Like initiating CPR on a patient who was dead in the field and remained dead on arrival, the effort to resuscitate the “public option” is mistaken and futile.
Once upon a time, proponents of the “public plan option” sought a “Medicare-like” program that might enroll every other person in the nation and thus run private insurers out of business.
“A roadblock to reform” cried the insurance companies. In turn, nothing in the bills passed by the House and the Senate would erect a public insurer that could possibly influence the insurance market.
The House bill included a feeble government plan, to start in 2013, that would enroll perhaps 2 percent of the nation by 2019. The Senate bill simply nixed the idea altogether. Now the President, in his latest proposal, has also abandoned the "public option."
In reality the “public option” was never much more than a K-street phrase, a shadow-puppet, a political posture. All along proponents of adding a new government-sponsored insurer boasted “talking points” but never offered workable health reform.
But the insurance companies oppose the “public option” and that proves its virtue, its supporters exclaim.
Hello? Of course the insurers oppose it.
Why would the insurers want to yield even 2 percent of the market to a public plan (House bill) when they’ve been given the “option” (Senate bill) of keeping 100 percent of the market? Why would the insurance companies not fight for the whole pie when the White House let slip that it saw the “public option” as simply a bargaining chip in private dealmaking?
But there is something else here.
With its reliance on the magic of the marketplace, the “public option” is simply not a proposal for reform. In fact, it has already been tried, and failed: in Maine, a “public option” insurer known as DirigoChoice, was established in 2003. It has failed to enroll but a tiny percent of the uninsured, did nothing to reduce the costs of insurance or health care, nor did it reduced overall health spending, nor did disparities in care improve – and in the last year DirigoChoice has fatally tanked.
In the United States a corporate oligopoly of huge insurers, with near-monopoly control in most locales, dominate the market. A government insurer of any size would simply add yet another bureaucracy to the present byzantine insurance mess.
Does it really make any sense to think that a government plan could give the private insurance companies a run for their money – within the contemporary corporate marketplace – without draconian regulation upon the industry? Even with regulation, as former Cigna executive Wendell Potter explained at the PNHP annual meeting this year, insurance companies simply “flaunt regulations.”
The insurance market cannot be tricked into reforming itself. The health insurance company that wins at the marketplace avoids and jettisons sick and poor patients and enrolls the healthy and the wealthy – and a “public option” will not change this fact. The market that serves the private interests – profiteering at the expense of the sick – would continue to do so.
The proper name for this kind of “market magic” is the race to the bottom. Adding a public plan into the private mix can not and will not change the character of this cruel game.
Any successful “public option” insurance plan would wind up covering the sick and the poor. It would be designed to lose, not win, the market competition. It would not prove affordable or comprehensive. Worst of all, a highly successful “public plan option” could put our nation on a fast-track to permanent two-tiered health services, exacerbating deplorable disparities that plague us.
Regrettably, that the “public option” has been given attention at all is but a measure of how deeply our culture has surrendered to neoliberal ideology, the ideas popularized by Ronald Reagan. It is a lie that the market will always provide, most especially when it comes to health care. So why would some of our friends still seek to revive the false promise of the “public option”?
Marie Gottschalk, University of Pennsylvania Professor of Political Science, identified the psychology at work. In a remarkably prescient essay written in late 2009, she compared health reformers in the United States to victims of the Stockholm Syndrome, in which hostages identify with – and even defend – the hostage-takers.
We ought to reach out with sympathy to our friends who have fallen captive to Ronald Reagan ideology and say: Do not resuscitate the “public option.” It is time to let it go.
All along, adding a feeble public insurance plan to the insurance market has been but a very poor excuse to support “insurance reform” that will criminalize the uninsured, divert billions of tax dollars to subsidize unaffordable private insurance premiums and protect pharmaceutical industry super-profits.
Another world is still possible. It is called Medicare-for-all, expanded and improved.
Andrew D. Coates, MD is a leader of Physicians for a National Health Program and the grassroots coalition Single Payer New York. (An earlier version of this essay appeared at The Progressive Media Project in December.)
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