Bridging the divide over the ideological ground zero on care

The ongoing debate involving the inclusion of an option for a public health insurance plan has taken on very clear political overtones. It has become the ideological ground zero. Most Democrats strongly believe that it should be an option. Most Republicans strongly oppose it.

It may be an issue on which no compromise can be found. Yet, I am hopeful, based upon my conversations with many on both sides of the aisle, that such a pessimistic outlook is unwarranted. There are many ways to accomplish what both sides say they want.

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But, as counterintuitive as it may sound, there are five compelling reasons why conservatives and Republicans generally might consider the value of a public option before saying no, unequivocally, to all the myriad ways to create one.

First, few experts on either side dispute that without a public plan option in the proposed health reform bill, private insurers will be subjected to heavier regulation to achieve affordable access to care. Those same experts acknowledge that inclusions of a public plan would actually mean more competition and less regulation — in fact, too much competition. Some fear a public plan option will be so affordable and attractive that a large number of Americans will join it. There is little doubt that we can level the playing field to protect from creating certain unfair advantages in the public plan. Given the choice between more competition and more regulation, my expectation would be that Republicans would choose more competition.

Second, most Republicans assert that of all the goals involved in the creation of a new health system, one of the most important of all is to ensure that Americans have a choice of options. This is also a high priority for Democrats. If this is truly the goal of both parties, is it not contrary to our stated goal to deny an option of the choice of a public option? Is it not difficult to argue the importance of choice and then limit one of the most important choices available to every American?

Third, another area where Republicans and Democrats agree is the need to contain costs.  We will have failed in our efforts to reform healthcare in this country if we have not included specific tools to make healthcare affordable.

Virtually every study that has been done on the implementation of a public option lists its ability to reduce cost as one of the most compelling reasons for inclusion. With greater competition and effective choice, even when rules to level the playing field are included, according to these studies, the cost of healthcare comes down. If this is the case, and if cost containment is as important as most people acknowledge, why would we want to disallow the contribution toward that goal that a public option can provide?

Fourth, there are millions of Americans who cannot afford or access public or private insurance today due to high costs or preexisting conditions. It is largely understood among policy makers that these people will be put into the state insurance pools and exchanges in the new system. If that is the case, it is hard for me to understand why Republicans would want to burden the insurance companies with the complete responsibility to insure all of these people and do so with a community rating as they calculate their premiums. We know from experience in virtually every state that the current side-by-side system works well today. Republicans have long championed this approach with Medicare Advantage.  State employee health plans, CHIP and state high-risk pools have not crowded out private plans. In fact it is just the opposite. They have allowed private plans to work better.

Fifth, this is one of those rare occasions when good public policy is also good politics. Many legislative decisions require some political courage. This one does not. It is clearly a choice between special interests on one hand and the popular will on the other. Overwhelmingly, the American people support the inclusion of a public plan. One poll reported that 68 percent of Republicans, 73 percent of Democrats and 78 percent of independents are supportive.

Given the compelling reasons why Republicans and Democrats should support a public option, the argument should not be “if” but rather “how” a public plan can be implemented. Providing states with the authority they already have in other health contexts or allowing for the federal government to assume some or all the risk while contracting out the services are certainly options worth exploring.

And as we do, there is one more healthcare fact upon which there is little disagreement. The status quo is no longer acceptable.



Daschle is a former Democratic senator from South Dakota.

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