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Ways To Skin Cat

A lot of progressives are focused on today's events in the Senate Finance Committee as a sort of Battle of Armageddon on health care reform, since the Committee will formally vote on a Rockefeller-Schumer amendment to add a public option to the Baucus proposal, which currently lacks one. You can follow the action via Tim Noah's liveblog at Slate.

But as Chris Bowers keeps pointing out at OpenLeft, the Finance markup isn't the last, or even the best, opportunity for a public option to emerge in the Senate debate. That will happen when the Finance and HELP Committee versions of health care reform are merged under the direction of Senate Majority Leader Harry Reid, with our without the benefit of budget reconciliation rules. There's another possible shot at a public option in a House-Senate conference committee, but it's unlikely the Senate will be any friendlier to the idea later rather than sooner.

Now that's all she wrote to a lot of progressives; either the public option is attached to the bill, or health care reform legislation has failed and isn't worth pursuing, since it merely represents gigantic subsidies to private health insurers. If you are in that camp, you might want to force yourself to read Jonathan Cohn's piece today on health reform without a public option in The Netherlands.

Cohn's basic point is that aggressive government regulation of private health insurers can accomplish a lot of the same things as competition from a public option, particularly in terms of limiting out-of-pocket consumer costs and preventing discriminatory treatment of the sick and/or poor. Moreover, such regulations are often politically popular, even among rank-and-file Republicans. So it might be a good idea, during the Senate Finance Committee and later in the process, to focus a bit on the regulatory questions that will determine the ground rules for any new competitive system of health insurance, whether or not a "robust" public option is one of the players.

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The chance of passing real insurance reform, like that in the Netherlands, or Germany or Switzerland, all of which have systems based on private insurance, is probably less than that of a public option.

In most of these countries the insurers are regulated like public utilities, and are generally by law required to be not for profit. What is the chance of current insurers going or that? Right, and slim has left town. If you think they are putting up a fight now, wait for a bill that strictly regulates their coverages, premiums and corporate policies and makes them essentially non-profits. Can you say, "Republicans (and all too many Democrats) screaming Government takeover?" I thought you could.

In this political climate the public option is our only option.


My understanding of the Swiss system is not that the insurance companies cannot make any profit on policies, but that they cannot make any profit on BASIC policies. Supplemental insurances, boutique policies, the kind (I surmise) where you get a private room and a private duty nurse, etc., or access to the pricier long-term care facilities, can be sold for a profit. It might not change the willingness of the insurance lobby to fight reform, but it's a point that perhaps should be made.

aggressive government regulation of private health insurers can accomplish a lot of the same things as competition from a public option
Even mild regulation won't last a decade, if that long; it will be bound and smothered and neglected in a thousand ways, from under-the-radar 'relief' for businesses to race-to-the-bottom 'federalism' to outright refusal to enforce said regulations,all accelerating as Republicans gain more power. And because most of the ill effects of this non-regulation will be borne by those under the radar for many years (until we reach another tipping point), people won't care.

A public option's big advantage is that it's, well, public-- we can see it and will know others who use it and will all have at least some interest in it not being overly corrupt. And one most likely would grow instead of decaying the way regulations inevitably will. Bottom line: American regulation is a joke, because our political system is not designed to protect the common good, no matter what the founding documents say.

Democrats know perfectly well that whenever they build anything benefiting citizens by GOP blueprints, the foundation will eventually fail, and that's a feature, not a bug. The right can tinker with cosmetics without doing too much damage, but I will never buy anything they helped design (or even influenced) from the ground up.

We can't even bring ourselves to regulate Wall Street immediately after the biggest meltdown in living memory. They've taken the bailout money, thank you very much, and jumped right back into derivatives trading. And you're pinning your hopes on regulating the insurance and pharmaceutical industries?

No doubt the American health insurance industry will oppose rigorous regulation even more fiercely than the public option. It seems almost a silly exercise to even consider the prospect. However, I do wonder whether insurance regulation such as that imposed on auto insurance by California Prop 103 might work. As a counterbalance to mandatory auto insurance, the State exerts control over premiums. When the proposition passed in 1988, the auto insurance industry forecast doom, warning that companies would abandon the California market in droves. 20 years later, there are plenty of choices of auto insurance to choose from and most Californias are pleased with the results. California premium rates have dropped from the second highest in the US to 21st (http://www.consumerwatchdog.org/insurance/articles/?storyId=18988). Note that voters, not legislators, imposed regulation in California. Can you imagine Conrad, Baucus, and Lincoln standing up for stiff regulation? I sure can't. I'm hanging in there for a public option and wondering whether I could ever support mandated health insurance without either a public option or regulation. I think not.

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