Sunday, August 16, 2009

Good News or Bad News?

This made a banner headline at the NY Times -- which has apparently started to feel guilty about failing to more aggressively report the truth about the false "death panels" claim, because they slip a rehash in at the bottom. Medium-length story made short, the administration seems like they're willing to drop support for a public option in favor of a network of private, not-for-profit cooperative insurers.

What does that mean? Are health insurance co-ops -- non-profit organizations that provide an alternative to private insurers -- going to serve the US in the same way that the public option will?

Looking into it just a little bit, I can already see a few differences. 1) Negotiation power. The NYT makes this point -- small co-ops, regional or local co-ops, have less muscle to force price cutting by hospitals and pharmaceutical companies. 2) Regional inequity. The co-cops here in Los Angeles will likely be really nice -- there are a lot of motivated people and a lot of resources pressed up together. In Arkansas, though, or Georgia, they'll probably be considerably less nice, because enrollees will have less money with which to support the co-op, more problems, and the talent and dedication needed to run the co-op itself will be spread over larger areas. 3) Secret profit. Lots of 'non-profit' organizations are actually highly motivated by profits in the form of individual and executive salary -- this could provide the same incentives to deny care in order to 'keep the co-op afloat', i.e. maintain the for-profit employment of the not-for profit's employees. Because there will likely be many of these co-ops, government oversight will be a challenge.

These are significant concerns. They can be addressed -- a national purchasing system that unites the co-ops, for example, or some kind of federal sliding scale for funding them. Whether that will happen or not remains to be seen. What I am not interested in, very specifically, is analysis of this nature, from Cenk Uygur. Here's the key spot where he and I part company:
"But that's still not the main reason why the public option is so important. It's because it is a standard bearer. It is a road sign. It tells you what Obama is all about. Is he willing to compromise something he knows is essential to get a deal done so that he can brag in the next election that he got "healthcare reform" passed? Or does he actually give a damn about policy and getting it right? That is the central question."
This is not a standard bearer -- this is a policy. Uygur has here joined the ranks of people who are playing political football with health care reform -- I've become used to calling them "Republicans" -- and who are interested in forging win/lose politics and short-term horse-race headlines out of this very complex issue. A public option has to be for everyone, and that includes the farm family in Iowa who doesn't trust the government, or the 46% of the nation that voted for John McCain. That the far left is willing to sniffle and return to their tents because they lost a legislative battle, and that they can only conceptualize opposition to their chosen reform as an unwillingness by their elected officials to "insist" on a public option, shows a certain lack of civic engagement.

Which is to say that we should all maintain strong support for a policy that will cut costs, insure the uninsured, increase the quality of care, and strengthen competition against and between insurance companies. The reason for that? Comments like this one, from a man who had to fight his insurance company to receive lifesaving and medically necessary treatment. The goal of the public option is identical to the goal of health care reform -- better care for people. Narrow-minded dependence on scorecard politics isn't going to improve our health care.


  1. Which developed countries that don't have either some form of a single payer system or a public option provide high quality, cost effective universal healthcare?

    The answer to that question shows quite clearly that the Public Option IS a standard bearer.

    Ditching a Public Option and caving in to Big Pharma on druge price negotiation would not result in meaningful reform. To pretend otherwise is foolish, not to mention the fact that the ONLY reason to promote such a plan is to gain political points. That way they can say "hey look, we passed something we can call healthcare reform" without alienating the corporations that fund their campaigns.

  2. Hi, Anonymous.

    You've actually jumped straight ahead to tomorrow's post -- an around-the-world look at how different countries get their health care.

    The answers to your question might be a) Japan, where the government helps low-income citizens pay for private insurance (and there is virtually no public insurance) or b) Switzerland, which also has no public health insurance companies and no single-payer. Neither system is ideal, but both work better than ours -- and both are more strongly dependent on the private sector than non-profit co-ops would have to be.

    I'm obviously a strong proponent of the public option, but I think some of your suppositions aren't totally reasonable.

    I am, though, deeply worried that one of the few things Republicans, Blue Dogs and Democrats can agree on is private industry profit, and the reason they can do that is because of direct lobbying and campaign donation. That's worrisome to me, too.