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H.R. 676: a stronger public option than expected

By   Follow Me on Twitter     Message Don Smith       (Page 1 of 2 pages)     Permalink    (# of views)   3 comments

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One often hears the claim that single-payer health care bills, such as H.R. 676, would be "single payer, private delivery." For example, Ralph Nader said on OpEdNews: "All proposals, including single payer, are based on private delivery of health care." (source).

Another example: Kate Murphy in Single-Payer & Interlocking Directorates writes, "A single-payer plan would allow the delivery of healthcare to remain private." Try googling ("single payer, private delivery") or ("single payer, private delivery" to see other examples of the claim. I myself have made such a claim, I believe.

I now believe the claim is only half true.

Today I read the text of H.R. 676. I was surprised. In SEC. 103. Qualification of participating providers, it says "(1) In general, No institution may be a participating provider unless it is a public or not-for-profit institution. (2) Conversion of investor-owned providers.Investor-owned providers of care opting to participate shall be required to convert to not-for-profit status." Similarly, according to , "only public and non-profit institutions may participate."

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So, while H.R. 676 won't eliminate private delivery by individuals (e.g., physicians), it will eliminate private delivery by for-profit institutions such as hospitals and clinics. Private nonprofits and public institutions could deliver health care, but private, for-profit institutions could not.

Now, presumably individual doctors could continue to be for-profit. But what if a doctor opens a clinic (an institution)?

H.R. 676 also seems to prohibit private insurance companies from competing with the government plan. (Correct me if I'm misreading this!) H.R. 676's SEC. 104. Prohibition against duplicating coverage says " (a) In general.It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act. (b) Construction.Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, such as for cosmetic surgery or other services and items that are not medically necessary."

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Now, in my opinion, "single-payer" should be regarded as a particularly strong "public option" -- an ideal public option. One can imagine less strong public options that permit private insurance companies but that discourage private insurance by being competitive enough to win in the marketplace. Just build a strong enough public plan that nobody would bother using private insurance, except, perhaps, for purchasing supplemental insurance for extra coverage ("a Cadillac plan").

Therefore, wouldn't a strong public option that permitted but discouraged private insurance be enough? And wouldn't be less open to libertarians charges of "statism." Now, I strongly disagree with libertarian philosophy, but that doesn't mean that people don't have freedoms! Or would permitting private insurance (e.g. for "Cadillac coverage") make the public plan infeasible? For example, it would not eliminate the multiplicity of paper-work requirements and rules that providers need to follow -- one cause for high costs.

Similarly, a strong public option can permit delivery by private, for-profit institutions, provided they meet certain regulatory requirements. Progressives needn't insist on delivery by only public or not-for-profit institutions.

For example, Netherlands has a health care system that uses highly regulated private insurance companies. Its system is in fact similar to single-payer because the private firms act like utilities.

Even the US House's HR 3200 (the 1000 page health care bill proposed by the House) is redeemable, according to an in-the-know single-payer advocate. (I'm going to ask this expert to submit an article explaining the issues.)

Single-payer is an ideal, and it's good to use it as an initial bargaining point, but if we don't get it 100% we could still have good reform -- e.g., a strong public option that competes successfully with regulated private insurers.

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Now, I've been getting email from groups like OFA,, and DFA encouraging me to support Obama's quest for a "public option" -- whatever that is. Obama has never specified precisely what he wants in a public option, and the plans being considered by the House and the Senate are different and complex. The Senate plan being proposed by Max Baucus' finance committee is particularly weak.

I also get a lot of email, and read a lot of articles, encouraging me to support only single-payer health care. Many people say the bills being considered in Congress are merely sell-outs to the Insurance industry, Big Pharma, and Hospital corporations. We certainly don't want to see a repeat of the Medicare Bill that merely funneled taxpayer funds to drug and insurance companies.

But must we insist on as strong a public option as H.R. 676? In Particular, must we prohibit private, for-profit insurance and delivery?

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DFA organizer, Democratic Precinct Committee Officer, writer, and programmer. My op-ed pieces have appeared in the Seattle Times, the Seattle Post-Intelligencer, and elsewhere. See and for my writing, my (more...)

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