Arguments against a public option
Slartibartpants and I can’t seem to agree on whether or how to reform healthcare.
He worries about government intrusion from a public plan. I thought it would only affect those who elect a public plan and he writes,
This is assuming a public option doesn’t force out private options and employers don’t drop their coverage. If the government prohibits companies from dropping their insurance benefits this would also be a form of government intrusion.
Now, deep within my pinko soul, I still have the gnarled remnants of a capitalist in me. If the private industry can’t compete with the suposedly monstrously inefficient and crappy public option, I don’t feel sorry for it. Right now, there isn’t much meaningful competition in healthcare. The large players in most states have virtual monopolies. Are they really so ineffcient and wasteful that they can’t handle government competition on a level playing field? Maybe the saddest puppy in the world will cry giant puppy tears for them—but I’ll let them die. Similarly, I’m okay with the govenrment intrusion that prohibits employers from dropping insurance benefits for sick employees or requires some amount of warning or portability. I see that as a benefit.
Slartibartpants also writes,
Coverage to the uninsured already isn’t free—this point is moot and is one of the reasons health care is so expensive nowadays. The reason taxes will rise so substantially is that the public option will be unable to fail and will become inefficient.
Again, I’m happy to pay for coverage for the uninsured—just as my taxes pay for roads in places I don’t go, for wars I don’t want, for congressmen I voted against, for schools I don’t attend, and for the public library to buy a some books that I’ll never get around to reading. Now—I’m not really concerned about the public option being “unable to fail.” Isn’t this true of any large health-insurance company? If BCBS of a particular state suddenly ran out of money, wouldn’t the vast majority want it bailed out? The alternative would be a catastrophic collapse of a few state’s medical systems. So no—the public option is not likely to fail anymore than any established health insurance company is. However, if it sucks, we can come back and privitize it. The only remaining concern is that the public option will magically “become ineffcient.” I’ll need Mr. Pants to elaborate on what mechanism will cause this.
He also objects that the government spends less on R&D than private industry.
Innovation is almost inevitable. The question is whether or not the innovation will be less than that which would have come through private competition. If we compare the resources that public services can give toward R&D versus what private sector can give toward R&D the gap is outstanding (I’m referencing my forte in those links).
Again, I’m going to need more than an anecdote. Are the health insurers spending a lot on R&D? The pharmaceuticals are—but they make out like bandits in the current plan. Fortunately, with a wider base of insured, if the R&D costs built into every pill remain the same, we have more R&D. What sort of innovation are we looking for? If a private plan can do it and thereby become more efficient, shouldn’t it have a leg up over the public option? Wouldn’t the meaningful competition a public option would provide actually spur innovation? From my view, the public option and increased funding to subsidize the uninsured would lead to more innovation.
Fortunately, we agree that the private healthcare industry is horrendously wasteful.
You’re also using the private sector as your standard for efficiency—I don’t think this is fair considering it’s the health care industry. I’m not arguing the health care industry is perfect, I’m arguing I don’t want to be forced to subsidize more crappy services.
I’m not sure exactly what other industry we should compare the government’s ability to provide healthcare to. If the issue is that you consider healthcare a crappy thing and don’t want it for yourself or others—hey, you’re being consistent. If you want to take that message to a protest, I’ll help you with your slogans. Let’s start with, “Life-saving treatment unjustly subsidizes those with a will to live!”
Mr. Pants agrees with me to some extent on medicare, but has some reservations.
Medicare really is a fairly good service as far as the government goes. However a public option will be notibly larger than Medicare. Everyone will qualify for the public option. Medicare provides services for 43 million, a public option will be available to 300 million. Let’s take a look at another government-subsidized single-payer service: USPS. Branches are slated to close (due to an inefficient structure) and services might be cut.
Now, it’s a little absurd to assume that government healthcare is more analygous to government mail delivery than it is to, oh, government healthcare. (I’m also not sure when the post offfice became a “single-payer service.” Apparently my local branch has been pulling one over on me. It always asks me to pay for my stamps.) But let’s ignore the absurdity and roll with this. Is the post office really that bad? It’s planning to close some branches that are no longer necessary … and efforts to increase efficiency are proof of hopeless inefficiency? Are efforts to scale back services in response to decreased demand really a problem? Yes, the post office has had trouble lately. Demand has dropped for its services. All things considered, however, it’s doing a very good job. How well did print-dependent private industry handle the dawn of the digital age? I’ll have to ask my local newspaper. (Give me a second—somebody seems to have misplaced it.)
Mr. Pants also disagrees with my proposed benefits.
You’re counting on THE GOVERNMENT to be more transparent?
Yes. Check out the Freedom of Information Act. Every state has an equivalent statute. None of it applies to corporations.
Less redundency?
It comes with the transparency thing. Private industry races to complete an innovation and get a patent. Two companies do the same research. One wastes it. It happens all the time.
Increased accountability from the people who have a 98% incumbency rate?
Yeah. They have to at least try to keep you happy. That’s more than private industry does.
Universal availability of coverage is true. Universal treatment is less likely.
At least we agree on the universal availability of coverage. And even if treatment is only nearly-universal, we’re a lot better off than we were.
Slartibartpants closes:
I really think the United States is just way too large to efficiently provide services. If you’re comparing the United States’ and France’s public options let’s at least be fair about it—France has a population of 61.5 million. Italy has a population of 58 million. The UK has a population of 60 million. The United States has a population of 300 million. California, New York and New Jersey combined have more than any of those. There is no way that we can have the sort of efficiency they do. This is apples and oranges. Medicare is effective because it fits a small subsection of the population. It’s the difference between throwing a shindig in your parents’ basement and a kegger when they’re gone.
And if that’s the way you want to look at it—I suppose you can look at it that way. It’s sort of counter-intuitive. Economies of scale are supposed to become more efficient when you scale up. But maybe America is exceptional in that regard. If that’s a serious argument, let me know. There are all sorts of ways we could solve that problem. But I don’t think you really mean to argue that the United States is incapable of achieving universal coverage because it is too big and too wealthy. How does that make sense?
