Watching President Obama’s health-care speech Wednesday, I wanted to hear what he had taken away from the public back-and-forth of last month. While the only opposition he acknowledged explicitly was that of people using “scare tactics” to “score short-term political points,” his message was clearly crafted to reassure a nervous nation.
And his message of reassurance boiled down to: Trust me.
“I have no interest,” Obama said, “in putting insurance companies out of business.”
“No one would be forced to choose” the public option.
“I will make sure that no…bureaucrat gets between you and the care that you need.”
As you might have guessed, I’m skeptical that these claims will prove true. I still think the public option is a bad, unnecessary policy.
But let’s spend a few moments thinking about trust. Let’s pretend that all Americans did consider Obama a Super President who could fulfill all of these promises. That is, let’s pretend that we could just trust him.
Can we trust his successor?
Can we trust his successor’s successor?
Can we trust current and future members of Congress to make good on Obama’s pledge not to let new health spending add “one dime to our deficits — either now or in the future”? Can we trust them not to avoid health-related deficits with the same kind of accounting shell games that have put Medicare and Social Security in danger of insolvency?
These are not scare tactics. They’re legitimate questions about a new government program which Obama said would cost “only” $900 billion over 10 years. If other Democratic health proposals are any guide, even that 12-digit figure is optimistic.
A man with whom Obama has been contrasted many times, Ronald Reagan, had a phrase about goodwill and good sense that seems appropriate in this debate: “Trust, but verify.”
So, how to verify here?
Obama said Wednesday that he didn’t want to put private insurers out of business, that he valued competition in the health-insurance market. He said a single-payer system, which is exactly what many Americans fear would result from a government-run insurance option, would “represent a radical shift that would disrupt the health care most people currently have.”
If having five or fewer companies gobble up 75 percent of a state’s insurance market is a problem, as Obama said it was, then surely he wouldn’t want a public option to take up too much of a market, either.
So if all that’s true, why not cap the market share that the public option could have in any given state? Rather than a “trigger” for launching a public option, why not a “firewall” to keep it from getting out of control?
Obama cited a CBO projection that less than 5 percent of Americans would enroll in a public option. Five percent of Americans is about 15 million people, which happens to be approximately the number of uninsured people that other studies have suggested are the truly tough cases.
That figure excludes illegal immigrants, Americans who qualify for Medicaid but aren’t enrolled, and those who earn at least $50,000 a year but choose not to buy insurance. The remaining 5 percent fall through the cracks.
If covering those 5 percent would suffice, as Obama seemed to suggest, then a 5 percent cap on public-option enrollment sounds about right. Require a supermajority in Congress to lift the cap.
Plenty of Americans remain wary of a public option. If Democrats won’t consider something as conciliatory as a public-option cap, we can’t accept their “trust” fund for health care.