The Daily Beast, December 9, 2009
The Senate deal that's killed the public option isn't cause for tears. Why the left's dream of universal coverage is finally within reachand what the Democrats need to do next.
For my liberal friends who are mourning Tuesday's Senate health deal as somehow representing the death of "real reform," I have six words: Keep your eyes on the prize. Far from some "sellout," the compromise struck by five liberal and five moderate Democratic senators means that we're at last on the threshold of the biggest liberal achievement in decades.
Why? Because the emphasis on the public option in this debate has always been way out of proportion to its real impact. As the Congressional Budget Office concluded, a pure public option was likely to enroll only a few million Americans at most, and would likely have featured higher premiums, because it would attract sicker citizens as enrollees.
Truth is, the central progressive goal of reform should never have been the public option, but rather to make it possible for every American to access group health coverage outside the employment setting
. That access does not exist today, and that's what the new proposed insurance exchanges would enable. What's critical, therefore, is the structure of these exchanges, the rules about who will be eligible to use them, and the adequacy of the subsidies for those who need help.
These questions have received too little attention in the debate, but need to move front and center in the endgame. For example, current bills bar people who enjoy employer-based coverage from seeking insurance from the new exchanges; this ban should be scrapped in favor of the choice proposal offered by Senator Ron Wyden, under which employees would have the option of using the cash their firm spends on their benefits to buy coverage they prefer at the exchange.
If such tweaks are added in the weeks ahead, the emerging bills will deliver what most on the left would have considered a miracle a few years back. Nearly $900 billion will be spent over ten years to achieve near-universal coverage. Insurance companies will never again deny people coverage based on pre-existing conditions. New limits on out-of-pocket costs as a percent of income will mean that no American will ever go bankrupt from medical costs again. And, thanks to the Senate's Tuesday deal, Americans aged 55 to 64 who lose coverage (and can't find affordable new coverage on their own) would be able to buy into Medicare, with help via new subsidies-an idea the left has craved since President Clinton first pushed for it in the late 1990s.
Make no mistake: these changes would bring America at long last into the community of civilized wealthy nations.
To be sure, there are good reasons to worry that this year's health reform won't do enough to control health costs, a project that will remain a national imperative for the next two decades (though worrywarts here should read Atul Gawande's indispensable new piece in the New Yorker, which gives sophisticated grounds for hope on the cost score as well).
So is the bill imperfect? Of course. Will it need to be revisited in the years ahead? Absolutely. Is it also shaping up to be the biggest progressive achievement in our lifetimes? Yes, yes, yes.