synthetic zero

August 22nd, 2009

I understand the reaction on the left to the potential demise of the so-called “public option”; the sentiment is it’s an unconscionable retreat and one which could dramatically reduce the government’s leverage in holding down ever-rising cost increases in health care in the future. We’ve all seen the statistics; the United States spends roughly twice as much on health care as every other industrialized nation; our spending has risen from 6 percent of GDP in 1960 to 16 percent now; we spend more on health care than on food. Despite this, our health care outcomes are, taken as a whole, mediocre; and while we do well in certain areas, such as cancer treatment, so do Canada, Japan, Australia, and France, all of which spend just over half what we do per capita on health care. Clearly, a single-payer system has the best potential to dramatically reduce health care costs in the long run.

But, as we’ve seen, single payer appears to face intense resistance in the United States, and even if it could pass, it might mean the demise of the Democratic majority in the next election. So, is the “public option” the next best thing, a way of keeping the private insurance companies honest? On the surface, it may seem so, but we should keep in mind that the public option that was being discussed was going to be highly restricted; it was going to be available to people without health insurance, but wasn’t going to be available to the vast majority of Americans.

A strong health care cooperative, however, could in fact compete openly for anyone’s health care dollars; if it operated on a national level, had a large enough position to be able to negotiate effectively, and was operated on a not-for-profit basis, it seems to me at least in theory it might actually be better than a “public option” with heavily limited eligibility (as has been discussed). Furthermore health care cooperatives would eliminate the main Republican talking point, giving them less political ammunition. I do believe a robust single-payer system with the possibility of optional, private supplemental insurance would be better than either, but a highly limited public option might actually be worse than a set of well-run health care cooperatives. Just a thought.

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