As the health insurance industry and its defenders in Congress lay out
their case against permitting a public option in a reform bill, perhaps
their most curious argument is that some 119 million Americans are
ready to dump their private plans and jump to something more like
Medicare - and that's why the choice can't be permitted.
In other words, the industry and its backers are acknowledging that more than one-third of the American people are so dissatisfied with their private health insurance that they trust the U.S. government to give them a fairer shake on health care. The industry says its allies in Congress must prevent that.
The peculiar argument that 119 million Americans must be denied the public option that they prefer has been made most notably by Sen. Chuck Grassley of Iowa, ranking Republican on the Senate Finance Committee, which is one of two panels that has jurisdiction over the health insurance bill.
"As many as 119 million Americans would shift from private coverage to the government plan," Grassley wrote in a column for Politico.com. That migration, Grassley said, would "put America on the path toward a completely government-run health care system. ... Eventually, the government plan would overtake the entire market."
Grassley's logic is that so many Americans would prefer a government-run plan that the private health insurance industry would collapse or become a shadow of its current self. That, in turn, would lead even more Americans entering the government plan, making private insurance even less viable.
Rarely has an argument more dramatically highlighted the philosophical question of whether in a democracy, the government should represent the people's interests or an industry's.
But Grassley said he is simply upholding "the promise that if you like the coverage you have, you can keep it. ... That's why I'm concerned about a government-run plan that forces people out of private insurance."
The counter-argument, of course, might be that if the health insurance industry hadn't dissatisfied so many customers - indeed forcing many sick people into bankruptcy because of excessive fees, denial of coverage and gaps in permitted medical treatments - there wouldn't be so many Americans eager for a public option.
So, now to protect the health insurance industry, Congress must stop 119 million Americans from leaping into the arms of a government plan.
Grassley is joined in his position by nearly the entire Republican contingent in Congress. It also appears a few key Democrats, particularly Senate Finance Committee Chairman Max Baucus, D-Montana, agree at least in part.
Baucus has kept a single-payer option "off the table" during the debate even as he claimed "all options are on the table." He also has suggested that Congress might have to "sculpt" any public option, presumably to make it less appealing to Americans if some version survives in the reform bill.
President Barack Obama, whose mother had to fight with her health insurance company while dying of cancer, says he continues to favor including a public option in the bill as necessary to keep the insurance industry honest. Sen. Ted Kennedy, chairman of the Health and Education Committee which also has jurisdiction over the bill, also favors a strong public plan.
However, there is the additional fact that executives from health insurance companies and related industries are major campaign contributors to members of Congress on both sides of the aisle.
For instance, since 2005, Grassley's various political action committees have collected nearly $1.3 million in donations from the industries related to the health insurance debate, according to OpenSecrets.org. Grassley's top four donor groups were Health ($411,956); Insurance ($307,348); Pharmaceuticals ($233,850); and Hospitals ($197,137). Eighth on Grassley's donor list were HMOs at $130,684.
On the other hand, the health insurance industry appears about as popular with Americans as the tobacco industry, with both considered highly hazardous to your health. Except that Americans can choose not to smoke, while they run enormous risks for themselves and their families if they don't have some form of health insurance.
Health insurance companies do negotiate rates with hospitals and doctors that are far below what is charged to people who don't have insurance, sometimes as low as one-tenth what the uninsured patient might be charged.
These disparities, in effect, force many Americans to sign up for private insurance even if the insurance fees are excessive, padded with handsome profits for investors and unproductive bureaucratic costs (including investigations into whether people can be denied payments because of undisclosed "preexisting conditions").
If the health insurance industry had its way, Congress would produce a bill that simply required Americans (or their employers) to buy health insurance from private industry. That way, the government would compel citizens to become customers while denying them a choice of the public plan.
To avoid such an outcome, proponents of the public option - including those 119 million Americans who are ready to sign up - will have to overcome opposition from Republicans and some Democrats who are determined to protect the interests of the private health insurance industry.