Wednesday, July 22, 2009

Missing the Point of the Public Option

The following was written by guest author Sue Ann Orsini.

Tonight, President Obama gave a press conference to further discuss the health care reform initiative. (Transcript available here.) A question was asked regarding the public plan option, particularly on whether or not Obama would use his own Administration’s plan if his family members were sick, even if the plan didn’t offer all types of available treatment. The same question was posed by a doctor during ABC’s “Prescription for America” discussion held last Friday. And while the President fumbled his way through a mostly political response at both events, I wondered why he wouldn’t just say the truth – questions of this sort are meaningless and betray a deep lack of understanding about what a public option would mean.

Certainly, these questions illicit emotional responses, particularly fearful mob reactions to the word "socialism" that inevitably pops up when the public plan is discussed, and also anger over long-standing class-based complaints that the rich and powerful always get a better product. For me, asking whether or not Obama would use his public plan overlooks two very important issues. First, a public option may improve the health of the insurance markets by providing competition and regulation of the industry. And second, anyone who insinuates that the Administration’s public option will be the only option has obviously not read the text of any Congressional proposals.

The health insurance market is complex. It's not just composed of big name companies, like Blue Cross or Aetna, but a number of side-players, including Pharmacy Benefit Managers (PBMs), that actually have great influence on cost and sometimes commit outright fraud. Hardly any regulation governs these health care middlemen, and they are left relatively free to set prices. Such rampant manipulation hurts consumers and propagates an unhealthy market. Congress has been aware of this manipulation for years - the courts have, too. Major litigation occurred only a few years ago concerning pharmaceutical price-fixing. And just last Thursday, the Senate Commerce Committee held a hearing to address issues of competition in health care insurance. The public option would attempt to regulate the health care market by providing an alternative to private plans (keyword here is alternative).

As for my second issue, I wonder how many people running around screaming "Socialism!" have actually read the part of the recently introduced House bill concerning the public option. Nowhere in that bill text does it say that we will have to choose the public plan. Nowhere does it suggest that you can't continue with the coverage you have right now. The argument that a public plan will take away your choice and drive us down the road to socialism is a lie propagated by people who fear change. And to those people I would ask this question: Do you truly have a free choice now as to what kind of doctor you can see? Do you truly have a choice as to which treatments you can seek without paying through the nose?

My recent journey into the health care system tells the story - I hurt my back, was constrained as to which doctors, specialists, chiropractors, etc., that I could see through my insurance plan. I was constantly on the phone with my insurance company making sure as to what they would cover. And then, when I transitioned into employer-based insurance, I had to prove to that I'd been covered before in order to waive the "pre-existing condition" clause (something which would be forbidden by the current bill). I may be able to get insurance through my employer now, but I have no choice as to which insurance company I use. Adding a public option into this mix isn't going to make my lack of choices any more or less pronounced. It may improve things.

In the end, much of the discussion over the public plan amounts to nothing more than fearmongering disguised as rhetoric. Fearmongering gets us nowhere and rhetoric can leave a bad taste in the mouth. Check out the latest bill for yourself and come to your own conclusions.

Sue Ann Orsini is a law librarian that specializes in the legislative process. She works in Washington DC.

ALTERATION: on 23 July at 11:43 AM, the title of this post was changed.


  1. As a helath care professional, I agree with Sue Ann Orsini. Americans have not had free choice for a long time. Insurance companies decide which doctors they will accept and they have the last say to procedures covered and acceptable meds. I have spent hours arguing with these companies to have simple procedures ordered by MDs approved. Yet the cost continues to rise and the care is worse. Cindy

  2. If you do not think that the US Gov Obama med plan is what you and all of America is going to end up on then you must not have thought about it to much at all. First, when Obama Med puts your insurance company out of business because it can not compete with the Feds, who are you going to choose. That Question is easy to answer due to the fact that no insurance company is going to be able to compete. Once the Gov has complete control they can not only legally kill the unborn but also the elderly. They can limit care given to the lamb and lazy as well. If your child has a life time illness they can be put down by the means of limiting their care too.

  3. This is the same fear-mongering that prevents useful discussion over health reform in the first place. The very fact that you, "anonymous", can make the leap from 'competition in health care' to "the government is going to kill the unborn and the elderly" belies a desire to actually fix the broken system. If you cared about the millions of people suffering from problems in the system, then you wouldn't waste time on such scare tactics -- which divert attention -- in the first place.

  4. I agree with Kevin here. How can we have a meaningful discussion when people persist in throwing around fearful statements like yours, Anonymous #2? I'd like to know why you believe the insurance companies won't be able to compete? Where are you getting this information? From the insurance companies themselves?? No one actually knows what would happen if a public plan were injected into the industry. No one - we can speculate all we want (and think-tanks of all kinds have been trying). But we'll never know, we'll never fix anything if we don't actually try something! What's your idea?