Franken, who has always defined himself as "a DLC Democrat"* comes right out and says that he considers the bill only "aspirational," a "marker," and "a starting point for where we need to go." In other words: This is not real legislation and a real policy that I'm really supporting, but a kind of thought-experiment that I'm going to use to lead you to something else.
And that "something else" is something less than single-payer. Gillibrand puts that lesser card on the table. Bernie's bill, it seems, has sections that "help establish a road map for what some other strategies might look like." Gillibrand herself wrote into the bill an option to buy Medicare-like government plans on the "already available" Obamacare exchanges.
This is the pernicious "public option" that the Times delicately and deceptively says "didn't have enough support" to stay in the final ACA bill, (It didn't have Obama's support, and he killed it.) As Gillibrand describes it: "One part of the [Sanders] bill that I worked with my colleagues to put in was the ability for every American to buy into a nonprofit public option" This would create affordable, public health care that is available to any American to purchase in the already available exchanges." This "public option" is going to be pitched by Gillibrand as another "transition to get to single-payer." But it is no such thing; it is not a move toward, but a diversion away from, single-payer, and a damaging one.
The "public option" can be spun to sound like a reasonable and "realistic" progressive alternative, another Zeno step toward single payer, In fact, any "public option" with the real progressive intent Gillibrand claims would actually destroy the private health insurance industry and market rather quickly. But that is not what Gillibrand or any of these Democrats want. They want a public option that will preserve and stabilize the private insurance market.
There are a number of more specific reasons the public option cannot be the progressive "step" it is touted as. You can find them in the analyses of RoseAnn DeMoro, Russell Mokhiber, Margaret Flowers, Adam Gaffney, Physicians for A National Health Program, Naked Capitalism,, and many others. I'll mention a couple of them here.
First of all, the public option will not, and cannot, achieve universal coverage--something that single-payer advocates, including Bernie Sanders, have always presented as an indispensable goal. It will leave tens of millions of people without health insurance. Remember the vociferous moral outrage about the 24 million people Trumpcare would have taken coverage away from (and the missing moral outrage about the 28 million people Obamacare leaves uncovered)? Well, as Dr, Margaret Flowers asks, if Gillibrand and Franken think "it is acceptable to promote a policy that leaves some people out, then we want to know who should be left out."
Second, the public option leaves a segmented, multi-tier healthcare system (including the tier of the uninsured). As RoseAnn DeMoro of NNU notes: "Medicare works in large part by including all the people it covers in one large risk pool so that healthier patients balance out sicker patients in costs that must be reimbursed to providers." The public option scheme prevents the equalization and cost-cutting that would come from a fully public Medicare-for-all program. As Adam Gaffney says: "We don't need competing public and private insurance plans any more than we need competing public and private air traffic controllers." Throwing a public option into the mix on the "already available exchanges"--which are different in every state--is a scheme that maintains the waste and inefficiency of unnecessary parallel healthcare programs,
It also reinforces the class divisions and resentments those parallel programs create. One might be excused for thinking it maintains those wasteful inefficiencies in order to maintain those divisions. It would keep a "poor people's" tier of healthcare (Medicaid, etc.) distinct from what people with extra money in their pockets can purchase in the exchange. Because it's very important (for the intra-class division on which capitalism depends) for everyone to know, and continually parse, who gets "welfare" and who's "paying their way." Let's keep some extra layers of bureaucracy just so desperately poor people can be reminded that they're not precariously "middle-class," and vice-versa.
Furthermore, as long as the public option is competing in a market--i.e.," exchange"--system, the private for-profit insurance sector will be a rallying point for conservative wedge attacks to undermine the public program. Conservative Republicans and corporatist Democrats will conjure ways to create market advantages for the private plans, via subsidies, tax breaks, reducing the payments to providers from the public plan, etc. As the devolution of Obamacare has shown--with its skyrocketing premiums, narrowing networks, and the flight of many insurance companies--keeping the health insurance market profitable requires a lot of care and feeding.
It would be supremely foolish, for example, not to expect that "other strategies" coming from Gillibrand, Franken, and the neoliberal Democrats will be projects for "fixing"--more like resuscitating, at this point--Obamacare and its "exchanges" with a public option that, as DeMoro says: "becomes the ACA escape valve by welcoming in the sickest people selected out by the private insurers, in effect another bailout for a failed private insurance market." What a waste of time.
Any way you configure it, a --public option" integrated into a private market paradigm offers no discrete improvements they can point to that wouldn't be better achieved with a full public single-payer program. The only reason Clintonite Democrats want to divert the Medicare-for-all momentum into the "public option" cul-de-sac is to save the for-profit private health insurance industry. (I'll address the other ostensible reason below.) They oppose single-payer and are now presenting themselves as supporters of it in order to make sure no plan gets through that will actually break the for-profit market system.
Nothing indicates more clearly the fundamental commitment to the capitalist market paradigm the Democrats share with the Republicans than the game these Democrats are playing with healthcare. As Adam Gaffney p oints out, in 2016 Paul Ryan and the Republicans, insisting they only wanted to "save" Medicare, published a proposal by which "traditional Medicare would be transformed into a public plan that would compete against private insurance plans in a 'Medicare Exchange.'" Every sentient person understood that as a plan to destroy Medicare, and the Democrats denounced it as such.
Well, the Franken-Gillibrand "other strategies" Democrats are trying to do the same thing to the Medicare-for-all proposal as Ryan and the Republicans tried to do with existing Medicare. In other words, as Obama did in 2009, today's Clintonites are taking a Republican idea and dressing it up in Democratic finery. Their "other strategy" for taking a "step toward" it is to stop the train in its tracks and push it in the opposite direction. This time, as everybody did with Ryan, let's recognize this "support" for what is, and let's not let them get away with it.
The fundamental character of these RepubliDem proposals is signaled in the language of "affordable" healthcare. The "public option" does not make healthcare a right; it maintains it as a commodity that you have to buy and "afford." It's more of the "Go shopping!-- mandate. As if people shopped for health insurance like they do for tomatoes. Maybe I'll make some spaghetti sauce get some health insurance today. I'll just buzz by Whole Foods and Trader Joe's Aetna and Humana to see what's on sale which policies are most "affordable." Isn't it great that they're selling that store brand, too!
This paradigm is a cruel joke. Anybody who's spent year after year "shopping" in this market--i.e., slogging through ever-changing, ever-costlier, ever-crappier, and ever-more complicated plans--knows that. Haven't we had enough of it? Health insurance, which effectively means healthcare, should not be presented as a discretionary consumer commodity, "available to purchase" by individuals in some kind of shopping mall, according to "affordability." It should be organized as a necessary right, available via a publicly-funded program, on the basis of one's humanity.
This was the whole point of single-payer as Bernie Sanders emphatically presented it over the last two years. Putting a generic brand of bottled water on the shelf in the bottled-water store is not the same as providing a public water supply. Not the same at all. Not a "step towards." Two entirely different principles at work.
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