Public Option a Good One?

In a discussion dominated by mindless bickering, it's always refreshing to read a legitimate opinion. The health care debate has become just such a discussion. Fortunately, there are always those who actually spend time thinking about the issues rather than digging up information on who receives money from which lobbying firm. I think Roger Cohen of The New York Times might be just such a person. His editorial, "The Public Imperative", makes an interest case for a public insurance option.

The opening argument is an interesting twist on the old Ad Populum argument that, because the rest of the developed nations of the world have some form of universal health care insurance plan, the United States should as well. While the author's core argument isn't reliant on the fallacy, it still succeeds in setting a negative tone towards the conservative opposition. I'm not terribly surprised by the fallacy's use here, as it is one of the most common arguments used to support health care, especially by those who either are, or are in regular contact with citizens of another developed nation.

After some discussion of the wastefulness of the United States' health care system, Mr. Cohen finally starts talking about his core point, that the United States should have a public insurance system. This point is made entirely clear in his fourth paragraph, where he says:

Whatever may be right, something is rotten in American medicine. It should be fixed. But fixing it requires the acknowledgment that, when it comes to health, we’re all in this together. Pooling the risk between everybody is the most efficient way to forge a healthier society.

Trying to avoid immediate talk of a public option this early on, the author speaks of it in terms of "Pooling the risk". This pooled risk is exactly what insurance is, and his inclusion of the word "everybody" makes it clear that he's talking about a national insurance system, which is to say one that most likely resides in the public sector.

His first support is an appeal to a sort of public interest or good. By saying that we're all in this together, he infers that health care reform is in the public interest, that is to say that it is an interest held by all, and not just an issue for a small subset of the population. This is another common argument among liberals, however it's not entirely valid. While not being a logical fallacy, any serious study of political science quickly shows that the argument appeals to something that does not exist. There is no such thing as a public interest, just private interests. The reason is that interests are entirely subjective. It may be in my interest to save money by not paying for health care insurance. That doesn't mean that it's in the interest of any else to do the same. My values are entirely my own, and do not necessarily conform to any normative set of values. To assume that there is one interest held by all is incorrect.

His second supportive statement appeals to an increase in the efficiency of the health care system. He is correct in that larger risk pools lead to a more efficient insurance system, as the overall cost of health care will become closer to statistical predictions. This would theoretically allow the insurer, whether public or private, to lower rates because there would be less of a need to buffer against statistical anomalies. However, as the risk pool grows, it reaches a point at which further growth will produce only trivial cost savings. Since it is very likely that at least a few of the biggest private insurers have reached this point, this argument by itself is insufficient to support the idea of any real increase in efficiency. The author later strengthens the argument by saying that a public insurance option would create competition for the private insurers. However, this also has flaws. If competition is the goal, one should eliminate current anti-competitive laws from the books before considering a public option. This is especially true due to the fact that public non-for-profits tend to have a significant competitive advantage over private-sector businesses. Effectively, a public insurer is more likely to take over the market than it is to cause competition due to the fact that it doesn't have to worry about profits. If competition is the goal, allowing people to buy insurance across state lines would be far simpler and cheaper than creating a public insurance option.

Another interesting argument represented in the editorial is that health care is a moral imperative. This argument, to some extent, return to the idea of a public good. It tries to represent health care as a fundamental right, much like the rights to freedom of speech or freedom of religion. Again, these are his values. The problem comes when trying to make everyone else have those same values. Since the author is primarily trying to appeal to progressives, his values may very well correspond with those of his audience. However, this does not mean those values are mainstream.

There is no doubt that there are serious problems with the health care system in the United Sates. As Mr. Cohen pointed out, the statistics clearly show that our system of health care is not as efficient as those of other wealthy nations. However, that does not mean that we need to adopt the form of health care insurance used in other developed nations. Removing restrictions on the sale of insurance across state lines would go a long way in increasing competition. Lessening the government's role in economic processes would encourage insurers to be more competitive in the insurance business rather than in the lobbying business. Allow the market to work properly, and survival of the fittest dictates that the system will become more efficient on its own.