Making Sense of the Public Option

Joe Klein on the public option:

I never had much interest in a public option. I think the perils of government-delivered (as opposed to funded) services are obvious and immense....On the other hand,  I am very much in favor of a single-payer system in which the government gives everyone a tax credit, scaled according to income, that enables people to select from an array of government approved and regulated health insurance choices.

There's something very odd going on with the debate over the public option.  Granted, it means different things to different people, but I'm pretty sure that nobody in a position of legislative authority has ever proposed a public option that provides "government delivered" healthcare.  There are various versions of the public option, but all of them are alternatives to the private insurance industry, not the private medical industry.  In some form or another, a public option would be a federally run insurance program, similar to Medicare, that pays for medical services you get from the private sector.

In effect, a public option is a backstop.  The basic point of the healthcare plans currently on the table is to reform the insurance industry (community rating, no recission, no rules about preexisting conditions, out-of-pocket caps, etc.) and then to provide subsidies to low-income households so they can afford to buy this reformed insurance.  But all those new regulations have to be enforced, and a public option would be a way of keeping insurers honest via competition even if the rules turn out to be imperfect.  Ideally, though, the regs would work and very few people would have an incentive to sign up for the public plan in the first place.

Personally, I still think that backstop is pretty important.  New rules never work perfectly, regulatory capture is always right around the corner, and a public option would provide competitive pressure that would keep costs lower.  On the other hand, there's also a downside: a public option provides a kind of safety valve for private insurers.  Maybe they can no longer flatly turn down someone with an expensive preexisting condition, but they can probably slow roll an application pretty effectively — and the victim of the slow rolling is a lot less likely to complain about it if he has the option of just throwing in the towel and signing up for the government plan instead.

So as much as I'd like to have a public option (primarily for its ability to force more robust price competition), I just don't see it as something to threaten nuclear destruction over.  If insurance reforms are robust and low-income subsidies are decent, that's a huge win for millions of people, and it's a win we can build on.  And contra Atrios, social legislation does have a history of getting better after it's first passed.  Just ask Henry Waxman.

There's more to say about this.  For example: most European countries rely on regulated private insurers of one kind or another to provide universal coverage, and they've managed to make this work.  And: a credible threat only works if the opposition is afraid you might carry it out.  But as near as I can tell, the folks who oppose the public option aren't really all that afraid of the possibility that healthcare reform sinks completely.  Plus: the only way to get it is via reconciliation, and various comments to this post make it pretty clear that trying to pass a huge healthcare bill via reconciliation is probably impossible.

It's worth fighting for a public option.  But it's not worth sinking healthcare reform over it.  That would hurt too many real flesh-and-blood people who need this, and a second chance wouldn't come along for a long time.  We've failed on the healthcare front too many times to accept failure again.

Staying a Step Ahead

Should Democrats have foreseen the pushback against Medicare funding of advance care counseling and struck it from the House bill before it ever saw the light of day?  A couple of weeks I argued no.  After all, if conservatives hadn't gone crazy over that, they just would have found something else to go crazy over.

Now, I have to admit that the death panel frenzy we've been subjected to since then has shaken my confidence in this.  Maybe this was a uniquely vulnerable provision and we should have foreseen the reaction.  But no.  Amy Sullivan writes in Time this week about a completely different right-wing freakout over an even more innocuous provision in the bill: prenatal parenting counseling for expectant mothers.

Now conservative opponents of health reform have found a new threat: home nurse visits to low-income parents. "We are setting up a situation where Obama will be invading parent's [sic] homes and taking away their children," one columnist warned on RightWingNews.com. That something as harmless as home nurse visits has become a target of conservative ire is surprising because of its longstanding popularity with both Republican and Democratic lawmakers. But health reform advocates are scratching their heads at the attacks for another reason: funding for home nurse visits was largely included in health reform legislation to accommodate social conservatives.

....The home visitation provision in health reform legislation was modeled on a bill authored by Republican Senator Kit Bond of Missouri. Bond went through a parenting education program in Missouri when his son was born three decades ago and has been a fan of the idea ever since. "Being a parent is hard work," he says, "and babies don't come with directions."....Home visits have been so popular with conservatives that the idea kept coming up during conversations White House aides hosted with pro-life advocates earlier this year in an effort to find common ground on abortion. And when Democratic Reps. Tim Ryan and Rosa DeLauro drafted the abortion reduction bill they introduced last month, they specifically included funding for home nurse visits as a way of accommodating pro-life preferences for policies that support women who decide to give birth instead of having abortions.

Home nurse visits are about as bipartisan an idea as it's possible to have.  Conservatives like it because it reduces the incentive to get an abortion and liberals like it because it's good social policy.  Everyone likes it!

But has that stopped the lunatic fringe from attacking it as a secular plot to indoctrinate the mothers of America?  Nope.  It hasn't gotten a ton of attention yet, but that's only because the loonies have been obsessed with death panels instead.  If that weren't in the bill, Sarah Palin would have dubbed the home nurse program as the Baby Brainwashing Brigades and everyone would be going nuts over that instead.

So I'm sticking to my guns.  It wouldn't have mattered what was in the bill, just like it didn't matter that we elected Obama instead of Hillary Clinton.  The loons would have found something crazy to scream about no matter what, and the media would have covered it.  That's just the reality we have to deal with.

Whale Billboard: PETA, Please.

PETA is like your eccentric uncle who shows up drunk at weddings: Most of the time, his annoying antics are sort of harmless and funny, and let's face it: Were it not for him, your family wouldn't have a whole hell of a lot to talk about. But sometimes he totally crosses the line and does something truly mortifying.

Oy.

HT Feministing.

Cutting off Al-Qaeda

Alex Rodriguez of the LA Times reports that the time is right for a major push against the Taliban:

For years, Al Qaeda and the Pakistani Taliban have nurtured a symbiotic relationship that has paid off for both militant groups. The Taliban provided Al Qaeda and its leaders sanctuary within the rugged wasteland of Pakistan's tribal areas along the Afghan border. In turn, Al Qaeda trained and helped finance its host.

Now, with the purported death of Taliban leader Baitullah Mahsud and his organization temporarily rudderless, Al Qaeda finds itself made vulnerable by the disarray plaguing its patron, experts and Pakistani intelligence sources say. It's a window of opportunity that neither Pakistan nor the United States can afford to neglect.

....With the Taliban mired in disarray, experts say Pakistan and the U.S. need to ratchet up their bid to track down and eliminate other top Taliban commanders. The aim, they say, is not just to dismantle the Taliban, but to cut off Al Qaeda from the entity that keeps it insulated and secure deep within the badlands of Waziristan.

Italics mine.  Although the word "Afghanistan" is barely mentioned in this piece, it's pretty obvious that amping up the pressure on the Afghan Taliban is the flip side of all this.  So the question is: is it really true that the Pakistani Taliban is in disarray and al-Qaeda is vulnerable?  Or is this all part of a finely tuned media campaign to build support for a troop buildup in Afghanistan?  After all, we've been hearing that the Taliban is this close to defeat on pretty much an annual basis for the past five years.

And who knows?  Maybe it's true this time.  But even given the inherent difficulties in knowing what's really going on in the border regions, I think I'd still like to see some more concrete evidence.  As the article implies, one part of that would be evidence that the Pakistani army can actually fight effectively against the Taliban and al-Qaeda on its side of the border, something it really hasn't been able (or perhaps willing) to do in the past.  I'd like to see that happen first before we make any decisions about building up NATO and U.S. troop strengh.

What Obama Should Have Learned From The Gipper

One of the stranger things about the Obama presidency is how savvy and innovative he was as a candidate about mobilizing public opinion, compared with how conventional, even lackluster, his public outreach has been ever since he moved into the White House. Sure, he's given a lot of speeches, and some of them have been quite good. But he knew he had several giant contentious policy plans in the works that would infuriate conservatives, whose effectiveness as political performance artists is unparalled. Over at Politics Daily, David Corn argues that Obama hasn't done enough to prep his grassroots supporters to take on the right-wing noise machine, and that he could avoided the current health care mess by paying more attention to... Ronald Reagan. Check it out here.

 

The Co-Op Cop Out

So. The public option has been thrown overboard, and we’re back to co-ops. As I've pointed out previously, the co-op scheme is a weak, nearly meaningless idea that would represent no real alternative to business-as-usual in the health insurance industry.

In the best-case scenario—which is far from guaranteed—the co-ops might have a less corporate governance structure than other insurers and receive federal subsidies for startup costs and more expansive coverage. In the worst-case scenario, they would effectively be private insurance companies operating under another name. And at least some of the initial capital will, in all likelihood, come from members. All the out-of-work Americans who are too poor to buy insurance will appreciate that.
 

Eco-News Roundup: Monday, August 17

Twip of the day: To keep up with environment, health, and science news from Mother Jones and beyond on Twitter, follow @MoJoBlueMarble. In the meantime, here's a sampling of Blue Marbleish goings on this Monday morning:

Get your Kevin Drum fix: If you didn't get a chance to watch Kevin Drum's NetRoots Nation keynote live, this week's MoJo podcast is a short Pittsburgh dispatch from him. In it, we talk about the NetRoots Nation male-to-female ratio, Arlen Specter on the healthcare "death panels," and how fellow attendees are feeling about Obama. Listen to the podcast here.

"Hatred, vitriol, and racism:" James Ridgeway on how town hall meetings on health care reform have become the latest target of violent far-right rhetoric.

Bag ban battle: As more and more cities ditch plastic bags, the plastic industry fights back.

The fine print: Over at Climate Progress, two different takes on whether or not Wal-Mart's pricy eco-labeling plan will work.

Is renewable energy worth more quakes? The San Francisco Chronicle on the promise and the peril of geothermal.

Have you ever heard of an "urban whale?" Treehugger explains why the term is, unfortunately, not as oxymoronic as you might think.

 

 

 

U.S. Army Pfc. Ali Hargis, assigned to 55th Signal Company, Joint Combat Camera-Iraq, interviews a soldier from the Iraqi Army's 37th Brigade, 9th Iraqi Army Division, about his two-and-a-half week training with U.S. Soldiers on how to spot and report unknown explosive ordinances and improvised explosive devices at Camp Taji, Iraq, Aug. 3. (Photo courtesy army.mil.)

Music Monday: Pissed Jeans Grow Up (+ Free MP3)

Pissed Jeans
King of Jeans
Sub Pop


To people whose last whiff of Sub Pop came sometime in the late '90s—as grunge's last fart lingered just a little too long—Pissed Jeans probably sound like an evolution of sound. Their hard, slow-swinging punk is soaked in the patented, scuzzed-out heaviness that once made the label a king maker.

A critical distinction, though: Pissed Jeans have an absolutely ferocious angst creeping through each song, and deep punk roots, which makes them palatable to people (like myself) who could never get down with the Northwest grunge scene. Hailing from Allentown, Pa., the band draws its sound more from the old Amphetamine Reptile roster of noise rock or, going further, from the hectic noise of Touch & Go's Jesus Lizard and Butthole Surfers, or even Flipper.





 

Need To Read, August 17, 2009

Some must-reads to start your week:

Government refuses to provide even minimal information about detainees held in Bagram.

The map of failed banks.

Why newspapers are really failing.

The best-paid CEOs in the US.

Annie Leibovitz's personal financial crisis.

David Corn, Mother Jones' DC bureau chief, is on twitter, and so are my colleagues Daniel Schulman, Nick Baumann, and our editor, Clara Jeffery. You can follow me here. (The magazine's main account is @motherjones.)