Building for the future

A really, really good read by Ezra Klein on why the public health insurance option is not a Medicare expansion ...

A Medicare option would also probably have been a nonstarter in Congress, much as the public option attached to Medicare rates stands little chance of passage. But the advantage would have been that the ensuing debate would have been explicitly tied to the thing that makes a government option so effective: the power to negotiate on behalf of a huge customer base, as other countries do and as Medicare does. Instead, the debate has centered around the principle of an insurer run by the public, which is, at this point, going to have a lot less impact on premiums than most of its supporters expect. As a political move, that probably made sense, and allowed politicians to get to a place where they might just have a compromise that supporters like and skeptics don't hate.

The discussion surrounding the principle is crucial to me for a variety of reasons. Even if the public option has limited reach - or is delayed or minimized in its implementation - its passage signals a fundamental philosophical shift when it comes to health care policy in the country. It would set up a working foundation to build upon for the future in a way that is decidedly less overblown and unneccessarily dramatic than this current debate.