Thanks to a deal struck on Tuesday by a group on 10 Senators -- and Thursday's concession from House Speaker Nancy Pelosi (D-Calif.) -- it appears whatever health care reform ultimately passes into law will not include a public option.
But what will it include?
On top of a ban on insurance industry practices as denying coverage based on pre-existing conditions and a dropping of coverage when one gets sick; an individual mandate that would force people to buy insurance; along with limited subsidies to help those who can't afford coverage buy it, the basic outline of the compromise includes the following:
-An expansion of Medicare, meaning Americans aged 55 or older would have the option to buy into the program. Keith Olbermann reported on Wednesday night that this would start in 2011, and subsidies would not be used for Medicare buy-ins until 2014. Still, the Medicare buy-in has received support from liberal and moderate Democratic Senators alike.
-An extended version of the Federal Employees Health Benefits Plan to consumers in the exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would be offered on the exchanges in every state. However, according to TPM's report, if insurance companies don't step up to the plate to offer such plans, that would trigger a national public option.
-There may or may not be an expansion of Medicaid; the current bill expands it to those making above 133 percent of the current poverty level. Some liberals have fought for expansion to 150 percent, or even 300 percent of poverty. Pending Congressional Budget Office reports might determine which direction this fight takes. There's also an idea being tossed around -- and advocated by Sen. Maria Cantwell (D-Wash.) --fashioned after Washington state's program.
Am I disappointed in the presumed loss of the public option. Yes; as it stood, the public option was a compromise. Instead of fighting for single-payer from the start, progressives in Congress began trumpeting the public option. The fight over the months has been contentious and ugly -- in part because advocates did a poor job of explaining just what the public option was and what it was designed to accomplish.
Even so, the public option that was in the Senate bill was weak; rates were not tied into Medicare, and the option was only available to roughly 2 or 3 million people -- assuming states didn't opt out of it (which the Senate bill said they could). So in a way, completely mourning the death of a poor shell of a wanted policy is kind of hard.
The point remains, though: if this bill is going to force us to buy insurance -- and as of 2014, it very well could -- what does the bill do to make insurance more affordable? Do any of the plans outlined above accomplish that? Do the subsidies accomplish that? Are there industry regulations being discussed that we don't know about that would make private insurance more affordable and more efficient?
Maybe the individual mandate, coupled with the ban on pre-existing condition denials, would lower costs -- with so many more customers, of varying degrees of health, coming into the system, maybe that offsets costs.
Maybe it doesn't.
The reactionaries on the Internet message boards and in the media will likely frame this as a disastrous development and lay the failure at President Obama's feet; I refuse to do that at this stage, since the bill is nowhere near final yet. Debate is still raging, and the Senate has yet to vote on it. The House and Senate will then likely go to conference, where more amendments will be presented, and two more votes will be cast before the bill even sniffs Obama's desk.
So there's still plenty of time for us to tell our Senators, Representatives and the White House what we want. My main theme: cost control and affordability.
We've sadly become a nation of reactionaries, and sometimes I think we suffer from a societal version of ADD; rather than let things play out and analyze the final product for its merits, we fly off the handle at every little rumor or development, crying out in victory or ruin depending on which side we sit. That does nothing for our political process or discourse, and it really does a disservice to this country.
As does threatening Senators by withholding votes and campaign donations on this one issue. Republicans are often one-issue voters: they either fight over abortion or gay rights or defense spending or tax cuts. As Democrats, we really can't afford to do this -- because for all the angst centrist Democrats are causing with regards to health care reform, there may be other issues in which we agree.
Take one of my Senators, for instance. I'm frustrated by Sen. Jim Webb's refusal to support existing legislation, including the public option -- but I have a hard time outright saying I would vote against him, because 1) that might help the Republican candidate running against him, and 2) he's done some really good things in the Senate. I applaud Sen. Webb's work on the new GI Bill, and I appreciate his efforts to help local VA hospitals receive more funding and resources.
If I punish him for just his health care stance, what else do I potentially remove from the Senate? These politicians -- and these issues -- do not exist in a vacuum, even if we wished they did. Things would be much better if that were the case, but it's not.
Besides, if we kick out all the Democrats, who's left? Likely, more Republicans -- and the only way they would touch health care reform would be to try and repeal whatever the Democrats do pass.
Analytical thinking and perspective goes a long way; sadly, we're sorely lacking in both these days.
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