Friday, October 23, 2009

Public Options

For months now, I've listened to both sides of the health care reform debate, paying special attention to the Public Option that has been talked about ad nauseum.

The primary arguments against the public option (not including the patently irrational scare tactics like death panels or communism) seem to be:
1) It will drive private insurers out of business.
2) It will lead to long waits for 'vital' care.
3) It will lead to rationing care.
4) It will drive costs up.
5) It won't work efficiently.

So lets examine these arguments.

5) It won't work efficiently.
This argument seems to be based primarily on the idea that anything the government does is necessarily going to be complicated beyond measure, and have a mile of red tape, and generally not work well.

The counter to this argument, of course, is that the system works so efficiently now. Really, no one ever has to deal with red tape when dealing with an insurance company, or wade through page after page of legalese to find out if the procedure they need is covered or not.

4) It will drive costs up.
Yes, there are people claiming that including a public option to compete against private insurers will actually drive costs up. These people are bolstered by a report funded by the health insurance industry that seems to confirm this view.

The counter to this argument, however, is that the report in question only looked at four items out of the massive bill. There is no report covering the entire proposal that says prices will go up due to increased competition.

3) It will lead to rationing care.
The idea behind this argument is that if the government runs health care, then they can say what procedures will be covered, and who gets what.

The reality is that health care is already rationed. Insurance companies decide what they will or won't cover, and can decide not to cover certain people for certain treatments. And if they say no, you're basically SOL. So if rationing occurs under a public option, the only change will be that it is government bureaucrats instead of private bureaucrats doing the rationing.

2) It will lead to long waits for 'vital' care.
This objection is propagated by horror stories out of Canada about people who had to wait months to see a doctor for treatment. Basically, they say that with public health care, you would have people waiting years for life-saving treatment.

This is just patently false. The so-called 'vital' care that these stories generally refer to are things like cataract surgeries, and other elective procedures. Emphasis on elective. As in, not life-threatening. In Canada, if you have an emergency, you can go and get treated immediately.

1) It will drive private insurers out of business.
You all know how this song goes. No one can compete with a subsidized public option that doesn't have to worry about profit and blah blah blah.

Honestly, I find this argument the most laughable. Here you have people saying that the insurance companies provide the best care for the cheapest price, but that a government plan that is less efficient would put them out of business, because private enterprise can't compete against the government.

Really? Allow me to retort: Fed-Ex and UPS. Both compete directly against the government. Both do dramatically better than the government. How? They have found a niche that works for them, and that allows them to be leaner, and more efficient.

Just because the government provides a baseline insurance plan doesn't mean that people can't get a supplemental plan, if they need care that isn't covered in the baseline plan. Will the big monolithic insurance companies that kill competition die out? Yes. Will they be replaced by smaller, leaner companies that can specialize in niche services? Yes. Private insurance won't go away, but it will change. And anyone who says the system doesn't need to change is clearly on someone's payroll.

A public option will force competition into the markets where two main companies have a stranglehold on insurance. This will drive costs down. It will also ensure that people with preexisting conditions are able to find affordable health care, even if they change jobs.

Is it a perfect system? Of course not. In a perfect system, we wouldn't need insurance in the first place. But this is an imperfect world, and so we must do what we can.

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