I wrote some good (at least I think so) posts on another forum about why I don't think a public option should be a mandatory feature of a healthcare reform bill. I figured some people who read my journal might be interested in them, so here they are!
Post The First (in which Jeff sells out on the public option)
A lot of people are missing the forest for the trees, with regards to the public option.
The theory behind a public option is that it's single payer light. You get a whole bunch of people under a single government run plan, and the government uses that huge mass of people to negotiate costs downward with medical providers (doctors, drug companies, equipment manufacturers, etc). This is how Medicare delivers healthcare at lower costs than private insurers.
The public option in the strongest form currently being considered (basically the one in the various House bills) isn't very strong. It's only open to folks on the Exchange, and the Exchange is only open to about 20 million people. It's not allowed to use Medicare reimbursement rates. Not everyone on the Exchange is going to go with the public plan, so it's enrollment is going to be less than 20 million. It's just not going to do very much to reduce costs. This is precisely why it's worth bargaining away.
Unfortunately a lot of liberals have "Stick it to private insurers" as a higher priority than "Extend medical care to people who can't afford it," so we get nonsense arguments like "Any bill without a public option should be opposed."
Post The Second (Jeff thinks triggers are, on balance, silly ideas)
As far as triggers go - they're good politics, but bad policy.
They're good politics because they get you votes, plain and simple. Specifically, they get you Olympia Snow's vote. Assuming Reid can hold his caucus together on a cloture vote, a trigger potentially gets you over the hump and past the filibuster.
Additionally, like everything in politics - it's a bargaining chip. I can imagine a scenario where we get a relatively worthless public option without a trigger, but if liberals concede on a trigger they get a much stronger public option that might do something with regards to "bending the curve" on cost.
They're bad policy because triggers don't tend to get pulled. It's too easy for a future Congress to change the rules on the trigger, or for industry to massage numbers so that it's evaded.
Post The Third (Someone pointed out that subsidizing folks below the poverty line is silly because our poverty line is ridiculously low)
For what it's worth, the subsidies aren't just to the poverty level. Medicaid will be extended to individuals and families making up to 133% of the poverty level. Tax credits (aka subsidies) will be granted to families making up to 300%-400% of the povery level (with 350% being floated as a compromise).
Post The Fourth (StGabe asks why 20 million is not enough enrollees for a strong plan, Mister Widget laments that any bill passed this year will not fix the healthcare problems in the US)
StGabe: ~20 million is the number of people eligible for the Exchange, as currently envisioned. Presumedly not all of them (maybe not even most) will end up using the public option, so the real number of people enrolled on it will be something less. I have no idea how much less though. By way of comparison, Medicare (which generally has the lowest costs of any insurance plan) had 43 million enrolled as of 2007. I'd guess that's a pretty good baseline for how big a public option has to be to get Medicare-equivalent pricing.
Mister Widget: Reflecting the type of blogs I read on this subject, I'm a structuralist. I think there was always a 0% chance we'd "solve" the healthcare problem in this country this time around - the problem is truly enormous, and our Congress isn't good at solving problems. What we can do this time around is lay the framework upon which future Presidents and Congresses can build upon.
While I'd love a strong public plan as much as any other liberal, I also recognize that even without a public plan we're enshrining into law the principle that no American should ever go without medical care. That's a huge win, one I'll happily take, and one upon which we can build toward a sustainable (likely single-payer) system in the future.
