(09-04-2009 12:55 AM)CTRice10 Wrote: [ -> ]the general things I've been hearing is that one of the merits of the public option is that it mirrors what Congressman, federal employees, veterans, and seniors on medicare currently have. Maybe we're getting our news from different places, but I've seen townhall footage of people asking Senators and Reps why average citizens shouldn't be allowed to have the same healthcare options as Congresspeople, and why our elected Representatives are going out of their way to protect a private insurance system that they don't actually utilize (i.e. "if it's so great, why aren't you on it?!").
I believe you have been at least somewhat misinformed. I find this particularly troubling because, although we disagree on many issues, you seem generally to be intelligent and fairly well-informed, which makes me wonder--if people like you are this badly informed, how many people out there (on both sides of the issue) simply have no clue what's going on?
First, what congresspersons currently have is different from what federal employees currently have, which is different from what veterans currently, which is different from what seniors on medicare currently have. I am personally familiar with three of the four and have a general knowledge of the fourth, and no two are even remotely alike. None of the four is sufficiently like any of the other three that it makes any sense to talk about anything "mirroring" any two of them, much less all four of them.
Second, the public or government option would be a fifth thing, different from any of the other four. I'm guessing it would most resemble the VA system, which operates under the tightest budgetary constraints of the four alternatives and where health care is unquestionably being rationed currently to save costs.
Third, the congressional plan is really a basket of different private insurance plans (21, the last time I checked) from which congresspersons can choose the one that best suits their needs. Because of (a) heavy government regulation, particularly by the states, and (b) our current system of tying health insurance to employment, few if any in the world outside congress have that wide a range of choices. I heard yesterday that in California, because of heavy state regulation, there are only six plans available for employers to choose from statewide; that's admittedly anecdotal, and I don't have time to back it up, but that's about what I would expect intuitively. As an employee, you are further limited to those one or two options that your employer elects to provide. In effect, our representatives have access to a truly competitive private insurance market, to which the rest of us are denied access by state regulations.
So stating that they are protecting a private system that they don't themselves use has it exactly backwards; they currently deny us, and are seeking to continue to deny us, access to the truly competitive private system that they DO use, and are offering instead a government-run alternative (that will, in all fairness, get added to the bundle in the congressional plan, but I'd be willing to bet that few if any choose it). If you currently have a choice of two private plans selected from a group of six plans available to your employer, would you rather have a government plan as a different alternative or would you rather have an additional nineteen private plans in a truly competitive market? There are probably varying opinions here, but I'll take competition over government intervention any day.
What we have now might be called a private insurance system (your words) but is definitely not a competitive free market system. It is certainly less of a free market system, with more government intervention, than what France has (and I favor).
The French break health care into three components--primary care, elective care, and catastrophic care--and handle each separately. Catastrophic care is the one area where the government is directly involved; you have a cancer or AIDS and run up some threshold amount of cost, after that you're on the government nickel. This is probably a reasonable role for government since they have the deepest pockets, and being relieved of this exposure gives private insurers some freedom to offer more creative and competitive coverages. In particular, it eliminates a lot of pre-existing condition issues.
Primary care is universal, but there is no government agency like National Health Service. As a generally free-market economist, I can justify universal primary care because of the neighborhood effects. If I can afford health care but you can't, and my kid sits next to your kid in school, are my kid and I both better off if your kid has access to basic checkups and vaccinations? I think so, particularly if it can be handled in the private sector like the French do. What they do is to collect enough through their social security system to fund about $3400 per capita per year, which is turned over to a consortium of insurance companies, in exchange for which the insurance companies provide everybody an access card (I think it's green) to what I'll call the "free" system. It's not really free--there are some fairly heavy co-pays to discourage overuse--and it's not really good--somewhere between the VA and a really bad HMO in US terms--but it is universal. Unlike NHS or Canadacare, which try to be comprehensive but inevitably fail, necessitating quotas and queues (and, yes, some of those effectively become death squads), the French free system is intentionally designed to force quotas and queues in order to hit a cost number.
When you get quotaed out and forced to the queue, that's when elective care comes in. You can wait on your quota. Or you can go to the "pay" side and pay a private doc to do it today. Or you can buy private insurance that covers access to the pay side when you need it; coverage tends to be cheap, primarily because this is a very competitive market and it's basically supplemental coverage. Or your employer can provide private insurance (and the vast majority do, in order to get injured workers back on the job quicker). Or you can pay extra for a Cadillac version of private insurance that doesn't require you to go through the "free" side gatekeeper. I don't think the French have medical savings accounts, but they would work well with this model.
Over 90% of the French have private insurance; they don't want to get stuck in the free system. That's considerably higher than our percentage. And remember, they have universal care, we don't. And their government spends about half as much per capita on health care as ours does. The administrative costs under this system are very low. Because they are a civil law jurisdiction, they simply don't have the same jackpot jury awards and resulting malpractice costs that we do. They are currently experiencing some controversy between those who would like to see the basic coverage expanded to something like NHS or Canadacare and those who want to keep a lid on costs. There is a strong national disdain for "socialized medicine," so the cost controllers will probably win in the end.