I’m a liberal and would support the creation of a public health plan as part of a broader reform of the health care system. But, I don’t see the public option as an end in itself and believe that its inclusion in a health care bill is not essential to enacting real reform. In fact, if its inclusion makes health care reform more difficult to achieve, I believe we progressives should keep our eyes on the wider prize and ensure reforms to cover all Americans pass without it.
Let’s be honest with ourselves. We supporters of the public option have not made a compelling case for it to the wider public. We say a public option will keep the private insurers honest by ensuring greater choice and competition. But I haven’t really seen any evidence suggesting that only the public option can deliver greater choice and competition. President Obama, who has long supported and defended the public option, has compared it to the Postal Service in arguing that it won’t put private providers out of business. That is not exactly an argument in its favor if you ask me.
Cost control is seen as another reason to support the public option. Experience with Medicare and Medicaid suggests however that a public plan would not be immune to political and special interest pressure to prevent needed cost cutting. And while public plans are generally much more cost effective than private providers are to date, a strong and independent regulatory regime could force cost controls on private plans, analogous to the way in which certain utilities are regulated – or were before the right-wing push for deregulation of electricity and other markets in public goods took hold, something we will need to defend against post-reform no matter the lay of the health care landscape.
I share an instinctive mistrust of private insurers with most progressives. I am not yet convinced though, that a sound regulatory framework couldn’t be created to ensure basic consumer protections, mandate portability, prevent discrimination and promote competition. Marry this to a subsidy regime for those who cannot afford health care on their own, and expansion of current public programs to broader client groups that the private sector fails to provide for, and you have a robust reform package even without a universal public option.
I think our focus today should be on achieving the right outcomes – universal and affordable care for all – and not the right means. This would represent a sea-change in public policy, one that could be built on through future reforms. In that light, I consider threats from progressive Democrats in Congress to vote down any bill without a public option as unhelpful.
Believe me; I understand the impulse to want to show our voting strength, just as Blue Dog Democrats are doing from the other side. But let’s just remember that just the fact that reform is possible now is a great triumph; one that would be a shame to squander in a pissing contest with our President and our more conservative brethren. You can ask, why should we compromise – why shouldn’t they? There are 46 million-plus good reasons why. Let us not sacrifice their hopes because we can’t get all we wanted.
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p>This from John Gruber’s OpEd in today’s Globe,which really speaks to the fight to find and secure the funding for a balanced fair and adequate payment plan for a wide range of clinical and public health service providers, a quality public plan for the poor AND and a fair and adequate subsidy program for low income and many middle income working families.
From the op-ed you linked to…
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p>Perhaps at this point, the tax would only be on above average payments, but this is a perfect place for changes to be made in future administrations and legislative majorities where “tax the middle class” republicans would be happy to drop that cap so that the middle class will end up paying more and more all of the time. This is a working middle class tax hike. Do not fund health care reform on the backs of the middle class. The working middle class is already struggling to overcome the economic crisis we are in. The middle class needs to have every financial resource it currently has to drive this economy out of recession. Taxing provider paid health insurance benefits (even setting the precedent for it )would be a huge mistake.
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p>But, by all means, start providing statements to employees showing the total cost of premiums, and options for reducing those costs. This should be done anyway.
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but a few years ago my wife worked for a company which offered the employees a $2,000 “OPT OUT” payment. If the employee chose not to enroll in the medical insurance, they were given a check for $2,000. She opted out each year since I had a family plan and included her anyway. I thought it was a great mechanism for her company to both save money on their end AND award the employee some of the savings.
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p>I notified the company I worked for at the time and have told the company I now work for that they should consider the option since many people may be covered under two insurance plans but neither did so. Both seemed to want as many people enrolled in order to get to higher tiers for pricing breaks. I know for a fact that there were a number of people enrolled in multiple medical plans.
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p>Maybe this is something that could be used part of the reform.
If we are unable to get health insurance reform with a public option, then we would still want aggressive reforms in the private industry.
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p>This worries me to…
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p>but I don’t believe these Democrats would truly vote against the winning reform package only to have the status quo continue. I think at this point it is a strategy to
demand the most we can get out the final reform legislation.
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p>We’ve given inches, and they’ve taken miles. I think it’s a good idea to keep fighting for a public option. It’s too soon to give up.
If we assume that passage of a health care bill will ultimately be hashed out at the negotiating table, then it is incumbent on proponents to keep the public option on the table as long as possible, specifically because it is what is inflaming so much of the opposition. Democrats should not be dealing that away now.
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p>You mean because although I’ve been explaining single-payer until I’m blue in the face for thirty years, and a few astroturf insurance-industry thugs get their 5 seconds on Fox, I haven’t made a compelling case, and we should give up? Complete bullshit. Bullshit, bullshit, bullshit.
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p>If any public component of this gets compromised out, the status quo, the industry, Republicans, and conservatives all win; it’s not a meet-in-the middle compromise; they get exactly what they want. It’s like I’m selling my house for what it’s worth, the insurance industry offers me $100 for it, and you step in and say, “why don’t we just split the difference?”
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p>As if what this country needs is more milquetoast surrender-first so-called “moderates”. I f%#@ng hate them worse than conservatives. F%*#@ng hate em! If everything is heading in that direction anyway, then why even bother to lecture people of principle to give up their principles? The worst case if we fight is we lose. Why do we have to give up on the only meaningful component of reform, just to get something that will break the bank because there are coverage mandates but no cost control? It’s complete insanity.
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p>If that’s “being honest with ourselves”, then please, I prefer lying, whatever that is.
When people hear a halfway-honest description of the public option, they like it.
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p>However much I would love to have an honest negotiation based on the policy merits, that’s not what politics is. It’s power, raw power. We may not have enough for the public option. I don’t know; I don’t think anyone knows.
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p>So lanugo’s point is that you could have a package of reforms that is a vast improvement on the status quo, even without the public option. I think that’s true — but it would be better with the public option!
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p>But are you willing to scotch the whole thing if there’s no public option? Does “no surrender” on that point mean there’s no reform of anything?
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p>I’d suggest that the people who actually want to get something done are always going to be “weaker” in some way than those who want to keep something from happening — unless you’re talking about something that really lights people up, and has consensus support, like war. (People seem to really like war, going in at least.)
I fear that making the public option an all or nothing argument is not going to help. When you threaten to “take your ball and go home” and you opponent has little interest in playing ball to begin with, what have you gained?
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p>My feeling is that the big win with reform is regulation. Guaranteed issue, portability, perhaps some conflict of interest or anti-cartel regulations, etc.. My homeowners insurance seems better regulated than health insurance and that doesn’t seem right.
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p>There is a lot of fear of the public option out there. Some of it is total BS (e.g. death panels), but some of it (e.g. stifling innovation) may have merit.
“Something” that perpetuates a failed paradigm (relying on “market forces” to allocate health-care dollars), blocks a more successful paradigm (a healthy population is as important to society as a literate population), and enriches a handful of already-wealthy elites is worse than doing nothing.
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p>A government-funded single-payer health care system is the only approach that works. Anything that delays the transition to that is a step backwards. Anything.
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p>As a wise attorney once counseled me: “A bad deal is worse than no deal”.
Your thinking on single-payer as “the only approach that works” is doctrinaire, and just plain false. It ain’t so just because you say it’s so.
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p>No deal means 47 million remain uninsured; people still get booted for getting sick; costs spiral upward; insurers still unregulated.
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p>But you would rather wait another 15 years and then go over it all again. No thanks.
Just because the Clinton bill failed and Congress didn’t take it up again doesn’t mean the same will happen this time. There are major differences now: (1) Congress is more hands on, so this can’t be pinned entirely on Obama. They will want to pass it again; (2) HC is more expensive, and reform is more urgent than in 1993; (3) the republicans are nowhere near where they were in 1993-94 in terms of regaining control; (4) getting it right sometimes takes a few tries, to shift the balance of power from one group to another. see more here: http://yglesias.thinkprogress…. and my post below.
Nobody wants that.
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p>But an equally likely scenario is that a weak, ineffective bill is passed, adding another trillion or so to the budget deficit, and after the Republicans take back Congress — because progressives finally realize they are Charlie Brown kicking the football with Lucy holding every time, and no longer have an appetite for what it takes to elect Democrats in big numbers — the Republicans dump the whole scheme as too expensive, and we’re no better off than we were.
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p>After all, they came this close to nuking Social Security after it had been the law of the land for decades (who’s trying to pull the plug on Grandma?).
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p>Or, Democrats could keep faith and not pass a bill in October, but maybe next year, after the thugs get bored or their parole officers catch up with them. One thing we can do is outlast them; but if we put a deadline on it, we tie our hands behind our backs and allow the debate to start and end within a timeframe that allows the opposition to take advantage of short attention spans. Spurious arguments have the most power in the short term, whereas the persistent promotion of truth and common sense should prevail over time.
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p>We have a historical opportunity vis a vis the balance of power. It won’t last forever. Health care reform is one of those things that — like fluoridation of public water (dating myself, but you could look it up) — three weeks after it’s in effect, half of everyone who opposes it now will either love it or won’t care. We have to keep trying to do it right. That’s not the same as public option now or give up immediately.
Adding flouride to public water is the way to improve public health. Half-way measures that don’t add flouride were a waste of time.
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p>The same was true of airbags and seatbelts.
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p>We just have to get it done. Period.
These are incremental improvements. I don’t see the down side. It would be bad with an individual mandate, but I thought Obama was against that from the start.
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p>It would be interesting if anyone in Congress took your “Anything” stance. Shutting down government until a public option passes. Personally I wouldn’t be against that, but I don’t think anyone in Congress has the cojones to pull that off.
These “incremental improvements” nibble at the edges (and those make precious little difference when the dust settles), and distract attention from the actual problem.
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p>The only reason reactionaries (like the insurance industry) support these is that they already know how to game them to their own benefit (and profits).
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p>The problem is forcing people who are sick to pay for their health care. The solution is to collect a small amount of money from everyone and use that to provide health care to the much smaller fraction who require treatment. The government is much better able to do that, through taxes, then private industry (through insurance) because the government doesn’t have to generate constantly-growing quarterly profits (not to mention obscene executive compensation packages).
The problem is that if you line people up right to left, the median makes the choice. As you get “something”, then the number of people who want “more” decline; the number of people who are satisfied becomes the majority.
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p>Effectively, you end up compromising on a compromise. Sometimes if you take incremental progress, you give up the chance for a big win.
what seems like an exorbitant amount for my family’s health insurance. It’s like a second mortgage–a killer bill every month. Other than the public option, what other aspect of the health reform package will give me the hope of lower monthly health insurance premiums?
If Obama drops the government health insurance option, so-called “moderate” democrats specifically will lose in 2010 elections. And, Obama himself will not be re-elected in 2012.
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p>I know many democratic party activists. And I think the following reflects their opinions:
1. Activists are already giving Obama and the democrats the benefit of the doubt in what they perceive as them selling out to financial industry interests in the bailout & stimulus packages.
2. Activists are already giving Obama the benefit of the doubt in what they perceive as him selling out to Bush/Cheney administration detention/interrogation policies.
3. Activists are already giving Obama & the democrats the benefit of the doubt in what they perceive as them selling out to oil and coal interests in the climate change bill.
4. Activists are already giving Obama the benefit of the doubt in what they perceive as him selling out on changing Don’t Ask Don’t Tell.
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p>Activists already believe that the public option is a compromise. They truly want single payer — Medicare for All. For Obama and the Democrats to back away from what they see as a compromise, the public option, is a bridge too far. The public option is to activists a MAJOR campaign promise of Obama’s and a key indicator whether Obama truly represents CHANGE.
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p>Without a public option, democratic activists will say to themselves, “Why bother?” Obama and the democrats couldn’t more obviously sell out to health insurance interests — exactly what Obama promised in his campaign what he was going to CHANGE.
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p>If Democrats don’t pass a bill with a public option, I don’t see them working for any of their re-elections. And, I’ve heard many state that they won’t vote either — that is, they’ll stay home on election day.
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p>So,the Democrats with the most to lose are precisely those in the most competitive districts. It won’t be the party’s liberals who’ll lose their seats. It’ll be those so-called “moderates” and Obama himself.
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p>For Obama to drop the public option would be political suicide.
this list of speculations and the conclusions make no sense at all. Except as an idle threat by a tiny minority of pouting politically inexperienced ideologues.
Are your political interests more closely aligned with the “tiny minority of pouting politically inexperienced ideologues” as you call them, or Congressmen Phil Gingrey and Senator Chuck Grassley? All I’m saying is, save your venom for those who stand in the way, not those pulling in the same direction.
just scratch the “venomous” 2nd sentence characterizing the tiny minority.
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p>I stand by the first sentence.
😉
Are you saying that activists don’t feel this way? I know plenty and they ALL feel this way.
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p>Are you disagreeing that activists aren’t becoming disillusioned? I know that they are. And, the latest polls seem to back my assertions up. Obama’s approval rating is being most affected by losses among LIBERALS.
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p>Are you saying dropping the public option wouldn’t be a sell-out to the health insurers? Because it would be.
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p>Are you saying activists aren’t zeroed in on the public option. Then, what are all the petitions to Obama about? Why’s Firedoglake pressuring legislators about the public option? Why’s the AFL CIO threatening not to support any Democrat who votes against the public option?
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p>Maybe they’re asking themselves exactly what does “CHANGE YOU CAN BELIEVE IN” mean?
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p>If Obama and the Democrats can’t deliver health reform with a real public option, (with a big Congressional majority, 60 Senators and the White House) what good are they? They won’t deserve re-election!
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The folks on the other side of health care reform don’t want a bill so who are the Democrats negotiating with and to what end? Even John Kerry doesn’t know how to make it work with co-ops, not that Chuck Grassely would vote for it if he did. This bill cannot turn into a multi-billion dollar bail-out for the health insurance industry. We’e tried the nonprofit co-ops before, they became Blue Cross/Blue Shield.
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p>The President floated this trial balloon yesterday. I think the American people lose if we go along.
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p>If we are going to have an individual health care mandate, we must provide an efficient non-profit, nationwide model for maximum pricing power to deliver cost control and not require taxpayers to fund profit and overhead. It is a solution to the question: Why should taxpayers fund the 15-30% overhead for-profit insurance providers have built in when medicare can do it for 2.4%? Maybe we should go “Medicare for all” but I don’t think that has more momentum than 4 of the 5 bills in Congress.
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p>All three bills in the house have public option. Kennedy’s committee bill in the senate does too. The Senate finance Committee’s bill does not. The objective is to get the Kennedy Bill passed not the Baucus/Grassley bill.
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p>Barack wants to prove he is not just the president of blue states. The folks in red states are telling him to go it alone and have been since January. When will he start listening to them …because he certainly isn’t listening to us.
Like it or not, the battle over public option is a test case of the power of the Progressive Caucus. Blue Dogs play brinksmanship all the time and get away with it. Why shouldn’t we?
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p>Besides, it’s not a choice between a perfect bill or NOTHING. We need to do away with that silly notion.
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p>I think this thinkprogress post sums it up best:
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p>http://yglesias.thinkprogress….
The public option is one means to a key end: providing high quality affordable health care to all Americans. We’ve failed to reach this goal again and again for decades. If we can get universal health care with some gains on cost we need to do so even if key Senators do not accept one means to that end.
Where can one find a concise breakdown of the current situation, and convincing evidence of the desperate need for reform of the health care system?
Look here >http://dartmouthhitcingpost.blogspot.com/2009/08 for an argument based solely on the economic reasons that health care reform is essential. Add to that the moral side that the richest nation in the world is allowing its citizens to suffer needlessly. I think you have a compelling case between the two.
http://www.nchc.org/facts/econ…
Lot more from http://www.nchc.org
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p>President:
http://www.nytimes.com/2009/08…
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p>Commonwealth Fund:
http://www.commonwealthfund.org/
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p>Health Care for America Now:
http://healthcareforamericanow…
pdf of faq’s
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p>Any of that helpful?
Thanks to you both.
My point is similar to lanugo’s, but I have to make it my own way.
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p>NO. Sorry, I refuse to take a scintilla of blame for this. We worked our asses off last year, raising gobs and gobs and more gobs of cash to elect Democrats, and we did, and they all ran on “change,” and we’ve told them in poll after poll that we SUPPORT the public option, and they won’t do it.
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p>It is the fault of every Democrat in Congress if the debate has gone awry. It is Barack Obama’s fault. It is Charles Grassley’s fault too, but I have no intention of holding him acocuntable for it.
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p>I heard Bob Dole say on NPR yesterday that he’s been working on healthcare since 1977. But it’s our fault that we haven’t made the argument? Don’t be ridiculous.
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Sorry, my point is similar to shiltone’s.
Tell me how this sounds for a health care reform plan.
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p> * A national health care exchange
* Buy-in to Medicare at age 55
* No discrimination against those with pre-existing conditions
* No waiting period for Medicare for disabled
* CHIP covers up to 250% of poverty level
* Credits for small businesses and individuals to make health care affordable
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p>Oh, and don’t forget this bit:
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p> * A public option
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p>Now, it may surprise you to learn this. But the architect of this program is none other than Max Baucus–the guy who has been pushing against a public option since the insurers were allowed to drive this debate. Here’s the language from his white paper–dated November 12, 2008–on the public option:
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p> The Exchange would also include a new public plan option, similar to Medicare. This option would abide by the same rules as private insurance plans participating in the Exchange (e.g., offer the same levels of benefits and set the premiums the same way). Rates paid to health care providers by this option would be determined by balancing the goals of increasing competition and ensuring access for patients to high-quality health care
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p>It’s worth reading the whole thing. It’s like a journey through the looking glass, to a time when even a conservative Democrat would openly espouse doing what’s right to truly improve health care. It’s a voyage to a time before the corporations started running this process. And it’s proof that Max Baucus doesn’t believe the option (or lack thereof) that he is currently pitching is the best for this country.
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p>link
it’s a complete corporate giveaway, with no real competition mechanism to make sure they actually have someone knocking on their doors to take costumers if they don’t reform their ways. What on Earth has convinced people these companies can be trusted?
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p>No public option, no mandate.
What about the cost savings? It’s missing from your argument.
The “cost” of health care is the cost of health care providers delivering services to patients. Period.
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p>Here are some things that are not health care costs:
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p>The purpose of the opposition to single-payer and public-option plans is to preserve all or most of these. The alleged “cost savings” are a bad joke, a self-serving rationalization for perpetuating business-as-usual.