understand the theory behind the regulatory state, i.e. that if the government creates the right rules and regulations for the private sector in the interest of social goods, then the private sector can them provide those things and also make a profit, and everyone ends up happy. But in practice, regulatory capture is what is happening in our society, and until we can get money out of politics and policy, it will continue to be the case.
This is why the Public Option became the fulcrum of the battle between progressives and the health insurance industry. Regulation of their industry is one thing; they have plenty of experience in how to effectively deal with that. Subsidizing their industry is of course a no-brainer benefit for them, as are the mandates to buy their products. But the creation of a real alternative, a public agency tasked with delivering what they have not -- that is something that they waged all-out war to prevent.
That is why IMHO, without a Public Option, we are unlikely to see any real health care reform achieved out of this.
I will, however, just add here at the end that the subsidization of coverage to people who are currently uninsured is enough of a benefit in the current bill to be worthy of support. I don't like that 20-30% of my tax dollars that go for this purpose will be eaten up by health care insurance company overhead, profits, etc., but I do like that more people will have access to health care. So, it's a tough call on that front. But health care reform this is not, IMHO.