So What if a Public Option Leads to Single-Payer?

A common indictment by conservatives against a public health insurance option is that it's a Trojan horse for a single-payer system. Providing people with a public option today, they say, will drive out private insurance companies tomorrow and lead to a purely government-run insurance program -- a la Medicare, but for all.

The problem with this argument is not that it's entirely implausible; the problem is that it implicitly prioritizes the well-being of providers over consumers. To its defenders, it seemingly doesn't matter how vexing the system is for patients as long as Blue Cross Blue Shield is profitable.

If the public option leads to a single-payer system, it'll be because private health insurance couldn't offer as good a product to consumers -- that government-run insurance turned out more affordable, of higher quality, and better overall. It'll be because consumers preferred government-run health insurance to private insurance. Isn't that their choice? Isn't the main purpose of business enterprises to effectively serve consumers?

The public option puts consumers in the driver's seat, letting them decide whether to trust corporations or government with their health insurance. People should have that choice -- just as they do between public and private universities or between FedEx and the Post Office. It's very likely that private insurers will continue to coexist alongside a public option -- many two-tier systems prove this works. But if private insurers don't survive, it's because they were ripping off customers or operating inefficiently. Quite simply, if they fail, they deserve to fail.

In other words, wherever the public option leads -- single-payer or not -- it's up to the consumer. One way or another, the competition would force insurance companies to behave more decently and humanely, creating a better deal for all patients.

The conservative indictment against a public option is deeply ironic, and when closely examined, consists of two entirely contradictory cases about the nature of government.

The core conservative conviction for the last thirty years has been that government is inherently inefficient and incompetent at performing serious tasks. Therefore, it should refrain from meddling in the private sector -- be it with regulation or public enterprise -- because that will just spoil things. Free markets can better address consumer problems, including health care, they say.

Cut to today's health care debate, and the conservative view of government suddenly morphs into exactly what it once dismissed. Government is now too good, too effective and too capable at providing consumers with good products -- so much so that it'll put well-oiled, multi-billion-dollar corporations out of business if allowed into the market. That's ostensibly why we can't have a public option -- because poor little Aetna could never compete.

The fact that both these arguments are being simultaneously used by the same people reflects a perverse irony, if not hypocrisy. So, what's really going on?

It's that somewhere along the way, the end-game for lawmakers gradually shifted from satisfying consumers to satisfying providers. Private enterprises used to be the means to an end -- they would spur growth, innovation and provide choice and competition for consumers. Now, with contributions from corporate lobbyists increasingly necessary for political survival, the goal itself has become to serve the interests of narrow, wealthy industry groups.

That's why it's less relevant to Republicans and some conservative Democrats that people are dying and going bankrupt because of the failed health care system -- insurance companies are making money, and that's what important. So, anything that could get in the way of that -- such as the creation of an entity that would make life better for consumers by increasing competition -- should be dismissed off-hand.

The notion that the public option might lead to a single-payer system isn't a cause for concern. The real Republican fear, as their Freudian slips show, is that a public option will be popular and serve consumers better than private insurers. After all, these are the people who have long said government can't do anything right. It would devastate their political philosophy if rapacious private enterprises are unable to compete with a self-sustaining government enterprise that plays by the same rules.

Ultimately, if conservatives really believe in their core conviction -- that government is ineffectual -- they would be willing to put it to the test, and let the people decide whether they're right or wrong. But that's not the case. Instead, their actions and rhetoric continually raise questions as to what their true motivations are, and their loyalty to special interests increasingly seems to trump their loyalty toward their real constituents.

 

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