A sense of irony is clearly a luxury that politicians can't afford. So was the irony totally lost on Republican senators that after months and months of relentless attacks on a "government takeover of health care," they spent most of the week stomping their feet "defending" Medicare, our national government health insurance program for seniors and people with serious disabilities?
There have been a lot of comments on Republican hypocrisy, with John McCain as Hypocrite-In-Chief, for railing against Democratic proposals to reduce the rate of Medicare spending. Republicans have a long history of proposing gutting or privatizing Medicare which, unlike the Democratic proposals, included reducing Medicare benefits. But what has largely gone unnoticed is the broader context of the debate. Following their traditional playbook, with a refresher chapter written by longtime author Frank Luntz, Republicans have founded their major message against reform this year as a "government takeover of health care." Then this week, they put all their political capital into defending the biggest government health insurance program in the nation.
If you ever needed proof that big government programs are popular with the American people, the Republican defense of Medicare could be exhibit one. Medicare is so popular that the best political attack Republicans have against the health care reform bill is to scare seniors about the legislation's impact on Medicare.
For Republicans, the leading example of the alleged government takeover of health care is giving some people the choice of a public insurance plan to compete with private insurers. The public option would be a very small version of the very big Medicare program.
There are lots of reasons that Medicare is so popular. It allows you to go to any doctor or hospital without having to get permission from an insurance company. It doesn't require your doctor to beg at the feet of an insurance bureaucrat to provide the care that he or she thinks is needed. You can take it with you wherever you go, every community across the country. And you don't have to worry about being dropped from Medicare or seeing your premiums hiked because you have a history of actually needing health care.
You'd think with all these features, Medicare would have trouble controlling health spending. But the fact is that despite its fee-for-service system, Medicare costs for the benefits it offers went up 4.4% a year from 1997 to 2007 while spending under private health insurance increased 7.4% a year. In other words Medicare does a much better job of controlling health care costs than private insurance. The same is true when held up against its privatized competitor, the inaptly named Medicare Advantage. MA commands a 14% cushion to provide the same services as in Medicare.
That's one big reason that we need a public insurance option to compete with private insurers in the new health care system. If insurers have to compete with a health insurance plan that offers better access to care and costs less, they'll either have to become more efficient and charge less - reducing their huge administrative costs, executive salaries, and profits - or lose customers to the public option. It's also one big reason why Republicans don't want the public option to be established. If it is, they'll soon have to face the embarrassment of defending another popular government program.