Robust Public Option?

Written by: John McBride on Aug 4, 2009 2:50 PM EDT

The way of Congress seems to be to engage in public battles, name calling and mud slinging over issues that are not well defined.  In health care reform, the battle has now shifted to whether or not there should be a public option and how robust it will be.  It's mostly about the politics and not about substantive health care reform.

Side Note Speaker Pelosi has committed to allowing a vote on H.R.676, the single-payer bill.  

There is near complete silence on just what the public option will be.  Similarly, those who will only support a "robust" public option have not defined what that means.  Meanwhile progressive organizations are pleading for activists to lobby our representatives to support the robust public option

The point of the health care reform is pretty simple: provide health insurance to everyone and reduce the cost of health care.  Knowledgeable people I have read generally agree that only a single-payer plan can accomplish these goals.  But because Democrats were convinced (by whom?) that single-payer could not be passed in Congress, they shifted to a public option.  

It appears to me that the public option was the plan originally developed by Prof. Jacob Hacker.  Broadly stated the plan had five basic elements:

giving all non-elderly Americans access to the public program, ... [and]

• the public program must be pre-populated with tens of millions of people;
• subsidies must go only to Americans who enroll in the public program;
• the program must be authorized to use Medicare's payment rates; and
• the insurance industry must be required to offer the same benefits the public program is required to offer.

As near as I can tell, the last four elements of the Hacker plan have been abandoned.  It appears that they were abandoned in favor of the perceived need to put the public option on an even playing field with private insurance companies.  The effect of this need for fairness directed to large corporations is that the public option, in all likelihood, will be doomed to failure.  The qualifier is necessary, since there is no way to know what kind of public option is actually on the table and what will eventually be passed.  But it seems pretty clear that most of the critical elements necessary for a public option to succeed have been taken off the table.  

For detailed discussions of the devolution of the public option see here and here

The health care reform bill with a public option, as it appears to be now, will leave about 17 million uninsured and will cost billions.  The public option insurance will cover only about 10 million people.  At that size, the public option will not reduce health care premiums below the cost of private insurance.  

Spending political capital on the fight over whether we have a public option is a waste.  No one knows what the fight is truly about.  It is possible, even likely, that the progressive left is out there, right now, fighting for a public option plan that is doomed to fail and will set back health care reform in this country for another generation.

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