[PAA-Discuss] Do Not Resuscitate the 'Public Option'

[Juli3 at aol.com]

Do Not Resuscitate the  ‘Public Option’
by Andy Coates



 
 
 
_http://pnhp.org/blog/2010/02/22/public-option-dnr/_ 
(http://pnhp.org/blog/2010/02/22/public-option-dnr/) 

Like  initiating CPR on a patient who was dead in the field and  
remained  dead on arrival, the effort to resuscitate the “public  
option” is  mistaken and futile.

Once upon  a time, proponents of the “public plan option” sought a   
“Medicare-like” program that might enroll every other person in the   
nation and thus run private insurers out of business.

“A roadblock  to reform” cried the insurance companies.

Now nothing in the bills  passed by the House and the Senate bills  
would erect a public  insurer that could possibly influence the  
insurance  market.

The House bill included a feeble government plan, to start in  2013,  
that would enroll perhaps 2 percent of the nation by 2019. The  Senate  
bill simply nixed the ideaaltogether.

All along  proponents of  adding a new government-sponsored insurer boasted 
“talking  points” but  
never offered workable health reform. But the insurance  companies oppose 
the “public option” and that proves  
its virtue, its  supporters exclaim. 
Hello? Of course the insurers oppose it.

Why  would the insurers want to yield even 2 percent of the  market to a  
public plan (House bill) when they’ve been given  the “option” (Senate  
bill) of keeping 100 percent of the market? Why  would the insurance  
companies not fight for the whole pie when the  White House let slip  
that it saw the “public option” as simply a  bargaining chip in private  
dealmaking?

With its reliance on  the magic of the marketplace, the “public option”  
is not a  progressive idea. Consider two examples of how the market 
performs when  private insurers  
compete with a public plan. Example 1: under  Medicare Advantage the  
private insurers enroll the healthy and  dis-enroll the sick and yet  
cost more per patient than traditional  Medicare. Example 2: in Maine,  a “
public option” insurer  was  established in  2003. 
Thus far it has failed to enroll but a tiny percent  of the  uninsured, has 
not reduced costs for insurance, 
nor reduced overall  health spending, nor  lessened disparities in care – 
and this year it  has fatally  tanked.

In the United States a corporate oligopoly  of huge insurers, with near- 
monopoly control in most locales,  dominate the market. A government  
insurer of any  size would simply add yet another bureaucracy to the  
present  byzantine insurance mess.

Does it really make any sense to think that  another government plan could  
give the private insurance companies a run  for their money – within  
the contemporary corporate marketplace –  without draconian regulation  
upon the industry? Even with regulation, as  former Cigna executive  
Wendell Potter explained at the PNHP annual  meeting this year,  insurance 
companies simply “flaunt  regulations.”

The insurance market cannot be tricked into reforming  itself. The  
health insurance company that wins at the marketplace  avoids and  
jettisons sick and poor patients and enrolls the healthy  and the  
wealthy – and a “public option” will not change this fact.  The market  
that serves the private interests – profiteering at the  expense of the  
sick – would continue to do so.

The proper  name for this kind of “market magic” is the race to the  
bottom. Adding a  public plan into the private mix can not and will not  
change the  character of this cruel game.

Any successful “public option” insurance  plan would wind up covering  the 
sick and the poor. It would be designed  to lose, not win, the  
market competition. It would not prove  affordable or comprehensive.  
Worst of all, a “public plan option”  could put our  nation on a 
fast-track to permanent two-tiered health  services,  
exacerbating deplorable disparities that plague  us.

Regrettably, that the “public option” has been given attention at  all  
is but a measure of how deeply our culture has surrendered  to  
neoliberal ideology, the ideas popularized by Ronald Reagan. It  is a  
lie that the market will always provide, most especially when  it comes  
to health care. So why would some of our friends still seek  to revive  
the false promise of the “public option”?

Marie  Gottschalk, University of Pennsylvania Professor of Political   
Science, identified the psychology at work. In a remarkably  prescient  
essay , she compared health reformers in the  United  States to victims of 
the Stockholm Syndrome, in which hostages   
identify with – and even defend – the hostage-takers.

We ought to  reach out with sympathy to our friends who have fallen  
captive to Ronald  Reagan ideology and say – Do not resuscitate the  
“public option.” It  is time to let it go.

All along, adding a feeble  public insurance plan to the insurance  
market has been but a very  poor excuse to support “insurance reform”  
that will criminalize the  uninsured, divert billions of tax dollars to  
subsidize  unaffordable private insurance premiums and protect   
pharmaceutical industry super-profits.

Another world is  still possible. It is called Medicare-for-all,  
expanded and improved.

[An  earlier version of this essay appeared at The Progressive and in   
McClatchy newspapers around the  nation.]
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