Agreed: Public option needed



The Presidential debate Tuesday night presented an entertaining discussion of health insurance around which all the Democrats agree: Consumers need a public option (that is, a government insurance plan something like Medicare) to bring down costs and assure accessible health care for everyone. Bernie (“I wrote the damn bill”) Sanders and Elizabeth Warren stood strong for a “Medicare for All” plan that would immediately see the end of private health insurance. All the others favor Medicare Lite or some sort of public option that suggests the end of private health insurance at an indeterminate date. The die is cast. People are sick of lousy health insurance coverage.

John Delaney, foremost, argued that Sanders and Warren would increase taxes and upset union members who negotiated good health insurance plans, only to see them taken away and substituted with a government plan. Sanders and Warren replied that their costs will be lower, with no premiums, copays or deductibles, and they will have more choice of providers. Warren and Sanders chided the other candidates for not being bolder about health care — it is the top issue for likely Iowa caucus goers — and for repeating Republican talking points.

Sanders will fall on his sword over Medicare for All. You have to admire that. Warren is ready to give it her best fight, and she knows that most Democrats are in for that fight. In the end, we suspect that she will take what she can get from a Senate that will not go farther than a public option no matter which party is in control. Meantime, her full throat will call for Medicare for All.

“I don’t understand why anybody goes to all the trouble of running for the President of the United States just to talk about what we really can’t do and shouldn’t fight for,” Warren declared. “I don’t get it.”

The crowd in Detroit erupted.

Sanders and Warren were smart to cover each other’s back over a fundamental issue. People who expected to see the progressives blow each other to smithereens were disappointed by their embrace. Note that Warren has not attacked front-runner Joe Biden as some others have. Yet she has made a steady climb in the polls that we expect will continue, especially in Iowa, because she is right on the issues and sticks to them.

One reason for Warren’s traction in rural areas is the lack of health care choice and almost no competition in the Iowa small-group insurance market. Sen. Chuck Grassley made sure of that when he and Sen. Max Baucus wrote out the public option 10 years ago in a back room of the Senate Finance Committee. It was a bipartisan smothering, but thanks to the likes of Warren and Sanders the public option has a new life. Over the decade, Grassley helped to kill the only cooperative insurer in the Iowa exchange, Co-Opportunity Iowa, by refusing to fund it. And, Gov. Terry Branstad made matters worse by weakening Medicaid when he handed it over to the private insurance industry. We now know that it costs $400 million more per year for private industry to cover the working poor and disabled than it cost for the Department of Human Services to administer Medicaid. The government ran the program cheaper and was able to keep rural nursing homes alive. Private insurers provide leaner coverage and caused more than a dozen rural Iowa nursing homes closing in a year. Those who say that Medicare for All would somehow short consumers are just plain wrong, in the Iowa experience.

Delaney and Tim Ryan were able to finally get people to listen to their concerns over 150 million people who currently buy private insurance. We are among them. We don’t care what you call it, but we need a government insurance program in Iowa. Eventually, it will out-compete profit-oriented health insurance. Union members will be happy to flock to a better government program. Senior citizens love Medicare. We would love it too, if only we could buy it. If it takes people awhile to get used to the idea, or if Mitch McConnell is still calling the shots through Grassley’s ear, then Medicare for All can wait awhile. But a public option that gives rural consumers an affordable choice cannot be put off any longer. On that all Democrats agree, and we can thank Bernie Sanders and Elizabeth Warren for sticking with it and keeping hope for relief alive.

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