Friday, September 4, 2009

What's at Stake in the Health Care Debate

Let's cut through all the chaff, spin, and whatnot of what has been flying around about the proposed health care reform and get down to the brass tacks of why the public option is really the only sane option. There have been a lot of other choices offered up, the most popular in the Republican Party being that of co-ops and tax credits. There also have been a lot of outright lies, like the "death panel" whopper that's been kicked around. Let's just look at things from a simple, pragmatic perspective about why the public option really is the best and only option we have.

The main opposition to the public option when you cut out all the fat and spin comes from three main criticisms: that it would lead to something that private industry cannot compete with, that it costs too much, and it would lead to too much government control over our lives mislabeled as socialism.

The first one is probably the most self-serving argument out there.

Why is that?

Because the people advancing this line of thought the most are the insurance companies. The same insurance companies that by law are immune to anti-trust legislation leading to many insurance companies dominating the different markets in the US. In many cases there are insurance markets where 90% and up of all health care is provided by one insurer. These are the same insurance companies who, in the midst of a recession that is forcing everyone to make do with less and tighten our belts, continue to post massive profits.

Of course they resent the idea of competing with someone who will actually force them to provide good health care. Right now they have it MADE. If they actually had to compete then they wouldn't be raking in their obscene profits, their massive bonuses and stock option packages.

If the public option was put in place then, Gods forbid, they would actually have to WORK for a living!

It's not like the public option would force them out of business. Private postal companies like UPS and FedEx do just fine right up against the Post Office who is hitting hard times mostly because the bulk of their business is being made obsolete thanks to e-mail. Even in the United Kingdom where you have a government run healthcare system there are private insurance companies that are still in business and doing quite fine. There is no reason to believe that the insurance industry will up and disappear if the public option is put in place.

There is, to the contrary, EVERY reason to believe that if we inject a competitor into the market who doesn't have to worry about big corporate bonuses then the insurance companies, to stay in business, might actually have to cut the gristle they are shoveling up to the fat cats running the companies.

I guess it must be unreasonable of me to think that those poor, persecuted multimillionaires and billionaires can only make it on a couple million dollars a year of after-tax income.


The second argument, that it costs too much, sits in good company with the counter-proposals of co-ops and tax credits.

This argument misses the point completely. Right now health care costs too much because of the rising cost of insurance premiums entirely because of the monopolistic control that the insurance industry exercises over the market. Currently wages rise at a rate of 2% a year on average over the past decade while health insurance premiums have risen on average 10% a year.

That's five times what the average wage-earner makes in terms of increase. That is already costing us too much. If this trend continues unabated would it be possible for people to even afford health care anymore and still pay for other things like food, mortgages, rent, and transportation to get to their jobs that they would be spending long hours at just to fork over most of their money to the insurance industry? As things stand now we can't afford health care as is.

But what about tax credits? Couldn't giving people their money back from the government address that problem?

Tax credits would create more problems than they solve. For one, to be able to actually address the problem, they would have to be indexed with the inflation of health care costs. If they aren't then very quickly they will go from barely enough to a band-aid over a bullet wound.

If they are indexed in a way to be useful then not only are we cutting out money from the federal budget, which would lead to a corresponding rise in the deficit at a rate that would very quickly wreck the federal budget. At that point it would be cheaper for the federal government just to pay the insurance companies directly.

But wouldn't co-ops fix the problem without leading to unnecessary government intrusion?

Newsflash: one of the worst offenders in the industry, Blue Cross Blue Shield, is a co-op network.

That and co-ops, unlike a public option, once on their own would be stuck trying to cut out a niche in markets so heavily dominated often by one or two providers that they would be quickly shoved off-stage by the insurance companies to keep control of the market. It would be a very short-lived, costly, and ultimately doomed effort.


To the last argument I only have this to say:

Why are you so afraid of the government who we elect and we as the public can hire and fire representatives who shape policies and how said public option is run who would have to operate under full accountability and transparency to the public running your health care as opposed to private corporations who have no incentive to be level with the people?

Why are you afraid of a government that ultimately you have the final say on covering your health care costs when as things stand right now the people who have the say on your health care in the insurance industry make money by denying you care that you need?


The health care reform bill addresses many of the worst actions of the insurance industry. The problem is without the public option it will be worse than useless for America. Without a public option to force the insurance industry who has proven time and time again not to be trusted to play honest and by the rules any reform effort is nothing more than smoke and mirrors.

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