The public option

Color me - moderately - amazed. Reid said today that the public option will be in the final Senate health care bill. Now I try to avoid the prediction game - and often fail. (It's just so much fun!) I fully expected the public option to disappear by this point - and predicted it would. I don't like being wrong - or rather my ego doesn't - but in truth when I'm wrong out of pessimism I'm fine with it. The public option is the only part of the health care debate that counts as real reform. The mandate, the taxing of "Cadillac policies", the fines, the lack of cost controls - even the removal of the "pre existing condition" out for insurers - will have deleterious effects without cost controls in place. All have unintended consequences. Or , more on point, the consequences are being ignored. Consequences legislators are paid to ferret out.

The intended consequences of the public option are out in the open. The public option empowers people - actual people. It checks insurance company abuses. It draws a line in the sand. Yes, the public option will be of lesser quality than private insurance. Public schools often can't compete with private ones- but we need them and they serve a purpose. The post office can't compete with U.P.S. in terms of efficiency - but the public has a vested interest in basic postal service.

I'm not a delusional liberal about this either. I'm quite sure that IF (it's still a big if) a public option survives it will be an unholy mess for a while. Still, after single payer was taken off the table, the public option was the only element left that established some boundary against insurance company abuse. Without the public option health care "reform" amounts to mass indentured servitude to insurers.

I believe in the free market in most areas. Health care is not an area in which the free market can go unchecked. It too often penalizes those who need care. Not all who need care. Most who need it - get it. But enough don't to make it a moral imperative for the government to exercise some control.

And no, I'm not irrational and delusional about rationing and wait times. But I always return to this simple fact: rationing and wait times already exist in this country. Health care is often rationed for the middle class NOW. I personally know of two people - who by American standards are middle class - who are indebted severely becaue they needed treatment for real conditions. One simply did not follow through with her treatment and lives with the debilitating condition. Neither are poor. Neither are slothful or entitled. Both had insurance....THAT is rationing.

When Natasha Richardson sustained a lethal head injury in Canada some conservatives stated that her family brought her back to the U.S. because health care was better here. What was not stated was this: Health care IS better here...if you are rich. Yes, a public option will ration some care. Honest proponents of the public option should not refrain from stating this. A muscular public option will ration care in a more egalitarian way.

The cost will mortify. I've got no talking points handy to get around this fact. Nor do I want any. This is about priorities as much as it is about cost. Reasonable access to health care for as many as possible is a higher priority than TARP, or saving GM, or boneheaded stimulus packages, or even welfare - yes welfare. In 2009, do we need 18 military bases in Germany? The point is we can and should have a wide open debate about how we spend money.

I'm openly cynical here. Truth be told - the public option was viable during Clinton's surpluses. We are playing Russian roulette now. But we are playing it with or without the public option. We are broke. I know that seems contradictory of me - but the poor must prioritize. What is our priority? That's the question.

We'll see how Reid's inclusion of a public option plays out. It's gone much farther than I expected. I do not trust Reid's word and am still looking for the gamesmanship - the moment that becomes the excuse to bury the public option - allowing all the say "Hey, at least we tried!"

My support aside, in a purely political sense Conservatives better find a way to stop it. Once entitlements are in place they create constituencies. The long game for the Obama is clear. He's got to have something that looks like real health care reform to be re-elected. It's entirely feasible that it will be all he has in 2012. The deficit, Afghanistan, and - I bet - the economy will not be working for him in November of 2012.