By Dr. Andrew D. Coates
Florida Times-Union, Dec. 13, 2009
The public option is effectively dead.
Once upon a time, proponents of the idea sought a Medicare-like program to offer a check, they said, on the private insurance industry.
“No fair!” cried the insurance companies.
Nothing in the House or Senate bills would erect a public insurer that could influence the insurance market.
The House bill includes a feeble government plan that would start in 2013. Six years later, it would enroll less than one out of every 50 people under 65 years of age. The Senate bill initially contained a miniscule “community health insurance option,” also to begin, state-by-state, more than four years from now, but that has been stricken from the legislation.
The public option was a bad political compromise. Its premise was that the government could give the private companies a run for their money. In other words, it was the old lie that the market will provide.
The public option was a shadow puppet, a political posture. Its proponents talked about the need for a public insurance plan to make the private companies “compete on a level playing field.” They said the public option should be “robust,” with lots of talking points but few specifics.
But once the industry-friendly legislation came in, even 2 percent of the market was too much for the insurers to yield.
Proponents of the public option said its purpose was to keep the private insurance companies honest. But these corporations are not honest and never will be. In fact, several of the biggest have had to settle fraud cases with the government.
And private insurance entities, geared toward making a profit, should anyway have no place in delivering health care, which is a public good.
Ironically, a public option would simply add yet another bureaucracy to the present insurance mess. It would lose, not win, the market competition, by disproportionately covering the sick and the poor. This could put our nation on a fast track to permanent two-tiered health services, exacerbating the deplorable disparities that plague us.
It is time to let go of this dangerous idea. Adding a feeble public insurance plan to the private insurance market is no excuse to support legislation that will criminalize the uninsured, divert hundreds of billions of tax dollars to subsidize unaffordable private insurance premiums and protect pharmaceutical industry superprofits.
Another world is possible. It is called Medicare for all.
Single-payer national health care — popular and practical, just and necessary — remains the essence of genuine health care reform.
Dr. Andrew D. Coates, assistant professor of medicine and psychiatry at Albany Medical College and a practicing physician, is a member of the board of directors of Physicians for a National Health Program and co-chair of the statewide grassroots coalition Single Payer New York. Courtesy of the Progressive Media Project/McClatchy-Tribune News Service.