Politics and the Public Option
There hasn’t been a lot of clarity in the sturm und drang over the so-called public option in current health care reform schemes. The best discussion of the public option I’ve read is in a column by Robert J. Samuelson in The Washington Post.
The political divide over the public option, like so much else in Washington, is defined by raw partisanship.
Most Democrats want it, some because they see it as the first step in their march toward single-payer health care. The single payer, of course, is the government. Inevitably, because there’s only so much money to meet health care demand, unaccountable bureaucrats who would run a single-payer system would ration health care. That’s fine with many liberal Democrats because, as they see it, everything would be done for the greater good.
Almost all Republicans are against it, partly because Democrats want it, but mainly because they think they see it for what it is. They believe that a public option, even if it begins in a limited way or with so-called “triggers,” will destroy the health insurance industry and emerge over time as true socialized medicine. This violates their free market principles and, some would say, their instinct that “them that’s got” ought to always be able to get more.
The Obama Administration and the Democratic leadership in Congress have at least one very big problem with the public option. Some Democrats who will face angry voters next year in shaky districts and states would like to keep their jobs. So whatever their personal inclinations, they’re not eager to march over that cliff.
As Samuelson explains it, there are plenty of practical reasons for Democrats and Republicans alike to oppose the public option, at least in any form that resembles what’s now under discussion:
In the health-care debate, the “public plan” is all things to all people. For supporters, it would discipline greedy private insurers and make health-care coverage affordable. For detractors, it’s a way station on the path to a single-payer insurance system of government-run health care. In reality, the public plan, also known as the public option, is mostly an exercise in political avoidance: It pretends to control costs and improve access to quality care when it doesn’t. …
The promise of the public plan is a mirage. Its political brilliance is to use free-market rhetoric (more “choice” and “competition”) to expand government power. But why would a plan tied to Medicare control health spending, when Medicare hasn’t?…
Many would say: Whoopee! Get rid of the sinister insurers. Bring on a single-payer system. But if that’s the agenda, why not debate it directly? It’s not insurers that cause high health costs; they’re simply the middlemen. It’s the fragmented delivery system and open-ended reimbursement. Would strict regulation of doctors, hospitals and patients under a single-payer system provide control? Or would genuine competition among health plans over price and quality work better?
That’s the debate we need, but in truth, doctors, hospitals and patients don’t want to be limited, whether by government or markets. Congress reflects public opinion. Fearing a real debate, we fake it.
A public option for health insurance could be a good thing, if it’s structured and managed properly. This might be done, for example, by a public corporation with independent authority, free of political meddling. That may sound like pie-in-the sky, but it could make a public plan a fair competitor in the insurance market. Its premiums would reflect the market, and competition would play out in terms of the quality of service provided. This could accomplish the goals of bringing prices down and improving quality.
Couldn’t Democrats and Republicans sit down together, sing Kumbaya, and work it out for the benefit of the people? Sure, but don’t hold your breath. Politics in the Age of Obama is and will remain bitterly partisan. It wasn’t much better during the Clinton and Bush 43 years, but then they didn’t promise to end it, did they?
(This article was also published at Opinion Forum.)
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