by BAR managing editor Bruce A. Dixon
The generous, expansive public option on the lips of Congressional progressives, which would be open to all and compete to lower insurance prices is largely imaginary, while the president’s stingy, divisive and means-tested version is all too real. But what about the third version of the public option? What is the Congressional Progressive Caucus doing to promote it, and to allow states to pursue single payer on their own?
Some highly profitable and job creating industries simply can’t be reformed. Slavery and child labor cannot not be made humane and reasonable, not with kind and solicitous masters or school and limited hours for the kids. Both these practices were eventually cast aside. Allowing souless, greedy private insurance corporations to collect a toll for standing between patients and doctors may be next.
The president’s health care plan is designed to preserve the parasitic private insurance industry a little while longer. In this context, the public option is a cruel and cynical hoax, an excuse not to abolish the role of private insurance death panels and toll collectors in the nation’s health care system.
Nobody can read the president’s mind, but he did promise to construct health care legislation in an open and transparent manner, even “on C-SPAN.” Instead, Obama handed off the drafting of health care legislation to five House and three Senate committees. The most generous view is that he did this to give legislators a stake in the bills, and because there is this thing called the separation of powers between the executive and legislative branches.
Another view is that the embedded influence of Big Insurance, Big Pharma, and Big Medicine were easier to conceal when spread out over several committees, where the lobbyists are themselves former congressmen, senators and their top staffers, and many current members and staff look forward to the same career paths. These are the men and women who wrote what is and will be the president’s health insurance reform legislation. The result has been a half dozen versions of a thousand-plus page bill, chock full, as Rolling Stone’s Matt Taibi points out, of deliberately obscure references to other legislation. Nobody can authoritatively claim to have read, much less understand all of it. And that’s just the way insurance companies and the president like it. HR 676, the Enhanced Medicare For All Act, which does provide universal coverage at reasonable cost, comes in at under thirty pages.
To begin with, there are no less than three versions of the public option. The first is an imaginary public option first conceived by Political Science grad student Jacob Hatcher in 2001. It was to postpone the death of private insurance companies by forcing them to compete with a publicly funded insurer open to all comers which would drive their prices downward. This imaginary public option has never been written into law, and is not under consideration in Congress this year. It lives pretty much in the minds of the public and the lips of the Congressional Progressive Caucus, MoveOn.Org and many others. It’s in the mouth of Howard Dean, who says it will be just like Medicare, only available to everybody. To distinguish it from the President Obama’s version, it is usually called “the robust public option.”
The second version of the public option is not imaginary, it is all too real. President Obama explicitly outlined its contours in his health care address earlier this month. Unlike the expansive and inclusive imaginary public option championed by MoveOn.Org, the president’s public option will be stingy, means-tested, socially divisive, actuarially unsound and doomed to failure, unless its objective is simply to discredit the word “public” in the term “public option.” The president has said it will be limited to 5% of the nation’s population, those Americans too poor to afford the cheapest insurance available on his regulated “insurance exchanges” which won’t be fully implemented anyway till 2013.
Hence those making more than a very small wage will be ineligible for the president’s version of the public option, and those who currently get insurance from their employers, no matter how skimpy the coverage, how high the co-pays and deductibles, will also not qualify. Those who receive relatively good (or maybe not so good) coverage from their employers will pay a special tax to support both the public option and the subsidies the government will pay to enable others not quite poor enough for the public option to fulfill their legal obligation to buy shoddy insurance from private vendors.