The Washington Post’s Ruth Marcus tackled health care reform in an op-ed this Sunday, and her article nicely laid out many of the key areas of dispute and offered some interesting ideas for compromise. But in doing so, she exposed the internal contradictions of those arguing for a “public plan” and why a public plan cannot be part of reform. Marcus writes:
Should there be a public insurance option? This is a question that evokes near-religious fervor and that could crash the whole enterprise. Republicans hate the notion of a government program because they fear, with ample reason, that it is a slippery-slope step to a single-payer program. Liberals demand a public insurance alternative for precisely that reason.
Potential solution: Have the public program abide by the same rules as private plans, so it has no inherent advantage.
But then Marcus writes:
What mechanism should there be to control costs? Specifically, should there be some kind of national health board to determine what benefits should be covered — or not? Electronic health records and comparative-effectiveness research are important steps, but not enough on their own to bend the curve of ever-increasing health-care costs.
Potential solution: Have a board that makes these decisions only for federal programs.
So which is it? Are we going to have a single set of rules which all plans have to follow, or are we going to have one set of rules for the public plan and another set of rules for the private plan and so push the entire system down the public plan road? Marcus reveals the gameplan and its problems for public plan advocates when she writes:
As with Medicare now, that ends up influencing private insurers’ behavior. … This opens the door to charges of rationing and government-controlled health care — and ads that make “Harry and Louise” look like “Sesame Street.”
Marcus is dead right: creating a public plan that will control costs by rationing care will inevitably lead to industry wide regulations that will ration everyone’s care. And proponents who portray it as merely just another plan in a fair competition are either disingenuous or know nothing about the way Washington actually works.
Fortunately, there is a better way.