The Case for a Public Health Care Plan
Peter Harbage and Karen Davenport have a new report for CAPAF in which they make the case for a robust public option as a component of a systematic health care exchange, and spelling out some details:
The operational features of this public health insurance plan and exchange would include: health insurance plan and exchange would include:
* A health insurance exchange that offers private insurance plans and a public health insurance plan—all of them competing on a level playing field.
* A public insurance plan operated by public employees separate from existing public and private plans.
* Comprehensive and affordable coverage, with guaranteed access to health insurance and other consumer protections offered by all plans in the exchange.
* A service delivery model that provides choice among insurance providers, better care coordination, and fair and efficient payment processes for patients and physicians alike.
* A health care system that promotes innovation rather than risk segmentation.
* An option for individuals to keep the coverage they have today if they so choose.
The point that I think receives too little attention in the debate is the one about innovation rather than risk segmentation. At the moment, insurance companies primarily compete by getting better at risk segmentation—at avoiding the riskiest cases, and doing various kinds of price discrimination. We can and should regulate much of this away. But if that’s all we do, we’ll still have a situation in which the companies are trying to find new and more creative ways of doing risk segmentation. We’ll end up “overly dependent on government enforcement to achieve the goals of health reform,” playing an endless game of cat-and-mouse to see whether or not we’re actually achieving our policy objective of promoting health in a reasonably fair and cost-effective manner. Inserting a publicly managed enterprise into the framework lets us rely more on competition and less on regulatory mandates.
The way this works is that if the private plans can’t or won’t compete by offering innovation, value, and quality then the bureaucrats at the public plan should be able to beat them. That, in turn, creates incentives for the private sector to unleash its own imaginative powers on beating the bureaucrats. Otherwise, it’s just bureaucrats drawing up rules and then the private sector dully complying with the rules while working creatively to find loopholes.
65 Responses to “The Case for a Public Health Care Plan”
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March 25th, 2009 at 3:52 pm
Matthew,
You’ve got this all wrong: “That, in turn, creates incentives for the private sector to unleash its own imaginative powers on beating the bureaucrats. Otherwise, it’s just bureaucrats drawing up rules and then the private sector dully complying with the rules while working creatively to find loopholes.”
You see, there is no creativity in the private sector because everyone is corrupt and or evil. What we need to do is just totally do away with the private sector and let creativity and relentless work ethic of the public sector take over.
Who’s with me? Joe? Anyone else?
March 25th, 2009 at 4:16 pm
Matt, I think what the private sector is scared of is that since the public plan has no need to make a profit and has the huge resources of the USFG behind it (not to mention the political mandate that health care has to be cheaper), it will simply outspend the private sector and be able to offer cheaper plans than any private company could and still operate.
At some point, health care costs will just overwhelm the federal budget, but by then no one will want to give up free health care so we either a. default on the debt b. rapidly inflate the monetary supply c. jack up marginal tax rates to confiscatory levels.
March 25th, 2009 at 4:24 pm
Ed’s being an uninteresting troll but has uncovered an interesting point: what the hell is the point of “innovation” or profit in health insurance? All you’re doing is moving money around, and private insurance is inferior to medicare because it’s a profit-driven middle man.
It’s called single payer, and it’s not that hard, guys.
March 25th, 2009 at 4:25 pm
I think where that would end up though, would just be private insurers putting out very attractive policies for ‘healthy’ people, and just none for ‘unhealthy’ people (or high-risk or whatever heartless label one wants to put on the people in question). That would leave the govt. plan insuring large numbers of people in the ‘unhealthy’ side, and there would be all kinds of pressure from the industry to make that health care bad and expensive as a consequence for being ‘unhealthy’.
ugh, who knows. I just don’t see a useful, workable system coming out of this Congress. maybe Obama really should wait two years, give people the COBRA subsidies for the time being, and wait until we get that 60th Dem in 2010.
March 25th, 2009 at 4:30 pm
The idea is that insurance companies will crack the whip on health-care providers to reduce inefficiency. That has actually happened. Patients now receive non-optimal or even completely unnecessary treatment in a much more effecient manner than they used to.
After all, determining what treatments are necessary and effective is health-care rationing, which must be forbidden.
March 25th, 2009 at 4:38 pm
There’s always a silver lining to my presence…Intended or not.
Njorl, answered your question about the 1974 near meltdown in the previous forum. Would be interested to hear your response.
March 25th, 2009 at 4:53 pm
The idea is that insurance companies will crack the whip on health-care providers to reduce inefficiency.
There are other elements: subsidised gym memberships, in-workplace checkups for people with group policies, etc. Though as Njorl suggests, much of this is superficial and doesn’t address the simple point that for-profit health insurance needs to die, for the very reason that it’s so damn hard to kill.
March 25th, 2009 at 4:57 pm
for-profit health insurance needs to die, for the very reason that it’s so damn hard to kill.
It needs to die because it’s hard to kill?
Do you ever write anything that makes the slightest bit of sense?
March 25th, 2009 at 5:03 pm
A health insurance exchange that offers private insurance plans and a public health insurance plan—all of them competing on a level playing field
Right. Congress would monkey with the public company, either subsidizing it or handicapping it. There would not be a level playing field. Not going to happen.
March 25th, 2009 at 5:23 pm
A health care system that promotes innovation rather than risk segmentation.
Surely progressives don’t oppose all forms of risk segmentation? Or maybe they do but this hatred for personal responsibility is not shared by many Americans. I would go so far as to say it is antithetical to the objectives of nearly every other public policy currently adopted in the States.
March 25th, 2009 at 5:24 pm
Oh, silly Mixner, learn to read. Then learn to think about what you’ve read.
March 25th, 2009 at 5:36 pm
I am a member of the public, I am a citizen, and I prefer to have the option of purchasing / signing up with a public health care option.
I’m not preventing others from keeping up their private insurance, however inefficient it may be.
But stop getting in the way of me having my preferred option.
March 25th, 2009 at 5:49 pm
The conservative sites are quite frank about why they see the public sector as more efficient. They argue that the larger purchasing power of government will be able to control health care bills that the plan must reimburse.
Since cutting such bills has been said over and over to be increasingly urgent (even by some who consider universal health care a less pressing issue), this should be a good thing. And if one simply believes that any competitor has to compete, as presumably conservatives are committed to believing ideologically, it should also be a good thing. And that’s not even counting the argument that liberals put forth, that the government sector would have less administrative cost (perhaps a claim that would be less overstated once private insurers were forced out).
It shows that conservatives will put preference for business over the rest of their ideology anytime. Welfare for the rich is their only real commitment.
March 25th, 2009 at 5:53 pm
I’m not Mixner. I did read your post and it makes no sense at all.
March 25th, 2009 at 6:03 pm
The problem with a “public option” is that the government would be able to undercut private insurers by using its size and power to negotiate, or demand, preferential rates from health care providers. This would eventually force private insurers out of the market and we’d end up with single-payer health care.
Proponents of this “option” might have a little more credibility if so many of them hadn’t already admitted that their goal is to use this mechanism as a backdoor way of getting to single-payer.
March 25th, 2009 at 6:05 pm
Re: Matt, I think what the private sector is scared of is that since the public plan has no need to make a profit and has the huge resources of the USFG behind it (not to mention the political mandate that health care has to be cheaper), it will simply outspend the private sector and be able to offer cheaper plans than any private company could and still operate.
The private plans will not be able to compete on cost– but they can still compete on quality, and the fact that we have private schools, FedEx, private security firms and private transportation alongside public options in these areas shows that this can indeed be done successfully. I actually suspect that the public plan would end up being rather chintzy (see: Medicaid) and most people will prefer private insurance– or perhaps they will purchase supplemental private plans as Medicare recipients do now to cover what the public plan doesn’t.
Re: A public insurance plan operated by public employees separate from existing public and private plans.
I suspect that any public plan will end up being administered by private firms, perhaps as a sop to the insurers by allowing them a cut of the business. Which isn’t a bad thing as their personnel has the training and experience to do the job.
Re: At the moment, insurance companies primarily compete by getting better at risk segmentation
It’s actually very difficult nowadays for insurers to do this in the group insurance market. HIPAA mandates that they take all applicants in employer groups (with minor exceptions) and while the ability to work does filter out some disabled people, nothing filters out disabled, chronically ill dependents of workers.
March 25th, 2009 at 6:06 pm
Replace “for-profit health insurance” with “Godzilla”. Or get a grown-up to explain it to you.
March 25th, 2009 at 6:12 pm
okay, pseud, I’ll just keep you in the “too dumb to bother with” file.
March 25th, 2009 at 6:15 pm
The private plans will not be able to compete on cost– but they can still compete on quality, and the fact that we have private schools, FedEx, private security firms and private transportation alongside public options in these areas shows that this can indeed be done successfully.
You can also point to the supplementary / complimentary insurance market in many foreign systems that are usually regarded as “single-payer”. Plus, you don’t really get publicly-traded firms like UnitedHeath whining about BCBS having a competitive advantage.
March 25th, 2009 at 6:18 pm
Oh, that’s funny: “gregor” forgot that he was “gary” upthread, and so the sockpuppet show rolls tediously on.
March 25th, 2009 at 6:22 pm
This thread is where gary-Mixner was being gregor-Mixner, and forgot to change socks.)
March 25th, 2009 at 6:28 pm
gregor, I agree.
March 25th, 2009 at 6:29 pm
The problem with a “public option” is that the government would be able to undercut private insurers by using its size and power to negotiate, or demand, preferential rates from health care providers. This would eventually force private insurers out of the market and we’d end up with single-payer health care.
I doubt a country as large and as affluent as the US will ever find itself without private sector actors — including insurers — willing to compete for healthcare dollars. It may be true that private insurance firms will be pushed to the margins (ie., insuring a relatively modest — and wealthy — percentage of the population, or offering only top-up services (private rooms, greater MD choice, what have you)), but, well, if they can survive in France surely they’ll survive in America. But yeah, at the end of the day, something’s gotta give: it’s hard to see how we get universal health insurance coverage and cost containment and the continued presence of a mass market for private, comprehensive health insurance.
March 25th, 2009 at 6:35 pm
Hilarious. If he wasn’t such an abrasive asshole, I’d almost feel sorry for Mixner/gregor/gary/johnson/dildo/peckerwood/shut-in. What a sad, broken person.
March 25th, 2009 at 6:38 pm
I doubt a country as large and as affluent as the US will ever find itself without private sector actors — including insurers — willing to compete for healthcare dollars.
If the public option is able to undercut them, they won’t be able to compete. They’ll be pushed into supplementary insurance roles, like the private insurers in France and the UK. Which is one reason why the public option isn’t viable.
March 25th, 2009 at 6:40 pm
You’re not fooling anyone, ‘Waingro’.
March 25th, 2009 at 6:44 pm
Jasper, you’re forgotting the President’s secret ingredient: Magic Obama Powers.
March 25th, 2009 at 6:52 pm
They’ll be pushed into supplementary insurance roles, like the private insurers in France and the UK
Boo fucking hoo. Let me find the world’s smallest violin.
March 25th, 2009 at 6:58 pm
Boo fucking hoo. Let me find the world’s smallest violin.
Sarcasm. Mighty powerful weapon you’ve got there. The health insurers don’t stand a chance.
March 25th, 2009 at 7:27 pm
Maybe they’ll be happier in that position, like luxury automakers or elite cabinet-making companies, or some former high-pressure, high-earning executive who quits to launch his/her own boutique organic food / niche industry product company. Sure, they’re not making cheap hatchbacks or mass-market cabinets, but the job’s so much more satisfying, and they can spend more time promoting quality.
March 25th, 2009 at 7:54 pm
Matt, I think what the private sector is scared of is that since the public plan has no need to make a profit and has the huge resources of the USFG behind it (not to mention the political mandate that health care has to be cheaper), it will simply outspend the private sector and be able to offer cheaper plans than any private company could and still operate.
What the private sector is scared of is that the public plan will compete by making people who don’t want to participate in the public option pay for it anyway through taxes. You cannot have fair competition between two businesses when one has to convince you to buy its product to get money from you and the other can force you to pay for its services whether you use them or not.
Patients now receive non-optimal or even completely unnecessary treatment in a much more effecient manner than they used to.
After all, determining what treatments are necessary and effective is health-care rationing, which must be forbidden.
I don’t trust the government to make better rationing decisions than the private sector.
I am a member of the public, I am a citizen, and I prefer to have the option of purchasing / signing up with a public health care option.
As long as it’s funded only by money taken from those people who sign up for it, it’s your business. If you want me to subsidize your public health care option, however, then you are making it my business.
I’m not preventing others from keeping up their private insurance, however inefficient it may be.
But are you trtying to take our money to pay for it?
But stop getting in the way of me having my preferred option.
Sure, as long as you don’t force me to pay for it.
March 25th, 2009 at 8:02 pm
No problem. Give me my choice of what to take out of the federal budget and I’d gladly shift the money from what I currently don’t want being paid for to what I do.
Other than that, I really don’t care if you don’t want your taxes paying for it. I don’t. People can take their whining about how they don’t want their taxes paying for social programs and go shove them up their a**es. I don’t care, nor am I seeking to make you types happy.
March 25th, 2009 at 8:06 pm
I don’t trust the government to make better rationing decisions than the private sector.
I do. Unlike the former, the latter has an incentive to make decisions based not on what’s optional for my health, but rather what’s optimal for their bottom line. You’re better off arguing against rationing cum public option because you don’t like rationing. But arguing that the private sector does rationing more skillfully than the government seems quite a stretch.
March 25th, 2009 at 8:19 pm
I do. Unlike the former, the latter has an incentive to make decisions based not on what’s optional for my health, but rather what’s optimal for their bottom line.
Here we go again. Then why don’t you favor government funding of all other insurance too? Why just health insurance?
March 25th, 2009 at 8:34 pm
Re: If the public option is able to undercut them, they won’t be able to compete.
As I noted above they will be free to compete on quality rather than price. People can and do spend moe money on a product they perceive to be superior. This is why we don’t all shop 100% at Walmart (if not he Goodwill) and why most of us spend thousands of dollars on autombiles rather than riding the bus.
Re: What the private sector is scared of is that the public plan will compete by making people who don’t want to participate in the public option pay for it anyway through taxes.
I have spent the last six year paying for a war I did not want and which I regard as a moral abonmination. But in a democracy that’s the way it works: you pay for things you don’t like and may even vehemently disagree with. Grow up.
Re: I don’t trust the government to make better rationing decisions than the private sector.
That makes no sense. The government has no more an incentive to make bad decisions than the private sector does. Both, presumably, want to save money of course, but whereas the private sector is answerable only to its owners, the government is answerable to the entire citizenry, and so is at least marginally more dependent on public good will. And by your logic ought we go back to the good days of private armies and courts answerable only to someone’s Lordship?
Re: Then why don’t you favor government funding of all other insurance too?
I actually would do something like this with car insurance: maybe a pay-at-the-pump fee which would fund the minimum insurance liability requirement for all drivers– that would force all drivers to pay into the system (no more people cheating by going bare) and if there was a need to soak bad drivers more that could be done with surcharges on traffic tickets and/or registration fees. Meanwhile people could purchase additional insurance (for greater liability, to insure the vehicles themselves etc.) as now.
March 25th, 2009 at 9:04 pm
As I noted above they will be free to compete on quality rather than price.
This doesn’t make any sense. If the government can negotiate, or demand, lower prices from providers for drugs, tests, surgeries, consultations, etc. then private insurers will be at a competitive disadvantage and may be forced out of the market entirely.
March 25th, 2009 at 9:16 pm
I have spent the last six year paying for a war I did not want and which I regard as a moral abonmination.
Tough shit. The national defense is a public good and no one seriously argues that it could be effectively funded through private, voluntary donations. The vast majority of health care services are not a public good and can be funded privately. So why should people who don’t want to participate in the public option be forced to pay for it anyway through taxes?
I actually would do something like this with car insurance:
The argument was that public funding of health insurance would be better because the government doesn’t have to make a profit. If this is a valid argument, why doesn’t it apply to all other forms of insurance too, rather than just (a minimal level of) car insurance?
March 25th, 2009 at 9:39 pm
Your god damn interpretation. Thankfully that’s why the field of politics is competitive so that some people win and some people lose. I don’t want my money to fund a bunch of bullsh*t some hawk assholes said were necessary. National defense is not a yes or no check mark either. I don’t give a sh*t that libertarians think health care needs to be a private good.
With luck you’ll lose this fight, and be pissed off. Meanwhile your coworkers and neighbors will find themselves happier and better off under a sane health care system and they’ll tell you to take a hike as well, even some of my right wing, white, Obama-hating Georgia neighbors.
March 25th, 2009 at 9:50 pm
Your god damn interpretation.
It’s not a matter of “interpretation.” Its instrinsic to the nature of the goods. You can’t be meaningfully excluded from the national defense. Your consumption of the national defense doesn’t meaningfully reduce the amount available to others. Neither of those things is true for health care. The only form of health care that may reasonably be considered a public good is public health – public sanitation, munipical health codes, vaccination against serious infectious diseases, etc.
March 25th, 2009 at 10:17 pm
Neither of those things is true for health care.
Your god damn interpretation.
March 25th, 2009 at 10:29 pm
It is possible to effectively exclude individuals from receiving medical tests, drugs, surgeries and consultations. In fact, such exclusion happens frequently. Consumption of any of these medical goods by one individual reduces the availability of the good for consumption by others.
It takes a special kind of stupidity to believe that these claims are a matter of “interpretation” rather than fact.
March 25th, 2009 at 10:33 pm
You’re entitled to your own opinion, Mixner.
March 25th, 2009 at 10:49 pm
More idiotic games with the stupid incantation of marketplace rhetoric instead of argument, because to morons it sounds like real philosophical inquirty.
Calling all these expenditures “the national defense” magically makes all those expenditures in reality “the national defense.”
So, I’ll tell you what: I’ll now place individual health care under the philosophical category of “the national defense”, and thus the problem has been eliminated. Health care is part of “the national defense,” and I’m sorry if you or any number of people disagree, because I have spoken, and since this discussion is about what you or I do or do not wish your taxes to pay for, the discussion is concluded.
Meanwhile, you can take your opposition to having your taxes go to publicly subsidize health care and go cry in a corner. If you lose this battle, no one will care about your whining.
Actually, no one cares now.
March 25th, 2009 at 10:59 pm
Calling all these expenditures “the national defense” magically makes all those expenditures in reality “the national defense.”
No, they’re called national defense expenditures because they are expenditures for the Department of Defense of the United States government. If you seriously want to propose funding the DoD through private, voluntary donations, go ahead, but everyone will just ignore you because the proposal is incredibly stupid.
March 25th, 2009 at 11:16 pm
Putting aside the fact that everyone already recognizes that your objections to a public health care option because ‘you don’t want your taxes paying for it’ is stupid, the above isn’t even close to addressing anything I said. It’s a point you got in your head, which you think addresses something, and you keep repeating it.
The notion that what is and is not justifiably spent under a hazy concept of ‘national defense’ by locating its bureaucratic flow is as silly as the ‘I don’t want my taxes going to’ genre.
However, until you define the word “Defense”, prove that it is a useful term, and cite its most common uses empirically to my satisfaction, I’ll keep repeating that you have failed in your argument, because that’s what mixner does.
In fairness, you should go ahead and declare victory, since I’m not debating this anymore. I’ve expressed clearly that I don’t care what you do or don’t think your taxes should or should not go to, particularly with regard to a public health insurance option which I support, and to which I prefer both my and your taxes go toward, whether you like it and find it properly a universal public expenditure or not. And if my side wins, you lose forever.
March 25th, 2009 at 11:21 pm
It’s funny you put it that way, since that’s a pretty good description of the private health insurance system we have right now.
March 26th, 2009 at 12:01 am
El Cid: Other than that, I really don’t care if you don’t want your taxes paying for it. I don’t. People can take their whining about how they don’t want their taxes paying for social programs and go shove them up their a**es. I don’t care, nor am I seeking to make you types happy.
You are missing the point. I am not criticizing you for wanting public health care. I am cirticizing you for the dishonest way you framed the question in your earlier comment, #12:
I’m not preventing others from keeping up their private insurance, however inefficient it may be.
But stop getting in the way of me having my preferred option.
In other words, “please just leave me alone,” as if those who oppose government-run insurance were impinging on your freedom. If you want to force others to pay for your insurance, fine, but don’t dishonestly pretend that you are just asking to be left alone.
JonF: I have spent the last six year paying for a war I did not want and which I regard as a moral abonmination. But in a democracy that’s the way it works: you pay for things you don’t like and may even vehemently disagree with. Grow up.
You are missing the point of my critique. A lot of people are essentially arguing that the fact that private insurers are scared to compete with a government-sponsored plan proves that the government plan is cheaper and more effective (i.e., better); if the government were not competitive, what would they have to worry about? My point is that private insurers are afraid to compete with the government not because they are afraid that the government will do a better job, but because they know that it will rig the rules in its favor. Put another way, the government will certainly have an advantage whether it is more efficient or not, because it doesn’t need to rely on customers to keep getting paid.
That makes no sense. The government has no more an incentive to make bad decisions than the private sector does. Both, presumably, want to save money of course, but whereas the private sector is answerable only to its owners, the government is answerable to the entire citizenry, and so is at least marginally more dependent on public good will.
As the government operates not on a pay-for-service basis, but by taxing private activity, the government does not understand the concept of “no such thing as a free lunch” in the way that a private insurer would. There are also a lot more “tragedy of the commons” issues with government, which is why I am less likely to trust them.
March 26th, 2009 at 1:34 am
I have spent the last six year paying for a war I did not want and which I regard as a moral abonmination.
By the way, JonF. I opposed the war as well, and gave $700.00 to the Ron Paul campaign and a few times gave $100.00 to AntiWar.com, as well as a $15.00 monthly donation.
March 26th, 2009 at 2:00 am
How many advocates of national health insurance here would be willing to have their payroll taxes raised to actually cover the cost of it? Remember that the portion of the payroll tax that currently goes toward Medicare (2.9%, uncapped, split between employer and employee) covers less than half of the program’s cost, so it would have to at least double to cover Medicare. Then it would have to go up some more to cover the cost of covering those under 65 (it would have to go up even more if you wanted it to be more comprehensive than Medicare, i.e., to obviate the need for supplemental insurance).
I’d like to see the number-crunchers at CAP come up with an estimate of how high the health care portion of the payroll tax would have to go up to cover this. My guess is that once people saw the cost, their enthusiasm for single-payer health care would wane. A related example: our local utility here funded a survey asking (among other questions) whether people were in favor of the utility generating more electricity from wind and solar — 84% said yes. A follow up question asked if they’d still be in favor of it if it meant their energy costs would go up 20% — that time, only 42% said yes.
There’s no free lunch. Unless we’re going to ration health care and reduce spending on R&D, single-payer health care would require much higher taxes on most Americans. There’s no way to pay for it by just raising taxes on the top 5% while asking nothing of the other 95%. The top 5% aren’t as rich now as they were during the credit bubble-fueled years.
March 26th, 2009 at 2:03 am
It’s also worth revisiting Dr. David Gratzer’s comparison of health care in the U.S. to health care in single-payer systems in Canada and Europe.
March 26th, 2009 at 2:32 am
Only if you turn a blind eye to Gratzer’s dodgy statistics.
As to your earlier post, what’s your point — that percentages are psychologically scarier than monthly premiums? The median cost of family health insurance is already just under 25% of the median family income.
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Oops…forgot to say great post! Looking forward to your next one.
March 26th, 2009 at 5:11 am
i agree with it.
March 26th, 2009 at 6:29 am
I’m tired of being forced by free marketoids into buying overpriced, inefficient private health care because they have ideologies about the lack of taxes being freedom. Your fake concerns about freedom are impinging on my freedom and my own material best interests.
I don’t share your view of freedom. I’m not letting you define those notinos.
I’m not asking to be left alone. I’m asking to win this political fight and have you types lose on this issue and yes, be forced to have your taxes pay for things you don’t like, just like I’m forced to pay for taxes for things I don’t like.
If you want to propose a revamp of the economic system in which all participation is voluntary and based on democratic decisionmaking, great; we don’t live in that world yet, so right now I’m preferring to win this political struggle, have you who are opposed to public service health insurance to lose and to continue to bitterly oppose it, because it is in my best interest to do so and in the interest of my view of the common good.
March 26th, 2009 at 7:12 am
Re: This doesn’t make any sense. If the government can negotiate, or demand, lower prices from providers for drugs, tests, surgeries, consultations, etc. then private insurers will be at a competitive disadvantage and may be forced out of the market entirely.
Of course it makes sebnse, and I even gave examples where it works in other public-private mixes: schools, package delivery, security, transportation. People can and do pay more for goods and services they perceive as superior. Again, why do people spend thousands of dollars on automobiles rather than just using public transportation? Why is FedEx a viable business? Cost is not the only factor determining what people purchase. This should not be difficult to understand. Unless you desperately poor, I would suggest you can easily find examples in your own life where you buy a more expensive item rather going for the cheapest thing on the shelf.
Re: The national defense is a public good
Bingo! Now apply that to healthcare: it too is a public good– or perhaps a mixed public-private good like education.
Re: So why should people who don’t want to participate in the public option be forced to pay for it anyway through taxes?
I can think of any number of government services I do not use, yet I still I have to pay for them. Schools for example– I have no children. That’s how life works: you have to accept that your taxes will pay for things that you don’t use don’t like and may even actively disapprove of. Grow up.
Re: . You can’t be meaningfully excluded from the national defense.
Of course you can be! Come on, the Iraq War benefited no one except a handful of defense contractors and their employees. Most of us were excluded from its benefits.
Re: Your consumption of the national defense doesn’t meaningfully reduce the amount available to others.
Defense resources are not infinite either. A dollar spent in Iraq cannot be spent anywhere else.
Re: It is possible to effectively exclude individuals from receiving medical tests, drugs, surgeries and consultations
In principle we could exclude people from police protection recourse to the courts, etc. The issue is not whether you can exclude people– you could even exclude, say, Alaska, from our defense system after all– it’s whether doing so would be just and proper. Excluding people from basic public srvices like police protection, education, and, yes, healthcare is both stupid and evil.
Re: the government does not understand the concept of “no such thing as a free lunch” in the way that a private insurer would.
Nonsense, You write of the government as if it were some alien visitation. It isn’t. It’s made of human beings who are not in any significant way different from the human beings who staff Aetna. Human nature, and in the aggregate human intelligence, is the same everywhere.
Re: How many advocates of national health insurance here would be willing to have their payroll taxes raised to actually cover the cost of it?
I would. But plaese note: I am not espousing
a single payer system; I am espousing a public plan option alongside the current system.
I am also saying that people who sign up for tht plan should be required to pay some reasonable fraction (5%?) of their income for coverage under it. I do not support a free plan, but I do support one that charges its premiums pro-rated to income.
March 26th, 2009 at 9:03 am
Nonsense, You write of the government as if it were some alien visitation. It isn’t. It’s made of human beings who are not in any significant way different from the human beings who staff Aetna. Human nature, and in the aggregate human intelligence, is the same everywhere.
Irrelevant. The difference is that the government does not make money by the same means that private companies do, so the incentive structure is totally different. When every cost must be either absorbed or passed on to willing consumers, with the caveat that too high a cost will result in losing customers, it is ovbious that there is no such thing as a free lunch.
When you can print or tax away the money you need, and it is quite difficult for people to leave the system so as to no longer be a paying customer, this effect is reduced and the “no free lunch” principle is obscured.
The fact that people are intelligent and are not aliens does not mean that the differeing incentive structures in government do not give people different motivations. In fact, you believe this yourself, it’s just that you look only at the areas where different motivations have positive effects, and ignore the possibility that there are negative effects as well.
March 26th, 2009 at 6:46 pm
Re: difference is that the government does not make money by the same means that private companies do, so the incentive structure is totally different.
The incentive for politicians is of course to remain in office. To do so they must keep the public reasonably content. This is not too terribly different from the fact that private businesses must keep their customers reasonably happy to stay in business. And I’ve said this before on this blog: My worst experiences with customer service have not been with public employees, where I’ve dealt with some sullen postal clerks and one a$$hole cop. No, my Hall of Shame is populated with the likes of certain fast food restaurants, convenience stores, Time Warner and Comcast Cable, and (winner of my Triple Tiara of Dung) Expedia.com
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