http://www.pnhp.org/news/2009/july/public_option_leads_.php<snip>
For reform advocates, the full article is a “must read:”
http://www.pnhp.org/blog/2009/07/20/bait-and-switch-how-the-”public-option”-was-sold/
Comment:
By Don McCanne, MD
What a mess.
The progressive community has really blown it. The decision was to make “choice” the rallying cry for comprehensive reform - choosing to keep the insurance you have if that’s what you want, or to choose a program like the members of Congress have. It seemed not to matter that the public didn’t understand that FEHBP was basically an exchange of private plans offered to government employees, much less how a Medicare-like program might play a role.
That decision secured a solid role for the private insurance industry in any comprehensive reform proposal. All the industry had to do was to be certain that any government option could not be an effective competitor to the private industry, and they have done just that. AHIP has already destroyed the original concept of the public option, although they continue to chisel away at what vestiges remain.
Although an effective public option is a dead issue, the opponents of social insurance are not finished. They have successfully blocked action before the August recess which will allow time to build opposition to some of the remaining elements of the reform proposals.
Perhaps the most important policy in the legislation is the provision of subsidies for the purchase of private plans. If health care is to be affordable, these must be very large subsidies for a very large number of people. But Congress is at an impasse on how to pay for them.
The principles of social insurance require a transfer from the wealthy since low- and moderate-income individuals can no longer pay their full actuarial share. Yet Republicans and conservative Democrats have blocked the tax surcharge on high-income individuals, pulling out one more plank from the platform of social insurance.
Another source would be to tax employer-sponsored plans, but that would threaten losing this important source of health care financing and coverage. Many in Congress recognize that this is a risk that cannot be taken under the current model proposed by the legislation. Unions are particularly concerned that employees would face unacceptably higher costs, so this tax source has been rejected.
Since the private insurers would gain the most by this legislation, some are suggesting that we should tax them. But those taxes would be passed back to us in the form of higher premiums, which would then require still higher subsidies.
Congress has selected the most expensive model of health care reform. When they go home on their break the anti-tax forces will be out in full strength to communicate loudly that we can’t pay for it.
In September, they will face the reality that the subsidies will have to be smaller and the eligibility thresholds lower than currently proposed, simply because they can’t find the revenues to pay for them. There is an easy fix for that, as President Obama stated. We’ll have to issue hardship waivers which will exempt us from the fines that would be assessed for not having the insurance that we can’t afford.
Even there, the number of hardship waivers that would have to be issued has been grossly underestimated. With a typical family income of $60,000 and average family health care costs of almost $17,000, the majority of Americans should qualify for a waiver.
You really should read Kip Sullivan’s article. He shows us that there still is hope. As he states in his article, “at this late date in the 2009 session, it is unlikely that a single-payer bill could be passed even if unity within the universal coverage movement could be achieved. But if the ‘public option’ wing and the single-payer wing join together to demand that Congress enact a single-payer system, December 2009 need not constitute a deadline.”
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