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Public option will weaken health care protections

Michael Eisen, Professor of molecular and cell biology | October 24, 2009

I understand all of the reasons people favor a strong public option in the health insurance reform bills percolating through Congress, and I know that it’s an apostasy to say so, but my recent experiences with the health care industry make me deeply concerned about the public option.

My wife recently had a baby – born at 2:00 AM. By the middle of that day – less than 12 hours after the baby was born, it was clear that the hospital wanted us to leave. But my wife wanted to stay – and the hostpital couldn’t send us home because federal law requires hospitals to let newborn mothers stay for at least 48 hours and insurers to pay for it.

What does this have to do with the public option? This law that gave us that 48 hours was passed by Congress in response to cost-driven abuses of the insurance industry. Its existence highlights the important role that legislative bodies play in setting limits on the natural cost-cutting efforts of insurers. We get these laws because such protections are popular and – crucually – they don’t really cost legislators anything to enact.

But if there is a public option – especially a large and successful one – I worry that this dynamic will be altered. And while the public option is supposed to be financially independent – I don’t really believe that will happen. And so the the government will have a financial incentive to minimize costs in a public option and Congress will now be conflicted – and will inevitably shun even  popular patient protections in the name of saving money. And then who will be there to step in?


Comments to “Public option will weaken health care protections

  1. As a UCB alum of the Public Health School and PH professional for over 20 years, I am frankly quite surprised to hear an argument against a public option formulated around a story of your wife getting more care than she desired. This is hardly the case for many people, who like me, have been capriciously and arbitrarily denied benefits from private insurance because I’d maxed out onwhat they decided were my “allowable” benefits. Let’s not forget that private insurance takes an average of 31 cents out of each dollar for profits and administrative costs–Medicare can do it for less than 10%. Private insurers’ primary legal obligation is to their shareholders, not to their customers. Recent studies have validated that most “non-profit” plans closely mimic the business practices of their for-profit peers. A public option is just that, an option. Anyone who can find private insurance that they like (and can afford) should stick with it. Most people don’t realize how inadequate their coverage is until they have a real need. Talk to my mom with MS; it might be a real eye opener for your to understand the awful things that private insurers do to get out of their obligations. A public option is a refuge we desperately need.

  2. Phillipe – I support, in the abstract, the idea of a national health system. But the reason such a system works as well as it does (which, fwiw, is far from perfect) in France and other European countries is because there is a national political consensus that supports the high tax rates required to sustain the system. But we live in the US and not France, and – whatever you think of the merits of such a system, you can not deny that the political consensus needed to create it here clearly does not exist. So, I worry that a government health program would be chronically underfunded, and that price pressures on this system would induce lawmakers to relax patient protections on both the public and private insurance systems.

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