Why Do We Need a Public Option Anyway?

Political games are alive and well in Washington, D.C. First the House releases HR 3962, a disappointing bill with an optimistic and completely misleading name – the Affordable Health Care for America Act. Then the GOP decides it’s an opportune time to release its own bill, which House leader John Boehner says will lower cost and expand access by “making the current system work better” with less government intrusion into the private sector. Sounds great John, only, well, there is no system … and that whole government intrusion line? Well, that brings me to my point. Why do we need a public option again?

It seems politicians on both sides of the aisle have lobbyist-induced amnesia on that aspect. Democrats hope including a public option – no matter how weak and ineffective (a more expensive alternative to private plans that covers 2% of the population? Please!) – is all it takes to please the public, even if it’s designed to fail. Meanwhile, Republicans decry government intervention and propose tweaks around the edges of our disastrous healthcare mess that conveniently avoid touching the profit-driven culprits themselves. In other words, the US has heart disease and our D.C. representatives suggest blood transfusions, an artificial knee replacement and a flu shot.

Case in point: the central aspects of the GOP bill are tort reform, insurance pools, and inter-state policy purchases. Two of the three are already in place in many states – they haven’t budged healthcare costs significantly (tort reform achieves 10% reductions in malpractice insurance, per the CBO.) Tort reform is a good idea anyway, but not for cost curve reasons. The third proposal, while useful, doesn’t help much when insurance costs are out of control nationwide.

Douglas Holtz-Eakin, a senior policy adviser to John McCain’s presidential campaign, knows that now. The same man who touted a $5,000 insurance tax credit per family as the answer to our insurance woes now remains unemployed and his $1,000 per month COBRA is running out. He’s shopping the individual insurance market at age 51 and with a pre-existing condition that insurers cite in denying coverage. Think he’s a bit worried? All politicians should be placed in that situation; maybe they would get a clue.

Anyone familiar with T.R. Reid’s body of work on international universal healthcare systems knows that a public option isn’t a part of many of them (gives “socialized medicine” a rather hollow ring, doesn’t it?) There is a single public payer in some (Canada), multiple private insurance payers in others (Germany, Switzerland) and some countries use a combination (England.) What’s the difference then? Very simply, their ‘private insurers’ are non-profit corporations governed by iron-clad regulations: no loopholes, no kickbacks, no lobbyist favors, no profit or surplus beyond required reserves.

Why is that? Insurers are there to provide payment for the care of country residents, with no deliberate and systematized waste and no tricks. Patients are not pawns in a giant profit mill. Now, does this sound like the situation in the US? It seems like the banks and the healthcare industry own Washington, D.C. While Joe Public pays for congressional salaries and benefits (with fantastic health plan choices), lawmakers actually work for Joe Lobbyist. So whatever regulations are placed around the health insurance industry, we can rest assured they will be weak and full of holes by design.

Making sure people are covered and making sure that coverage is affordable are two different things, a distinction neither party has addressed satisfactorily. A strong public option is just one of two methods to keep private insurer prices and practices in line, regulation being the other. But if regulation is to be the answer, we need a representativectomy and a lobbyist exterminator to spray the capital. That seems unlikely. As Nancy Pelosi “mistakenly” left Kucinich’s state single payer amendment out of HR 3962 (as of scheduling this post, it hadn't been reinstated), we can’t vote with our feet by becoming interstate medical refugees. So I’m still pushing for a strong public option.

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