|Right now, insurance companies often refuse to cover care for conditions that were present (whether known or not) prior to them being the insurer. This is known as pre-existing condition exclusions. And there's widespread agreement that this is one of the things that needs to be fixed.
Okay, so we outlaw preexisting conditions: every insurer has to cover every condition for everyone they insure.
For this to be meaningful, they have to insure everyone, and they can't cherry-pick by charging those who need care way more than the healthy. (These are all key elements of the current proposals.)
Great! Now lots of people won't buy insurance until somebody in their family gets really sick - since they know that the insurance company will have to cover them once they buy in, and in the meantime they can save themselves the cost of the premiums.
That clearly doesn't work: if the only people who buy insurance are the sick ones, the cost of insurance skyrockets, setting up a vicious cycle that destroys the risk-spreading insurance element of the whole thing.
So you say that in order to spread risk broadly, everybody has to pay for insurance. This individual mandate is also in the current versions of the bill.
So now everybody has to buy insurance. And without a public option, this guarantees that premiums will skyrocket. Why? Right now, insurance companies are held at least a little in check by the option of people deciding that the insurance is just so expensive they're better off with nothing. However, if everyone has to buy insurance (individual mandate), there is nothing to keep the two or fewer companies in each of the markets in most of America to raise their prices as high as they wanted. After all, everyone would still have to buy in.
The public option is the only thing on the table that would provide a meaningful check on insurance companies. It would guarantee a high-quality low-cost alternative would be available that the insurance companies would have to compete with for the business of the American people.
So yes, progressives should kill a bill without the public option. No sane Member of Congress should vote for it.
No sane Member of Congress should vote for a bill that will spike the cost of health insurance at the same time we require all Americans to buy it.
And as for the arguments this would be catastrophically damaging to President Obama? He has a choice. He can chose to succeed with a robust public option, or he can choose to fail.
If you have ways of getting messages to your Members of Congress or to the White House, now might be a really good time to send them.