A Modest Proposal

Use the "public options" that already exist—the ones people aren't afraid of

Call it a missed opportunity.

When President Obama arrived in office, a stimulus package was the prescription to bring us out of the recession. Congress gathered up every spending bill and pork project it had lying around and approved over $800 billion in new spending. This followed on the Bush administration's TARP bailout for Wall Street and the banks, which totaled another $700 billion.

Then we had the car-company bailouts. Only God and Ben Bernanke know what the FDIC has spent.

Many Americans are increasingly concerned about government spending and huge looming deficits. Part of the concern about a national health-insurance plan is adding to the national debt and our inability to afford it.

Just what is the plan for national health insurance? It is a collection of massive bills floating around Congress. Arguments abound about what's in them, but given our experience with massive Congressional spending bills there is a very real fear of the outcome. There is a fear of the unknown in setting up a new insurance system and its effects on existing private health-insurance plans and Medicare.

Imagine what might have happened earlier this year if, instead of a stimulus package, Obama had gone to Congress with a national health plan instead.

They needed to give states money? Increase Medicaid to cover everyone who had an income up to 200 percent of the poverty level and have the federal government assume the state's portion of the cost. This would have given recession-wracked states budget relief and would have gone a long way toward providing health insurance for a large segment of the population that lacks it.

Obama could then have offered a simple bill, by comparison. Any small business, independent contractor, or person with a preexisting condition unable to join a cheaper group plan could sign up for Medicare and pay a premium for coverage. People understand what Medicare is. It works for grandma. It's already in place. Doctors and hospitals are already part of the system. The influx of these premiums would have staved off the projected bankruptcy of Medicare down the road. It is not some scary new plan hatched in the bowels of Congress ready to leap out and take control of our lives.

Taking the burden of health-care costs off small business would have been a direct stimulus to the economy. Small business is where new jobs are created and freeing up more money for small business would have allowed more people to be hired.

This simple plan would not be dramatic. It wouldn't be a "signature" victory. It wouldn't be a universal single-payer national health care system. It would have had the virtue of being doable and affordable, and it would solve most of the problem. After a few years we could have studied the result and tweaked it.

The expansion of current Medicaid and Medicare would not have been a huge shock to the existing health-care system. It also preserves private plans if people are happy with them.

Cigna insurance administers the Medicare program in 18 states. There is no reason for private insurance companies to oppose the expansion of Medicare and Medicaid, and in fact could handle the processing of new members.

The real source of rising health-care costs lies in the huge number of the uninsured. Doctors and hospitals shift costs to people with insurance in order to cover losses in treating the uninsured. Providing Medicare coverage for the uninsured would ensure that doctors and hospitals actually get paid for all the services they provide, which should act to bring down the cost to everyone else.

Conservatives could come to accept it as an alternative to a government takeover of the health-care sector of the economy.

Expanding the existing "public options" is something people can understand. It removes the fear and the uncertainty. It prevents the creation of a new government bureaucracy. It can be implemented much faster. The system is already in place.

Remove uncertainty. Go with the familiar. Use what's already there.