Why the Public Option is Doomed To Fail, and What Can Be Done About It

Some
highly profitable and job creating industries simply can't be
reformed. Slavery and child labor cannot not be made humane and
reasonable, not with kind and solicitous masters or school and limited
hours for the kids. Both these practices were eventually cast aside.
Allowing souless, greedy private insurance corporations to collect a
toll for standing between patients and doctors may be next.

The
president's health care plan is designed to preserve the parasitic
private insurance industry a little while longer. In this context, the
public option is a cruel and cynical hoax, an excuse not to abolish the
role of private insurance death panels and toll collectors in the
nation's health care system.

Nobody
can read the president's mind, but he did promise to construct health
care legislation in an open and transparent manner, even "on C-SPAN."
Instead, Obama handed off the drafting of health care legislation to
five House and three Senate committees. The most generous view is that
he did this to give legislators a stake in the bills, and because there
is this thing called the separation of powers between the executive and
legislative branches.

Another
view is that the embedded influence of Big Insurance, Big Pharma, and
Big Medicine were easier to conceal when spread out over several
committees, where the lobbyists are themselves former congressmen,
senators and their top staffers, and many current members and staff
look forward to the same career paths. These are the men and women who
wrote what is and will be the president's health insurance reform
legislation. The result has been a half dozen versions of a
thousand-plus page bill, chock full, as Rolling Stone's Matt Taibi
points out, of deliberately obscure references to other legislation.
Nobody can authoritatively claim to have read, much less understand all
of it. And that's just the way insurance companies and the president
like it. HR 676, the Enhanced Medicare For All Act, which does provide
universal coverage at reasonable cost, comes in at under thirty pages.

To
begin with, there are no less than three versions of the public
option. The first is an imaginary public option first conceived by
Political Science grad student Jacob Hatcher in 2001. It was to
postpone the death of private insurance companies by forcing them to
compete with a publicly funded insurer open to all comers which would
drive their prices downward. This imaginary public option has never
been written into law, and is not under consideration in Congress this
year. It lives pretty much in the minds of the public and the lips of
the Congressional Progressive Caucus, MoveOn.Org and many others. It's
in the mouth of Howard Dean, who says it will be just like Medicare,
only available to everybody. To distinguish it from the President
Obama's version, it is usually called "the robust public option."

The
second version of the public option is not imaginary, it is all too
real. President Obama explicitly outlined its contours in his health
care address earlier this month. Unlike the expansive and inclusive
imaginary public option championed by MoveOn.Org, the president's
public option will be stingy, means-tested, socially divisive,
actuarially unsound and doomed to failure, unless its objective is
simply to discredit the word "public" in the term "public option." The
president has said it will be limited to 5% of the nation's population,
those Americans too poor to afford the cheapest insurance available on
his regulated "insurance exchanges" which won't be fully implemented
anyway till 2013.

Hence
those making more than a very small wage will be ineligible for the
president's version of the public option, and those who currently get
insurance from their employers, no matter how skimpy the coverage, how
high the co-pays and deductibles, will also not qualify. Those who
receive relatively good (or maybe not so good) coverage from their
employers will pay a special tax to support both the public option and
the subsidies the government will pay to enable others not quite poor
enough for the public option to fulfill their legal obligation to buy
shoddy insurance from private vendors.

In
a social culture where Americans have been taught to despise poverty
and the poor, even when they themselves are poor and near poverty, this
will be bitterly and inherently divisive. It will provide economic
incentive for the working poor to look down on and resent whatever
benefits those even poorer than themselves receive. It turns medical
coverage for the poor into stigmatized welfare subsidized by the
near-poor, and all to the continuing profit of insurance companies.

And
since the pool accessed by the public option will be relatively older,
poorer and thus more chronically ill, it will not be economically
viable in and of itself, much less of the size needed to compete with
private insurers and drive their prices downward.

The
only good thing one can say about the president's version of the public
option is that even he is not firmly attached to it, and does not
regard it as essential to his package. That's actually good news.

Beyond
the imaginary "robust public option" of MoveOn.Org, and the divisive,
destructive public option of the president, there is a third public
option, a very real one. It's HR 676, the Enhanced Medicare For All
bill, sponsored by John Conyers and Dennis Kucinich. Unlike the mostly
imaginary "robust public option" of MoveOn.Org, it actually exists and
ordinary people can read and understand it. Unlike the president's
public option, which does not take effect till 2013, a fact still
ignored by most of the mainstream media, HR 676 can be put into effect
almost immediately. The first Medicare back in 1965-66 took only
eleven months to send out the first cards and pay the first medical
bills.

The
White House of course, is not listening to the public outcry for
Medicare For All. For example, a group of Oregon physicians calling
themselves the Mad As Hell Doctors put up a web site that included an
email-the-president page. After the White House received only about
5,000 emails in the first few days, it elected to block emails
coming from the Mad As Hell Doctors as spam. Never mind that tracking
polls as late as this June indicate majority support among the public
for the simple extension of Medicare benefits to everybody.

And
although the progressive caucus in Congress continues to wistfully
describe its imaginary version of the public option as a line in the
sand, it is neither lining up votes for a promised HR 676 floor vote,
nor are they demanding that caucus members support amendments to let
states to pursue their own versions of single payer in the near future.
Congress is being set up to accept anything with the name "public
option" and be done with it, even the president's cynical and divisive
proposal. The die is cast. The Obama proposals, written by the health
insurance lobbyists may pass, but they're not worthwhile. The
president's version of the public option, if it stays in the bill is
doomed to fail, and the MoveOn version never existed. The only
possibility for the real public option, Medicare For All, this year is
on the state level. That door will be opened or closed by the Congress
this year.

The
Congressional Black Caucus and the Congressional Progressive Caucus can
partially redeem their sorry capitulation to the president and Big
Insurance by insisting that states be allowed to go their own way on
single payer, the only real public option.