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The Left's Public Health Option Problem

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Given the failure of similar programs in states, single-payer should not be thrown aside for this battle.

For advocates of guaranteed truly universal healthcare the debate over Obama's reform efforts have been rather disappointing.

Despite the fact that a clear majority of Americans prefer joining the rest of the developed world and having a comprehensive government plan that cover everybody, President Obama and most of Congress, all of whom have received large sums of campaign donations from the drug and insurance industries, have made a government run plan that would not sell healthcare as a commodity to make profit, a non-starter. As a result, single-payer healthcare advocates, despite having overwhelming grassroots support, have been dismissed in Washington.

Now, with few other options, liberal members of congress and advocacy groups have largely focused their advocacy and money behind what appears to be the most heated battle over possible healthcare reform this summer: the fight to include a "public option" to compete with private plans in the healthcare package.

Predictably, ideologues opposed to any kind of government involvement in healthcare are fighting tooth-and-nail to oppose this option, ridiculously, calling it a step towards socialism. But as much of the left rallies to counter these shameful distortions, they may want to consider a very important question. What exactly are they fighting for?

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By taking single-payer off the table at the start, Obama and his supporters may have put all of their fuel into a sputtering vehicle. To date, two state governments Massachusetts and Vermont have attempted to implement "hybrid" pseudo-public solutions to major healthcare problem. Both of these plans have been floated as possible templates for national reform; the Mass plan is often cited as a possible angle, and Rep. Peter Welch, D-Vermont, has introduced legislation for a public option that is somewhat similar to Vermont's state-wide plan. Sadly, in both cases the results of these efforts have not been promising.

Those of us living with the new and once-highly touted Massachusetts plan, which aims to cover everyone by requiring that everyone buy insurance (and providing subsidies for those who cannot afford it), have become all-too familiar with the problems of this arrangement, which was worked out in 2006 between Mitt Romney and the Legislature.

The Boston Globe's recent front-page article highlighting how Boston Medical Center, which provides more healthcare to the poor than any other hospital in Massachusetts, is facing major deficits largely because the 2006 healthcare legislation has bled money from the "free care pool," is only one example of how this legislation, well-intended it may be, is not sustainable.

By June 2011 enrollment in the plan is projected to be 342,000 people at an annual expense of $1.35 billion up considerably from the original projections of covering 215,000 people at a cost of $725 million.

Moreover, because so much of the funding for the plan has come from the state's free care pool, many low-income residents who were once able to get care, now face unaffordable co-pays, premiums and deductibles (which have already risen 9.4 percent since passage of the reform.) According to a study done by the Physicians for a National Health Program, if a middle-income person on the cheapest available state plan got sick, he or she could end up paying $9,872 in premiums, deductibles and co-insurance for the year.
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"The Massachusetts reform law is not providing universal access to care even in a state with highyl favorable circumstances including previously high levels of spending on health care for the poor, high personal incomes, and low rates of uninsurance," the report said. "It is not a model for the nation."

A recent New York Times article, aptly titled "Massachusetts Takes a Step Back from Health Care for All," reported problems as well. The July 14 article states (emphasis is mine), "The new state budget in Massachusetts eliminates health care coverage for some 30,000 legal immigrants to help close a growing deficit, reversing progress toward universal coverage just as Congress looks to the state as a model for overhauling the nation's health care system."

Vermont's Catamount Health, public-private hybrid effort to cover the state's uninsured population now at 11 percent is also failing. Passed in 2006 as a compromise after Gov. Jim Douglas vetoed single-payer legislation, the bill, unlike the Massachusetts plan, does not mandate residents buy insurance. Instead it offers residents a chance to purchase healthcare from Blue Cross Blue Shield of Vermont with help of government subsidies based on income. But the plan, even according to its own advocates, does little to solve the problem.

One reason: the plan is unaffordable for many working Vermonters. Even those with no income must pay a monthly premium, and someone earning $30,000 a year still must pay $160 a month for coverage, plus monthly deductibles and co-pays for prescription drugs and doctor visits. Accordingly, less than a quarter of those eligible have signed up for the plan. Catamount can also deny coverage for pre-existing condition and the recently unemployed must wait a year before they are eligible for the program.

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Michael Corcoran is a freelance writer based in Boston who has been published by The Boston Globe, The Nation, Common Dreams, Alternet,, Campus Progress, Blast Magazine, and Extra!. His work, focusing largely on foreign policy, the (more...)

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I've been reluctant to comment on the "public opti... by David Kendall on Thursday, Jul 16, 2009 at 4:53:14 PM
What the public option may look like i still a mys... by Michael Corcoran on Thursday, Jul 16, 2009 at 5:37:44 PM
Thank you for responding, Michael. Your comments a... by David Kendall on Friday, Jul 17, 2009 at 5:57:18 PM