The Public Option May Arise Again
In response to my dismissal of Sen. Bernie Sanders’ campaign for the presidency, my best friend and mentor advised, “never underestimate an old man with a sociology degree.”
True that. The candidate with the socialist agenda is the fancy of voting women and young Democrats around our nation. If Sanders does what everyone expects him to do at the convention in July, the Democratic Party most assuredly will woo his supporters by moving to the left on many platform issues, including the adoption of some version of his Medicare-for-all proposal.
Hillary Clinton got the message, and she isn’t waiting for the convention to move leftward on healthcare reform. She recently went on record in support of opening Medicare as an option for some Americans who want it but are not currently eligible. Essentially, her proposal would allow those people 55 or older to purchase insurance from the Medicare program, years shy of current eligibility for those who are able-bodied.
In many ways, that echoes the “public option” that had been debated as the Affordable Care Act legislation was authored a half-dozen years ago.
The public option was stricken from the ACA legislation to garner then-Senator Joe Lieberman’s much-needed vote of approval. As Lieberman’s home state of Connecticut contained many powerful insurers, he was coming under pressure not to favor the ACA if it continued to contain such a provision.
Had the public option been left in the legislation, our government would be competing with commercial health plans in the private insurance market. Whether that might have kept premiums in check from the commercial sector -- or whether more of them would have opted out of the exchanges -- is unknown.
While Clinton’s support of the public option is neither new nor news, her recent promotion of a new version of this defeated plan is. But she also understands the folly, though, of asking a divided Congress to approve it or a Medicare option.
So, a President Clinton would use the authorities of her office and the ACA to work with interested governors to allow states to create and operate a public option-style health insurance plan.
And why wouldn’t states jump at the chance? Many would be motivated to use a public option-style plan to cure the ills caused by the lukewarm, uneven and often contentious participation of commercial plans in their ACA Exchanges.
Moreover, health insurance premium rate hikes are returning to their pre-great recession levels, with Covered California itself saying that increases could average 8% next year. That will contribute to the pinch consumers continue to feel in their pocketbooks, as out-of-pocket expenses for healthcare have almost doubled in some parts of our nation since the ACA was enacted.
I am thinking that it’s a sure bet that our left-leaning, program expansion-oriented California Legislature would be one of the first to create a government-run private health insurance plan if a Clinton Administration gives the go-ahead.
Covered California is ready-made and poised to run with the task. And while you’re thinking about the possibilities, brush up on your knowledge about single-payer health insurance systems…because that’s where all this is headed.
So, what about the Republican side of this issue? What will it and a President Drumpf do?
I don’t learn, I guess, so I dismiss “The Donald” like I did Sanders, to which my mentor responds with a modified Ronald Reagan favorite, “There you go again!”
Jim Lott is a healthcare consultant in Los Angeles and was the long serving executive vice president of the Hospital Association of Southern California. He is a member of the Payers & Providers Editorial Board.
