My Concerns about the Public Option

This commentary is the opinion of the author and does not necessarily reflect that of other authors at Box Turtle Bulletin.

Timothy Kincaid

November 9th, 2009

On Saturday, the US House of Representatives voted for the Affordable Health Care for America Act, a healthcare reform bill which has been the highest priority of the Democratic Party leadership since the party took control of the presidency and both houses of the legislature. There are a number of very positive inclusions in that bill, including some that deal specifically with the GLBT community.

Probably the most specifically significant to our community is the incorporation of the McDermott/Ros-Lehtinen bill to remove the special ‘gay couples tax\’ on spousal benefits provided by an employer. Currently, heterosexual spousal benefits are provided tax free and employers may claim them as an operating expense, but same-sex spousal benefits are considered to be part of the employee’s taxable income. This can result in thousands of dollars of tax demanded from our government solely because the spouse of the taxpayer is the same sex. Removing this tax is a tremendous relief on gay taxpayers.

Also included are changes in treatment for HIV patients, heath data collection related to the LGBT community, new sex education rules, and non-discrimination language.

However, the bill, as passed by the House, also provides for a “public option”, or insurance provision by the federal government. This government run health care mechanism is by far the most controversial aspect of the bill. And, depending on where you fall on the right/left scale, you may well have strong arguments either for or against such a move.

But while I have opinions in general about the decision on the part of the government to compete in the world of service provision, that is not the point of this commentary. Rather, I wish to express specific concerns about how this effort may impact our community negatively.

First, I preface with an assumption that while the public option is being discussed almost as though it is a supplement to current insurance coverage, it is likely to be an immediately significant player in the healthcare world. Additionally, based on the current provisions in the law, I cannot see how it will not over time become more, rather than less, influential.

And, based on my understanding of government and its current track record, that gives me concern. Here are the specific reasons why:

Federal Privilege

The federal government does not apply to itself the rules that it readily applies to citizens or private industry. Although it may seem unfathomable that lawmakers would specifically exempt themselves from the burdens they place on you and me, this is quite often the case.

And the federal government does not fall subject to state laws in regards to employment and non-discrimination. So exceptions made for the federal competitor would be exempt from state law requirements.

Let me give you a real life example of how the federal government, even in the way it reacts with private industry, exempts its rules from state overview.

Currently, companies in states like California are required to offer to their gay employees the same benefits they offer to straight employees. However, due to federal ERISA rules, most big companies do so entirely at their own discretion.

Morrison and Foerster explains:

The May 15, 2008, California Supreme Court decision held that same-sex spouses must be treated the same as opposite-sex spouses for all purposes under California law. This applies to employers with California employees to the extent that California law applies generally to them. However, the majority of employee benefit programs maintained by non-governmental employers are governed by ERISA. ERISA broadly preempts state attempts to regulate the operation of employee benefits, and as a result, it does not appear that state law could require employers to modify their benefit plans to provide additional rights or benefits to married same-sex couples.

While Congress seems seldom reluctant to direct the actions of private business, it sees restrictions on the “people\’s business” to be contrary to the best interest of the citizenry. That attitude is unlikely to change any time soon.

Federal Tax Dollars and Controversy

The healthcare reform bill passed with a very small margin. And essential to its passage was an amendment banning the use of federal dollars to pay for abortion services. Whether or not one approves of abortion, this vote tells us something important about the way in which the Public Option will be administered. The provision of controversial services will be subject to the political whims of whoever is in majority.

Issues such as abortion, contraception, in-vitro fertilization, sexual health information, HIV and AIDS care, HPV vaccination, and a host of other issues that are deemed “controversial” will be decided based not on medical need or even on what is best from a long-term health care perspective, but rather on political ideology.

More conservative lawmakers will, with conviction and determination, argue that it is unfair and un-American to tax the citizens in order to pay for things which they find abhorrent. Such as health services that reward sinners for their abominable behaviors.

Government Lag

When it comes to the provision of equality and decency to gay and lesbian employees, the private sector far outpaces the federal government. Currently, HRC has found that 99% of the employers they review provide employment protections on the basis of sexual orientation. The federal government does not.

The President has some leeway with which to assert protections for gay employees, but those change with each administration. And they do not apply broadly across all areas of the government.

In fact, in some areas of government – most particularly the military – private contractors, such as Halliburton, doing jobs identical to federal employees have orientation based protections against discrimination where their government counterparts may have official policies requiring discrimination. It is accurate to say that the only significant employer in the country with an anti-gay employment policy is the federal government.

And with poll after poll showing that large majorities of Americans support non-discrimination laws and open service in the Military, it is difficult to see the federal government on the forefront of protecting civil rights. When the voters in Kalamazoo, MI, have endorsed employment protections before the federal government, you know that there is a very significant lag.

Republican Antipathy and Democratic Apathy

There are segments within the Republican Party that, as a matter of policy, oppose any and all efforts to treat gay citizens equal to heterosexual citizens. And these segments have been so successful in their anti-gay efforts that they have made antipathy to our concerns a “Republican value”.

It is considered “pro-family” to actively seek out ways in which to discriminate against gay citizens and to make our lives difficult. These are not limited to “protecting the definition of marriage”, but often extend to bans on adoption, exclusion from public view such as public library offerings, and pretty much anything else they can think of.

Far too often, the unspoken answer that elected Republicans give to, “You are hurting my life”, seems to be, “Yes, that\’s what I am intending to do.”

And while we can count on opposition from Republicans, we cannot count on the Democratic Party to come to our defense.

Recent actions taken by the party clearly illustrate to us that the Democratic Party leadership sees us as a secondary priority. Our equality will be considered only when it is convenient, incidental, and comes with no cost of political capital.

So we are a people at the mercy of the whims of political expediency. Within the federal government structure, our rights are frequently bargaining chips to be used in the negotiation of benefits for the real priorities of politicians and lobbyists.

So What Can We Expect?

Should the Senate go along with the establishment of a Public Option:

  • A large segment of the healthcare industry will be moved outside of state and local protections. While Kaiser or Blue Cross may be subject to state law which disallows discrimination in employment, the Public Option likely will be exempt. Further, such spousal benefits as may be provided by private insurance companies will not be provided to the employees of the Public Option in accordance with DOMA.
  • There is a good chance that the pro-gay provisions in the House bill will be removed during reconciliation with the Senate version of the bill.
  • It is likely that Republicans may regain control of one of the houses of Congress in 2010. If not, it is almost a foregone conclusion that the House will have a majority of members, both Republican and Democrat, who are socially conservative and unlikely to support gay rights. If Republicans gain control, one item high on the agenda will be revision to this healthcare reform. It is reasonable to assume that anti-gay provisions will be proposed.
  • Future exclusions from health care provisions are likely to include limitations if not and outright ban on “federal tax dollars” spent on (i.e. the Public Option providing healthcare for):

    HPV vaccination for boys
    Gay specific preventative health care
    Sexual health programs which include mention of same-sex health
    Health data collection for the LGBT community
    Policies which include same-sex spouses/partners in health decisions

  • And I do not think it beyond possibility that an administration of someone like Mike Huckabee would be pro-active in “preventing the spread of HIV” or in denying services to someone they deem to have “taken deliberate risks”. And should some new “gay plague” come down the road, I am not confident that any administration would not respond with punishment before care.

I hope that my concerns are overblown. I hope that I am just being reactionary. I hope that the federal government will not seek under any administration to advance conservative social policy by means of meddling in the health provisions of a significant segment of the population.

But in the midst of the euphoria that much of our community is expressing over the Public Option provision of healthcare reform, I hope that we can consider the possibilities that can arise and recognize the risks that are inherent in a federal government run health company.


November 9th, 2009

No, you are absolutely right. This will be politicized just like everything else. We saw it already with the abortion amendment (which I believe was redundant in light of another act from 30 years ago that already prevents that). I doubt sex changes will ever be a popular consideration for a public option. Also note that private insurers take their cue from the government as to what they’ll cover, which won’t be a good thing in this regard.

If it were up to big business, we’d already be completely equal in every way as it’s great for making money. Ironic given how demonized they are for so many things.


November 9th, 2009

The entire bill is a 2,000 page mess. I am all for health care reform, but this is an attempt for an entire overhaul that is going to be as incomprehensible as the IRS tax code. Can anyone show me a link to the entire document online that has been posted by the House of Representatives?

Bryan J. Blumberg

November 9th, 2009

The link to the entire bill that was passed by the House of Representatives as well as every other bill in Congress is at

The bill that was passed on Saturday night is HR 3962.

Emily K

November 9th, 2009

I’m gonna move to sweden. They like the gays and they have a public option. And europe has historically been much friendlier to artists than America, which is obsessed with low taxes, guns, and patriotism.


November 9th, 2009

The problem seems to lie not with the public option, but with the social conservatives mucking it up. It’s a forgone conclusion that we should be fighting anti-gay amendments that prevent us from getting the health care that we need and that can be done without opposing the public option. It’s true that by opposing the public option, we’ll deny the republicans from blocking HPV vaccination and abortion coverage, but we’ll be blocking everything else too. It seems better to take the public option, and all the benefits that come with it, and then fight the amendments. Even if we lose a lot o the battles, we’ll still come out on top in the end.

Also, a lot of your complaints can be solved with the passing of the ENDA and the repeal of the DOMA. Yet another reason why we need them ASAP.


November 9th, 2009

Emily K: Move to Canada! We’re closer :-)


November 9th, 2009

I guess it it would fine to move out of the country. But what happens to the next generation of gay boy’s and girl’s that are just coming up or just being born. Do they just have to suffer the same as we have or do we keep trying to do something now! One way or the other government is going to make it hard for us. But we still need to fight for future generations.

Richard Rush

November 9th, 2009

Timothy, your post is the first words I’ve read (or heard) that has given me any reason to possibly rethink my position. I had not thought at all about any of the concerns you raised, and they are certainly worth considering.

Here is where I’m coming from: I’ve been self-employed for nearly sixteen years, and thus have been purchasing my own health insurance. It has increasingly become a nightmare over that time, even though I had the benefit of purchasing via the Chamber of Commerce. (My partner is covered via his employer.)

Then something wonderful happened this year – I went onto Medicare (traditional Medicare coupled with a Medigap policy), and I now have far better coverage than I ever had in a private plan, and at half the cost! I researched the Medicare “Advantage” plans and concluded they are a bad deal – mainly because they involve Medicare paying private insurance companies a flat fee for each person’s coverage. Then these private companies can engage in their usual crap: marketing slight of hand, obfuscation, denial of services, and the creation of deliberate frustration that I experienced for sixteen years. Naming these plans “Advantage Plans” was a disgrace.

So, with the concerns Timothy raised for our community notwithstanding, I have favored the government’s reform plan, including the public option, and would have favored it more if it were a single payer system (basically, Medicare for everyone). I think the “public option” is a good compromise, though. But I’m very disappointed about abortion coverage being explicitly removed from the public option (this ties in with what Timothy was talking about).

The private insurance companies have had many years to figure out how to create a system that is equitable for everyone, and they have not done that. Instead they have perfected a system that maximizes their profits by excluding people that may be more likely to get sick, and by other strategies. People are not only excluded directly, but also indirectly by making the cost prohibitive and by creating roadblocks and frustration. Now it is time to force the private sector to do the right thing, or let them go out of business. I am a purist about the concept of insurance – we all share the risks and we all share the benefits. it’s really not all that difficult.

While Timothy’s concerns do give me pause, I am reluctant at this point to favor holding the plan hostage until those concerns are addressed – because they won’t be addressed any time soon. But maybe my opinion on all of this will evolve.


November 9th, 2009

Maybe on the bright side… if one company gives thebenefits and the other doesnt… guess which one gay ppl are going to choose.. innate $$ for the private companies.


November 10th, 2009

Timothy touches on what is ultimately the biggest failing of Big Government – being subjected to the whims of whoever is in power. When you take responsibility away from private companies with a profit motive and give it to the government you are giving your trust to the ocean tides that will inevitably flow back and forth from one party to the other. What one side gives, the other side can take away and you can do nothing about it because you sanctioned the notion of giving that power to them in the first place.

Quite simply, I do not trust the government to be concerned with the gay community in any way. When you hitch your wagon to a group (gay, black, Jew, whatever) and look to the government to benefit that group, you will always be subjected to the whims of the majority in regards to that group.


November 10th, 2009

Yeah, but Canada has a right-wing government that hates gays, the arts and would dismantle single payer if they could as well… and it shows no sign of being tossed out :(


November 10th, 2009

The fact remains that big insurance by refusing care to patients and reimbursement to doctors over typos has ticked everyone off. They have a monopoly over the whole process and a well financed lobby team (including Lieberman’s wife) and representatives on both sides of the isle.

A friend of mine recently laid off just he and his spouse is paying $2,500.00 dollars a month for his COBRA. Health insurance costs more than his mortgage. Anyone taking up the insurance industry’s cause doesn’t know what they are talking about.

If you think the insurance companies are going to voluntarily lower their cost while having a monopoly over the process – you are being disingenuous …Over 60% of all US bankruptcies are attributable to medical problems. Most victims are middle class, well educated and have health insurance – (The American Journal of Medicine)

The insurance companies and their representatives in Congress would love to perpetuate a business model that is crippling our overall economy – a bunch of great Americans aren’t they?

90% of the wealth concentrated in 1% of the population is no way to run a country but a heck of a way to establish a royalty ruling class. Yacht sales can not sustain 350 million people. I’m for the public option, competition and a level playing field or break up the big insurers like we did AT&T.

A slavish focus on profit margin might be good for the individual or a business, but it is one helluva lousy way to “govern” a Country. The GOP being a wholly owned subsidiary of Corporate America has a hard time with that concept.

Paul Burke
Author-Journey Home


November 10th, 2009

When you take responsibility away from private companies with a profit motive

This right here is the epitome of the problem I see when I look at the current healthcare system. The people providing me with health coverage are worried about profits? My continued health has become a money-making venture for them?

And ultimately, I find it strange that people who worry about government bureaucrats deciding what’s right for someone’s health care have no problems with executives concerned about profits making those decisions instead.

But then, that’s exactly what I think is wrong about the current health care system. It’s not about health. It’s about money. And changing how it gets funded won’t change the inherent problems caused by such a focus.


November 10th, 2009

“My continued health has become a money-making venture for them?”

So, you have a problem with doctors and nurses making a good living? Are they supposed to work for free?

Of course, your continued health is a money making venture. They aren’t making money off the dead.


November 10th, 2009

Tim brings up many aspects of this that I had not considered at all up until now. I must admit I am beginning to rethink my support for the public option.

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