The public option mirage

AFTER MONTHS of rancorous right-wing complaints about a government "takeover" of the health care industry, a proposal for a "public option" has made it into proposed legislation for health care reform under consideration in both the House and Senate.

But the public option is so scaled back that it's barely public--and it can hardly be called an option for most of the millions of uninsured in the U.S.

The House version of health care legislation is supposed to be more "radical" than the Senate's, and closer to what proponents of reform have long pressed for. But the 1,990-page bill unveiled by House Speaker Nancy Pelosi October 29 shares all the hallmarks of proposals that put the interests of the medical-insurance-industrial complex before those of ordinary people.

Liberals like Rep. Anthony Weiner admit that the public option--a government-run program to provide health insurance for people who aren't covered through an employer plan--has been whittled down to a shadow of what they first envisioned.

According to a Congressional Budget Office (CBO) study of the House bill, only 6 million Americans would be enrolled in the public option by the time it's fully phased in, in 2019. That's just 2 percent of the 282 million Americans younger than 65 (who aren't covered by Medicare). The CBO explains that the low numbers are in large part because the plan "would typically have premiums that are somewhat higher than the average premiums for the private plans."

"Somewhat higher" prices for the government-run public option? If that's the best the Democrats can do, why bother with reform at all?

On top of this, conservatives are pushing for "opt-outs" (giving individual states the right to opt out of offering the public option) and "triggers" (under which the public option would only go into effect if no insurance option exists at a given price level in a particular state)--and the Obama administration is indicating that it's open to these proposals. Leaving the decision to individual state governments would cancel out what little effect the public option could have as a national alternative.

Why all the compromises and retreats? "The concern was that the public option would destabilize the bulk of private insurance," economist Karen Davis, president of the Commonwealth Fund, told the Associated Press. Under the House plan, though, Davis says, the industry has nothing to worry about. "It's not going to be taking away the insurance industry's core business," Davis concluded.

This is a far cry from what Obama promised during a 2007 campaign debate. "My emphasis is on driving down the costs, taking on the insurance companies, making sure that they are limited in the ability to extract profits and deny coverage, and the drug companies have to do what's right by their patients instead of simply hoarding their profits," he said.

AND THE public option is supposed to be the concession to progressives to get them to swallow the parts of health care "reform" that are outright giveaways to the health care industry, at the expense of ordinary people.

Like the Senate bill, Pelosi's health care legislation includes a provision that mandates everyone to purchase insurance, with the government providing subsidies to the poor to help them get coverage. This is a bonanza for the insurance industry--a government requirement that tens of millions of people buy their defective product.

People who don't get coverage through their employer--or who have their health insurance dropped at work because companies will have a further incentive to dump benefits--will face a painful financial burden meeting the mandate, as the New York Times, a strong proponent of the Democrats' reform legislation, admitted in an editorial:

A survey by the Commonwealth Fund found that 73 percent of the adults who tried to buy insurance on the open market over a three-year period never bought a plan--because they could not afford it, could not find a plan that met their needs, or were turned down.

Pending legislation would help some of them by preventing rejections or high charges based on health status and by setting minimum benefit requirements. But many people who might still find the premiums too high will face an agonizing choice: buy insurance coverage or pay a penalty of hundreds or even thousands of dollars per family if they still decide to forgo insurance.

A plan that forces people to buy insurance, and then offers them no affordable alternative, isn't reform at all, but the opposite. The federal government is bending over backward to protect the insurance industry's profits--and no matter what Obama administration officials say, they're doing it by requiring workers to pay more for health care than they did before.

FROM THE beginning, the Republicans unleashed an all-out assault on health care reform in any form. They haven't stopped yet, either. According to Rep. Virginia Foxx (R-N.C.), the House bill is downright dangerous. "I believe we have more to fear from the potential of that bill passing than we do from any terrorist right now in any country," said Foxx.

The insurance industry has given support to these Republican opponents of health care legislation--from organizing its employees to join right-wing protests at town-hall meetings this summer to issuing reports targeting Democratic proposals as wasteful and expensive.

But the industry also played the other side of the fence. Its lobbyists have been hard at work shaping Democratic proposals for reform--to make sure the mandates have as few loopholes as possible and the public option is as restricted as they can make it.

Throughout the discussion of health care, the Obama White House and Democrats in Congress have done everything they can to appease the health care industry--while cracking the whip to keep liberal supporters in line. The arguments for compromise aren't directed at Republicans--or the conservative Democrats who have relentlessly hammered away at any provision that the health care industry doesn't approve of--but progressives.

Now, we're left with health care legislation in the House that will do more harm than good--and the final shape of the proposal in the Senate is bound to be even more tailored to the interests of the industry.

In the long run, when this legislation passes--as it likely will, in some form--and people feel the full consequences, the fact that it was considered "reform" will contribute to the conservative, pro-business sense that the government can't be put in charge of doing anything.

In reality, the central problem with health care reform as it has emerged in Congress this year isn't that it goes too far, but that it doesn't go far enough. It leaves untouched what is the chief source of the health care crisis--domination of the system by private companies and their thirst for profit.

A small core of people who support a single-payer alternative--a government-run system that covers everyone, and cuts out the private insurance industry--have challenged the half-measures and concessions put forward by Democrats throughout the discussion this year. Their participation at forums, their demonstrations and their sit-ins helped keep the possibility of an alternative alive.

If congressional Democrats showed any backbone in the health care debate--for example, by not dumping the public option altogether--it's because they felt pressure from below. One important source of that pressure was the activists who pointed out a real solution to the health care crisis.

The battle for a rational health care system will go on, and the case made for a single-payer system during the debate now can help shape the struggles of the future.