My Summary Thoughts On Health Care (cont.): Is the Public Option Necessary?

TW: Necessary for what would be the relevant follow-up question. Necessary for universal care to be attained, absolutely not. One can have universal care strictly using existing public programs and private insurance. Necessary for cost controls. There are numerous means by which to control costs. The public option is one of them but by no means the only one. Necessary to keep the left-wing of the Democratic party happy. Definitely as many on the left have decided this is their Waterloo (to quote Mr. Kos from Daily Kos for example).

To many progressives the public option has come to embody more than perhaps its actual substance. It symbolizes for them, corporate interests and their lobbyists losing for once amidst the tumult of the legislative process. There are also more substantive arguments in favor of the public option, Paul Krugman as usual articulates them more succinctly than most:

"...[One] the huge overhead of the private insurers, much of which involves marketing and attempts to cherry-pick clients — and even with community rating, some of that will still go on. A public plan would probably be able to attract clients with much less of that. [TW: reducing OH cuts real costs from the health care system]

Second, a public plan would probably provide the only real competition in many markets...."
[TW: many states have very poor competition amongst the private insurers]
http://krugman.blogs.nytimes.com/2009/09/08/why-the-public-option-matters/

TW: I agree with Krugman on these two points. But there are also two primary rebuttals relative to the public option:

One, the public option would, if not immediately in time, receive public subsidies rather than merely be a low cost conduit by which folks could pool their insurance risks. Should subsidies emerge private insurers would be at a disadvantage. This is one of the features some conservatives latch onto in order to extrapolate the complete takeover of health care by "government".

Two is the politics. For better or worse, rightly or wrongly folks fear "government". There may not be enough votes to include a public (aka government) option in the reform bill. This is somewhat circular and certainly a political calculation incorporating the actual benefits and risks of the public option.

As I said earlier I am an incrementalist, I have yet to see any progressive define why a health care bill without the public option is worse than no health care reform bill. Or for that matter why it is crucial to the bill. The public option would not be a magic bullet to control costs or seal universal coverage. The former will require multiple efforts, legislation and initiatives; the latter will be attained without it.

So do I believe the best bill would include the public option? Yes. Would it make it better? Yes, but then I can think of a dozen things that would make the current bill better.

ps as far as this "trigger" thing goes, it is a B.S. way for folks to back down from the public option without appearing to totally cave. I understand why folks do such things but it is not a meaningful measure. But again if it makes folks feel better and vote for actual reform so much the better.