Going into tonight's big health care speech by Obama, I just need to rant for a second. Because I've found that a lot of people I speak with - even supporters of health care reform - are confused about what a "public option" is and why it needs to be "robust". So here's the skinny:
Right now, let's say you can choose from three insurers - Aetna, Kaiser Permanente and Blue Cross. Each of the three can charge whatever they want for premiums, whatever the market will bear. And the market will bear far, far more than it should, because, you know, people don't want to go bankrupt trying not to die. But these are for profit companies, and they need to please their shareholders and their boards and pay out huge bonuses and spend untold millions on marketing and political lobbying. How do they do that? By denying coverage to people with pre-existing conditions, refusing to pay for tests and treatments that doctors deem medically necessary, and, of course, continuing to raise premiums.
So what's a public option? It's company number four. It's the Uncle Sam Insurance Company. It would not mean free coverage. People would still pay to be covered. But because there is no profit motive - and less bullshit overhead - there is no reason to exclude people with pre-existing conditions, and denial of care won't be necessary and costs can still stay low. And anyone who tells you that it will mean "government bean counters will be making medical decisions" is just plain wrong. First of all, right now, insurance company bean counters are making medical decisions. How is that any better? And they make those decisions - usually to the patient's detriment - because they have a profit motive. Without that motive, there's no reason for bean counters to screw policy holders out of doctor recommended care.
Why does the public option need to be "robust"? Because unless the government administered insurance is nationwide and strong, it won't have the leverage and bargaining power to keep costs low and coverage fair.
So why are so many people against the "public option"? Well, the misinformed oppose it because they misunderstand it. They think it means the government dictating care to doctors - or deciding when people live or die - when it's actually just a cheaper, more effective way for people to get insurance. And since insurance companies are already making those life or death decisions, what's the difference? Why wouldn't you want an option which had less incentive to deny care?
For those who know full well what a public option is and still oppose it, it's because it threatens the one thing they hold most dear - their bloated profits (or political war chests). The very argument used to oppose the public option is the proof that it's effective. Opponents claim that the coverage will be so good, and so inexpensive, that private insurers won't be able to compete. It's hardly the truth. There will still be plenty of people who opt to stay with their private plans. And if people run in droves to the public option then it is solely because it is effective. Which means that the private insurance is ineffective. Politicians who oppose the public plan are simply protecting insurance companies from having to be effective! How exactly is that competition?
The public plan by definition won't be Cadillac Coverage - that would be untenable if costs are to remain low. Which is why private insurance companies will always have a very lucrative role. There will always be Americans willing to pay a premium for what they believe to be better coverage. Generic ketchup is cheap and accessible - and it gets the job done on your hamburger - but millions of us still buy Heinz. The brand names - in this case the major insurers - aren't going away.
A public option is not single-payer (where private insurers disappear and doctors and hospitals get to bill a single government source which then pays out all reimbursements), it's not government run health care, it's not socialized medicine, it is absolutely no different than the medicine we have now. It's simply another insurance option, one that by definition will be so cost effective and successful and popular that politicians want to kill it because it will be too cost effective and successful and popular.
AETNA is Heinz Ketchup. Kaiser is Hunts. Blue Cross is Del Monte. And the public option is the grocery store's brand. The store's ketchup is cheaper because it doesn't have the marketing expenditures and corporate bonuses that the other brands have. And plenty of people buy it because they have to save money wherever they can but still desperately need their condiments. Regardless, most Americans still buy the brand names and Heinz, Hunt and Del Monte thrive. And just because the store itself also owns the generic brand, and can use the product as a loss leader, giving it an "unfair advantage", those are the rules of the marketplace and we all take them for granted. Maybe it even forces the big guys to lower the price of ketchup in a way they could have collectively avoided before. Nobody is rioting in the streets over this. It's how business works. At the end of the day, we all manage to get the ketchup that works for us and plenty of money is made, and God bless us everyone.
So what's the big fuckin' deal? Private insurers might be forced by a public option to lower premiums and increase coverage and stop denying care to make a buck? Bonuses might be pared down, you say, to allow for this? It may make their absurd profits merely ridiculous? Am I demonizing the insurance industry? You bet your ass I am.
It is the job of the American government to protect the American people, not to use all the power at its disposal to protect a specific industry from having to adapt or die. A public option is merely one more choice in a menu of choices. Why shouldn't we all have the opportunity to pay less and get decent coverage? Why is protecting the insurers from irrelevance more important than protecting American consumers from being forced to overpay for a shitty product? Why is it so terrible and un-American to keep them honest?
If Blue Cross decided on its own to unilaterally drop prices and increase coverage and never turn anyone down, would those against the public option scream that Blue Cross was unfairly forcing the other two companies to compete with it? Would Blue Dogs and the GOP ask the government to intervene and force Blue Cross to re-raise their prices and water down their coverage to meet what Aetna and Kaiser were doing? It's absurd on its face, but that's what opposition to the public option is: rage at the idea that private insurance would have to negotiate deals as effectively as a supposedly ineffective government. Are we really trying to protect the industry's unfettered right to collude against us?
So for the record, any so-called health reform without a public option is no reform at all. It is merely a reinforcing of the health insurance oligarchy and it ensures less choice, not more, and more "take it or leave it" behavior from the few companies that monopolize the industry; lets 'em gouge with impunity. I am not anti-business or anti-profits. I am, however, against profits, particularly grotesque profits, when they are earned by harming consumers and not giving them the quality product that they paid for... especially when there is then no recourse. Jump to one of the competitors, you say? They've all agreed to behave the same way. Only a public plan would have the teeth to be a truly viable alternative; would afford you the opportunity to give the insurance company you want to punish a big "fuck you". Only a public option would have the ability to force the monoliths to change their ways and behave like good corporate citizens. They ain't gonna do it on moral grounds (you hear me, Evangelicals?), or principle, so what else is going to motivate them?
Single-payer does away with private insurance altogether. And although I think that would be terrific, that's not what a public option does in any way, shape or form. It's just another insurance company... one that's less expensive, more effective and, because profits are not an issue, one that allows decisions about care to be made by doctors and not bean counters looking for any way to screw you out of coverage. After all, you can't really claim out of one side of the mouth that Obama is for unlimited, profligate spending and then claim out of the other that he wants a bureaucrat to kill grandma so he can save a few bucks.
And as a little coda: I'm not one who goes around suggesting that people flout the law. Far from it. I pay my taxes accurately and on time and I don't even itemize although I'd probably save money. But if legislation is passed - as is currently being contemplated - requiring that all Americans buy some kind of insurance or pay a tax penalty, but a public plan is not one of the options we are allowed choose from, not only will I refuse to buy the insurance (because I will not allow the government to force me to enrich a private company under penalty of law) but I won't pay the tax penalty either. Let 'em throw me in jail. At least in there I'll be able to see a doctor for free.