Well, in policy terms, this isn’t bad. Harry Reid has announced that the Senate health reform bill a public option that allows individual states to opt-out if they fear they’re on the road to socialism. This may–emphasize, may–help control costs in some states, especially those where one or two insurers have virtual monopoly control.
But it’s still a very small, and relatively peripheral, part of the plan. It will make a difference to less than 5% of the population. And, in political terms, if it costs the Democrats a 60-vote majority in the Senate, it will not have been worth the struggle.
But now, at least, some attention can be directed to several far more crucial important aspects of the plan. Here are a few:
1. the tax credits that are offered to working and middle-class families to help them pay for their newly mandated health insurance should be robust–that means families with incomes up to 400% of poverty have to be eligible for help on a sliding scale, according to their incomes. (I’d also include cheap insurance options for young people, focusing on preventive and catastrophic care.)
2. the health care exchanges where people buy their insurance have to be well-constructed and include large numbers of people. Regional exchanges would be best; state-run exchanges would be worst.
3. the plan has to go into effect as soon as possible. If we wait until mid-2013, as posited in the Senate Finance Committee billl, naysayers will have both the 2010 and 2012 elections to scare the hell out of people. It could cost Obama reelection. States like Massachusetts, which already have universal plans, should be able to join the federal plan as soon as possible. The insurance reform provisions–no denial of coverage for pre-existing conditions and so forth–should be realized by 2011, at the latest.
There are other concerns. But the above three are huge and need to be attended to now.