Secular Right | Reality & Reason

Oct/09

27

About those other public options

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The newly reinvigorated advocates of a “public option” in health care argue that government, with its limitless deep pockets, with its ability to sustain an economically unviable operation indefinitely through its taxing and borrowing power, provides fair and meaningful “competition” to private health care providers and insurers.  Well, then, why not have private providers compete with government across the entire range of government services?  Maybe the supporters of actual market-based competition in health care could offer the following deal:  We’ll give you your health care public option, now open garbage collection, road-building, transit operations, mail delivery, parks maintenance, education, sewage treatment, prison management, inter alia, to private sector competition, and let the most efficient player win. 

(I do not, by the way, believe that even an appropriately deregulated market in health insurance will succeed in lowering health care costs significantly over the long run.  As long as people retain their desire to sustain their own or others’ lives long beyond what our biological shelf-life is naturally programmed for, human ingenuity will create ever more fantastic and expensive new technologies and drugs for doing so.  The Fountain of Life does not come cheap.)

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16 comments

  • Susan · October 27, 2009 at 7:22 am

    What you propose will never happen, of course. The ultimate aim is to have government provide as many goods and services as possible, and taking over health care is a good way to start. The conviction on the left that this is the only way to go can be best explained by an acquaintance of mine (he’s moved from a belief in socialism to a belief in communism), who once said to me that “the first duty of government is to protect people from themselves.” If you live your life according to that principle, then it follows that you would be incapable of choosing your own garbage hauler, mail deliverer, etc. The government will ALWAYS make better choices for you than you as an individual will.

  • Aaron · October 27, 2009 at 7:44 am

    HMC’s modest proposal:

    We’ll give you your health care public option, now open garbage collection, road-building, transit operations, mail delivery, parks maintenance, education, sewage treatment, prison management, inter alia, to private sector competition, and let the most efficient player win.

    “Efficient”?! The most “efficient player” in education? God save us (oops, sorry) from the technologists.

  • Polichinello · October 27, 2009 at 8:35 am

    As long as people retain their desire to sustain their own or others’ lives long beyond what our biological shelf-life is naturally programmed for, human ingenuity will create ever more fantastic and expensive new technologies and drugs for doing so.

    There’s a more prosaic reason: Our population is getting older, so just plain simple medical services will be more and more in demand.

  • Quote Of The Day at Hispanic Pundit · October 27, 2009 at 9:23 am

    [...] inter alia, to private sector competition, and let the most efficient player win. ” — Heather Mac Donald, blogging at Secular Right Share and Enjoy: These icons link to social bookmarking sites where [...]

  • Tomato Addict · October 27, 2009 at 10:20 am

    Are not many of those services regularly provided by private contractors? It seems that where private agencies can do the job more efficiently, they may be doing it already. The public option is needed because the private insurance companies are unable or unwilling to cover everyone.

  • Susan · October 27, 2009 at 11:15 am

    @Tomato Addict

    It’s true you have to hire a private contractor to haul your trash in some communities. And you can send packages by UPS or FEDEX rather than the USPS. And you can send your kid to private or parochial schools rather than public schools. But the intent of the public option isn’t to compete with private insurers; it’s to put private insurers out of business so that the public option is the only option.

  • mike · October 28, 2009 at 9:24 am

    “I do not, by the way, believe that even an appropriately deregulated market in health insurance will succeed in lowering health care costs significantly over the long run.”

    It depends on what you mean by “health care costs”. Usually, when we discuss “food costs”, we don’t mean the price of Kobe beef. A properly deregulated market could provide basic, catastrophic, and tailored plans at affordable rates.

  • sg · October 28, 2009 at 11:08 am

    Yes, private insurers are unwilling to provide insurance for free.

    @Tomato Addict

  • Clark · October 28, 2009 at 8:33 pm

    As Susan noted and most liberals are quite open about the public plan is just a way to get started on a Canadian/British system. I honestly can’t quite fathom why they want a Canadian system so badly. Canada spends a lot of taxes on medical. Further I’m not at all convinced that liberals are paying attention to the idea the US is subsidizing a lot of the rest of the world with our costs to pay for R&D. I honestly don’t think the US could realisticaly get a Canadian styled system and be the kind of superpower we are. (i.e. our spending on military, diplomacy, etc.)

    I think the GOP have really misplayed this. They are assuming things are going to be so bad that there will be a backlash against the Democrats. However it’s almost impossible to pull back from these things and the GOP have never been able to. That’s because Dems can just paint them as cold uncaring people cutting services from those most in need. So Dems are quite right that this is the camel nose in the tent.

    Had the GOP acknolwedged the problem and formulated a competing plan (say more on the German or Australian models) it would have been much better. And while I’m anything but a McCain lover he at least did deal with the tax issue of company supplied medicine. Someone just needs to acknowledge the mandate issues. (But even Dems don’t do that)

  • Susan · October 29, 2009 at 8:18 am

    @Clark

    You’re operating from the wrong premise when you say you can’t understand why people want a Canadian/British system. Ply an ultra-leftie with enough liquor (if you can stand the time and expense) and sooner or later he or she will admit that it’s not about providing health care to all, it’s about control. I once had a proponent of government-subsidized health care tell me that anyone who thought his or her health care would improve, or even stay the same, under such a system was “stupid.” Of course it would be worse. But everyone would have “access” to it.

    As to the U.S. remaining a superpower, did you ever meet a left-winger who thought this was a worthy goal?

    The remainder of people who think national health care is a good idea have no idea what the tax burden would be. Or, if they do, don’t care, because they don’t pay taxes.

  • Derek Scruggs · October 29, 2009 at 8:49 am

    The Pentagon is the single biggest discretionary line item and I’ll wager a whole lot of that money ends up in the hands of private contractors.

    The public option IMO will not make much of a difference. A lot of players want to be in the health insurance market, and they’ll find a way to compete. Nobody wants to be in the health care financing market, which is the real crux of the problem.

    This is most obvious for people at retirement age. You don’t hear Aetna complaining that government prevents them from insuring my 78 year-old dad because at that age it’s no longer insurance; it’s an obligation.

  • Susan · October 29, 2009 at 9:02 am

    @Derek Scruggs

    Yes, but most people of working age are insured by their employers. Won’t a lot of companies dump their health plans once a INITIALLY less expensive public option becomes available? Realistically, what state is going to take the “opt-out” option?

    In Massachusetts it recently became law that an employer had to provide health insurance for his or her half-time employees as well as the full-time ones. The result was that a lot of employers fired their half-timers or made them go part-time (i.e., less than half-time).

  • Polichinello · October 29, 2009 at 5:39 pm

    The Pentagon is the single biggest discretionary line item and I’ll wager a whole lot of that money ends up in the hands of private contractors.

    Having seen that money spent, I can tell you it’s extremely inefficient and subject to all sorts of fraud. It makes your average health insurer look fit and trim by comparison. For example, look at the expense needed to fight a bunch of guys with roadside bombs.

    A lot of players want to be in the health insurance market, and they’ll find a way to compete.

    It’s almost impossible to compete against an entity that can draw on taxpayer funds to cover for its lack of economy. At best, private insurance could in the long run survive in niches, especially covering richer people seeking to escape government care.

    This is most obvious for people at retirement age. You don’t hear Aetna complaining that government prevents them from insuring my 78 year-old dad because at that age it’s no longer insurance; it’s an obligation.

    What exactly is this supposed to prove? Do you think they’ll cop the same attitude when the government begins to use its near-infinite subsidy power to undercut them for healthier customers? Mind you, we’ll still be financing Medicare.

  • Tomato Addict · October 30, 2009 at 4:43 am

    Susan wrote: “The remainder of people who think national health care is a good idea have no idea what the tax burden would be. …”

    Certainly we know what the burden is. Make no mistake, we are already paying for this burden through inefficiency and misuse. Use of ER’s for primary care, unnecessary tests and procedures, insurance bureaucracy, waste, and more. We are paying for these things *now*, AND a lot of people still aren’t getting the care they need. We also pay the hidden cost of lost productivity, which is rather harder to measure.
    We can have a public option, and the costs will shift, but we should not pretend these costs don’t exist already.

  • sg · October 30, 2009 at 8:20 am

    Sure would be interesting to know the total of all malpractice premiums paid by all providers.

  • sg · October 30, 2009 at 10:55 am

    It will be interesting to see how it shakes out. It may not be what it seems on the surface and liberal architects of the plans may be shaking their heads wondering why opponents can’t read between the lines for the implications that can’t be stated out loud because they aren’t politically correct. For example liberals wanted abortion legalized. The net effect is that there are at least 14 million fewer blacks than there would have been. A fact likely few social conservatives lament despite their revulsion at the actual abortion procedure itself. Now we know Congress and their friends will have none of the public option for themselves and their families, so private plans will continue. The poor will be forced into a less expensive (because it is substandard) public option with only the least competent doctors (and paraprofessionals) willing to accept the meager reimbursements. Perhaps the gov’t will later pass some malpractice relief for practitioners who are willing to accept the public plan. Maybe the media will even comply by ignoring the denial of more expensive services and limited screening schedules in the public plan. Maybe the media will comply by simply not noticing the poorer outcomes for patients in the public plan. That could help contain costs by minimizing public knowledge of the actual situation. Then more folks who are at the bottom of the social scale will sign on to the public plan blissfully ignorant of what they are getting themselves into.

    From a different angle, many states have trouble getting the people who qualify for Medicaid and SCHIP to actually sign up for it even though it is free. This is part of why they show up “uninsured” in ER’s. How will the gov’t get people to actually sign up? How will they collect fines from those who don’t sign up?

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