The Public Option

The public option failed to clear the Senate Finance Committee yesterday which may, or may not, result in its exclusion from the final bill. The health care reform effort is still a work in progress. Once out of the Finance Committee, the bill will go to the floor of the Senate where it will be in competition with another Senate bill. Meanwhile, three bills in the House will be vying for final passage. And once both chambers pass something, there will be a Conference Committee to reconcile the two finalists. Still, it would have been better if the Senate Finance Committee had included a public option.

The television ads that run on CNN are highly misleading. They insist that the problem with the entire health care reform effort is that it amounts to "government-run" insurance and that the public option will force people to abandon the coverage they currently have. Both assertions are wrong and the operative word here is "option."


Democrats, however, have brought some of the controversy on themselves by being too cute by half. For example, while it is true that no one will be forced by the government to select the public option, it is also true that an employer may force her employees onto the public option if it is cheaper than their current plan. Democrats tend to leave out that second half of the equation. And, I don’t see why they do so because doing so points out the lack of freedom in the current system. You are at the mercy of your employer now for your health care, most obviously because you can lose insurance if you lose your job but also because your employer, not you, chooses the plan or plans available to you.

As well, rather than creating a distinct entity, Democrats should have said, "And if you don’t like the private choices you can buy into the plan we in Congress get." Or, even better, allow people to buy into Medicare. The phrase "public option" lacks concreteness in most people’s mind. They know what Medicare is. And, if Republicans attacked a Medicare option, they would have to be careful because some people would think they were attacking Medicare. There is no quicker way to political defeat than to attack Medicare or Social Security.

I suspect there will be a compromise, the so-called "trigger" for the public option. If there are insufficient cost-savings in three or five years without it, the public option would be activated automatically. Indeed, the threat of a public option might achieve what an actual public option is intended to achieve, a reduction in costs by the insurance companies. We could find ourselves, a few years hence, in the almost comic situation where the only way for insurance companies to make gargantuan profits would be to take that threat of a public option off the table, and the only way to do that would be to elect a GOP majority in Congress. But, then, the immediate result of such an election would be a hike in insurance premiums so the GOP would have to threaten a public option too. If that comes to pass, I hope someone keeps a tape of the scare ads they are running today.



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8 years 8 months ago
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9 years 3 months ago
"But, then, the immediate result of such an election would be a hike in insurance premiums so the GOP would have to threaten a public option too."
Mr. Winters, you are being too optimistic about and kind to the GOP who aren't ever going to threaten the insurance industry about anything.
"Indeed, the threat of a public option might achieve what an actual public option is intended to achieve, a reduction in costs by the insurance companies."
Never happen.  Arrogant Big (Regional Monopoly) Insurance will go right on gouging the American public, especially if Republicans are in the majority. 
Sadly, their are plenty of citizens who can be manipulated into voting against their own best economic interests.
9 years 3 months ago
     Who figures out cost savings from health care reform?  Whose spending comes into the equation? 
     If whatever entity reports back that it is saving so that the public option is not triggered (should this be how they set it up), does this mean that people who currently cannot get the medical attention they need because they cannot afford it-because they can't afford the basics that insurance does not cover and that insurance requires the insured to pay-will still not be given any kind of help to get even the basics and will just be covered by insurance policies that do them no good?  Or, does it mean that whatever the insurance companies want to charge in exchange for giving everyone the basics will include the cost of being an insurance company and having to pay high executive salaries, and that we taxpayers will have to pay this extra money for something that could be provided much more cheaply by the entity that currently provides Medicare (our government)?
     The current proposal to address the problems of health care in this country by turning to the insurance industry is unnecessarily complex and likely to be unnecessarily expensive.  It would be much simpler if each person's medical care costs were sensitive to his or her income and his or her medical care were always available from birth until death based on need.  Furthermore, why should the employer have any involvement in this at all?  That insurance companies and employers are involved in the medical care of US citizens would be very unusual but for the fact that people have become used to the idea. 
     That most of the discussion of this situation is not a debate how to get the most benefit to the most people for the least amount of money shows that the interests of the politicians working on this are corrupted by concerns for the well-being of insurers, who may be paying for that attention, but who hardly need it.  They would have people believe that their freedom is compromised by their having access to health care at a price they can afford, as if having this forces them to go to the doctor when they don't want to.  However, the reality is that the current proposals for reform, as well as the current system of employer sponsored insurance, only force people to give money to insurance companies that could be better spent on direct payments for medical care.
9 years 3 months ago
Much of the continued opposition to health care reform comes from the insurance industry and it has nothing to do with the public option.  Indeed, without the public option, ending pre-existing condition and loss prevention practices will increase health insurance prices for everyone.  There is another way to do this, although it involves compromise.  Here is what I propose:
-         Drop restrictions on pre-existing condition and loss prevention clauses
-         Drop individual mandates
-         Adopt a Public Option restricted to people dropped from coverage and families with a member excluded for a pre-existing condition, with automatic enrollment in the public plan upon such a dropping or denial with the insurer contributing 70% of the premium to the government as a consequence and annual automatic reapplication and continued insurance company funding until the individual or family is covered.
The alternative to this, if pre-existing condition and loss prevention clauses are prohibited, is further consolidation, greater regulation (including eventual price regulation) and eventual enactment of single payer insurance with health insurance company administration.
9 years 3 months ago
"Here is what I propose:
-         Drop restrictions on pre-existing condition and loss prevention clauses
-         Drop individual mandates
-         Adopt a Public Option restricted to people dropped from coverage"

Sounds like a good idea to me. Fundamentally, I think that so long as discussion and compromises are centered on numbers, things are going well and health care reform will pass.
If the debate turns to ideology: "Health care reform is socialism" or "Abortion and Euthanasia are health care" then compromises will be impossible. Obama has already backed away from the "abortion is health care position". If only democrats can agree to write that into the law in a permanent fashion.
9 years 3 months ago
Michelle Loughlin, I do not recall insurance rates being low during the Clinton years.  Get your facts straight.  Big business owns both political parties.  The lawyers who fight tort reform are in bed with the Obama Administration. 
9 years 3 months ago
In a 13 -10 vote, our patrician legislative body refused to restrict abortion funding in any health care reform bill.  A second vote of 13-10 refused to strengthen conscience clauses for health care providers.  I remember a week ago the author of this blog asking where to draw the line on abortion?  Why not here?  Is the democratic coalition so weak you need the pro abort liberals to pass health care reform?  Is health care reform so imperative you’re willing to throw the unborn under the bus?  While I agree abortions are non sequitur to the funding or non-funding of abortions, imagine the Christian symbolism and statement for the culture of life such a vote would project.  It makes me question the real reason democrats, specifically partisan Catholic democrats, are so fixated to pass this legislation.
9 years 3 months ago
Medical malpractice settlements account for around 0.5% (yes, one-half of one percent) of U.S. healthcare costs each year.  Texas imposed a $250,000 cap in 2005.  Healthcare premiums in Texas have continued to increase more and faster than in states without caps.  The cap did NOTHING to drive down premiums, but it did have the intended result of increasing insurance company profits.
Obama has much bigger fish to fry in order to cut healthcare costs.  Better that he spend his time going after healthcare industry fraud and eliminate subsidies being paid to already highly profitable insurers.
Cries for tort reform are just another Republican obstructionist strategy.
9 years 3 months ago
With regard to the name Public Option being partly to blame for its being unpopular in some circles, one might note that it has the same ring to it as does Final Solution.  A much better name for a system where people contribute a portion of income into a national health savings account out of which all citizens' medical bills are paid, would be National Health Savings Program.
9 years 3 months ago
One note, the Abortion Funding Amendment would have amended the bill beyond abortion neutrality, which is already in the underlying bill and is what Obama promised.  The key is what happens in the Senate when the two bills are reconciled and then in conference.  If the Baucus abortion language is adopted, it should be exceptable to the Church.
It would be better for our credibility if we didn't try to overreach under the radar and then call foul when caught out.  The Pro-Life movement has a history of doing that - for example the FOCA postcard effort (there is no FOCA in the current Congress) and a partial birth abortion bill that does not specify trimesters.  Such moves are fundamentally dishonest and give the Church a black eye - not for the content but for the tactics.
9 years 3 months ago
Michael Bindner is correct. Any attempt to sneak in anti-abortion restrictions will discredit the anti-abortion effort.  The best anti-abortion legislation is that which makes medical expenses a non-issue for someone who is unintentionally pregnant.
9 years 3 months ago
Ms Loughlin:  I'd like to know the source for your claims on tort reform and are you sure rising health care in the state isn't due to other factors (immigration).  As far as ''Rebublican obstruction stragtegy,'' I suggest you take a head count of our legislature and remember these two numbers - 60 and 256.  Republicans can't stop anything!
Mr Binder:  Your absolutely right!  On the other hand, I find it an oddity that health care reform is morally imperitive yet we must retain ''abortion nuetrallity.''  Once again, I question the real reason for this bill and wonder what is really being done ''under the radar.''  As for under the radar, what are your thoughts that the Senate commitee refuses to post the working copies of the bill for public scrutiny?
9 years 3 months ago

As for the numbers of Republicans in power making it impossible for them to obstruct anything: "A lie can travel halfway around the world while the truth is putting on its shoes."

9 years 3 months ago
Bills posted during markup change to often.  Now that the bill is marked up and reported, it will be posted.
9 years 3 months ago
Michelle:  Thanks for the links, I'll give them a look.  As for your metaphor, what is untruthful about 60 and 256?  Yes, I know Senators Lieberman and Sanders are independents but they caucas as Democrats.  More specifically, just how can republicans stop health care?  Please, no lame metaphors!
Michael:  We shall see!  I'll make you a sporting bet of the over/under kind - when the three House of Rep bills are merged, I'll bet under 48 hour review before final vote. 
9 years 3 months ago
At this stage, as long as the staffs have had a chance to look at the bill (albeit with sleepless nights), that is adequate for a representative democracy.  My question is how open the rule will be when it comes to debate and whether an amendment will be offered and allowed to add the Baucus abortion neutral language to the House final bill - thus taking the issue off the table for the conference committee.  That would be nice and it would absolutely devistate the opportunists who woul fundraise about the issue or use it as cover for their own Calvinist opposition to the bill.


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