Letter to the Editor

[cos]

Last night, I submitted this as a letter to the editor to USA Today:

For decades, private for-profit insurance companies have been spreading fear about "government run health insurance". Despite the fact that people on Medicare - run by the government - are more satisfied with their insurance than people on private insurance, the private insurance companies have been telling us that national health care wouldn't work, because the government can't run a good insurance system, and we're all better off with private insurance. Obama's plan puts their claims to the test, and it's time to put up or shut up.

Obama proposes a compromise between a national single payer system, and the private insurance we have now: he wants to put a public health insurance option in the same market as private companies, to let people choose and see what works better.

Insurance companies' complaints about "unfair competition" are a smokescreen. They want to mislead us into a conversation about how to be fair to insurance companies, while they continue being unfair to the American people.

What the for-profit insurance companies are really saying is that they fear the government can run a better health insurance - that satisfies people more, and leaves us healthier, at a lower cost. They may be right. Congress owes it to us to create a public option so we can try it and find out. Stop worrying about the health of the insurance companies, and care for the health of the American people for a change.

Comments

[cos]

My point is that, right or wrong, that debate is a pointless distraction. Fundamentally, there's no reason for us (the general public, the Congress, etc.) to care whether having a public option would be "fair" to insurance companies. What we care about is whether it's fair to the people in general. Insurance companies and Republicans are trying to misdirect us into debating its purported unfairness to insurance companies, and that's not the point. Sure they care, but the rest of us have no reason to care. It doesn't matter if it's okay that it's fair, or not okay, or whatever. What matters is to get off that ridiculous subject altogether, and talk about what matters, and to do that, I want to clearly point out how they're misdirecting us.

I've done this in person when people have honestly asked, out of genuine concern, whether it's fair to insurance companies to ask them to compete with the government. I've asked, essentially, "why do you care?" and they've thought about it and realized that I'm right, that question doesn't matter so why waste time on it?

Here on my own livejournal I don't really mind arguing that it's okay that it's unfair, but to a broader audience I'd rather focus on the main point: that we're being misdirected into debating the wrong question.

[fenicedautun.livejournal.com]

First, in response to your earlier comment to me, I was going to point out that the "unfairness" is not a smokescreen to the question the insurance companies are trying to ask, but you're answering a different question (which you've just pointed out).

Second, I think it does matter that there is private insurance, and the reason is for competition. Here, I'll point to the British model, where there is an automatic public option but something like one third of the population also have private insurance (including one set of my grandparents, but not the other). Private insurance should continue to exist because I don't think the public option should be funding all the medical options available (easiest example is types of assisted living, big gradients without necessarily referring to actual health outcomes). Plus, monopoly service stifles innovation (desperately needed in healthcare - wouldn't it be interesting if a private insurer worked out how to cost less than a public option?) and can promote sloppy performance.

[cos]

I was going to point out that the "unfairness" is not a smokescreen to the question the insurance companies are trying to ask, but you're answering a different question (which you've just pointed out).

Huh, that comment confuses me. My point all along was that the very question the insurance companies would have us debate is the smokescreen: it obscures the real question we should be debating, which is whether having a public option would make health insurance for Americans better, with a question of their own, which is whether the competition would be "fair". Ultimately, we the people don't care about that latter question, we care about the former: will the overall result of this be better or worse for us (not "will it be better or worse for insurance companies")?

Second, I think it does matter that there is private insurance, and the reason is for competition. Here, I'll point to the British model [...]

Nobody suggests that any plan that actually eliminates all private insurance could possible get anywhere close to passing the Congress, so that's a strawman. Private insurance would only disappear entirely if it could not provide anything whatsoever that anyone finds value in. It might get much smaller than it is now, or might not, depending on how good a job it does, but complete disappearance seems far-fetched (and if it does happen, it would happen only because it turns out that we get no value out of having private insurance).

As you point out, even if we had a public health system as comprehensive as the NHS (which neither Obama nor Congress seems to be contemplating), there would *still* be some niches for private insurance as long as we didn't ban them. And you certainly can't pretend that there's "fair" competition between the NHS and the private insurance companies in the UK. It's clearly dominant, with huge structural advantages, and no pretense of a level playing field. But so what? A level playing field between private and public insurance is not a legitimate public policy goal, better more effective health of the people is.

[gwillen.livejournal.com]

A level playing field between private and public insurance is not a legitimate public policy goal, better more effective health of the people is.

Just to try to fathom, for a moment, the minds of those who say they want a level playing field: As I see it, "efficient allocation of resources" is a legitimate public policy goal. If one finds a way to structurally favor the public plan, _despite_ the fact that it allocates resources inefficiently, then there would be legitimate complaints against that. For example, if the public plan was tax-subsidized, I would see "uneven playing field" as the following legitimate complaint: the public plan could be _worse_, by all available measures, than any private plan, and yet might still outcompete them due if it had heavy subsidies. This would be a negative outcome for everyone, and I think this is the outcome envisioned by those who complain about the evenness of playing fields.

So to me, the right answer to "uneven playing field" is "show me where resources would be allocated inefficiently". An uneven playing field which can't pass that test is potentially bad; one which can is potentially good.

Mind you, I _also_ suspect that most of the people who complain about level playing fields are under the misimpression that the public option WOULD BE subsidized. So if you don't directly attack that point, you may not get through to many.

(BTW, I am arguing here entirely under the hypothetical view that subsidized public healthcare would be bad. This is not because I hold that belief; I just want to point out what people who DO hold that belief are probably intending to argue about.)

[cos]

*nod* I see what you're saying - it is part of what some people who are formulating these messages are thinking. It's not what they're communicating to the general public, though, and there's where my letter is aimed.

Purist Libertarians tend to believe that just about anything we currently subsidize by taxes would be better done privately, but only a very small proportion of the public agree with that view, so it's not a winning argument.

I'm on the other side: I'd be much happier if we had a ongoing-tax-funded public option. That's not going to happen this time around. I suspect my position has a lot more support than the Libertarian position, though I'm not sure whether it's a majority (it's really hard to measure to that level of precision, it's probably in the 35%-65% )