The insurance industry hates it because it would ding its profits. Democratic leaders fear it could kill passage
of health care reform. But reports of the death of the public option have been greatly exaggerated.
Poll after poll shows that Americans want to be able to choose a public insurance plan, and for good reason. It
would be tragic to lose this pillar of health care reform to cynical inside-the-Beltway political horse trading. Here's why
we need the public option:
It can really deliver on the benefits. The proposed bills would outlaw common and perverse industry loopholes
such as pre-existing condition exclusions, which exclude sick people from buying insurance as individuals, and rescissions,
which let companies deny treatment retroactively for people they already insure. While outlawing these rules will help, private
insurance plans have demonstrated that they are willing to challenge patients' rights to the grave and beyond in the interest
of clinging to the premium dollar.
We've witnessed a heartbreaking parade of insured patients trooping to corporate headquarters to plead for lifesaving
treatments that were denied, even though the benefits are covered in writing. In contrast, no one at the government-run Medicare
program gets a bonus for turning away sick people. We need to be able to choose a plan in which the financial incentives to
provide needed care line up with the proposed new laws, and that can only happen in the public sector.
It will drive down costs. Health care reform will cover millions more Americans - a great achievement.
But we need to use the increased buying power of this newly covered population to control costs, a job at which private insurance
companies consistently fail. Some companies can't reduce premiums because they're too small to hold leverage in negotiations
with private hospital chains and big drug companies. Or if they do save a buck, they put it back in their own pockets in the
form of profits and executive bonuses.
In Massachusetts, large nonprofit insurers recently testified that they had negotiated sweetheart deals that benefited
certain employers and hospitals - and confidentiality agreements that kept the details secret. When the Veterans Administration
negotiates lower drug prices, the savings buy more drugs for veterans, and the transactions are all transparent. We'd like
to be sure that the change we voted for turns into change we save on reduced premiums, which is possible only in a public
plan.
It will allow us to re-engineer how we deliver and pay for care. How? By coordinating with Medicare initiatives that
will bolster quality while lowering costs, like financial incentives that promote primary care and better coordination of
medications. The public plan will be most effective if it starts right away and is available to everyone - policies we can
continue to fight for. But the projection that the public option would offer savings too small for too few, or would be too
expensive, is off the mark.
It's democratic. Most Americans know this in our bones. The majority of the House voted for it, including
many in our powerhouse delegation from California. The majority of senators expressed support for it - including committee
chairs Max Baucus and Tom Harkin. We're tired of arcane rules that let minorities of one hijack the public's interest.
There will be efforts to leverage the public option for other benefits. One benefit of that debate would be if
the antitrust exemption for health insurance companies were revoked so they can be regulated by the Federal Trade Commission.
But we need a real institutional alternative to the present system. Americans want - and need - a public option. Don't let
your representatives trade it away.
