April 21, 2018
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Keep public option

As Congress tackles the difficult and contentious matter of rebuilding the way Americans pay for health care, a skirmish has broken out over the role the so-called public option will have in the final product. How this conflict is resolved is critical to the form the final product will take. And if the public option — that is, a government-run health care payment system — is off the table or consigned to the back row of the room, private insurance companies have won and small businesses and families have lost.

Last month, as the Senate’s Finance Committee began to dig into the president’s health care proposal with stakeholders, a protester disrupted the meeting to demand that the single-payer option be represented. The protester, it turned out, was Jerry Call of South Thomaston. Before being arrested, Mr. Call told Sen. Max Baucus, D-Mont., that 60 percent of Americans favor the single-payer option, yet no one before the committee represented that approach.

Senate Republicans on the committee have written a letter to President Obama outlining their opposition to the public option. “Washington-run programs undermine market-based competition through their ability to impose price controls and shift costs to other purchasers,” the Republicans wrote. “Forcing free market plans to compete with these government-run programs would create an unlevel playing field and inevitably doom true competition.”

The statement betrays a bias for the profitable insurance industry and against “price controls,” which one would assume would be a desired outcome. Describing the result as an “unlevel playing field” misses the point; when a small group of corporations controls a market, government is the only means by which consumers are protected. It is the same approach the Public Utilities Commission uses in protecting consumers from steep rate hikes from privately owned electric and telephone companies.

Sen. Olympia Snowe is the only Republican on the committee to not sign the letter to the president. She advocates keeping the public option as a “trigger” that would be pulled if private insurance rates do not decline sufficiently. Such a move neuters the public option by painting it as a threat rather than a viable fix and quarantines it in the future so it does not become part of a hybrid solution now. This is the wrong move.

The public option must remain on the table if only because it already plays a large role in the health care portfolio. Now, 81.6 million Americans, 27 percent, have public health insurance through Medicare, Medicaid, Veterans Affairs, SCHIP, Indian programs or state-specific programs. Those Americans are well served, for the most part, by those public plans, and removing them from the private insurance market has not put any of those companies out of business. In Maine, 475,000 or 36 percent are on publicly funded insurance.

There are many approaches Congress can take to turn the tide on the crippling cost of health care, from government-run single payer to the Massachusetts plan in which everyone must own health care insurance. As the debate begins, every component of a fix must remain on the table, especially the public option.

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