In all the hate and discontent that dominated the health care debate during the August recess, the facts have been the biggest casualty. The “death panel” myth has been largely debunked, although significant numbers of people, and a vast majority of Fox News viewers, cling to it. Interestingly, they are many of the same people who cling to the myth that Saddam Hussein was actively connected to the 9/11 plot, despite the fact that even President Bush finally tried to dispel that one.
Another myth is that a public option will kill private insurance. The doomsayers contend that it will suck so many people into “free” medical care that employers will drop health insurance benefits like a hot potato, forcing everyone into the government-run program. That line contains a number of canards, the first being that the public plan would be “free.” It would, in fact, be paid for through premiums, just like private insurance, whether provided by the individual or partly funded by employer contributions.
The second canard is that it would be the death knell for private insurance. The Congressional Budget Office, in its evaluations, has stated categorically that it would do no such thing. In fact, there are good reasons to want a hybrid system. People’s needs differ when it comes to medical care, as do their ideological preferences. So it makes sense to have a series of options. More importantly, public and private systems each have their strengths and weaknesses. So having the ability of both in the mix will serve to take advantage of the strengths of each.
One of the key reasons for public plan choice is that public plans can offer a set of valued features that private plans are generally either unable or unwilling to provide. Stability, wide pooling of risks, transparency, affordability of premiums, broad provider access, the capacity to collect and use patient information on a large scale to improve care—these are all hallmarks of public health insurance that private plans have inherent difficulties providing. On the other hand, private plans are generally more flexible, and they have, at times, moved into new areas of care management in advance of the public sector. The bottom line, then, is that both public and private plans have unique strengths and weaknesses, and all Americans, not just the elderly or the poor, should have access to the distinctive strengths of a public health insurance plan, as well as the strengths of private plans.
Those people who believe that health care is a privilege, not a right, will not be moved. They come to the debate from a definite ideological perspective, one that has complete faith in the ability of the free market to provide the necessary access and controls. I disagree. The market will not put people first. It cannot by law put people ahead of profits.
As a nation, we agree that there are some things that are best socialized — i.e., done by government. Public safety is a perfect example. Just imagine what would happen if fighting wildfires, like the ones currently plaguing California, was privatized. People who could afford to hire a fire-fighting company or purchase their own equipment to fight it on their own would do so. People who could not would have to sit by and watch their homes burn. And what would the additional risk be to those who could afford it if 1/6 of their neighbors (either immediate neighbors or those upwind) could not? I would wager that not one of the people whose property has been or currently is or may be later today or in the weeks until the fires are put out would argue for privatizing fire fighting. We turn to the city, the county, the state, and even to federal resources to fight the fires. If your area is prone to other forms of natural disasters, simply substitute your disaster of relevance.
For me, there is a parallel argument regarding health care. Making sure that a nation’s population has access to affordable health care is a matter of enlightened self-interest, and ultimately a matter of national security. A healthy population is more productive. Healthy children are better able to learn. And an educated population is required if we are to be competitive in a globalized economy. Not having a viable social safety net puts American business at a competitive disadvantage. I support a public option as one among multiple choices simply because ensuring that all Americans have health care is the right thing to do. It is more economical for individuals, for businesses and for the country at large if we can get costs under control. Having a public option is part of that process.