| Man, it's been frustrating to watch insider pundits one-by-one abandon the idea of the public option. I've been arguing for months now that the public option is crucial to reform. Most of the reform proposals that don't include the public option concentrate solely on getting the uninsured an insurance policy. There are no cost controls. There are no real protections for consumers against their insurers. In fact, the proposals the Senate Finance Committee have been mulling would degrade the quality of private insurance, force millions to change their insurance policies, and probably increase out-of-pocket and premium costs.
So it's good to see Krugman step up for the public option.
Krugman claims the public option would achieve three things: keep costs down, provide the only real competition in many markets, and offer a buffer for consumers from an individual mandate.
Klein - one of the targets of Krugman's column - objects to the idea that the public option would help tamp down costs. He sees the public option's customer base as being too small to negotiate prices down - but then one assumes, also, that the public option wouldn't implement a pay-for-service model, but a patient-centric payment model, which would lead to lower costs and better care. And Krugman also notes the public option wouldn't be burdened by the private insurers' administrative costs. The public option wouldn't have to worry about profit, either. The public option would be cheaper - and private insurers would have to react in order not to lose customers as soon as their customers have access to the health insurance exchange.
Josh Marshall addressed Krugman's point about the political necessity of the public option on Monday:
Am I the only one who thinks that if the Dems pass a bill with mandates and subsidies for poor and moderate income people to purchase it but no public option or competition with the insurers, that it will be pretty much a catastrophe for the Democrats in political terms?
You 'solve' the problem of the uninsured by passing a law forcing them to buy health insurance which, by definition, most a) cannot afford or b) are gambling they won't need because they're young and healthy. Either you end up with low subsidies which still leave it onerous to buy, thus creating a lot of disgruntled people, or you get generous subsidies, which cost a lot of money.
It's sort of like reform with all the cool political downsides but none of the reform.
Under an individual mandate - what Baucus is currently threatening us with - the effect is increased exponentially, as some employers will no doubt dump their workers from their expensive benefits packages and let them fend for themselves. (RJ Eskow makes it clear that a mandate without reduced costs is madness, and explains how misguided progressives put us in this awkward position.)
Bob Cesca:
Backlash understates the impact. But there's also a core values and morality component here that feeds the backlash. The politics are bad, yes. And the backlash will be significant. But the Democratic Party and the White House will be asking us to do something that is morally impossible for many of us. A compulsory corporate giveaway is unthinkable.
Righties are calling the public option "a Trojan Horse" for a single-payer system. In a sense, they're right, although their fears are absurdly overblown.
For one, the public option would allow the American people to decide for themselves what kind of healthcare payment system they want. If the public option is efficient, provides good service, and costs a fraction of a private policy, consumers will use it. If the fears of the right are realized - the public option, as a government program, is bloated, inefficient, expensive, and inhumane - consumers will not use it. If the public option is what they say it is, it will die.
It's not a top-down mandate. No one's being forced to buy a government-provided policy. No one's being forced to abandon their private insurance. The public option won't transform the way we deliver health care - this isn't a plan to implement socialized medicine.
The public option is just that - an option to buy insurance that is provided by a public institution. It's that simple. The public option will allow Americans to drive healthcare reform at their own pace and in the way that they like.
But without the public option, reform is merely a (temporary?) brake on the degradation of service from private insurance, and an expensive bribe to private insurers to cover some of the costs of our sick. |
