Whatever Happened to the Public Option and the $35 Insulin Cap?

How politicians forget their promises! Take, as an example, president Biden. Campaigning for the 2020 election, he promised a Medicare-style public option. He said it would be one of his first acts as president. He assured Bernie Sanders’ supporters that this was his plan. People would be able to sign up for publicly funded health care, with no more worries about premiums and deductibles. Well, promises, promises. According to the Lever, which looked into the matter, Biden has not mentioned a public option once since his election. It has gone the way of the $15 per hour minimum wage, the $35 price cap on insulin and other such irritants to fabulously wealthy corporate donors. In short, for Biden a public option was kaput the moment he strolled into the White House. This is hardly a surprise, since a medical public option would benefit mere constituents, but not well-heeled health-care donors. Still the brazenness of Joe “The Check’s in the Mail” Biden’s approach demands attention.

An insurance industry lobbying group, Partnership for America’s Health Care Future (PAHCF), “spent $60 million in 2019-20,” the Lever reported on August 11, and a good bit of that probably helped torpedo a public option, which PAHCF had earlier opposed. Also, years before, in 2009-10, an “insurance industry lobbying group…spent more than $100 million to kill a public option.” That’s real money. It was also a red flag to those agitating for a public option. And it meant those supporters certainly must have known their cause teetered on shaky ground with a centrist, corporate-backed politician like Biden.

Still, a promise is a promise, so it doubtless shocked public option advocates to learn that for Biden this promise was more on the order of something he might dream of doing maybe as an afterthought if he gets reincarnated as the parliamentarian in a millennium or two. Because supporters naturally would have figured that something so popular had a chance; but it’s popular for precisely the reason Biden finds it radioactive and that powerful lobbyists killed it – a public option would save people money. It might even – horrors! – make health care affordable. The only question is, why did Biden mention it in the first place, when he knew darn well he would never deliver?

He wanted the votes. And he got them, from millions of Sanders supporters, who now know they were suckers for this blather and may never vote for a Dem again. Remember, at the start of the 2020 campaign, Sanders was ahead of Biden. That’s because people liked his platform of social benefits – Medicare for All, a $15 an hour minimum wage, cancelling student debt and so forth – and Biden had to pretend to care about these things. Folks particularly liked M4A, which would solve the scandal of the parlous U.S. health care mess that bankrupts so many Americans and leaves so many others to die, untreated, because treatment in this medically barbarous country is a privilege for the rich not a right for the rest of us proles.

Then, with Sanders out of the race courtesy of some chicanery from South Carolina representative James Clyburn, who thus single-handedly crushed the dream of millions of Americans for sane, civilized, humane health care, the inevitable backtracking began. M4A got pared down to lowering the eligibility age of Medicare and extending the program to cover vision and dental, all of which was just too much social justice for the dismal Dems and so, eventually, all this leftover M4A paraphernalia got unceremoniously ditched. Oh, and Obama’s bugaboo – the public option. Because just like Biden, Obama was for it before he was against it, though Obama reached for the fig leaf of the insufficient senate support, when he double-crossed public option supporters, while Biden didn’t even bother with that. Two slippery politicos who know how to talk the talk and walk something else entirely.

Meanwhile, in this matter of disappearing promises of social benefits, Biden has elevated the practice of blaming other people, specifically a nonentity called the parliamentarian, to an art form. $15-an-hour minimum wage? Biden says the parliamentarian nixed it. There’s nothing he can do, he’s only the president. There’s nothing senator Chuck Schumer can do, he’s only the majority leader. More recently, diabetics pinned their hopes on legislation that would cap the insane, astronomical price of life-saving insulin at $35. But, sorry folks, the parliamentarian didn’t like this either.

This is particularly galling, because insulin costs a mere pittance to produce, and the original patent was sold to the University of Toronto, one hundred years ago, for $1 for each of its two discoverers. As one of them, scientist Frederick Banting said at the time, “Insulin does not belong to me, it belongs to the world.” That was because prior to its discovery, a diagnosis of diabetes was a death sentence. And also because Banting was a normal person, of normal, recognizable, human decency. Unlike the highly-placed pharmaceutical Gorgons who received the rights to mass produce this medicine, but who proceeded to use insulin to price gouge desperate patients worldwide. And unlike the senate parliamentarian.

As astute twitterati asked, who knows how much arm-twisting it took to get this senate factotum to take the fall for liquidating this $35-dollar cap threat to Dem health care donors. But she did. She said “extending the cap to the private market was not compliant with the rules of the reconciliation process,” CNN reported August 7. Without reconciliation, Dems couldn’t rely on a mere majority vote to pass the $35 insulin cap. They needed 60 votes, and of course they didn’t get them. But what could the mealy-mouthed Dems do? The parliamentarian said no. By the way, the GOP would never stand for such insubordination from this senate employee for an instant. Back in 2001, when this official defied the GOP over tax cuts for the lavishly well-to-do, senate majority leader Trent Lott fired him.

That parliamentarian, Robert Dove, was canned without further ado. According to the Washington Post at the time, “Dove’s immediate boss issued a terse statement describing the situation as an ‘internal matter’ and declining further comment.” That’s how the party that gets things done rolls. Unfortunately for most of us, what this paragon of purpose, the GOP, enshrined and strove for as its ideal is catastrophic. It rammed through a near-fascist agenda over the past 20 years, and it ain’t done yet.

Meanwhile, Dems babble idiotically about their nonsensical “accomplishments.” Here’s a recent tweet from senator Amy Klobuchar: “Still can hardly believe it, but after a decade of fighting, we finally beat Big Pharma and lifted the ban on Medicare negotiating lower prescription drug prices.” Well, uh, kinda. As Margaret Kimberley of Black Agenda Report tweeted in response: “But it covers only 10 drugs and doesn’t start until 2026.” The GOP spreads a gourmand’s feast for its base and backers; the Dems? They offer a few stale crumbs, after a mandatory, four-year starvation diet.

Speaking of the parliamentarian Lott fired, the issue, tax cuts for the rich has not evaporated. Plutocrats still got ‘em. And Trump enacted another round of them. Have the Dems, those ferocious tribunes of the people, attacked these giveaways to billionaire oligarchs? Alas, not a peep from this Democratic-controlled congress and white house about undoing the tax damage inflicted by the party of the entrenched financial elite, soon to be the party of fascist shock troops. The American aristocracy gets what it wants from the GOP and, apparently, has terrorized the Weimar Dems into submission. There was lots of abracadabra about undoing the GOP tax cuts during the 2020 campaign, but our rulers dropped that hocus pocus the instant they found themselves in a position actually to do something about it. Then we got drivel about what was and wasn’t possible.

Regarding the public option, Colorado, Washington and Nevada buck the presidential betrayal trend. Colorado, the Lever reports, “is creating, through an approved federal waiver, a public option plan.” According to the Commonwealth Fund back on March 29, all three states “have enlisted private carriers to offer public option style plans.” These states do not propose a traditional, government-administered public option, and that is a weakness. They will reduce costs for patients but not eliminate them, as a genuine public option would.

Four other states are watching these developments closely: Oregon, Wisconsin, New Hampshire and Minnesota. So a public option, in some form, could take off. Just not at the federal level, which is too bad, because a bona fide public option remains immensely popular. Citing a Morning Consult/Politico poll, Heath Affairs reported May 3 that a public option received 68 percent overall approval, “including 80 percent of Democrats, and, notably, 56 percent of Republicans.” States could implement it in a variety of ways, including a Medicaid buy-in, or a plan modelled on Medicare, or something more market-based. The publicly funded Medicare template is what most people mean (and want) when they talk about a public option. This version of course is what provokes health care industry apoplexy and the frantic corporate geschrei that communism is coming for your doctor, who at your next annual physical will induct you into a soviet that will then brainwash you into reciting Marx’s Capital at the dinner table.

Indeed, getting any public program passed into law would be a miracle in this country, at this fraught moment when radical right-wingers control so much of government and are poised to gobble up even more. That we ever even obtained Medicare is itself astonishing. And it scarcely needs saying that we could never get it enacted into law today, simply because we lack any Democratic politicians of the stature, tenacity and grit of Lyndon Baines Johnson. He sure had his flaws and was a war criminal to boot, but he rammed Medicare and the Voting Rights Act through a largely resistant congress, something which is unimaginable for a timid Biden who never yet met a large corporation he didn’t want to fawn over or a tepid, yacht-lounging Obama, dedicated to evicting mostly Black and Brown homeowners to save corrupt bankers from the consequences of their criminality.

After all, look at what Obama chose to expend his political capital on – the Affordable Care Act, better, but not by much, than nothing. It is primarily a funnel to pour government money into the pockets of rich health care oligarchs. It does not eliminate costs for patients, as most civilized countries do. Instead, it showers billions of dollars on health care corporations, already rolling in money. Indeed, the total cost of ACA to the federal government was estimated at $825 billion over 10 years. That’s some very happy, very affluent health care ceos. Ordinary people looking at bloated premiums – not so much.

In fact, under Obamacare, when you add up your premium, deductible and out-of-pocket costs, you could be looking at mega bucks on the regular. This means that middle-class people of somewhat above moderate means can face over $1000 per month per person in costs, and thus may frequently opt for that echt-American arrangement, the one 31.6 million of our countrymen are stuck with – no health-care coverage whatsoever. If they wind up in the emergency room, well, they forfeit at least their bank account, and likely their home and car into the bargain.

M4A, though expensive, would have been cheaper than ACA. According to Public Citizen in February 2020, when sane, rational and humane health care actually loomed on the horizon as a possibility thanks to the rip-roaring Sanders campaign, U.S. health care spending “will reach nearly $6 trillion a year by 2027. That means…we will spend around $42.9 trillion on health care over the next decade.” But M4A spending in the same 10 years would have been less, roughly $37.8 trillion, and it “would save around 68,000 lives a year, while reducing U.S. health care spending by around 13 percent or $450 billion a year.” Unfortunately, those 68,000 lives per annum lacked the clout of the health insurance lobby. Public Citizen vainly added that even the arch-conservative, Koch-funded Mercatus Center “found that Medicare for All would save around $2 trillion over a 10-year period.” Vainly, because even though these Koch “free-market” ideologues had the honesty to admit the fiscal superiority of M4A, that didn’t mean they’d actually, um, muscularly advocate for something whose undeniable socialistic physiognomy made them want to vomit. So in the end, despite its merits and overriding excellence compared to the status quo, M4A found no rescuers. Well, you can’t live in the past.

Besides, a public option is nowhere near as effective as some form of single payer, because it’s not as big. Call it a foot in the door for Medicare for All. That’s why it gives health care bigwigs an attack of the vapors. Today a public option, tomorrow socialized medicine. Because don’t kid yourself, if anyone could get free health care by signing up for a public option, they’d do it in no time. Enough people do that, and the public option leads straight to the end of the current national health care nightmare. That’s why it would be great for us hoi poloi. And that’s why Biden hasn’t mentioned it once in the past 18 months; and in case you were wondering, no, he won’t mention it in the next 18 months, either.

Eve Ottenberg is a novelist and journalist. Her latest book is Lizard People. She can be reached at her website.