The Good News is That it Probably Can't Get Any Worse

Yeah, yeah, yeah... Public option, public option, public option... It's all I'm talking about lately. Sure, I take the occasional sidetrip to Iran or Crazytown, but -- let's face it -- the big domestic story is still healthcare reform. Among supporters and opponents, it's almost like a presidential campaign. Unless the moon explodes or something, this thing is going to suck up all the oxygen in the room until something passes or the whole thing dies.

To a certain extent, this may be a good thing. People who don't follow the mechanics of government are getting a pretty good education on the legislative process. We didn't watch the resolution to authorize the use of force in Iraq as closely as we're watching this legislation. We all remember "How a Bill Becomes Law" from Schoolhouse Rock, but that didn't really tell the whole story. You've got your horsetrading and your conference committee and your internecine political warfare; this is how the sausage is made and we didn't tell kids about it back in the day because we didn't want them to grow up cynical and convinced that the political system blows. It's a real education.

But back to the public option; what is it really? Senate majority leader Harry Reid has begun promising one. "We are going to have a public option before this bill goes to the president's desk," Reid said Thursday. "I believe the public option is so vitally important to create a level playing field and prevent the insurance companies from taking advantage of us."

The problem is that Reid has suggested that what constitutes a "public option" may be open to interpretation. It's generally assumed to be a government-run health insurance program that you can choose to buy; hence the "public" and the "option" parts. But Reid seems to believe that this definition is a straitjacket and maybe we should broaden it to include things that are more "publicish" and "option-like."

Senate Majority Leader Harry Reid (D-Nev.) called the public option a "relative term" and Sen. Chuck Schumer (D-N.Y.) said "there is not one way to Rome, there are lots of ways to Rome."

"Remember, a public option is a relative term," Reid said. "There's a public option, there's a public option, and there's a public option. And we're going to look at each of them."

None of the leaders discussed the specifics of what a watered down public option would look like. Two versions have already been rejected by the Senate Finance Committee.

And in the Finance Committee anyway, the "option" part is out the window. That is, unless you want to call something that the vast majority of Americans won't be able to choose an "option." In a fit of righteousness, an MSNBC morning host called it like it is.

MSNBC host Dylan Ratigan says the efforts of some congresspeople to kill the public health care option and limit access to the proposed health care exchange system is a sign that Congress is defending the "corporate communism" of the health care industry.

On MSNBC's Morning Meeting, Ratigan pointed to the fact that health insurers are exempt from anti-trust laws as proof of the "communist" nature of the health care industry.

Anti-trust laws were enacted to prevent companies from forming market monopolies. Health care companies are exempt from these laws, which is why, for example, BlueCross BlueShield is able to control 83 percent of Alabama's health insurance market, and why WellPoint is able to control 78 percent of the market in Maine. (See the complete chart here.)

"If you're looking for choice in your own health care or competition to break up the corporate communism that burdens our country at this point and prevents any of us from finding work -- no no, your Senate is not working for you, there will be no competition, nor will there be any choice," Ratigan said.

"Ratigan was referring to an amendment proposed by Oregon Democratic Senator Ron Wyden that would have allowed anyone with health insurance from an employer or a labor union to shop for health care on a so-called health insurance exchange," Raw Story reports. "Wyden withdrew that amendment last week after heavy pressure from business and labor leaders, meaning the health reform bill being debated in the Senate will allow only those without such insurance policies to use the exchange, rendering it useless for a majority of Americans."

Even without a public option, an exchange would be a vast improvement over what we dishonestly call a "healthcare system" today. Insurance companies would have to compete on the retail level and -- barring collusion or price-fixing -- this would go a long way toward keeping them honest.

But a public option without an exchange kind of kills that whole "option" part, doesn't it? Killing the exchange was "a great tactic," Ratigan said. "It protected health insurers from having any real competition, perpetuating their corporate communism... These are literally people who are paying off our government to make sure they don't have to compete, whether it's the too-big-to-fail banks or in this case the health insurance companies."

I'm not sure how they're planning on undermining the "public" part of the public option, but they've certainly managed to get rid of the "option" part. Still -- and expect me to keep saying this until a bill is signed or this whole thing explodes -- every serious observer expected the Senate Finance Committee's bill to be the worst. But it isn't the final bill. Look at the committee's bill as the lower limit of suck; no matter what happens after it gets out of committee, it can't possibly become worse. It can only get better. That's what I keep telling myself, anyway. There's always markup and amendments on the floor.

Still, rays of hope shine out in the form of pure self-interest. Moderate dems, seeing how popular the public option is with the base, are unwilling to be seen as being among those who killed it off. Brian Beutler, writing for the blog Talking Points Memo, puts it this way; "One difficulty that both the White House and public option skeptics appear to be facing is that, though they may be perfectly happy to advance a bill without a public option, the measure remains very popular, and intensely so among politically engaged, Democratic voters. That's a dynamic to keep an eye on: At this point, nobody wants to be identified as the driving force behind its demise."

In the end, that's the best hope we have for getting an actual, honest-to-goodness public option on the president's desk -- as opposed to a publicish optionoid -- pure fear. They're afraid of us and, for once, they're afraid to be identified as the one who screwed us over.

We've got the leverage here, so we need to use it.


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