It’s rare that people arguing about health care reform come
at me from the left. But more and more
these days, that’s what’s happening.
Today I was on the phone with a friend who was threatening to be done
with the Democrats once and for all if they didn’t pass a public option. I told him he was over-reacting.
You heard me right.
At this point, I can live without a public option.
Lest you doubt my progressive credentials on health care
reform, I’ve never hidden my belief that a single-payer
solution is the most cost-effective way
to achieve universal coverage. I haven’t wavered. I still say that
when asked, and I have no problem defending that position.
But too many, in politics and out, said that was never going
to happen. We wanted to tinker and
tweak, not revamp and rebuild. And now that
we see the result, many are rallying around the public option like it’s a
singular opportunity to save the world.
It’s not; it’s not even close.
Be real. The House
version of the bill contains perhaps the most robust version of a public option. The CBO
estimates that maybe a third of people in the exchange will choose it. That’s fewer than 10 million people, maybe 3%
The public option has never been about coverage. It’s about cost. No more people will obtain health insurance
if we have a public option. Nor will the
quality of care go up. Some very
smart people think we also need it for political cover, but I don’t really
care about providing politicians with extra protection right now. The public option is meant to increase
competition and lower the cost of insurance.
How much lower? At best, maybe
billion over 10 years. I’m not
scoffing at that amount. It’s real
money. But remember that’s an average of
$11 billion a year in savings in a country that’s spending at least $2.4 trillion for health care. I just can’t
get worked up about a measure that might knock off less than one half of one
percent of total costs. For this you’d
kill health care reform? Are you kidding
Since we decided to “build
on what works and fix what doesn't”, let’s be truthful about this.
All of the bills, even the Senate Finance Committee’s, accomplish the
Increased Medicaid and CHIP coverage
Subsidies to help lower income families buy
Universal guaranteed issue (no denials of coverage)
Universal community ratings (no penalties for
Increased insurance company regulation (no
6) An insurance exchange for those buying on the individual market
Out-of-pocket caps (maximum amounts you can ever
No one will be denied insurance because of pre-existing
conditions, no one will be priced out of coverage because they are on the
individual market, and no one will go bankrupt because of medical
expenses. There’s still a lot of good in
Don’t get me wrong.
I’d rather have a public option than not. I’m in favor of lower costs. I’m so enamored with lowering them I’m for a
single-payer system. In fact, as I’ve
said before, I’d be in favor of almost any other comparable
country’s system. But we didn’t want
that. And I do realize this is an awesome deal for the insurance companies. It's also an awesome deal for pharma, for hospitals, and for doctors. Since we chose a path that buys off industry, let's be honest that this may work out well for them, too.
It’s fine to push for a public option. It’s fine to push for even more. It’s even fine to negotiate from a position
of strength. But, please, in your
hearts, calm the rhetoric. Those of you
on the left, don’t overestimate the importance of the public option to the
overall goals of health care reform. If
we don’t get it, yes, the cost of the bill will be higher. But we’re already pretty used to high health
care costs. The public option isn’t a
back door to a single-payer system either, so don’t make that mistake.
Those of you on the right, don’t go crazy either. The public option isn’t the devil. It’s not going to lead to a nationalized
system or to the end of private insurance.
It’s just a means to increase competition and try to reduce the cost of
reform. There was a time when those
craving fiscal sanity would have liked that.
So let’s have a debate.
Maybe we will get the public option.
Maybe we won’t. Either way, the reform we are going to get is not nearly
enough. We’ll still have a significant
number of Americans without insurance, a system that lacks sufficient quality, and
costs even higher than before. We won’t
be able to afford it for long, and we’ll need to do this again. Throwing a tantrum and running home will mean
your voice will not be heard next time.
So fight for your goals, fight for what you believe is
best. But don’t burn down the village
over the public option. It’s not worth
Read more about health care policy and get your
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