The public option dissonance in health reform

Health reform will do a lot of things that most Americans don’t realize it will do, and it will not do a lot of things that many Americans mistakenly believe it will do.

One of the most recognizable components of health reform that didn’t actually become law is the public option. The public option was the lighting rod in the health reform debate. After all, it had a concise name, and was easily talked about–by both proponents and opponents–whereas the other minutiae of reform are difficult for most people to understand. It was seemingly at the epicenter of the debate over government’s role in our lives and our health care system, despite the fact that it might, some would argue, be the best chance of preserving our private insurance system.

But for all the attention it received, and all the attention it diverted from other aspects of reform, it didn’t make it into law. The question is why not? How is it that a major piece of legislation–one that succeeded where others had failed for decades–was able to be passed, while a minor piece of that legislation received so much attention and had to be eliminated in the end? The easy answer is Joe Lieberman, but I don’t think that’s the full story. After all, the legislation wouldn’t have cost significantly more with the public option intact, and it would have covered more people and given all Americans more, rather than fewer, choices. Well, perhaps that last point is debatable. Some felt strongly that the public option would have an unfair advantage that would lead to the collapse of the private insurance system and the implementation of a single-payer system. Maybe so. Of course, that ought only to happen if the people chose the public option over private insurance consistently.

What I think the fate of the public option demonstrates is the sharp distinction between policy and politics. You see, as policy, the public option makes a good deal of sense. Granted, it has not been implemented nationally in the United States, and therefore we have no real empirical evidence to demonstrate that it works, but we do have a sound understanding of economic theory, incentives, and markets that go a long way in predicting the outcome(s) of a public option. The public option actually draws on many–but not all–conservative principles. So, on policy grounds, at least some Republicans should have supported it.

But, on the other hand, we have politics. In that game, the “enemy” that is the other party cannot be allowed a victory, because even if the results are beneficial for the nation and its people, when the other side wins, you lose. The trick then, becomes to use politics, but make it appear like policy is the focus–to blur the dividing line between the two. When the opponents of health reform latched onto the public option–a piece of policy–they did so for political reasons, and they didn’t discuss the merits of the policy, but framed it with negative politics.

Thus, the public option was “socialized medicine,” a “government takeover,” and a “threat to our private insurance system.” These labels may evoke a visceral response, but what they don’t do is articulate any specifics of the public option–what it would or wouldn’t do. It’s effective politics, masquerading as policy, and it works. In fact, it works so well that I firmly believe that you could take a cute puppy or newborn baby, call it “socialized medicine” and watch sizable groups of people shun it. It’s a label–and while it may go nowhere in describing the content to which it is applied, it matters tremendously in determining how people respond to it.

And so it was with the public option. There were the strong supporters of a single-payer system who saw the public option as a major policy compromise made to navigate the politics of reform, and the strong opponents who painted the public option as the death of American capitalism to engender hostility among their constituents.

But here’s what I really believe: If the Republicans had been the ones to propose health reform, they could have included the public option without violating their public policy positions–and they wouldn’t have had to put up a nonsensical, albeit quite effective, political fight on that issue, because the Democrats would have welcomed the approach.

Brad Wright is a health policy doctoral student who blogs at Wright on Health.

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  • F. Castle

    MAKES NO SENSE

    ” .. because the Democrats would have welcomed the approach ..”

    Really? The two political parties don’t always try to one-up each other? There’s not a zillion possible differences between proposals — contrary to T.R. Reid’s weird attempts to compare Japan (mono-racial) with the USA (multi-racial)?

    And single-payer workable? Try these on –

    1. Fannie Mae / Freddie Mac — just thrown under the bus by Bwarney Fwrank.

    http://online.wsj.com/article/SB10001424052748703649004575437574151872544.html?KEYWORDS=barney+frank

    2. SocSec — technically bankrupt.

    3. Medicaid/Medicare — technically bankrupt.

    Finally — health care deform has officially been declared a disaster by Democrats –

    http://www.politico.com/news/stories/0810/41271.html

    “Key White House allies are dramatically shifting their attempts to defend health care legislation, abandoning claims that it will reduce costs and the deficit and instead stressing a promise to “improve it.”

    • Alina

      Are there any links for these “technically bankrupt” claims of yours?

      • F. Castle

        Finally — health care deform has officially been declared a disaster by Democrats –

        http://www.politico.com/news/stories/0810/41271.html

        “Key White House allies are dramatically shifting their attempts to defend health care legislation, abandoning claims that it will reduce costs and the deficit and instead stressing a promise to “improve it.”

  • Alina

    Excellent post!

    They slapped the usual labels on so they can do the “peoples’ surveys” and tell us how the “majority” is against a public plan. Of course, the money, connections, and the whole shebang didn’t hurt either.

    Well, in the end, they got exactly what they wanted even though they cried all the way through the fiasco.

    The masses got cheated once again. The most important thing that needed to be addressed, exorbitant prices, was conveniently overlooked once again.

    The more things “change”, the more they stay the same.

    • http://www.twitter.com/alicearobertson Alice

      Alina wrote: The masses got cheated once again. The most important thing that needed to be addressed, exorbitant prices, was conveniently overlooked once again.The more things “change”, the more they stay the same. [end quote]

      Well…….I am glad I wasn’t dubbed by the “change” mantra of the current administration the liberals are responsible for. Imagine finding out you supported a false platform? Must be crushing on a personal level, because now we (the “masses”) all pay the price for that idealistic vision that isn’t panning out.

      But then again we did get “change” on a negative level.

      • Alina

        “Must be crushing on a personal level, because now we (the “masses”) all pay the price for that idealistic vision that isn’t panning out.”

        If you mean the insurance companies and the repubs did it to the people once again then I agree with you. Why are you upset? The “free” market won once again.

        It’s rather surprising to see that the right wing is all bent out of shape with Obama’s policies but you embraced the same policies during Bush’s presidency. After all, Obama is the best republican president anyway.

  • erik

    While I welcome your analysis in trying to explain the (seeming) chasm between politics and policy, I find your explanation unconvincing.

    The “politics” of the democrats and republcans (equally) are not merely a function of ideology, but also of the interest groups that back them. This is particularly the case in issues such as health care that would see a tremendous redistribution of wealth and a profound change of how firms compete.

    Thus, I don’t think your breaking down the issue among republicans and democrats is ultimately convincing. I don’t believe the republicans, under any circumstances, would have introduced a public option; and if they did, it certainly wouldn’t resemble a “real” public option.

  • David Allen

    I find it surprising that the author doesn’t actually explain what the public option is, since he regards it as so misunderstood.

    Private people paying for private doctors and using privately funded facilities would be consistent with capitalism. The closer one gets to government control and ownership of the apparatus required for this, the closer one gets to socialized medicine. Current we are in a mixed system with large elements of government control and payment (hospital and doctor regulation, large payments to hospitals and physicians in the form of Medicare and Medicaid, etc.) One big difference right now, is that the Federal government funds a lot of services, without actually providing them itself. Proposing that the government provide health insurance to more Americans (the public option) is simply another move in the socialist direction. While it is a matter of degree, the direction is unmistakable.

    So if the author is in favor of socialized medicine – then he should be honest about it. Embrace your label! The author fears these labels because they in fact identify the nature of what is happening, linking it to an entire history of socialist and communist failures throughout history. The author does not like these linkages, because he wants to believe this history had nothing to do with what is being proposed: “Granted, it has not been implemented nationally in the United States, and therefore we have no real empirical evidence to demonstrate that it works…”

    It the author believes that socialism ‘works’, then let him present the arguments on behalf of it. If the author believes that socialism in general doesn’t work, but medicine is a special case – then let him identify what makes it special and able to avoid the problems that socialism creates.

    I maintain that socialism doesn’t work in general, and in the particular case of socialized medicine.

  • Max

    The Democrats are the one who labelled this as reigning in the cost of medicine. Throw a public option in there, socialized medicine which the author clearly embraces, and the costs skyrocket. Tax and spend. Tax and spend. That’s all Democrats want to do. You think seniors (who vote through hurricanes and hailstorms while young socialist democrats sleep til noon) would vote for a public option? Not a chance. They worry, correctly, that they will be rationed and no doubt, they will. Hip replacement at age 85? Are you crazy, granny?

  • http://www.twitter.com/alicearobertson Alice

    I don’t know if Brad will answer, but his blog seems a bit more outspoken than this particular article. He reminds me so much of Twicker (who used to post here and at Huffington Post) that I wondered if it was him. I liked Twicker…even though we disagreed on many items.

    Anyhoo……….maybe Brad’s blog shows his own bias? Which is fine, because we are here to discuss opinions. I just want the truth and I enjoy watching people chisel away at the fantasies presented by often well-intentions idealists (again idealism is good, but a closed-mind is not):

    ***Some of you might be wondering, “Why the sudden criticisms of Fox News?” Well, frankly, because I’m just tired of people who engage me in “debate” about health reform doing little more than parroting the talking points fed to them by a biased “news” network. . **********

    • Max

      Agreed. Same applies to MSNBC and CNN and Huffington.

  • http://www.childup.com/ Phine

    Most americans saw the main problem with health care, the rapid rising of its costs and not the lack of insurance coverage for a few million individuals who still had access to publicly refunded health care. The reforms will definitely make it worse, and it’ll probably lower the quality of health care than improving it.