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I have a thing for Nancy Pelosi. At the risk of seeming sexist (probably because in many ways I am), I think she’s about the hottest thing that ever stood up in the House and said “Oyez!” (the Speakers do say “oyez!”, don’t they?). But I can detach my heterosexual urges from my political reason: politically Nancy is just another politician who has to be watched every second. I don’t slavishly agree with everything she says. But at the moment we are perfectly in tune.

Steny Hoyer (who I don’t have a thing for) has been quoted as saying he can vote for a health reform bill that doesn’t include a public option. And right away Pelosi stepped out in the hall and corrected him, affirming that a bill without the public option was not on the table. Like I said, Nancy Pelosi is a grade A politician, and might step back out in the hall tomorrow and say the opposite. But for now she’s right. The public option is essential. In fact, without it, there is no “reform”, just a shuffling of paper on the part of insurance companies.

When we talk about “health care reform”, we can’t just mean a realignment of the insurance companies’ payment schedules and benefit packages. The people who need health care the most are exactly those people the insurers won’t cover: the poor, the elderly, those with pre-existing conditions. If you believe the insurers (who spend quite a bit of money in Washington) are going to allow government to mandate acceptance of these “demographics”, you probably also believe those same companies are going to take a profit cut to accomodate reform. They won’t. They’ll just change the jargon used to describe “revenue sources”. They’ll charge less and supply less.

In fact, that’s what they do now. In California Blue Cross administers the county and state health programs (“welfare” if you hate it, “public access” if you don’t). Per patient, Blue Cross is paid much less through these programs than an insurer makes privately. But they also do less. Take MRI scans, for example. You can get an MRI of your arms, your legs, and in some cases of your torso. But you can’t get an MRI of your head. Because that’s what most MRIs are for. So what is most needed is what is least given. The only way to get one is if your doctor essentially lies and says he or she thinks you’ll die without it. And so, doctors do.

Same thing with drugs. Older drugs – generally less effective drugs – are covered. Newer drugs are not. So if you have something they’ve just developed a drug for, suffer – it’s not on the list.

Now, what’s interesting about public care is the people providing it are some of the most capable, most dedicated doctors, nurses, and technicians you’ll ever meet. If they actually had the equipment and supplies they need, they could work wonders. If you step into an exam room in most public clinics, here is what you’ll see: rubber gloves, tongue depressors, a blood pressure spirometer, and an old and very worn exam table. And that’s it. There are no real diagnostic tools. It ain’t like “House”, with all the pretty blinking toys. It’s nineteenth century medicine. So diagnosis can take a long time while all the approvals are put through to Blue Cross, the insurer. It’s not the government that’s holding things up – it’s the bean counters a the insurance company making sure they don’t expend a nickel on someone who might die anyway.

The public option is health care reform. Personally I would rather see a bill that has only a public option, and let’s let the people who can afford health care wait their turn for a change. Ah, but the poor don’t pay taxes, often because they are too old or ill to work. Now, is that the fault of the person who goes to work every day? No. And generally it isn’t the fault of the poor, either. But in America poverty is synonymous with “laziness”. That makes no sense, and there is no evidence for it. It’s one of those things people believed back in the eighteenth century when our country got started. And then in the nineteenth century it was a tenet of social Darwinism. And in the twentieth century it was the argument against welfare and public housing. Now it’s the twenty-first century – and I’m not sure what the current excuse for hating the poor is – I keep hoping people will run out of them.