UPDATE – Public Option Has Got Legs

I’ve been surprised at how the public option has stayed in the news since the President wrote in favor of it in the American Medical Association journal in July.  It’s got legs.  Hillary Clinton supports a public option.  This week, it was announced that 33 Democratic senators – including Harry Reid and Chuck Schumer, joined by the independent socialist Bernie Sanders – also support a public option.

Supporters of the public option say it is necessary because so many parts of the country are down to one insurer in the Obamacare exchanges.  A public option would cut prices and boost competition, they say.  They have a website – WeWantAPublicOption.com – and point to polls saying a majority of the American people want it, as well as a CBO study from 2013 saying a public option would lower the deficit.

Of course, we know that a public option would only be able to cut prices because it would be subsidized one way or another.  This would drive the remaining insurers out of business very quickly and the debate over single-payer would be upon us.

There’s another scenario within the realm of possibility. It’s getting to be crunch time for Obamacare.  It can’t go on the way it is, that’s pretty evident.  Whoever wins the White House, suppose the public option is put forward in Congress as the way to keep and fix Obamacare.  Suppose also, enough Republicans are not on board with repealing Obamacare outright, but are willing to make a deal.  Suppose the deal offered is this: we get rid of the individual mandate, the employer mandate, and lots of other bad stuff in Obamacare in exchange for keeping Obamacare and instituting the public option.  Such a deal would be very tempting to lots of Republicans.  Obamacare stays but gets re-branded with a new name, the way states have been re-branding Common Core to fool the public into keeping it.

Even if the Republicans hold the Senate, I wonder whether there are enough Republicans in both chambers willing to stand up to stop a deal like this.  I can see the Republicans caving, can’t you?

Under this scenario, we would certainly have our work cut out for us.  We would have to convince the country that keeping any part of Obamacare, or whatever the reshuffling gets called, is the wrong way to go, then convince people that single-payer is not the answer, either.

Finally, let me mention that one of our tweets zoomed up in the first hour it appeared, to become our most popular tweet in the entire last month.

Here it is: Medicaid expansion is a classic third-party payer problem: state politicians feel free to overconsume because someone else is paying.

I guess enough people are familiar with the third-party payer problem in insurance to get the analogy immediately.  Our tweet is intoxicating; use it responsibly.





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