August 30, 2009

A Public Option, Despite It All

Justin Katz

Sometimes a conclusion seems actively to grapple with the reasoning that precedes it. Such is the case with Michael Fine's Friday op-ed in the Providence Journal. Having complained of the rampant malpractice suits that current law allows, having lamented the "3 zillion government oversight agencies, having observed that "money distorts the public process of reform," and having acknowledged the power of lobbying public officials, Dr. Fine still concludes:

A few years ago, many doctors who thought they were self-employed realized they were working for health-insurance companies. If we are not careful, before long we'll all be working for health-insurance companies, and the U.S., as a nation, will be in a worsening economic mess.

That's why we need the "public plan." It ain't perfect, but it provides a way to control the power of the health-insurance companies and the other health-care profiteers while we provide health insurance for all Americans. We'd really be better off if we just focused on what works, and built a health-care system for these United States, but as Winston Churchill so wisely observed, the U.S. usually gets the right answer, after it has tried all the other ones.

Why doctors would rather work for the government than for insurance companies, Fine doesn't explain. Neither does he grapple with the necessity of defining "what works" with reference to the corollary "for whom." But he does, through it all, highlight the common purposes that exist between those who desire government-centered reform and those who prefer government-averse reform. Far from empowering insurance companies, the conservative prescription is to ease the opportunity for others to compete and to transition health insurance back toward true insurance, rather than the whole health management programs that the term currently describes.

Our nation does need doctors to be self-employed business owners, offering personal care to clients whom they can rightfully call theirs. That requires a shortening of the distance that patients' dollars must travel, and changing the path from employer-insurer-biller-doctor to employer-tax collector-bureaucracy-doctor moves in the wrong direction.