"Public Option" is the term for allowing at least some additional people to opt-in to some form of Medicare. While it falls far short of "Expanded & Improved Medicare for All," it at least offers the possibility of putting the private insurance companies on notice that they are going to have to compete to actually provide access and care. It was a critical part of the Edwards proposal during the campaign, and was in the subsequent Clinton and Obama campaign proposals. It has become the rallying point for HCAN, Hacker and others. Governor Dean voiced his strong support for it:
If Barack Obama’s bill gets changed to exclude the public entities, it is not health insurance reform...it rises and falls on whether the public is allowed to choose Medicare if they’re under 65 or not. If they are allowed to choose Medicare as an option, this bill will be real health care reform. If they’re not, we will be back fighting about it for another 20 years before somebody tries again.
As of now, it is missing from the Obama/Baucus blueprint!
Of course I have also been pointing out some of the other limits of the Obama proposal compared to single-payer, real "Expanded and Improved Medicare for All" most recently including the fact that their plan does not control costs and single payer would. Meanwhile Eddie C reminded us last night that 18,000 people die each year in our United States because they do not have health insurance; unless the real number is more like 22,000.
I have reminded us that even those of us who think we are okay because we have private insurance are often screwed due to realities of UNDER-insurance and all that the private insurance companies don't cover, don't pay, what nyceve has called and documented as "Murder by Spreadsheet"
What is critical to realize is the insurance industry now wants mandates! Mandates amount to using the "police power of the State" (in the legal sense) to force you to buy a private for-profit corporate product that is more expensive, less efficient, and of lower quality than what we the people could be getting directly without the completely unnecessary middleman. Mandates by themselves are a political and policy loser.
Only the United States is so reliant on private insurance companies and it is this exceptionalism that is a key driver of our runaway costs and many of our other health care woes.
According to Ezra Klein, here is the outline of what Obama is proposing:
• Guarantee Choice. The plan should provide Americans a choice of health plans and physicians. People will be allowed to keep their own doctor and their employer-based health plan.
• Make Health Coverage Affordable. The plan must reduce waste and fraud, high administrative costs, unnecessary tests and services, and other inefficiencies that drive up costs with no added health benefits.
• Protect Families’ Financial Health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness.
• Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking—as well as guarantee access to proven preventive treatments.
• Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions.
• Aim for Universality. The plan must put the United States on a clear path to cover all Americans.
• Improve Patient Safety and Quality Care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology with rigorous privacy protections and the development of data on the effectiveness of medical interventions to improve the quality of care delivered.
• Maintain Long-Term Fiscal Sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue.
Bizarrely, so far, the Obama/Baucus plan seems to endorse the worst of the mandates that Obama rejected during the campaign which are critical for insurance company support, but does not include the previously promised "Public Option."
In addition, where are the minimally needful "Community Rating" and "Guaranteed Issue"? Without ALL THREE OF THESE, there is no reason for liberal or progressive support!
Here is the YouTube embed of Governor Dean three days ago:
Now lots of us have pointed out that when he was Governor, Dean opposed single payer and other strong public options for his version of health reform in Vermont. Vermont went on to be one the many, many (.pdf) failed state experiments with no increase the insured. Perhaps having been through this, he has learned a lesson that Obama, Baucus and others are ignoring. Again, a real public option with at least Medicare opt-in, along with affordability and universality, are the reform Obama ran on, and the least any American not working for AHIP should accept or support.
I have critiqued Jacob Hacker and HCAN for pre-compromising to just "public option" and as to why it is not enough and will ultimately not work. Nevertheless, they are at least on the side of good.
As Frank Clemente points out, public option has strong public support, is what Obama promised and is the least reform must offer. Learn about what is meant by "public option" from the folks who are pushing it here and in more details at the links below:
http://www.ourfuture.org/... (.ppt)
http://www.ourfuture.org/... (.pdf)
http://www.ourfuture.org/... (.pdf)
http://institute.ourfuture.org/... (.pdf)
On a side-note: we single payer advocates find the "guarantee choice" meme to be particularly offensive, since the only choice being talked about there is choice of private insurance plan, which actually limits your choice of doctor or clinic or hospital. Under John Conyers' HR-676 with strong single payer, you would actually have free and greater choice of doctor, clinic and hospital, which is the real choice that counts. But even if choice of keeping the private plan you already have is something important, then Peter Stark's weaker version of "Medicare for All" compromises for just that. And even he is being shut of the discussion so far.
If we are really serious and honest about achieving health care coverage that is universal (all people), comprehensive (all care) and controls both total costs (percent of GDP) and individual cost (so you do not go bankrupt from out of pocket costs), then single payer "expanded and improved Medicare for All" is only to go. I still refuse to accept that a proposal that makes the most sense economically, and has 60 percent support among both the American public and physicians, be pre-determined and pre-compromised off the table? None of these other proposals, other than single payer, actually controls total system costs, nor the risk of a big hit to individuals (huge debt or bankruptcy) when you actually get sick and need care. None takes advantage of the benefits of the savings between the efficiency of 3 to 4 percent Medicare overhead, compared to the inefficiency of the 15-20% overhead inefficiency; the savings inherent in monospony, in global budgeting and rationalized planning. Obviously insurance works best to spread the risk when the pool is as large, generalized and unselected as possible - that is means all American, everybody-in and nobody-out.
But even if you are not a single payer advocate (and maybe even if you are) Public Option, along with Community Rating (meaning everybody pays the same insurance rate, even if they have prior conditions) and Guaranteed Issue (they can't turn you down for coverage if you have a prior condition), are the minimum for any real reform!
Updated:
Call President Obama, the White House number is: 202 - 456 - 1414.
Call your Representative & Senators, the Capitol Switchboard number is 866 - 338 - 1015.
Senators Kennedy and Dodd are most critical.
Baucus should be shamed and put on the spot as much as possible over this.
All Democrats should be able to support Public Option + Community Rating + Guarantee Issue.
As for a single payer bill in the Senate: Bernie Sanders has specifically promised activists that he would introduce a single payer senate bill, though not necessarily as a direct companion bill to Conyer’s HR-676. In addition: Merkley ran on single payer and should be held to that campaign promise. Tom Udall (NM) was a co-sponsor when was in the House. Beyond that, there are the usual assortment of liberals (Boxer, Brown, Feingold, Harkin, Kloubacher, Leahy, Stabenow, Whithouse, etc.) and economic populists and/or economic populists (Dorgan, Casey, etc.) might put their name on a senate single payer bill?
Update 2:
For more on singe payer supporters take on the limits of the Obama approach, read this debate between Dr. Himmelstein of PNHP and Len Nichols of New America Foundation.