White Coat Underground

Public option off the table?

I had a chance to watch the President take questions at town hall meetings this weekend. He sought out opposing views, and handled them brilliantly, responding to them rather than giving empty answers. He also didn’t talk down to the audience. The pity is that the take home message in the news today is that he may abandon his push for a “public option”. This would be a grave mistake.

This President is no dummy. He gets this issue. When a citizen asked how private insurers can possibly compete with a government plan, he responded in great detail, explaining how changes need to be phased in, how a public plan cannot simply have the backing of the Fed but must borrow on equal terms with private insurers, how we cannot expect the privates to include pre-existing conditions without increasing their rolls of healthy patients—this guy has thought things through.

I’m not saying there are no disadvantages or potential problems with health care reform. There’s lots that can go wrong. But we’ve already sacrificed our best possible option, single payer health care. Our military families and seniors can take advantage of this, but the rest of us are out of luck. What the hell scares people so much about “public options” and single payer systems?

The horror stories from other countries have been debunked—there are well-recognized problems with single payer systems that are not insurmountable, and are probably preferable to our current set of problems. The argument that “government just fucks up everything it touches” rings rather hollow to anyone who has Medicare.

I’d like to know what—specifically—people fear about a public option or about a single payer system. So far all I’ve heard is rhetoric, canards, and content-free talking points. So what’s the deal? What do we have to fear that no one else in the world seems to fear? What is unique about America that having a single payer system would be the end of our way of life?


  1. #1 Bob O'H
    August 17, 2009

    I thought it was obvious. If you have a single payer system, the only person rich enough to be the single payer is Bill Gates. Hence, we would all be forced to use Windows, Word and Explorer, just to support the sick of the US.

    If you support socialised medicine, you support Micro$oft. And the only things coming out of Seattle now are Microsoft and the Discovery Institute, so you’re obviously supporting IDcreationism as well. It’ll be the End Times before you know it.

  2. #2 Phillip IV
    August 17, 2009

    I’d like to know what—specifically—people fear about a public option or about a single payer system. So far all I’ve heard is rhetoric, canards, and content-free talking points.

    And doesn’t that remind you of something? Let’s face it – anti-vaccinationism and the Republican Party survive on the same principle: that their message is emotionally more satisfying than reality. Hey, where else can you feel like a noble patriot, on par with the founding fathers, just for wanting to keep more of your money? Where else can you feel that everyone who is less fortunate than you deserves it for not being responsible enough – so that you can nobly aid them by not helping them any? Reality just can’t compare to that.

  3. #3 JohnV
    August 17, 2009

    I don’t get it. What’s the point if there’s no public option? Driving more business to private insurance companies?

    Insurance companies exist so that they (the companies) can take in as much money as possible while expending the least amount of money as possible (anesthesia and bone grafts aren’t medical procedures if your jaw is involved, huzzah). How is that going to be reformed away? 😛

  4. #4 outwest
    August 17, 2009

    I don’t know. Really, after all the rhetoric from both sides of the issue, I just can’t say one way or the other if having a single payer system would be better or not.
    I have some friends in England that tell me that anyone there that can afford it, also has private insurance as well as NHS. These people are not “rich”, but middle class and they pay the extra premium so that they can bypass NHS when they need to do so.

    Is this what we would have to do as well?

    I work with a lot of veterans. They have something called “TriCare”. Yes, a single payer system. Most don’t like it and many have insurance as well through the private sector.
    I really think that my biggest concern in all of this is: who’s going to be seeing all of these patients? If we add 47 million more to the rolls by a single payer system, are there enough doctors out there?

  5. #5 D. C. Sessions
    August 17, 2009

    What the hell scares people so much about “public options” and single payer systems?

    Simple: that “public option” will be so horrid that nobody will want it, causing all of the private insurers to go out of business. Without private insurers, nobody will be able to get health care at all and Granny will die.

  6. #6 Jared
    August 17, 2009

    Empty rhetoric is what many politicians do; calling something “socialist” or “capitalist” or “liberal” or “neoconservative” without addressing the actual problems with it. Giving something a label is useless if you don’t explain how or why that is a bad thing and how it specifically applies to the situation.

    We have many problems in this country ranging from public education and public health to the economy and financial system. All of these need reform in some way. I’m not concerned with rectally derived statistics thrown about by politicians, I’m concerned about the problems, let’s fix those problems and see what problems the solution brings.

    My former flight instructor had a saying “if you have a major problem, do something to fix it, that may give you another problem, but you can keep battling problems all day, when you try to figure out the best solution, inaction may cost you dearly.” Our country is delving into inaction.

  7. #7 Will TS
    August 17, 2009

    If everybody gets health insurance, how will rich people know that they are better than poor people? If poor people live as long as rich people and have babies that are just as likely to survive as rich babies, that’s one less thing that rich people can use to feel superior. And if just anybody can go to the doctor, where will rich people be able to park at the medical center?

    I have actually heard each of these arguments. Mostly from poor people on Medicare that now feel superior to younger poor people.

  8. #8 BaldApe
    August 17, 2009

    this guy has thought things through.

    Well then the plan is doomed.

    What the hell scares people so much about “public options” and single payer systems?

    Well isn’t it obvious? I mean really, it’s the same thing as TEH GAY and Socialism and letting the government run Medicare and the Death Squads and the “we came from monkeys” and…

    IOW, nothing that makes any sense.

    How do you scare a moron?
    Put Sarah Palin on TV.

    How do you scare somebody with some sense?
    Take Sarah Palin seriously.

  9. #9 Chris
    August 17, 2009

    Bob O’H:

    And the only things coming out of Seattle now are Microsoft and the Discovery Institute, so you’re obviously supporting IDcreationism as well.

    Actually Microsoft is in Redmond, not Seattle. I assume you don’t fly anywhere, because Boeing still designs and assembles airplanes in the Puget Sound Area (the test center is still in Seattle). Does anyone remember what main issue caused a strike of Boeing engineers?

  10. #10 gg
    August 17, 2009

    I just got into an argument on Facebook with a long-time right-wing “friend” who was raving on about single-payer turning the country into the VA. When I pointed out that nobody is currently looking to nationalize hospitals (and that the VA, despite past troubles, is working reasonably well right now, as I understand it), and that the more apt model is medicare or European plans, he wrote, “I don’t care about Europe. This is America.”

    I didn’t have the heart to ask whether: (a) He believes that Americans are singularly too stupid to make a working health-care system, or (b) he believes that Americans are singularly too corrupt to make a working health-care system. I’m not sure what other options there are. USA! USA!

  11. #11 Donna B.
    August 17, 2009

    A huge part of the problem is the confusion generated by naming (or framing). In the first place, is health care reform the same as insurance reform?

    When Obama talks about doctors practicing medicine in a way optimized to make money, ie, amputation instead of treating diabetes, isn’t he confusing things even more?

    Shouldn’t we be having two conversations? One about how to pay for health care and another about how to lower the cost of it?

  12. #12 PalMD
    August 17, 2009

    It’s all the same question. Costs and how to pay for them are inseparable

  13. #13 Nigel
    August 17, 2009

    Where is the mystery here? All the so-called waste in the current system does not go nowhere. Ultimately it goes into someone’s pockets, primarily those of insurance companies (also pharmaceutical companies, for-profit hospitals, etc.). These large, powerful and very wealthy institutions stand to lose enormously if there is any sort of serious healthcare reform, and consequently they will do anything they can to stop it. They know, as well any other informed person does, that a single-payer system, or a government option (or, to a lesser degree, many other sorts of reform) would be of enormous benefit to the American people. They thus have no honest argument against reform as a public good, and must instead devote their resources to the corruption of the political process, and the spreading of misinformation and confusion among the public. Unsurprisingly, since they have enormous wealth and power, and they (insurance companies, etc.) are fighting for their very lives, they are doing a pretty good job of it.

  14. #14 Nigel
    August 17, 2009

    I think Donna is right. There are a lot of potential saving to be made at the level of insurance reform, even if the actual practice of medicine does not change at all. A universal, single-payer* system could vastly reduce the current levels of bureaucratic expense. There would be no need for all the duplication of bureaucracies between different companies, no need for all the paperwork involved in checking what each patient’s coverage actually is, and a greatly reduced need for dealing with disputes about coverage. When I was a National Health patient in Britain, I did not have to fill out a huge pile of forms every time I went to a new doctor, as I do in America (and, of course, no-one had to be employed to process all that paperwork), neither was I regularly involved in lengthy disputes about improperly denied coverage, which, in my experience, frequently happens in America, even to the well insured. And again, the point is that such disputes do not just waste the patient’s time, but also create the need for more bureaucracy. (This is not, of course, to say that treatments are never denied under single payer systems like the NHS. Of course they are. But the process, when you have a single bureaucracy and a single standard of care, is much more standardized and consistent, and thus much less likely to lead to errors and disputes.)

    Now, with a more rational and standardized insurance system, it should also become a lot easier to deal with waste at the level of care delivery: unnecessary testing or procedures, negotiation of drug prices, more emphasis on preventive medicine, inefficiencies in hospital organization, or what have you. I do not claim to have much insight into what can most usefully be done at this level, but I don’t doubt there is a lot of room for improvements that can benefit both patients and the bottom line (and probably doctors too, in many cases). But as Donna says, this is a separate issue, a secondary advantage of insurance reform, and the politicians who talk about this sort of thing when they are really concerned, at the moment, to further the reform of insurance, do risk confusing their message, and thus playing into the hands of the anti-reformers, who are relying upon generating as much confusion as they can.

    *[I believe the anti-reformers are right to think that a government option is a Trojan horse for single-payer. Unless it were made artificially uncompetitive, it would be very well placed to out-compete private insurers – probably in both price and coverage – and ultimately drive them out of business (or reduce them to a niche market as a high-end luxury for the wealthy, as private medical insurance in Britain is).]

  15. #15 Dacks
    August 17, 2009

    Does anyone else feel like weeping these days? Yes, there probably will be a health care bill by the end of the year, but it is likely to be so “compromised” (in the sense of having a compromised immune system) that it will do nothing to solve the current problems. In the book “Collapse” Jared Diamond documents how various societies cope with adversity: some take measures to adapt, some continue business-as-usual. Guess which ones have a better chance of surviving!

  16. #16 Donna B.
    August 17, 2009

    PalMD, I’m not sure costs and how to pay for them are inseparable. Politically, perhaps. But I’d like to see more than a political solution.

    Even with a public option, we’re going to be faced with the same sort of regional differences that the various TriCare regions have. We’re still going to hire the same people (ie, the insurance companies) to process the claims. The insurance companies really stand to lose little either way this goes. They will almost be guaranteed a profit.

  17. #17 SimonG
    August 17, 2009

    outwest: If they mean it literally, then your friends are ill-informed. There are a great many people who could afford private health care in the UK but choose not to take it. (I was one of them until recently.)

    The various private schemes are not independent of the NHS. They use a lot of the same resources, (personnel and physical). For the most part, all they offer is a way to jump the queue and a nicer room when you get there.

  18. #18 10,000li
    August 17, 2009

    “It’s all the same question. Costs and how to pay for them are inseparable.”

    Spoken by someone who obviously has never run his own competitive business.

    It’s interesting that you asked for people’s opinion on why they would be scared and got a dozen responses saying why anyone who would even question the idea must be some kind of evil right-wing hater of the poor.

    Out of all the responses, Nigel’s was the most well-reasoned.

    If we do get an NHS-style system, eventually, any person who can afford to pay to jump the queue would be insane not to do so.

    I don’t think there’s anything wrong with both. It’s certainly in my best interest to have the middle class pay for medical care for the poor while I use my money to buy better coverage for me and my family. Is there anyone who believes it could really work out differently? That we rich are going to pay for care for anyone else? What planet do you live on?

  19. #19 MikeB
    August 18, 2009

    10,000li – ‘If we do get an NHS-style system, eventually, any person who can afford to pay to jump the queue would be insane not to do so’.
    And yet we largely don’t. Its true that there are people who do start with a private appointment, and then go NHS after that, but since treatment for conditions like cancer move pretty fast anyway http://www.performance.doh.gov.uk/cancerwaits/index.htm , its probably not really worth the hassle.

    The reality in the UK is that only about 8% of healthcare is ‘private’, and as SimonG points out, most private treatment actually takes place in NHS hospitals anyway. The food is slightly better, you get a private room (the NHS in years past really didn’t get rooms, since they were more expensive to build than wards) and TV on tap. But in the five years I worked for the top cancer hospital in the UK, I saw no difference in treatment between the two. Once you were in, you got the lot.

    As for the fear? I suspect that 50 years of saying that government healthcare = socialism and the input of a huge amount of special interests are the biggest factors. Oh, and watching Fox news….

  20. #20 gg
    August 18, 2009

    10,000li: “Is there anyone who believes it could really work out differently? That we rich are going to pay for care for anyone else? What planet do you live on?”

    1770: Is there anyone who believes it could really work out differently? That the British Empire will give a bunch of filthy colonials independence? What planet do you live on?

    1850: Is there anyone who believes it could really work out differently? That males are going to allow women to vote? What planet do you live on?

    1940: Is there anyone who believes it could really work out differently? That the British Empire will cede its most profitable colony to a bunch of nonviolent Indians? What planet do you live on?

    1950: Is there anyone who believes it could really work out differently? That whites are going to allow blacks to have equal rights? What planet do you live on?

    1990: Is there anyone who believes it could really work out differently? That the Soviet Union will really dissolve itself without a fight? What planet do you live on?

    Change happens.

  21. #21 Coriolis
    August 18, 2009

    Well gg, it doesn’t so much “happen” in the unstoppable tide of history, as people make it happen.

    At this point it looks like it won’t happen this time around unfortunately. And really I cannot put that much blame on the republicans – they are lying spoiled brats, and that’s how they act, but that’s nothing new. The real problem is that the democrats cannot stand up to them and call them what they are, courtesy be damned. And of course that most of the media has effectively abandoned even pretending examining the issue of what’s true and what’s not and is purely focused on the political horse race.

    Really, if Jon Stewart being the most trusted “journalist” doesn’t get them to clean up their act, they deserve to fail.

  22. #22 Joe
    August 18, 2009

    Pal, et al, I think the administration has issued a correction- the public option has not been abandoned.

    Also, there was a good piece on NPR about the National Health Service in Britain http://www.npr.org/blogs/health/2009/08/britains_health_service_defend.html The interview underlines the nonsense we are being told about the public option.

  23. #23 Denice Walter
    August 19, 2009

    Yesterday, Chris Matthews spoke with Chuck Todd(video @ MSNBC.com/ poll details @ NBC.com))who presented a poll showing disapproval of Obama’s plan based on people’s misperceptions(e.g. covering “illegals”, government “takeover”,government paying for abortion, and the infamous “death panels”)i.e. much of the fuel for the town hall meeting furor.Even though I live deep in the heart of Liberalville, I chose not to deal with the meeting, instead calling my congressman and informing his staffer about *my* views and why I didn’t attend. Anyone can do this: while I called locally, if you don’t have the number, you can call Congress directly (1-202-225-3121)- even though it is recessed,the operator informed me that the staffers are there and will take your comments.

  24. #24 Charlotte
    August 19, 2009

    Point of Information (for outwest@4, MikeB @19): US news sources have been quoting ~12% of the UK population with private healthcare, the best source I can find for this is the industry site here. That gives 12.8% in 2002, roughly 2/3 of whom are covered by their employer, meaning only 4% bothered taking out private plans. I’m not sure what plans this covers, either – there’s a real problem with dental care on the NHS, it’s hard to access and not cheap, so dental only cover is popular. Earlier government statistics show slow growth in the sector.

    I don’t think you can argue that the middle-classes are much affected with those numbers. It’s considered a job perk here, but not a major one since some employers just use it to make you see the doctor outside working hours if you’re sick, so you don’t take time off. Most people would go for a company car or private gym membership instead IME.

    Right, carry on arguing, all you folks who are actually affected by this.

  25. #25 catgirl
    August 20, 2009

    I’d like to know what—specifically—people fear about a public option or about a single payer system.

    They fear that poor and/or dark people will get something that they don’t “deserve”. They would rather stick with a system that doesn’t work well for them, simply to make sure the correct people continue to suffer.


  26. #26 DLC
    August 21, 2009

    Pal : I think mostly it’s change that people fear.
    Most people have some sort of medical insurance coverage and most of them just don’t see a problem. Not seeing a problem they simply don’t wish to change. Other people hear the “death panels” bull and other stuff and don’t apply critical thinking skills to the story, mostly because they haven’t got any. They were brought up in an environment that does not encourage critical thinking and so aren’t really capable of it. And then there’s the Austrian School of Economics crowd, who think that somehow there’s a free or open market for medical services, when in fact it is nothing of the sort. A man having chest pains, difficulty breathing and nausea doesn’t have a choice — he can’t comparison shop for medical treatment and reject Hospital A over Hospital B. I really hope they make some serious moves to fix the health care business, but being that it’s politicians we have to trust to do it, I don’t see anything much happening. And yes, not being able to trust politicians is another part of the problem.

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