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John Sherman, Published October 07 2009

Only three serious choices for real health care reform

The Forum’s editorial of Oct. 2 defending Sen. Kent Conrad’s, D-N.D., votes against the public option would have been more persuasive if it had gotten some basic facts right. In a body of 100 such as the Senate, a majority is 51. For example, when Republicans pushed through the last major health care reform bill in 2003, it passed in the Senate 54-44. It is not necessary that 60 Democrats vote for a public option; it is only necessary that 60 vote for cloture to allow the Senate to vote on a bill.

The idea of co-ops also would be more persuasive if Conrad, Forum editors or anyone else could provide a business plan that would produce a plausible vision how it would work. For example, how would a co-op seriously cut into Blue Cross Blue Shield of North Dakota’s monopoly in a reasonable amount of time?

Any health care reform bill that becomes law will almost certainly have universal, or nearly universal, mandated coverage and federal support of premiums for low-income people, which taken together would create a pipeline from the federal treasury to the private insurance companies.

There really are only three serious choices.

(1) Do nothing and let the insurance companies take all they want out of the federal treasury. The likely result is indicated by a recent study of Medicare Advantage showing that for every dollar that leaves the treasury, 14 cents go to the beneficiary and 86 cents stay with the insurance company.

(2) Regulate like some European countries do. Does anyone believe that the insurance companies would let their congressional hirelings vote for tough European-style regulation? Having just watched the allegedly regulated finance industry crash and burn, we don’t really want to see health care go the way of housing.

(3) Public option. The public option is simple, competitive, efficient and market-oriented. Detractors claim that a public option will eventually supplant private insurers. If that happens, it will be because, based on the record, a public option will have

3 to 4 percent administrative overhead compared to the private insurers’ 20 percent. The private insurers will either have to compete with the more efficient public option or die. And if they die, so what?