There are a lot of folks in the conventional wisdom, establishment-oriented Democratic circles that are trying the sell the argument that reform without a public option is still big, important, transformational health care reform. I totally get why they are doing it, and even have some sympathy for what they are trying to achieve: worried that we can't get a public option bill out of the Senate, they are scrambling to make it seem like whatever passes isn't a failure or disappointment.
The latest example is Third Way's Roll Call op-ed, "Don't Pass on the 'Next New Deal'". The folks at Third Way know how to make an argument, and what they say sounds reasonable enough, that if we regulate insurers to stop the worst things about our current system, that will still be a big improvement in health insurance rules.
What I fear instead is another bill like Kennedy-Kassebaum which, as I have written before, was supposed to solve some of the same insurance problems like people losing their insurance when they switched jobs, or being deprived of pre-existing conditions- all of which continues to happen.
Another bad outcome would be that we get something like the Massachusetts health plan, which passed with a lot of hype a few years ago. It's not working very well, though, as way too many people can't afford to sign up for coverage, and the costs are quickly spiraling out of control.
These two pieces of legislation are failing because of the same problem: neither one took on the power of the insurance industry. These two bills, both passed with great fanfare in the thoroughly bipartisan fashion, are not working because they provide no check on insurance industry power, no competition and no reason for insurers to control their costs- which, by the way, is exactly why they passed so easily with such big bipartisan support.
Remember, insurance companies are granted exemption from anti-trust laws by the McCarran-Ferguson Act. A very small number of them have overwhelmingly market power in huge parts of the country. Their rates are unregulated by the federal government. And they have enormous political power to go along with their massive market power.
What my friends at Third Way don't mention is that the insurance industry has happily signed off on all the regulatory changes mentioned above, just as they supported Kennedy-Kassebaum and the Massachusetts health bill. They know that with all the market and political power they have, without anti-trust or federal rate regulation to worry about, without competition from a public option, they can raise rates as much as they want and probably write loopholes into the regulations that they agreed to so that they will be easier to slide around.
This is the simple fact that has made progressives in the House draw a line in the sand in terms of keeping a public option in the final bill: without the public option check on private insurance, there will be no check on insurance company power to set whatever rates and rules they want to, and health reform will not work. A bill with no check on insurance company power, with no competition for insurers, will drive health care prices higher and will fail to solve the real problems we have in how insurance companies treat people.
So don't give up on a health care reform bill that keeps insurance companies honest, my friends at Third Way and my other friends in the DC establishment. In spite of all the doom and gloom of the conventional wisdom spinners, we have a path to victory, as long as we don't give up and decide we don't have the courage to do what needs to be done and take on the insurance industry. If we do what the President wants, and have competition and choice so that we keep them honest, we really will have accomplished something that can be compared to Medicare and Social Security.
There is a buzz building in the traditional media and in some DC Democratic circles about how we should just accept the fact that we are not going to get a bigger health care reform bill passed, and should just agree to accept the things that the insurance industry has already said they are willing to give us. The insurers say they are willing to give us doing away with coverage denial for pre-existing conditions, for example, or not charging sick people high rates. Let's just take what we can get, some Democrats are saying, declare victory, and go home.
This line of thinking reminds me of a piece of legislation that all you non-health care wonks out there probably have never heard of: the Kennedy-Kassebaum Act of 1996. This bipartisan bill passed the Senate 98-0 and the House 421-2. Its stated aims were to protect health insurance coverage for workers and their families when they change or lose jobs, and to limit to the pre-existing conditions denial problem. It was all policy the insurance industry agreed to, and the bill passed with a lot of fanfare. There was a very nice bipartisan bill signing ceremony (which I attended) on the South Lawn of the White House. Pundits were delighted.
There was only one problem with it, which you may have noticed if you think about it: it didn't actually do anything to solve our health care problems, even the ones it was specially intended to solve. People still lose their health insurance when they lose their job. Insurance companies still deny people with pre-existing conditions. And the problems of our health care system get steadily worse year after year.
You see, the insurance companies are really good at writing loopholes for themselves, especially if you announce in advance that you will only pass what they agree to.
Look, this should be obvious, but apparently it's not: when some big piece of our economy is really messed up, but some major corporate interest is making lots and lots of money off the system, if that corporate interest doesn't object to the "reform" being proposed, whatever legislation being proposed will not solve the actual problem. The 98-0 votes that folks like David Broder love and extol, the bipartisan bill signing ceremonies that thrill the hell out of everyone in DC - they don't actually solve or resolve anything important.
If Democrats take the easy path, and get that big bipartisan love fest on the White House lawn, health care will still be messed up in all the ways it's messed up now: health care costs (and the federal budget deficit) will still be spiraling up and up, the number of uninsured will keep going up as well, people who lose their jobs or have pre-existing conditions will still be priced out of the ability to get insurance. And instead of congratulating us for our great bipartisan compromise, voters will be pissed. President Obama and Congressional Democrats need to grit their teeth and stick to the business of comprehensive reform. It will make the insurance companies, and the Republicans, really mad. But failing to actually solve the problem AGAIN is a train wreck. Stick with it, folks, put your noses to the grindstone, and do what needs to be done.
STATE BLOGS
