There have been a few interesting comments made in response to my post on the public option a few weeks ago. Thank you for your perspectives! I think the two Jeffs have posted very valid criticisms of the public option and it's kind of refreshing to be having the debate on this level instead of the death panel level. It's obvious now as I reread this post that I was swept up in the moment and wasn't thinking through all the examples perfectly clearly. Unfortunately there is no real good parallel withthe health care industry. The imbalances are so severe that it really doesn't seem like a market to me. In that respect, I think it's interesting/ironic that this is the main selling point used by democrats - that it will create competition for private insurance companies who often otherwise have none. Despite the irony, I still think it would be a good step.
As far as I can tell, this debate centers on two issues: 1) what is the role of government, and 2) is health care a right or a commodity. If you are skeptical of government's ability to solve problems and think of someone's ability to have quality health care as a commodity in the same vein as someone's ability to buy a nice house, then you are understandably opposed to the public option. If you think government is the ideal way to solve societal problems and you feel so strongly that everyone should be able to buy a nice house that you're willing to have the govt spend tax money on it, then you probably don't think the public option is enough.
I come down somewhere in the middle on both of these issues. I am cautiously optimistic that the government can play a positive role in alleviating suffering and helping people create opportunities and take advantage of them. But I share some of the concerns expressed by my friends that I don't think a "government takeover" of the health care industry would solve the problems. As much as I love Canada and admire aspects of their system, I don't think it would work in the US right now and I am glad we're not going that route. Although not specifically stated in our constitution, I lean closer to viewing health care as a fundamental right that everyone should have access to as opposed to strictly viewing it as a commodity. Just as I don't think everyone has a right to own a very nice house (to the degree that the government should give everyone a four bedroom home), I don't think everyone has a "right" to get as much health care as they want. But I do think everyone should have access to some basic level of services at an affordable price.
With this frame in mind, I think the public option is a good compromise solution that deserves a chance. There is no reason to trust the insurance companies will help keep costs low and provide some basic coverage. The fact that they're increasing their prices so dramatically right now because of fear of health reform strikes me as circumstantial evidence that they are committed to doing their job - maximizing profits. Believing that health care is more a right than a commodity, I don't think it's wise to completely rely on companies whose job is to make money by denying just enough services. I think a non-profit option should be included.
All that being said, I'll be honest (since I'm more an academic than a politician) that I understand the concerns expressed by the Jeffs and am sympathetic. I don't think it will be perfect and I don't think it will solve all the problems, and it won't do as much as it's advertised to do. I think it's better than the status quo and I'm afraid that without the public option we're much more likely to end up with the status quo. Even still, if the public option gets defeated from the final bill, I still really hope that the other reforms are passed and implemented.
1 comment:
Here are my thoughts as I read your post, rather muddled and not organized:
I completely agree on what this debate is all about, and I think, most issues go down to some fundamental points like this. And, in the end, very honest and informed people can differ on very fundamental points like this (is X a right?), and so very honest and informed folks can come up with very different opinions. Unfortunately, as a society, we rarely hear about these fundamental issues.
Commodity has a very strict economic definition, and health care is not a commodity, is not subject to commodity pricing, and the comparison is bad. However, interestingly, affordable housing is held up by a right by many to be a right, which was subsequently legislated into mandatory lending guidelines for mortgage lenders, which undoubtedly contributed to the housing bubble and the current economic crisis, making somewhat interesting your analogy.
I still don’t understand how “right” and “commodity” are the two options. Was privacy a commodity in the pre-Roe V. Wade days, but now that the courts have guaranteed privacy as a right, it is no longer a commodity?
I find this one interesting, “everyone should have access to some basic level of services at an affordable price.” I would agree. I guess where we probably disagree is what defines a “affordable price,” and what constitutes basic level of services. For example, one of the big debates that is having to be compromised on is if abortion should be included I would contend that most people who currently do not have insurance could get it, but at a price they are currently not willing to pay. I would also suggest that many of them simply do not care/think ahead enough to think that getting sick can be very costly, and to properly insure themselves against such costs.
By far the best thing I have read about “rights” is found in Equality by Default (http://www.amazon.com/Equality-Default-Modernity-Confinement-Crosscurrents/dp/1932236333/ref=sr_1_2?ie=UTF8&s=books&qid=1257730197&sr=1-2), an essay by French political philosopher Philippe Beneton. It is amazing.
“deserves a chance” – Something that I have come to believe very strongly in the last couple weeks is that there is no trying anything out. Once we commit ourselves to some level of publically provided care, there is not turning back. Would anyone ever consider taking away social security, WIC, the food stamps program, or anything else? Once we give out social welfare goods, the same level of those goods must almost be maintained.
A non-profit is an extremely different than a public option.
Insurance companies are one of the lowest profit margin industries there is. Health care costs are very, very, very expensive. One huge reason that the costs insurance companies face is that hospitals must price their services realizing that one of their major current payers (the federal and state governments) only pays 50-70% of the billed cost, so, the price must be raised to insurance companies (who pay a negotiated rate, but a much higher rate than the government) so that little hospitals can just break even.
Two more points on promises. Our current president made two large promises when campaigning. 1) There would be no new taxes for those making under $2X0,000 (the promise changed around a bit depending on where he was speaking), and 2) He would “reach across the aisle” and be this great leader. So far, he is pushing hard to implement the first tax the U.S. has ever had for existing. Under the mandatory insurance regime, those without insurance will be charged a fee, administered by the IRS and legislated through the IRC. Call it the existence tax. Poor people are subject too. And, there are virtually no (perhaps no) republicans voting for this bill, and the difficulties in passing it are coming through getting enough democrats to vote for it. Not only is he not reaching across the aisle, persons on his side are not willing to play along.
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