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The Public Option Is Back: Our Enthusiasm Should Be Tempered


The Public Option Is Back: Our Enthusiasm Should Be Tempered

Don McCanne

Last week an intensive campaign was initiated in support of a “public option”—offering the choice of a public, nonprofit insurance plan which competes with private health plans. Our enthusiasm should be tempered.

Following are a couple of points to keep in mind, especially when you hear promises that the public option is a giant step towards single payer:


I appreciate Dr. McCanne's passion and mostly insightful observations, but I wish we could do without the conditional predictions.


Bernie favors a single payer system like Medicare for all - so this article does not pertain to that. The types of problems discussed in the article are reasons why the public option supported by Clinton may not be helpful. That's because she is likely to favor a type of public insurance that doesn't allow government to benefit from the natural advantages it should have over private insurance (no profit necessary, ability to negotiate care and drug prices, etc...). The program in the Democrat's platform is kind of an in between plan (Clinton-type public option if you are under 55; buy-in to Medicare if you are 55 to 64). That could be a positive step toward a single payer. Unfortunately, as many CD commentators often point out - platform items that aren't really favored by the nominee aren't likely to move forward.


... aren't likely to move forward unless we the people demand them.


Of course, wide public support is always key - and I am truly a proponent of "the people united shall never be defeated" idea. However, progressives should be demanding single payer. Then, any compromise gets things like what's in the platform that might build toward single payer. Starting with the platform position and compromising further advances nothing. We should always consider whether incremental change advances toward progress or detracts from progress.


It seems unlikely the public option will ever pass Congress but the critical need is to reduce the cost of healthcare regardless of what the type of coverage there is. Single-payer in this country is not affordable without certain reforms in the way healthcare is provided. One focus should be fee for service. Should it be changed to fee for outcome? Martin O'Malley claimed this was done in Maryland with good results. The cost of drugs is generally too high.This need to be dealt with. The fees for certain specialized medical procedures is much to high. That is another problem. The same with certain surgical procedures. The biggest problem is probably end of life care. That accounts for about half of all healthcare costs. It is hard to see reducing such care so how than can be addressed is perplexing. Nobody should be fooled that single-payer by itself is the solution. There is no way universal healthcare coverage of any type is affordable as long as physicians and drug companies are making the type of money that they are making.


Get rid of insurance companies or make them non-profit the way it used to be when we had regulated capitalism. When I got my first job, benefits, including insurance; dental was a given; vacation time after 1 year, sick time, etc. It was a part of you deciding if you want the job. I was paid $5,500 per year in 1972. Public option will still cheat everyone; medicare for all!


Good job, Chelsea!


The Green Party Platform doesn't call for a National Health Service as far as I can tell. They call for a single payer system - but with a more comprehensive list of services than usually discussed (see http://www.gp.org/social_justice_2016/#sjHealthCare).


Did we say "public option"? NO. We said, SINGLE PAYER UNIVERSAL CARE!!



When I point out the same thing (insurance companies were non-profit and those that were for-profit couldn't receive licensing in most states), people look at me like I must be crazy. Even people my age seem to have forgotten this. I'm not talking about 200 years ago, for God's sake - how is it that everyone thinks the extraordinary, over-the-top, unbelievable profits big companies and banks make is the way it's always been? Like it's some immutable fact of nature or something. Heck, utility companies were state-regulated back in the day; they were allowed something like a 10 to 17% profit margin (after paying their employees/management what the state considered reasonable compensation - and the state decided what was reasonable), and weren't allowed to charge their customers more than what it took to achieve this.

Suddenly, utilities, telephone companies, and insurance companies are completely deregulated, given government subsidies to run their businesses, and permitted to charge whatever they want to a public that needs their services. When I think about how much internet costs each month, knowing that the government paid for all the cables to be laid across the country, it drives me crazy.

Regarding jobs, there was a silly movie years ago called "9 to 5"; and that really was what most people worked. Even my first pitiful full-time job after high school was 9 - 5, with an hour-long paid lunch. It included a two week vacation after the first year, basic health insurance, and ten sick days. The workers in this country are being screwed for corporate profits, CEO salaries, and federal and state Congressional "representatives".


Support Brand New Congress please (google that phrase and sign up in a hurry; they are having an internet telecast tonight 9 pm EST). A congress that works for us would pass meaningful health care reform in a minute, including the removal of obstacles to negotiate prices. We've lost the election (HRC or Trump, all the same), so we need a congress that works for us and that can pass legislation "by force", i.e., by defeating the predictable presidential veto.


Even my part-tme job at the mall--last 2 yrs.of high school and 2 yrs. of higher education at $2.35 an hour let me take sick days and vacation time with no threat of being fired and a 15-min break for four hours:an hour off for lunch when I worked 8 hrs. on weekends.


Just to note that BNC is focused on the 2018 midterms. See also the downticket candidates supported by Our Revolution in this round.


Maybe Our Revolution is excellent, and yet, I associate it with Bernie, the Great Betrayer. So I'm staying out of it.

Brand New Congress, on the other hand, is being run by personnel from the Bernie primary campaign, who understood the great potential of their infrastructure they had in their hands, and decided to use it to replace (most members of) Congress. It's a great idea, and as you say, they are working on a realistic timeline; that's why they are targeting the 2018 congressional elections. We'll have to cross our fingers and hope that there will still be a world out there by then, i.e., that the world will have survived the chances of the nuclear holocaust that HRC is eager to bring on. But we still have to try.


Bernie's Facebook page today published a terrifying comparison of a few drug prices here and in Canada:


How does it help depression to pay more than $2,600 for a month's supply of Abilify?


It doesn't. Yet