We're hearing disturbing hints lately that the Obama administration will, or may be forced to, drop its insistence on a government-sponsored insurance program as part of the overall remedy for our health care system. Obama himself has restated his determination to include a government option, but others like discredited former Senator Tom Daschle are murmuring that the reform effort is too important and too timely to be allowed to fall apart over any one issue.
Meanwhile, insurance and pharmaceutical companies and their stalking horses in Congress continue to insist that the government option is a deal-breaker, or in the words of another has-been Senator, Bob Dole, "dead on arrival." Some analysts, not just on the right, have this little red herring on a hook halfway down their throats and have begun to argue for "compromise" on this issue.
The problems we're now facing have resulted from a system in which we relied on the private sector. It brought us skyrocketing costs, 40 million uninsured, severe treatment disparities based on income, and a not-very-healthy population. Proponents of the private sector generally tell us that business can deliver anything more efficiently and at lower cost than the government, even when they're taking profits out of it. That's true up to a point - the point where people need basic services but can't afford them (or get second-class care for other reasons). If we were to enact revised rules on health care without a government option, how would that basic equation change?
If the private sector is truly so efficient, why on earth would they fear competing with a stodgy ol' government program? Basically, because the preferred and most profitable business strategy is not to compete at all, if you don't have to. A no-frills government program at an honest cost would tend to set a standard against which private policies could be judged. Presumably, the more efficient private sector could offer something similar at a lower rate, but profit margins would be slimmer. A government program offering a handful of limited but understandable options would make it more difficult for for-profit companies to roil the waters with the welter of confusing, hard-to-compare options that they find so profitable.
Politics is the art of the possible, the art of compromise. Yet I must agree with E.J. Dionne that the major compromises have already been made. The idea of a single-payer, all government program isn't even on the table (even though some politicians continue to try to scare people with that prospect). No one is suggesting programs that "won't allow you to choose your doctor," though that IS the model for most private sector HMOs. (Incidentally, if a government plan wouldn't allow you to choose your doctor, and people really want to choose their doctors, wouldn't that be another inducement for them to go private?) Moreover, the private health care industry is being handed 40 million new customers on a silver platter; they can't wait to get their hands on them, but they sure don't want anybody setting any bothersome new restrictions on how they deal with those customers.
Up to now, the big private-sector players have been the problem; they say they want to be a part of the solution but haven't brought much to the table beyond some vague promises of future savings. I can't imagine an effective fix that doesn't include the government option. What if the government option were dropped but with strong, enforceable controls and regulation of all private policies? I have a feeling that Sen. Dole would declare that option even deader on arrival.
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