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Hullabaloo


Monday, June 29, 2009

 
Beyond The Public Option

by digby

Health wonk Jonathan Cohn warns that the focus on the public plan, while useful, is not the only issue:

I happen to be a strong public plan supporter myself, for reasons this magazine laid out in a staff editorial several weeks ago: It will guarantee the possibility of affordable, reliable coverage to everybody; it will promote cost control, by leading the way on reforms of how we pay for medical care; and it will promote a healthy competition with private insurers, keeping them in line and--hopefully--prodding them to perform better. (For a more detailed explanation, please read the actual editorial.)

I also think the public plan’s centrality has produced some obvious political benefits. The antipathy towards--and distrust of--the insurance industry has led many activists to shun past reform efforts that relied heavily on private coverage. And that’s been a major reason why those past efforts failed, since those same activists tend to be reform’s most passionate supporters--the ones who will make phone calls, go door-to-door, and show up at rallies like the one that made headlines last week. The public plan option has given these people reason not only to support this year’s reform push, but to support it enthusiastically.

And yet I confess to a certain ambivalence when I hear, as I frequently do, statements like the one Dean made at the rally. Yes, the public plan is a key element of reform. But it is not the only one.

Just consider what was going on inside Capitol Hill meeting rooms as Dean was speaking. Over the past week, leaders of the Senate Finance Committee have been busy hacking away at their proposed legislation, in order to bring the total price tag in at under $1 trillion over ten years. To accomplish this, the committee leaders have proposed cutting the subsidies that reform will make available to people who have trouble paying for insurance on their own.

If those cuts end up in the final legislation, fewer people would get assistance and, quite possibly, those that still got assistance wouldn’t get as much. The result would be more uninsured and more underinsured.

And that's not the only major issue in play.

Read on for others. They are significant.

Here's the thing. When it comes to legislative sausage making, there's little we as grassroots activists can do about the actual ingredients. We can call out congresspeople and we can sign petitions and we can run some ads and write letters to the editor. All of that is useful. But when it comes to the minutia of the bill, it's highly unlikely that we can have a direct effect.

What we can do is rally around a specific concept like the public plan (or in a political world with better organization and foresight, single payer) and push with all of our might to get that one thing done. The beauty of doing that around the public plan is the rhetorical simplicity of it. And it actually uses the word public as if that's something good.

Clinton's health care plan was derailed largely because it was perceived as being cumbersome and complicated. They had to explain things like "managed competition" and "global budgets" and "premium caps." Those things don't exactly read well on a bumper sticker and the right was able to persuade people that the whole thing was a big mess that wasn't going to work.

Times have changed. People have learned a lot about health insurance in the past 16 years -- more than they ever wanted to know --- and they have come to realize that the system is already complicated and that it's not working for them a good part of the time. But using the public plan as a rallying cry keeps the pressure on the congress to at least see this through.

I recognize that there are people of good faith out there who believe that the public plan is a sham and that progressives are selling out their beliefs by backing it instead of insisting on single payer or nothing. I would just say that if there were any other path to getting reform in the next eight years, I'd agree. But I don't see that there is. The politicians are already making the sausage. We don't know yet what they are going to put together and for the sake of all those millions of people who have no insurance or are about to lose theirs, it seems to me that we at least try to get something passed. I wish it could be more perfect, but I have absolutely no idea how to make it better at this point. Standing in the way without a serious strategic alternative that could actually result in real reform seems short sighted to me.

The sausage may end up tasting like shit or it might not be too bad, but people need some relief and I'm not willing to say on the basis of what I know now that what they are going to get will make them sicker than they already are. And you never know, it might just make them a little bit better.

And remember, it was only a few years ago that George W. Bush was going around saying "they [liberals] think social security's some kind of government program!" So, if nothing else, getting the idea of "public" back into the political lexicon as a positive concept is worth something.


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