The Senate bill would extend coverage to more than 30 million Americans who would otherwise be uninsured—and provides $900 billion in government subsidies to get there. It would crack down on the most abusive practices of the insurance industry. No longer would insurers be allowed to refuse to cover individuals with pre-existing conditions, charge them more because of poorer health, or cancel their policies once they get sick. People who lose their jobs, or their insurance, would have a place to turn for coverage through the new insurance exchanges. For the first time, childless adults living in poverty would be guaranteed health care through Medicaid.
MSNBC’s Keith Olbermann calls this a “hollow shell of a bill” and warns President Barack Obama of the “distinct possibility” of a primary challenge in 2012. Former Democratic National Committee Chairman Howard Dean calls it a “bigger bailout for the insurance industry than AIG” and “not worth passing in its present form.” Blogger Markos Moulitsas tweets, “Time to kill this monstrosity coming out of the Senate.”
The fundamental problem, they argue, is the Senate’s failure to include a public option—a government-run insurance plan to compete alongside private companies in the insurance exchanges. Without such a public option, they contend, there will be no discipline on insurers to control premium prices—even as individuals are required by the new mandate to buy insurance they won’t be able to afford.
This dire assessment assumes all sorts of failures—of the marketplace, of regulation—that I don’t consider inevitable. It invests the public option with more magical power to affect premium costs than I think is warranted. But let’s assume the critics on the left are correct and that insurers are only pretending to be unhappy with the Senate bill in order to lure lawmakers into passing it—at which point (actually, in 2014) they’ll be able to pounce on millions of new customers.
What do you imagine would happen if premiums turned out to be unaffordable—even with hundreds of billions of dollars in subsidies? Would Congress enforce the mandate for individuals to buy insurance, or ease it? Would Congress keep subsidies at the same level, or make them more generous? Would Congress play nice with insurers, or add a public option? History teaches that, once in place, entitlement programs tend to become more generous, not less. The approach to programs that do not work as intended is to lubricate their operations as Congress does best—by spending more money. This is a cause for concern about the Senate bill, but not among liberals.
Those who denounce the Senate plan imagine that President Obama and fellow Democrats possess political muscle to achieve something more. They don’t. If health reform does not get done soon, its moment will be gone for years. Congressional Democrats are likely to be in a weaker position after 2010.
And Americans, particularly poorer Americans and those without insurance, will be far worse off with the status quo, which is what will result if liberals succeed in their effort to kill the Senate bill. That would be the real monstrosity.
Ruth Marcus’ e-mail address is marcusr(at symbol)washpost.com.