Brown students agree that there is a problem in the current U.S. health-care system: It isn't meeting its tremendous potential to deliver quality, affordable and timely treatment. In response, Congress is likely to adopt one of the following methods: institute the public option, or change the arena in which health insurance companies operate.
Jonathan Cohn, an editor of the New Republic, came to Brown on Tuesday to deliver a lecture on health-care reform. He phrased his argument for the public option in a form that was particularly compelling to Brown students: Cohn implicitly placed the issue of health-care reform within the broader context of a slow but inevitable march towards a more enlightened society in which the government not only protects a few fundamental rights, but guarantees a basic array of goods and services.
This is a good story, a stirring story and the only story public option supporters relate when they advocate their plan. Arguing for deregulation is less exciting. It requires tracking down and explaining several less dramatic, seemingly unrelated stories.
The average person can retain seven dull, unrelated pieces of information (hence seven-digit phone numbers). Here are seven dull, unrelated reasons why supporting the public option isn't a question of good vs. evil, but rather the much less titillating question of effective vs. ineffective.
1. There is no health-care crisis. In the last ten years, there's only been a 0.3 percent increase in the number of uninsured individuals, according to the 2007 Census Bureau. Three-quarters of the uninsured regain coverage within a year — since tax laws make it cheaper to buy insurance through your work, if you change jobs, you lose insurance in the interim. The poorest 14 million of the uninsured already qualify for public coverage but haven't enrolled. Why not? The law allows them to enroll after they become sick at the same rate as before they become sick.
2. The public option wouldn't "keep private insurers honest" by setting a price benchmark. Medicare and Medicaid are often cited as successful examples of public plans competing with private, but these programs do not save money — they just shift costs onto other consumers. For example, Congress sets the Medicare compensation for a $50 procedure to $30, so doctors simply jack up the price of the procedure paid by private insurers to $70. The public option would not make the private insurers honest; it would make them bankrupt.
3. High prices are another casualty of the unpopular drug war. Put just a few prescription drugs in front of the counter, or at least let nurses prescribe them, and watch prices plummet as people skip the costly doctor's appointment and buy drugs directly.
4. We can change the system by rendering tax-free every dollar spent on or saved for health-care purposes. When individuals start shopping around and making decisions to purchase health insurance policies, two things happen: Consumers become more proactive about staying healthy, and insurance companies are forced to offer better, more customized products.
5. We can smooth out insurance regulations in order to lower prices. Each state has different rules regarding what insurance plans can be sold in the state, which makes it very difficult for an insurance company to expand across state borders and restricts the field of competing insurers.
6. Repealing mandated benefit laws would lower prices. Allow people to purchase plans covering unexpected, catastrophic illnesses like cancer without forcing them to buy unneeded and expensive add-ons like chiropractic coverage.
7. There is a simpler way to ensure that those in dire need of health care are provided for. People need food more than they need health care, yet there is no public option for food, and starvation is virtually unheard of in the United States. We have a food stamp program and private charities that act as a safety net. Why not do the same for health insurance?
Public option supporters have done a great job of framing the test questions in a manner that appeals to one's sense of decency. "Isn't health care a fundamental right? Is it ethical for insurance companies to profit off of those that are undeservedly ill? Why is it wrong to keep the private insurance companies ‘honest' with a public option?" Translation: Have a heart, support the public option.
Every time somebody offers these questions, instead ask him or her to examine health-care reform through the lens of three distinct, open-ended questions. What is the problem? What is the end goal? How do we best reach that end goal while minimizing extrinsic costs?
The government-run public option has the advantage of appealing to your heart, yet it carries the unfortunate burden of not working. It is the role of the heart to identify a problem. Let us not forget it is the role of the mind to solve it.
Will Wray '10 is in the market for a heart.