Public Option Overblown?
I have to say I learned a lot from this piece by Dr. Aaron Carroll who is NOT a right-winger but is, in fact, a supporter of single-payer i.e. total government-run health care.
He argues, in short, that obsessing over the public option in health care legislation is a distraction. And that few who absolutely, positively demand it are missing the larger point. I find his arguments intriguing and persuasive.
Like him, I prefer not only the option but the Fully Monty — single payer. But getting a bill with it or without it is almost a minute difference, he says. Read his whole piece. Here’s an excerpt:
Be real. The House version of the bill contains perhaps the most robust version of a public option. The CBO estimates that maybe a third of people in the exchange will choose it. That’s fewer than 10 million people, maybe 3% of Americans.
The public option has never been about coverage. It’s about cost. No more people will obtain health insurance if we have a public option. Nor will the quality of care go up. Some very smart people think we also need it for political cover, but I don’t really care about providing politicians with extra protection right now. The public option is meant to increase competition and lower the cost of insurance.
How much lower? At best, maybe $110 billion over 10 years. I’m not scoffing at that amount. It’s real money. But remember that’s an average of $11 billion a year in savings in a country that’s spending at least $2.4 trillion for health care. I just can’t get worked up about a measure that might knock off less than one half of one percent of total costs. For this you’d kill health care reform? Are you kidding me?
I don’t know how solid Dr. Carroll’s numbers are. But if he’s even close, he at least makes an excellent argument. What I find appalling is the idiotic and vitriolic abuse heaped on this guy by so many HuffPost commenters,. Whew! There is no difference between them and a mob of blindly religious zealots.
October 22nd, 2009 at 3:55 am
I’ve never thought we should kill health care reform just because it doesn’t include a public option (there are some pretty good health insurance systems in Switzerland and the Netherlands that are based on heavy regulation of private insurance groups), but I’m strongly inclined toward pushing hard for a public option in the reform package because it provides a benchmark and a path for expanding public insurance. The reality of this reform bill is that it’s likely to need some tweaking down the road once we see how its working. My bet is that expansion of an existing public option holds more promise than increasing regulation of private insurers.
What has been missed by Beltway commentators is how smart the pro-public option faction has played their cards. They’ve been dismissed, Obama’s support has been deemed weak and the option has been declared dead by Beltway Villagers for months, but after all the blowhards and political opportunists have had their say, it looks like the public option will become part of the bill because its opponents have been allowed to box themselves in on the cost issue. The public plan, of course, helps keep costs down according to CBO. I’m seeing a triumph of strategy over the other side’s bullshit tactics on the part of the White House and the public option supporters. The savings may be modest, but the impact on deficit has been a major line in the sand. I questioned whether Obama should have made deficit neutrality a centerpiece, but I’m beginning to think he saw this CBO scoring of the public option package coming at a crucial moment and now will use it to club the Blue Dogs using their own rhetoric. At this point the only opposition to a public option is ideological. Try to sell some crank “free market” ideology to mainstream America, when we’ve already got a huge piece of the federal budget going to pay for health insurance costs and insurance monopolies in many states.
October 22nd, 2009 at 4:23 am
Incidentally, I think one major reason to push hard for the public option politically is precisely because of who is so strongly against it – Leiberman (I-INS.) being the most putrid example – as well as the attempts by a handful of marginal Democrats representing a relative handful of voters to bludgeon the majority. The best response is to bludgeon them back with everything we’ve got, if for no other reason than to defend democracy over demagogy. The Blue Dogs and the whining jerk from the Insurance industry don’t have to vote for the bill itself, but if they side with the GOP on the issue of a filibuster – which is the only vote where “60″ matters – they should all be stripped of any prestigious committee assignments and sent off collectively to preside over a special Committee on Dog Poop and any earmarks or amendments they want to attach to bills that privilege interests in their states should be shot down for a year or two minimum. They’re self-absorbed bullies and should be treated as such.
October 22nd, 2009 at 6:42 am
At this point I believe the public option is a but a token in a classic power struggle. Its value, as you point out, is modest (at best, if we’re generous). The public option was, initially, a much stronger idea but has been pushed and pulled into a mere place holder; a piece on a game board.
Still, it begs an interesting question. If the public option, as described above, is so insignificant that it’s not worth the spiking the legislation because it’s excluded from the bill, why is it not true that it’s also not worth spiking the legislation because it’s included in the bill?
One answer to that riddle is it might serve as a camel with its nose in the tent. I’m not optimistic, but some have argued it that way.
October 22nd, 2009 at 6:50 am
Yes, the battle is more political than substantive. But it is a necessary one. The moment progressives give in on this issue, the other side will go after other stuff that they are not bothering with right now.
October 22nd, 2009 at 6:52 am
“they should all be stripped of any prestigious committee assignments and sent off collectively to preside over a special Committee on Dog Poop and any earmarks or amendments they want to attach to bills that privilege interests in their states should be shot down for a year or two minimum…”
Damn those bullies who refuse to agree with me.
October 22nd, 2009 at 7:13 am
On several occasions I posted links to this same point. Single payer or nothing is the only logical step to be made.
reg, the whistle blower, Potter, damned the public option and gave reasons why.
OT…just caught this weird little line in a news bite:
‘…Madoff’s recreational activities consist of walking around the prison track at night, and eating pizza cooked by a convicted child molester, the lawsuit says.’
October 22nd, 2009 at 7:31 am
I agree with Dr Carroll, Robert Reich, Marc, and democratic socialists, not the corporate Democrats. The so called public option is window dressing at best, a boon for insurance conglomerates at worst.
Expect true national health care in about 17 years, at the earliest. Maybe then the bankrupt US Empire will be out if Afghanistan and Iraq. (And Korea, and Germany, and Japan, and…)
October 22nd, 2009 at 8:16 am
Expect true national and free health care in about 17 years after the Evil Empire, that is already made bankrupt by the failure of our selfish leaders to control the selfish Capitalist Beast and now the bleeding-heart-free-stuff Socialist Beast.
Yeah Serge. That would make logical sense to just another extremist, of the free stuff kind this time.
No one believes the new promises of mandates to buy insurance, pay a fair portion for your own if you can afford it, and crack down on decades of waste and fraud in already gov’t run free stuff social programs is going to really actually happen.
Never has and never will. We are on the fast track to becoming just another over-extended banana Republic, and one gets the feeling several here believe it can’t happen soon enough.
October 22nd, 2009 at 8:36 am
It is already clear the existing ‘reform’ plan that is likely to pass has watered down penalties for failure of individuals and employers failure to pay for insurance, while doing nothing to prevent one from jumping in at the last minute when they actually need it.
All the incentives are for the individual to pay the much less expensive weenie penalties and for employers to do the same, even to dump existing employee health insurance plans to the gov’t dole for the penalty instead, with or without a public option.
The weenie penalties and subsidize premiums IS the public option, and I predict it will make Medicare debt look like a college freshman’s credit card abuse in comparison.
For this reason, and because I actually believe the Evil Empire is the least Evil of all the others, I am now supporting the single payer plan in order to potential save it for at least another generation. Given our leader’s inability to say no to anything, I am willing to accept full gov’t control of our health.
The Empire is not sick. It has become exceedingly burdened down by the selfish ask not what I can do for my country….
October 22nd, 2009 at 8:53 am
If it hadn’t been for those evil Republican and big corporation funded, Nazi, right-wing mobs of old people protesting at the Townhall meetings, you would already have an incredibly flawed bill pushed through by the Democrats when not even read and you wouldn’t even be able to consider what you learned from Dr. Carroll, because there wouldn’t have been a reason for him to write it. Give some credit to those evil Republican and big corporation funded, Nazi, right-wing mobs of old people protesting at the Townhall meetings for helping our nation.
October 22nd, 2009 at 9:06 am
“….right-wing mobs of old people protesting at the Townhall meetings for helping our nation.”
Weren’t they helping to keep themselves to keep access to struggling younger peoples money to pay their insurance premiums, while manynot most are living the good life from past pension paying good and secure jobs?
How are they not a classic example instead of the socialist problem of creating loud and voting bases of dependents used to free stuff….forever!
October 22nd, 2009 at 9:16 am
Will Washington have the unselfish leadership to do the right political thing for their constituents instead of themselves, by including those over 65 with all others now expected to pay for their own insurance costs if they can afford it.
Let me answer that. The question was a rhetorical one….of course.
October 22nd, 2009 at 10:01 am
It’s not like no one can see through you guys. You have to depend upon greedy and/or stupid people and a complicit liberal media (unlike FOX News, which really isn’t a news organization) for support of the Democratic Party’s grabbing of power over people’s lives for its political gain and entrenchment.
The Public Option Deception
Answer: You can’t.
You guys can’t win arguments based upon merit, so you depend upon lies, deception, and falsely labeling opposition.
Pathetic,…especially from people who pretend to be so concerned justice. I think there is a model somewhere in history about people who lose their freedoms when goverment decides that it knows what is best.
But, it’s like the old story that Marxism failed because the wrong people were in charge. Do you really think that you and Obama are the “right people?”
October 22nd, 2009 at 12:39 pm
Jim R wrote: “How are they not a classic example instead of the socialist problem of creating loud and voting bases of dependents used to free stuff….forever!”
What free stuff are you talking about?
I pay into both Social Security and Medicare trust funds, I pay state, local and property taxes for a whole range of goods and services, and I pay Federal taxes. I can’t of one thing I get free from any level of government. Please clue me in on the free stuff…
October 22nd, 2009 at 12:54 pm
Marc, thanks for posting this. I, like a number of others here, believe it endorses what I have been writing and saying for weeks: that having or not having a “public option” is not the sine qua non of health care reform. Mr. Carroll’s conclusion is 180 degrees away from both (1) Anna C’s and (2) Woody’s solutions to the problem: (1) all or nothing, resulting in nothing; or (2) nothing, and name it after Ronald Reagan and Terry Schiavo.
There is reason to say that the Senate Finance bill will be a boon to health insurers. The public option mitigates that to a small extent by offering limited competition in the marketplace, but it does not replace the marketplace. But I believe it is flat-out wrong to turn away from the substantial reforms that will improve many Americans’ lives because it may end up being good for health insurers. Health care reform is not a zero-sum, we-win, you-lose proposition.
October 22nd, 2009 at 12:56 pm
Sorry, it’s Dr. Carroll, not Mr. Carroll.
October 22nd, 2009 at 1:23 pm
“…It’s a political marketing ploy designed to move the nation to a single-payer system – like the one in Canada – over the next decade. The public option is the Trojan horse.”
If only it were true.
October 22nd, 2009 at 2:00 pm
I’d like to sit down with David Geffin and Marc Cooper right now, watch Obama’s campaign statements on Heath Care reform, and then see if either still feels like calling Hillary Clinton a liar.
Beyond that, Pelosi is obviously the one fighting to get me insured. The “logic” of single payer or the highway is the typical Nadar stance, bring back the 1930s and then maybe we can do something.
October 22nd, 2009 at 3:09 pm
I would be interested in hearing from someone who knows more than I do about the effect of health insurers’ exemption from antitrust, and the effect of either threatening to remove it or actually removing it.
October 22nd, 2009 at 3:38 pm
Third Charmer, maybe you should sit down and have a meeting now with me but with Hillary. Last time I check she was working for and under the orders of Barack Obama.
October 22nd, 2009 at 5:27 pm
I admit, after the Dodger season ended last night, I slept like a baby.
I’d sleep for a hour, wake up and cry, sleep for an hour, wake up and cry…
October 22nd, 2009 at 6:05 pm
Michael your assertions are disavowed by those who actually have been studying the problem.
I think the CIGNA whistle blower probably has a better feeling for who has been putting their paw prints on the legislative process to date than you. Not to mention every other critique I have read. And frequently posted ahead of this blog topic in the past couple of months.
Forgive me if I am wrong, but are you the guy who used to be in the insurance business or am I confusing you with Michael Turmon?
October 22nd, 2009 at 6:05 pm
Oh shit there are 3 Michaels now.. I was addressing Michael Crosby.
October 22nd, 2009 at 6:07 pm
PS Originally, I pounced on the idea of the public option and suggested that it might be a sort of Trojan horse and sideways slide to the real thing…but once the other reports started coming through…
October 22nd, 2009 at 6:45 pm
My assertions stand without refutation.
October 23rd, 2009 at 12:17 pm
Yes, Anna, I was in the insurance business. I actually worked for a third-party administrator that advised multiemployer health and welfare funds for Carpenters Union, Bricklayers Union, and other unions in construction industry. My feeling was the same then as now: my goal was to get the best deal for the members. Sometimes that meant letting the insurers we dealt with make a buck, sometimes it meant shaving their percentages as far as we could without running them off entirely.
As for my point of view being disavowed by all who have studied the problem, you must not have read Dr. Carroll’s post very closely, because I don’t think he “disavowed” this point of view at all. As for Wendell Potter, I respect his point of view. He does in fact know a lot more about the subject than I do, as do a number of people who look at possible solutions much as I do. I think when push comes to shove Potter will agree that incremental but substantial insurance reform would be a good thing.
My final point: the results of this process should be judged by whether we have extended better health care to more people without bankrupting them, not whether the insurance companies have survived and profited.
October 24th, 2009 at 7:39 am
Michael: My uncle was a doctuh. He was the one who once informed me this debate has been going on since Truman who felt not getting to grips with health care was a huge failure of his administration.
I think 60 odd years is incremental enough, don’t you?
December 17th, 2009 at 2:52 am
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