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Health reform: Public option vs. political reality

Post by Patrick O'Callahan on Aug. 17, 2009 at 8:41 pm |
August 17, 2009 8:41 pm

This editorial will appear in tomorrow’s print edition.


When the admiral starts pulling out the white flag, it’s a safe bet the battle’s nearing an end.


President Obama now appears close to conceding the battle over a government-run "public option" for health insurance.


Liberals have argued vehemently that a public option must be a part of any legislation deserving to be called health reform. Yet Obama all but dismissed it Saturday as "just one sliver" of his proposed reforms.


The president can count votes. It increasingly looks as if a new Medicare-like plan just can’t clear the Senate, though a potential substitute – nonprofit health care co-operatives – might have a chance.


Political realities, in the Senate and beyond it, argue for pursuing the co-op alternative.


A public option could work in this country. For that matter, a government-financed single-payer model could work here. Could.



The reality is that the United States does not have the same political culture as Canada, Spain and other countries where similar models are not controversial. America was born of an anti-government revolt. Many Americans remain suspicious of any stepped-up federal role in their lives.


In this month’s town hall-style meetings on health care, accusations of "government takeover" have proven a devastating line of attack on the public option. Some of the backlash in those meetings has been stage-managed. But much has been genuine.


Citing Medicare as a successful example of public insurance is not persuasive. Medicare is indeed efficient. But efficiency isn’t a monumental achievement when the chief thing you do is hand out checks. For more than 40 years, Medicare has helped drive the hyperinflation that has priced many Americans out of any health insurance whatsoever. It’s also fast going broke.


And look at the rage in those town halls about Obama’s proposals to rein in the costs of Medicare. Bringing Medicare spending under control will require some restraints – however sensible – on treatment. The French and the Canadians don’t go berserk at the fact that their treatment options are constrained by public budgets.


The gripe against private insurers is that they devote much of their overhead to preventing people from getting care. That model hasn’t been a smashing success, either – hence the logic of expanding access to insurance and giving Americans a low-overhead, not-for-profit alternative.


But as Obama is starting to acknowledge, no law of economics decrees that the alternative must be an arm of government. The large nonprofit co-operatives advocated by Sen. Kent Conrad, a North Dakota Democrat, may prove to be a functional equivalent that doesn’t raise the specter of a federal "takeover."


In any case, the co-op model appears to be the only option left in the Senate at this point. That’s an excellent reason for giving it a respectful hearing.

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