A must read on health care reform today. It's titled, "Health Care Deform: Afraid of the public option? This is what America will look like without it." The authors explain in great detail how the country will look. It won't look good for most Americans, although the insurance companies will love it. This should be a must read for Democratic Senators on the Hill and their staffers -- the ones who are rejecting the public option and falling for an insurance industry gimmick
Opponents of the plan paint a dystopian future in which the government takes over American medicine, limiting choice and competition. The claim is demonstrably false: If the public plan option were enacted, most Americans would continue to get private insurance through their employers as they do today, and the public plan would be just one choice offered alongside a menu of private plans. Yet a post-reform world of unraveling choices, runaway costs, and rampant health insecurity could well materialize--if critics get their way and the public plan dies as a health care bill wends its way to passage.
Fast forward a few years to the first day that this reform bill--signed with much fanfare in the Rose Garden, with a beaming bipartisan coterie--takes effect. The bill's crown jewel is not the public option, but a "national insurance exchange," a benefit clearinghouse that is supposed to sign up private insurers to provide choices to people without workplace insurance. These choices vary based on the region you live in, to reflect the plans in the local market.
In many markets, however, the choices turn out to be roughly as limited as they are today, when the dominant insurer enrolls at least half of privately insured people in 16 states and at least a third in 38 states. The national insurance exchange is meant to create greater competition, but for most of the country, the choice is basically between WellPoint and UnitedHealth--gargantuan for-profit insurers each about the size of Medicare. Yes, there is more than one choice in most areas, but not choices that meaningfully differ from each other, or from what is on offer today.
Ironically, the problem is worst in the rural areas of the country whose Democratic Senators--such as Kent Conrad of North Dakota and Finance Committee Chair Max Baucus of Montana--have been among the Democrats most willing to forsake the public health insurance plan. In these rural areas, one or two dominant insurers hold over 90 percent of the market. (In all of Montana, for example, one insurer has 75 percent of private enrollees.) For people in these parts of the nation, a real choice of health plans is as mythical as unicorns.
Equally mythical, it soon becomes clear, are the consumer cooperatives that Conrad and Baucus had backed to attract Republican support. The reform legislation envisioned that these cooperatives would be chartered by the government and owned by consumers--the idea being that a democratically-controlled enterprise would be driven not by profit, but by serving the interests of its citizen-owners. But the cooperatives are almost impossible to get off the ground, just as similar consumer-oriented ventures have been in the past. Doctors largely boycott them, insurers undercut them, state politicians argue over them, and federal dollars are woefully insufficient to nurture them. It soon becomes clear that they represent little more than a fig leaf covering a lack of commitment to the basic aim of a public plan: having a tough competitor that forces large insurance companies to bring up their standards and bring down their prices.
Seems like Senators Baucus and Conrad aren't actually looking out for the best interests of their constituents.
It would probably help if President Obama were more definitive about his plans. The Obama campaign had hundreds of experts involved in crafting solutions to the health care crisis. It feels like right now, the decision-making is being left to the knuckleheads on Capitol Hill who have shown themselves incapable of fixing this problem. If Obama doesn't step in soon, insurance company lobbyists are going to be writing health care legislation, and we're going to be stuck with more of the same disguised as reform.
If this is truly Obama's signature issue, the White House needs to step in now and make it clear what is and isn't acceptable. It's time for a line in the sand. The president needs to lead. And, he needs to tell his former Democratic colleagues in the Senate to grow a spine and really reform health care.
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