Public Option Or Bust

Last week I wondered whether or not key Democrats were already bargaining away the public option in their universal health care proposal. Pete Stark has some control over the final bill in his perch as chairman of the House Ways and Means Health subcommittee, and according to him, either the public option stays or no deal.

Advocates of a government alternative to private health insurance fired the first shot of the new battle to reform the nation’s health-care system on Wednesday, saying that efforts to water down this key component of Barack Obama’s health-care plan should be rejected by members of Congress.

“In the absence of a public plan you would have to so strictly regulate [private] health plans that they would all have to become public plans,” said Rep. Pete Stark, D-Calif., chairman of the House Ways and Means Health sub-committee.

Stark spoke out on Wednesday because he is concerned that any effort to reform the private health-insurance market will prove ineffective if Americans are not offered the kind of Medicare-style government option contained in Obama’s 2008 campaign proposal.

Most important, Health Care for America Now backed Stark up on it, with their national campaign manager declaring any plan without a public option a "non-starter." I think HCAN is going to be crucial in this fight to beat back right-wing smears and insurance industry lies, so they probably have to be on board with any proposal.

Jacob Hacker released a report last week describing the importance of a public option in any universal health care plan. Especially if a "Medicare-for-all" single-payer plan is not being considered, the public option is crucial to create competition over quality care instead of over profit. And the current public plans (the VA, Medicare, Medicaid, etc.) do a much better job at reining in costs. Of course, there's a case to made that if the public plans improve upon private industry so much, they should be the only option allowable, because otherwise insurers will cherry-pick the healthiest clients and either drive the public option into bankruptcy or increase their costs and make themselves look more attractive. On the other hand, there are measures like guaranteed issue and community rating that can be written into the bill to ensure this cannot happen, and in addition, scaling up Medicare might have drawbacks of its own.

Overall, I think that untangling the mess that is our health care system is priority number 1, because it's woefully inefficient. Streamlining all the various public programs to deliver health care along with a public option anyone can buy would certainly increase that efficiency and hopefully lower costs, no matter the set of patients. So would placing limits on insurers, through guaranteed issue and community rating and mandatory percentages of premium money going to treatment, to reduce the energy and cash that goes into blocking care. So there's a lot we can do.

Interestingly, John Dingell is going to do a lot of it. Despite being upended as Chair of the House Energy and Commerce Committee, Henry Waxman has offered Dingell the lead sponsorship on national health care legislation. The Waxman-Dingell fight was always over energy, not health care, and this allows Dingell a legacy setter at the end of his career while still giving liberals what they desired on energy and global warming policy. It's a magnanimous and smart move. Hopefully Dingell understands the importance of a public option, too.