Public Option = Holy Roman Empire

[eridani]

The traditional historians’ joke about the Holy Roman Empire is that it was neither holy, nor Roman, nor an empire. Once upon a time, the original framers of the public option proposal envisioned a plan that would be open to anybody, and very likely have more than 100 million enrolled—a really big and cheap risk pool which would drive prices down. All current legislative versions of the public option, unfortunately, are neither public nor options given that 95% of the public will not be allowed to take advantage of them. Our Democratic representatives have figured out by now that their base likes it whenever they act tough advocating a public option. Few of those people understand that the public option will most likely never be there for them. When they find out, I predict very serious political blowback.


Why are so many on the side of health care reform are more interested in the idea of a public option than the actual facts about the proposed real legislation? Probably because it is an automatic reflex response against the Republicans and insurance companies who don't like the idea, but please consider that they are taking this approach because it enables them to win no matter what happens. This is already becoming a close replay of 1993, when Clinton's bill, written in secret by big insurance companies at Jackson Hole, was attacked by Republicans and small insurers. Of course the big insurers didn't defend her and the legislation they had written—they preferred no reform at all, and the Clinton legislation was just a Plan B fallback in case it was forced on them. That is exactly what is going on in the current debate.

Of course the public likes the public option idea. After all, this is the same public that overwhelmingly wants government involvement in health care one way or another, whether a comprehensive single payer plan or just taking care of all the people who don't now have access to health care in some unspecified way.

But the facts on the ground are this. The public is going to absolutely hate any of the bills being considered if they are actually enacted. For one thing, we have two election cycles to go through before anyone sees anything at all happen in 2013, during which the victims of a jobless recovery are going to see health care in this country go further and further down the drain. Yes, I know that forbidding discrimination on the grounds of pre-existing conditions comes into effect immediately, but that has no practical significance as long as insurers are allowed to charge whatever they want for such policies.

Also, what people will experience instead is being forced under penalty of financial sanctions to spend 8-12% of their incomes to buy private insurance which at the basic level will only cover 70% of medical expenses. (Mandated private insurance in other countries using that approach is not only far cheaper, but also has minimal or no co-pays or deductibles.) They will still have insurance companies choosing their doctors and denying claims at will. Expenses will still be going up from an extremely high baseline, despite limits on the allowable percent increase per year. Those worried about deficit spending will be asking "We've gotten ourselves another trillion into national debt for THIS?"

Older people are going to hate the mandated age discrimination. Younger people are going to hate having to pay anything when most aren't going to see any benefits.

How to get around this while our legislators insist on incremental reform? Very simple—just make the Medicare program that exists right now open to anyone. If there is concern about a big rush to the door, open the door in increments, starting with early retirees over 55 and the unemployed of any age. No set-up time necessary, since Medicare is a working system right now. The result will be a visible and good-sized minority who will counter any insurance company lies about reform with a really big fact on the ground. If anyone is thinking "Don't let the perfect be the enemy of the good," let me just say this about that. In this case it's the existent that is the enemy of the non-existent.

Still, there will be problems even with an incremental approach that starts to pay off for people immediately. Clearly, those who volunteer to enroll in Medicare with be sicker, driving up costs without a commensurate input of funds. The cheapest and most efficient solution of all is still single payer Improved Medicare for All. If you are going to force everyone to pay into a health care system, why not the HR 676 system for $125/month instead of insurance “exchanges” for $400-$2000/month? The latter will wipe out large swathes of middle class discretionary income in return for nothing at all, not a good thing in an economy 70% dependent on consumer spending.

[eridani]

1. Not getting why legislators refuse the simple option of gradually opening Medicare n/t