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.

White Man's Neutrality

Last Thursday, Steven Colbert (on The Colbert Report) used his conservative pundit spoof, yet again, to express through humor what most news media either miss, skew, or don't say outrightly. In this case, he performed another in his regular segment called "The Word" -- a satire of Bill O'Reilly's "Talking Points" -- in which Steven pontificated the claim that Supreme Court nominee Sonia Sotomayor's life experience is a scar on her record while all past (white) nominees' life experience was an asset to their qualifications as a judge. Using this ridiculous argument, Steven was pointing out the hypocrisy of those (in news media or politics) that focus on Sotomayor's pride in her life experience as a problem. Most delightfully, Colbert makes this argument using a comparison between the nomination and an ordeal over the color of Band-aids. I'll let you see for yourself the brilliant connection -- watch the clip below. (If the video does not show up, then click this link.)

This clip also had me thinking: pushing out material like this four nights every week, it must be exhausting to be a writer for The Colbert Report.

What Scares the Chinese Communist Party?

The past couple of months have seen events heat up (and then cool down) over internet censoring system in China, called Green Dam Youth Escort. This program is purportedly meant to protect Chinese youth from pornography, though many are concerned that the program could be used to expand surveillance or censorship. In May, the CCP (Chinese Communist Party) ordered that all computers sold in China have that software installed by 1 July. The ultimate result was a rare occurrence in national Chinese politics: on 30 June, the CCP retracted its directive. Actually, to be more accurate, they "postponed" the directive. In fact, a government official said that the CCP "will definitely carry on the directive on Green Dam. It's just a matter of time." But even if this does happen, it is questionable whether or not the directive will be enforced strictly.

Setting aside the distinct possibility that Green Dam will eventually be mandated on all Chinese computers, there is a more important question that bears on whether or not the directive is ever truly carried out: why did the CCP step back in the first place? In other words, what scares the CCP enough to so clearly reconsider their policy?

In short: the people of China.

The blowback against Green Dam came from both domestic (primarily netizens) and foreign (IT industry, governments, civil liberties groups) sources in China. But while some claim that pressure from the outside was important, I think that pleasing foreign audiences is only a bonus in the calculus of the CCP decision -- not the primary factor.

There are two particular reasons why Chinese citizens -- not foreign entities or foreign NGOs -- are most responsible. First, the reaction from Chinese internet users, who would be most affected by Green Dam, was powerful. This community of 300 million is a tremendous social force, particularly if a great number of them become unified behind an interest. And the CCP monitors internet chatter constantly, gauging reactions to certain policies. In the case of Green Dam, the CCP had overstepped a line. Chinese netizens saw it, at best, as a computer-wrecking software and, at worst, a threat to their rights. Most profoundly, an open letter was published by a group of anonymous Chinese netizens, in which they explicitly threaten the CCP:

"We hereby declare that we, the Anonymous Netizens, are going to launch our attack worldwide on your censorship system starting on July 1st, 2009."

The attack was never commenced. But the CCP also retracted its directive the day before the netizens' action was to take place. So it is hard to know for sure whether or not the letter was a bluff. In any case, the rejection of Green Dam by the Chinese public was clear. And as a one-party state, significant discontent of the people cannot be expressed through voting or organized lobbying. It can only be expressed through dissent. This is not a road down which the CCP wants to trek.

Second, in past events involving domestic civil liberties, foreign entities have had little to no leverage over the CCP. China and its government is now too large, powerful, and prosperous to be heavily influenced by other governments when it comes to domestic policy. The CCP knows full well that any threats of economic sanctioning are empty because most large nations are too intertwined with China's trade sector. And no amount of protest from the outside has ever changed CCP policy over, for example, forced citizen relocation for infrastructure projects and the Olympics, policy in Tibet, political prisoners, or policy in Xinjiang. (A caveat: governments or foreign entities that work to develop Chinese civil society can arguably have a long-term effect on grassroots pressure for change from within the country.)

Even foreign companies that were affected by the Green Dam directive do not have as much influence as some would like to think. Technology firms do business in China knowing very well that the government has myriad restrictions. But if and when the Green Dam directive is carried out, those companies will continue to do business in China for the same reason that they were there before the new rule: the Chinese tech market is huge. (And this is particularly attractive in a time when the world's previous champion of consumerism -- America -- is dealing with a deep recession.)

In addition to both of these reasons, Green Dam has been shown to be rather ineffectual, thus reducing the opportunity cost for the Chinese government.

The lesson here is that the CCP knows to whom it is primarily accountable. And those people are standing firmly within the borders of China. More accurately, many of them are probably sitting in front of their computers... blogging.