Choice?

"Now, if you're one of the tens of millions of Americans who don't currently have health insurance, the second part of this plan will finally offer you quality, affordable choices." President Barack Obama, September 9, 2009, Remarks by the President to a Joint Session of Congress on Health Care.

So here we are at the beginning of autumn and Congress has yet to pass health care reform. To make matters worse the legislation that we’ve been given is the Baucus Bill. While there are numerous problems with the bill I want to center on only two elements: weak, poorly funded health care cooperatives and the lack of a public option.

First, the problems with the provisions relating to health care cooperatives. While I strongly support their creation, which I’ve mentioned previously, the details in this bill will handicap the new co-ops. According to the bill the start-up capital would only be $6 billion, which would be spread among the new co-ops. That’s far too little investment to create the type of co-ops that can challenge the private insurers. Add to this the co-ops will be limited in their scope. Ezra Klein with the Washington Post reports that rather than being able to contract with large employers the co-ops would be limited to contracting only with "small groups and individual markets." Another major flaw in the cooperative provision is that it fails to give the co-ops special pricing power. While they can band together to increase their purchasing power they’re restricted from setting national payment rates. To challenge the big boys these co-ops need this power. As Klein put it, "The insurance industry is, in other words, being protected from not just public competition, but co-op competition." Finally, even if the above flaws are fixed there needs to be a restriction placed on these co-ops that would prevent them from some day demutualizing into private corporations as some co-ops have done in the past.

Second, the Baucus Bill lacks a public option. The poorly funded co-ops, as they would be set up by the Baucus Bill, simply would not be able to reign in the abuses of the private insurers. If we’re not going to properly fund and empower the co-ops where that they’re able to challenge the private insurance companies then why not create a strong public option that could have a real effect on the private insurers?

Let me make my position clear. It’s my belief that quality, affordable health care is a fundamental human right. A sure way to guarantee this right would be through a Single-Payer system operating within a network of private practitioners and community-based, non-profit clinics/ hospitals. But we know that no matter what legislation comes out of Congress this year it will not include this. So whatever legislation that we do get must have the ability to restrict the power of the private insurers and to provide access to quality health care to those who currently don’t. This means that we need legislation that includes either a strong public option or well-funded and powerful health-care cooperatives.

One last comment. I can’t help but wonder why couldn’t a bill include both a strong public option and well-funded, powerful co-ops? What would prevent such a combination? The President said that this legislation will include "quality, affordable choices." Then I say that Congress should give the American people exactly that. Give us the ability to choose either well-funded co-ops with real power or a strong public insurance.