The Blue Dogs are right to hold Obama and Democratic leaders to their commitment to real cost control. But they are wrong to see this goal as conflicting with a new national public health insurance plan for Americans younger than 65. In fact, such a plan, empowered to work with Medicare, is Congress's single most powerful lever for reforming the way care is paid for and delivered. With appropriate authority, it can encourage private plans to develop innovations in payment and care coordination that could spread through the private sector, as have past public-sector innovations.
(Emphasis supplied.) I agree with Hacker. And Hacker of course understands that the shadow of the public option proposal he first championed years ago is a "camel's nose under the tent" initiative. He still favors it.
If the public option is jettisoned, reform is jettisoned. Potential cost containment is jettisoned. We are left with an important initiative - health insurance assistance, but not reform.
Since the mandate is regressive and only to be used in conjunction with public competition, it seems clear that if there is no public option, there should be no individual mandate (there already is no employer mandate.)
Similarly, the mandate coupled with subsidies is intended to capture low income person who choose to not purchase insurance because of cost. Without the potential for public competition, the subsidies could be budget busting, to use Broder's phrase.
Couple that concern with the anti-choice measures being extracted by the likes of Bart Stupak, elimination of the subsidy provisions should also be considered. In lieu of the subsidies, the Congress could increase the eligibility for Medicaid even more.
In the end, the good in this bill is the health insurance assistance provisions. And these are important. Providing health insurance for 30 million uninsured Americans is nothing to sneeze at.
But it seems time to end the pretense of health insurance reform. That is not going to happen. The important thing, it seems to me, is to not do anything that will hinder reform in the future. The mandates would do that. The subsidies MAY do that.
Medicaid expansion is clearly a good. I have no objection to the regulations and the Exchange so near and dear to the hearts of the Village Wonks. Let them have their "reform."
But no to mandates without a public option.
Speaking for me only