Back to basics

BACK TO BASICS…. Sen. Chuck Grassley (R-Iowa) quoted Ezra Klein, out of context, this morning on the public option. It prompted Ezra to raise an observation that’s been common for months, but which hasn’t been repeated enough lately.

Let’s call this a back-to-basics moment. What do advocates of a public option think will happen if it’s included in the system? Eligible consumers will a) be able to choose a cheaper, Medicare-like alternative to private insurance; b) private insurers will offer better coverage as a result of competition; and c) both.

But that confidence rests on a very simple premise: The public sector does a better job providing health-care coverage than the private sector. If that proves untrue — and I would imagine most every conservative would confidently assume that that’s untrue — the plan will fail. The public option will not provide better coverage at better prices, and so it will not be chosen, and it will languish. Indeed, if it languishes, it will lack customers and thus lack bargaining power and economies of scale, and get worse even as the private insurers get better. In that scenario, the public option not only fails, but it discredits single-payer entirely.

The liberals are willing to bet that they’re right. It’s not a sneaky strategy: It’s an up-front wager. The conservatives are not, however, willing to bet that they’re wrong. They’re willing to say the public option will fail, but not give consumers the chance to decide that for themselves.

Exactly. One of the common criticisms from the right is that a public option would offer awful coverage — government-imposed rationing, long wait times, bureaucrats making treatment decisions, etc. But here’s the angle that often goes overlooked: if that were true, no one would pick the public option, private insurers would be thrilled, and conservatives would have nothing to worry about. If people are given a choice, no one would pick the nightmarish option.

Except, of course, conservatives don’t really believe that, or at a minimum, they aren’t willing to take the risk.

The public-private competition is something for the right to fear, precisely because they’re confident the private insurers would lose in a straight-up, level-playing-field fight. With this in mind, the goal is to protect insurance companies, even if it costs more, even if the treatments aren’t as good, even if consumers might prefer a better alternative.