People are used to taking a leap of faith. With President Obamas health-care reforms, they take a leap of ideology. How else to explain the mad rush by the President and Congress to pass a “public health insurance option” that remains a mystery even to its most committed supporters?
Of course, even in the absence of details, the endorsements for the public option the centerpiece of the Democrats health reform proposal that would establish a Medicare-style government-run insurance to compete with private insurance plans were unconditional.
Last year, American Prospects Paul Waldman declared the public option “a beautiful jewel” of health reform despite the fact that no one could actually describe the color, cut, or price of this stone. In the Washington Post, blogger Ezra Klein wrote in early June that a “strong” public insurance option was “the single most recognizable marker for victory,” even as he acknowledged that there were three very different “flavors” of public insurance under consideration. And, earlier this month, The Nation raised the bar, editorializing that “a public option is needed but it is by no means sufficient.”
And liberal blogs are littered with endorsements like “if you dont like the public option, get the hell out of the way.”
With such breathless enthusiasm and presidential backing, its no surprise that almost three quarters of Americans polled support the idea, even if less than a third actually want to use it.
Some warn that the public option could well be a Trojan horse for government-run health care. After all, the incremental growth of public insurance was the foundation for socialized medicine in countries like Canada.
But for all we knew, it might have been better to call it a Trojan duck, or perhaps a Trojan bear. Until last Tuesday, few people on either side of the Beltway could be sure about the size, shape, or color of the beast in question Democrats, after all, hadnt produced a meaningful draft bill in the House; Senator Max Baucus is still flushing out details in the Senate. A consulting firm with long experience reviewing the government plan likened costing its economic impact to “nailing jell-o to the wall” because even the broadest details hadnt been settled by anyone, anywhere.
No one could be sure whether it would follow state laws and mandates. No one could be sure how it would be governed. No one could be sure whether the plan would arbitrarily set prices as Medicare does, or negotiate them the way the private sector does. No one could be sure whether the public plan would be subsidized by government or financed the way insurance plans are, despite the stated goal of “honest competition.”
Well, now we know sort of. Last Tuesday, the House released draft legislation that includes a public health care insurance option. We can safely describe the Trojan horse as... a Trojan skunk.
It will curl up and release noxious gases, but only if attacked just as public plans around the world have fought health inflation by rationing services, denying care, and leaving patients holding their noses in disgust. Its a scavenger, since it will likely attract patients and businesses because it isnt bound by market pricing or state taxes, giving it a competitive advantage over private plans. And, just as a skunks black and white stripes act as camouflage, the public option will confuse voters. Some will think theyre looking at an insurance fund, financed by “premiums;” others will assume its a government program, financed on a pay-as-you-go basis. (For the record, the House bill falls somewhere in between, calling for some, but not much, capitalization which sounds like Fannie Mae.)
Of course, its still too early to fully judge. After all, at press time, Congressional leaders have endorsed the skunk, before theyve even figured out how to finance the subsidies built into the overall plan. Were still waiting on the Senate bill. So in a few days, the public option could look more like a Trojan donkey, a snake, or an elephant.
And, until Congress flushes out those details, Americans deserve better. The President suggests that the time for action is now. Lets put the rhetoric aside, Mr. President, and have a real debate with real details, now.
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