The socialists are coming!

From the moment it was proposed, the Republicans have pointed to the public option as the precursor to socialized medicine, a federal takeover of health care wherein government bureaucrats come between you and your doctor. And not to forget those fringe conservatives, packing tea bags and side arms, who have taken "The socialists are coming!" and pushed it off a rhetorical cliff into claims of Nazism, Stalinism, communism and any other "ism" that might be handy. Clearly, the public option has become the conservatives' red herring extraordinaire, rolled out when needed, a nice distraction from the inescapable reality that our health care system is broken and must be changed or financial ruin will find us.

Other than to obstruct and deride, the Republicans long ago absented themselves from the health care debate. As it turns out, however, those who could block this major reform legislation, akin to Social Security and Medicare, are conservative Democrats, also known as Blue Dogs, such as Mary Landrieu of Louisiana or Ben Nelson of Nebraska or Blanche Lincoln of Arkansas — all buttressed by that curious Democrat-turned-surreal-Independent, Joe Lieberman, Al Gore's V.P. nominee, who, in the last election, campaigned vigorously for John McCain.

Ask them what their central concern is about health care reform and they say, almost reflexively, "the public option." Give them reform, they insist, but jettison the PO and they might vote for the Senate bill now under consideration. Might.

So, why has the public option become a line in the sand for the Blue Dogs (as well as the Republicans)? All have stated, flush with gravitas and piety, that their opposition is a matter of conscience, a principled stand against big government, or words to that effect.

To begin with, it's not a federal takeover of health care. That's pure hyperbole or overt mendaciousness. A single-payer Medicare for all would be government-run health care (a most efficacious solution that was, regrettably, long ago abandoned).

In reality, what the Blue Dogs define as a long slippery slope to socialism (think Canada and then shudder), is an anemic, narrow strand in a complex quilt known as reform.

Here, loosely, is how the PO is constructed (subject, of course, to change):

If you are now on Medicare (78 million Americans), nothing will change. No one is going to put grandma out on an ice floe.

Those who are 133 percent above the poverty line — the federal poverty threshold is $10,830 (single) and $22,050 (family of four) — will be eligible for an expanded Medicaid (15 million Americans).

If you have employer insurance (122 million Americans), new consumer protections will be written (pre-existing conditions, etc.) and you will keep your insurance. For those not insured by employers, and depending on your income (percent above the poverty line), individual insurance will be subsidized, also with new consumer protections (57 million Americans). There will be a public option, run by the government for these individuals and families, giving them a choice between private and public insurance. For individuals and families whose income is 300 percent above the poverty line, there will be unsubsidized individual insurance with consumer protection (25 million Americans). This will include an unsubsidized public option.

So, using the above figures, let's say 3 to 5 percent of all Americans select the public option. It could be far less, depending on how competitive the private insurers become. Recall that those who receive insurance from their employers will not be eligible for the PO, though Oregon Senator Ron Wyden has proposed that it should be open to everyone (an eminently reasonable suggestion, but not likely to gain any traction in Congress).

If the math is substantially correct, those eligible to enroll in the PO are a fraction of the total number who will choose or remain with private insurers or are enrolled Medicare or Medicaid.

So, why are the Blue Dogs (and the Republicans) using the PO as the hook upon which to hang their objections? Why would they rail against something as benign as the PO? Clearly, it doesn't threaten free enterprise, which thrives on competition. Doesn't it? And not by any stretch does it represent big government.

So, if it's not the PO, then what? Is all this principled resistance a form of diversionary Kabuki theater meant to distract us from the truth that this is really about money, meaning that avalanche of cash that flows from special interests into the campaign coffers of Congress? Are we getting the best government that money can buy? Granted, that sounds deeply cynical, the implications being that our elected officials have surrendered their fiduciary duty to the electorate and sold out for money and power. And, by extension, forsaken not only those millions of Americans who have no health insurance but, ultimately, those 44,000 who die yearly as a result. Is that possible?

Honoré's reviews appear weekly in Revels.

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