Affordable, portable healthcare has been an issue in American politics since long before the 1990’s. Unfortunately, little, if anything has been done in that time to ensure that Americans have access to insurance coverage, despite a great deal of support for reform. Today NBC News and The Wall Street Journal published a poll stating that 76% of Americans polled support a “Public Option”.

In this space we’ve covered The Public Option and a Trigger mechanism for the Public Option proposed by conservative Democrats as a hedge against real reform favored my the majority of Americans.

While the debate continues in Congress, and on the airwaves, a bipartisan group of former Senators have come together to promote a plan of their own.

As part of the plan, former HHS nominee Tom Daschle argues against the Public Option saying

“We’ve come too far and gained too much momentum for our efforts to fail over disagreement on one single issue,”

WTF?

The plan endorsed by Daschle would give states the duty of establishing “public options”. This may be favored by Republicans, but it creates a serious problem in establishing nationwide portability. Further, as we have seen here in Tennessee, as budgets get tighter, state funds for such programs dwindle and the working poor suffer. Finally, the plan also makes any savings that would come from establishing a nationwide risk pool and throws them out the window.

In short, this is a stupid idea that will likely result in no real savings, or expanded coverage for the 47+ million uninsured, who, like myself, who cannot afford insurance due to sheer cost or pre-existing conditions.

I’ve always liked Senator Daschle. I feel he brings a lot of knowledge and experience to this debate, and I was hopeful about the possibility of true healthcare reform when President Obama nominated him to HHS. In light of his current position, I find myself questioning his motives. You may remember that in the two years before he was nominated he banked some $200,000 from the healthcare industry. I don’t want to sully the man’s reputation, but it raises serious questions about his motivation and intentions.

In the end, there is overwhelming public support for a “Public Option”. If our elected officials in DC are too scared to pass something that has the support of 76% of Americans, they need to get their butts spanked by their constituents. We have the political will to get this passed, the question is, “Will they do what’s right or what’s easy?”. Right now they’re leaning toward the easy.

Most importantly, we can’t let the ghost of a past nominee derail the reform that we, the people are in favor of.

Do what’s right, pass the “Public Option” or suffer the ire of your constituents. This reform is way overdue.

About two weeks ago I wrote about the public option. Around the time I was writing that, I started seeing some discussion of putting a “trigger” into any legislation that included a “public option”.

I could go off and spend a lot of time trying to explain what a “trigger”, but I’ll let Igor Volsky from Think Progress’ The Wonk Room handle that:

Democrats on the Finance Committee said Mr. Baucus was exploring a possible compromise. Under this proposal, the public plan would be created only if private insurance companies had not made meaningful, affordable coverage available to all Americans within several years.

In essence, if Senator Baucus and some Blue Dogs get their way, private insurers will have a couple of years to do what the market was supposed to do way back in the 1990’s, make their coverage affordable and competitive for consumers.

Senator Baucus, this trigger’s already been pulled.

Let me lay it out to you like this. If I, a self-employed single male who makes more than average for my education level (Source I fall under “Some College”) can’t afford to insure myself, partially because of pre-existing conditions, and partially because I just can’t afford it, then how can any individual who makes less than me?

The reality is, allowing individuals and companies to “buy in” to a healthcare plan that is administered like Medicare, or something similar, will greatly reduce the cost to the consumer and help provide access to people, like myself, who currently pay for regular checkups, etc. out of pocket, which works until you either get REALLY sick, or REALLY hurt.

This is where a lot of the cost to insured individuals comes in. When the uninsured get REALLY sick, or REALLY hurt, they often end up REALLY bankrupt. Over 60% of bankruptcies in the US are related to, or involve a great deal of debt due to medical expenses. 78% of those same people had some form of private health insurance.

When these bills don’t get paid, the doctors and hospitals have to make the money back somewhere. Eventually, that comes out of your pocket.

Further, healthcare costs are bankrupting our companies. Take GM for example

In dollars-and-cents terms, there was another reason the American car companies fell behind the rest of the world in their investments in technology and quality control: health care costs. All through the period of its decline, the U.S. auto industry was forced to spend sums on worker health insurance that were unmatched anywhere else in the industrialized world, because the United States was the only one without a government-sponsored health care system. (Source)

We don’t have time to wait for some arbitrary “trigger”, which could possibly be nothing more than a free pass to current insurers, to bring more affordable, portable, and transparent health insurance to our citizens. We need a solution now.

At the same time, there’s plenty of room for a discussion on what a “public option” plan should look like. It’s telling that Rep. Jim Cooper, a member of the Blue Dog Caucus, supports a plan without any trigger. Clearly, Rep. Cooper, whom I have been critical of in the past, sees the benefit of public insurance for those who can either not afford private insurance, or those who wish to “opt in” to a federally sponsored plan with competitive rates.

In the end, there’s plenty of room for discussion, but people on all sides of the debate need to remember that the ultimate goal is to insure everyone. Over the coming weeks we’ll hear objections from insurers and providers. Many of these objections will focus on the minutae rather than the larger issue of providing affordable healthcare to everyone. In the end, that’s the only real argument they have any more. Americans are tired of suffering a death of 1000 cuts from the insurance industry. The tide has turned. As Nicholas Kristof writes in yesterday’s New York Times, This Time, We Won’t Scare. Hopefully, our legislators in DC won’t either.

When people think about a recession, they primarily identify with purely economic measures. Considering the current economic climate, it’s easy to understand why people are thinking about their financial future. But more and more people in this country are experiencing a “Healthcare Recession”.

What is a “Healthcare Recession”? It is the steady diminishing of the availability of services and the health of a populace due to increasing costs, restrictions, or loss of coverage.

The US spends $2.4t a year on healthcare, or 17% of our GDP, yet we have some 47+ million living with no insurance. Other nations, such as Germany, France, and Canada spend between 9% and 11% of their respective GDP and they still manage to cover everyone.

Healthcare expenses are, at least partly responsible for 50% of all personal bankruptcies in the US. That’s right, 50% of the people who declare bankruptcy aren’t the deadbeats some in government would paint them to be, they’re sick people.

Insurance premiums for employer-based health insurance have increased at least 5% in each of the past 3 years. Imagine the impact that expense must be having on employers as we weather this economic recession.

The average employer-based health insurance plan for a family of 4 is $12,000/year. Multiply that by 25 employees and that accounts for some $300,000 of either raises, or business expansion spending taken out of the economy, and put into a system that is retracting benefits at an alarming rate.

Employer-based health insurance premiums have increased 120% since 1999. This compares to a cumulative inflation rate of 44%.

A survey of Iowa consumers found that in order to cope with rising health insurance costs, 86 percent said they had cut back on how much they could save, and 44 percent said that they have cut back on food and heating expenses. My question is, how many have cut their insurance as the result of a receding economy?

All these statistics come in whole or in part from the non-partisanNational Coalition on Health Care.

As we contemplate the economic recession, we have to consider the impact it will have on the healthcare industry.

Since July 2008 there have been nearly 2.5 million new unemployment claims (Source). Think about how that impacts the healthcare system, and the health of those affected. We now have 2.5 million new people who have either lost, or are about to lose their health insurance. That’s 2.5 million more people who may lose their home, or their savings, or both, as the result of a catastrophic illness or injury. What impact will those losses have on the economy? What impact will those losses have on society? How much of that loss can our current healthcare system absorb?

The long hard truth is that we can no longer afford our current health care system. It was ill considered from the start, making healthcare coverage dependent on employment or affluence. Doing so neglects several segments of the population, including children, who through no fault of their own, may just happen to be the child of an unemployed, or uninsured worker.

What about Medicare or Medicaid? Both have been political footballs since the “Reagan Revolution”, subject to the whims of those who chose to demonize or vilify it for political gain. There’s a misguided sense that people who use these programs are somehow failures, or deadbeats, but that’s hardly the case. Most are retired workers who are no longer or were never covered under employer-based healthcare plans, or the working poor, who are also, by and large, not covered by private healthcare.

Consider this, a minimum wage earner makes $13,000/year, if they work 40 hours a week. What employer is going to double their employee cost to cover them and their children? One of my favorite responses to this “reality” is the retort, “No one only makes minimum wage.” Well, if that’s the case, then what was the big deal about raising it?

In talking to friends in the healthcare industry, they report that they have had to either take on additional costs or staff nearly every year since 1992 to manage the 3 dimensional puzzle that is our healthcare system. The US spends some $480b/year more than other Western nations with universal coverage on ADMINISTRATION ALONE.

The result is that the availability of healthcare and healthcare coverage has become a tool in a class war that is driving all of us further and further down the ladder, both economically, and medically.

I’m not demanding universal single-payer coverage, though some argue that’s the only real solution. I realize that at this time it may be a bridge too far for those politicians too weak to be bold, or to pompous to think beyond their narrow political future. I am asking for people in Washington to stop making the availability of insurance or healthcare a political football to be bandied about like as if it doesn’t affect anyone. I’m asking our elected officials to start treating this like the crisis it really is, instead of the “carrot on a stick” stupidity that it has become over the past 16 years.

Streamline the process. Take away some of the ridiculous hoops that our hospitals and physicians have to jump through to get paid. Take away the barriers to getting care. Build a system where all insurers use a standard form instead of creating their own standard, and by extension, raising the bar on receiving coverage or payment, and lowering the quality of care in the process. Most importantly, do something for God’s sake!

Any reform that may have come has taken a hit by the withdrawal of Fmr. Senator Daschle from his nomination to HHS. I’m not sure that he really was the right man for the job, but his withdrawal, at the very least, delays any progress on reforming healthcare, and at worst, makes the prospect of reform even more of a political football than it was at 8am this morning. I know there are a lot of people out there supporting Howard Dean for the post, but to be honest, I don’t care who it is, as long as they are an honest arbiter of positive change, and have the political skills to make some meaningful reform happen.

We can reform segments of our economy as much as we want to, but if we do not have a healthy populace to support these industries, both with labor and spending, our economy will neither recover, nor grow with any sustainability. It’s way past time to make some sense out of healthcare, and restore our place in the world both economically and medically.

Update:HR 676 The United States National Health Insurance Act. Co-Sponsored by our very own Steve Cohen

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Paul Krugman