It is not the be-all and end-all of health-care reform. It is not the long-awaited safety net for the uninsured. And if, as many liberals hope, it turns out to be nothing more than Medicare for All, it won't do anything to hold down long-term growth in health spending.
via Public Optioned-Out – The Opinionator Blog – NYTimes.com.
The debate is primarily on the left, or among the Democrats, where partisans are furiously arguing along two intersecting fronts: First, the public option is or is not an essential element of reform. Second, abandoning the public option will or will not make passing the remainder of reform more likely.
"I don't understand why the left of the left has decided that this is their Waterloo," said a senior White House adviser, who spoke on the condition of anonymity. "We've gotten to this point where health care on the left is determined by the breadth of the public option. I don't understand how that has become the measure of whether what we achieve is health-care reform."
"It's a mystifying thing," he added. "We're forgetting why we are in this."
Meanwhile, I never had much interest in a public option. I think the perils of government-delivered (as opposed to funded) services are obvious and immense. Sarah Lyall had an excellent piece in the Times today about her dealings with the British National Health System, which has some very real strengths, but also some terrifying weaknesses…. I spent the weekend traveling through the west with the President, watching him perform at health care forums in Montana and Colorado. He did quite well, I thought.
A set of consumer protections that would cap out-of-pocket health costs, guarantee access to preventive care, and prevent insurers from treating people well as long as they're healthy only to start monkeying around when they get sick. This would be a big deal. The bills in Congress also envision expanding the Medicaid program that currently serves the poor. This would only help a relatively narrow slice of the near-poor, but for those who are helped, the help would be enormous.
So as much as I'd like to have a public option (primarily for its ability to force more robust price competition), I just don't see it as something to threaten nuclear destruction over. If insurance reforms are robust and low-income subsidies are decent, that's a huge win for millions of people, and it's a win we can build on. And contra Atrios, social legislation does have a history of getting better after it's first passed. Just ask Henry Waxman.