Saturday, June 16, 2012

A Public Option Without Health Care Reform?

Health care reform passed without the public option.  If the Supreme Court strikes it down, I wonder if we can get the public option without broader health care reform.

The public option could just be its own thing.  Medicare is a big popular insurance program that serves the elderly and is paid for and operated by the government.  Companies seeking to buy health insurance for their workers could be offered the opportunity to get in on Medicare, for a fee, as an alternative to Aetna or Blue Cross or whatever.  Obviously, this wouldn't have all the benefits of comprehensive health care reform (universal coverage, for example), and the public option does more good stuff within that framework.  But it's at least a good simple thing we might be able to pass at some point, even if for some reason we can't get a comprehensive bill.

It'd at least do some work in terms of cost control.  Getting more people into Medicare would make the program more able to use monopsony power in bargaining down costs.  And making the program larger would set up the sort of situation where it's in someone's interest to do comparative effectiveness research.

A standalone public option was actually suggested in 2009 by Blue Dog Mike Ross, which surprised a lot of people because it was a much more liberal idea than anyone was expecting from him.  I don't want to fall into the trap of "This right-wing guy supported this idea, so we'll get right-wing support if we try to pass it!"  That hasn't worked very well.  But the proposal at least is on the map.

Jonathan Bernstein was wondering why there's so little to-do about the public option now after people cared about it so much -- why people aren't pressing Senate primary candidates about it, for example.  All I can think of is despair about passing things with the structure of Congress as it is, and uncertainty over whether health care reform will survive the Supreme Court decision.  But those aren't good reasons.  Eventually (perhaps after Merkley and Udall do things to restrict filibusters) we'll get the ability to pass things, and we should plan for then.  And as far as I can tell, it can stand on its own without a comprehensive system.
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