Friday, August 28, 2009

EDITORIAL >> Snyder pulls his punches

Rep. Vic Snyder may be the most reasonable person in all of the United States Congress. His natural inclination to try to understand the point of view of everyone from his fans to the whooping critics of government is the principal reason that Snyder is so popular in his district. That and his occasional willingness to venture out almost alone with an unpopular stand, such as his vote against authorizing the invasion of Iraq in 2003. People admire civility and courage.

But Snyder’s patience and understanding are sometimes contrived, and they lead him to a position that seems to be the safest politically in a volatile atmosphere, not the best for the country and his constituents. That is where he is in the debate over health-care reform.

In three town-hall meetings this month, Snyder has impressively tamed the raucous crowds by listening with studied patience to the sometimes bizarre and misinformed ravings of people who have been told by their insurance companies, Fox News, Rush Limbaugh, Glenn Beck, or somebody, that the various bills pending in the Senate or House of Representatives would impose the cruelest penalties, even death, on Americans and that the bills would produce government-rationed medical care or turn the United States into a socialist state. Snyder says he understands their concerns and explains the problems that the bills are trying to address and how the House bills would address them. He doesn’t shout back or turn the tables on a protester as Congressman Barney Frank and a few other lawmakers have done. When elderly people expressed alarms about the prospect of government medical care, Snyder did ask a big crowd at Conway how many were on Medicare and would like to give it up. (Medicare is the government.) One man shouted yes.

Good for Snyder. Every ounce of civility in this supercharged atmosphere puts us a little closer to reasoned judgment. But it is hard to escape the conclusion that on one of the central issues in the immensely complicated health-care debate, an optional public-insurance plan, Snyder is pulling his punches. He finds safety in a middle-of-the-road stand. The insurance industry, the chamber of commerce and the right-wing echo chamber have made the so-called “public option” the central issue. They say it would lead to a government takeover of the whole health-insurance industry.

The House bills, which have slight variations, would mandate everyone to buy health insurance either individually or through their employer. Families with low incomes would get a sliding subsidy from the government to help them buy a policy. The individual or the employer could keep their present insurance if they liked it or they could opt for one they liked better in an exchange where insurance companies would offer their various products. One of the options in the exchange would be a policy or several policies that the government would offer. People could buy whichever plan they liked.

Insurance companies and the chamber of commerce say the insurance companies could not compete for customers because the government plan would be a lot cheaper. Premiums for the government plan would be based on actual medical costs and the government’s very low overhead, but the insurance companies would have to calculate premiums that would cover their higher administrative costs plus sufficient profits to keep stock prices high and executives in clover. Their best argument is that Medicare, the largely government-insurance program, costs far less than private-sector insurance services, even though Medicare covers the sickest Americans, the elderly and disabled who demand far more expensive medical services.

Snyder explains that he doesn’t see much benefit from a public option and he would be happy with a bill that gave all the expanded insurance business to the handful of private insurance companies, Blue Cross, Aetna, Cigna, United, Wellpoint, Humana. On the other hand, he says, if a public option somehow made it into the final bill, he probably would vote for the bill.

But he isn’t going to fight for a public option.

Here is the reason that he should. The biggest crisis, even larger than the 47 million Americans who do not have any form of insurance, government or private, is the horrendous expense of medical care in the United States — now 17 percent of GDP, far more than any other nation on earth. Countries that guarantee care for everyone — and excellent care in most cases — do it far more cheaply. The costs are skyrocketing every year. Even the harshest critics say it is a crisis that cannot be put off any longer because it undermines the nation’s economic stability.

But without a public option that will offer cost-contained care at a low premium and force the private insurers to compete, how will they stabilize the costs? They won’t. Oh, they can slash Medicare and Medicaid, which Sen. John McCain said he would do if he were elected president, but if you think us oldsters are mad now, try curtailing and really rationing Medicare services.

Here is what will happen without an optional government plan: The insurance companies will at once get 20 to 40 million new premium-paying customers, many of them subsidized by the taxpayers, and they will not have to spend a dime on TV commercials or direct mail to sign them up. Yes, Congress may stop them from cutting off people with pre-existing conditions or stopping coverage when a longtime premium payer contracts an acute illness like cancer, which is how companies keep their profits and stock prices rising even in the darkest times. But the insurers would only have to increase their premiums to cover the increased risks. There would be no government rule or market force to restrain them.

Congressman Snyder needs to tell us how the cost containment would work without a public option. We don’t think he can.