Friday 9 October 2009

Dr Stangelove 2009, or, How I Learnt to Stop Fearing Socialism and Love the Public Option

I have always been sceptical of people who support increased government power explaining why this or that further incursion is “for my own good,” or prop up the action by offering that opposition to it must necessarily be due to lack of clarity, or worse, because of propaganda that has obscured. Now that the Democrats appear to be on the verge of passing some sort of health care bill (really, calling a piece of legislation that is physically larger than the Manhattan yellow pages is a stretch), and Speaker Pelosi has said that it *will* include some sort of ‘public option,’ I’ve decided to set aside my worries about Big Government and embrace the creeping socialism.

Before I get into any further detail, I’d like to start with a few clarifications ahead of time.

I think the Republican Party has contributed in a large way to the mess we are in. I voted for President Obama. I do not believe he is a crypto-Moslem plant, nor was he born in Kenya or an illegitimate president. I don’t watch Glenn Beck or listen to Rush Limbaugh. I think Fox News is tabloid rubbish. I do not own a gun, do not think that the Democrats are trying to disarm us and install a Soviet or Nazi regime. I have never seen black helicopters flying over, and am not particularly concerned about the Masons or that a black man is president.

But I do believe that the “public option,” as is being discussed by the Democrat House leadership, is a kind of soft socialism. Using monies taken by taxation from one group of people to redistribute in the form of services to others who have not paid for those services is almost the definition of socialism.

Accept it, and move on.

So, in that spirit, here is what I propose as a sort of sugar (Splenda, perhaps?) to help the socialism go down.

Let’s have a public option. But let’s make it a real option, not something delivered at the point of a tax policeman’s gun.

Let the federal government set up a true insurance scheme, run and administered by government experts. Put whatever rules into the plan that they think will make it ‘work’ (i.e., it must cover this that or the other procedures, cannot charge higher premiums according to actuarial data, cannot refuse care for pre-existing conditions, etc.). Allow it to negotiate fees, prices, and co-pay rates. Give people the option of buying into this system or opting out. The profit motive presumably would be removed, and the only goal of such a scheme would be the health of its participants.

That is what proponents such as Dennis Kucinich and Bernard Sanders argue is the fundamental problem with private insurance, and hence the motive of pushing a public option.

But this public option must be subject to the same rules as other choices. Doctors and other health care providers can freely look at re-imbursement and other factors, and choose not to take patients who use the public option.

And, most important of all, require that this public option be self-sustaining. Put simply, it cannot use tax money for funding, and must be sustained by the premiums paid in by its participants. The bottom line here is, the word “option” implies that one has choices, and that participation is voluntary, not compulsory. I like the current health insurance I have, and I do not want to see my quality of care go down (which it would with the sort of single payer scheme seen in Canada or the UK) and my costs go up (which I suspect they would given what Speaker Pelosi is pushing – expanding “coverage” to 45 million additional people).

The maths simply do not work – you cannot provide the same level of care to a larger group of people without an increase in total cost. And presumably, since these additional 45 million (or whatever number you choose) currently do not participate in the current system because they cannot afford to, they would use resources without contributing a proportional amount of money.

Put simply, health care reform, with a public option, must not be yet another means by which federal kommisars rob Peter to pay Paul.

I propose we go forward with this reform, inclusive of such a public option, and after a period of years, see how it has worked out.

2 comments:

Nick said...

This is where the "public option" wheels come off the wagon:

"The bottom line here is, the word “option” implies that one has choices, and that participation is voluntary, not compulsory."

If the healthy do not fund the sick, it won't ever work or pay for itself.

Why not skip to the only possible, workable solution here:

A mandatory, single-payer, national health care system, where everyone who works pays in through taxes, and everyone in our borders is covered from birth to death.

This is not really insurance, it's more like paying for the military. We may or may not use the military, but it's standing around waiting to be used.

If you want additional insurance on top of whatever would be covered by this solution, then you're free to layer on your own insurance plan to get the "Ferrari" of health care coverage.

The problem with the "public option" is the word "option".

DWBudd said...

Nick:

in general, I agree that one problem is that the reformers are trying to obfuscate with loose application of language what it is they are trying to do; what in fact is being proposed (and seconded by you) is a form of welfare - those who are working are going to be asked to pony up money to pay for those who are not. Perhaps Mr Obama, Ms Pelosi, et al ought to just come right out and admit this is the case.

Also, that the healthy fund the sick is precisely what risk sharing is about. There was an excellent article some weeks ago that explained this - you "buy" insurance with the hope you will not use it, but the belief that if catastrophe strikes, you will be covered. Health insurance is not really geared to covering small items such as office visits, etc.

That being said, I still think that the military analogy (or, equally, the police, the fire department) are not appropriate. Fee for service for emergent situations simply will not work for obvious reasons - the police need to react to situations without pausing to inquire if the parties have 'paid up.' It's simply not feasible to do otherwise.

Health coverage, on the other hand, is something that one has the luxury of time to consider and buy or not buy, assessing the risks and benefits.

One final item - you're right that if we are to go to a single payer system, it *must* be mandatory to avoid the moral hazard problem. If people can ride along with no premiums, wait until a big illness comes along, and then buy into a scheme with no discrimination about "pre existing conditions," then who would be dumb enough to buy insurance until one gets sick?