Ideas At Work vs. Self-Negating Arguments

June 12, 2009

The opposition to a public health plan option seems to be imploding, victimized by logic which looks something like this:

1. A public health plan will be a nightmare. You won’t get the doctor you want. Waiting times will be horrendous. Government pencil-pushers will stand between you and your physician while political hacks decide what treatment you’ll get. Everybody will hate it.

2. Public health care will have an “unfair advantage” on price. It will then drive private insurers out of business because it will be so popular that everybody will join it.

What’s wrong with this picture?

These self-negating arguments1 aren’t displaying much faith – either in free markets, or in the imagination of people working within the current system. Speaking of which …

There’s a very interesting new proposal from “Health CEOs For Health Reform,” a project of the Health Policy Program at the New America Foundation. The “Health CEOs” come from a diverse set of healthcare companies, and their proposal focuses heavily on – in their press release’s words – ” quality, efficiency, care coordination, and patient-centeredness.” The proposal itself emphasizes a radical shift away from today’s fee-for-service model, favoring total case care, accountability for outcomes, and new payment models for chronic care. Many of these ideas have been around for a long time, but the proposal seems to go further in some of its global recommendations.2

Yesterday Sen. Kent Conrad announced a new alternative to the public plan option: non-profit health cooperatives. I would argue with Sen. Conrad’s timing. We don’t need a milder alternative to the public option, since momentum for it seems to be building . And independent cooperatives would not have the research, development, or innovation capabilities that a public plan could muster. This is not the moment to undercut the public plan idea with another fragmented program. That said, Sen. Conrad’s “chartered cooperative” alternative could enrich the set of choices reform can offer, even if it’s not a substitute for the public plan.

We already have operational health plan cooperatives and other nonprofit groups throughout the country. Some of them incorporate elements that relate to the “Health CEO” proposal, and surveys usually show that their members are very satisfied with the care they provide. The presence of a public plan option doesn’t preclude all sorts of imaginative initiatives from the private and nonprofit sectors. It should encourage them, in fact, germinating new financial and medical models that help them thrive.

It’s particularly disappointing to see someone like Sen. Charles Grassley echo the opposition’s self-contradicting arguments. Grassley’s a Republican who’s often been willing to reach across the aisle on health care. His hearings on corruption in medical research have been both courageous and profoundly important. It’s time for Sen. Grassley and others to either frame a more defensible and coherent opposition to the public plan option, or step down and let it be enacted.

Why not create a health system that taps into all of our country’s resources – government’s tools, the private sector’s energy, and the capabilities of our growing nonprofit/”social entrepreneurship” sector? After all, choice and competition are basic American principles.

Let’s redesign our health system so that it encourages ideas that work. And how will we know what works? In our country’s tried-and-true way: by letting the people decide.

1 I may be oversimplifying, but not by much. Opponents may say, for example, that their real concerns involve a long-term scenario where a public plan forces its opponents out of business and then turns dictatorial. But we don’t make policy based on hypotheticals, especially extreme ones. Congress can always pass new laws if circumstances change. And private capital will always move in if there’s a new marketing opportunity.

.2I should note that I need to study this just-released plan in greater detail, especially its recommendations for an overhaul of Medicare’s reimbursement structure. And the “CEO” plan is silent on the issue of a public plan option.


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