Wednesday, September 9, 2009

Why The Public Option Matters

Paul Krugman makes the case for including the public option in any healthcare reform: lower costs, increased competition, and more choices.

So far all of the arguments against the public option have run exactly counter to those points, but I suspect they are based on misconceptions — we’ll convert to a British-style national health plan, which no one has proposed (and about which most people are grossly misinformed) — or deliberate lies and scare tactics: rationing! death panels! government bureaucrats denying you coverage! Interestingly enough, most of those claims are coming from people who are either listening to or in the thrall of insurance companies that already practice rationing, which includes insurance company administrators deciding if it’s cost effective for you to get a new kidney. What seems to worry them most is that they’d have to justify their overhead and expenses, and the gravy train would come to an end. They would — horrors! — have to actually compete for their business. How un-American!

Let me add a sort of larger point: aside from the essentially circular political arguments — centrist Democrats insisting that the public option must be dropped to get the votes of centrist Democrats — the argument against the public option boils down to the fact that it’s bad because it is, horrors, a government program. And sooner or later Democrats have to take a stand against Reaganism — against the presumption that if the government does it, it’s bad.

It seems paradoxical to some that a government-run health insurance program would actually increase competition, but it’s been a business model for healthcare for decades now — Medicare is not mandatory — and there are any number of plans out there for seniors who choose not to take it… although you’d be crazy not to. And for every example of inefficient government-run institutions, there are twice as many that run well and effectively, including Medicare, the VA health service, to name just a couple of relevant examples. You just don’t hear about them. It’s also ironic that the people that complain the most about government bureaucracy and red tape are the ones who also demand that those government agencies be fully accountable and able to report on how we spend every tax dollar. One requires the other.

By the way, if you’re a football fan in Florida, you do realize that both the Gators and the Seminoles are government-run football teams?