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.


low-tech cyclist said...

My attitude is, we got what we could get on health care in 2009-10. It took a major push just to PTDB after Scott Brown won Ted Kennedy's old Senate seat.

Meanwhile, we face a ton of more pressing problems. Massive unemployment as far as the eye can see. Global warming, ditto. If we get a more hospitable legislative landscape, those concerns matter far more than a public option.

Assuming the ACA survives SCOTUS, all I really want to do with health care is let the ACA take effect, see how it works, and see what needs improving then. By 2017 we'll have a better idea of what changes need to be made, and how much of a difference a public option might make anyway. Right now, it's all theoretical.

Meanwhile, I really doubt that the Dems are going to make much dent in the filibuster, even with Harry Reid's support. This is a Democratic caucus that, seventeen months ago, wasn't even willing to make a Motion to Proceed non-filibusterable - and that's the sort of reform that even the Broderists would have a hard time objecting to, and that more right-wing pundits would have a hard time explaining their objections to.

Maybe they'll do that much, and a little more, this time, but I don't see them denting the filibuster itself. Assuming the Dems remain in control of the Senate next year, it'll be just barely, and there are enough dinosaurs in our caucus who want to keep the damned thing.

Blar said...

Would the stand-alone public option discriminate based on preexisting conditions?

If it uses all the same tricks as private plans, it's hard to get too excited about. If not, it risks the adverse selection death spiral.

A public option works better if we change the game (as the ACA does) so that insurance companies aren't competing to avoid covering the sick.

Neil Sinhababu said...

I feel a lot of that, LTC. But basically everything we're doing has to be aimed at 2017 -- given how the Senate races look, that's the next time we have a nice majority that we can use to pass stuff.

Blar, let me go with 'yes'. After all, this isn't a universal coverage story. It's a cost control through monopsony and comparative effectiveness research story. And, yeah, I guess that does make it less exciting.

Carl Ballard said...

I wondered if there was a way after the 2010 elections that a reasonable GOP House of Representatives might horsetrade a weak public option for eliminating the mandate. After all, they would get rid of the dreaded mandate, not have to have as much money into a public option as one they might fear, and it's closer to what Obama ran on (I was a Clinton supporter who preferred her health care plan, FWIW). Of course expecting a reasonable GOP after 2010 was probably the opposite worthwhile.