In an effort to thwart growing skepticism of a public health insurance option, proponents of the idea are becoming more strident in urging the White House to keep its eye on the prize: Do not compromise in overhauling the U.S. healthcare system so all Americans can have affordable health coverage.
"Without a public option, the parties that comprise America's non-system of healthcare–private insurers, doctors, hospitals, drug companies, and medical suppliers–have little or no incentive to supply high quality care at lower cost," said Robert Reich, former labor secretary and public policy professor at the University of California Berkeley.
"And that's precisely why the public option has become such a lightning rod. The American Medical Association is dead set against it, big Pharma has rejected it out of hand, and the biggest insurance companies won't even consider it. No other issue in the current healthcare debate is so fiercely opposed by the medical establishment and their lobbies [are] now swarming over Capitol Hill," he said.
"Of course they don't want it. The public option could squeeze their profits and force them to undertake major reforms. That's the whole point," he added.
Reich was joined in a news conference yesterday by Jacob Hacker, co-director of the UC Berkeley School of Law's Center on Health, Economic and Family Security, one of the leading advocates of the public plan option.
"We can't afford not to act right now," Hacker said. "We can't afford to cut the heart out of this reform legislation."
To reinforce their points, they cited a new report from Health Care for America Now, which documented that in the last nine years, the cost of health insurance has risen 120% while wages grew by only 29%. Health expenses have been the underlying reason for thousands of bankruptcies, which have prompted thousands of employers to discontinue coverage for their workers and caused many people to delay getting needed care. Lack of health insurance, the report said, causes 22,000 U.S. deaths each year.
Reich and Hacker spoke as the lawmakers and health policy experts are more seriously entertaining a proposal that would substitute smaller health insurance purchasing cooperatives for the public option, an idea proffered by North Dakota Democrat Sen. Kent Conrad.
Reich said "the strength of opposition (to the public plan) along with the president's own commitment to making the emerging bill bipartisan, seems to be leading to some very oddball compromises on the Hill, particularly in the Senate," Reich said.
He urged the president to forget about convincing Republicans to support a bipartisan effort. The public plan option "can pass with a majority vote," Reich said.
In recent days, California Sen. Dianne Feinstein voiced her doubts about a public plan, saying yesterday President Barack Obama may not have the votes for such an ambitious overhaul of the system.
"There's a lot of concern in the Democratic Caucus," Feinstein said on CNN. "If you change the Medicaid rate (to pay for the public plan) it has an impact on California of between $1 billion and $5 billion a year. Now how could I support that? Because it would take down the state."
Just covering the 6.6 million Californians who lack health coverage and are below the poverty line "becomes a huge, huge problem" Feinstein said.
But Reich and Hacker, who yesterday took their views before the House Education and Labor Committee, said Congress and the White House should do what recent polls say America wants, which is to give private health insurance companies some much needed competition.
Reich said the idea getting the most traction this week (smaller private cooperatives that would buy health insurance for its members) sounds like a good idea, but "doesn't have the scale, the authority, or the scope necessary to negotiate better rates for its enrollees."
Smaller cooperatives also would not be able to generate the badly needed outcome data that consumers need to learn what providers and healthcare strategies get the best results.
Hacker and Reich also said that other suggestions, such as states operating their own decentralized cooperatives or public plans, falls apart for the same reason.
Health insurers have said they would accept all members regardless of pre-existing conditions and not charge women more for individual insurance in hopes of derailing public insurance, but Reich said a public plan is a better option.
"Without a public option from the start, private insurers won't have an incentive for a system-wide model to reach these targets," he said.
"It is critically important for the president to make crystal clear to Democrats and Republicans alike that he will not sign a bill that does not have a real public option in it," he added.