Rumors of the Death of the Public Option Are Greatly Exaggerated

To hear the news you'd think the public option is dead in the water, but according to Democracy for America, it isnt. The house will need at least 218 votes to pass a healthcare reform bill and 64 Democrats have said they will not vote for a plan without a public option. That would leave only 198 Democrats, not enough to pass any kind of reform bill. While I've noted that the Congress would rather err on the side of doing nothing, they also don't want to appear to do nothing. They'd prefer passing a bill that kind of fades out like an old fifties pop song, but they know passing nothing will lead to death by a thousand cuts come election time. So the public option looks like the only alternative.

So, is the public option really so important? I agree with Howard Dean that reform without a public option is not real reform. It will just be another attempt at reform that sputters and dies. Think about it. Some are floating the idea of medical cooperatives, similar to Kaiser Permanente. In these cases doctors and other healthcare providers work for the coop as opposed to contracting with it as they do with HMOs and PPOs. Often these coops are contained within single buildings or several buildings throughout the area they cover. I think this is an excellent idea for providing low-cost healthcare. I really do, and if these coops had started organizing 30 years ago when President Carter proposed healthcare reform, they might have taken root by now. As it is, I can't imagine it is going to be very easy to incentivize enough healthcare providers in enough places to challenge private insurance companies soon enough to bring any relief to those of us chafing under the costs.

The other idea is health insurance coops. This, as best I can tell, is where the consumers, or the insureds, own the company, kind of like the venerable Green Tree that sold perpetual fire and homeowners. However as this article points out, they are difficult to start, difficult to keep going, and even harder to gain any real bargaining power.

In other words, these are smoke screens, exactly the kind of programs that will be rolled out with great fanfare as the Dems celebrate victory. Maybe even some money will be put behind them, but they won't get off the ground, and even if a few do, they will be the first budget items cut if/when another Republican administration comes in.

The real reason we need a public option is that it is the only way to make reform permanent. I'm old enough to remember the outcry against Medicare. Plenty of people then, including Ronald Reagan who was still just an actor, warned that it was a step toward Communism. Now that we have it, people can't think of living without it. Yes, Medicare has its funding problems, mainly because there was no way to predict how healthcare costs would rise and how different healthcare delivery to the elderly would become, and how long people would live. However, now that it is a fixture we continually find solutions to keep it going. We don't scrap it because without it tens of thousand of elderly would be bankrupted by their medical costs.

While Dean says it's a go, I do see signs of Obama caving. So much has been made of this being his Waterloo, that he may be finding it politically expedient to call whatever Congress passes a success. I think it's time to bring out the threats, like the Republicans did to Arlen Specter. The Dems need to get with the program, or as Dean warned, the Dems will put up more progressive primary candidates to run against everyone who voted against reform.

I hope and pray Howard Dean is right and the public option is not really dead. If it is, we are too.