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The Case for a National Petition
for a Strong Public Health Insurance Option By Hank McCurdy
J.D., PhD
A. The Urgency of Reform
Americans want reform
because we pay twice as much for health care than almost all the rest of developed world. For instance, European countries
have universal coverage and better health while paying about 8% of GNP while we spend 16%. As a result of the expense vast
numbers of us put off, or go without care entirely and, overall, we die sooner. Credible estimates are that 14,000 of
us lose our health insurance daily and 44,000 of us die annually for lack of health care. We rank 50th in life expectancy,
47th in infant mortality, and according to the World Health Organization, our health care ranks 37th overall. Our health insurance
is so expensive that even with high deductibles millions of us cannot “choose” to buy it. Much of the reform debate
centers on the public option.
B. What is the Public Insurance Option?
Opponents claim that the public option is a socialist
attempt at a government takeover. Some in positions of national leadership still make emotional, ideological, and irresponsible
claims. The lack of honest debate has left most people without a clear understanding of what the public option is, or the
difference between the strong and level playing field public options.
Our current system’s bloated bureaucracy
is, without question, a major cause of expense. Reducing that bureaucracy will clearly make care more affordable resulting
in additional savings as more people with chronic conditions, such as diabetes and hypertension, are able to afford routine
preventative care before their diseases reach acute stages requiring expensive intervention. Expense associated with life
style factors, such as smoking and lack of exercise, is a more intractable problem. A strong public option is the most effective
way to reduce bureaucratic waste. The level playing field public option, on the other hand, perpetuates bureaucracy.
Both
types of public options are legislatively created health insurance policies that add choice in the marketplace. Neither needs
to result in a government takeover, nor need they be government run. Just like Medicare, either version of the public option
can be privately administered.
The U.S. private insurance industry has an anti-trust exemption, meaning that the industry
can fix prices and carve out territories limiting competition. It is marked by consolidation, not competition. The strong
public option is far more competitive than the level playing field version and must be available across the country.
C. Why the Strong Public
Insurance Option is the More Competitive Solution.
With the strong public option, policy benefits, premium and fees paid to providers are set by the legislature,
while with the level playing field public option, the fees paid to providers are individually negotiated with providers through
a legislatively established bureaucracy. Additionally, level playing field fee negotiators are unlikely to achieve greater
cost reductions than the private insurance bureaucracy can. Indeed, by having experienced negotiators, the private insurance
bureaucracy will have an advantage over level playing field bureaucrats.
There are a number of other elements
needed to make the strong public option truly competitive. First, it must be available to all. Those that currently have insurance
through employers must be permitted to purchase the strong public option and be reimbursed for the difference in the premium
cost between the two, as Senator Wyden has proposed in his free choice amendment. Additionally, no insurance, public
or private, can be permitted to charge higher premiums for pre-existing conditions. In short, there can be no discrimination
in any form for any reason. For instance, women cannot be charged more because they might come down with “babyitis.”
Nor can people be cancelled because they get sick. All insurance, public and private, must be available across state lines
and transportable at no additional premium if a person changes or loses their job.
Unless all insurance, public
and private is available to all who are legally present in the U.S., the number of people who choose the pubic option will
be small- limited to those who are self-employed, or employed in small businesses, or who did not have insurance previously,
often because a pre-existing condition made it too expensive. Unless all insurance is available to everyone, the public option
will become the dumping ground for the sick. Especially if it is the level playing field pubic option, providers will demand
high fees making it more expensive than private insurance and it will fail because risk has not been spread fairly. We are
all in this together. We all get sick, we all die, and we all need to share in our common humanity.
D. The significance of
Ways the Public Insurance Option Can Become Law
Congress can make whatever public option it finally passes applicable nationally without granting
the states the right to opt in or out. If, however, Congress allows the states to opt out, the public option will apply nationally
unless a particular state decides it does not want the public option. Congress can also decide that the public option will
not be applicable in a state unless that state decided affirmatively that it wanted the public option.
The final way
in which the public option might become applicable is through a “trigger.” Under a “trigger” a pubic
option would not come into effect unless an as yet undetermined reform measure failed to attain uncertain benchmarks by an
undetermined date.
Allowing states to opt in or out delays implementation and will likely reduce the pool of those that
could be covered by the public option. Finally, the concept of a trigger is so vague that its merits, if any, cannot truly
be assessed. It is clear however, that a trigger entails more delay in resolving a problem that has festered since WW II,
and cries out for urgent and immediate attention.
E. Tried and True: The only thing we have to Fear
is Fear itself Opponents argue we cannot afford reform because any addition
to our staggering national debt will bankrupt us and our children. Indeed, quite the opposite is true. Instead, it is the
status quo that is bankrupting us. This is clear if one works through the logic that follows from a few fundamental, undisputed
facts. These are: (1) the United States pays 16% of GNP for inadequate health care that covers only a part
of our population, while (2), Europeans pay half what we do for universal coverage with better results, and
(3), the average family in the U.S pays $15,000 per year for health insurance, while the median household
income in the U.S. for 2007, before the recession took hold, was $50,233[1]. By cutting our national
health care bill in half, like the Europeans, we would increase American family incomes 15%, resulting in a tremendous boost
to our economy. If it is understood that during recessions the largest contributor to deficits is not government spending
(for example, our much maligned government stimulus), but instead results from the decrease in tax revenues,[2] the need for health care reform is even more apparent. Families
with incomes in the $50,000 range are not prospering, but are just getting by. They would spend increases in their incomes.
The missing ingredient in the present recovery is the consumer. When consumers don’t spend, people get laid off.There
is no question our growing national debt is a problem, but it is one we have worked through in the past. Health care reform
will help us, not hinder us in doing so again. WW II gave us the reason to inject vast government stimulus into the
economy which pulled us out of the Great Depression. Then, we sent great masses of material and the flower of our youth to
destruction, not exactly a prescription for an economic miracle. In 1946 the national debt stood at 119% of GNP.[3] Now it is approaching 80%, and will rise further in the coming years. But if we cut
our national health care bill with a strong public option we will save money, and make ourselves healthier and more productive.
The burden of the average family will be reduced, and the savings will be invested back into our country, not plowed into
the soil of Europe or spilled on the sands of Iwo Jima.The opponents of reform would have us believe that the not only is
the President so irresponsible as to lie when he asserts that he will not sign any reform bill unless it is deficit neutral,
but also, but they would also have us believe that the Congressional Budget Office is incorrect in it assessments that the
bills it has scored will reduce, not add to the deficit. Think of the deficit reduction we would have if any of those bills
had a strong public option. Conservatives preyed on our fears to oppose the New Deal during the Great Depression. We
overcame our fears then. We can do it again.
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[1] U.S. Census Bureau News, 8/26/2008, CB) 8-129, http://www.census.gov/Press-Releases/www.releases/archives/imcome_wealth/012528.html. [2]
Carmen M. Reinhart and Ken Rogoff, This Time Is Different: Eight Centuries of Financial Folly (Princeton, Princeton University
Press: 2009), 224. [3] William Greider, The
Secrets of the Temple: How the Federal Reserve Runs the Country (N.Y., Simon & Schuster Paperbacks: 1987), 103. Despite
the burden of the Cold War, the national debt was 35% of GNP by 1975. Greider, 103.
F. What We Can Do We can demand true reform by signing the petition below and letting our legislators know that we know what is required
and that we will hold them accountable.
The fight is far from over. The first thing is not give up. The opposition
is not more powerful than us. They are tiring and we are winning. They are spending millions and millions and we are just
beginning to find our voice. We are the grass roots and we are the strength of this country.
The strong public
option is gaining strength despite the opposition of the powerful health insurance lobby, and despite the lies and misinformation
of the summer and fall because, as the Congressional Budget Office has found, it is the best cost saving idea on the table.
The desire of some to make health care reform the Administration’s Waterloo has not been enough to defeat the public
option.
After you sign the petition, you need to contact your Senators and Representatives to tell them that you have
signed the petition and refer them to this website so that they can clearly see what we demand: nothing more than what the
other advanced democracies have, care for our people and not the waste of our precious resources and outsized profits for
the few.
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