The mirage of a public option

/ 16 April 2009

A few days ago I spoke with Matt Entenza, one of the likely DFL (that’s “Democrat” to all you non-Minnesotans) candidates for Governor here in Minnesota in 2010. My main concern was health care. I believe that resolving the growing health care crisis is essential to resolving our economic crisis, and I fear the Obama team is going about it the wrong way. Matt, too, insists that “Medicare for all” is more realistic than a “single payer” plan, and I do have to grant that making something actually happen is more important than tilting at windmills. Still, after some thought I sat down and wrote Matt the following email. I want to share it here for the record.

My fear about “medicare for all” is similar to my fears for the Obama plan. A “public option” which leaves in place the wealth and complexity of the private insurance infrastructure will likely fail. It will be left with scraps, the big money being in the hands of private insurers. It will depend on reducing payments to doctors and hospitals to make up for its lack of wealth. It will have to draw a harder line on the limits of care to afford covering those who join. It will underperform and put a sour taste in the mouths of those who trust it.

I think that, in fact, insurance companies know this. They are making such as stand on the public option because if they don’t make us fight for this scrap, we might have the energy to push for more. To simply defend and probably water down the public option in response will be just what they want, it keeps our mind and effort off the real battle: ending private insurance once and for all.

The value of single payer is much more than that it covers our citizens. The value is in the ways it simplifies practice for doctors and hospitals and for all of us. The way it could eliminate the maze of billing and contracts, eliminate the worries about degrees of coverage, eliminate the time wasted on making decisions every year about health plans and alternatives. We are all human beings, we are each given a body susceptible to similar disease and in need of similar care. Our nation, and if not our nation then our state, should take the opportunity to pool together the risks we all bear and provide for us one common solution that puts us all on equal health care footing.

Sure, there is room for private plans and a for-profit health care industry at the margins. Elective care and extraordinary care will always be attractive for those who can afford it. They will thrive even in the face of a single public health plan that covers the basics.

But making a public plan just one option that “competes” against an industry as rich and misguided as our health insurance industry will, I fear, leave us spending way too much energy on the competition and realizing way to few of the potential benefits. We need to radically simplify this system to really gain the efficiencies that can transform the money we currently spend on the health industry into real health care.

While I realize that the “public option” and “medicare for all” may be easier sells, I am afraid they will not get to the heart of the solution we need. Now is the best opportunity we have had in decades to sell the solution we really need. Now is when the constituency for health care (that is every one of us) is most frightened by the gaps in our current “system”. Now is the time that small businesses, educational institutions, and government itself is being drowned by the costs of “managed” care. Now is the time that many feel at risk of losing their tenuous hold on the employer-sponsored plans that tie us to companies we would rather not be doing business with given how poorly they treat us. Now is the time to make a push for the solution this state and this country really need. We need more than a “public option”. We need to remove the maze of private insurance. We need a simple plan that serves all of us. We need to trust government to deliver this in the way it did deliver on medicare many years ago.

Yesterday Andrew Sullivan quoted scienceblogs with regard to some CDC statistics, and they put it much more succinctly:

The simple truth is that one of the major reasons we have such a lousy health care system and receive such bad value for our money in the US is that we placed health care financing into the hands of the same folks who helped make our economic system such a disaster: private insurance companies, who are little more than disguised investment banks with the added incentive not to pay back their depositors (the premium payers).

We don’t need health care reform with a public option. We need one with public financing by default, perhaps with a private option for those who wish to and can pay extra for it.

Here in Minnesota, please consider supporting the Minnesota Health Plan.

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