Secretary Sebelius on Sunday claimed that the public health insurance option is “not an essential element” of health care reform. President Obama said at a town hall on Saturday that the public option was just “one sliver” of reform. This could hardly be more wrong. A universally accessible public option would give low-income people too rich for Medicaid access to meaningful health insurance and is the only way to approach universal access to insurance without a mandate or single-payer.
The wave of chronic conditions America faces over the rest of the century demand early detection and intervention to control the costs and misery that they produce. Gaps and lapses in coverage will make those diseases more expensive for those patients and the rest of us. Preventing those gaps in coverage will require serving the low-income patients currently ill-served by the current mix of overstretched public programs and private high-deductible plans and still bend the cost curve down. That will require a plan that can deliver overhead in the 3-6% range. Only a public plan can do that.
The best solution would have been to put the entire population on a very low overhead plan. This was HR 676, Medicare for Everybody, Single-Payer. It never had a chance. Both Houses “placed it off the table” before negotiations began. The reasons for that decision are irrelevant, its consequences are all too clear. Moderate Democrats now pronounce the barely adequate public option DOA in the Senate. Without single-payer to draw fire, the opposition can focus on defeating the public plan option, If they had focused their energy on the socialism (i.e., public policy with which conservatives disagree) of single-payer health care, we could respond with the massive market reform of retaining the entire private health insurance with a single public program with subsidies for those who earn up to 4 times the localized poverty rate. Conservatives would hail this as a leg-up to the middle class, rather than welfare. We would have gotten the public plan we wanted, with ribbons affixed. They would hail their great market-driven defeat of the evil socialism of the hated liberals and declare it a great victory,
Instead we took the bogeyman away before the game started, leaving the public option as the target of the antis. We did so hoping to make them pros. This was possibly the most naive moment in contemporary American politics. The antis are anti not because of the actuarial tables or because Ludwig Von Mises hated regulation, but because we’re not them. We can’t be trusted to worship at the alter of God, CEO, therefore we are the enemy of all that is fine and good.
President Obama and Congressional leadership egregiously underestimated the irrational sectarian motivations of their opponents and chose to try to accomodate them, which merely served to slide the agenda rightward while buying nothing we couldn’t already take were we willing to ignore those we beat in November, as they have done to us and will again.
Thus are 22,000 Americans a year sacrificed to the demon of “Dear God, don’t let us be seen being Democrats.” God Bless America.
