The first of these is affordable, portable insurance coverage for everyone, including those who are presently uninsured.

Then he mentions the broad goal of controlling costs and cutting systemic inefficiencies, and gives examples of ways in which such cost-cutting measures would impact other aspects of the system.

It is on his fourth point that President Obama’s editorial waxes the most eloquent with specific policy agendas for the legislation under discussion:

Our reform will prohibit insurance companies from denying coverage because of your medical history. Nor will they be allowed to drop your coverage if you get sick. They will not be able to water down your coverage when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime. And we will place a limit on how much you can be charged for out-of-pocket expenses. No one in America should go broke because they get sick. Most important, we will require insurance companies to cover routine checkups, preventive care and screening tests like mammograms and colonoscopies.

All of these are, as I say, admirable sentiments: goals which you would think our whole country could unite behind.

Yet as it turns out these goals are quite divisive.  Such a hoopla in the press and in the halls of Congress has rarely been heard; and the things some of the pundits are saying are just simply unbelievable, as in, “I can’t believe you actually said that!”  The wild accusations are beneath us here at the Principles blog, we have no time for them.  Heck I hardly have time to post at all, these days…

But I think it’s worth noting here that there is a certain taste of political vagueness to that first point mentioned in President Obama’s op-ed piece.  In presenting the tremendous goal of providing affordable health insurance to everyone (including all those who are presently uninsured, as well as the significant portion of the population whose head of household is presently unemployed) the President’s op-ed does not mention any specific mechanism for providing affordable health care to those who can’t afford it.

We’ve all heard some options tossed around lately.  Some say, make health insurance mandatory.  Some say, create a whole bunch of local health insurance co-ops that would somehow offer alternatives to the large national health insurance corporations.  But what the Senate so far has been unwilling to say, what the President is no longer saying as loudly because he wants to get some darn legislation passed already, is that the best way to control the cost of health insurance is to offer a government-backed alternative and truly give people a choice.

This is what I would like to hear from the President:

All those who want to pay more for less coverage, you go ahead and keep your current private insurance provider.  All those who want better coverage for less money, fill out this form to sign up for the government option, and then just keep going to your preferred physician or other care provider.

I discussed this issue explicitly in the book in section 5.2.2, Universal Health Care:

In current public debate, the opponents of public health care never fail to mention that there are sometimes waiting lists for certain health services in other countries with public health care systems. Never do they mention that trauma patients must already wait several hours for emergency care in many underserved American hospitals. Never do they mention that the economics of health care in America excludes millions from the system.

It is defeatist to say, “We should not try to improve our system because there are problems with someone else’s system.” That is not a positive, winning attitude. Instead we must acknowledge our own faults as well as those of our neighbors, learn from those mistakes, and move on to create a new system, perhaps the best one devised so far.

The insurance system is the problem: it costs too much, and it provides too little care to too few people. The single-payer system, where a portion of all tax revenues is paid into a health care fund which in turn covers the operating costs of the health care system as a whole, is part of the solution. Re-instating the ban on advertising prescription drugs, which was lifted in the 1990’s and which is strictly enforced in many other developed nations, would help to decrease pharmaceutical costs and unnecessary prescriptions.

…The idea of mandatory health insurance completely misses the point. Our health care system has been destroyed by the insurance industry. We cannot look to the insurance industry to fix the problems they have caused. Instead we must make a new system.

Health care, including preventative medicine, should be free of charge for all Americans.

As you see, the goal I outline in the book is a much broader, more aggressive goal than anything Congress is debating right now.  Since it is clear that my ideas will not be passed into law this year, I think offering a government-backed health insurance plan that competes with private insurers is the best alternative that I have heard.

If Congress does manage to pass a health insurance reform bill in 2009, the reforms they implement could possibly be a first step towards the creation of such a system as the one I describe: health care funded by tax revenues instead of user fees.  Or, if their new system works well enough for now, the reforms implemented this year might continue to work well enough for the next fifty years or more.  Alternatively, if the new legislation is widely seen as a total waste of money flop and a failure, then the Republicans will have a better shot at the White House in 2012.  The Republicans are doing their best to convince people of this already, before the legislation is even passed.  They would prefer no reform to any reform; and if reform is to be passed, they will pick at it and pick at it until only the most useless parts of it remain.  I fear that if a complete compromise bill is passed with two or three grudging Republican votes, it will end up simply providing a tax subsidy to the insurance and pharmaceutical industries without actually changing anything.

The Democrats must not let the party of George W. Bush follow up the twin disasters of Iraq and the economic depression with a third disaster by letting the health care system continue to ruin lives by forcing people into health care related bankruptcy even when they have insurance.  Reform is essential, and the broader and more lasting the reform, the better.

If the Democrats in the Senate cared what I said, I would tell them not to listen to all the lobbyists crawling all over the capital right now; because if the Democrats in the Senate can stand together long enough to get the public option through, the American people will certainly thank them by giving them a majority again in the next two or three election cycles at least.

I’m sure President Obama will continue to do his best to exhibit leadership on this issue.  I hope that he will recognize how essential a public option is to any real reform.