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I joined in the health care fight in May… sending out email alerts to all I knew telling them to support the public option, and to tell everyone they knew… called my reps asking for the same thing. Joined with nycve, Jane and slinkerwink in their appeals for a strong (robust was the phrase used at the time… long ago abandoned as it became clear that it was not and never would be)….
I even organized a very successful rally at Senator Bingaman’s office in July… I spoke with his legislative healthcare aides personally… they assured me he "supported" the public option.
I pointed out to them that it’s easy to say you "support" something, but to really mean it, you have to fight for it. Perhaps Bingaman fought for it behind closed doors, but he never showed in his one town hall or his appearance on Charlie Rose or publicly.
I began to get suspicious of the "public option" in August, as I know many others here did as well. I asked Howard Dean in his live blog here at FDL a couple of months ago how he could support a public option that would essentially exclude those covered by employer insurance because of the unrealistically high premium percentages that had to be exceeded… Dean’s response was along the lines of "well, we’ll get our foot in the door and build on it from there."
So I went along with that… usually I take what Dean says as gospel… he is the one voice I know I can trust.
But as time has gone on, and the House version came out and the Senate version came out and as even Obama said in his speech to both houses of Congress… "The public option ONLY will cover about 5% of Americans…" I really began to wonder why progressive were still fighting for something that had become a mere shadow of its former self… or as I had said before on FDL… a public option with barely a pulse.
So I wondered if others in the progressive community were feeling as I … that the health care bills as they presently exist are really almost laughable in their handouts to the insurance companies and big PhRMA.
Wendell Potter, another voice that I imminently respect, told O’Donnell last week that "Yes, if we keep the public option in, the Senate bill is still worth passing." He said the insurance companies were really fighting to exclue the public option clause… so that meant that it really does threaten them… hmmmm…. I remain skeptical.
So today in the NYT… Paul Starr (former healthcare aide for Clinton … I know not his true conmpass… is he a corporate shill like Begala and Carville and Emanuel?) makes what is to me a pretty compelling argument for jettisoning the weak and near death PO for other concessions such as implementing some major changes before 2014, etc.
I began reading his OpEd with suspicion… after all, we’ve been so indoctrinated that we MUST support the public option at all costs… but as I read what he said, it began to make more and more sense. As I think Dave Dayden pointed out here at the Lake a day or so ago, the PO will receive the denied dregs of individual and small business
policies (I myself could easily be among them if I became seriously ill as I have junk individual insurance….)… therefore the premiums will be higher, and no one will want to switch to higher premuims (I’m sure this was all elegantly orchestrated by the insurance powers that be… see recent logs of WH visitors).
If so, the PO will be an abysmal failure out of the gate… and why not fight for stronger concessions that take effect before 2014?
AS the health care debate enters its decisive stage, liberals in Congress should be ready to trade the public option for provisions that will actually make the reforms succeed.
Discussion of the public option — a government insurance plan that would be offered to individuals and small businesses buying coverage through new insurance exchanges — has been dominated by ideological politics. Conservatives claim it would amount to a government takeover, while liberals imagine that it would radically alter the insurance market by providing better protection at lower cost.
As it now stands in Congress, however, the public option would do neither. According to the Congressional Budget Office, it would enroll less than 2 percent of the population and probably have higher premiums than private plans. For progressives to say they will block reform without a public option is not just foolish, but potentially tragic if it results in legislative deadlock.
An earlier version of the public option, available to the entire public, might have realized progressive hopes and conservative fears. By paying doctors and hospitals at Medicare rates (which are 20 percent to 30 percent below those paid by private insurers), the public option would have had a distinct price advantage. But by severely cutting revenue to health-care providers, it would also have set off such a political crisis that Congress would never have passed it.
Instead, the bills in Congress now call for the government plan to negotiate rates with providers, as private insurers do. That limitation exposes a defect in the idea. The government plan may well have to charge higher premiums because it is likely to attract more than its share of the chronically ill and other high-cost subscribers. It could go into a death spiral of mounting costs.
….. Strengthening that authority and accelerating the timetable for reform are what liberals in Congress should be looking for in a deal.
The basic aim of reform is to create a more efficient and equitable system for health insurance and health care and to provide subsidies so everyone can afford coverage.* Those who obtain insurance individually or through small businesses now get a rotten deal in the market. Out of every dollar in premiums they pay, nearly 30 cents goes for administrative overhead (as opposed to about 7 cents in large-employer plans). And those in poor health may be denied coverage for pre-existing conditions or be charged astronomical rates for insurance.
By creating a single, large “risk pool” for individuals and employees of small businesses, the exchanges should give those vulnerable groups the advantages of large-employer plans. The bill would also ban pre-existing condition exclusions and require insurers to offer coverage to everyone in the exchange at the same rate regardless of health (albeit with some adjustment according to age).
For these reforms to succeed, there needs to be effective regulatory authority to prevent insurers from engaging in abusive practices and subverting the new rules. The bill passed by the House would provide for that authority and lodges it in the federal government, though states could take over the exchanges if they met federal requirements. The Senate bill would leave most of the enforcement as well as the running of the exchanges to the states.
Yet many states have a poor record of regulating health insurance, and some would resist passing legislation to conform with the new federal law. ……
Accelerating the timetable of reform ought to be a priority. Although the legislation calls for some important interim measures, the Senate bill defers opening the exchanges and extending coverage until 2014. …..
For Congress to put off expanding coverage to 2014 would be asking for a lot of patience from voters. It would also give the opponents of reform two elections to undo it. President Obama would have to run for re-election in 2012 defending a program from which people would have seen little benefit.
To speed the process, the legislation ought to give states financial incentives to adopt the reforms on their own as early as mid-2011. A state like Massachusetts, which already has a working exchange, could move expeditiously to qualify for federal money. The final deadline for the federal government’s expansion of coverage should be no later than Jan. 1, 2012.
Let the moderate Democrats who oppose the public option say they stopped a government takeover. Liberals should be prepared to give up what is now a mere symbol for changes in the bill that would deliver affordable insurance more effectively and quickly to the millions of Americans who desperately need it.
* "The basic aim of reform is to create a more efficient and equitable system for health insurance and health care and to provide subsidies so everyone can afford coverage."
If this is Starr’s polite way of saying "stop the murder-by-spreadsheet" and "rape and pillaging of Amercans by the healthcare industry… then I agree with him… cus that is certainly my reason for wanting healthcare reform.
My reason for wanting healthcare is also to get the for-profit insurance company out of healthcare decisions in American…
So what do you guys think?
Would we be better off:
1) With no "healthcare" reform bill at all?
2) With a combined Senate/House bill similar to both bills at this time?
3) With a "healthcare" bill sans the weak PO but with other provisions that are stregthened?
Of course No. 3 begs the question of what is the likely success of strengthened provisions being granted? We could lose all the way around…
Or perhaps, as Potter and Dean have said, having any public option is better than no public option, even tho as presently construed it will like fail.
My thoughts are that some bill will pass… it will favor the healthcare industry as Obama/Emanuel set it up from the beginning… people will be required to buy private insurance and their profits will only increase. We must make it effective before 2014… and really, it probably doesn’t matter if there is a public option or not… having it in would be a pyrrhic victory at best.
And finally… what a fine mess Obama’s White House has created.
20 Comments
I am healthy at age 64.
Some day, I will die.
I’ll take care of myself.
Why do I need a mandate?
I’ve bid a “public option,” of whatever stripe, adieu. I can’t in good conscience urge anyone to support any of the Rube Goldberg messes that the various health insurance bills constitute.
I’ve had enough inside experience with government regulation to read these bills and weep. The gov’t and private overhead in trying to decipher them and administer them would be horrendous. There would be mistakes. Some people would die from them.
I, too, have a lot of respect for Howard Dean (though not for his support of the Iraq invasion.) When he talks about getting at least something for a PO, and building from there, he knows whereof he speaks. In his 10 years as Governor of Vermont, he finally got most Vermonters covered by insurance by taking it step by step, one demographic after another.
But I don’t think the situations analogous. If Congress passes and the President signs — something, our domestic and foreign imbroglios are so severe that I see no stomach for more health care legislation for a long, long time.
The least we must get with a health care bill is individual states’ authorization to constitute themselves as single-payer (state Medicare for All) entities.
Massachusetts, my own state, has single-payer bills ready to go in both houses of the legislature just as soon as a federal OK is enacted. IF it is enacted.
To my mind, that’s far more important than an eventual “public option.” Canada got its single-payer system province by province. We could do likewise.
If no bill passes, though, we must and I will still fight for single-payer. It is the only system that will provide medical care for all, while being financially viable over time.
So, we’ll get it eventually. The only questions are how many hundreds of thousands of Americans will die unnecessarily, and how many millions will become bankrupt unnecessarily, and how many billions the for-profit insurance companies will bilk out of us, before we do.
The thing is just a bag of maggots. The best thing would be to kill it.
Or, if they really need to pass “a bill, any bill”, then strip out the mandate and the phony PO and keep the worthless “regulations” which anyone who knows anything about this government and these politics knows will never be enforced. How’s every other kind of regulation been doing over the last thirty years?
That way they could have their rotten “victory” speech and their lying hype while leaving the status quo intact without making things worse, which this bill does by rounding up this conscript market to mandate that it buy worthless “policies” from racketeers who should instead be strung up.
I’ve never been able to understand why they didn’t just do that in the first place. That’s what Obama’s campaign position was – a phony reform which would just leave things exactly as they were.
I know Obama and Rahm want to help fatten the rackets’ profits and enable their extortions any way possible, but the point is not to commit political suicide in the process. The Reps would never be this stupid. That’s why they’re going to run against the mandate.
This bill is bad principle, bad policy, and bad politics. It’s really quite an achievement.
And most amazing of all: the Dems did this 100% ALL BY THEMSELVES.
I agree this insurance reform is a mess and we should drop it. All it really does is provide insurance companies with more indentured subscribers. Only a year into his presidency and I can no longer console myself that at least Obama isn’t a republican. God, how disheartening.
There is no health care reform of any deep sorted headed our way. The legislation that will emerge from the Congress that will be signed by Obama is going to be a fiction salable to the party’s base in time for the 2010 mid-terms. There will be some sort of hokey “public option” which was designed primarily to preserve the profits of the health insurance and pharmaceutical cartels. There will be a law compelling all of us to, one way or another, hold an insurance product, with no meaningful alternative to private insurance plans, and no meaningful regulation of the industry. The pharmaceutical cartel will be treated to indulgent provisions guaranteeing its artificially-maintained wealth for generation to come.
Health care reform is almost not newsworthy anymore, except perhaps as coverage of a political disaster.
All I know for certain is that each of us must do the best we can to banish feelings of disappointment, disgust, and what’s the use in trying, because it’ll be virtually impossible to make an intelligent decision in such an emotional state of mind.
I want single-payer, so my decision will be to choose a course of action that creates the best future chance of passing a single-payer system. I fear that a weak public option will not survive very long and opponents of single-payer will claim that its demise proves it won’t work. Since I also despise the mandate as presently constituted and I do not want Roe v. Wade gutted via the back door, I’ve tentatively decided that the best solution is not to pass a bill.
Since I’m uninsured, that means I’ll remain that way, which I’m willing to accept.
I would also like to see Obama eat it for what he did.
“Kill it, It’s the Enemy of the Good.” And other blogs on this subject here and here.
We just can’t face the fact that the for profit insurance companies run the show.
It doesn’t matter what we need or want, national healthcare that would really work has always been off the table.
The so-call public option was a teaser to get people to support some kind of bill. Never a good bill or one that would really change things.
So no matter what they give us it will end up costing us more, and even those supposedly to be helped will find the help little, and mostly useless.
Our voices werer heard, and dismissed just as fast as they were heard.
You see our voices never mattered and won’t until we really decide to take back our Government.
That could be many years down the road, or after something so bad happens we are forced to.
When the Congressmen and Senators responsible for this mess come up for re-election, how many here will give the bastards their money, their time, and their vote anyway? Judging from the re-election rates I’d guess 90%.
No bill at all! There is so much evil in this thing already, it needs to be killed.
I’m now as certain as certain can be that we must kill this bill.
“The specter of “healthcare reform” that requires individuals to stretch their personal finances for often-abysmal insurance coverage is the worst of all worlds — government intrusion for corporate benefit without any guarantees of decent health coverage”-Norman Solomon at CommonDreams.org.
I would also add that the “Romney model” so often touted as a possible answer, and the basis for people requesting the “state single payer” is no different than the national give-away to Big Insurance, just on a smaller scale, with the requisite failure to control costs, increasingly punitive fines, and greater numbers of uninsured.
KILL THE BILL! Everybody in-Nobody out!
Thanks everybody for your thoughts… I truly wanted to know what other people thought/think of the bill we are now facing… and agree with much of what everyone has said.
Re “don’t let the perfect be the enemy of the good”… I understand that concept… and truly believe it.
My problem is wondering if there is enough good in the two bills to justify keeping it.
In reality what I think or what any citizen thinks obviously dosn’t matter… I think this bill will pass … I just wish, as Starr says, that the timeframes would be moved up to actually do some good.
I know Jane has said the reason that the timeframes are so far out is to meet Obama’s demands for a deficit neutral bill… which royally pisses me off. We’ve funded an illegal war (and still are) and are escalating troops in another one… not to mention the fucking corporate bailouts in the trillions… but we can’t help our own people….
He is just continuing this travesty.
(and btw… to someone upthread… Dean did not support the Iraq war…)
I want to agree with you… that including options for states to “do their own thing”, eg single payer will be effective… and I know Canada eventually got national health insurance that way…
I just wonder if it would work like that in the good ol’ USofA….
The music producer, David Foster, said, “The good is the enemy of the great”. Don’t ever strive for just good. Strive for great. Now we are left with not even good. We are left with gruel. And more cruel to come.
Kill the bill. It was a setup from the start, just like Afghanistan, TARP, Honduras, etc. Read Paul Street Obama: As Predicted
How about employing what I call the “Let it fester, lester” approach? That is to Kill the Bill and start re- agitating for Medicare For ALL and let the premiums continue to skyrocket and the pre-existing condition and rescission stories to proliferate and let small and medium businesses start howling about how they can’t remain competitive, and continue to hold the free clinics, and support and join “Protest Groups for Healthcare” who have put their freedom and bodies on the line-(and encourage much greater media coverage) and make all candidates in all upcoming elections pass a litmus test on Medicare for All (yes I said litmus test-nothing is more important to this country at this point in history.) Keep pounding away at one simple, explainable theme: Medicare for All. And see if we can enlist the folks on Medicare to help explain it to people in a grandparent-ey sort of way.
Also push for state by state single payer programs.
I was also surprised to read in the NYT that the public option will offer more expensive premiums than private insurance. This is probably disinformation because without reform the sick can not get affordable private insurance. We don’t know what will happen after the bill. I would discuss eliminating mandates without a strong public option. Howard Dean has always said insurance reform did not require mandates or money. Strip the bill out and pass the reforms. We need to pass something that takes effect now. With what we have I think the GOP will be back in power in 2010.
I think the reason the CBO scored it with higher premiums is beause people with insurance can not qualify for the PO… so only people with sucky individual insurance or small businesses will partcipate…
It is confusing and I’m not completely convinced that would happen… but I think it is a strong likelihood.
I have to say, don’t you just think it is wonderful that now the members of the Democratic establishment are making it sound good to liberals to not worry about a PO after they drained it of everything that made it a threat to the insurance companies? Sounds to me like playing this hand plays right into the Obama-Rahma plan. They so thoroughly gutted it that even we can see no real reason to keep it. The only way we can fight this subversion is to be subversive ourselves, by supporting a complete rejection of the health care bill. That is the only way the Democratic establishment is going to give liberals any voice in policy. They must fear us and we must put a big road block in their plans. The only way to do that is to kill the bill, which they desperately want passed, whether it has a PO or not. Don’t buy into the idea that any bill doing some good is better than no bill. As Letsgetitdone argues, this bill will actually turn out to be worse than nothing because of the mandates and the bailout for the insurance companies at virtually no cost to them. As he also says, Everybody in, nobody out — Medicare for all or nothing, because nothing good is what the bill offers the american people.