RaceWire on A Quest to Answer: What IS The Public Option?

By Julianne Hing Aug 13, 2009

The healthcare system is intimidating and full of droves of wonkety wonks. Digging into the current debate often seems like it requires learning a whole ‘nother language, and it feels like lobbyists’ and politicians’ aims are to deliberately obfuscate the landscape to ram through unjust policy. Throw that in with my longstanding disaffection towards DC politics and healthcare is just not my favorite topic of politics. But now that the conversation threatens to be derailed by old white people in town hall meetings shrieking, "Socialized medicine!!! Death panels!!!?!?" I realized I can’t afford to be uninformed about the debate. I needed healthcare reform 101, and so I turned to Lynne Nguyen, a community organizer in Seattle with Washington Community Action Network working on national health care reform. Read on for my very, very basic questions, and Lynne’s helpful (and jargon-free!) analysis and explanations. —- RaceWire: Let’s start at square one. What is the public option? Lynne Nguyen: The public option is an alternative to private insurers. It’s a system managed by the government to pay health care providers for services. Medicare is an example of a public plan that’s made specifically for seniors and those with disabilities. If you think of healthcare responsibility and healthcare in terms of who is responsible for providing it, on one end you have the individual who pays for their insurance or pays into a system their employer provides. If you’re not employed you go buy yourself insurance. That’s the private market you have right now. On the other end, you have the “single payer” system, where everyone is responsible. Everyone pays in. Everyone floats this big pool of people to pay for healthcare services. It really is a triangle. You have the person on top who gets coverage, just under that you have the entity who provides the actual healthcare service (doctors), and then you have the payer, in most cases it’s the insurance, but in the case of the public option, it’s the government. That is the crux of it. Hospitals have entire departments to deal with administrative work because if you think about it, insurance companies pay a lot of money to not have to pay anything. They dig into people’s histories, review claims, screen people to find all the ways they don’t have to provide coverage or can drop coverage. RW: What are the pluses of this public system? LN: It would, because it’s government-run, be accountable to people who vote. Right now there’s absolutely no accountability when it comes to private insurance. Because it is a government alternative and because the costs are so much lower–4% of Medicare’s budget goes to administrative costs, whereas 33% of private insurance companies’ money goes to administrative costs—I think it provides a really good source of competition for private insurance. The government is not in it to make money, although it will have to stay afloat, but it does not pay their executives billions of dollars every year. It’d be a nationwide, publicly accountable program where more competition would drive down prices. RW: Can you debunk some of the myths that are circulating about what healthcare reform will do? LN: People are concerned about rationed healthcare, being denied coverage, not having access, but these are all problems that we already see in the private market. In a new public market, you can go into it as an individual, with or without a job. You can go in as an employer, with or without employees. Anyone can browse this market, and to be a vendor within this market you need to play by certain rules. Vendors, which can include private plans, will have to offer a standard set of benefits. Kaiser and Blue Cross will all have to have an accessible quality plan in this market. The public option would be just another vendor in the market. But it has the benefits of also having sliding scale subsidies for people who are at 400% of the poverty level or lower. (For a point of reference, it’s common for state healthcare programs to offer sliding scale options if you’re at 300% of the poverty level.) So you have this market where everyone contributes: individuals pay premiums, employers pay in, government pays. You still have Medicare, Medicaid, CHIP, because these are programs that work, and they catch people and communities that really need it. So those programs are going to stay untouched. RW: One more time, can you break down what Medicare, Medicaid and CHIP are? LN: Medicare is government health insurance for people over 65. Medicaid is insurance for the poor. CHIP is for kids. RW: So this all sounds so great. What are all those old people responding to in those violent town hall meetings? Why do they feel so threatened? LN: People are literally spreading lies. People are listening because they’re afraid. There is the issue of immigrant inclusion. This comes up in every town hall, where someone says the way to fix healthcare is to not give it to people who are illegal. And it’s a terribly racist thing, but it’s actually also moot, because the bill excludes undocumented immigrants. And to have the bill not even cover that in the first place and have to be defended against the allegation is just ridiculous. People who are pro-reform are put in a position of saying, “No, don’t worry about it. There are no immigrants in this!” RW: So the new plan won’t okay euthanasia? LN: Laughs. I think responding to the coding and key words is a little ridiculous. Again, the bill is not about taking away options, it’s about giving choices. I don’t want to waste time giving these words face time. We want to talk about how this gives people sliding scale coverage, how, if you are an employer, you’ll get tax credits to pay for employees coverage under this plan. If you lost your job it gives you a way to get healthcare that doesn’t rip you a new one. The fears that people have, especially seniors, are just really kind of silly. RW: How do you argue with these irrational fears? What can you do but laugh at these people? LN: People who have already made up their minds about how awful it is, won’t be moved by telling them how awful it isn’t. Facts are not effective because there’s no foundation with them to begin with. We have to remember we have the same values, we all want the same things with healthcare. We all want control over who we get to see and when we get to see them. There’s been interesting polling. When people are asked, “Do you support President Obama’s healthcare plan?” They say no. But if you break it out into little pieces of what’s in the bill, people say yes. That’s the conversation we need to be having, bridging values. The people who are supportive of this type of reform and healthcare need to step it up. This is the farthest we’ve come as a country on healthcare reform. To have a tiny, really loud minority be able to run us over, is ridiculous. We can’t let that happen. We have to keep pushing forward. RW: What are some criticisms you have with the current healthcare bill. Can you talk about where immigrants fit in this? LN: Well, the Black caucus, the APA caucus, the Hispanic caucus wrote a thing to address healthcare, and a lot got picked up. It includes culturally competent work forces, data collection, translation services, rural vs. urban access issues. One thing it doesn’t include is access for undocumented immigrants. Legal permanent residents in some places have to wait five years for coverage. We’d like to see improvement here. But the issue of immigrants is so hot-topic that I feel like people don’t have the courage, there’s no political capital around it. But it’s something that we’re going to keep fighting for. RW: How is this going to get paid for? LN: I mentioned the concept of shared responsibility, where everyone pays in and supports. We’re talking about a progressive tax where the top 1.5% wealthiest are supporting the healthcare subsidies within the exchange. It’s a progressive tax, where working and middle class people are not going to be bearing the burden of the healthcare system like they are already. RW: Is bipartisanship even worth it anymore? LN: People who are writing legislation have already stepped into the room compromising, and they have created a situation in which pieces that could be very strong are not what they could be. Right away we saw people compromise. Healthcare reform is not something you can do halfway. I think it’s a total waste of time. And the reason for that, to be blunt, is the compromise is not about actually finding solutions, the compromise is, “How much can we get you to not do what you want to do?” But the public supports you. Reform is what people want, despite that vocal minority. We can’t afford to wait on health care.