The story that hasn't been told enough is that the rising cost of private insurance is hurting corporate America. It's been a terrible strategic mistake. Progressives could have a powerful ally in the fight against Big Insurance/PhRMA: Corporate America itself.
Consider that even Wal-Mart, which spends far less than its peers just to offer it's employees a junk insurance package, spent an average of $3,500 a year per employee on health insurance in 2002. The way to beat UnitedHealth Care and Blue Blue Cross is by offering Wal-Mart a public plan that is cheaper, yet offers better benefits: Medicare for Anyone Who Wants It.
Allowing any person, business or local/state agency to buy into Medicare is not single-payer, because it allows private insurance to continue to operate. But unlike the other falsely-advertised "robust public options," Medicare for Anyone Who Wants It will actually lead to a public plan that covers at least 164 million Americans and will control cost. It makes real the false rhetoric for the public option.
164 million is the sum of 43 million Medicare enrollees plus the 130 million Americans Jacob Hacker said would enroll in his original version public option (minus the 9 million Americans who are enrolled in both Medicare and Medicaid/SCHIP). Another untold story is how Hacker's original version of the public option has been dwindled down to somewhere between zero and 10 million people.
Progressives are right to focus on the insurance industry's fight to eliminate the public option, but we must too recognize that they have already succeeded in making even the "robust public option" completely impotent. Much love goes to Physicians for a National Health Plan's Kip Sullivan for pounding this point:
Hacker’s papers laid out these five criteria that he and the Lewin Group said were critical to the success of the “public option”:
- The PO had to be pre-populated with tens of millions of people, that is, it had to begin like Medicare did representing a large pool of people the day it commenced operations (Hacker proposed shifting all or most uninsured people as well as Medicaid and SCHIP enrollees into his public program);
- Subsidies to individuals to buy insurance would be substantial, and only PO enrollees could get subsidies (people who chose to buy insurance from insurance companies could not get subsidies);
- The PO and its subsidies had to be available to all nonelderly Americans (not just the uninsured and employees of small employers);
- The PO had to be given authority to use Medicare’s provider reimbursement rates; and
- The insurance industry had to be required to offer the same minimum level of benefits the PO had to offer.
[....]
Of Hacker’s five criteria, only one is met by these bills! Both proposals require the insurance industry to cover the same benefits the “public option” must cover. None of the other four criteria are met.
If you care about having a "robust public option" that controls cost, Sullivan's posts on PNHP's website are MUST READS. You will become as convinced as I and many others that what is currently coming out of Congress can only be "Really Bad" or "Even Worse" (to steal a line from Matt Taibbi) and that nearly no block of members is fighting for a robust public option, and you will be angry at liberal groups and blogs for failing to declare "Shenanigans!"
But I digress...Hacker was attempting to create a program that was "like Medicare," and after they have significantly watered down and firewalled the public option to near meaninglessness, Congressional Democrats continue to falsely state that the public option as "like Medicare." The explicit implication is that a public insurance plan like Medicare can obtain it's cost-efficiencies, which Sullivan rightfully disputes. But instead of putting so much energy composing and trying to sell to the public a public option that is "like Medicare," why not simply PUSH A PUBLIC OPTION THAT ACTUALLY IS MEDICARE?
Based on cost projections for single-payer, Medicare for Anyone Who Wants It would feature The Kennedy Plan and be funded by an optional insurance premium that would be 7% of payroll (or slightly higher). The 7% of payroll would be split between employer and employee and would ONLY apply to those businesses/employeees enrolled in the Kennedy Plan. Employees in companies with private insurance plans could tell the scum-sucking bastards to go to hell opt-out out of the private plan in favor of the Kennedy Plan and the employer would be required to provide a match. The current split 2.9% Medicare tax would remain in tact for all Americans regardless of whether they're enrolled in the Kennedy Plan/Medicare or a private plan.
Just do the math to see what I mean by winning the health insurance war by pitting corporate America against Big Insurance/Big PhRMA. If the optional 7% payroll premium is evenly split 50-50 between employee-employer (it could just as easily be some other type of split), by switching to Medicare Wal-Mart's health care insurance cost per employee would plummet from around $3,500/year to $700/year (Wal-Mart's average employee salary is less than $20,000/year). Wal-Mart employees would enjoy lower-cost and thereby more accessible health care with better benefits. And that's Wal-Mart! a company that spends significantly less on it's employee's health insurance than nearly any other big corporation. Imagine the savings to good employers. When presented with cost reductions that huge what corporate C.E.O. could actually rationalize keeping private health insurance to it's board or shareholders?
Wal-Mart and other big corporations would be the FIRST IN LINE to dump the private health insurance parasites plans. Small businesses struggling to survive in this economy would be next in line. The Chamber of Commerce would be all over it. Frankly, I think 164 million is a terrible underestimate.
So in essence FIGHT THE MARKET WITH THE MARKET!
The cherry on top of the sundae are the benefits to Medicare. Just 9 months ago, the CBO reported that by populating the Medicare rolls with patients who are younger, healthier and more affluent the Medicare program becomes more solvent. (Currently, Medicare and Medicaid is only populated with patients who are the most expensive to insure: the elderly, disabled, and poor.) It's a win-win for everybody...except Big PhRMA and Big Insurance.
Also consider that the next time Big PhRMA tries to steal $220 billion of taxpayer dollars (like the White House's current $80 billion deal with Bill Tauzin), they won't just have the progressive caucus and American people they'd be trying to screw, they'd also be trying to take money out of Corporate America, as such deals would increase the cost of premiums.
This is a WIN-WIN for everybody! Progressives get the decent affordable universal health care we want, Corporate Dems get to continue taking bribes campaign donations from Wall Street, state governments get a windfall of resources, and businesses across America see a windfall of profits. Sure Republicans will go on Fox News and call it the second coming of Stalin, but I'd bet you we'd get at least 80 votes in the Senate!
Let me conclude by saying I totally believe in Medicare for All and I think if we had a block of Congressional members passionately fighting for that now we wouldn't be in the mess we are currently. The biggest mistake made thus far, among many big mistakes, was not just the White House and Congress taking single-payer off the table, but the progressive leaders as well. When we did that we completely redefined what the middle was.
At the same time, I and I think all other single-payer advocates need to realize Big Insurance and Big PhRMA aren't the only obstacle to Medicare for All. There are a lot of delusional people in America, and I'm not just talking about the people who voted for W and Sarah Palin, but those who believe that their private health insurance policy is worth the paper it's written on the moment they or a family member get really sick and need it. So I consider Medicare for Anyone Who Wants It, the KENNEDY PLAN, or "a public health insurance plan with a private option" (however you want to sell it) as good as we can get today and as close as we're ever going to get to the benefits of Medicare for All. It is much easier to sell to the American public, cheaper, preserves "choice," and brings together a uncharacteristic, but effective alliance that accordingly would make it much more difficult for Republicans and Blue Dogs to vote against. It also is an easy pivot for willing public representatives from their current positions. They simply need to say, "All this time we've been talking about a public option that is like Medicare, how about we have a public option that IS Medicare?"
So how do we get it done?
First, public option advocates and single payer advocates MUST COME TOGETHER NOW to define Medicare for Anyone Who Wants It as the ONLY "robust public option" (because it is) and begin selling this as an economic stimulus. There's time and the presidents falling numbers present an opportunity.
Second, we need to whip up votes for Medicare for All/HR676, and in the process tell the Progressive Caucus to tee-off on private insurance industry and pump up the benefits of Medicare. Then it will be clear that the middle is Medicare for Anyone Who Wants It, and that's where the great compromiser comes in to declare victory and threaten a veto.