Public Option or Bust?

As noted in my last post and various articles, there is much question whether President Obama will draw a line in the sand for the public option. Most indicators say, no. The thinking on this, I would imagine, is going one of two ways. Appease the conservatives so sometime later on they will concede on something the administration wants––though I can't believe Obama is that naive––or half a loaf is better than none.

Half a loaf is better if the bread is fresh, but what if it's stale? Without a public option what we have is a utopia for private insurers where everyone is mandated to have coverage. They never had any quibble with that part of the reform package, but what incentive is there for them to keep costs down? And if people worry about healthcare rationing under a public plan, what do they think will happen when insurers are forced to community rate and cover pre-existing conditions? They will cut back on services in order to continue making huge profits, but they are not likely to do that in conjunction with oversight panels working toward the best care at the best price.

Maine Senator Olympia Snowe has a put forward a compromise option where the public plan would kick in in any state where private insurers don't reduce costs to a level set by the Department of Health and Human Services. A complaint I've heard over and over is that the House reform bill is too complicated. This would make it more complicated. One of the criteria for rate-setting is location. What private insurers can charge will differ not just from state to state, but within the state, as will the allowable costs of healthcare providers. These trigger points not only need to be set, they will need to be monitored, and I assure you, private insurers will start squawking immediately that limits are too restrictive. Then, as soon as we have a Republican Congress again, the limits will be raised or done away with. Or, conservative governors will say the federal government has no right to impose a public option on their state.

The only way to force private insurers to lower costs is to have a public option that acts as the pace car. It has to be the final line in the sand.

So the question remains, what if the bill can't pass without it? Politically I think it's better for the bill not to pass at all than to pass without the public option. Congress is mistaken if they think their constituents will let reform die this time. Unlike the Clinton years, too many have been following this for too long, pouring their money and their time into the effort to get this done. Many are from the Obama campaign who picked up where they left off after the election. They've been at this for nearly three years and they don't believe in lost causes.Should reform not pass this time these folks (or should I say we) will take to the streets and demand it. We should start by demanding single payer. Next to that HR3200 will look like heaven to conservatives, and we'll be d---ed sure to get real reform passed this time.

Single Payer Advocates: Why You Should Support ObamaCare

The problem with polls, or at least the way they are usually reported in the media is that they require a yes or no answer. With regard to healthcare reform, many of the contacts I've made through meetings and organizations don't support any of the current reform options, because they don't believe they go far enough. Many feel that a single payer plan is the only way to truly reform the system.

Until a few weeks ago, I was one of them, and I continue to prefer single payer and remain appalled that it was never even considered as an option. A single payer system involves more than the government simply picking up the tab for healthcare. At its best it would be an overhaul that would lead to an integrated system of healthcare delivery with oversight by a cabinet office or government agency. I still fear that anything less will not contain run away healthcare inflation or ensure delivery to under-served communities. Without cost containment and without the requisite number of doctors (particularly General Practioners) and hospitals to serve all those new insureds, I see a strong possibility for failure.

So it may sound odd that I am exhorting supporters of single payer to get on board with the Obama plan. The reason is what I stated in the beginning of this post. This is being cast both by opponents and our famously no-nuance media as a "for us" or "agin us" issue. If health reform goes down this time, no one is going to re-visit it and push for single payer. Congress will be only too glad to let this drop, hiding behind the excuse that the American people once again decided they weren't ready for change.

Real healthcare reform isn't one of those feel-good issues everyone can get behind, like just telling insurers to cover everybody. Real reform is complicated and requires major concessions from everyone involved (including consumers). Even a half-way measure like a public option means facing contentious issues like denying certain services and reconsidering end-of-life expenditures. Members of Congress today see their job more as a popularity contest and with Americans having notoriously short memories, they'd rather err on the side of doing nothing––which voters will soon forget––than facing the merest chance of a failure that could still be hanging over their heads at re-election time.

While I have my fears that the simple addition of a public option won't be enough, there's still the possibility it could turn into the opponents' greatest nightmare–– a success that will lead to even more changes. If, with the public plan, premiums are lowered and outcomes improved, individuals as well as businesses will vote with their premium dollars and we may achieve single payer by evolution rather than revolution. Once all the dust settles and citizens take the public option for granted as they do Medicare and no member of Congress worth his/her salt would threaten it, maybe it ccould be used as a platform for the next step.

If the public option fails now or eight years from now, it means the end of major healthcare reform, but if we let it fail now, we'll never know if it could have worked or at least served as a stepping stone. That is why it is extremely important for those who prefer single payer to step up and support the public option. Call your senators and representatives, show up at rallies, attend town hall meetings, and make your voice heard. If you are asked in a poll or on the street if you support the president's healthcare reform plan, say yes instead of no.

Don't let the perfect become the enemy of the possibly good.