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Problems for the Public Option | The Nation

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Problems for the Public Option

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The House has released a final version of the health reform bill. It has a public option all right, but not the robust version progressives were hoping for. The public plan would only cover 2 percent of Americans and premiums will cost more than anticipated.

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Lindsay Beyerstein
Lindsay Beyerstein writes about health care for the Media Wire project at the Media Consortium. She is a freelance...

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Meanwhile, Sen. Joe Lieberman continues to threaten to join a Republican filibuster of a healthcare bill with a public option. A lot of people still think he's bluffing. Realistically, the public option probably faces more serious threats from inside the Democratic caucus. It's been whittled down at an alarming rate.

Nick Baumann of Mother Jones asks "What now for the public option?"

The Congressional Budget Office has estimated that public option premiums will actually be higher than the premiums for private plans on the health insurance exchanges. That doesn't mean it's going to cost the government more money--the public option is paid for by premiums, not taxes; it actually cuts the deficit. But it will be more expensive than some private plans. Wasn't part of the point of the public option to prove that a government-run program could compete successfully with privately-run plans? Well, yes, but here's the problem: that was all based on the idea that the public option would pay healthcare providers at Medicare rates.

Baumann predicts that insurers will do everything they can to drive the sick people off private insurance onto the public plan, a phenomenon known as "adverse selection." Hopefully some of the proposed insurance reforms will curb their worst excesses, like rejecting insurance applicants for misspelling their pre-existing conditions on their application forms.

Mike Lillis of the Washington Independent reports that the House healthcare bill would eliminate the popular and cost-effective Child Health Insurance Program (CHIP) and shift its low-income beneficiaries onto private health insurance exchanges.

This looks like a stealthy pre-emptive strike on the prospect of single-payer healthcare. CHIP is a single-payer program that progressive health policy types envisioned as a prototype for a future single-payer system for all kids, or even eventually for everyone.

As Lillis points out, abolishing CHIP is also a gimme to insurance companies. Generally speaking, kids are cheap to insure because they're healthy. Private insurers would love to stock their risk pools with kids on federal subsidies. It's like getting paid to stock your pond with delicious trout. We worry about adverse selection making the public plan more expensive. Well, CHIP is the reverse of that because this public program is keeping the good risks for itself.

Suzy Khimm argues at TAPPED that killing CHIP could be a good thing, provided the kids continue to enjoy the same legal protections that they get under the public plan. Khimm suggests that moving low-risk kids into insurance exchanges could help keep costs down for everyone by making the risk pool healthier on average:

That being said, if CHIP's dismantling ended up moving more folks into the health-insurance exchange, it wouldn't simply be a boon for "the insurance lobby and moderate Democrats." It could strengthen one of the most fundamental parts of the Democratic reform package--a robust insurance exchange with a pool of participants that's large enough to drive down costs precisely because insurance companies have an incentive to jump in and compete for customers. Moreover, folding CHIP into the exchange would add a younger, healthier pool of participants to the exchange, offsetting its potential of becoming a dumping ground for the sick and elderly. Finally, CHIP has always suffered from under enrollment--about 6 million children aren't insured in the program who should be--and by bringing whole families in under the same plan, more children will be covered.

That's a nice idea, but it seems foolish to scrap one a popular and successful social program in favor of an untested insurance exchange system.

The frustrating thing about so-called healthcare reform is that legislators don't really want to change the system. They want to make the system work better while catering to all the established interests that made it suck in the first place.

Politicians aren't the only ones to balk at fundamental change. The Real News Network interviews Sam Gindin, a former assistant to the Canadian Auto Workers Union, now a professor at York University. Gindin says that, over the years, labor conceded too much on healthcare and thereby failed to re-establish itself as a leading force for progressive change in the United States. Helping elect Barack Obama was a step in the right direction for labor, he maintains, but it's not nearly enough.

As John Nichols of The Nation put it, when the House finally wrote the bill, the compromise was even more compromised than expected.

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