Medicare for All No Harder Politically Then The Progressive Ideal Of A Public Plan

by: masslib

Fri Jul 03, 2009 at 00:18:54 AM EDT

Doctor Don McCanne discusses the recent debate between Starr, Reich and Kuttner on the public option for the PNHP blog.  He starts with Starr's argument on the importance of not design of the public option but that of the exchange for which it is offered in:

To rephrase the very important point that Paul Starr brings to this debate, it is not the design of the public option that is crucial to successful reform under the model being advanced in Congress, but rather it is that the design of the insurance exchanges must be absolutely compliant with the rules of social insurance. If the exchanges are poorly designed, the public option would become a Medicaid-like dumping ground for low-income people with high-cost problems, and would suffer from a lack of willing providers because of chronic underfunding.

He then comments on Reich's wishful thinking in terms of how the public option will operate:

Robert Reich would have us design an empowered public option that could shape up the private insurers by exerting full competitive pressure within the exchanges. That’s a nice wish, but all Republicans and an insurmountable number of Democrats in Congress have already made an irrevocable decision that an empowered public option will never survive the legislative process.

His premise is that only if the so-called public option operates exactly as social insurance can it effect the behavior of private insurers.  Since Congress has already outlined plans in which it will not work in the fashion of social insurance, and none in which it does, the answer is the reform as it is written can not and will not alter the private insurance model.  McCanne argues Congress and state governments wants Medicaid limited to the poor because they are already crippling state budgets, therefore that program will not be open to the larger public.  Because the mandated private coverage is already too expensive for average americans tax subsidies are necessary.  However, because Congress is unwilling to bust the budget with too many subsidies, they have already concluded reform must include a hardship waiver, which McCanne argues will provide "tens of millions of individuals with a government permission slip to remain uninsured."  Finally, he asserts the government will provide for several tiers of coverage, where by "the lowest tier will be designed to be affordable, even though affordable plans, by design, are under insurance products that fail to protect those who need health care."

He ends with Kuttner's argument that the public option plans envisioned by Congress are simply not good enough, and will not meet the terms set by Reich and Starr:

As Robert Kuttner states, “progressives would need first to crush the industry influence in Congress that is very likely to hobble either strategy.”

But then, “It is high time for progressives to stop settling for badly flawed second bests and to throw their energy into a first best that could rally popular support and produce a system that serves everyone.”

And, “The political reality is that Medicare for All is no harder politically than a version of the Obama plan that would meet all the tests that Reich and Starr apply. And it would be far simpler and more cost effective.”

And, this really is the crux of the problem.  Any public option that would lead to single payer or a model by which any american could purchase social insurance is not in the plans to redesign health coverage as presented by the White House or the Congress.  Wishing it were so does not make it so.  If progressives want social insurance for everyone then they should be pushing for Medicare for All, not hanging their collective hats on a "public option".