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.

 

Follow Sahil Kapur on Twitter: www.twitter.com/Sahil_Kapur

Comments

[The Professor]

The Wall Street Journal had a very interesting opinion piece from the editors called "The Worst Bill Ever".
http://online.wsj.com/article/SB10001424052748703399204574505423751140690.html?mod=djemEditorialPage
It's a very eye open read and explains much of the concerns that conservatives have with the House bill, and proposed health care reform.

[jakiew]

of course the wall street journal is against healthcare. they're corporate republican hacks. read the article above. it is an excellent article about why repubs don't healthcare passed. and it's truthful. not a bunch of lies.

[tribalogical]

Here's an update, taken from an article on Michael Moore's blog (love him or hate him, you have to respect his passion... in my opinion, he's a great American, regardless of whether or not you agree with his positions).

Anyway, this is an update to the single payer HR676 "Medicare for all" house vote. Numerous people have been saying they'd like to see it CBO scored, and that is about to happen.

"Rep. Weiner was on a conference call just last night with the activists of the Progressive Democrats of America. He said that his amendment is currently being “scored” by the Congressional Budget Office.

The score assigned will measure the amendment’s impact on the federal budget. The results of that score will be out sometime soon. Then it will be up to Speaker Nancy Pelosi to honor her commitment to Rep. Weiner to bring his substitute amendment to full debate on the floor of the House when H.R. 3200 is under consideration.

Rep. Weiner says that will be happening sometime in the next few weeks – maybe as early as the first week in November. He also said more Congressional members are learning more about the economic and moral benefits of his amendment. We need to support that work."

Weiner is truly rocking my world on this issue. We have a champion in him, and he's working the system brilliantly. My prayers go out to him, and for us all!!

peace.

[DrPaulProteus]

Public Option leading to Single Payer should be the GOAL here.

[tribalogical]

Agree!

I've had enough of "profit motive" calling the shots where my health care is concerned!

[ceefee]

Agreed!

[JustBNice]

Excellent article.

Can someone please make this article front page headline news ?

[AnneMarie27]

I wish this article were mandatory for every member of Congress. Just the right mix of logic, simplicity- even in its detail.

I heard another horror story today at lunch. A doctor recommended surgery was turned down by the insurance company. The insurance company is insisting on rehab instead. The patient is in great pain. So now her parents are stepping in with the finances (and they are not rich) so that their daughter can have the surgery.

A single payer system for all .. like Medicare for seniors. What a concept. And more Medigap customers for the insurance companies. Ours is not cheap. They will still make money.

[S E Martin]

“Death panels” already exist. They’re called insurance companies.

Rationing already exists. It’s called the private insurance system.

Inefficiency already exists. Ever call your insurance company with a problem? The private sector is not more efficient. That’s a myth.

Profit has no place when lives are at stake. Profit is a fine motive when it comes to shoes and cell phones, but not who lives and dies.

A single payer system makes more sense because insurance is all about spreading risk. When the entire nation is in the pool of lives covered, the risk is spread as broadly as possible.

Taxes might go up? Sure, as they should to provide a Medicare for all type of system. I’d rather pay another, say, 10% of my income to the government for Medicare coverage than the 20% of my income I currently pay.

To me, and I’d guess for most Americans, a single payer system would be a net gain in disposable income. This could even HELP our economy.

[JustBNice]

S E MArtin - Excellent ! thank you.

I don't understand why Single Payer isn't desired by the majority of Americans.

Probably because it hasn't been explained concisely. It's hardly been discussed.

[tribalogical]

It IS desired by the majority of Americans......

The idea that it's "off the radar" because the MSM isn't shouting about it from the rooftops, or it's "off the table" because someone just says it is... That's just part of a brutally efficient corporate sponsored media campaign.

Never mind that single payer has PASSED COMMITTEE and is coming to the floor for a full debate and vote (delayed from last week). You'd hardly know it...

A great number of those Americans are still confusing "public option" with "single payer".... it's a well-orchestrated confusion.

Sometimes too much competing information is worse than none at all. It becomes a confusing morass (mostly on purpose. Part of the insurance industry strategy is to obfuscate.. ever watch the Wendell Potter interview and testimony?).

We're very handily being kept divided. I'm pushing to get some of the larger pro-single payer groups to join forces, and combine their supporters. But it isn't easy. They all want their own slice of the 'contributions" pie I guess....

In the meantime, we just keep raising our voices, and adding to them. Eventually, we'll get the critical mass we need... :)

Yes we can!

[S E Martin]

The funny thing is: it's pretty simple to explain.

The federal government acts as one big, self-funded insurance company (meaning that what comes out must go back in according to use). End of explanation.

Many small scale insurance works this way, but the problem is that there aren't enough "lives" in the plan to make the risk manageable.

There's no profit; rates would be reflective of what they need to be to be self-sustaining. Everyone would be healthier because they wouldn't wait until an illness was more expensive to treat (prevention would be more likely).

Would it be free? Nope. Would it be cheaper and better than private insurance? Yes, I believe so.

[JustBNice]

Right now the Rethugs are more interested in just be opposed to anything the Democrats or Obama are for.

It's really that simple.

[JustBNice]

This is the sad reality being missed .

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.

That's the American way, capitalism for the capitalists. And if you're not, tough luck.

Thanks Congress. For nothing.

[windup]

"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."

That's why it's entirely implausible.

[mgpayne]

This health care business is crazy. But I do know that currently MEDICARE only pays 61% of the Doctor bill etc. So who pays for the other 39%???? It certainly would be wonderful if everyone could have health care.
I believe that the people currently out of work should have been taken care of first. Set up a plan other than Cobra (joke) that is affordable. Speaking of affordable I never hear any mention of what the consumer will pay for this 61% plan? Is it $200 individual, $400 family? Any one know? If your not working how can you pay?
Also the thought that Ilegal Immigrants will not be covered is rediculous. You don't hear the ACLU or LaRaza (sp) screaming. The taxpayer currently pays for their school and college so please lets be real about this.

[Chris1950]

Who says the other 39% is justified anyway. Who set inflated doctor rates. Who says a procedure or a test is worth what evrer they charge. Where did the rates come from ???? Have you ever seen a health care rate chart ????

[S E Martin]

I got charged 19 dollars for two ASPIRIN!

I've read others have been charged 100 dollars for a "mucus recovery system" (otherwise known as a box of scratcy tissues!)

If Medicare says: B.S., we'll pay you 2 dollars for aspirin and 5 dollars for the box of tissues, then I think that's totally justified.

[mamalisa38]

In 2004, George W. Bush and the Republican's gave $950 million to Iraq for universal health care.

[S E Martin]

Do you happen to know the resolution number for that? Did it originate in the House? I've been trying to locate the exact legislation for this.

[on2them]

The citizens of the United States of America are nothing more than a commodity to insurance company's stockholders and many politicians who have profited off the deaths and suffering of citizens for decades.

They have no moral compass. In their eyes, if you have money you will survive, if you don't you will die and they have no problem taking your money knowing so.

[Emucrat]

Amen. That's what I was always talking about. But now since we have a weak public option, the option of the American people to decide to keep private insurance or switch to gvernment-run health care has been kil.led.

The only hope for government-run health care would be an amendment on the public option so that it opens up to all people.

[krocklin]

What is ignored is the agony people are having right now without real healthcare.
Most people can afford it, not matter how much costs continue to escalate.
This is weighing heavily on the psyche of the American people, never mind the enormous burden it poses on the economy.
My doctor friends and nurses too are sick of all the paperwork they have to do in lieu of actual care they can provide.
And the pharmaceutical pressures put on them are making our healthcare even worse. They have no idea what the side effects of these drugs have on their patients. On the whole they are ineffective and malicious.

[S E Martin]

My health insurance, for just myself (a 35 y.o. health male, all stats well within normal range, no history of cancer, etc.) is over 9K annually. It's over 20% of my total compensation (salary plus fringe benefits.)

Want to fix the economy? Give me medicare; I'd happily pay another 10% of salary to Medicare instead of 20% to a private insurer.

Then, I'd have about 4.5K a year to blow my money on crap I don't need and spur the economic recovery!!!

[upriser]

To the person who calls for tort reform, another point. All the talk about "defensive medicine" is just that - talk. There are no controlled studies that provide any evidence as to the amount of money defensive medicine costs. There is only anecdotal stories and "estimates" which are used to dramatize the one-sided point of view of many in the medical industry. However, there are several controlled studies about the actual amount of medical mal-practice that there is in this country. And we all know that the "fee for service" method that doctors and hospitals use help drive up the cost of health care because the monetary incentives to order more testing and procedures than are necessary drive these costs. And since we know there is unchallenged knowledge about the amount of mal-practice going on, it stands to reason that defensive medicine may be practiced as a result of doctors' knowledge of how frequent medical mistakes are made. That is probably the driving force behind defensive medicine - not the threat of a lawsuit so much because only one lawsuit occurs per 25 cases of malpractice.