It’s time for liberals like me, who favor the public option or its functional equivalent, to give up on the idea and move forward to enact historic, landmark national health insurance legislation. And to do so now - not next week or next month.
Without the public option, the votes are there, with at least some Republican support, to do what Democrats have been trying to do since Harry Truman and pass national health care legislation that would accomplish the two goals that have always been the Democratic Party’s priority for more than 60 years: First, virtually universal health insurance, including those who are too wealthy to qualify for Medicaid, but too poor to afford health insurance; and second, mandatory coverage for all — meaning insurance companies must insure everyone regardless of status, age, or pre-existing conditions. (Both go hand-and-hand, since insurance would not be affordable unless there is a broad mix of healthy younger people with less healthy older people in the customer mix.)
In short, the dream of progressive Democrats for a national health insurance system that guarantees that matters of life or death should not be a function of wealth can finally come true; but only, in my view, if liberal Democrats in Congress who support the public option put it aside now. I have four reasons.
First, it is a pragmatic judgment: It is only a matter of time before the conclusion will be unavoidable that there are not 60 votes in the Senate to allow a vote on any health care bill that includes the public option.
Second, if pro-public option lawmakers wait too long, the polarization between the parties and within the Democratic Party could get geometrically worse — thus threatening the passing of any bill this year, or perhaps for a long time. Already some liberal organizations, bloggers and strident hosts and guests on the liberal evening cable-TV shows are making vicious attacks on those in Congress whose consciences and/or constituents will not let them support a public option.
This is already happening. Sen. Joe Lieberman recently was accused of “whoring for the insurance companies” by one of the liberal cable network’s leading hosts because the Connecticut independent has suggested he might back the filibuster of a bill containing the public option. I strongly disagree with Mr. Lieberman’s position, since I not only support the public option, but believe there should be an up-or-down vote in the Senate. But I also, as always, greatly respect Mr. Lieberman’s integrity and sincerity. It is too bad, but not surprising, that some liberal critics cannot debate Mr. Lieberman’s position on the merits without attacking his motives or using scurrilous personal epithets.
Third, I think the public option is not as important as the other two reforms that are long overdue — universal insurance and universal coverage. I have heard certain liberals claim they would rather have no bill at all than a bill without a public option. I would bet that every one of them already has health care insurance. Or to put it another way, I’ll bet that there isn’t a single uninsured person who can’t afford health insurance, or who faces bankruptcy because of a health care emergency, or who is forced to rely on hospital emergency rooms for basic health care for their families, who would agree with that all-or-nothing position.
And fourth, the public option in the current Democratic House bill and in the Senate health committee bill actually only lets a small percentage of people purchase it. It is a fact, rarely mentioned by liberals supporting the public option, that the pro-public-option Democratic bills would prevent more than 150 million people - i.e., all employees who currently are provided health insurance by their employers - from purchasing the public option. This is apparently because both business and labor don’t want their employer- and/or union-controlled plans disturbed.
That leaves about 25 million or fewer that would have access to a public option — i.e., the uninsured, small businesses not mandated under the bills, and self-employed individuals. That’s a big number, but still a small fraction of the population.
If the public option is intended to create competition to “keep the private insurance companies honest,” there is a private-market alternative. It was, in part, at least, proposed by progressive Sen. Ron Wyden, Oregon Democrat, and conservative Sen. Robert F. Bennett, Utah Republican, and many other liberal Democrats and conservative Republicans.
In the Wyden-Bennett approach (included in their “Healthy Americans Act,” which, for reasons I have never understood, the Senate and the House never seriously considered or debated), all state insurance exchanges would be required to include as one option the Blue Cross health insurance plans that all members of Congress and federal employees currently have, or its actuarial equivalent.
Since the Blue Cross plan is heavily regulated by the states, is a nonprofit corporation, and even various state Blue Cross companies often receive tax subsidies from the federal government, it walks, talks and looks like the public option - but is still a program run by the private sector. And with a requirement to offer the Blue Cross federal employee plan on every state exchange, private insurance companies would have an incentive to sharpen their pencils and chase our business - or else we can take our business and opt for the Blue Cross federal employee plans.
Whatever the final outcome, clearly there are more than 60 votes in the Senate, and substantial majorities in the House, ready to vote out a national health insurance plan that has universal coverage, individual mandates, and mandatory coverage but no public option. We can always come back in several years to look again at the need for a public option if private insurance companies haven’t felt the pressures of competition on the public exchanges - the so-called “trigger” proposal that Sen. Olympia Snowe, Maine Republican, said she could support.
The perfect is the enemy of the good.