Why the House progressives *should* kill healthcare reform if there's no public option

by: Darcy Burner

Sun Sep 06, 2009 at 18:00

I keep having the same argument, in which someone says, "The progressives won't really kill healthcare reform, right? Even if they don't get a public option - right?"

And I unfailingly respond, "Actually, they will. And they should."

A no-public-option bill would mandate that every American buy health insurance while ensuring skyrocketing premiums. What sane politician would vote for a bill like that?

The public option is essential to the success of the reforms - not merely for political reasons, but for fundamental policy reasons.

Simply put, if you want other reforms like elimination of pre-existing condition exclusions, you need a public option because:

    * Reforms such as eliminating pre-existing condition exclusions only work if you have an individual mandate.
    * If you have an individual mandate, rates will skyrocket unless you have a public option to provide competition (or rate controls, which aren't even on the table).

So what opponents of the public option are proposing is that we pass a bill that will spike the cost of health insurance at the same time we require everyone by law to buy it.

Given that as the alternative, we are in fact better off with no reform.

Let's pull apart the logic I described a little more to understand it better.

[More below the fold.]

Darcy Burner :: Why the House progressives *should* kill healthcare reform if there's no public option
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.

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I'm So Glad You Posted This Darcy (4.00 / 13)
Because I've been thinking about posting something similar all weekend, but it's a lot more authoritative coming from you.

The basic argument you lay out above the fold really should be obvious to everyone.  But if nothing else, we've seen conclusive proof these last nine months that nothing is harder to get across than things that should be obvious.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

Which argument? (4.00 / 1)
That is, there are two parts of it, should and will.

I agree with the first, disagree with the second.

House progressives are going to kill Obama's bill? Come on.

It'll pass with a trigger.

[ Parent ]
They should just stay home (4.00 / 3)
If progressives fold on the public option they better just stay home, because they will be the whipping boy on congress for ever.

They will be a joke, a child always made fun of. If you don't hold this time they will have lost all hope of ever effect legislation in the future. This is about more than healthcare to them. It is about progressives ever being able to make any demand ever.

[ Parent ]
Wrong. Democrats <i>will</i> kill it. (0.00 / 0)
For the reasons Burner outlines, it'll be more than just progressives killing this. Republicans of course, but lots of moderate Democrats will smell the stink and want to distance themselves from it. Even with a public option on a three to five year delay it's hard to see how a bill passes out of Congress.

[ Parent ]
Why doesn't a "trigger" answer these problems? (0.00 / 0)
I keep harping on this point because I think, on an intuitive level, it's hard to overcome.

In other words, all of the arguments against the "trigger" I've seen mostly come to a skepticism that it will work in practice, rather than whether it is theoretically a good idea.  Yet, actually proving that the trigger concept cannot work in practice is not so easy (if, for no other reason, it's akin to proving a negative).

I believe that the average Joe or Jane on the street would find a certain common-sense appeal to the trigger concept.  To defeat it, we need do more than express skepticism about how the details always end up favoring the entrenched interests.  We need more of a detailed analysis, showing why the trigger simply CANNOT work, even in theory.

Admittedly, this may be hard, or even impossible, to do without seeing the language of a "trigger" bill. But once that language appears, foes of the trigger better be ready to do more than express doubt that a trigger would ever go into effect.

A trigger is designed to fail (4.00 / 9)
A trigger is very easy to design to fail. Even if it is "good" at first all it takes is some 7 word admendment to some silly spending bill to make it worthless.


[ Parent ]
Especially if Repubs control one or both houses of congress (4.00 / 1)
or the presidency just before it's intended to kick in. I'm no doubt that any trigger would be worded in such a way that it would be very easy to amend or misinterpret, and very hard to invoke. It's not even "half a loaf". It's a worthless piece of paper that's an IOU on "half a loaf", redeemable...never.

"Those who stand for nothing fall for anything...Mankind are forever destined to be the dupes of bold & cunning imposture" -- Alexander Hamilton

[ Parent ]
If he will not fight for a public option why protect a trigger (4.00 / 2)
If Obama will not fight hard for a public option there is no reason to trust that Obama will protect the trigger and makes sure it is pulled. Obama made it clear progressive should never trust him to keep a promise.

[ Parent ]
Do you trust Congress .. (4.00 / 9)
to pass "triggers" that actually work for the people .. that will bring costs down?  I don't

[ Parent ]
I agree the trigger is the worst compromise (4.00 / 4)
The trigger is the worst possible "compromise." It would be a complete fig leaf. It would be a big FU to the progressives.

Things like forcing companies to be non-profits or setting a minimum lose ratio of 92% might at least help. A trigger is Obama treat the movement like children and hoping we are stupid enough not to notice.

[ Parent ]
How about the reverse? (4.00 / 8)
Given the realities of the  Wall Street bailout, FISA, no prosecution of war crimes, etc., what evidence do you have that a trigger would ever be pulled?

If you're asking people to take a leap of faith like that, it seems like it ought to be based on SOMETHING.

Montani semper liberi

[ Parent ]
Fools rush in... (0.00 / 0)
The theme song of the modern Democratic party.

"Those who stand for nothing fall for anything...Mankind are forever destined to be the dupes of bold & cunning imposture" -- Alexander Hamilton

[ Parent ]
Sadie perhaps you should change your sig (0.00 / 0)
If you liked Bush, you'll love Obama.

[ Parent ]
Don't tempt me . . . (0.00 / 0)

Montani semper liberi

[ Parent ]
I don't trust what trigger they'll write (0.00 / 0)
no reason to give them more chances to screw things up

[ Parent ]
to the other replies (4.00 / 4)
I would add:  What is the actual substantive policy objection to the public option?  It's good policy in and of itself, and the idea of putting it in "trigger" status seems to need to be justified along stronger lines than "well, the members of congress in thrall to the insurance industry would have an easier time voting for it..."

So I think you're putting the onus wrongly on us to argue against a trigger rather than on the opponents of a PO to explain why it would be bad.

[ Parent ]
The substantive policy objection (4.00 / 2)
to the public option is that it would be so beneficial to the American people that they will go to that and the poor, poor insurance thieves will be put out of business.  Cry me a river.

What I just don't get is why the Democrats in Congress and the White House cannot see that the American people will keep them in office for decades if we can get a Medicare for all provision in place.  The Republicans know that.  Why are the Democrats being so stupid?

[ Parent ]
The Only Point Of A Trigger Is To Prevent Taking Action (4.00 / 2)
Our present system has been failing for decades now.  Why do we need to wait for it to fail for a few more years before doing anything?

keep harping on this point because I think, on an intuitive level, it's hard to overcome.

I suppose so, if you intuitively trust televangelists and used car salesmen.

Otherwise, not so much.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

[ Parent ]
Oh Come On (4.00 / 5)
we're talking about a political system that won't even monitor imported toys or Spinach from California, that won't track how many jobs are lost to trade and outsourcing, that won't re-instate Glass-Steagall or break up large banks, even though the whole system almost crashed less than a single year ago.

And we expect these politicians and their owners to honor a trigger?

[ Parent ]
Only If There's A REAL Bullet Involved (4.00 / 1)
And it's pointed at their head.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

[ Parent ]
wow! (4.00 / 1)
Paul, you're making me laugh here. thanks. this is such a depressing topic and we need to keep our spirits up.  

[ Parent ]
Politicians Can Take a Trigger-Public Option Away (4.00 / 4)
Think about it this way: can politicians take away Medicare now? In a word, no. Medicare is popular and up-and-running, and its constituency (seniors) would severely punish any politicians who would take it away.

A trigger is comparatively easy to take away. Pre-trigger, there's nobody signed up for the public option. Ergo, there's no political constituency that would punish lawmakers for taking it away. The moment the winds shift slightly, and voters aren't paying attention, Congress does the insurance industry's bidding and gets rid of even the trigger fig leaf (or neuters it).

We've been down this road before. Medicare Part D has a trigger. The trigger has never been tripped, even while costs escalate.

And what's the rational argument for not starting a public option yesterday? "Because the insurance companies don't like it?" Is that why government exists, to assure higher profits and overhead for middlemen in the provision of life-or-death services? Is that the "best" argument? It would seem so, because I haven't heard any other rational argument in favor.

Here's another problem. Let's suppose (incredibly) the trigger does get triggered in, say, two years. In other words, let's suppose the trigger actually works, i.e. that it's a well designed, League of Women Voters-approved sort of trigger. In the meantime, government has forced millions to buy soaringly expensive (and crappy) health insurance. (The trigger fired, which means health care sucked.) Voters would (rightly) storm the ballot boxes with pitchforks (metaphorically) and throw any politicians who voted for such a monster out of office, before the trigger fires. Politically, why put your party through that pre-trigger phase? Because it's a good idea to piss off your constituents and get your asses booted out of office just before the trigger fires? (And that's assuming the people replacing you won't cancel the trigger.)

A trigger is both bad policy and horrible politics!

[ Parent ]
The reform won't even take place until (4.00 / 3)
2013, and the trigger is way down the road after that.  Talk about another credit card boondoggle.  

If the Democrats insist on governing like Republicans, the progressives cave to the Party establishment, and the activists keep on fund raising for more/better Democrats that end up a total waste, e.g. Tester, those of us who are old time Democrats, not activists but regular voters, are just going to walk off. Maybe we don't matter and recruiting people to help support the base is no big shakes.

I want to be a Democrat, but I can't.  I didn't leave them.  They left me.  

[ Parent ]
To me, the four-years-away start date is a trigger. (4.00 / 1)
We'll have two elections between now and the beginning of the public option. Surely that's plenty of time for the public to weigh in on whether or not they want the government to compete with private insurers in an exchange.

And if the public is on board, what other trigger is necessary?

[ Parent ]
That's another stupid (4.00 / 2)
policy decision on the part of the Democrats.  Why in God's name does the public option not kick in until after the next Presidential election and two congressional elections?  It makes not political sense for the Democrats.  As a previous poster said, if people are already signed up for the public option when the elections roll around, the Democrats will stay in power because they will have a constituency like the people on Medicare who will make certain no politician who opposes the public option is put into office.

[ Parent ]
They have failed in practice (4.00 / 2)
There were triggers in the Medicare Part D bill. If certains areas only had X amount of private competiton then there would be a trigger for a public plan for drugs plans.

Well lo and behold there never was a public plan because indeed the insurance companies created plans for those ares....because it was profitable.  Of course the prices were no lower for the consumer/patient. As the the durg companies made significant profits.  

So triggers fail in practice, if there is no mechanism for controlling prices via competition.

Of course there is the power to change to change, defer and loophole regulations....to change when the trigger is triggerred.

"Incrementalism isn't a different path to the same place, it could be a different path to a different place"

[ Parent ]
It seems (0.00 / 0)
like most of the responses to you have been along two lines:

1) it's easy to remove a trigger after-the-fact and
2) the trigger won't ever fire.

Addressing point 1: For the next few years the GOP wouldn't be able to modify the trigger because Obama could veto it.  After that, even assuming Obama loses reelection, the GOP would need 60 votes to overcome a Democratic filibuster, also probably not likely for a while.  Also, if costs ARE skyrocketing, and people see that the trigger is likely to fire and give them an option of a cheaper plan, killing that option seems like a very politically risky thing to do.

And point 2: What if the trigger was something along the lines of what Nate Silver posted today: "suppose that the trigger were triggered if the average cost of health care for a represenative cohort of adults rose by more than inflation + 0.5 percent over the next five years."  In other words, what if the trigger is directly lined to premiums, so they couldn't go up without check?

I'm mostly playing devil's advocate here because I strongly support a public option (and one sooner than the 2013, at that).  And I totally agree that a trigger, assuming it fires, will mean that it takes even longer to get a public option started, which sucks.

But I think the "trigger" is going to seem like a reasonable compromise to a LOT of people.  Pretty much everyone I've talked to supports it.  And if Obama comes out supporting it, like I suspect he will, it's only going to gain credibility.

So, while campaigning for a strong public option from the start, I think it would be very wise to start figuring out how to make a trigger as strong and foolproof as possible, too.

[ Parent ]
Because we'll all be dead before the "trigger" is pulled (0.00 / 0)

[ Parent ]
I fully agree (4.00 / 9)
A bill that forces people to pay large amounts of money for junk insurance with little help from the government and does nothing until 2013 is a political disaster.

If you try to have a big signing statement and proclaim that your party fixed health care it will be a disaster when people realize how nothing is really improved.

It'll be like Bush declaring Mission Accomplished (4.00 / 3)
Only to have the problems get worse. People are not stupid. Especially anyone with health problems.

[ Parent ]
So True! (0.00 / 0)
Obama is continuing so many Bush policies.

That would just be too much.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

[ Parent ]
YES! (4.00 / 2)
Thanks Darcy. This is the best "news," and I hope they follow through on this.

It's time to hit the RESET button and make them all start over.

Obama has to decide who's side he's really on and stand there like a respectable person. This issue is bigger than him. The WH doesn't seem to get that.

Here's hoping the CPC stands their ground and does the right thing,

"More than any other time in history, mankind faces a crossroads. One path leads to despair and utter hopelessness. The other, to total extinction. Let us pray we have the wisdom to choose correctly." -Woody Allen, My Speech to the Graduates

Thank you Darcy, I completely agree (4.00 / 3)
A bad bill is not worth supporting or passing, not only from a policy point of view, but also from a political one, for several reasons.

First, a bad bill will backfire on Obama and Dems when Americans are forced to buy substandard insurance, or are locked into insurance that they don't like, perhaps as early as 2010, but certainly 2012.

Second, passing a bad bill will only strengthen centrist, conservative and corporatist Dems, and the Repubs that they're aligned with, weaken progressives, and embolden the former to push for even worse policies down the line.

Third, blocking a bad bill will finally make the former stand up, take notice of and start respecting progressives, as a force that must be taken seriously politically, which doesn't merely make noise, but follows up on it with tough politics. This will make it easier to pass better bills in the future.

And finally, by fulfilling their promise to block a bad health reform bill, progressives can not only prevent such a bill from being passed, but force a better better to be passed. Centrist Dems want to pass a bill, and know that having one blocked because it's not progressive enough will hurt them far more than it'll hurt progressives, so they have every reason to back down and accede to progressive demands. This is a game of chicken, smart people (like you) on both sides know it, and the side that holds its ground will end up winning.

I'm also reinforced in my belief that the other side is frightened and can be made to buckle by the rise in diaries and comments on various progressive blogs, and commentaries by news pundits, to the effect that Dems had better pass any bill, however watered down, because it's better than nothing, and if they don't pass anything, it'll hurt them. This is, of course, rediculous, the same argument used to pass the horrible FISA bill last summer, and whenever I hear it, it makes me realize that the people pushing it are scared, and resorting to outright lies and scare tactics. Let's not fall for it this time. It's a trick, and we're smarter and tougher than that.

Also, on a different note, I'm not sure if you noticed, but CSPAN was supposed to broadcast a panel earlier today from this year's Netroots Nation, that you took part in:

Netroots Nation 2009 - Day 3
Congress and Policymaking
Burner, Hamsher, McCarter, Thomas & Waldman

At the last minute, they cancelled it, and replaced it with a panel from a conference held this summer by a conservative outfit called the Steamboat Institute, with hacks like Tony Blankley of the Washington Times and the like participating. I thought this to be strange. They're showing panels from this conference all day, but not one from Netroots Nation.

Something, perhaps, that the FCC should look into? Meaning, CSPAN's policies regarding balanced coverage in general. I believe that studies have been conducted that show a 2 or even 3 to 1 conservative-liberal bias in its broadcasts and guests.

"Those who stand for nothing fall for anything...Mankind are forever destined to be the dupes of bold & cunning imposture" -- Alexander Hamilton

Hoorah for Darcy Burner (4.00 / 5)
Thank you for this insightful, strong promise and explanation. It is gratifying that this is so well understood in the progressive caucus, and that the Progressive caucus and pledge block has made just this commitment.

I find it a touch disappointing that such a pledge needs to be made, but that is the state of politics in America at the moment. So be it.

But we have to continue to get their backs and get more people in congress with just this much spine.

Thanks again Darcy (I'd prefer to call you Representative Burner).


The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

The fundemental problem (0.00 / 0)
I have with this position, which I have struggled with for months, is simple: how is this position moral?

If the bill gives access to millions who currently do not have it, how is it moral to oppose the bill?

I haven't really heard an answer to this question.  

Moral? (4.00 / 5)
How is it moral to refuse to buy children out of slavery?

Yet anti-slavery advocates are virtually unanimous in opposition. They say--quite rightly--that buying anyone out of slavery simply supports the market, thus increasing the number of slaves down the line.

It's often the case that what looks moral on a case-by-case base has abhorrent long-term consequences.

One must think systemically, and resist blackmail.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

[ Parent ]
Because without real cost control (0.00 / 0)
it would break the budget, which would dramatically endanger the same victimized people it purports to help.

[ Parent ]
Puts us in a better position to fight for real health care (0.00 / 0)
I think many believe that by rejecting the bill it will finally put progressive in an effective negotiating position that will result in better health care for more people, and other positive changes in other policies.  

Wouldn't it be immoral to oppose that course of action?

Regardless, the basic flaw in your hypothetical is that it is predicated on an assumption that there's no possible way any alternative could ever be passed in the near future.  I think you may also be overestimating the number of people who would see improvement in care, and the effectiveness of the reform measures that were written by the same industry they seek to regulate.

[ Parent ]
How is it moral (4.00 / 7)
To tell people "yay! we passed a bill that will give you coverage!" And then not tell them "oh by the way, it will cost you more than you can possibly afford, the policy you can probably scrape together enough money won't actually provide you the care you need to be healthy and you're still going to be subject to denied care."

What is moral about that?

I have to assume you are coming at this from the perspective of someone who is insured, with a good policy, and has been insured for quite some time.

When I was uninsured just 2 years ago, I became one of the leading online opponents of Arnold Schwarzenegger's mandated insurance plan. I don't know how much my activism contributed to the death of that plan. Maybe none at all. But from the perspective of an uninsured person, mandates were a ruinous disaster utterly lacking in morality.

Why? Because while I didn't have insurance, I had some basic level of financial stability. Under the proposed subsidies (which have proven to be insufficient in MA and will likely be insufficient under a non-PO bill) my wife and I wouldn't have qualified, so I'd have been on my own. And judging by the policies being offered in MA, I wouldn't have been able to afford the mandate. If I tried to comply, I'd have literally gone bankrupt - I simply did not have the money to buy it.

Pushing people into financial ruin is not moral. Telling them they have a health care solution when in fact their core dilemma remains unsolved is not moral.

And finally, passing a health care plan so bad, so unpopular, that it hands power back to Republicans in 2010-2012, is not moral either, considering what they are going to do when they get back in. They'll make the Bush years look idyllic.

[ Parent ]
The one holding the gun (4.00 / 5)
to the head of the hostage is the one responsible for the hostage situation.

The insurance companies could have chosen to insure those millions any time they wanted to. They have always had that power.

Why do we give them mandates now, and subsidies? Where is the morality in rewarding them when for years they have been killing for profit?

Montani semper liberi

[ Parent ]
Good point (0.00 / 0)
and it's the same point that got Jan Schakowsky her only real standing ovation at her town hall last week.  "They say they have a plan to cover everyone.  What's stopping them from introducing it now?  They don't even NEED a bill to do that, if they want to."

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.

[ Parent ]
the moral case (0.00 / 0)
to quote a smarter fellow:
Forcing people to pay money they don't have for high deductible insurance they can't afford to use is not moral.

not everything worth doing is profitable. not everything profitable is worth doing.

[ Parent ]
Concur (4.00 / 1)
When the public realizes that they are stuck with the same old shitty system, it will kindle the spirit for reform.

Whereas a bad plan will kindle thoughts of the horrors of "socialism" and "Big Government".

Meanwhile: grassroots, grassroots, grassroots.

Continue to support better eating, self-care, exercise, care for the sick and the elderly (you don't need a government paycheck in order to visit a nursing home, or sick children).

Push this complete argument! (4.00 / 3)
Progressives on TV have been dancing around the controlling cost argument, mostly focusing on the "choice" side.  It is rare to hear the individual mandate without a public option in place has exactly the opposite of the desired outcome of lowering costs, offered as a coherent argument as Darcy has done here.  The follow-up question is, "What cost effective solution other than the public option has been introduced?", and according to the CBO the answer is none! The only solution from the Reps to do this as far as I'm aware is the interstate selling of insurance policies and tort reform, neither of which solves the inherent competition problems in a reasonable way.

I'm hoping Obama does the right thing on Wednesday, but I personally am not very optimistic after watching the news shows today.  

Yeah, this is a great idea (0.00 / 0)
Instead of possibly being able to get 15 million more people covered, we will get no more people covered.  

WHAT Coverage??? (4.00 / 4)
You evidently haven't been following the news lately.  Like for the last decade or so.

Mandated coverage in name only for another 15 million people = 15 million new GOP voters!

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

[ Parent ]
"coverage" is not an abstract term if you are sick (0.00 / 0)
Paul, please see my comment below. I am a sick person, and I see this clearly as a civil rights issue. I agree with the push for a public option, but there is hysterical rhetoric going on everywhere on the left these days (even in usually non-hysterical venues like OpenLeft) which refuses to acknowledge how ending the preexisting condition regime, shortening patent life for designer meds, etc, actually WOULD make a huge and tangible difference in the lives of many less fortunate Americans.

I'm not saying back down, but if we can't get reconciliation and Obama is ready to throw in the towel, it will be time for progressives to compromise, find the best price controls that are politically possible, and make sure some of these reforms get passed.

[ Parent ]
They won't actually be covered (4.00 / 5)
If we want to cover 15 million people, we can do that through an S-CHIP style solution, a model which was already enacted earlier this year. There is no need to drop a nuclear bomb on household finances and to risk losses in the 2010 and 2012 election by joining an expansion of coverage to a mandate that will blow up in our faces.

[ Parent ]
Why are we outlawing something that's already illegal? (4.00 / 1)
Google "HIPAA" and "pre-existing condition" to see what I mean.  They're already illegal and have been for over 10 years now.  So why are we outlawing something that's already illegal?  Oh yea, because previous health insurance reform measures, just like this one were written by the very industry it intended to regulate and they left loopholes big enough to drive a truck through.

I'm done trying to get paid off refs to call the game straight.  Let me buy into Medicare, along with every other sane American who isn't under the delusion that their "great private insurance company" will do right by them when their costs for care gets out of control.

Allowing anyone who wants to buy into Medicare is the only public option!  It's the only "public option" that will actually live up to the false promises of the current public options being debated.  Indeed, if the public option is "like Medicare" (as falsely professed by so many on the left), how is a public option that IS Medicare, any better or worse?

Continuing down this road where liberal activist and top blogs demand a "robust public option," without actually making any concrete measurable demands for it is a total waste of energy.  All Congress will do (including a good contingent of the Progress Caucus) is pass a bill that has a "public option" that ain't worth a shit, just like the current public options in all the bills.

I mean does the diarist not know that the public option as proposed is likely to never get off the ground, and if it does will have a firewall so high as to only be available to a small number of people at a cost not much lower than private insurance?


Google "Darcy Burner" (0.00 / 0)
and then you tell me.

Montani semper liberi

[ Parent ]
homework (4.00 / 1)
I mean does the diarist not know that the public option as proposed is likely to never get off the ground, and if it does will have a firewall so high as to only be available to a small number of people at a cost not much lower than private insurance?

from what i've read (mostly analysis and also a little bit of the actual bills) i'm inclined to think you are correct in your description of the public plan in either the july 17th version of hr 3200 (i haven't seen the ecc version) or the help committee bill.

furthermore, on July 27, a fund raising email was sent out (from Darcy and ProgressiveCongress.org)

The current House bill includes the robust public option demanded by the Congressional Progressive Caucus...

i don't think this is actually true. the cpc put out a list of requirements:


included in the list is the following:

Be available to all individuals and employers across the nation without limitation

either i am profoundly confused or someone is misinforming Darcy about the legislation.

[ Parent ]
request for feedback (0.00 / 0)
if i have it wrong in the above comment, would someone please correct me?

and if i'm not wrong, and darcy doesn't return to read the comments, would someone in contact with darcy please let her know?


[ Parent ]
In part you are right (0.00 / 0)
Over 80 percent of all health insurance is tied to an employer.  A person may not participate in the "Exchange" - where the public option is available - if they have an employer provided health plan - even if it is one of the grandfathered "non-complying" health plans.  Furthermore, in the first year only employers with less than 10 employees can use the Exchange to provide health insurance.  The bill expands to employers with 20 employees in the second year and will expand after that per direction of the Secretary.

This was intended to protect the employer based insurance industry from a radical shift.  Unlike individuals, employers are hard numbers people.  The public option will be cheaper and provide better benefits than a host of current employer plans.  Employers would abandon the private insurance industry like rats on a sinking ship.  I know because I am one of them.  Fortunately, I have fewer than 10 employees.  If and as soon as the public option becomes available, I am dumping the HMO that I have.  I represent what the insurance industry is desparately afraid of.

[ Parent ]
The question however is (0.00 / 0)
Will the public option deliver the cost savings its purported to?  If a public option is only 10-15% less than the cheapest private insurer, wouldn't Blue Cross simply privately negotiate a cheaper rate with the employers ready to jump ship and simply pay for it by increasing their denials?

And there are other issues with the P.O. regarding the lack of a provider network and standardized fee for service.  Even the best bill requires the P.O. director to make deals with tens of thousands of doctors across the country.

And oh yea, the P.O. isn't designed to go into effect until 2013.

It's much wiser and easier to simply let people buy into Medicare, which has the added benefit of making the program more solvent and cheaper to administer.  But no one is talking about that.  They're all bought off.

[ Parent ]
i think you are wrong on pre-existing condition exclusions (0.00 / 0)
Reforms such as eliminating pre-existing condition exclusions only work if you have an individual mandate.

that's just not so. it takes regulation and enforcement, not a mandate.

i know this from personal experience because in MA we had this reform (no exclusion for pre-existing conditions) working for years BEFORE the 2006 reform to implement mandates.

now that we have mandates, my impression is that after some initial cost savings costs are again increasing as before -- i don't think (but don't know for a fact) that the mandates caused skyrocketing costs per capita. is there any per capita cost data to back up your assertion?:

If you have an individual mandate, rates will skyrocket unless you have a public option to provide competition (or rate controls, which aren't even on the table).

There are rate controls in HR3200 (0.00 / 0)
They just kind of hide in Sec 116 of HR3200.

But rather than argue the point with Darcy who I love to death I will just leave it at that.

There Are Ciminals Running Our Health Care Industrty (4.00 / 2)
especially the insurance side.

Without the sort of forcing mechanism that a robust public option provides, excuse me for not trusting anything else to work as promised.

After all, nothing works as promised now.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

[ Parent ]
Thank you for writing this. (0.00 / 0)

Fortunately, my Representative understands this clearly (4.00 / 1)
My representative, Lynn Woolsey, is very clear on this concept. Even several months ago when I talked to her staff about this issue, they clearly stated that no bill was better than one without a public option.

Darcy, I really appreciate you making this point so clearly. Compromising on a public option is not something we can do to promote party unity, bipartisanship, or for any other reason. It does not take a lot of thought to realize that a mandate with no cost control would not just be a problem for citizens, but would lead to such a negative reaction that it would end the influence of the Democratic party for a generation. It would be like the polar opposite of the new deal. All the GOP talking points about government intrusion and coercion would come true.

It is a testament to the successful corruption of government by corporate influence that many politicians think a mandate while maintaining a private insurance monopoly is a rational choice.

ec=-8.50 soc=-8.41   (3,967 Watts)

Thanks Darcy, I've had a hard time (4.00 / 1)
with the idea of rejecting something that might help some people. Having worked in health care, I see it in terms of individuals, not in the abstract. But I now agree on killing it if it's mainly a windfall to insurance companies because of the widespread harm that would result for many people.  And we can start over with a new, better bill. If you're served a meal that is inedible, or even poisonous, you send it back to the kitchen and order something else. You don't eat the damn thing, unless maybe you're a victim of learned helplessness. "Something" is definitely NOT always better than "nothing".  

Obama as Carter? (0.00 / 0)
I hope Obama grows a (new) pair before next week and simply follows through on his campaign promises. I'm really beginning to wonder if Obama is emulating Carter's presidency.

Carter and the Democratic Congress increasingly diverged over the course of his presidency. (Carter acted much more "conservatively" than Congress wanted.) In retrospect, Congress was largely correct and Carter was largely not.

Obama needs to be careful not to repeat Carter's mistakes.

Not only should it be killed, (4.00 / 1)
it should have a stake driven through its heart. And after the Progressive Caucus is done with this, I hope they start to take on the WH and Party establishment on all the other things they are flip-flopping on.  

I am one life-long Democratic voter that is going to drop this party firmly on its ass if it doesn't return to its roots on health care, trade, jobs, bank bailouts, tax cuts for the rich, and getting us out of warS.   If I want a Republican in the office, I'll vote for the real one.  I'll still lose, but now they will, too.  

Great Post - But you forgot the other half of the equation (4.00 / 1)
You hit the nail on the head.  However, you did not mention the other half of the equation - subsidies.  The primary cost of healthcare reform is taxpayer assistance to individuals and small businesses who cannot afford to pay the ridiculous premiums that private insurance companies charge.  Without a public option, healthcare reform becomes nothing but a $1 trillion bailout for the insurance industry.

If you will recall, the financial industry was making profits hand over fist just before the fall.  Similarly, the health insurance industry has recently seen its profits rise over 4 fold.  I suggest that the health insurance industry is poised for a fall similar to that of AIG because the premiums are so high that businesses and individuals will soon be abandoning insurance is nothing changes.  Just in time - we have have corporate welfare for the insurance industry.

All progressives should oppose more corporate welfare.

Thanks (0.00 / 0)
I sent this to Obama twice (once to the White House, once to info@barakobama.com), and to Sen. Kerry and Rep. Frank all with my urgent endorsement. The current bill is a trap: the insurers get a bunch of new suckers required to buy their insurance, and thus at the insurers mercy. The insurers will capture any regulatory scheme set up, so the premiums will spike. Only the Public Option is any threat to them. They know this and they've shown their fear of the pubic option. I'm fairly disgusted by all this. Back in 1979, I went into law practice at a firm that specialized in representing hospitals in Medicare reimbursement controversies. I was a "Medicare for All" enthusiast and wanted to scope out the other side. After 6 months, I gave up: the hospitals had too much money to allow themselves to be beaten. Today's health insurance sector seems even richer and Obama seems to be listening to their money talking.

that's great logic if you're not sick (4.00 / 1)

I have multiple sclerosis. I already have to pay "skyrocketing premiums." A reform bill, with or without public option, offers me the prospect of equality with my fellow non-sick Americans.

Can you really tell me with a straight face that "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"? Really? There are no other price regulations built into any of the bills before Congress? No prospect of progressives winning other forms of price regulation in a compromise?

How about, for instance, shortening patent life on prescription drugs? That's a big expense for me (or, more accurately, for my insurance company.) Hell, if we allow generics of 10-year-old drugs, I might not even need insurance, I could pay my med costs out of my pocket. And that is another element of reform that a lot of Congresspeople support.

It's frankly true that the public option is not the central issue here. The central issue is ending medical discrimination against sick people, now and in the future. (One day, you'll get sick too, I promise.)

ending medical discrimination against sick people (0.00 / 0)
That is a powerful argument. Very strong point.

There's three lenses that people use to view HCR (they are not mutually exclusive):

ideological: what strategy generates the most "progressive" outcome
political: what strategy generates the most advantageous power dynamic, both in terms of 2010, and in terms of dynamics within the Democratic party
pragmatic: what strategy generates a final bill that delivers results for the least powerful members of our society, especially those who've been screwed over by the for-profit insurance industry

You've made a powerful point that every Congressperson should think about.

[ Parent ]
trying to cave (0.00 / 0)
I know you've been busy with your cult, but are you really trying to set up the cave against the progressive block strategy of getting a good bill instead on an insurance company bailout.

On twitter: @BobBrigham

[ Parent ]
the best case (0.00 / 0)
is still not good enough.
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.

No it will not. Not when the vast majority of those American people will be ineligible to buy into the public option. And not when removing the linkage to Medicare rates, and forcing the plan administrators to individually negotiate new deals with providers - producing spotty inadequate coverage for about the same cost as private insurance - an explicit goal of many of the people putting these bills together.

I like Nick Beaudrot's flowchart for getting a handle on the numbers involved. In the very best case, a public option affects around 12 million people, out of close to more than 200 million people who would potentially need that choice.

That is just not enough to change the rates of private insurance in any way. Their customers will not be able to go anywhere else.

And even the very best case depends on subsidies for poor people. The American political process is death on subsidies for poor people, especially when they are directly linked to a huge regressive tax increase for the middle class. It's like everyone has forgotten that Democrats will not always run things.

There is no actual bill with any chance of being signed that is not going to end up being a nightmare.

not everything worth doing is profitable. not everything profitable is worth doing.

Another Feature of HR3200 That Will Be Vastly Unpopular (0.00 / 0)
is the tax that you will pay if you decide not to be covered by health insurance.  Section 401 of the bill is a little hard to understand, but it appears to require that taxpayers who do not get insurance will pay 2.5% of (their modified AGI minus the standard deduction).  If so, a married couple with an AGI of $60,000 who does not buy private health insurance will get hit with a penalty of perhaps $1,000 for the privilege of not buying health insurance.  So, not only does this couple still not have insurance, but they need to pay an additional tax because of their 'failure.'  That's bound to go over great with the voting public!

Decarbonize, Deglobalize, Demilitarize

Deductibles are triggers too (4.00 / 2)
There is no way I could afford to chip in on insurance itself (even with subsidized help) and handle copay and deductibles.

It would simply make actual care that much more difficult to get. I would imagine this is true for virtually all who are currently uninsured and a great many who have insurance now.

Why on earth would we all want to pay more for no actual care, barring catastrophic needs?

I want to pay what I can for a good Medicare policy..and have access to a doctor or nurse when something ails me... dammit!


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