Sorry to be so negative, but really: people just shouldn’t be getting pissed about the absence of a public option, for at least three reasons:
1. Even with a public option, we always would have needed to address subsidies for those with low incomes. People are welcome to chime in with other information here, but the public option does not address affordability at all. It addresses the quality of insurance. Subsidies were always the bigger deal.
2. *We got coverage for 32 million people*. We got *affordable* coverage for 32 million people. We got coverage that *saves 32 million people from health-care-related bankruptcy*. Liberals of a certain stripe have gotten monomaniacal about their preferred policy, rather than focusing on the end goal — which is *to help people who couldn’t afford good health insurance to afford good health insurance*.
3. Now we have something that we can fix. Before we had nothing. New entitlements don’t disappear, as David Frum has now-famously pointed out. Entitlements get better. So let’s make this one better.
This has been, in some ways, a great hour for the Left. In other ways, it has revealed them to be monomaniacal public-option fetishists. Now is not the time to continue the fetish. Now is the time to consolidate our gains and *keep moving forward*. You want a public option? Great! You’re closer to a public option than you were a year ago. So go get it. Donate to candidates who support it. Call Bernie Sanders’s office and ask what tactical advice he’d give. Don’t act like an armchair quarterback and complain that the big bad U.S. Congress with its big bad traitorous liberals didn’t give you what you wanted.
Steve Reads 
The public option could have addressed affordability if it could reduce premiums by virtue of eliminating administrative overhead and profit-seeking. Now one might say that all insurance companies will be able to eliminate overhead, because cherry picking will now be illegal. But this isn’t quite right. Yes, guaranteed issue, community rating, and a generous minimum plan (except for those under 30) will mean that individuals cannot be denied the same coverage as everyone else at the same rate. But there will still be insurance companies seeking to use creative marketing to attract a healthier pool. Assuming the public option would not seek to do the same, it could save on overhead. But then it could also lose by acquiring a higher risk pool of enrollees. This was Paul Star’s concern about the public option.
But then there are Uwe Reinhardt’s concerns about the public option that I have pointed to before. Matthew Yglesias had a post a week or so ago (http://is.gd/aT5OB) identifying provider market power, structure, and incentives as the next frontier of health care reform. The clout of providers to insist on and win concessions and higher payments from health insurance companies is the great unspoken issue in the health care reform debate to date. Reinhardt has said all along that the public option had the potential to be a “mouse that roars,” since adding one more insurer into the mix reduces further the bargaining power that any one insurer has vis-a-vis health care providers (http://is.gd/72A7F). I’m not expert, but this seems to me to be the best response to those who go on and on about the public option. The last thing we want is for health care reform to be pegged to the public option, and then to have failures in the next frontier to reflect failures of reform in general.
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I have a deeper question with regards to the subsidies. Let’s say you were designing a wealth redistribution system for the United States from scratch. For a family of one adult, two children, in which the adult works full time earning $15k a year, what would be the total dollar value of the transfers/benefits minus total taxes, that you would give that family? What if the adult earned $25K a year, how much net redistribution would you give them? $35K? $45K? $55K? And then what total tax rates would you set on families earning $75K, $150K, and $300K a year?
Now on to the predictions/bets. Give me a number for the following:
1) Right now blacks have almost double the rate of uninsurance. The cancer mortality rate for blacks between age 60 and 64 is 36% higher. By 2020 (or 2025 if you wish), will the mortality gap decrease? By what percent will the black cancer mortality rate still exceed the white rate?
2) Currently Canadian life expectancy is 2.3 years greater than the American life expectancy. Do you expect that gap to close now that the U.S. has instituted universal insurance? By how much? What will the American-Canadian gap in life expectancy be in 2020?
3) How much will bankruptcy rates fall from 2013 to 2018?
4) What percent of GDP will be spent on healthcare in 2020?
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