Today, in an editorial, WaPo continued its campaign against the public option, asserting that it must, as a practical matter, be abandoned. Here’s the heart of its argument:
”This is not a matter of ideology but of political nose-counting. The kind of comprehensive health reform that the president rightly wants — changes that would extend affordable coverage to millions of people and help slow the growth of health-care costs — requires 60 votes in the Senate. Democrats could muscle through some provisions with 50 votes, but a Senate rule limits how much can be done through that route. Measures such as establishing insurance exchanges or imposing new coverage requirements on insurance companies, as President Obama has been emphasizing, might be vulnerable to being stricken. And there’s no way to amass 60 votes with a public option in the bill.”
This is not exactly a watertight argument, even though it may pass for wisdom at this smug and dying excuse for a newspaper whose progressive instincts died long ago. Yes, the PO being proposed in HR 3200 would require 60 votes in the Senate, and so would the President’s exchange. But, under reconciliation, eligibility for actual Medicare coverage could be extended to the whole population, as could Medicaid, with 50 votes plus the Vice President’s, and this measure could be made revenue neutral by raising taxes on high-income Americans. This would give everyone a Medicare or Medicaid “public option,” and that, I suspect, would be entirely acceptable to progressives favoring a PO even if the words were never used in the bill.
It’s true that prohibiting insurance companies from discriminating based on preconditions, or performing rescissions for any reason, charging higher rates to the sick, or charging outrageous rates for individual coverage, can’t be done under reconciliation, and neither can a market exchange be established. However, matters like these can be taken up in a separate bill, or bills after reconciliation is done, and Medicare coverage has been extended to the population. I think that regulatory prohibitions for private insurance companies should be handled separately from the market exchange mechanism and from any requirement mandating individuals or businesses to buy insurance, accompanied by subsidies for lower income individuals. That way, the regulatory bill would be very clean, and all Democrats: progressives and Blue Dogs alike, as well as some Republicans, could be recorded as voting up or down for eliminating the outrageous abuses used by the insurance industry for generations to destroy the security, lives, and economic well-being of Americans.
After passage of the extension of Medicare or Medicaid to everyone through reconciliation, and regulatory reform for those who still want to remain insured by private insurance companies, the questions of a health insurance market exchange, mandates for individuals and businesses, and subsidies for low income individuals can be taken up in a third bill, which would be subject to filibuster, and may or may not get 60 votes. I suspect there might be enough support for a market exchange among the items in this third bill, and perhaps also for subsidies, but I doubt that the mandates for individuals and businesses will get 60 votes in the Senate and perhaps not even a majority in the House.
What if this third bill did not pass, where would we be? Well, we’d still have everyone eligible for Medicare and we’d have the major abuses of the insurance companies outlawed. But we wouldn’t have a Government-run exchange, mandates or subsidies. What’s wrong with such an outcome? It seems to me it would be the greatest advance in health insurance reform since 1965, and a wonderful achievement. Moreover, I’m sure that the private sector would be happy to step into the breach and offer an insurance exchange for those who wanted to stick with private insurance. As for mandates and subsidies, I don’t think those would be necessary once eligibility for Medicare and Medicaid is extended to everyone. If the insurance industry thinks that mandates and subsidies are necessary, I think they can try to convince the American people of that, and progressives can stand by and watch the fun as Republicans try to justify coercing people into buying insurance from the health insurance companies.
Let’s summarize now. The important aspects in the present bills can be broken into three segments. 1. Establishing a public component to compete with private insurance. This can be done by extending Medicare and Medicaid eligibility to everyone under reconciliation and will take 50 votes + 1 VP vote in the Senate to pass. 2. Eliminating the worst insurance company abuses. This will take 60 Senate votes in a separate bill, but would be hard for any Democrat and even a few Republicans (Snowe, Collins, Voinovich, Lugar) to vote against. 3. Creating an exchange, and providing subsidies and implementing mandates. This will take 60 votes in a separate bill and is most vulnerable to defeat. But it is the least important of the three segments. And from the progressive point of view, it is not important whether it passes or not. So, lastly, it isn’t at all obvious that a public option needs to be abandoned by the President, and, whatever he does, by the progressives and Democrats in both Houses. All that’s necessary is for progressives to give up the words “public option” and provide that option by extending Medicare and Medicaid eligibility to everyone.
Before I end this one, I want to comment on another portion of the WaPo editorial.
”To listen to some Democrats talk, reform without a public option is scarcely worth doing. This is crazy. Rep. Eddie Bernice Johnson (D-Tex.) has asserted that "without the public option, we’ll have the same number of people uninsured. If the insurance companies wanted to insure these people now, they’d be insured." But under the proposed reforms, even without a public option, insurance companies would have to agree to cover people regardless of their health status. The government would extend Medicaid coverage to millions and provide subsidies so that millions more could purchase insurance. Mr. Obama was right when he described the public option as "just one sliver" of the overall proposal.”
I think this statement is, at best, disingenuous, as if the only issues here are whether people get insured, and whether discrimination based on health status ends. Other issues include whether people and business will have to continue to pay an exorbitant amount for insurance, whether the insurance industry will be allowed to continue its runaway inflation of insurance prices and profits, whether the industry can be made competitive rather than monopolistic, whether people and businesses will be mandated to buy insurance, and the cost of subsidies. All of these issues are impacted by the presence of an operative public option on day 1 of the reform (where day 1 is not some date in 2013, but at most 12 months from passage), whether or not that PO is called a “PO” or an extension of Medicare and Medicaid. Further, without a PO that is powerful enough to force the private insurance companies to lower prices, the cost of subsidies for taxpayers will drive up the cost of the reform program in order to maintain the excessive profits and executive salaries of the companies and their executives.That’s not just a side issue. It’s another bailout or "lemon socialism" issue that both progressives and the WaPo should be very concerned about.
So, the PO aspect of any reform is not just a “sliver,” it is the critical piece in any reform, because it changes the whole power structure of the health insurance market, and prevents the program from becoming a bailout. It will force the companies to stop raising prices on consumers and it will wring profits out of the insurance industry. Every other nation with a better health care system than ours spends a fraction of what we do per person on health care, and they do so largely because they have wrung the profits out of health insurance. Now, it is time for us to do that too. And it is time for WaPo to discuss all the issues involved in health insurance reform, and not just those that it, from its increasingly plutocratic point of view, thinks are important.
(Also posted at Alllifeisproblemsolving blog)