The battle over the public option

Washington may be empty with Congress on recess and even the Obamas headed to Martha’s Vineyard, but August is shaping up to be anything but quiet.

With the battle for health care reform in full gear, the fight moves from Washington to our hometowns, where town hall meetings hosted by Democrats to sell their strategy are already underway.

So far they’ve been anything but quiet with protesters—many organized by conservative groups that are providing talking points—shouting down the moderators, including Health Secretary Katherine Sebelius.

But the Democrats are facing heat from supporters too, in part because the Blue Dogs, who we wrote about last week, struck a deal weakening a key component of the Democrats’ push for health reform in one of the House bills (there are three): the public option.

To go public or not
While they disagree on many levels about how to enact reform, conservatives and liberals say they agree some kind of reform is necessary. That said, the main dividing line between the two camps pits those in favor of a government-run, public insurance option (mainly liberals) against those who aren’t (mainly conservatives).

The arguments for a public option go mainly like this: 

People not covered by a private plan through an employer or their own plan would have access to a publicly run insurance program (think Medicare for the masses) that would not deny them based on pre-existing conditions and would make health care more affordable for them. The options would be available through an “exchange,” likely a term you’ll hear referred to a lot—this is a hub where people and small businesses could compare and select from a variety of private plans and a public option. (Read a cheat sheet here.)

The argument against a public option goes largely like this:
A public option run by the government will stifle competition because no one will be able to compete with government pricing. Private insurers will be forced out of business. (Read one case against the public option here.)

One report you’ll likely hear quoted a lot is the Lewin Report, which says that over 80 million people would be dropped from private health plans provided by small businesses because it would be less expensive to simply move the employees to the public option, obviously a bad outcome for insurers. You’ll also hear that the public option is a slippery slope toward “single-payer” health care, or universal health care, where everyone pays taxes into a fund that then everyone is eligible to coverage within.

The big picture
If you watched some cable news programs this week you might have come away thinking that every single American is against a public option. Interestingly, our poll last week showed that 63% are willing to pay higher taxes for more equitable coverage for everyone. Clearly both sides are gathering their talking points and statistics, and August, typically sleepy, will provide the fodder for an even larger battle come September.

Comments

[Chrisie Brown]

I don't think answering yes to the question "are you willing to pay higher taxes for more equitable coverage for everyone" is necessarily a vote for public option. I think the question simplifies the issue way too much. Simply increasing taxes and letting the government create a large program like Medicare does not guarantee that the resulting plan will be 1) well-run 2) economical or 3) equitable for all. I think the majority of people would like to see all people have good, affordable health care - the argument is over what means will provide that end in a way that taxpayers' money is spent wisely and that our options become more as opposed to fewer. The government is very good at a lot of things, but the history of government-run health care (medicare, medicaid) shows large systems that are running out of money and in bad need of reform. My personal opinion is that we should begin by reforming these programs, and take small steps to reform health care so that we can ensure we are headed in the right direction before we jump off the cliff - it's easier to fix small mistakes than big ones. Unintended consequences result from almost every policy (it's hard for anyone - even the most well-meaning people -to anticipate all outcomes) and rushing to create a huge program has the potential to make a big mess that will take decades to reform. Small steps would allow easier evaluation of the impact of certain changes, and help guide reform in the most efficient direction. Thanks.