The Fundamental Dilemma of Health Care

I have a piece at the Prospect about Aetna bailing on most of the ACA exchanges is participates in. On the one hand, it shows the necessity of the public option; on the other hand, is shows (as Erik said yesterday) why it will be enormously difficult to pass:

The Obama administration shouldn’t cave. Instead, Democrats should take steps to address the health law’s underlying problems. The obvious solution is one that surfaced repeatedly in the multiple draft versions of the legislation that eventually became the ACA, and that is now part of the 2016 Democratic Party platform: a public option. This would entail making a government-operated health-care plan available on public markets. Allowing good public insurance to compete would both ensure that decent, affordable insurance is available in all 50 states, and prevent power plays like Aetna’s by making public insurance available as a backstop. If private companies can provide insurance that people want to buy at rates competitive with the public option, good. If they can’t, this would also be fine, because the public sector would absorb a bigger share of the health insurance market, a positive development in itself.

What makes the public option desirable will also make it very hard to pass, of course, even in the event that Congress becomes more Democratic and more progressive after Election Day. Insurance companies know full well how a robust public option would eat into their customer bases and profits, and will fight it with everything they’ve got. Democrats should exhaust every avenue for winning a public option. But if they fall short, there are other ways to strengthen health insurance exchanges.

There are some alternative measures which might be more viable, the best of which is the Medicare buy-in Joe Lieberman torpedoed. You can click the link to find out!