A Public Option Is Not the Boogeyman

As a pediatrician reviewing objections to the inclusion of a public insurance plan in health reform, I can’t help but think of a few of my young patients who have suffered from nightmares. Their parents brought them to clinic, concerned about the quality of their sleep, and the harm these bad dreams were having on their psyche. There are no quick fixes to cure nightmares, but they can be treated, and the process has special relevance to the current health reform debate over a public insurance plan.

First, a person with nightmares needs to be reassured that what she saw and heard was not real. There is no monster under the bed. A similar point needs to be made about the misconceptions around a public insurance plan. One of the biggest fears is that it will put the private sector of health insurance out of business. This is simply not true. We have examples of public agencies and private businesses offering similar services to the American people, and both exist side by side. FedEx, UPS, and DHL are not at risk of disappearing because the US Post Office can also send letters and ship packages for the average American to any destination around the world. A public plan for health insurance will have lower administrative costs than plans offered by the private health insurance cartels, which will have to ask, answer, and act on the question: “Are we getting the best bang for the buck?”

Protectors of the private health insurance industry ask why any American would choose a private plan when they could go with a cheaper public option. Under this line of reasoning, none of us would be driving a Mercedes-Benz when a Toyota Camry can get us from place to place. In a CBS News poll done last week, over 900 Americans were asked the following:
"Suppose the federal government offered a public health care plan that anyone could join at any age. What would you probably do? 1. I'd definitely join the plan. 2. I'd probably consider the plan, and compare it against my private insurance options. 3. I'd probably consider the plan only if I had no other insurance options. OR, 4. I'd probably never join the plan."
Here are the results:

• Definitely Join: 12%
• Compare against private options: 43%
• Consider only if no other options: 31%
• Probably never join: 11%
• Unsure: 3%

So most Americans would shop for a plan, meaning that the private health insurance companies will have to do a little something they haven’t done in a very long time. They’ll have to compete. Given that competition kills cartels, it is not surprising that the health insurance industry opposes a public option.

Coming back to the subject of nightmares (or maybe we never left it), to help a patient, her family must be honest about the real stresses happening in her life. Family members who are in denial about a patient’s problems, or who block resolving those problems because of an unwillingness to change, make the already difficult recovery process that much harder. In the health reform debate, critics of the public insurance plan claim that our flawed system is better than introducing any government efforts, wherein a public option would allow government bureaucrats to ration care.

Not only is this argument wrong, but the American people should also remember that the corporate bureaucrats in the private health insurance companies always ration care, first by income and then by illness. Screening patients for pre-existing conditions might become a thing of the past with some of the legislation under construction, but thousands of Americans have been the victims of rescissions, which the health insurance companies told Congress under oath they have no intention of even limiting, much less ending. The opponents of a public option must think sick Americans are doing just fine as they gamble their health and their family’s finances in Russian roulette games against the private health insurance cartels.

Some members of Congress are also spreading the fear that a public option would disrupt quality and research in medicine, pharmaceuticals, and biotechnology. But if that were really the case, then how do we make sense of the Veterans Health Administration? The VHA cares for over 5 million Americans (without rationing), and the overwhelming majority of them have been happier than private health insurance customers with the quality of their health care. The American Customer Satisfaction Index has proven it year after year. Furthermore, thousands of VHA hospitals partner with academic medical centers, contributing to cutting edge research for the betterment of all Americans. These unsung success stories can serve as a wake up call to those who are unaware of the possible benefits of a public option.

A public plan for health insurance is not a panacea, but it is more than a band-aid in reforming American health care. 18,000 Americans die every year because of a lack of health insurance. A public option is thus a vital first step, and it is supported by over 70% of Americans. We should applaud President Obama and many members of Congress for their efforts, but they cannot go it alone. It is time for other Senators and Representatives to support that work. Our problems will not go away with a pat on the head and a glass of water.