Who knows if the outlines of the Senate deal will hold? The deal, as I understand it, will be to permit individual Americans to enroll in public insurance version of Medicare at age 55, and would also expand Medicaid to 150 percent poverty and would create some version of a national insurance exchange to enhance competition, the exchange being overseen by either not-for-profits or government.
If the final Senate bill is an expansion of both Medicare (as public insurance, not as entitlement) and Medicaid is signed into the deal, we will have a much higher percentage of health care spending coming from government sources than have now, perhaps as much as 65 percent. And that makes the big reform we are going to need---something close to a single payer---much closer to a reality in the next 10 years.
If I were a progressive in the House, and this deal passes the Senate, I would take the deal and send it to the president.
The Senate compromise, again as I understand it, would be very good news indeed. The critical issue in health care reform is to convince the public that the government is our best hope for controlling spending, not the market.
I've always thought that the major problem with the public option is that it prolongs "competition" as the major disciplinary instrument for health care. The theory was that competition would reveal the utter inadequacy of private health insurance and that the public option would drive down private health insurance costs.
Surely a little competition or a lot would help. But even in the short run it won't save us, not by a long shot. For stopping spending's upward spiral we will need government, and I still don't know whether the big brains in the Senate have come to realize that.
And I'm the first to admit that the Obama administration has muddied the case for strengthening government's hand anywhere by its using tons of bail-out money to save Wall Street and getting almost nothing in return.
One critic in the Daily Beast says that the Senate health care compromise is "the surest flight path to Canada."
Let's hope that's wrong and instead it's the surest flight path to our version of Medicare for All. The critic is Tunku Varadarajan whom I've never heard of, but he's a research fellow at the Hoover Institute, which likely means that he is another right-wing conservative mouthpiece, and likely an Any Rand disciple. He also is on the faculty of the NYU School of Business.
The public option is pale beer compared to a greatly expanded Medicare footprint in the health care system.
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