In the wake of the tentative Senate health care compromise, I am going to reiterate the case I made last night that the public option campaign was actually a real success. While it looks like we didn't get a new public option program, we have received at least:
These are all concessions directly made to progressives in return for dropping a Medicare +5% public option that would have covered 10 million people. Not bad.
- 4 million more people covered by Medicaid, which is a public option, than the July version of the House bill
- 1-2 million covered by a Medicare buy-in, which is also a public option, and which was entirely absent in the July version of the House bill
- An increase, from 85% in the July House bill to 90% now, in the percentage of money companies receive on health insurance premiums that must be spent on health care.
The Progressive Caucus spent five weeks in September and October trying to round up support for health care reform with a Medicare +5% public option in the House. While they came up about 10 votes short, they knew they were doomed to fail from the start. A public option tied to Medicare rates had no chance of passing the Senate, and the CPC knew it. As near as I could tell, the point of passing a Medicare +5% public option in the House bill was improve the bargaining position for the public option in the conference committee. The hoped-for end point was a negotiated rats public option (which would have covered about six million people, but not as well as Medicare), plus concessions like the ones listed above.
At its fundamental core, the goal of the public option campaign was to get more people onto public health insurance plans. The Senate compromise will result in 16-17 million more people entering public health insurance plans than current law. This is down from 21 million in the bill that passed House committees in July, but it isn't zero. How can a campaign that was designed entirely to get more people on public health insurance be a failure if it resulted in 16-17 million more people receiving public health insurance?
Assuming for a moment that the Stupak language is defeated, the major objection I am still seeing to this bill from the left is that some people will be facing a mandate without the choice of a public option. Specifically, that means people between the age of 27 and 54 (inclusive) who do not have insurance from their employer and whose income is above 133% of poverty level. That is certainly a substantial group of people, numbering somewhere between 20 and 22 million.
That group, however, will still receive substantial subsidies to purchase insurance, and several thousand lives will be saved every year as a result. Further, now 90% of the money they spend will go to health care, up from the current national average of around 70%.
Covering 16-17 million more people on public health insurance than current law, among an overall decline in the uninsured population by 30-35 million, with a cut in health insurance industry waste and profits from 30% to 10%, is, in my estimation, much better than the status quo. Public insurance rolls will be increased, lives will be saved, and industry profit margins will take a real hit. If a $95 per annum mandate penalty in 2014, and a $750 per annum mandate penalty in 2019, makes all of that too much to swallow for you, I am not going to argue with you. But there is a strong case to be made for this compromise.