One of the roles of government is to make the country run efficiently and effectively. Unfortunately, government cannot be separated from politics. Politics, more often than not interferes with effective government. Such is the source of my dismay with the current health care reform (HCR) debate. There is much chatter about Obama needing a “win”. The suggestion is that any health care bill is better than none. With Joe Lieberman now endangering the prospects for passing the bill and with talk of an end run involving reconciliation, isn’t it time for us to take a sober look at what we’re fighting for?
A few nights ago, MSNBC’s Rachel Maddow did a good job of articulating the various choices before us:
1. Robust public option: A government run reimbursement system similar to Medicare that forces private insurance companies to compete for customers.
2. The opt-out: Every state adopts the public option at first but gets a chance to opt out at a later time. (This creates the interesting scenario of seeing which states would have the balls to opt out after their residents have gotten a taste of the public option.)
3. The opt-in: Only states that want to use the public option have to. Does this go far enough to make affordable health care available to everyone?
4. The “trigger”: The public option gets enforced only after the insurance companies have had time to clean up their act and have failed to do so. Does anyone really believe the legislation could be written strictly enough for the trigger to ever get pulled?
5. No public option under any circumstances.
If the goal is to make insurance available to more people and at lower cost, then option 1 is really the only one that achieves this. Options 2 through 4 provide too much wiggle room to be effective. Option 5 is essentially the Baucus bill out of the Senate that simply puts more customers into the hands of a malicious insurance industry.
Has anyone noticed that all the debate is centered around expanding care to all at an affordable price but little debate revolves around reforming insurance “worst practices” such as exclusions based on pre-existing conditions. Of course, this gets mentioned in Obama’s speeches and we hear story after story of insurance company abuses against their customers. But no one is fighting over that point. Maybe because only a callous fool would defend not insuring a baby because he was “too fat” or not insuring a woman because her pregnancy was considered a pre-existing condition.
What I fear is that while Washington fights over the money, we may lose important reforms that don’t cost us a dime (other than lowering insurance company profits a bit). I am no longer sure that I agree that any bill will do. I am not sure that the result we are awaiting is a flashy bill signing ceremony at the White House, another notch in Obama’s belt. Finally I am not sure that if reconciliation cannot get us option 1 (the only real option for availability and affordability) that it is worth it to go that route. To run an endgame around the system to get a sad compromise just increases the polarization in our government for no good reason, not to mention the fact that all these options don’t kick in for years to come.
I say if we don’t have the votes for option 1, then let’s strip out all of the affordability/availability legislation and draft a bill that simply regulates the insurance industry to stop abuses. Let’s make the regulatory legislation effective within 12 months. That will be a major step forward. With that done, we can build on that victory and get everything else we want down the line.