With all the fighting over a public option in the debate over how to fix the nation's health care system, it's amazing how few journalists report a simple fact — that under both the House and Senate versions of proposed legislation, the so-called public health insurance option would only be "optional" for less than 10 percent of Americans.
Each of the bills introduced so far don't take effect for another four years (incidentally following Obama's re-election bid) and seven years down the road — in 2019 — the vast majority of Americans will not have any more lawful ability to choose their own health insurance than they have today.
According to the Congressional Budget Office, under the House bill announced by Speaker Nancy Pelosi, D-Calif., last week, just 21 million Americans by 2019 are expected to buy health insurance through a newly created health insurance exchange program.
It's through these exchanges only that the public option will reside. Another 168 million Americans will likely receive coverage through their employer no differently than they do today, based on CBO estimates on page 16 of its report.
Odd then, given these numbers, that the health insurance industry's top lobbyist Karen Ignagni would continue to stoke fear of a vast government takeover.
In comments following release of the bill, Ignagni said the government-run insurance plan "would bankrupt hospitals, dismantle employer coverage, exacerbate cost-shifting from Medicare and Medicaid and ultimately increase the federal deficit."
The CBO, in fact, estimated the bill deficit would reduce the federal deficit by $104 billion over 10 years.*
Pelosi's statement wasn't exactly accurate either, though she did say the plan succeeds at "preserving" choice rather than expanding it.
"Today's development ... will make us a step closer to achieving a bill this year that lowers cost, preserves choice, creates competition and improves the quality of care," Pelosi said on the steps of the capitol.
President Obama followed up with a statement about "ensuring" choice and competition. "As I've said throughout this process, a public option that competes with private insurers is the best way to ensure choice and competition that are so badly needed in today's market."
Sen. Ron Wyden, D-Ore., on the other hand, said the bills were setting the public option up to become a "health care ghetto."
"Everybody talks about choice and talks about competition, but when it comes to really taking on these powerful interests, it's not getting done," Wyden said on The Ed Schultz Radio Show following Reid's announcement.
Wyden, like Obama early on, argues for giving Americans the ability to shop for health insurance like members of Congress. Under their benefits — and that of all federal employees — they get to choose from a handful of insurance plans that compete to offer standard benefits. This idea is emulated in the health insurance exchange market.
Under the House proposal the exchange would only be open — and therefore the public option would only be open — to individuals and small business, phasing in businesses with up to 100 people in the third year.
"The bottom line is that the public option can't really hold private insurers accountable if it is only competing for 10 percent of the insurance market," Wyden said in an official statement, "because private insurance companies aren't going to change their business practices if 90 percent of their customers can't take their business elsewhere."
The choice to include the public option in the bills rested on support by a majority of Americans in several polls. But none of those polls asked whether respondents supported a public plan available to just 10 percent of the American people.
"So picture what this means," Wyden said on The Ed Schultz Radio Show. "If your insurance company is abusing you, even if you have coverage from your employer, you are just tethered to that lousy policy. I don't think that's right. A member of Congress has access to more than a dozen good policies. I want all Americans to have all the choices. Because without that kind of leverage to hold insurance companies accountable, things are not going to change much."
* An earlier version of this post incorrectly stated that the Congressional Budget Office estimated the House bill would be revenue neutral.
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