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Monday, August 17, 2009

So Now the Public Option Seems to be Off the Table -- And That's a Crying Shame

President Obama, in the spirit of his reputation as The Great Compromiser--which I do in fact applaud as one of his stronger political attributes that enables him, like Bill Clinton, to at least get SOME things accomplished in the face of stiff opposition from within his party and without--has now backed down entirely on the much and very unfairly maligned "Public Option" for healthcare reform.

The fringe contingents of tea-baggers and town-hall-meeting disrupters, spurred on by their deceitful talk-radio gurus, like mustacheoed villains in an old melodrama, appear to be winning the battle.

I think that this is a crying shame, for the following key reasons:

  • Proposed as the "alternative" to a public option is a seemingly vaguely defined notion of "nonprofit cooperatives," a model that some commentators have argued is virtually untested and has a shaky track record in areas of the U.S. where it has been tested.

  • I have a sinking feeling that, without a public option, whatever plan ultimately passes will result only in a very limited change to the status quo. The non-profit cooperatives may not impose sufficient checks-and-balances on the for-profit insurers, with all their clout and public relations, marketing, and lobbying muscle.

  • Non-profit organizations that DO become successful usually do so by acting a lot like for-profit organizations. I know that from the experience of having worked for a successful non-profit. And just look at Blue Cross/Blue Shield as a key example from the healthcare industry itself. So the differences between the private insurers and the non-profit "options" may end up being very superficial.

  • As I have argued previously, I believe that the biggest flaw in our current system is also its most basic attribute: it is employer-based. Calling any new initiative a "reform" without substantively addressing this basic flaw is, in my opinion, highly suspect.

  • The President's backing down on this issue in spite of a strong majority in both the House and Senate--and, for goodness sake, a filibuster-proof majority in the Senate--is a testament to just how powerful are the special interests who support the status quo. For example, as I have discussed in a previous post, there is evidence that the one senator who arguably has the most influence on the process may be vulnerable to heavy pressure from the healthcare industry.
Oh, well. At least we'll hopefully get some baby steps toward a better system. I guess meaningful reform may have been too much to hope for. Maybe after another 30 years of Waiting for Godot. Sphere: Related Content

1 comment:

  1. How is it that you think you need a public option to compete with private companies in order to have "checks and balances"? If that was the case there should be a public soft drink company to keep Coke and Pepsi honest. Or a public grocery to keep Kroger, Safeway and Whole Foods honest. Or a public auto company to keep Honda and Toyota honest (oops..we already have that!)

    A public plan option would fundamentally change health care for the worst in the U.S. I am in charge of a large self-insured employer plan and I can tell you with some certainty that our employees would not like it.

    We have looked at the numbers and with avg pay of $70,000 and current health care costs of $6,000 (employer costs only) per employee we would probably elect to pay 8% of payroll (the House bill charge on employees who do not offer coverage) to dump this liability on the public plan over time. And we have a relatively highly paid white collar work force compared to most employers. If it makes sense for us it would make sense for thousands of employers.

    Just run the numbers...the public option would be a tremendous drain on the treasury and would require gigantic tax subsidies to be viable and also lead to lower overall quality and accessiblity compared to what people have currently.


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