General Interest Review 00009

The Public Option

The public option (or 'so-called public option' in New York Timespeak) is a provision being kicked around by Congresspeople in the midst of the current debate over health care reform that would create a government-mandated health insurance entity. The idea is to introduce another stakeholder into the health insurance market that will offer competitive rates, and can provide health insurance for people that don't have it under the current system. Implicit in the new entity's creation is that the government would also require people to have health insurance, or they would pay a penalty. This option, however, would still not guarantee that everyone could get coverage when they need it. The only way to do this would be to set up a single payer system, in which private insurance is done away with and everyone receives access to health care provided by the government.

That option -- more public than the so-called public option -- has scarcely been mentioned throughout the debate, except as an example of an idea that shows how far to the center Democrats have come.

During the debate so far, Republicans have withdrawn their support completely from any bill that includes a public option. The Senate Democrats as a whole previously did not support a public option, but Senate Majority Leader Harry Reid turned on the more conservative wing of his party and said this week that a public option would be included in final legislation.

Understanding why this provision -- which would improve the health care system dramatically while basically keeping the current framework intact (and, again, is not all that radical, or anything close to what the best-functioning health care systems in the world offer) -- is not supported resoundingly requires an understanding of what many term 'the ways of Washington.' That is to say, practical ideas that can be defended with logic are immaterial. The idea that a health care system should work does not have political support, even though a vast majority of the country indicates their desire for change. What is so often not stated among countless hours of videotape spent debating health care is that the health insurance industry is not considered in this sample of the country. The industry is an amorphous force in this case, wholly dependent to pass legislation but never mentioned in debate. Much like the will of the country.

And the economy in general. Key to the provision's detractors are the arguments that the public option would drive the insurance industry toward the brink. But Blue Cross/Blue Shield is not a mom and pop shop. It is a multibillion dollar corporation with a huge impetus to keep things as they are. What these opponents rail against is competition in an industry that profits from untold sums of waste every year. But it is essential, we are told, that this industry survives, because it is a linchpin of the economy. In this alternate universe dictated by the ways of Washington, the people serve the interests of businesses instead of the businesses serving people. What the detractors are generally for -- a robust marketplace that leads to general well-being -- is not a part of the debate. The industry does not support change, so there cannot be change.

In this debate, the industry -- through interest groups and the pharmaceutical industry -- have said they are working for change. But the deals cut by the Obama administration have not led to support from any Republicans. Even Senator Olympia Snowe, who claimed she was strongly considering supporting the bill, withdrew once the public option was introduced. It is a sure sign that support can be twisted a number of ways, and that the subtle difference between "not oppose" and "support" is glaring here.

When the bill is passed, health costs are still likely to be out of control. And, still, Europe's system will be better. So, perhaps, the industry will get what it wants anyway. Looking back in a legacy interview at the end of his presidency, Barack Obama will likely chalk one more up to the ways of Washington -- the result scarcely conceived by the well-intentioned, the idea made to look foolish for an attempt to meddle in an effectively propagated illusion -- that government, on the most basic level of the need for medical care to stay alive and participate in society -- serves the people it purports to sustain.