One of the little-noted details of all the health care reform bills floating out of congressional committees everywhere is they don't take full effect until 2013. The state-level insurance exchanges -- basically, a list of the private insurance products available to small businesses and individuals, plus (perhaps) a public insurance "option" something like Medicare -- aren't slated to go into effect for four years.
The insurance industry reform aspects of the bill -- no excluding folks because they have pre-existing conditions, or over-charging them, or dropping them when they sick, or all the other vile ways insurance companies make a buck by avoiding their obligation to actually insure people -- would come first. So would the money to train more front-line doctors and nurses and to figure out better "standards of care" so that wasteful fee-for-service practices (i.e., the padding of health care bills) can be reined in.
So a little light went on in my head tonight listening to President Obama talk about the public option. He's committed to it or something like it, he said. He mentioned coops. He mentioned triggers. But the point is, he said, and then repeated himself, everybody deserves a choice of good, affordable insurance products wherever they live.
Well, doesn't that mean that the insurance industry has four years to figure out how to offer good, affordable insurance products in every state? And if it doesn't -- if one overpriced United Health or Blue Cross product continues to be a monopoly in Alabama or North Carolina, for example -- reform would then "trigger" the introduction of a public option in the aggrieved state(s)?
Four years to curb their costs, insure all comers, pay out when they should and stop with the blizzard of paperwork, and turn themselves into the health-care equivalent of a public utility, doing what the public wants but in a private, for-profit or nonprofit way. Actually, make it three years, because a public option will need a year or so to get off the ground.
Here's what Obama said:
[S]ome have suggested that that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others propose a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.
Think lovely thoughts, Congress. But just in case the bastards can't do it, do load the public option into your legislation and attach an easy-to-pull trigger. With a three-year deadline.