For now, at least, the concept of a government-run public health insurance option remains on the table as the Senate crafts health care reform legislation. This is an essential component of the comprehensive effort at restructuring the costly health care system, because it ends the stranglehold a few insurance companies have on the market in most states.
Without the public option — Democrats are now calling it the “consumer option” and “competitive option,” to explain its raison d’etre — the health care bill is a partial fix, something like putting three new snow tires on the car. Republican Sen. Olympia Snowe, whose vote for the Finance Com-mittee’s version of the bill without a public option was gratefully embraced by the Obama administration, is now signaling her disapproval of the revival of the government-run plan. Her GOP colleague, Sen. Susan Collins, also appears likely to abandon the reform effort if it contains a public option.
Health insurance company whistle-blower Wendell Potter has said that without a government-run plan, the legislation will make insurers richer while continuing to raise the cost of premiums for consumers. Most of the agreed-upon components of the legislation — no more exclusion based on pre-existing conditions, mandating some degree of coverage — will drive millions of new customers to the insurance companies. To balance that windfall, consumers who are unable to get insurance through employers — such as the self-employed — should be able to use a government plan, something similar to the government-run Medicare.
Yes, the public plan will mean the government is in competition with private health insurance companies. But that competition is not likely to run insurance companies into bankruptcy. There is no end of analogous scenarios — state university systems don’t put private colleges out of business; we have city, county and state law enforcement agencies, but private security firms still have a niche.
Recent national polls show the public support for a government-run insurance plan at 50 percent to 61 percent. In Maine, a mid-October poll showed 57 percent support a public plan. The public understands, it seems, that the government must intervene on its behalf, because health insurance is no longer a luxury; it is a safety net that protects people from a fatal fall.
The control for-profit health insurance companies have on Americans’ lives, and on the one-sixth of the economy that is health care, must be restrained. The government, just as it did during the early 20th century when railroads and oil companies ran roughshod over consumers, must act to balance the scales of economic justice and economic well-being.
The compromise of allowing states to opt out of the public option is a reasonable tweak. There may be more such adjustments. But a small Medicare-like plan as part of the insurance portfolio should not be reason enough to reject the reform effort. And without a public option, the legislation will not achieve the goals on which all can sides can agree.