Pushing for a public option
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Published: November 29, 2009
en. Bernard Sanders is pushing hard for inclusion of a public option in the health care bill now before the Senate, warning that he might not support a bill that lacks it.
Congress remains far from final passage of a bill; debate in the Senate has just begun. But a report on the legislation as it stands now shows the considerable benefits that Vermonters would gain, and Sanders ought to think long and hard about voting against it, even if in the end it lacks the kind of public option he favors.
The report from the U.S. Department of Health and Human Services states that nearly all uninsured Vermonters and about 25,000 others who are underinsured would gain access to affordable health care plans under the new bill. They would do so through participation in health insurance exchanges that the bill would create.
In addition, about 100,000 Vermont seniors would gain free preventive care, and about 18,000 would see their drug costs decline because of reforms to the Medicare prescription drug plan.
According to the federal report, about 58,000 Vermonters would qualify for tax credits to help make the purchase of health insurance affordable.
Then there are the insurance reforms that would protect all Americans, such as the requirement that insurance companies extend coverage to people, despite pre-existing conditions, and the portability of plans from one job to another. At present, people who lose their jobs often face the double blow of also losing their health insurance.
Democrats face a difficult balancing act as they put together a workable bill that will also pass. Partly, this is because of the Democrats' role as the majority party.
To gain the majority, any party must become a big tent — a broad coalition that embraces people with divergent views. It is only by assembling this sort of coalition that any party can gain support broad enough to constitute a majority. Thus, the Democrats have assembled a coalition of liberals, moderates and conservatives who must find a way to reach agreement if they are to govern successfully.
The Republicans, in contrast, have become a small tent — narrow and growing narrower, rigidly dedicated to an anti-government ideology that has made them incapable of actually governing.
That means the Democratic coalition includes leftists such as Sanders, who are saying their votes depend on inclusion of a public option, as well as moderates such as Sen. Joe Lieberman of Connecticut, who says he will not vote for a public option and might even join a Republican filibuster to kill a bill that contains one.
The public option is an important component of the health care package the Democrats are now pushing. Supporters say that if the government is able to provide a government plan, private insurance companies will face the kind of competition that will help hold down costs.
The Democratic line is that the public option will help keep the insurance companies honest.
Sanders performs an important role in speaking on behalf of a public option. He is a supporter of a single-payer health care system — something akin to Medicare for all — that would leave out private insurance altogether. A public option could be a step in that direction, as Republicans fear and as some liberals hope. But the public option ought not to be a litmus test capable of sinking the bill.
Obama has chosen not to pursue a single-payer system because he believes it would be too disruptive of the present system. European nations who have moved toward universal coverage have done so each in its own way. The system under consideration in Congress may most closely resemble the Swiss system, which enlists private insurance companies to provide coverage, without a public option. It would be foolish for Congress to reject such a system just because it does not measure up to some unachievable ideal.
There is a long way to go before Sanders has to vote on a final bill.
Vermonters and all Americans stand to gain, even from an imperfect bill. Let's hope Sanders does not let ideological purity stand in the way of doing the right thing for Vermonters and all Americans.
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