Sacrificing the Public Option, Expanding Medicare and Universal Coverage

How does the latest health-care proposal in the U.S. Senate measure up on Progressive principles?

The Progressive movement has rallied behind single payer and public option reform proposals in the belief that not only is universal coverage a fundamental right, but not-for-profit medicine is a better way to get quality health care at a reasonable price.

Unlike most developed nations, the United States has a sizeable part of its population that goes without health insurance. President Obama took up the cause of greatly expanding coverage in his presidential campaign. He also spoken firmly of reform in terms of bending the cost-curve, making insurance and medical care more affordable to individuals and to the nation, in light of fast-rising health-industry costs. However, Mr. Obama stopped short of embracing single payer, leaving in question what type of structural changes would be used to achieve reform goals.

The political reality is that both the House of Representatives and Senate are split among those who want to change the system towards government-run health insurance and those intent on maintaining a mostly private system. In the House of Representatives, the Democratic majority was able to pass legislation substantially expanding coverage and including a limited public option, a small government-run insurance program for those not insured through their employer. The vote was fairly close and may have reflected inclusion of a controversial abortion-funding restriction, such that the exact count of Representatives who would support a public option if the anti-abortion funding provision were not part of the final bill is uncertain.

In the Senate, Democrats need sixty votes to close debate and move forward. They have close to, but not quite, that many, who will accept some form of a public option. Thus, negotiations have continued to explore what types of limited government insurance programs would be acceptable to at least a few conservative Democrats, independents or moderate Republicans.

This week a Senate group reached a compromise that attempts to replace the public option with a public/private non-profit insurance program like that which is currently offered to Congressional legislators and federal employees. The compromise proposal did not stop there, however. It also included a provision to significantly expand Medicare, by lowering the age of participation from 65 to 55.

How should Progressives look on this proposal?

All the proposals under consideration push towards universal coverage. It is really the structure that makes them different. The use of a public/private program is not equivalent to the public option, or government-run program. However, the federal authority sets rates, controls profits, and guides provision of health care. It is a strong control on profit-driven insurance.

Moreover, expanding Medicare is a major step in the direction of single payer. The Medicare program is single payer for its participants. Private insurance does not participate except in supplemental programs. There are approximately 35 million additional Americans who would be eligible to participate, if the age requirement was lowered — more than 10% of the population. Those under fifty-five would remain in their current employer-provided plans and a small number would participate in the new public/private plan.

Given that there is not political power to create a nationwide single-payer program, the expansion of Medicare to include 35 million additional participants and the coverage of uninsured by a public/private program is much more than could have been achieved by the limited public option as it was contemplated. The small public option is replaced by a public/private plan, which covers those currently uninsured. The vast expansion of Medicare offers many more Americans a single payer model of insurance. Whether this shifts the political equation in the Senate or House is the big question, and this should become known in coming days.

Care2.com/causes blogger Jessica Pieklo and I discussed the new proposal as soon as we got word. You can hear our conversation by following this link and clicking the December 11, 2009, podcast, and more information should become available as soon as the Congressional Budget Office provides “scoring” or budget estimates.

December 14, 2009, UPDATE: First responses — Senator Lieberman

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Marion Y.

12:49PM PST on Feb 16, 2010

The Public Option LIVES!!!!

For months now D.C. insiders and T.V. blowhards have said the public option is dead, but Senator Michael Bennet (CO) just proved them wrong and Senators Kirsten Gillibrand (NY), Jeff Merkley (OR), and Sherrod Brown (OH) have already stood up to join him.

These four Senate Healthcare Heroes are circulating a letter calling on Majority Leader Reid to use reconciliation to pass healthcare reform with the choice of a public option.

CLICK HERE TO SEE A SAMPLE SCRIPT AND REPORT YOUR CALL
http://act.boldprogressives.org/cms/call/bennet_letter/?source=dfa1

Thanks to your hard work, 120 House Democrats signed and delivered the Polis/Pingree letter to Harry Reid a little over a week ago.

Four Senate Healthcare Heroes saw that leadership and your hard work -- and aren't sitting around and hoping for change -- they're taking the lead and making it happen.

Think of it this way: if this was a football game, House Democrats threw the Senate a Hail Mary pass and these four Senators just caught it. But now, they have to score the touchdown. That means we need to call on other Senators to join them.

So today, members of Democracy for America, Progressive Change Campaign Committee, CREDO Action, and MoveOn are calling their Senators and demanding they sign Senator Bennet's Public Option letter too -- and join these Healthcare Heroes in fighting for real reform.

We won't quit until we win.

Charles Chamberlain, Political Director
D

send a green star

gerlinde p.

12:01PM PST on Dec 30, 2009

universal healthcare is a must. everyone has a right to be insured .it works perfectly here in europe.if i want alternative medicine i either pay for it myself, or get a private insurance that will cover most of the costs.

Jim S.

6:02PM PST on Dec 21, 2009

So, if you support this Bill, you are either uninformed, or a Shill for Wall Street. This Bill guarantees higher costs, and massive increases of profit for the Wall Street Masters of Washington. This Nation deserves affordable Health Care. Not another rip off of the American people.

5:57PM PST on Dec 21, 2009

6. Many of the taxes to pay for the bill start now, but most Americans won't see any benefits -- like an end to discrimination against those with preexisting conditions -- until 2014 when the program begins
7. Allows insurance companies to charge people who are older 300% more than others
8. Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market
9. No reimportation of prescription drugs, which would save consumers $100 billion over 10 years
10. The cost of medical care will continue to rise, and insurance premiums for a family of four will rise an average of $1000 a year -- meaning in 10 years, you family's insurance premium will be $10,000 more annually than it is right now

5:56PM PST on Dec 21, 2009

This Bill is a complete sell out of the American People (To Wall Street of Course) Best analysis from Firedoglake: http://action.firedoglake.com/page/s/killthisbill?source=web&subsource=side

Top 10 reasons to kill this Bill:
1. Forces you to pay up to 8% of your income to private insurance corporations -- whether you want to or not (#)
2. If you refuse to buy the insurance, you'll have to pay penalties of up to 2% of your annual income to the IRS (#)
3. After being forced to pay thousands in premiums for junk insurance, you can still be on the hook for up to $11,900 a year in out-of-pocket medical expenses (#)
4. Massive restriction on a woman's right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court (#)
5. Paid for by taxes on the middle class insurance plan you have right now through your employer, causing them to cut back benefits and increase co-pays

Continued

Jaette C.

1:28PM PST on Dec 18, 2009

I hope that in the final days our legislative body will keep it's head screwed on straight. Like it or not, we are coming to some kind of conclusion regarding the health care bill. Hopefully it will be made to tweak when passed.

Robert B.

7:08AM PST on Dec 17, 2009

The Senate floated the idea of making it possible for people 55-64 to buy in to Medicare. The original proposal was just another fake health care reform scam to divert attention from the Public Option! Then to add Insult to Injury they teased us with the ability to get lower cost drugs from Canada and elsewhere. But it seems the 20 million dollars supplied by the Drug industry lobbyists bought off some of our politicians once again and Guess What? no low cost drugs. Surprise, Surprise! It's just one big BAIT AND SWITCH, smoke and mirrors, shell con game! And the saddest thing of all?: The Public ALWAYS falls for it! There are 3 things we need to do: Term limits for congress, NO money from lobbyists! and Real campaign finance reform! One can always dream!!!!

Mary B.

9:15PM PST on Dec 15, 2009

Money already has become a luxury item to far too many. Some people actually live on the amount that some pay for health insurence.What is it going to take to get progressives and conservatives to understand that relief must come to the low income people before anything else can get better? I'm not talking about 'hand outs' or hand ups, I'm talking about avoiding total chaos by providing the basic neccesities of life to the retired low wage earners and the present working poor.Ill, under nurished people cannot think straight.Ever try to do something properly when your gums are constantly acheing, or your eye glasses are so out of date or scratched up you can't see clearly? The health coverage is just the tip of the iceburg.

Marilyn K.

3:05PM PST on Dec 15, 2009

Lies are being perpetrated by individuals in politics for their own individual gain whether it be money or political advancement for their own party. Medicare and the Veterans Administration are known for their expert handling of health care. Medicare has the most efficient method of payment and gives you and your doctor the ability to have whatever medical care is necessary without limiting accessability.
Politicans that cave into the lobbyist demands are getting something for their vote. Lobbying is legal bribery and there should be an end to it. The only way to curb deceit, poor care and rising costs is with a Public Option.

Linda M.

10:40PM PST on Dec 14, 2009

thanks for the article