Dan Froomkin has some good things to say about the current state of the health care debate.
But the fate of the public option is not yet sealed. And it’s much more than just a bargaining chip. The concept of offering health care consumers a government-run alternative to the rogues that comprise the modern American insurance industry not only has a powerful appeal to the general populace, it’s central to effective health care reform, both symbolically and concretely.
In fact, the most extraordinary thing about the mainstream media’s attitude toward the public option is how an opposition movement so obviously born of the insurance industry’s rapacious self-interest, so blatantly fueled by calls to arms that have little to no basis on reality, and so dependent on a particularly ugly strain of know-nothingism, has become viewed by our elite journalists as the pinnacle of rational centrism.
Let’s be blunt. The public option — emphasis on the word “option” — is a way to hold the insurance companies accountable should they (entirely unexpectedly, of course) fail to live up to their promises, ignore the rules, and keep doing things the way they have for the past several decades.
By contrast, the core of the argument against the public option is nothing more than a sort of whiny plaint of “Leave the insurance companies alone!”
We’re getting the same crappy journalism, by and large, that fueled the Iraq War. Credulous regurgitation and a focus on process over substance.
The concept of the public option is fairly simple. It’s a safety valve that keeps insurers honest. It’s a check and a balance to their natural incentive to put profit ahead of paying out (in their jargon) “medical loss” (i.e. the very thing you pay your premiums to get.) The insurance is able to dump $1 million/day into lobbying against health care reform — clearly your ever-increasing premiums haven’t been entirely devoted to increasing medical costs as we have been lead to believe.
Oh, and another thing, this bit irked me:
The high priests of Washington conventional wisdom summed things up this morning in a Washington Post editorial calling for the public plan to die. “This is not a matter of ideology but of political nose-counting,” said the editorial. “[T]here’s no way to amass 60 votes with a public option in the bill.”
You don’t need 60 votes for the public option. You only need 50 votes for the public option. You need 60 votes against filibustering a health care bill. Not voting for a public option is not the same thing as filibustering a health care bill that contains it. We need to know if, among others, Senator Bayh is committed to killing a health care bill that a majority of the Senate supports.
Since it’s a given that the goal of the public option is to get to single-payer, let’s be honest and talk about that, shall we?
I’ll happily support single-payer as soon as anyone can tell me a) why it’s a good thing to let the government push legally operating companies out of business, and b) what Constitutional authority they have to do such a thing.
Yeah, I won’t hold my breath.
Odd thing about public policy — the various policymakers have different goals. So, it’s hard to identify “the goal” when lawmaking is involved.
The legally operating companies are a means, not an end. If — and I realize this is a very hot topic of debate — the government can provide the service more effectively, then there is no particular reason to care overly much about putting insurers out of business; any more than I care overly much about public fire service putting private fire companies out of business.
Constitutionally – and, again, this is going to be unsatisfactory to you – but that debate pretty much ended when Lee surrendered at Appomattox. The government already provides Medicare, Medicaid, VA services, subsidies to hospitals, regulates pharmaceuticals, and is otherwise embroiled in health care in any number of ways. As broadly as the interstate commerce clause is interpreted, regulation of health care fits comfortably within the interpretation of the last 100 years.
Speaking of interstate commerce, it would be nice if our congress would repeal the law that forbids insurers from offering coverage that goes across state lines.
That would not cost a dollar, and would increase real competition.
States need to take on tort reform, and need to reduce mandated coverages for health insurance policies.
As to 100 years, there are lots of things in history that you can point to that went on longer than that, which we now hold to be wrong. I believe the Civil War was associated in some way with one such thing…
The idea that the government is putting health insurers out of business is a popular straw man in this debate, but like all straw men, is void of substance.
There are all sorts of services we expect our government to provide at the expense of privatization. I don’t recall anyone defending the private security firms when the TSA was formed to conduct airport screenings. And in this case, nobody is preventing health insurers from offering plans.
In addition, anyone who has this notion that health insurance is a competitive marketplace is mistaken. For the basic laws of economics to apply to a market, there are certain criteria that must be met, the cornerstone of which fails right out of the gate.
Buyers and sellers must be free to enter and exit the market place with little or no barriers to entry and exit. Clearly this is not the case with private health insurance. The inability for consumers to easily switch providers is a deal breaker here. If a person has a current health problem, they cannot switch to another provider with the same coverage because the other provider will not offer the same benefits, or they will raise price barriers that prevent any sort of market competition. In addition, we all have very little input to the purchase decisions, as they are dictated by employers in most cases. So there is no market for insurance. At least not one to which you can apply micro-economic analysis.
In addition, health insurance is insulated from being penalized for poor performance. If a bank screws up someones checking account, they move to another bank, taking their deposits and base for the bank to lend money with them. This creates a strong incentive for the bank to act in the consumer’s interest. When a health insurer does not perform, in many cases the consumer dies. Virtually no penalty for poor performance while a huge incentive to actually work against the interests of the consumer. In essence, the way the “market” for insurance works, the incentive is directed toward innovation on abdicating the duties under the policy, not innovating to create a more efficient system. Actually, the private insurers are incented to create the most inefficient system available by denying coverage, payment, and benefits to policy holders, hoping enough of them die before they can get through the 17 levels of 1-800 hell that accompanies their new found ailments.
I am convinced that anyone who thinks the health insurance industry “works” has never had to actually USE their insurance for much more than office visits.
A member of my family (mother) was diagnosed with a blood/bone cancer 18 months ago. A transplant and treatment has cost over $400,000 since then. My father was a member of a strong labor union for his entire career and because of that, my parents are better off than most. Even still, it is a Herculean effort to actually get paid for those expenses.
And I never fail to consider the person diagnosed with this sort of disease who has no health care coverage. In most of those cases the option is to check in to hospice and die.
We evaluate the public good versus liberty all the time. It is why we are screened at airports and have our phones tapped on international calls. It is why we don’t privatize the fire department. It is why we have Social Security and Medicare. This is another one of those evaluations. There are many, many ways an innovator in insurance can make a living. So health insurance isn’t one of them anymore. Seems like a trivial price to pay for the betterment of tens or hundreds of millions of lives.
Bravo!
The whole issue seems over reaction on a great number of fronts. As a sometime economist do believe in seeking a free market situation when feasible—- and the amount of money and effort being spent on defeating the health insurance matter is difficult to comprehend without funding from sources that raise concerns as to reasons–and can’t believe it is all for the good of the citizentry. But, all that said, agree with points presented—interesting that so many million people are currently dependent upon government health care programs (which I am one old enough to be there), millions on welfare, social security income well beyond the payments they made (and I am one of those), government programs in many, many areas—yet defenders of a medical world which as pointed out works more for the interest of investors (and executives) than for needs of the population. And, again, a believer in the free enterprise system but yet keep thinking of the financial systems collapse brought on by the (greedy and unethical practices) system we have in place. Insurance of any type is a hedge we all make with high hopes of not every needing (including life insurance.)
Wouldn’t a fresh unbiaised view be refreshing?
By the way, Parker, Mr. Masson, Esq., is referring to 100 years of solid legal precedent, which is not the sort of thing that’s tossed out the window because we change our minds, any more than slavery was abolished because people decided it was wrong, a modern conceit I must say I find particularly disconcerting in its avoidance of fact. Leaving aside the implication that someone relaying the indisputable character of a century of Federal Commerce clause intervention–which has, by the way, hardly been anti-Business in a practical, let alone ideological, sense–stands in moral equivalence to an antebellum defender of chattel slavery, let’s just note a couple of ways your contention falls flat. Even if we abandon the quibble over the right of secession, the Late Unpleasantness wasn’t spurred by any attack on slavery, except in the minds of firebrands, but the issue of expansion into the Territories. As such it was no more a reaction to a hundred centuries of human chattel than our current laws against streetwalking are informed by the religious practices of the Babylonians. The issue, at the time of the attack on Ft. Sumter, had reached the age of 73, and the issue of expansion was only as old as the slow collapse of the Missouri Compromise of 1820. Slavery was never legally threatened until the Emancipation Proclamation. So the matter was much more purely legal than moral. And, of course, the Constitutionality wasn’t changed without the 14th and 15th Amendments. Similarly, Doug’s point holds until such time as a century of precedent is overturned.