Public Option

Andrew Sullivan opines that:

It seems to me that a public option which allows the government to use its huge buying power to achieve cost cuts that no private company could manage would be a Trojan horse. But a government option forbidden to use such leverage, but allowed to have an edge from administrative and overhead savings, is a useful compromise. It's one more incentive for cost control.

This strikes me as completely nonsensical. After all, we have the brilliant Medicare prescription drug program engineered by the Bush administration along the lines that Sullivan approves -- that is, the government does not have the ability to negotiate prices -- which has done nothing but shovel money into the pockets of drug manufacturers. Neither I nor anyone else has seen any cost control under that kind of plan.

Given, for example, that we spend 300-400% more for prescription drugs than anyone else in the world, I think Sullivan’s “Trojan horse” may be just what we need. Those kinds of inflated prices are not singular, by the way - we pay more than anyone else for health care, and get less than most. Yes, we have “the best health care in the world,” if you’re rich and/or you participate in one of the socialized-medicine programs we have here - for example, the plan that congressmen and senators enjoy. For the rest of us, it’s not so great.

One of Sullivan’s readers nailed him on his through-the-looking-glass thinking:

You call the public option a "Trojan horse." I take it that you do not mean that allowing a public plan in which the government could generate savings by using its collective buying power will not, in fact, result in lots of Greeks with swords jumping out and killing us in our sleep. I am at a loss, however, as to what exactly you imagine the danger to be -- your sentence follows with no explanation. This is one of those things that I just do not understand at all when public option opponents gesture in this direction: what is the perceived worst case scenario here and why do you find it objectionable?

Let's say that such a government public plan would prove so effective at negotiating low rates that it would price private plans out of the majority of the health care insurance market. Is this a problem in some way? Anyone who had enough money could assuredly buy whatever high-end services or plans they would wish--you can't seriously believe that such a government plan would result in the absolute legal preclusion of private payment for medical insurance or services, can you? Or is this just a generalized fear that people will overwhelmingly prefer the public option, and the portion of our collective income going to the government in taxes (rather than private insurance policies) will increase? Really wondering what your fear is.

Let me note that Sullivan did not have an answer.

This idea that there is something inherently evil about "socialized medicine" is so much garbage, frankly. What it stands for is the right/libertarian idea that government is bad and that government-run anything is wasteful and inefficient -- which, amazingly enough, it turns out to be under Republican administrations. What strikes me as the inherent evil in the position Sullivan is taking is the idea that the wellbeing of citizens should be contingent on their ability to pay. (Which is probably fine for the Sullivan/McArdle wing of the privileged libertarian establishment, but for the rest of us, isn't so great.)

As for the state of care as it is, John Cole has an observation that strikes me as apt:

The simple refusal to admit that we already ration care in the United States is maddening. We ration all the time- poor people don’t get it, or if they do, it is in the most costly and inefficient way possible.

This seems to be what the right wing wants to preserve.