Op-Ed: Partisan Loyalties Obscuring the Debate for Health Care
The "public option" component of the Obama administration's push towards mandatory health care provision is drawing heat from critics. A lot of the complaints about the public option actually come from a misunderstanding of what the term means.
Having a public option does not mean that the government will be the sole provider of health insurance. Obama has not proposed doing away with private insurance; rather, he has proposed a public insurance plan that will provide affordable coverage to many Americans who are currently uninsured, and who cannot afford or obtain private insurance.
Many opponents to the public option call it "socialist" health care. They are confusing the public option with single payer health care, an system for health care provision that was really never on the table for the U.S. . The single payer system, which exists in many OECD countries including the U.K., Canada, and Australia, is a system where there is one provider of health care insurance (either private or public) who collects all health care fees and pays all health care costs.
Progressives know that a single payer system could never work in the U.S., given the political sway of pharmaceutical and insurance interest groups. Up until Obama's most recent address on health care, they were settling for the public option as the next best thing. Now that Obama no longer insists on a public option, those on the left are disappointed in him, and the provision of public health care has become less an issue on how to most efficiently provide it and more an issue of loyalty to party ideology.
In the partisan playground of American politics, it is unclear what the Americans want in their health care system when arguments for or against the public option are veiled in standard partisan arguments of more or less government.
I would argue that the U.S. has been the black sheep among OECD countries regarding universal health care provision because the question of who deserves health care and on what conditions has never strongly entered the debate. The real issue is: do we believe that all American citizens should have health care?
We know that at least 18% of Americans are uninsured. Private insurers are able to deny coverage to Americans with pre-existing conditions, forcing many to become bankrupt to bay their hospital bills. We know that our system of employer-provided health care is a product of history and not common sense.
So what's keeping us from changing? Could it be that we don't see health care as a universal human right? Do we, as Americans, think that if you can't pay for it you don't deserve it?
Many single payer systems in other countries have morality worked into the structure of health care delivery. In Canada, the abolishment of private providers ensures that all Canadians achieve the same amount of health care, and for better or for worse, most Canadians are proud of the equity principle inherent in their system. Some countries also distribute health care progressively. In Australia's Medicare system, the ethic is that "all Australians should contribute to the cost of health care according to their ability to pay."
Some countries are similar to the U.S. in that they have multi-payer systems - systems where both the public and private sector provide health care. The contrast is that in these countries there is a social safety net; a majority of citizens can access affordable, publicly provided health care if they need it. In France, 90% of all citizens are covered for basic services, and in Germany and Japan, health benefits are mandatory and co-financed by employers and the government.
Countries like France, Germany, and Japan show us that we can still offer a public option and have private insurers at the same time. The American health care debate is so mired in left versus right ideology that we can't understand what a mixture of public and private sector insurers could look like. We also aren't able to frame health care as what it should be: a public good.
As Obama said during his address on health care, "That concern and regard for the plight of others – is not a partisan feeling. It is not a Republican or a Democratic feeling. "Perhaps it will take nothing less than a moral invocation to get us past the partisan politics. When we soften the debate by thinking of real people needing care, then health care can be framed as a human right rather than a political stance.
