In the Arena

What the Public Option Actually Does

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If conservatives seem ridiculously hyperbolic about what the public option does and does not do–it does not, for example, increase costs (it could decrease them) or mean a government takeover of health care–some progressives have been a bit confused about what a public option might actually accomplish. Here’s Ezra Klein, who has established himself as a real voice of sanity in this debate, on what a public option actually might accomplish–and what it won’t.

Again, there are two reasons why someone–like me, for example–who supports universal health insurance might oppose a public option:

1. that it sets up an unfair competition with private insurers, leading to a government-provided, rather than just a government-funded insurance system. (I don’t think it’s very likely–it’s the domino theory of health care–but I would be opposed to a system where every doctor and nurse was employed by the government. I do favor a single-payer system where the government uses tax credits to give people the money to buy health insurance.)

2. the right-wing smear campaign has succeeded and moderate Democrats, and a few stray Republicans, who might otherwise vote for health care reform won’t do so…perhaps enough to kill legislation that would make health care more available and affordable for Americans, while prohibiting insurance companies from denying you access because of pre-existing conditions or an increased need for care.

The latter seems a plausible reason to oppose a public option. I do think that there’s a good alternative available–a public option that would be triggered in states where there isn’t much competition now (in some states, Blue Cross has a virtual insurance monopoly) or if we find that health care exchanges–the super-stores where individuals and small businesses will be able to choose among an array of insurance products–don’t provide the cost controls that are expected. It is possible that this sort of triggered compromise could pass the Senate. If it can’t, I still believe that insurance reform and the expansion of coverage are too important to let lapse right now, even if a triggered public option isn’t included. There are real people who will have a better life as a result, and we will have a more decent and just nation.