I fought for the public option because I simply didn't trust the ability of our current government to strongly enforce regulations against some extremely wealthy corporations without it. After watching the finance sector collapse, taking down our whole economy, I would expect my skepticism to be broadly shared. The incredible size of the collapse of the financial sector was not due solely to a lack of regulation, but was helped by the lack of tough enforcement of the regulations we had.
The danger of the weak regulations in the new health care law is especially serious because most enforcement is left up to the state insurance commissioners and state exchanges. The state insurance commissioners who are not already too close to the insurance companies are often desperately underfunded and unable to go up against insurance companies top-notch legal teams.
The other problem is that one party in our two-party system has a dangerous love of de-regulation. I don't know why anyone would put trust in the long-term success of a health care system completely devoid of tough regulatory enforcement, and when the Republican party is in power, they seem to have a pathological disdain for enforcing regulations.
Public programs are unlike regulations in this country. People use public programs and come to like them. It is much harder to kill a popular public program than it is to let a regulatory system slowly get corrupted through weak enforcement. Once a public program gets going, it creates a voting block of constituents who use it.
As we can see only two days after the bill was signed into law, the insurance companies are already looking for new loopholes to exploit to screw over sick children. This is what the for-profit health insurance companies do, this is what they are designed to do, this is how they make money. This can be stopped, and a highly regulated private health care system can work in theory, but only if you have dedicated, well-funded enforcers, and a government always on its toes looking to plug every loophole the insurance companies find.
If there were a public option, things might be different. It would be a constant quality benchmark with which to compare the private insurance companies. It would ensure that even if all the private insurance companies come up with a clever plan to keep out a specific group of sick people, there would be a good public option for them that was not trying to screw them over. Private insurance companies would not just fear regulations, but the bad word-of-mouth, which could cause people to flee to the public option. Since the government would need to closely monitor its public option, it would have a strong financial interest in making sure other companies were not breaking regulations to drive away sick, unprofitable customers, who could then possibly end up on the public option.
I always saw the public option as the single biggest stick to ensure the success of the new regulations. It did not matter how big it was as much as it mattered that it was out there, waiting to grab huge market share if the private insurance companies did something that truly disgusted the American people. As a benchmark, it would force insurance companies to prove their worth fearing a future Congress might start to question why they were wasting tax credits on a middleman when the public option can do it better and cheaper.
Without the public option, we must rely only on the tough determination of regulatory enforcers to protect us. Of course, regulators trying to boss around massive health insurance corporations with billions of dollars and continued exemption from anti-trust laws is going to be a very difficult task--one I fear our current state and federal government is not up to. But, for the millions of Americans that will need to depend on this new regime, I hope I'm wrong.