CALPIRG Blog

I get confused sometimes when I hear what opponents of health care reform are saying.  In general, given the reality that premiums are going to double in eight years if we don't win on reform, I'm confused about how they can defend the status quo.  But there are other, more specific arguments that are even more confusing.

Take opposition to one of the key planks of reform -- giving consumers the choice of a public health insurance option.   Briefly, what this policy would do is allow people either to stick with the insurer and doctor they have now, or instead opt for coverage through a publicly-run health insurance plan, along the lines of Medicare.  Giving patients more freedom to choose will give them better options, and providing some competition will help keep private insurers honest.

To hear the opponents talk about it, this is worse than one of the trumpets heralding Armageddon.  The only problem is, they can't quite make up their minds about why it's so bad.  Take Utah Senator Bob Bennet:

“The sticking point in this entire debate is the demand on the part of the Obama administration that the final product have a government plan as one of the options... Right now, nearly 1.8 million Britons are waiting for hospital or outpatient treatments at any given time. Let's realize that the American voter will never stand for the kind of rationing by delay that seems to have crept into every other government-run health care system.”

OK.  So the problem with the public health insurance option is that it will provide low-quality coverage and force people to wait on lines.  Got it (though I'm not sure whether the successful Medicare program is included in "every other government-run health care system").

But then there's the other argument you hear, made by the insurance industry among others, that private insurers won't be able to compete with the public plan, and it'll drive them howling from the marketplace until only the public plan is left. 

OK.  So the problem with the public health insurance option is that it will be too good, providing high quality coverage at a lower cost than existing private insurers can offer.

To put it mildly, these arguments are hard to reconcile with each other.  But they're often cited in the same breath -- going back to Senator Bennett, in part of his speech I didn't quote, he says he's "convinced there would be only one option that survives" after the public plan competes on the existing marketplace. 

So the problem is that the public plan is going to outcompete existing private insurance by offering lousy benefits and waiting lines?  Somehow Americans will be poundng down the door to opt into a terrible, Kafkaesque program that will tie them up in red tape and never give them care (any resemblence to existing insurance companies must surely be coincidental)!

You can't have it both ways.  If the public plan is truly going to outcompete most private insurers, it will have to be because it's doing a better job -- Americans will be better off, but insurance companies that can't keep up will lose business.  Pretty clear where the public interest lies in that dilemma.

And if the critics are right when they say the public plan will be a bad deal for patients?  Well, then nobody in their right mind will enroll with it, and there's no harm done. 

As it happens, there are other problems with these critiques, and other benefits of a public health insurance option.  But even on their own terms, the opposition arguments just don't add up.