The Problem Without the Public Option

To understand why so many were fervently against the removal of the now notorious public option, hindsight is the best teacher. The worst part of the new health care legislation is its mandate to purchase insurance or face financial penalty. Insurance mandates in and of themselves are nothing new. States mandate at a minimum liability insurance on vehicles because the use of vehicles carries inherent risk. Homeowners’ insurance is also mandated, again because of the inherent risk—not necessarily for the owner/occupants, but for the mortgage holders and in some ways communities. From a public health perspective, which should really be the primary perspective in controlling and reducing health care costs, risk protection strategies and mandates are necessary and long overdue in the US.
When someone without insurance exhibits risky behavior through poor diet, sedentary lifestyle, reckless motorcycle use, or heck let’s face it just living within our crime ridden nation, and they visit the emergency room instead of seeking care from a primary or urgent care facility, the public pays dearly. The government already pays the tab on 42% of health care costs, anticipated to reach 50% within a year without reform. So something had to be done. In the US we practice curative care or care after the fact of disease or chronic condition onset. Other nations with healthy universal coverage systems devote more resources to preventive care and spend a smaller percentage of their national budgets on health care. Because we invest very little and have no comprehensive or organized system to incentivize preventive care, we pay the cost in much more expensive curative care.
The public option as part of the current legislation would have worked to curb costs in the long run more effectively than the legislation that passed because it would have modeled successful systems in other nations which provide public universal coverage with options to purchase additional private insurance for perks like private rooms (in the US we don’t like being told to share, we believe that passive sharing through checkbooks is enough). With the public option, the insurance mandates would not have been the burden that they are likely to become. However, the insurance industry flexed some muscle and in this capitalist economy cried “unfair”. Well, life isn’t fair, but opportunity should be equal. Capitalism in the US requires entities to compete among both public and private. The Germans manage a successful universal system with a much older population and are much happier than with it, spending quite a bit less than we do. Of course the propaganda machines rarely if ever mention Germany or Japan; only Canada and the UK are mentioned usually with only anecdotal references.
To understand this, one must examine cultural differences, a lengthy examination no doubt, but the nuts and bolts of it are that the US is a staunchly individualistic society that prides itself on individual achievements over collective ones intra-nationally. Collective achievements are only lauded internationally. Is the reform an expensive endeavor? Yes. The debt was already on pace to be catastrophic and would have cut into defense and capital projects budgets without reform sooner than it will now. The insurance mandate without the public option is a bad idea, but with our pay per procedure (capitalist) medical system, we will be paying through our you know whats anyway. Rationing already occurs in the fact that those with less money and little to no insurance do not receive the same level of care as those with good insurance and/or money. Moreover, the public option along with mandates or incentives to reduce or eliminate the practice of pay per procedure, would effectively reduce costs in the long run.