On Wednesday the Women in Public Policy group of Pepperdine hosted a debate on health care. The question posed to each side was essentially is government-sponsored health care necessary in America? The two sides argued for the affirmative or the negative. I argued for the negative side.
I’m against the public option for a few reasons, but I think the most reasonable one is that there are much better ways to accomplish the same goals, namely the Wyden-Bennett bill (my thoughts are here at NewMajority.com and an op-ed by Wyden and Bennett is here). It imposes universal coverage, replaces the tax-free treatment of health care benefits with tax credits to individuals, and to my knowledge is the only health care bill that is both revenue neutral and bends the cost curve backward. The latter part isn’t an unfounded or partisan claim – the CBO scored it. When you put up the public option against the Wyden-Bennett bill, the choice is clear. I don’t think that is campaign rhetoric; I’m still waiting for *anyone* to offer any evidence to the contrary.
Anyway, Ezra Klein and Megan McArdle offer better critiques of the public option than I can muster.
From Megan McArdle:
At this point, I’d say that conservative and liberal health care analysts both know the score. Everyone knows that this bill won’t work as advertised: it will not cover as many people as promised, and it will run into budget shortfalls, if for no other reason than because Congress is not going to enact the cuts as written–they will get lobbied into repealing many of them.
Liberals don’t care, because they think it’s worth it to cover more people. Conservatives care, but their kabuki complaints about what everyone in the wonkosphere knows go mostly unheeded.
I think Megan is right: even if you are for the public option, you don’t have much reason to believe optimistic estimates of its costs or results.
Ezra Klein gets into the effect that moving uninsured people into insurance will have on the public option’s premiums:
But because the public option is, well, public, it won’t want to do the unpopular things that insurers do to save money, like manage care or aggressively review treatments. It also, presumably, won’t try to drive out the sick or the unhealthy. That means the public option will spend more, and could, over time, develop a reputation as a good home for bad health risks, which would mean its average premium will increase because its average member will cost more. The public option will be a good deal for these relatively sick people, but the presence of sick people will make it look like a bad deal to everyone else, which could in turn make it a bad deal for everyone else.
This also illuminates one of the more problematic inconsistencies in the health-care debate. Insurers have been blamed for, among other things, doing too much to discriminate against bad health-care risks and refusing to pay for care far too often. They’ve been blamed, in other words, for saying “no.” But they’ve also been blamed for doing too little to control costs.
But that is how they control costs. We saw this in the late-’90s, when tightly managed care brought cost growth down to the 4 percent range but also triggered a public backlash (it did not, however, appear to hurt health outcomes). Insofar as the public option has been presented as a big part of the answer to our health-care woes, it’s been in part because it won’t do the things that make insurers unpopular (the saying “no”), and in part because it will control costs. But the only way to make both those things true at once is to give the public option pricing power along the lines of Medicare, which it doesn’t have in either the House or Senate bills.
I think it is realistic to say that the public option won’t do a good job of controlling costs, based on political pressures and historical examples of government run insurance plans.
Somebody argue with me!