The American political system is resistant to change, and it undertakes reform -- progressive reforms, I mean -- incrementally if at all. So no one should be foolish enough to think that the health care reform legislation coming out of Congress this year, or perhaps early next year, will produce immediate improvements to health care delivery, either in terms of coverage, quality or cost. And lord knows, the reforms on the table are at least two decades overdue, if not five or six. (Truman wanted universal health care, after all).
Nonetheless, the announcement today by Senate Majority Leader Harry Reid that the "blended" bill he will bring to the floor will include a public option is a major breakthrough. It's the "opt-out" version of the public option, meaning that it's not the "robust" option (with rates tied to Medicare's rates), but it's not the weak-as-pond-water "trigger" version either, nor the also-weak "opt-in" version. This one will create a national insurance option available in every state unless your state's leaders are so dumb they opt out of it -- kind of like turning down federal stimulus money when 1o percent of your state's population is unemployed.
This public option won't change anything immediately, and it will be four, five, six years or more before its impact even starts to be felt. But if it works as it should (famous last words?), it will make good health care coverage available to a limited number of consumers at rates 20 percent (or more) below what private insurers are charging, forcing the private companies to respond or else watch as Congress gradually expands the number of people allowed to choose the public plan.
The public option was a must-have for progressive organizations; Washington pundits considered it unlikely from the get-go, "knowing" as they do how politics works; and it was pronounced dead by the in-crowd about three weeks ago. But now, it's back, it's in the Senate bill, it will be in the House bill, and it's odds-on to be in the bill that Congress sends to the President, assuming that it will send something to the President -- and I do assume that.
The reason for its rebound is simple: Without the public option, the costs of reform -- especially with all the side deals that Congress and the White House have cut with Big Pharma, the American Medical Association, the hospitals and the rest of the industry -- were projected to be north of $1 trillion over the next 10 years, with little hope of off-setting cost reductions. With the public option, cost reductions become possible in amounts that should be equal to or greater than the costs. The public option will "bend the cost curve," as the President says.
Give President Obama credit -- he stuck with the public option without shoving it down anyone's throat, letting the debate play out so that advocates could make their case and opponents demonstrate that they had no case to make. Give the public credit -- they listened, and the more they heard, the better the public option polled. (Obama's statement is below the fold.)
It ain't over 'til it's over, of course, so knock on wood and all that. But this is big.
From the White House:
THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release October 26, 2009
STATEMENT FROM PRESS SECRETARY ROBERT GIBBS ON HEALTH INSURANCE REFORM
“The President congratulates Senator Reid and Chairmen Baucus and Dodd for their hard work on health insurance reform. Thanks to their efforts, we’re closer than we’ve ever been to solving this decades-old problem. And while much work remains, the President is pleased that at the progress that Congress has made. He’s also pleased that the Senate has decided to include a public option for health coverage, in this case with an allowance for states to opt out. As he said to Congress and the nation in September, he supports the public option because it has the potential to play an essential role in holding insurance companies accountable through choice and competition.”