By Rep. Anthony Weiner
July 23, 2009, Washington, DC
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Published by Politico.
It seems that big legislation isn’t complete until it develops a collection of catchphrases. (“Shovel ready,” everyone? “Cash for clunkers,” perhaps?) The effort to tackle the long list of failings of our health care system and the way we pay for it has been no exception. This time, we are arguing over the so-called public option.
The phrase has become something of a Rorschach test for lobbyists, commentators and legislators. To the president and to bill writers in Congress, the public option has come to mean that a government-run plan is the only way to truly keep private insurance companies honest, by guaranteeing that at least one provider is focused on something more than the bottom line.
To insurance company lobbyists and—from the sound of it—nearly every Republican, the public option is more a confirmation of their fear that the Obama administration is out to nationalize another industry. They argue that the public option would soon become the only option because it would have too many advantages in the marketplace.
Without acknowledging it, both sides seem to agree with the argument for a single-payer system. But instead of having a debate about its value, both sides have turned the idea into an odd punching bag. The right uses the term “single-payer” to condemn the White House approach, while the White House—and my colleagues in the House and Senate—quickly decry the scurrilous charge and concoct legislative language to make their public option look less, well, public.
By conceding that the public option would have less overhead, be more efficient and have the freedom to focus on health care rather than profits, opponents of the public option are in fact arguing for it. Isn’t complaining about the marketplace “advantage” of the public plan just another way of saying that people are going to want it?
The public option would prompt Americans to ask a basic question of the insurance company that is chasing their business: “What is it that you guys do, exactly?”
Insurance companies don’t really do anything to make people healthier. They need to be efficient gatekeepers on behalf of their shareholders. Profits at 10 of the country’s largest health insurance companies rose 428 percent from 2000 to 2007. So if you think that the private “option” won’t be selected by citizens, it stands to reason that they want a public one.
Democrats who have been tasked with drafting the health care bill have been going to great lengths to assure everyone that it will not be a single-payer system. This is more a testament to a branding problem than a policy one. (Remember: It wasn’t a “bailout”; it was a “recovery.”)
But the arguments for a public option do leave you wondering why you would need or want a private insurance plan. We know that insurance companies rely on a formula to provide as little health care as possible for each dollar they take in. This isn’t because they are uncaring. It is because they are good business people.
With taxpayers, consumers and workers paying an enormous amount more than necessary because of this model, it seems odd that we would be so concerned about protecting it.
What would a public-only or a single-payer system look like? It would look like Medicare for everyone. We are all aware of the problems facing Medicare: looming deficits; incentivizing expensive institutional care rather than alternatives; squeezing doctors; etc.
But these are not a reflection of a failure of the single-payer system. They are failures to make smart decisions about what we pay for and how. There is no doubt that we must fix our present single-payer system, but none of its problems change the fact that Medicare is a popular, well-understood, amazingly efficient form of—wait for it—socialized medicine.
The dean of the House of Representatives, John Dingell, had it right when he introduced the notion of Medicare for all in 2006. We can correct the many gaps in today’s Medicare, not by buying stock in an insurance company or by staying on hold for a “benefits specialist” or by complaining to a state insurance commissioner. We do it by passing a law or a regulation that reflects the best interests of the nation.
Implicit in the Democratic plan—and the Republican opposition to it—is a tacit recognition that single-payer health plans like Medicare are the best way to go. I want to engage in this debate and will offer a single-payer plan to a vote as my colleagues and I mark up the health care bill. Maybe this issue is important enough that we can do the right thing even without a great catchphrase.
Rep. Anthony Weiner (D-N.Y.) is a member of the Energy and Commerce Committee’s Subcommittee on Health.
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