Public health insurance option
Encyclopedia
The public health insurance option is a proposed government-run health insurance agency which competes with other health insurance companies. It is not the same as Publicly-funded health care
. Called the public insurance option or public option, for short, it was a proposed health insurance
plan that could be offered by the federal government of the United States
. It had been featured in two bills considered by the U.S. House of Representatives: the proposed Affordable Health Care for America Act
(H.R. 3962), passed by the House in 2009, and its predecessor the proposed America's Affordable Health Choices Act . Another bill, the Public Option Act
, also referred to as the Medicare You Can Buy Into Act, , would have allowed all citizens and permanent residents to buy into a public option by participating in the public Medicare
program.
In the first two bills the public option took the form of a Qualified Health Benefit Plan
competing with similar private insurance plans in an internet based exchange or market place, enabling citizens and small businesses to purchase health insurance meeting the minimum federal standard. Persons covered by other employer plans or by state insurance plans such as Medicare would have not been eligible to obtain coverage from the exchange and therefore could not obtain this form of federal health insurance. The federal government's health insurance plan would have been financed entirely by premiums without subsidy from the Federal government. The plans stated in the Senate HLP Committee and H.R. 3962, the two that contained clauses establishing a public insurance option, required the repayment of "seed money" to the Treasury over a ten year period.
President Barack Obama
promoted the idea of the public option while running for election. After becoming President, Obama downplayed the need for a public health insurance option including calling it a "sliver" of health care reform, but had not given up pursuing the idea before the health care reform was passed. Congressional Democrats
tended to support this idea, stating that it would drive down premiums and provide choice where few options exist. Congressional Republicans
opposed the idea, stating that it would cause the private health insurance industry to collapse. Since the public option in H.R. 3962 would have initially kept rates for services between Medicare and most private insurers, private insurers complained that it would result in cost-shifting
to them.
E.J. Dionne, argue that many places in the United States have monopolies in which one company, or a small set of companies, control the local market for health insurance. Dionne has labeled a public option a "monopoly-buster". He has also stated those opposed to a government plan know public opinion is against them and are resisting it by trying to move discourse towards abstract and demagogic ground. He has referred to Sen. Grassley's calling government a "predator" (see Criticism below) as a "most revealing" example of this.
Nobel Laureate economist and New York Times columnist Paul Krugman
has stated that local insurance monopolies exist in many of the smaller states represented by "balking" Democrats, and that those who oppose the idea of a public insurance plan on the grounds of defending private competition are in practice just defending lucrative local monopolies. He also stated that traditional ideas of beneficial market competition do not apply to the insurance industry given that insurers mainly compete by risk selection. He wrote, "The most successful companies are those that do the best job of denying coverage to those who need it most." Krugman also said in 2007 that a single payer system would be the most efficient and cheapest solution and a public insurance option would get the country towards single payer as through competition it would drive the private insurers out of business.
According to economist and former US Secretary of Labor, Robert Reich
, only a "big, national, public option" can force insurance companies to cooperate, share information, and reduce costs. Scattered, localized, "insurance cooperatives
" are too small to do that and are "designed to fail" by the moneyed forces opposing Democratic health care reform.
In a public rally in Cincinnati, on September 7, 2009, President Barack Obama
said: "I continue to believe that a public option within the basket of insurance choices would help improve quality and bring down costs."
Democratic Representative Sheila Jackson-Lee, who represents the 18th congressional district
in Houston
, has said, "Surveys show that nearly three out of four voters want a public health insurance plan." She also has said that "73 percent of doctors and 1,000 state legislators favor health reform legislation with a public option. The American people want a strong public option heard in Congress... because their voices have been drowned out by insurance company propaganda and disruptive tea-baggers
at health reform town hall meetings."
President Obama elaborated on his reasons for a public plan in his seminal September 9 address to the Joint Session of Congress:
s (co-ops) to get them to become large and established enough to provide cost savings and into setting up transparent health insurance exchange
s that would host them among health insurers. These co-ops would likely be statewide. Howard Dean
and other Democrats have been critical of abandoning a public option in favor of co-ops, questioning whether the co-ops would have enough negotiating power to compete with private health insurers. Prominent economists such as Robert Reich
and 2008 Nobel Economics Laureate Paul Krugman
have also questioned co-ops ability to become large enough to reduce health care costs significantly and thus support the public option instead.
Those desiring reform beyond the public health insurance option have argued for a single-payer system
, which is planned to be brought for a vote. A single-payer system has been claimed by some as politically difficult, and Barack Obama has come out against it, stating in a joint session of Congress, "...it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch." Obama had expressed that he is a proponent of a single payer universal health care program during an AFL-CIO conference in 2003.
Instead of creating a network of statewide public plans, Senator Olympia Snowe
has proposed a "trigger" in which a plan would be put into place at some point in the future in states that do not have more than a certain number of private insurance competitors. Senator Tom Carper has proposed an "opt-in" system in which state governments choose for themselves whether or not to institute a public plan. Senator Chuck Schumer has proposed an "opt-out" system in which state governments would initially be part of the network but could choose to avoid offering a public plan.
, has argued that the federal government can hide inefficiencies in its administration and draw away consumers from private insurance even if the government offers an inferior product. Cannon reported that a study by the Congressional Budget Office
found that profits accounted for less than 3% of private health insurance premiums. Cannon believes that the lack of a profit motive reduces incentives to eliminate wasteful administrative costs. The chief executive of Aetna
, Ron Williams
, has stated on the News Hour with Jim Lehrer that a public option creates a situation where "you have in essence a player in the industry who is a participant in the market, but also is a regulator and a referee in the game". He said, "we think that those two roles really don't work well."
Senator Charles Grassley, an opponent of the public insurance option, was asked for his opinion of Medicare, a much more government controlled entity than the public insurance plan. Grassley stated that Medicare was "part of the social fabric of America", but he went on to say that "I think there is a lot wrong with it". Later in the same exchange he said “the government is not a fair competitor. It's a predator”.
Dr. Robert E. Moffit of the Heritage Foundation
has argued that a public plan in competition in private plans would likely be used as a "dumping ground" for families and individuals with higher than average health risks. This, in his view, would lead to costs that business should pay passed onto the taxpayer. Republican House Minority Whip Eric Cantor
has argued that a public plan would compete unfairly with private insurers and drive many of them out of business.
John Murphy, an independent candidate for Congress from the 16th District of Pennsylvania in 2006 and 2008, has called the current public option plan "a de facto bailout of the healthcare insurance companies" pointing out that "Here we have a health care bill (H.R. 3962) which will not only drive up insurance costs but will not even permit the government to negotiate with pharmaceutical companies, thereby driving up pharmaceutical costs as well! The Congressional Budget Office
(CBO) estimates that only 2% of Americans (6 million) will be able to participate in this plan while 33% of Americans will remain either uninsured or underinsured
."
Both before and after passage in the House, significant controversy surrounded the Stupak–Pitts Amendment
, added to the bill to prohibit coverage of abortions – with limited exceptions – in the public option or in any of the health insurance exchange
's private plans sold to customers receiving federal subsidies. In mid-November, it was reported that 40 House Democrats have said they will not support a final bill containing the Amendment's provisions.
Marcia Angell
, M. D., Senior Lecturer in the Department of Social Medicine at Harvard Medical School
and former Editor-in-Chief of the New England Journal of Medicine
, has written "...older under-65's will be more likely to go without insurance, even if they have to pay fines. That's OK with the industry, since these would be among their sickest customers. (Shouldn't age be considered a pre-existing condition
?) Insurers also won't have to cover those younger people most likely to get sick, because they will tend to use the public option (which is not an "option" at all, but a program projected to cover only 6 million uninsured Americans (2%)). So instead of the public option providing competition for the insurance industry, as originally envisioned, it's been turned into a dumping ground for a small number of people whom private insurers would rather not have to cover anyway." She lists five recommendations for modification of this bill, including "#1: Drop the Medicare
eligibility age from 65 to 55."
polls for NV, IL, WA, MO, VA, IA, MN, and CO were conducted for the Progressive Change Campaign Committee
, Democracy for America
and Credo Action of 600 likely general election voters in 2010, interviewed in each state by telephone, showing that in key swing states, the public option is far more popular than the Senate plan.
In 2010, 82% of Obama voters who voted for Brown in Massachusetts support the public option.
A poll from November 10 and 11 by Angus Reid Public Opinion found that 52% of Americans supported a public plan. Their research had a 3.1% margin of error.
Between October 28 and November 13, 2009, Democratic Senator Dick Durbin's campaign organization polled Americans to rank their support for various forms of the "public option" currently under consideration by Congress for inclusion in the final health care reform bill. The 83,954 respondents assigned rankings of 0 to 10. A full national option had the most support, with a 8.56 average, while no public option was least favored, with a 1.10 average.
On October 27, journalist Ray Suarez
of The News Hour with Jim Lehrer stated that "Public opinion researchers say the tide has been shifting over the last several weeks, and now is not spectacularly, but solidly in favor of a public option."
A Pew Research Center
report published on October 8, 2009 stated that 55% of Americans favor a government health insurance plan to compete with private plans. The results were very similar to their polling from July, which found 52% support. A USA Today
/Gallup
survey described by a USA Today
article on October 27 found that 50% of Americans supported a government plan proposal and 46% do not.
In a poll in which the data were gathered on August 19, 2009 Survey USA estimated that the majority of Americans (77%) feel that it is either "Quite Important" or "Extremely Important" to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance." When asked to choose between three statements about a "public health plan administered by the federal government", a 46% plurality chose "... patients might not always have access to their choice of doctors and the government would lower costs by limiting medical treatment options and decisions that should be made instead by patients and doctors."
A Rasmussen Reports
poll taken on August 17–18 stated that 57% of Americans did not support the current health care bill being considered by Congress that did not include a public option. A NBC News
/Wall Street Journal poll, conducted August 15–17, found that 47% of Americans opposed the idea of a public option and 43% expressed support.
A July survey by Quinnipiac University
found that 28% of Americans would like to purchase a public plan while 53% would prefer to have a private plan. It also stated that 69% would support its creation in the first place.
A survey published on July 17, 2009 by Rasmussen Reports
found that 50% of Americans opposed and 35% supported the creation of a government health insurance company. The survey presented the option as “the health care reform plan proposed by President Obama and congressional Democrats.”
done over the summer of 2009, surveying a random sample of more than 2,000 physicians, found that most medical doctors, at 73%, support a public option.
An IBD/TIPP
poll of 1,376 physicians showed that 45% of doctors "would consider leaving or taking early retirement" if Congress passes the health care plan wanted by the White House and Democrats. This poll also found that 65% of physicians oppose the White House and Democratic version of health reform. Statistician and polling expert Nate Silver
has criticized that IBD/TIPP poll for what he calls its unusual methodology and bias and for the fact that it was incomplete when published as responses were still coming in.
A survey reported by the New England Journal of Medicine
in September, based on a random sample of 6,000 physicians from the American Medical Association
, stated that "it seems clear that the majority of U.S. physicians support using both public and private insurance options to expand coverage."
Publicly-funded health care
Publicly funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population...
. Called the public insurance option or public option, for short, it was a proposed health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
plan that could be offered by the federal government of the United States
Federal government of the United States
The federal government of the United States is the national government of the constitutional republic of fifty states that is the United States of America. The federal government comprises three distinct branches of government: a legislative, an executive and a judiciary. These branches and...
. It had been featured in two bills considered by the U.S. House of Representatives: the proposed Affordable Health Care for America Act
Affordable Health Care for America Act
The Affordable Health Care for America Act was a bill that was crafted by the United States House of Representatives in November 2009. At the encouragement of the Obama administration, the 111th Congress devoted much of its time to enacting reform of the United States' health care system...
(H.R. 3962), passed by the House in 2009, and its predecessor the proposed America's Affordable Health Choices Act . Another bill, the Public Option Act
Public Option Act
The proposed Public Option Act is a bill that was introduced to the United States House of Representatives in 2010. It would permit U.S. citizens to "buy in" to Medicare public health insurance by paying premiums. The bill was introduced by Representative Alan Grayson, a Democrat from Florida...
, also referred to as the Medicare You Can Buy Into Act, , would have allowed all citizens and permanent residents to buy into a public option by participating in the public Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
program.
In the first two bills the public option took the form of a Qualified Health Benefit Plan
Qualified Health Benefit Plan
A Qualified Health Benefit Plan is a health care plan that follows rules included in the proposed Affordable Health Care for America Act , preceded by America's Affordable Health Choices Act of 2009...
competing with similar private insurance plans in an internet based exchange or market place, enabling citizens and small businesses to purchase health insurance meeting the minimum federal standard. Persons covered by other employer plans or by state insurance plans such as Medicare would have not been eligible to obtain coverage from the exchange and therefore could not obtain this form of federal health insurance. The federal government's health insurance plan would have been financed entirely by premiums without subsidy from the Federal government. The plans stated in the Senate HLP Committee and H.R. 3962, the two that contained clauses establishing a public insurance option, required the repayment of "seed money" to the Treasury over a ten year period.
President Barack Obama
Barack Obama
Barack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...
promoted the idea of the public option while running for election. After becoming President, Obama downplayed the need for a public health insurance option including calling it a "sliver" of health care reform, but had not given up pursuing the idea before the health care reform was passed. Congressional Democrats
Democratic Party (United States)
The Democratic Party is one of two major contemporary political parties in the United States, along with the Republican Party. The party's socially liberal and progressive platform is largely considered center-left in the U.S. political spectrum. The party has the lengthiest record of continuous...
tended to support this idea, stating that it would drive down premiums and provide choice where few options exist. Congressional Republicans
Republican Party (United States)
The Republican Party is one of the two major contemporary political parties in the United States, along with the Democratic Party. Founded by anti-slavery expansion activists in 1854, it is often called the GOP . The party's platform generally reflects American conservatism in the U.S...
opposed the idea, stating that it would cause the private health insurance industry to collapse. Since the public option in H.R. 3962 would have initially kept rates for services between Medicare and most private insurers, private insurers complained that it would result in cost-shifting
Cost-shifting
Cost-shifting is either an economic situation where one group underpays for a service resulting another group overpaying for a service or where one group pays a smaller share of costs than before resulting in another group paying a larger share of costs than before...
to them.
Rationale
Supporters of a public plan, such as Washington Post columnistColumnist
A columnist is a journalist who writes for publication in a series, creating an article that usually offers commentary and opinions. Columns appear in newspapers, magazines and other publications, including blogs....
E.J. Dionne, argue that many places in the United States have monopolies in which one company, or a small set of companies, control the local market for health insurance. Dionne has labeled a public option a "monopoly-buster". He has also stated those opposed to a government plan know public opinion is against them and are resisting it by trying to move discourse towards abstract and demagogic ground. He has referred to Sen. Grassley's calling government a "predator" (see Criticism below) as a "most revealing" example of this.
Nobel Laureate economist and New York Times columnist Paul Krugman
Paul Krugman
Paul Robin Krugman is an American economist, professor of Economics and International Affairs at the Woodrow Wilson School of Public and International Affairs at Princeton University, Centenary Professor at the London School of Economics, and an op-ed columnist for The New York Times...
has stated that local insurance monopolies exist in many of the smaller states represented by "balking" Democrats, and that those who oppose the idea of a public insurance plan on the grounds of defending private competition are in practice just defending lucrative local monopolies. He also stated that traditional ideas of beneficial market competition do not apply to the insurance industry given that insurers mainly compete by risk selection. He wrote, "The most successful companies are those that do the best job of denying coverage to those who need it most." Krugman also said in 2007 that a single payer system would be the most efficient and cheapest solution and a public insurance option would get the country towards single payer as through competition it would drive the private insurers out of business.
According to economist and former US Secretary of Labor, Robert Reich
Robert Reich
Robert Bernard Reich is an American political economist, professor, author, and political commentator. He served in the administrations of Presidents Gerald Ford and Jimmy Carter and was Secretary of Labor under President Bill Clinton from 1993 to 1997....
, only a "big, national, public option" can force insurance companies to cooperate, share information, and reduce costs. Scattered, localized, "insurance cooperatives
Health insurance cooperative
A health insurance cooperative is a cooperative entity that has the goal of providing health insurance and is also owned by the people that the organization insures...
" are too small to do that and are "designed to fail" by the moneyed forces opposing Democratic health care reform.
In a public rally in Cincinnati, on September 7, 2009, President Barack Obama
Barack Obama
Barack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...
said: "I continue to believe that a public option within the basket of insurance choices would help improve quality and bring down costs."
Democratic Representative Sheila Jackson-Lee, who represents the 18th congressional district
Texas's 18th congressional district
Texas District 18 of the United States House of Representatives is a Congressional district that serves much of inner city Houston and the surrounding area...
in Houston
Houston, Texas
Houston is the fourth-largest city in the United States, and the largest city in the state of Texas. According to the 2010 U.S. Census, the city had a population of 2.1 million people within an area of . Houston is the seat of Harris County and the economic center of , which is the ...
, has said, "Surveys show that nearly three out of four voters want a public health insurance plan." She also has said that "73 percent of doctors and 1,000 state legislators favor health reform legislation with a public option. The American people want a strong public option heard in Congress... because their voices have been drowned out by insurance company propaganda and disruptive tea-baggers
Tea Party movement
The Tea Party movement is an American populist political movement that is generally recognized as conservative and libertarian, and has sponsored protests and supported political candidates since 2009...
at health reform town hall meetings."
President Obama elaborated on his reasons for a public plan in his seminal September 9 address to the Joint Session of Congress:
Alternative plans
An alternative that has been proposed is to pump federal money into various private non-profit health insurance cooperativeHealth insurance cooperative
A health insurance cooperative is a cooperative entity that has the goal of providing health insurance and is also owned by the people that the organization insures...
s (co-ops) to get them to become large and established enough to provide cost savings and into setting up transparent health insurance exchange
Health insurance exchange
A health insurance exchange is a set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance that is eligible for Federal subsidies...
s that would host them among health insurers. These co-ops would likely be statewide. Howard Dean
Howard Dean
Howard Brush Dean III is an American politician and physician from Vermont. He served six terms as the 79th Governor of Vermont and ran unsuccessfully for the 2004 Democratic presidential nomination. He was chairman of the Democratic National Committee from 2005 to 2009. Although his U.S...
and other Democrats have been critical of abandoning a public option in favor of co-ops, questioning whether the co-ops would have enough negotiating power to compete with private health insurers. Prominent economists such as Robert Reich
Robert Reich
Robert Bernard Reich is an American political economist, professor, author, and political commentator. He served in the administrations of Presidents Gerald Ford and Jimmy Carter and was Secretary of Labor under President Bill Clinton from 1993 to 1997....
and 2008 Nobel Economics Laureate Paul Krugman
Paul Krugman
Paul Robin Krugman is an American economist, professor of Economics and International Affairs at the Woodrow Wilson School of Public and International Affairs at Princeton University, Centenary Professor at the London School of Economics, and an op-ed columnist for The New York Times...
have also questioned co-ops ability to become large enough to reduce health care costs significantly and thus support the public option instead.
Those desiring reform beyond the public health insurance option have argued for a single-payer system
Single-payer health care
Single-payer health care is medical care funded from a single insurance pool, run by the state. Under a single-payer system, universal health care for an entire population can be financed from a pool to which many parties employees, employers, and the state have contributed...
, which is planned to be brought for a vote. A single-payer system has been claimed by some as politically difficult, and Barack Obama has come out against it, stating in a joint session of Congress, "...it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch." Obama had expressed that he is a proponent of a single payer universal health care program during an AFL-CIO conference in 2003.
Instead of creating a network of statewide public plans, Senator Olympia Snowe
Olympia Snowe
Olympia Jean Snowe , née Bouchles, is the senior United States Senator from Maine and a member of the Republican Party. Snowe has become widely known for her ability to influence the outcome of close votes, including whether to end filibusters. She and her fellow Senator from Maine, Susan Collins,...
has proposed a "trigger" in which a plan would be put into place at some point in the future in states that do not have more than a certain number of private insurance competitors. Senator Tom Carper has proposed an "opt-in" system in which state governments choose for themselves whether or not to institute a public plan. Senator Chuck Schumer has proposed an "opt-out" system in which state governments would initially be part of the network but could choose to avoid offering a public plan.
Criticism
Michael F. Cannon, a senior fellow of the libertarian CATO InstituteCato Institute
The Cato Institute is a libertarian think tank headquartered in Washington, D.C. It was founded in 1977 by Edward H. Crane, who remains president and CEO, and Charles Koch, chairman of the board and chief executive officer of the conglomerate Koch Industries, Inc., the largest privately held...
, has argued that the federal government can hide inefficiencies in its administration and draw away consumers from private insurance even if the government offers an inferior product. Cannon reported that a study by the Congressional Budget Office
Congressional Budget Office
The Congressional Budget Office is a federal agency within the legislative branch of the United States government that provides economic data to Congress....
found that profits accounted for less than 3% of private health insurance premiums. Cannon believes that the lack of a profit motive reduces incentives to eliminate wasteful administrative costs. The chief executive of Aetna
Aetna
Aetna, Inc. is an American health insurance company, providing a range of traditional and consumer directed health care insurance products and related services, including medical, pharmaceutical, dental, behavioral health, group life, long-term care, and disability plans, and medical management...
, Ron Williams
Ron Williams
Ronald Allen Williams is the Executive Chairman of Aetna, Inc.. In 2005, he was named one of Black Enterprise's 75 Most Powerful African Americans In Corporate America....
, has stated on the News Hour with Jim Lehrer that a public option creates a situation where "you have in essence a player in the industry who is a participant in the market, but also is a regulator and a referee in the game". He said, "we think that those two roles really don't work well."
Senator Charles Grassley, an opponent of the public insurance option, was asked for his opinion of Medicare, a much more government controlled entity than the public insurance plan. Grassley stated that Medicare was "part of the social fabric of America", but he went on to say that "I think there is a lot wrong with it". Later in the same exchange he said “the government is not a fair competitor. It's a predator”.
Dr. Robert E. Moffit of the Heritage Foundation
Heritage Foundation
The Heritage Foundation is a conservative American think tank based in Washington, D.C. Heritage's stated mission is to "formulate and promote conservative public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values, and a strong...
has argued that a public plan in competition in private plans would likely be used as a "dumping ground" for families and individuals with higher than average health risks. This, in his view, would lead to costs that business should pay passed onto the taxpayer. Republican House Minority Whip Eric Cantor
Eric Cantor
Eric Ivan Cantor is the U.S. Representative for Virginia's 7th congressional district, serving since 2001. A member of the Republican Party, he became House Majority Leader when the 112th Congress convened on January 3, 2011...
has argued that a public plan would compete unfairly with private insurers and drive many of them out of business.
John Murphy, an independent candidate for Congress from the 16th District of Pennsylvania in 2006 and 2008, has called the current public option plan "a de facto bailout of the healthcare insurance companies" pointing out that "Here we have a health care bill (H.R. 3962) which will not only drive up insurance costs but will not even permit the government to negotiate with pharmaceutical companies, thereby driving up pharmaceutical costs as well! The Congressional Budget Office
Congressional Budget Office
The Congressional Budget Office is a federal agency within the legislative branch of the United States government that provides economic data to Congress....
(CBO) estimates that only 2% of Americans (6 million) will be able to participate in this plan while 33% of Americans will remain either uninsured or underinsured
Underinsured
Underinsured refers to various degrees of being insured for some real risks and uninsured for others, at the same time.-Health care:Johns Hopkins University professor Vicente Navarro stated in 2003, "the problem does not end here, with the uninsured...
."
Both before and after passage in the House, significant controversy surrounded the Stupak–Pitts Amendment
Stupak–Pitts Amendment
The Stupak–Pitts Amendment was a proposed amendment to the Affordable Health Care for America Act of 2010 . It was submitted by Representatives Bart Stupak and Joseph R. Pitts...
, added to the bill to prohibit coverage of abortions – with limited exceptions – in the public option or in any of the health insurance exchange
Health insurance exchange
A health insurance exchange is a set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance that is eligible for Federal subsidies...
's private plans sold to customers receiving federal subsidies. In mid-November, it was reported that 40 House Democrats have said they will not support a final bill containing the Amendment's provisions.
Marcia Angell
Marcia Angell
Marcia Angell, M.D. is an American physician, author, and the first woman to serve as editor-in-chief of the New England Journal of Medicine...
, M. D., Senior Lecturer in the Department of Social Medicine at Harvard Medical School
Harvard Medical School
Harvard Medical School is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts....
and former Editor-in-Chief of the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
, has written "...older under-65's will be more likely to go without insurance, even if they have to pay fines. That's OK with the industry, since these would be among their sickest customers. (Shouldn't age be considered a pre-existing condition
Pre-existing condition
A pre-existing condition is a risk with extant causes that is not readily compensated by standard, affordable insurance premiums. Pre-existing condition exclusions by the insurance industry are meant to cope with adverse selection by potential customers. Such exclusions have become a topic in the...
?) Insurers also won't have to cover those younger people most likely to get sick, because they will tend to use the public option (which is not an "option" at all, but a program projected to cover only 6 million uninsured Americans (2%)). So instead of the public option providing competition for the insurance industry, as originally envisioned, it's been turned into a dumping ground for a small number of people whom private insurers would rather not have to cover anyway." She lists five recommendations for modification of this bill, including "#1: Drop the Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
eligibility age from 65 to 55."
Public opinion
In 2010, Research 2000Research 2000
Research 2000 is a U.S. opinion polling and marketing research company based in Olney, Maryland. It began doing research on upcoming elections in 1999 after its President, Del Ali, moved on from Mason-Dixon Political Media Research...
polls for NV, IL, WA, MO, VA, IA, MN, and CO were conducted for the Progressive Change Campaign Committee
Progressive Change Campaign Committee
The Progressive Change Campaign Committee is a U.S. political action committee which focuses on electing progressive Democrats in Congressional elections and advocating on progressive policy issues.-Past campaigns:...
, Democracy for America
Democracy for America
Democracy for America is a progressive, people-powered political action committee, headquartered in South Burlington, Vermont. Founded by former Democratic National Committee Chairman Howard Dean in 2004, DFA leads public awareness campaigns on a variety of public policy issues, trains activists,...
and Credo Action of 600 likely general election voters in 2010, interviewed in each state by telephone, showing that in key swing states, the public option is far more popular than the Senate plan.
In 2010, 82% of Obama voters who voted for Brown in Massachusetts support the public option.
A poll from November 10 and 11 by Angus Reid Public Opinion found that 52% of Americans supported a public plan. Their research had a 3.1% margin of error.
Between October 28 and November 13, 2009, Democratic Senator Dick Durbin's campaign organization polled Americans to rank their support for various forms of the "public option" currently under consideration by Congress for inclusion in the final health care reform bill. The 83,954 respondents assigned rankings of 0 to 10. A full national option had the most support, with a 8.56 average, while no public option was least favored, with a 1.10 average.
On October 27, journalist Ray Suarez
Ray Suarez
Rafael Suarez, Jr. , known as Ray Suarez, is an American broadcast journalist. Suarez joined the PBS NewsHour in 1999 and became a senior correspondent for the evening news program on the PBS television network. He is also host of the international news and analysis public radio program America...
of The News Hour with Jim Lehrer stated that "Public opinion researchers say the tide has been shifting over the last several weeks, and now is not spectacularly, but solidly in favor of a public option."
A Pew Research Center
Pew Research Center
The Pew Research Center is an American think tank organization based in Washington, D.C. that provides information on issues, attitudes and trends shaping the United States and the world. The Center and its projects receive funding from The Pew Charitable Trusts. In 1990, Donald S...
report published on October 8, 2009 stated that 55% of Americans favor a government health insurance plan to compete with private plans. The results were very similar to their polling from July, which found 52% support. A USA Today
USA Today
USA Today is a national American daily newspaper published by the Gannett Company. It was founded by Al Neuharth. The newspaper vies with The Wall Street Journal for the position of having the widest circulation of any newspaper in the United States, something it previously held since 2003...
/Gallup
The Gallup Organization
The Gallup Organization, is primarily a research-based performance-management consulting company. Some of Gallup's key practice areas are - Employee Engagement, Customer Engagement and Well-Being. Gallup has over 40 offices in 27 countries. World headquarters are in Washington, D.C. Operational...
survey described by a USA Today
USA Today
USA Today is a national American daily newspaper published by the Gannett Company. It was founded by Al Neuharth. The newspaper vies with The Wall Street Journal for the position of having the widest circulation of any newspaper in the United States, something it previously held since 2003...
article on October 27 found that 50% of Americans supported a government plan proposal and 46% do not.
In a poll in which the data were gathered on August 19, 2009 Survey USA estimated that the majority of Americans (77%) feel that it is either "Quite Important" or "Extremely Important" to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance." When asked to choose between three statements about a "public health plan administered by the federal government", a 46% plurality chose "... patients might not always have access to their choice of doctors and the government would lower costs by limiting medical treatment options and decisions that should be made instead by patients and doctors."
A Rasmussen Reports
Rasmussen Reports
Rasmussen Reports is an American media company that publishes and distributes information based on public opinion polling. Founded by pollster Scott Rasmussen in 2003, the company updates daily indexes including the President's job approval rating, and provides public opinion data, analysis, and...
poll taken on August 17–18 stated that 57% of Americans did not support the current health care bill being considered by Congress that did not include a public option. A NBC News
NBC News
NBC News is the news division of American television network NBC. It first started broadcasting in February 21, 1940. NBC Nightly News has aired from Studio 3B, located on floors 3 of the NBC Studios is the headquarters of the GE Building forms the centerpiece of 30th Rockefeller Center it is...
/Wall Street Journal poll, conducted August 15–17, found that 47% of Americans opposed the idea of a public option and 43% expressed support.
A July survey by Quinnipiac University
Quinnipiac University
Quinnipiac University is a private, nonsectarian, coeducational university located in Hamden, Connecticut, United States at the foot of Sleeping Giant State Park...
found that 28% of Americans would like to purchase a public plan while 53% would prefer to have a private plan. It also stated that 69% would support its creation in the first place.
A survey published on July 17, 2009 by Rasmussen Reports
Rasmussen Reports
Rasmussen Reports is an American media company that publishes and distributes information based on public opinion polling. Founded by pollster Scott Rasmussen in 2003, the company updates daily indexes including the President's job approval rating, and provides public opinion data, analysis, and...
found that 50% of Americans opposed and 35% supported the creation of a government health insurance company. The survey presented the option as “the health care reform plan proposed by President Obama and congressional Democrats.”
Physicians
A survey designed and conducted by Drs. Salomeh Keyhani and Alex Federman of Mount Sinai School of MedicineMount Sinai School of Medicine
Mount Sinai School of Medicine is an American medical school in the borough of Manhattan in New York City, currently ranked among the top 20 medical schools in the United States. It was chartered by Mount Sinai Hospital in 1963....
done over the summer of 2009, surveying a random sample of more than 2,000 physicians, found that most medical doctors, at 73%, support a public option.
An IBD/TIPP
Investor's Business Daily
Investor's Business Daily is a national newspaper in the United States, published Monday through Friday, that covers international business, finance, and the global economy...
poll of 1,376 physicians showed that 45% of doctors "would consider leaving or taking early retirement" if Congress passes the health care plan wanted by the White House and Democrats. This poll also found that 65% of physicians oppose the White House and Democratic version of health reform. Statistician and polling expert Nate Silver
Nate Silver
Nathaniel Read "Nate" Silver is an American statistician, psephologist, and writer. Silver first gained public recognition for developing PECOTA, a system for forecasting the performance and career development of Major League Baseball players, which he sold to and then managed for Baseball...
has criticized that IBD/TIPP poll for what he calls its unusual methodology and bias and for the fact that it was incomplete when published as responses were still coming in.
A survey reported by the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
in September, based on a random sample of 6,000 physicians from the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
, stated that "it seems clear that the majority of U.S. physicians support using both public and private insurance options to expand coverage."
See also
- Health care compared
- Health care reform in the United StatesHealth care reform in the United StatesHealth care reform in the United States has a long history, of which the most recent results were two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act , signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 , which amended the PPACA and...
- Publicly-funded health carePublicly-funded health carePublicly funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population...
- SustiNetSustiNetSustiNet is a Connecticut health care plan passed into law in July, 2009. Its goal is to provide affordable health care coverage to 98% of Connecticut residents by 2014.-Provisions of the legislation:...
External links
- Briefings of the Alliance for Health Reform, Washington, DC, 2008–2009
- Health Care for America NOW! An advocacy group that supports a public health insurance option
- Rep. Dennis Kucinich Takes on Democratic Leaders with Insistence on Public Option - video by Democracy Now!Democracy Now!Democracy Now! and its staff have received several journalism awards, including the Gracie Award from American Women in Radio & Television; the George Polk Award for its 1998 radio documentary Drilling and Killing: Chevron and Nigeria's Oil Dictatorship, on the Chevron Corporation and the deaths of...