Everyone labels their proposals “reform,” which is an empty label. You can’t be “for” or “against” reform until you know what the reform is (unless you’re 100% satisfied with the status quo, which few people are). Here are just three worries that occur to me and that have not been widely discussed in the media.
1. The term “public option” is a very clever neologism for socialism. That’s not a smear, just a simple statement of fact. It is a proposal for a state-owned medical system, a concept that most people find repulsive, until you dress it up in a new label that combines two attractive terms and was the result of extensive focus group research. But it’s a proposal for a state-owned and managed health care system.
2. It is absurd (maybe even “a lie”) to claim that it would be funded entirely from the premiums of those who freely elect to join it. The political dynamic should be clear. It will run a deficit, probably from the first year, and the political system will generate a clamor to ensure that it does not go under (leaving all those people without care!), so that deficit will be made up for with taxes, whether from general revenues or a new tax. Once it’s financed with tax revenues (which is inevitable), it will be hard to insist that only those who also freely elect to pay premiums should have access. Involuntary tax financing (a redundancy) will grow as a percentage of the financing. In a relatively short time, people will find themselves paying twice for health care, and private insurance (set aside that we don’t have a “health insurance market,” but a highly regulated and controlled and restricted market in pre-paid health care plans) will be increasingly crowded out.* It is a path to increasing state control, not “another option” or “competition for the insurance companies.”
3. Rep. Joe Wilson’s outburst during the president’s speech to Congress was a warning of what I fear will be the outcome of the interaction of the American “right” and “left” on this issue. We will get a state health care system that will increasingly crowd out the private sector, and, to placate the nativist right who fear immigrants getting access to that system, we will also get a national identity card system. The state will expand its power dramatically.
*See the history in other countries. A good history is David Green’s Working-Class Patients and the Medical Establishment: Self-Help in Britain from the Mid-Nineteenth Century to 1948.