Gaming Healthcare

Gaming Healthcare

Dropping the public option and Medicare expansion means breaking the promise of health reform: better care at lower cost.


One year after Democrats earned a mandate from the American people to deliver far-reaching healthcare reform, they are tinkering around the edges of–and in some cases reinforcing–the broken system that voters elected them to replace. It’s not just that top Democrats have abandoned the Medicare for All approach, about which Barack Obama said during the 2008 campaign, “If I were designing a system from scratch, I would probably go ahead with a single-payer system.” With his rejection of modest proposals for a public option and a lowered eligibility age for Medicare, Senate majority leader Harry Reid seems to have abandoned healthcare reform. The legislation he now seems willing to settle for is, at best, an attempt to impose a measure of responsibility on an insurance industry that has gamed the system for decades.

Yes, as Democrat Tom Harkin says, there’s still “good stuff in this bill.” Tens of millions of uninsured Americans could gain basic coverage. And while the Senate measure is again being rewritten as The Nation goes to press, it will in all likelihood attempt to regulate the worst insurance abuses and add new preventive-care mandates for women. But if the bill advances in the form accepted by Reid and the White House, champagne corks will be popping in the offices of insurance company CEOs. Without competition from a public option or an expanded Medicare program, Big Insurance stands to reap what former insurance exec Robert Laszewski calls “a bonanza.” How could they ask for more? They’ll get a plan that steers millions of new customers their way while providing government subsidies to pay premiums set by the industry.

The promise of reform has always been that Americans can have better–and universal–healthcare at lower cost. If the public option and Medicare expansion are dropped, and if schemes to pay for the proposal with Medicare and Medicaid “cost containment” are retained, the Senate legislation will break that promise.

Obama and key Congressional leaders appear to be more determined to get a bill, any bill, than to enact fundamental reform. The president’s failure even to mention the public option when he lobbied Senate Democrats empowered Joe Lieberman and others who were angling for its elimination. And Obama’s failure to use his bully pulpit was matched by Reid’s compromises and missteps. When the majority leader embraced rules that require sixty votes to act–rather than challenge the rules directly or via budget reconciliation procedures that allow a simple majority–he ceded authority to insurance-industry shills like Lieberman and Ben Nelson, who then blocked reform at every turn.

At this late yet critical stage, Congressional progressives must push back. Compromise is inevitable. The hard question is whether it opens the door to progress or closes it. In a Washington increasingly fixated on deficit reduction and entitlement cuts, a bill with neither a public option nor Medicare expansion could be disastrous.

As a conference committee sets out to merge House and Senate bills, progressives should declare that they will not back a bill that enriches insurers while raiding the treasury and squeezing existing federal programs. They should argue more aggressively than ever for real competition–ideally in the form of a public option but at least with Medicare expansion. That, after all, is what they promised Americans in 2008.

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