So on Tuesday night, news broke that the Senate may be close to ditching the public option, and predictably, many of my fellow progressives went berserk, declaring that the end was near and 2012 was really prophetic and the only option is to not vote in 2010, which will really show Democrats by giving Republicans majorities in both houses, which will help along progressive goals by…uh…something.
I understand the temptation to run screaming for the hills every time it appears the Democrats are about to betray their core constituency, because it happens so often. But in this case, I had a strange feeling that the best thing to do was to wait, patiently, to see what was actually happening. And you know what? It turns out what was actually happening isn’t all that bad, at least according to policy wonk Ezra Klein:
The details will be important here. What are the conditions for the non-profit plans? How many of them do there need to be? What’s the regulation look like? When does the Medicare buy-in start? But assuming those pieces don’t come in much worse than expected, the combination of national non-profits and a Medicare buy-in seems like a pretty good deal. Better by far than what Democrats looked likely to get a week ago. And more likely, by far, to seed health-care reform with scalable experiments.
A public option partnered with Medicare might have been better than these policies, but national non-profits and direct competition between Medicare and insurers is more promising than the compromised public plans that succeeded the initial policy idea. In fact, it’s like we split the strong public option into two parts.
The national non-profits are not exactly like, but not that far from, the compromised public plan in the House version of the bill. They won’t be publicly run, but with the OPM regulating them tightly and carefully choosing which offerings are accepted into the market, the impact might not be that different in practice. They have the advantages of offering a single product nationally and being freed from the profit motive, both of which were key to the theory of the weaker public option. Indeed, they’re like publicly-regulated utilities more than private plans. These look a lot like the semi-private insurers that function well in Germany, Sweden, and the Netherlands, among others.
Karoli also looks at the leaked details, and sees some room for positivity, as well an even better future if we let things develop:
When is a public option not a public option but it is a public option? When they call it something else, pull other ideas in that can be supported, re-use existing institutions to accomplish the goal, and they get 60 to agree to it.
After all, we can tilt after this thing called a public option and pound this bill into oblivion, guaranteeing that Democratic majorities in the Senate and House will be ground to dust, or we can step back, figure out the goal, and see if there is a pathway to the goal that makes something that looks like a public option but is really called a non-profit national co-op and Medicare expansion.
To me, that’s the nub of it. Ultimately, a bill that expands coverage, ends the practice of recision, allows coverage for everyone, regardless of initial rating, and provides for subsidies for less affluent health care consumers is a bill that is not only better than nothing, but quite a bit better than what we have now. The devil’s in the details, of course, and we’ll need to keep a close eye on exactly what the senate pushes through, but for now, it looks like we’re very close to a health care plan that will provide the opportunity for everyone in America to get health care coverage. That’s a hell of a lot better than what we have today, and while I’m sure it is imperfect, we must not let the perfect become the enemy of the good.
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