Call and Response

Karl Rove makes the five key arguments Republicans should use to fight a public option as part of the health care solution (with comments):

1) A public option is not necessary because there is already lots of competition. [This is a weak argument because the private market also has different incentives, namely, to deny coverage. The better argument is that proponents of health care should form a not-for-profit insurer; this in theory would allow for a more ethically-aligned industry that provided good care.]

2) A public option will undercut private insurers because they pay less. [This would seem to be a good thing, right?: if government can get away with paying less because it is effectively the largest insurer, costs come down for everybody. Just adding the uninsured alone would make this a powerful bloc for buying services, prescription drugs, etc.]

3) A public option would "crater" the private market since many employers would abandon plans. [Wal-mart and others have not supported universal health care out of a strong concern for employee health, so this is probably true. Of course, separating health care from employment might be a good thing. And employers competing for talent will offer supplemental coverage, as they do in countries with national plans: there will always be a two-tier system with faster access and premium care for those with more money.]

4) The public option is more expensive. [This argument alleges that the lower prices paid by Medicare to doctors and hospitals are effectively subsidized by private insurers who pay more. In any case, one thing Hillary got right last time around was that any move toward universal health should go hand in hand with a change in doctor liability. If we can reduce malpractice premiums doctors can make comparable incomes on lower fees, and maybe even enjoy their practice more.]

5) A public option puts the government between patients and doctors. [The Republicans' favorite bogeyman in the healthcare debate. It is true that the government will need to decide what services it pays for and how much it pays, just as they do with Medicare and as private insurers do (anybody with private insurance think their coverage is carte blanche?). Any insurance provider, public or otherwise, will always make choices on the relative value of services, period.]

So that's the Turd Blossom play book. To us the most astonishing thing in the whole piece is what is not said: there is no acknowledgement that the current system does not work for most Americans (especially in an economy when we are all one pink slip away from being uninsured).

Our ideas about how public health can be best served have evolved a lot over the last two years living in the U.K. The National Health System (NHS) is not perfect, but it is pretty damn good. And compared to a system that ties your health to great financial risk, and a good chance of being hung out to dry on needed care, it is sublime.