by Jacob Hacker
The Senate’s dramatic vote on health care reform early Monday morning [Dec. 24 -- ed.] was a bittersweet moment for those who have been fighting to increase competition and accountability for private health plans.
On the one hand, the vote moved the United States a major step closer to joining the company of other affluent democracies and ensuring every American is guaranteed affordable, quality health care. After nearly a century of defeated attempts, we stand on the threshold of historic changes that will provide major new subsidies for health insurance, impose new requirements on insurers and create a new means — the so-called exchanges — through which individuals and small employers can gain access to the same sorts of group health plans that workers at large companies take for granted.
On the other hand, the Senate bill fails to include a public health insurance option to provide an affordable, secure alternative to private insurance. This gaping hole in the bill would have greatly pained me even if the opposition had not been led by my home-state Sen. Joe Lieberman (I-Conn.). As the thinker most associated with the idea, I have long argued that the public option was the best hope for creating accountability for insurers, holding down premiums and ensuring Americans had access to a plan that didn’t deny needed care or shift costs onto them. Now, thanks to Lieberman, the institutional dysfunction that is the Senate filibuster and hundreds of millions in medical industry spending, the public option that a strong majority of Americans consistently supported is gone — in this round.
But while the public option is gone, it has not been forgotten. To compensate for its loss, Senate Majority Leader Harry Reid’s manager’s amendment puts a series of stronger regulatory checks on the insurance industry. The manager’s amendment sets a floor on the number of premium dollars insurers must spend on care and requires insurers to issue rebates to policyholders if they do not live up to this standard — a strong new regulatory check on insurer behavior.
And, for the first time, the federal government will require insurers to disclose many of their claims-payment policies and related practices, allowing consumers to understand more about the insurance products they are buying than ever before.
All of these steps represent a good beginning — but only a beginning. The gaping hole left by the removal of the public option must be filled, at least partially before the final bill is passed and more fully every year thereafter.