My friend Rick opposes the public option for health reform. In a recent email to me, he discussed his various options and “backup plans” for health insurance—his company, his wife’s company, VA Health care, and eventually Medicare. Notice that half of these are government run public options for those who qualify. I’m happy for Rick. He and his family are covered. They will face increasing premiums, particularly if there is no health reform and there is always the risk that Rick’s company will stop providing health insurance coverage to retirees and that Rick’s wife might be laid off or have her company drop her coverage. It all depends upon the size and viability of the companies. Even if that happens, Rick has the back-up public option of VA health care and Medicare at 65. He has options.
Rick also writes “I stayed on a career path with companies that provided insurance. I had several opportunities to move to independent employment at a higher income bracket, but would have had to purchase insurance on my own. I chose not to do that.” I know a number of people who have done that including people who were miserable in their jobs but felt they couldn’t pursue other options because they had pre-existing conditions that would make it difficult, if not impossible for them to get insurance. I know people who had great ideas for small start-up businesses that never pursued their dream because of the difficulty and cost of getting individual insurance. I know people who stayed with large companies even though they desperately wanted the excitement, independence and opportunity that employment in a small company might have offered them. I know people who dreamed of pursuing a career in the arts, who had the talent and were willing to make the financial sacrifices to do so who never pursued their dreams because they or a loved-one had a pre-existing condition that made getting individual insurance problematic and going without it too risky. I know people who wanted to stay with large companies not just because of the access to insurance but because they liked working in a large company who were laid off through no fault of their own, lost their insurance, and were unable to find work with a company that offered insurance. I know people who lost their jobs from a company that provided insurance not because of poor performance but because they developed cancer or another expensive-to-treat disease that would have driven up health insurance costs for their company. Of course, they weren’t told that their illness was why they were being fired or laid off but everyone knew that was the case. I’ve known people who wanted to take time off to care for an elderly relative during their few remaining years or sick child or who wanted to just spend more time with their family and would have made the financial sacrifice to do so it had not been for the risk of going without insurance or being able to afford individual coverage.
People go without coverage and/or have poor coverage and/or don’t have access to employer-subsidized health insurance for many different reasons.
Access to a public option is essentially an issue of fairness. Rick and most Americans have options for obtaining health insurance, many have multiple options and back-up plans. However, millions of Americans, sometimes by choice but most often for reasons outside of their control, have limited options for obtaining health insurance if they can do so at all. That’s not right.
Now I know the argument opponents of health reform make. A public option will destroy private insurance. A public option will lead to single-payer “socialized” medicine. Is it possible that such things might happen? Perhaps, but the chances are remote. I think it is equally likely that without health reform the majority of Americans will be without health insurance within twenty years because they either no longer work for an employer that provides insurance (companies are dropping coverage every day) and/or the cost of insurance, even insurance subsidized by their employer, is just too expensive. There are all kinds of possibilities.
What is certain is this. Nearly 50 million Americans today are without health insurance because they don’t have access to an affordable option. They are simply asking for an affordable public option. Most Americans have health insurance options, many multiple options. The 50 million don’t have affordable health insurance options, many not even one. We need a public option. It’s an issue of fairness. It's the right thing to do. It's the American thing to do.