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Who Needs a Public Option?
Even without it, health care would be the greatest piece of liberal legislation in years.
The progressive political world was sent into a tizzy over the weekend as Health and Human Services Secretary Kathleen Sebelius indicated on Meet The Press that the Obama administration would be okay with a health-reform plan that doesn't include a so-called "public option." Sen. Kent Conrad (D-ND) added fuel to the fire when he reiterated both his personal opposition to such an option and his doubt that a bill featuring a public option could pass the Senate. The level of panic about this is somewhat overstated, because the administration's position hasn't really shifted, notwithstanding alarmist headlines like "'Public Option' in Health Plan May Be Dropped." But more important, it's overstated because one can still easily imagine a health-reform plan that would be a monumental progressive achievement even without a public option.
It's no exaggeration to say that even without a public option, a health-care bill would be the greatest progressive legislative accomplishment in four decades.
Indeed, for all the fetishization of the public plan among liberals, it's worth emphasizing that the sort of plan being envisioned by congressional liberals would affect relatively few people. Moreover, the flipside of Barack Obama's promise that the currently insured won't be forced to change their coverage is that the currently insured also wouldn't be allowed to drop out of their current plans and opt in to a new public one.
Which isn't to say that the main plans currently being offered don't have a lot to offer the insured majority. In fact, they offer a great deal, most notably a set of consumer protections that would cap out-of-pocket health costs, guarantee access to preventive care, and prevent insurers from treating people well as long as they're healthy only to start monkeying around when they get sick. This would be a big deal. The bills in Congress also envision expanding the Medicaid program that currently serves the poor. This would only help a relatively narrow slice of the near-poor, but for those who are helped, the help would be enormous.
Finally, and critically, the plans in Congress aim to fix the broken individual market for health insurance.
Most kinds of insurance you can just go and buy for yourself. But health insurance doesn't work like that because nobody wants to sell an insurance policy to anyone who would want to buy one. The fear is that you'd let yourself go uninsured until you find our you're going to need medical care, and then go buy some insurance. This problem of so-called "adverse selection" means health insurance can only work when an employer can bundle together a big group of people, leaving the self-employed, the unemployed, and those working for small firms at a huge disadvantage. All versions of health insurance reform before Congress would offer a three-fold fix to this. First, force insurers to offer a defined set of benefits to all comers at a fixed price—no discrimination based on gender, health status, whatever. Second, fix the adverse-selection problem this causes by mandating that everyone get themselves some health insurance. Third, to fix the economic hardship this might apply to some families, offer generous subsidies to ensure affordability for all.
This would, if done correctly, more-or-less solve the problem of the uninsured. And those of us who do have insurance would be spared the insurance-related anxiety that's endemic in contemporary American life. No longer would the state of your health care need to be a dominant decision in making career choices, and no longer would the risk of job loss also be the risk of preventable death or medical bankruptcy.
The idea of the public option is that instead of the menu of choices available to consumers on this new individual insurance market ("the exchange") being restricted to existing private insurers, the government would also create a new competing entity. This is a good idea, that holds some promise for improving quality and reducing costs. But even without it, everything outlined above would still happen. That would be a huge win for the uninsured, the poor, the anxiety-stricken middle class, and ultimately for the economy as a whole. It wouldn't be an ideal health plan or the best bill you can imagine. But it's no exaggeration to say that it would be the greatest progressive legislative accomplishment in four decades, and that's nothing to sneer at.
Matthew Yglesias is a Fellow at the Center for American Progress Action Fund. He is the author of Heads in the Sand: How the Republicans Screw Up Foreign Policy and Foreign Policy Screws Up the Democrats.
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thekingofcheap
Thanks Mr. Yglesias, for proving my point in another comment thread about the liberal press giving Obama credit for his spinelessness. This legislation will not actually work out for anybod. Now I'll be forced to buy a product I don't want, or face fines??? Yeah, that sounds really progressive, expanding the corporate customer base. The rules you are so proud of will only have real teeth when there's a public option. Of course, the public option was supposed to be the compromise in the first place, so how can you celebrate Obama's caving in?
It's time for progressives to abandon the Democrats and unite behind a party that shares our ideals.
North49
What party shares your ideals as a "progressive", the CPUSA?
This comment has been removed by The Daily Beast's editors.
tehixe
Easyrider, either you're a Republican shill, or you may as well be, because you're doing their work for them. Delcaring that, less than one year into it, the Obama presidency is a failure puts you square in the Dittohead camp. How does it feel to agree with Mr. Bouncy? If it doesn't make your skin crawl, you're not a progressive.
I have a word I want to teach you people. It's called COMPROMISE. It's a thing for grownups, not big babies, so you might have trouble with it. Compromise is where we deal with political realities and do what is possible. We don't throw tantrums when the President doesn't manage the impossible. We don't throw up our hands and vote for a Bush-electing loser like Nader. We speak up, we let the President know what we want, and if things don't go our way, we grit our teeth and press on. In other words, we act like adults. The problem with politics on both sides is that people simply can't take of the diapers and behave like grownups. Take a long look at yourself and ask: if I refuse to compromise, aren't I just a different flavor of the right-wing loonies I despise so much? Aren't I just a big baby who isn't worthy of the right to vote?
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case1234
Obama can't lead? How about the dems CANT follow. Have you all even been watching this unfold. The Blue Dogs are bitting the hand of the man who helped many of them get elected. (many blue dogs are from the south and would not be there without the AA voter bump).
Also, the media has failed to defend the TRUTH at Obama's expense. They are so hell bent on Proving that they are not Pro-Obama that they let any absurd GOP attack line (death panels) gain legitamacy by reporting them.
Obama can't do this a lone. He is talking all the left wing flack... while next to none seems to be trained at the Dems in congress who are blocking his agenda for their own political benefit.
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maspring
Well, this article appears as number 2 on the Daily Beast. Article number 1 was entitles "The Republican Comeback."
Yet Republicans still complain about a "Liberal Media." Even when the most recognizable names in media today: Limbaugh, Hannity, O'Riely, Coulter and Beck are all far right-wing.
This underscores the Republican position: "All or nothing." No compromise. Hell, they're livid with John McCain for voting with Bush only 90% of the time.
Republicans can't be negotiated with. They don't compromise. They don't work toward consensus. They don't share. Bend their way 95% of the time and they'll demonize you for the other 5%.
This is why Republicans simply must be beaten. To hell with what they think and what they say. The Center and the Left must remember to kick their teeth in every single chance they get.
Maezeppa
Spoken like a Ron Paulite.
AlanD2
thekingofcheap: Why not? It looks like the extremist wingnuts are about to abandon the Republican party. I say let every body have his or her own party!
AlanD2
maspring: When Republicans complain about a "Liberal Media" , I just remind myself that these guys are liars. What else is new?
lauraharries
So many, so confused.
I have a straightforward "poll" that I'd like to share with anyone afraid of the right wing of the country -- the "immoral minority."
It was inspired by my congressman's website, Republican John Shadegg, who's only feed back he provided for his constituents was:
Do you support:
a. government- centered health care
or
b. patient- centered health care
I recognized the false choice and wrote a poll of my own, which I would like everyone to share with as many people as they can.
Do you support:
a. Insurance company executives making on average $11.9 million per year?
or
b. Jesus' message to his followers to take care of the sick and the poor?
Please report any and all feedback on my "poll."
BullMoose
No Obamacare for bums and illegals. See you in a few months so i can laugh at you . Dreamers and sceamers, these Obama socialist.
mindlessmissy
Uhhh.... NO !
I still DO NOT see a viable method of driving down Insurance Company Premiums without a good competition from a National Non-Profit Health Insurance Provider ...
I'm sorry BUT co-ops will NOT cut it ...
We can NOT count on the for profit Insurance Companies to do what is right without any form of coercion ...
AlanD2
A co-op member on cable news today said that it costs almost as much as private insurance. He also said that they reject some people with pre-existing medical conditions.
It doesn't sound like co-ops will help uninsured Americans very much.
DustyMills
So basically your saying that the insurance industry needs regulation, and I so agree. Perhaps it was too much to expect our President to take on this mega-greedy corp known as insurance, especially in these times of economic upheaval. If he would have pushed for regulation we could force big insurance to become more affordable, to quit the cherry-picking and to just quit deciding who deserves to live or die.
Until our government decides to rein-in the abuses that have come about in the last twenty or so years that allow these big corps to reap billions every year all the while holding their subscribers hostage, nothing will change. Until we have a President and Congress who will fight fire with fire with lying republicans, who will actually work for the people, nothing will change.
If Obama can't get politicians to work togeather for true reform, then I hope he pushes them out of the way. Unless the middle class gets a break here, we will become a society of rich and the poor, with nothing in between.
mcmchugh99
I'll tell you who needs expanded Medicare and Medicaid: the people who can't afford to buy private health insurance. This is not just some pie in the sky thing, it is harsh reality.
It is wrong to mandate that every individual buy private health insurance that they cannot afford. It would be a terrible mistake to pass a "reform" like that with no public alternative--and this administration is already making too many mistakes and fumbling around too much. I fear they are wasting the best opportunity for reform Democrats have had since the days of FDR.
Now, I'm all for expanded Medicaid and funding for public hospitals. That part of the bill should pass, and I think it will. They should not require everyone to buy private health insurance, though, and they should stop changing their story from one day to the next. It's causing a big loss of confidence among their base of supporters.
ThinkAgain
He should just scoop up the republican alternative and call it his and pass that. That worked for Clinton with Welfare reform and it drove the republicans nuts. I
whipmawhopma
Interesting thought. Do you think there should more to it than this?
http://www.gop.gov/solutions/healthcare
mcmchugh99
And I fear that mandatory health insurance will be as big a rip off as mandatory auto insurance. I do NOT trust government to regulate insurance companies, since it does such a bad job at regulating anything.
Unlike the Republicans, I think that big business interests actually control the government, not the other way around, and I have no confidence in the ability of government to do anything to protect the consumer.
Let there be more public options in health care, housing and banking, but forget about trying to regulate capitalism. The government has never regulated capitalism very well at all, since capitalism simply has to be allowed to act like itself. Public options, however, should be run like public services--not for-profit.
AlanD2
mcmchugh99: I agree that the government does a poor job of regulating, due to lobbying efforts by the companies being regulated.
But what do you think would happen without any government regulation?
Personally, I don't want to find out. Businesses tend to become criminal because it is cheaper and more profitable. Other businesses must either follow suit or go broke.
North49
Am I detecting a new strategy here? One that says when you face opposition to your plans to expand the interference of the state on an unprecedented magnitude - you first declare victory then retreat?
AmiBlue
Mr.Yglesias, I can tell you are a liberal because you are so hopeful. If you think health insurance companies are going to serve up *consumer protections* without raising the price on their products, you are dreaming. The only protection private insurance companies are interested in is protection for their bottom line.
Further, I'll bet you a dollar to donuts that there will be loopholes galore either by omission or commission for the insurance companies in any health insurance reform this Congress lets get past its grubby hands. The insurance companies expect a return on their investment after all is said and done.
The point of public option was to take the profit motive out of health care. Without a public option, there is no reform. Period.
jus1drun
"without a public option, there is no reform." with a public option huge dem losses next election cycle because there is no time to prove it works before the divided electorate pulls the handle in the voting booth. interesting dilemma.
AlanD2
jus1drun: Do you really think people will forget the disasters of the last Republican administration so fast? A $5 trillion national debt and two wars come immediately to mind.
akryan
It doesn't matter what they pass, the Dems are going to have a hard time in the mid-terms. No matter what passes it will be demonized. There aren't any low hanging fruit for the Dems to pick anymore. The right has a very fired up base and the left is disgusted with the spinelessness of their leaders. Voter turnout is low during midterms anyway. If something substantial doesn't happen now, Dems just aren't going to show up. They sure as hell won't raise money.
Ronym5
What matt forgets is that the presidents over the past 4 decades
Have been republican NIXON, FORD, REAGAN, BUSH, CLINTON, BUSH.
Carter couldn't do anything for the same reason obama can't corrupt democrats like max baucus who receive 4 million from the health insurance lobby and he's the guy writing the bill in the senate.
It's like letting Dick Cheney run a Mosque.
There is no reform without a public option.
Want proof look at banking regulation.
It got scrapped in the 90's and nobody cared and look what happened.
The same will happen with health care regulation.
The GOP will get in power scrap it and nobody will notice.
Now compare that with W's attempt to scrap social security.
He couldn't the GOP can't touch social security of medicare and get elected ever again.
The same would happen with the public option.
What don't you democrats get?
jus1drun
because the next election is too close. they get it.
AlanD2
jus1drun is right. Unfortunately, getting reelected is more important to most politicians than what is good for American.
The only way out of this mess is a Constitutional amendment to force our government to pay for elections. This would eliminate most of the power of the current lobbyists. This will likely never happen.
FactsTravel
Obama campaigned on reforming health care. He was elected by a landslide. The citizens gave him a majority in the Senate and The House of Representatives. Anything short of reforming health care with the Public Option is betrayal, pure and simple. We are witnessing the real war within America: the corporations versus the American people. Corporations are armed with large campaign donations, PAC support,and insidious lobbyists. The American voter doesnt stand a chance.
We are witnessing the lies many politicians tell every day in print, television, and the Internet. They lie with impunity. They do what they are told to do by powerful insiders and spin the voters, many of whom are ill informed. Their rhetoric creates an environment where it all boils down to my team versus your team. How sad.
With deregulation of banking we got the financial mess we have today. With the Enron Rule we got the very targeted deregulation of energy trading which made the rolling blackouts in California and sky rocketing gasoline prices possible as a result of unregulated energy futures trading in the United States and other markets throughout the world. Thank you Phil Grahamm. We bailed out AIG and a host of other financial organizations. We bailed out the car companies and at least saved American jobs... The Senate caved on banking reform as a result of pressure from bank lobbies. Credit reform was achieved but headlines today show these firms are rushing to stick it to the average consumer one more time, before the new law goes into effect.
We finally as citizens, have one opportunity; one opportunity out of hundreds which benefit special interest groups, to benefit each and every citizen in this country - lock in affordable, comprehensive, inalienable health care. In so doing, we make sure that life, and the quality with which it is lived, is extended to all, regardless of priviledge or economic advantage.
If this administration, at this time in history, doesnt achieve the goal and fulfill its promise, then many of us will never see this achieved in our lifetime. I fear health care reform, will be killed for several generations. I think politicians, including many Democrats, have been bought and paid for and if true, I will know once and for all, our political system is an image, a hologram, and not what many truly believe it to be.
I still believe Obama will keep his word, but I will work hard to help opponents of those who vote against healthcare reform, especially the Democrats, in my State or any other, as I believe them to be acting in the interest of the corporation and not the citizen.
jus1drun
how about we let potus fix the economy first. there's a few atta-boys in that. win the 2010 elections and have a health plan ready for deliberation the next day.
AlanD2
FactsTravel: Unfortunately, Obama does not have 60 votes in the Senate. There are too many blue dog Democrats, who are actually moderate Republicans (Arlen Specter is the most obvious example). Without 60 votes, there is little chance of a controversial bill getting passed by the Senate.
akryan
you only need 50 votes plus the VP to break a tie. There are procedural ways around a filibuster. Knashing of teeth.
PeteyPete
Congrats! You managed to write an entire column without branding someone a racist. It's baby steps, but we're making progress!
Maezeppa
Are you a racist?
PeteyPete
Have you stopped beating your wife?
FactsTravel
And... coops are a scam. You need 500,000 enrolled coop participants in a given region, and the coop model is a regional plan, to even begin to be viable, and the key word is "begin." Truth is, coops never get the enrollment and therefore never work. So a coop is a pacifier for the electorate. Coop = status quo.
melissamsouza
Excellent analysis. Thank you. But I have a question: if there is no mechanism for cost controls, what is to keep insurance companies from continuing to raise premiums? If they are kept from denying people insurance based on pre-existing conditions and other factors, what is to keep them from denying insurance based on prohibitive costs? Regulations will make insurance accessible, but if prices aren't regulated, there is nothing that can't keep it from being economically inaccessible to most people.
WorldGoneWrong
You're right up until the part where you say that insurance will be more affordable. This bill will very little to make it more affordable for most people. The subsidies will eventually be priced into premiums by the insurers, which basically means that we will be subsidizing the insurers and getting very little in return.
The public option is the key to affordability. Premiums will not rise excessively because then people will just buy the public option instead.
I know that it's politically challenging, and it would be better for Beltway insiders if we didn't challenge the establishment so much. But that's what Obama was elected to do. And it's the politically wise thing to do. It's about time he started doing it.
Lotto1
America does. The millions and millions of Americans who are without insurance or under insuranced or an preexisting condition Those Americans need protection also. It is a human face of this economically farce that the Republicans have created. If you just go and buy health insurance and are over 50 years old and health it costs over $5000 a year for single coverage!
jbuzz1
Oh so the govt is just supposed to give everyone free care, right. It doesn't matter the cost...just cover everyone with all the services they need. Oh yeah and the cost of care will somehow, magically, come down.
All you lefty, lefty liberals on this board need a dose of reality. Everything that this author talks about is reality here in New England and our premiums are sky high. I'm not saying it's wrong but we can't go around just giving coverage to everyone. I would rather not totally bankrupt the nation and pass all this debt on to my kids.
Ritarita
You're already
Paying for them
In the most expensive
Way possible-
Emergency room care.
Doesn't it bother you that you're
Being ripped off?
dcbooknurse
If, according to you, we can't give coverage to everyone who do you propose should decide who is worthy and who isn't? Because right now, it's the insurance companies. I take it you assume that your children will never face a serious health crisis or that their insurance company will decide it doesn't serve the bottom line to continue covering them. Some people don't have health insurance because they don't want it, but the vast majority aren't covered through no fault of their own and desperately want coverage.
Thank you.
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