Public Option? What Public Option?

Last week in the comments, E.D. noted that the more liberal and Canuck of the League’s contributors hasn’t offered much in the way of analysis around the current red hot health care debate. Earlier, I offered my own sense of bafflement over the inability for American health care debaters to have a realistic discussion about reform that actually looks at a single payer system in something approaching sensible terms and noted how many of the tropes involved in that subsection of the debate strike simply incongruous postures vis-a-vis my own life experience.And look, it’s just hard to sit down with the relatively sparse amount of free time that one has at one’s disposal and look through the particulars of the HR3200 v. Wyden-Bennet plans when neither plan’s options will be available to me.

But the broader context of the debate is something I’ve found pretty interesting to follow and in doing so I’ve noted how much the ontology of that context strikes me as largely contrived — and thereby leads to a fairly contrived debate.

Take for example the screaming dissidents of the proposed Obamacare reforms.

I mean, don’t get me wrong, I appreciate the impetus of citizens to take an acute interest and role in the machinations of their government and, indeed, have argued for the necessity of a more engaged citizenry. But I’ve also always called for said engagement to be of a higher standard of critical analysis than we generally obtain in these kinds of debates.

The essence of the complaints being volleyed seem to be that Obamacare represents a massive expansion of and take over of government’s role in the lives of American people. Which is all fine and well, except that I have to wonder where these folks were when George W. Bush presided over a similar, if not much more covert, expansions of government.

The response, of course, is that those were different circumstances, which might account for their lack of enthusiasm in 2001-2002, but does little to account for the deafening roar of their silence in the proceeding six years. Maybe I’m just becoming a little too jaded, but those kinds of inconsistencies stick our for me and make it hard for me to take the attendant fervor as much more than the thin veneer of partisan kabuki, as has been adequately and more eloquently expressed by a host of other voices.

But in taking much of the uproar in that fashion, it also strikes me how many unsubstantiated tropes are at play about the very nexus of discussion: the benefits and costs associated with privatized health care as opposed to public health care.

One such trope that grates as particularly glancing in its understanding is the notion that, by definition, publicly funded and government administered health care is bloated, inefficient, and poorly run, whereas privately funded health care administered by health insurance corporations is tightly run, well maintained, and as efficient as possible due to the nature of markets.

Don’t get me wrong, I’m not an anti-capitalist zealot by any means, but to think that, by definition, corporations and insurance companies are efficient and non-bureaucratic just flies straight in the face of experience. In fact, the larger a corporation gets the more, by definition, bureaucratic it gets, because large structures need well defined guidelines to maintain their operations.

There is no intrinsic difference between this principle at play in governments and corporations, except that in US political discourse it has become the accepted norm to trust what corporations and CEOs say on the matter. This point was made quite keenly by former IMF economist (again, hardly  a raving pinko) Simon Johnson regarding the financial industry in his widely regarded piece for The Atlantic, The Quiet Coup.

In that piece, Johnson noted,

[T]he American financial industry gained political power by amassing a kind of cultural capital—a belief system. Once, perhaps, what was good for General Motors was good for the country. Over the past decade, the attitude took hold that what was good for Wall Street was good for the country. The banking-and-securities industry has become one of the top contributors to political campaigns, but at the peak of its influence, it did not have to buy favors the way, for example, the tobacco companies or military contractors might have to. Instead, it benefited from the fact that Washington insiders already believed that large financial institutions and free-flowing capital markets were crucial to America’s position in the world.

I would offer that this cultural capital-cum-belief system c ontinues to extend well beyond the corridors of Wall Street and finds its reach every bit as influential as pertains to a whole host of pervasive issues littering American life. Which is not to say that corporations should inherently be mistrusted, but rather is to note that these powerful institutions a.) have a particular perspective and an attendant set of interests and b.) that the analysis they offer on a variety of issues is therefore limited and needs to be taken with a grain of salt.

As a fly in that ointment, a study of some years ago demonstrates how the myth of private health care aerodynamics may not hold up to scrutiny once applied.

Reported by Medical News Today,

The U.S. wastes more on health care bureaucracy than it would cost to provide health care to all of the uninsured. Administrative expenses will consume at least $399.4 billion out of total health expenditures of $1,660.5 billion in 2003. Streamlining administrative overhead to Canadian levels would save approximately $286.0 billion in 2003, $6,940 for each of the 41.2 million Americans who were uninsured as of 2001. This is substantially more than would be needed to provide full insurance coverage.

(Read the full study here.)

By citing it, I’m not suggesting that the study provides a silver bullet answer on the side of a public option to the health care debate. As anyone living under a single payer system will tell you, there are problems with such options. But look, the fact of the matter is that health care, due to the scope of the proposal with which you happen to be dealing, is an inherently bureaucratic proposal. The question one needs to be weighing is whether one would rather deal with government or corporate bureaucracy. Both are going to have their distinctive upsides and downsides.

But what the revelations of studies like this do reveal is just how skewed the health care debate in America is to the point where one can’t even have that debate because it is taken as gospel by most that a public option simply isn’t an option at all. And as much as I respect all of the contributors here, it strikes me as naive to believe that the influence in shaping the debate on health care by the very moneyed and powerful institutions that some of our more substantive contributors on the issue openly oppose hasn’t found its way into these hallowed halls undetected and unacknowledged.

To be sure, the debate about health care reform is a desperately important topic for millions of Americans and for the country as a whole. I wish I could look around and say that you were engaged in that debate with all of its facets clearly on the table and every player openly acknowledging those realities, but to date I remain unconvinced.

Update: Nate Silver over at FiveThirtyEight.com has a handy dandy explanation of how people tend to mix up single payer health care in Canada and socialized health care in the UK, with illustrations:

As well as some polling demonstrating that while the health care debate can’t stomach the idea of actually contemplating a singler payer option, at least 50% of Americans actually support the idea when it’s explained to them,

See? They’re actually pretty different!

It turns out that when you take a poll, most Americans don’t want the government to provide health care coverage. But the idea of government providing health care insurance: a lot of folks think that’s a pretty swell idea!

Related posts...

• In Praise of Jane Hamsher, et al: Redefining the Art of the Possible
• Thought for the Day
• Through the Looking Glass: The Health Care Debate from a Doctor’s Perspective

Tags | administrative costs, bureaucracy, coprorate influence, debate, efficiency, Health Care Reform, private option, public option, Simon Johnson, town hall meetings