Jacob Hacker (Creator Of Public Option) - "Why I Still Believe in This Bill" [View All]

[TomCADem]

A fairly balanced critique of the bill by none other than the developer of public option idea. He notes the weaknesses of the bill, but also discusses why he believes it should be passed:

http://www.tnr.com/blog/the-treatment/why-i-still-believe-bill

The public option was always a means to an end: real competition for insurers, an alternative for consumers to existing private plans that does not deny needed care or shift risks onto the vulnerable, the ability to provide affordable coverage over time. I thought it was the best means within our political grasp. It lay just beyond that grasp. Yet its demise--in this round--does not diminish the immediate necessity of those larger aims. And even without the public option, the bill that Congress passes and the President signs could move us substantially toward those goals.

As weak as it is in numerous areas, the Senate bill contains three vital reforms. First, it creates a new framework, the “exchange,” through which people who lack secure workplace coverage can obtain the same kind of group health insurance that workers in large companies take for granted. Second, it makes available hundreds of billions in federal help to allow people to buy coverage through the exchanges and through an expanded Medicaid program. Third, it places new regulations on private insurers that, if properly enforced, will reduce insurers’ ability to discriminate against the sick and to undermine the health security of Americans.

These are signal achievements, and they all would have been politically unthinkable just a few years ago.

To be sure, the bill also contains a requirement on individuals to have coverage, which has become the main target of criticism from the left. Without the public option, this mandate amounts to forcing people to buy private insurance without creating an affordable public alternative with which insurers must compete.

But the correct response to this critique is to make the requirement less necessary by providing greater assistance with the cost of premiums and by facilitating enrollment in the exchange--in other words, by making coverage more attractive and easier to obtain.

The lack of a public option also makes even more imperative tough requirements on insurers to make them live up to their stated commitment to change their business model and slow the spiraling cost of coverage. The most important way to do this is to move away from the Senate bill’s state exchanges and toward a national exchange such as that contained in the House bill. The federal government needs to be directly involved in implementing and enforcing strong national regulations of insurers and creating the new exchange. Otherwise, the effort for reform might fail at the hands of hostile governors.