As any good Persian rug dealer knows, you have to hold back a bargaining chip so that you can whip it out at the very end to tie down the sale. That's how President Barack Obama is playing the so-called public option in his healthcare program.
His plan seems to be to combine its abandonment with some form of tort reform and try to buy off some Republicans — maybe only Maine Sen. Olympia Snowe — to give moderate Democrats enough confidence in the veneer of bipartisanship to win their backing for his bill.
But it's a fraud and a trick.
Here's why: Whether or not there is a public option makes no difference in the fundamental objection most elderly have to the bill: that it guts Medicare and Medicaid. All of the bills now under consideration cut these two programs by one half of a trillion dollars. And all require the medical community to serve 30 million to 50 million new patients without any concomitant growth in the number of doctors or nurses. These cuts and shortages will lead to draconian rationing of medical care for the elderly, whether under a public option or not. The most likely proposal is to replace the public option with some form of buyer's co-op. But since there is no currently existing co-op to serve as a vehicle for health insurance, it would have to be formed. By whom? The government, of course. That would mean, as a practical matter, that the "co-op option" would be a government-run plan for several years. In fact, they may not get around to setting up a co-op at all. The other alternative, mentioned by Snowe herself, would be for a "trigger" mechanism. This provision would require the creation of a public alternative to private insurance plans if, after a specified period of time, they did not lower rates to a pre-determined level. Given the escalation of healthcare costs, it is almost inevitable that this provision would lead to a government plan. And, anyway, who says that the government insurance option would be more successful in reducing costs?
But Obama has to at least appear to be willing to compromise, so he has invented the idea of repackaging the public option in order to seem to be flexible.
The key, here, is not to be distracted by the debate over the public option. It matters very much to private insurance companies whether the government becomes their competitor, but, for the elderly (and the near-elderly), the key concern is not the public option but the rationing and cuts projected under the program.
In the Clinton administration, we worked hard to kill the proposed Medicare cuts and are no less committed to stopping them in the Obama presidency. That they were once proposed by the right and are now being pushed by the left makes no difference. A cut is a cut is a cut. And Medicare should not be cut.