The Big Picture: DISASTER

This emergency post will be brief, I assume the Strike will write something and I'll probably be back with more, but I had to give my shocked and appalled reaction to the news that the White House will give in on the public option. This is horrendous news, substantively and politically.

1. Substantively, the public option was the vehicle to keep insurance companies honest, but more than that, for liberals it was the whole point of health care reform: we were willing to compromise on Medicare for All by having a Medicare option that people could choose - the public option - and then people would voluntarily choose this public option because it had lower premiums and much better coverage, due to better regulation, no profit margins, and mass bargaining power. By giving in on this, without extracting any concessions, we have compromised away the central point of health care reform. Here was Robert Reich arguing for the absolute necessity of the public option:

Without a public option, the other parties that comprise America's non-system of health care -- private insurers, doctors, hospitals, drug companies, and medical suppliers -- have little or no incentive to supply high-quality care at a lower cost than they do now.

Which is precisely why the public option has become such a lightening rod. The American Medical Association is dead-set against it, Big Pharma rejects it out of hand, and the biggest insurance companies won't consider it. No other issue in the current health-care debate is as fiercely opposed by the medical establishment and their lobbies now swarming over Capitol Hill. Of course, they don't want it. A public option would squeeze their profits and force them to undertake major reforms. That's the whole point...

Reich says that any alternatives are simply unacceptable, and will not produce the drastically needed change.

One would substitute nonprofit health insurance cooperatives for a public plan. But such cooperatives would lack the scale and authority to negotiate lower rates with drug companies and other providers, collect wide data on outcomes, or effect major change in the system.

Another emerging compromise is to hold off on a public option altogether unless or until private insurers fail to meet some targets for expanding coverage and lowering health-care costs years from now. But without a public option from the start, private insurers won't have the incentives or system-wide model they need to reach these targets. And in politics, years from now usually means never.

To get health care moving again in Congress, the president will have to be clear about how to deal with its costs and whether and how a public plan is to be included as an option. The two are intimately related. Enough talk. He should come out swinging for the public option.

The public option was to be the vehicle for Obama's three goals : to cover the uninsured, improve the coverage of the already-insured, and move toward a quality-based incentive structure. And it was the vehicle to eventually achieve the liberal dream of Medicare For All, of health care as a human right provided by a democratic government. That dream died today.

We'll be back later with the political implications.