Obama’s reform needs a public option

As Canadians, it is easy to be astonished by the health care debate in the United States. It can seem surreal at times when viewed from a country like ours, where the principles of universality and accessibility are a given and no one is threatened with bankruptcy when faced with health issues. After a summer of mounting protests, boisterous town halls, and radical polarization, we are left with the impression that Barack Obama’s reform package may be in trouble and that, if he does end up with a bill, it will bring less change than was expected.

The context is clear: Americans acknowledge the need for reform. They are concerned about the exhorbitant profits at health insurance companies and the extent of coverage they provide. Healthcare costs are spiralling out of control and now represent nearly one-sixth of the American economy. Forty-seven million Americans have no health care insurance. Despite the fact the U.S. spends more public money on healthcare than any other country, leading health indicators show a less than stellar return in areas like longevity and infant mortality. Granted, Americans have access to quality healthcare when they can afford it, and the United States is the leader when it comes to innovation and advances in health care treatment. But the general consensus is that reform is urgently needed.

At least five bills have already made it through Congressional committees. Four of the five include a public option—that is, they call for the government to establish a health insurance plan of its own to compete with private plans. The one bill that does not came out of Democratic Senator Max Baucus’s finance committee and is the only one the Congressional Budget Office expects to reduce costs over a 10-year period. Predictably, the left wing of the Democratic party has been critical of the proposed legislation because of its lack of a public option, prompting some to draw links between the health insurance industry and Baucus’s campaign funds. There are currently over 500 amendments to the Baucus bill under consideration and the Republicans see the discord as an opportunity to bring Obama down politically.

Meanwhile, Obama has been all over the media and on the hustings, claiming that real reform has never been closer. He has the votes and, with the state of Massachusetts about to appoint a successor to Senator Ted Kennedy, he will have a filibuster-proof Senate. Yet, things are not exactly rosy for the president. Despite his efforts to find some bipartisan support, it seems unlikely at this point that Republicans will line up behind him. In addition, polls show confusion among voters and a lack of momentum for the proposed reforms. Finally, it is now apparent the real battle will take place among the Democrats, with the conservatives among them having the upper hand at this stage in the process.

There is a growing realization among Democrats that failure is not an option . Should the Democrats not produce a reform bill, it will likely imperil their control of Congress. Most observers believe there will be a bill for the president to sign before the holiday season. But will it be transformational legislation or a transactional kind of reform? Obama has fed expectations his initiative will be historic in scope, something similar to Medicare and Medicaid back in the LBJ days. Real transformational change of the Obama variety must achieve universality, cost control, and greater control over the behaviour of private health insurance companies. After months of debate, and with the stakes higher than ever, it will be difficult to call this real reform if it lacks a public option. The public option, either through co-ops, a government-run outfit, or the expansion of Medicare, is simply the most effective way to challenge the health care industry into lowering costs, changing its ways, and ensuring that Americans are no longer the only major democracy in the world without universal healthcare .