| I'm always mystified by folks who say that a public option is a "minor" reform - I hardly think they're motivated by insurance money, or greed, or a love of the status quo. I think they genuinely believe the other reform measures - a community standard, say - are much more important. But...why?
Let's start with why folks support a public option. Matt Yglesias:
...the main constituency for health reform consists of people who don't think the present system is fundamentally sound. That's a big part of the reason the public plan element of Obama's proposals has become such an emotional touchstone for the left. The public plan is a fairly modest part of a fairly modest package of reforms, but it's the slice of the package that holds out the prospect of eventual transformation of the system into something quite different and less driven by corporate profits.
The spoken corollary in Yglesias' post is that most folks, while not thinking the system insurance is necessarily sound, are more comfortable with the status quo than with the idea of sweeping and comprehensive reform. That is, there's a real and sizable constituency against, say, single-payer health care (and I'm not talking about Tea Baggers, who are a fringe group of quasi-violent obstructionists). Which also explains why younger politicos - who are more sensitive to consensus-building - readily support the public option, not single-payer health care.
The most interesting observation - at least for the purposes of this post - was from Ezra Klein:
The primary constituency for health-care reform has a political attachment to it, and in particular, to the public option portion of it. This is not, however, the most obvious constituency for health-care reform. That honor goes to the uninsured, the underinsured, the unemployed and others lower on the income ladder who are likely to directly benefit from the bill, rather than abstractly benefit from seeing their ideological preferences included in the bill.
They, however, are not in the streets or at the town halls. Broadly speaking, they're politically marginalized: They don't vote or march or yell.
Klein, for me, has been one of the more frustrating voices in this debate. He's always dismissed the more ambitious elements of reform as unimportant. What gives?
I think the answer is there in his opinion of who's the "constituency" of health care reform: the dispossessed, the indigent, and the sick. Essentially for Klein et al, it appears they see reform as a kind of assistance program for those that are shut out of the system. Reform addresses the marginalized, drawing them into the status quo, while seeking to curb the worst excesses of the insurance system. It's not transformational. It' doesn't fundamentally alter how we deliver and pay for health care.
It's easy for us to scoff at Klein's limited view of health care reform. But I don't think any of us should overlook the obvious benefits this limited reform would bring to millions. Sure, real and comprehensive reform would benefit these folks more, but even this limited reform is something. The goals of the "incrementalists," or the "insurance reformers," or the "cowardly un-progressives" - or whatever the slur du jour is - are good. Isolated from cost, politics, efficiency, etc & co, it might even be worth supporting.
That's still a long way from saying that this limited reform is acceptable.
For one, as I've argued before, I can't help but think these reforms are, at best, a temporary brake on the degradation of private insurance coverage, and no brake at all on health care costs. The insurance industry has a motive (profit) and the means ($$$) to sidestep regulation. (So they can't discriminate against preexisting health conditions - but what about denying a policy to someone because of their zip code, say?) The public option would act as a brake on this degradation, and an escape outlet for consumers.
For another, implementing an insurance mandate without the public option would be politically disastrous for Democrats, progressives, and future reform. Read JC's post about his broken ribs. Here's a guy who's been jerked around by private insurers for years: what feelings do you think he's going to experience when he wakes up one morning, suddenly required by law to buy a private insurance policy? There's the rub: most of those who'd benefit from Klein's limited reform will have been dropped from private insurance rolls because of preexisting conditions or age or general health or because they, you know, once used insurance money for a catastrophic event, and I'm guessing pretty much all of whom feel like they've been misled and cheated by their insurers - and you're going to compel these people to buy private insurance again?
That's not even considering the political fallout of an individual mandate (bandied about by the Senate Finance Committee), which would give employers an incentive to drop their benefits programs for employees. Imagine, then, how those voters will feel when they wake up one morning without insurance and compelled by law to purchase an individual policy at a much higher price?
And I don't even bring in all the other arguments - efficiency, cost, the idea of implementing a reform that essentially bribes the private insurance industry to take on the people who are the biggest risks.
Which is the long way of saying that what divides the left on reform isn't knee-jerk and simplistic dichotomies of "true" progressive vs. "false" progressive, or the courageous vs. the faint of heart, or "pure" vs. "corrupt," but in the difference in the way we define the problem to which we're applying a solution. |
