'Public Option' Fight Misses True Measure Of Reform, Says Expert

Main Category: Public Health
Article Date: 13 Sep 2009 - 0:00 PDT

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The political struggle over the "public option" continues to run the health care reform debate aground, stealing the spotlight from the true measure of any plan, argues University of Maryland Public Policy Dean Don Kettl. Instead, the debate should focus on what Kettl calls the 'r' word: not 'rationing,' but 'regulation.'

"What ultimately will decide the success or failure of health reform isn't who owns the insurance program," says Kettl, an expert on the federal bureaucracy. "It's how well we write and run the ground rules under which they'll operate: whether pre-existing conditions will exclude Americans from coverage, or whether they can afford insurance if they lose their job, or whether running up a big bill will get them bounced out of the plan. The rules on these questions - and many, many more - will determine how well any stripe of health reform actually works."

Yet even following President Obama's speech to Congress, Kettl says the public option remains an "ideological litmus test" that continues to divert attention from crafting the real core of health reform.

"We haven't yet tackled the big question that ultimately will decide whether the fight was worthwhile - whether reform can truly live up to its promise," he says.

Public debate has failed to address the serious problems involved in Medicare, Medicaid and other U.S. public health systems, which support a host of private contractors who implement much of these public programs on a day-to-day basis, Kettl adds.

"Behind the federal bucks is a small army of invisible private contractors, who assemble the bills, collect from the feds, and distribute it to caregivers," Kettl, says. "President Obama has promised hundreds of billions of dollars of savings from the current system to pay for the new reform, but that won't happen without doing a far better job of getting that army under control. Decades of effort haven't accomplished that yet. In so many ways, that's the soft underbelly of the reform effort."

Source
University of Maryland, College Park

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