I'll admit that I'm just an armchair political/policy junkie. There are many folks here that know much more about the proposed health care bills and economics in general than I do, and that is a grand understatement. Still, I thought I'd write a diary sharing my thoughts and reaction to the President's address, as well as the current (and constantly changing) state of health care reform. In particular, I'd like to share some of my thoughts, and hear some of your own, on the issue of the public option vs. regulation. After watching the President's speech and seeing the reaction of many on the left, it seems that this issue is of particular import at the moment. So please, join me, enlighten me, indulge me.
After watching last night's address, it appears to me that the President wants both the public option and strong regulation. I strongly agree with this position. Many folks here have been talking about the President's comment that the public option will only serve 5% or less of the population. The most common reaction is something like "Eff that! As soon as we get the public option, I'm dumping my private insurance and jumping on it! No more insurance companies will ever get my money!" I must admit, this was my initial reaction as well, and this was also the way I was thinking about things all along. However, after reflecting on it a bit, I'm not so sure. I'm starting to think that such an argument is made based on views of the current health care situation, rather than a long term view of potential situations that could come about.
Based on the President's comments, I've been tossing around the following thought experiment: if the President succeeds in his reforms, the public option will be there for people, but folks won't necessarily go flocking to it because the regulations will actually make private insurance worth having. Real regulation will drastically change private insurance, making it actually function for the benefit of the insured instead of the shareholders and executives. Think about it...if private insurance was regulated to the extent that the President is talking about, then most of the things that we hate about the insurance industry will be a thing of the past. The huge profits, the dropping of patients, preexisting conditions, the insane cost, etc. Isn't this the basic problem with private health insurance as it is: many people don't get the coverage they need because they can't afford it? Some people can't afford it because they are poor and couldn't afford health care at any cost. Some people can't afford it because their rates go through the roof when they get sick. Some, like my girlfriend, have a preexisting condition (she has Type 1/Juvenile Diabetes) and are denied coverage under most plans and can't afford the expensive alternatives. If these basic problems with private insurance were fixed, then there wouldn't be a reason to drop it, other than to spite the companies themselves. As long as coverage is mandatory and there is a public option for people that can't otherwise get coverage, then really our problems are solved. As far as I can tell, the specifics that the President outlined in his address amount to universal, affordable coverage. It just would not be government run, and the insurance industry would changed dramatically. I'm starting to think that:
A.This is what the President wants.
B.This is what the insurance industry fears.
C. This may actually be politically possible.
I think that the President envisions a Swiss style system. I think this is what the insurance industry fears. And I think it is politically possible. Viewing things from this perspective, the public option would not be such a large part of the resulting system, but I think is it still incredibly important that we get a public option. If we fail on the public option, I don't think we will get real regulation either. For one thing, if the public option is defeated, the industry will just move on to fighting regulation, emboldened by the victory of one battle and on to the next one. Another reason that the public option remains vital is that it will be impossible to effectively regulate the private insurance industry if there is no alternative to it. They will just do like they do now: operate as one big monopoly that acts in their own collective interest against the interest of their customers.
Here is a common argument:
We all know that half the argument against public insurance is that the private sector is scared shitless that they will go out of business.
I think that is observation makes a lot of sense, but I'm starting to see it from another point of view. I don't think the industry is afraid that they will literally go out of business. I think they are afraid that their business model will change so drastically that the huge profits will be a thing of the past. In other words, the robber barons will effectively go out of business, even if the old companies are still around. I think this is what Obama really wants, and I think it is what they are really afraid of. And honestly, I don't think it sounds so bad - as long as everyone is covered, no one ever has to worry about medical costs again, and the huge profits disappear. That's what we all want, right? Personally, I'm a single payer advocate, but like Obama said, we have to focus on what we're trying to accomplish (universal coverage, no more denying care because it is unaffordable, etc.) rather than just how we accomplish it.
Personally, I'm wondering if the ideas I'm expressing here might become the real battleground that reform ends up being won or lost on. I realize that it is probably very naive to think that this kind of regulation can be accomplished. However, one main reason that I want to put these ideas out there is that I think it may be possible (and necessary) to put much more effort into the reform side of things, and doing so may bring us a lot closer to achieving our goals - even with a public option. Also, my life experience has taught me that it is important to constantly visualize paths to achievable goals. Also, for those of you that are not familiar with my comments and views expressed here...I have always been a staunch single payer advocate that is often accused of being a "purity troll." I'm not interested in compromise, and that's not what I'm advocating.
Any thoughts on this? Am I crazy? Hopelessly naive? Inadequately equipped to appreciate the gravity of the situation? ;)
P.S. One thing that gives me hope that the President is on the right track is that we're seeing libertarian hack jobs on his speech. This dude's rebuttal includes things like an objection to the fact that the plan doesn't offer the "choice" for individuals to opt for less coverage or no coverage at all:
On the negative side, the president still champions a system where the government -- not patients -- mandates what's included in individuals' health-care plans, and what they pay for it.
In my opinion, when a prominent libertarian (an editor of Fortune magazine at that) is making a point to refute specifics of your plan, you're probably on the right track.