Another Voice / Health reform
Sam Berger: ‘Public option’ represents a useful new reality
The debate over whether health care reform should include a public option continues to dominate the headlines. But the controversy is about more than just one-sixth of our economy — it’s also a struggle between the stark ideology of the past and a modern understanding of the interplay between markets and government.
The public option, designed as a compromise between government-provided health care and a strictly market-based system, would create competition in a heavily consolidated industry, yet conservatives have responded with nearly unanimous opposition, calling it a “government takeover.” Opponents claim the plan will be a Trojan horse for a single-payer system, driving out private insurers.
Although a public option could be designed to undercut private insurers, it could just as easily be designed not to. Congress has proposed several ways the public plan could set rates, and there could be additional constraints.
Republican opposition might be explained as a strategy for winning midterm elections, but this misses the larger issue: Conservatives are concerned that a public plan would work.
Grover Norquist, one of the architects of the opposition to President Bill Clinton’s health care plan, acknowledged as much more than 10 years ago: “Had the Democrats taken over health care [under Clinton], I think we would have become a social democracy and we could have never undone it.”
An unregulated health care market doesn’t work; industrialized nations with government programs spend less money for better health results.
Conservative fears are not entirely misplaced; the public option could change the political landscape by performing well. Rather than foster a government takeover of health care, an effective public option would foster the idea that targeted government intervention can be a force for good.
This result would be anathema to the radical conservatives who currently have a stranglehold on the GOP. To them, government is always the problem, never the solution. But the world has changed since the conservatives’ rise in the 1970s. Democrats have accepted a broader role for market competition in a whole host of fields.
In the face of these changes, knee-jerk opposition to government involvement is out of tune with the country’s problems. A robust public option could help move us past old “government versus market” debates and address nuanced questions of where government intervention is appropriate.
Also, by demonstrating the shallowness of the anti-government view, health reform could create room for a moderate wing of the Republican Party. Sure, this might make the GOP a more viable force, but who are Democrats to be afraid of a little competition?
Sam Berger of Amherst attends Yale Law School and is co-editor of the forthcoming book “Progress in Bioethics: Science, Policy and Politics.” A longer version of this column first appeared in the Hartford Courant.
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