The Myopia of the Public Option

by Brien Jackson

There’s much to appreciate in Howard Dean’s comments on healthcare reform at Netroots Nation, both on the policy and politics fronts, but at the same time, I keep coming away with this nagging feeling about the continued obsession progressive activists and activist styled bloggers have with the public option. It’s not that the public option isn’t important or worthwhile, it very much is, it’s just that it’s not the center of the bill, by any stretch. And it’s not that Dean’s 2004 plan didn’t contain any sort of public insurance plan, (or many of the other meaningful regulations the current proposal seeks to implement), it’s that I can’t shake this fear that while progressives focus on the public option, reform opponents will go after the more central regulations like community rating. And I do have to wonder whether or not the fact that the public option is easy to understand while the other things are a bit more complex, and numerous, doesn’t play into this as well.

But as far as advocacy goes more generally, I think the public option is one of the places its needed least. The White House has already thrown down a marker on it, before there was even a House bill drafted I believe, and most of the Congressional Democrats have already come to something of a compromise; progressives will get some form of public insurance option, while conservative Dems will get concessions weakening it in the market place, from limiting who is eligible to purchase it to prohibiting it from using Medicare style rate bargaining. Which is sub-optimal, but nothing that can’t be changed later. And putting something in place is much more important than making sure it’s absolutely perfect, over even “good enough.” It’s much, much easier to expand a popular program than it is to construct and implement that program in the first place. See Social Security.

But that said, it does seem like the debate over the public option is pretty much over with, and that there’s going to be some sort of public insurance program. Progressive activists would do better to keep their guns trained on the central aspects of the bill reforming the health insurance industry. That’s where most people are going to be affected at, and that’s where the bill is going to do the most immediate good. It’s also what the insurance industry has the most incentive to try to derail.

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