The inevitable public option

The political pundits have all but proclaimed its death as a result of special interest pressure and the caustic and angry voices at town hall meetings.

“Government takeover plan, meet the death panel.”

But I smile as I think of how similar it is to the time I took my old, leaking car with strange noises emanating from the engine into an auto repair shop. I still remember the auto mechanic’s admonition. “You will pay me now or you will pay me later, but you will pay me or someone else at some point in the future.”

So it is with health insurance. We can adopt a public option now or we can adopt it later, but we will adopt it at some point in the future, like it or not.
It will happen for three simple reasons.

First, as costs continue to escalate, future Congresses and administrations will become increasingly desperate. As they analyze options, they will inevitably recognize that the only alignment of incentives with value is in publicly sponsored options. Too many dollars and lives are wasted by insurers’ paying blindly and looking the other way when a conflict between a provider and patient arises.

They will recognize that a vital aspect of effective cost containment is meaningful payment reform, where value, not volume, is rewarded. In so doing, they will conclude, as many of us have, that the most effective way to implement such reforms is to do it as we have increasingly done with Medicare, leading though example.

Second, Congress will also conclude that improvement in outcomes is essential. But they will recognize that the only alternative to a public option in achieving meaningful quality reform is the creation of a burdensome regulatory framework that will be forcefully resisted at every turn by virtually all stakeholders. Once having recognized that regulation is worse than competition, a public option will look like a very suitable compromise, even to many conservative members of Congress.

Third, as insurance companies struggle with new laws regarding guaranteed issue of health insurance, regardless of health or economic status, I predict that even the most vocal opponents of a public option in the health insurance industry will reverse position and become true believers.

So the message from my crystal ball is as clear as it is unequivocal.  A public insurance option: Do it now or do it later. But you will do it.

Before acquiescing to the pundits and special interests, I would hope that all members of Congress would ignore conventional wisdom, consider this inevitability and join on the side of those of us who advocate doing it now.

After careful deliberation, the Senate Health, Education, Labor and Pension (HELP) Committee and the House Energy and Commerce Committee have produced excellent public option proposals. They deserve careful consideration and the support of the full House and Senate. I commend Chairmen Chris Dodd (D-Conn.) and Henry Waxman (D-Calif.) for their admirable leadership in passing this historic work.

Unfortunately, my position on the public option has been mischaracterized. I always have, and always will, support it.

While I am willing to accept other options such as a health insurance cooperative or state-based public options in an effort to pass all of the other important and necessary reforms, I have serious doubts about their efficacy. Furthermore, I see them as a beginning, not an end.

But my position has little or no consequence in this debate. It is the positions of 535 elected members of Congress that truly matter.

And with that understanding, just remember that you read it here.  Either now or later, a public option will pass the Congress and be enacted into law.

And the vast majority of Congress will vote for it.

Daschle was formerly Senate majority leader.