Friday, September 18, 2009

Now Is the Time to Support the Public Option

In late July and early August -- before the farcical theater of the town hall meetings had degraded the public debate on health care to lows previously unseen in this country -- I argued (here and here) that progressives who favor the adoption of a single-payer health plan should not automatically support the Public Option as the next best approach to universal care. The standard argument at that point was that there were three choices: single-payer, the Public Option, and a better-regulated private insurance system.

With single payer unfortunately (and, I would suggest, unnecessarily) having been ruled out of the debate, the choice between the two remaining alternatives was supposedly simple: anti-government conservatives would prefer the non-Public Option aspects of the extant health care reform proposals (elimination of "pre-existing condition" exclusions and other reasons to deny care, enactment of universal mandates to buy coverage, and subsidies to allow lower-income people to satisfy such mandates), and progressives and liberals (who are not "pro government" -- a term with no meaning -- but who do not reflexively believe that the government is per se worse at everything than private actors are) would gravitate toward a plan that includes a non-profit government-provided insurance plan that would be available to everyone.

My argument was two-fold: (1) The advantages of single-payer health care, especially low administrative costs, do not automatically carry over to a Public Option, and (2) Political realities would so limit the Public Option that it would (unfairly but almost certainly) become an under-funded poster child for failed government-run health care.

Underlying that argument was the assumption that the non-Public Option alternative would be a plan that would actually force private insurance companies to change their behavior, to create real competition among private insurers in regions where currently no competition exists, and with real enforcement mechanisms. If the Obama administration had negotiated well, they could have essentially given their opponents that choice: an entirely private system that no longer abused patients, etc. or competition from the Public Option. Because of the fierce opposition among conservatives to anything run by the government, such a hard bargain seemed quite achievable.

Now we have the bad joke known as the Baucus plan, which essentially gave away the store with no concessions received in return. Let's call that Choice #4, after single payer, the Public Option, and effective regulation. With single payer even further from the table, and with no effort having been made actually to design a set of rules that would rein in the worst aspects of U.S. private health insurers, we now are down to a choice between a straight giveaway to the health care-industrial complex or a Public Option. The only real choice for anyone who cares about improving health care outcomes at this point is to support the Public Option and then to do everything possible to prevent the outcome that I predicted in my earlier posts.

This, of course, should not be the set of choices with which we are faced. When our leaders squander the best opportunity for real health care reform in a generation through inaction and a willingness to ignore the will of the vast majority of the public (to say nothing of the people who actually voted them into office), however, we have to make do.

-- Posted by Neil H. Buchanan

21 comments:

Josh83 said...

Professor Buchanan:

It's very, very hard to believe this post was written by a law professor.

" . . .before the farcical theater of the town hall meetings had degraded the public debate on health care to lows previously unseen in this country"

" . . .a willingness to ignore the will of the vast majority of the public"

Does your Dean know you are writing gibberish like this?

You are such a hardline zealot, I doubt you personally even realize that such loaded--and inaccurate--statements undercut the credibility of your arguments simply because they fatally undermine your own credibility.

Do you only associate with other Hard-Left zealots, and such accounts for your lack of perspective?

Or are you not getting enough meat in your diet?

Joshua

Michael C. Dorf said...

Josh83,

Perhaps you should also write to Paul Krugman to ask whether the Chair of the Princeton economics department is aware that he too is a left-wing zealot spouting gibberish.

Josh83 said...

Professor Dorf:

Alas, I have news for you: Andrew went to Princeton, and studied economics there, and is very well aware that Krugman—to put it as gently as possible—is very, very, very controversial within the Princeton Economics Department. At least half of the Department dismisses Krugman as a nutcase—but I suspect that such fact is already known to you, Professor Dorf, as you are similarly controversial at Cornell.

While Krugman’s one-man attempts to revive the theories of Keynes are undeniably amusing, at least as set forth on the pages of The New York Times, no one but zealots pays him the least mind. Have you heard anyone not from the Hard Left do anything but snort when Krugman’s name is mentioned? The man is a Trollope character, a modern-day Quintus Slide, his columns fit only for The People’s Banner.

If Krugman were not such a rigid Leftist, always pronouncing the same things, no matter what the environment—and I refer you to his books published in the 1990’s—he might perform one valuable service: address The Austrian School’s 1930’s dismissals of Keynes, and analyze why The Austrians were wrong.

Joshua

Michael C. Dorf said...

Josh,
I see what you mean about Krugman being shunned by his colleagues at Princeton, as for example, in the press release at
http://tinyurl.com/mcupz4
I aspire to be that controversial.

Now, to move away from sarcasm, given that you're dismissing anyone left of center-right as a left-wing zealot, I do appreciate your reading the blog. And I mean that sincerely. I appreciate engagement from people with other viewpoints. I just ask that if you choose to comment in the future, you'll actually engage with the substance of what bloggers say, rather than calling them names or simply proclaiming that everyone serious agrees with you in dismissing those with whom you disagree. Over the years I have had excellent comments on this blog from people on the political right who actually do engage.

And to anticipate a response, yes, the two lines you quote from Neil's post do make mere assertions about some of the opposition to health care reform, but the bulk of his post consisted of reasoned analysis. You are certainly entitled to disagree with that analysis, but if so, do so with reasoned analysis of your own. I honestly mean that as friendly advice.

Robert said...

The hardline leftwing zealots George Will and David Brooks found the town hall meetings, along with the demagogues orchestrating them, farcical too. They use such words as "crazies" and "insane." See, e.g.: http://hotairpundit.blogspot.com/2009/08/david-brooks-calls-town-hall-protesters.html

Center-left icon Anne Coulter holds similar views.

Ample nonpartisan polling data -- among the many, see, e.g., Pew: http://people-press.org/ -- indicates that Professor Buchanan is facually correct about the vast majority of the public's preference concerning single payer.

As it happens, the data also indicates that the vast majority of the public is disgusted by the unreasoned rancor coming from the right. On this point it shares, in other words, the opinion of the lefty anarcho-syndicalists George Will and David Brooks.

Let those who have ears, hear. Let those who have eyes, see.

Drew80 said...

Let those who have brains, think.

Drew80 said...

Uh, Robert, the most recent Pew survey I could locate on the issue of health care reform, dated September 17, two days ago, claims that 42 per cent of persons surveyed support health care reform (with 29 per cent strongly in favor of health care reform) while 44 per cent of persons surveyed oppose health care reform (with 34 per cent strongly opposed to health care reform).

That particular Pew survey is more-or-less in line with other surveys I have encountered--and hardly supports your bold claims (or Buchanan's, either, for that matter).

Robert said...

Random sampling of polls conducted over past six months:

Seven overwhelmingly "fer," one "agin" major overhaul of US healthcare, including universal coverage, single payer, public option, or some combination or variant thereof.

The seven fer run the gamut from NYT through Time, AMA, Pew on down to WSJ.

The one agin is Rasmussen, surprise surprise, consultant to George W. Bush.

Links follow:

Fer:

http://pewresearch.org/pubs/1160/health-care-support-stem-cell-opinion (Pew)

http://www.srbi.com/TimePoll4794_Final_%20Report.pdf (Time)

http://www.fivethirtyeight.com/2009/06/public-support-for-public-option.html (538/NateSilver)

http://www.surveyusa.com/client/PollReport.aspx?g=5ba17aa2-f1b9-4445-a6b8-62b9d1ba8693 (WSJ)

http://www.cbsnews.com/htdocs/pdf/SunMo_poll_0209.pdf (CBS, p. 4)

http://www.nytimes.com/2009/06/21/health/policy/21poll.html?_r=2&ref=us (NYT)

http://www.annals.org/cgi/reprint/148/7/566.pdf (AMA, p. 566)

Agin:

http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/august_2009/32_favor_single_payer_health_care_57_oppose (Rasmussen)

Hmm:

http://projects.publicintegrity.org/consultants/list.aspx?act=conDetail&id=122002 (Rasmussen heart Bush)

Drew80 said...

Robert, I would read the questions the surveyors posed to the respondents if I were you.

The Rasmussen numbers you so detest are almost identical to the Gallup numbers, which hardly comes as a surprise.

Robert said...

Specific cites would be helpful, Drew80. So would specification of what you find problematic about questions posed by Pew, WSJ, NYT, etc., but not about Rasmussen.

Note also that no one said anything about destestation, as disintinguished from skepticism, of the Rasmussen numbers. Had I cited, say, Axelrod, counterpart skepticism from your end would also have been warranted.

Drew80 said...

Robert, several of the polls on your list are push-pull polls. Once again, I refer you to the questions directed to the respondents. For instance, the Survey USA questions, and the sequence, had me falling on the floor.

Gallup data is available on the Gallup website.

michael a. livingston said...

For once, I agree with Neil Buchanan. Seeing as how people like me will probably be equally angry with any bill, I think it makes a lot more sense for Obama to support a bill that covers everyone or almost everyone--even if it fails--than one that doesn't. The worse possible situation for the Democrats is a bill that provides health insurance to people who don't want it . . . and not to some people who do.

Robert said...

I repeat my request for specific objections from Drew80 to specific questions, not cherry-picked, posed by the seven polls, ranging across the political spectrum, to which I provided links.

Drew80 said...

"Now I am going to tell you more about the health care plan that President Obama supports and please tell me whether you would favor or oppose it. The plan requires that health insurance companies cover people with pre-existing medical conditions. It also requires all but the smallest employers to provide health coverage for their employees, or pay a percentage of their payroll to help fund coverage for the uninsured. Families and individuals with lower- and middle-incomes would receive tax credits to help them afford insurance coverage. Some of the funding for this plan would come from raising taxes on wealthier Americans. Do you favor or oppose this plan?"

Classic push-pull question--and, quite naturally, the results were overwhelming in favor of the plan.

Josh83 said...

What’s interesting about the polls on health care reform is that they all say the same thing: Democrat voters are overwhelmingly in favor of health care reform, independent voters are strongly against it, and Republican voters are overwhelmingly against it. The results are the same whatever the polling organization, whether Gallup, Rasmussen, Zogby, TIME-CNN-Quinnipiac, Pew, etc. There is a minute range of variance in the poll results produced by reputable polling organizations—and all the polls show that only Democrat voters want healthcare reform.

However, if one examines subsidiary questions, such as whether voters are willing to PAY for health care reform, or whether voters think reform will IMPROVE health care, then the results become overwhelmingly negative for health care reform, and this is so across the board, whether polling participants are Democrat, independent or Republican.

The most recent detailed data put out by Gallup and TIME-CNN-Quinnipiac in this regard is very, very interesting.

This data would suggest to a professional pollster—or a professional politician—that health care reform is losing support even among Democrat voters. The data also accounts for current reports from Capitol Hill that the necessary votes for health care reform simply aren’t present in either chamber.

Were there no lessons learned from 1994?

I have not been following closely the daily or weekly approval/disapproval numbers, which I know have been tanking, but I looked at them today, and they’re dropping through the floor.

The latest from Gallup, Rasmussen, Zogby, etc. is very, very, ugly. The independent voter clearly has been lost.

Is this because of health care reform?

Robert said...

I repeat my request for specific objections from Drew80 to *specific questions,* *not cherry-picked,* posed by *the seven polls,* ranging *across the political spectrum,* to which I provided *links.*

Drew80 said...

Robert, you obviously have not even read the polls on your list (or the questions), nor have you read additional (and more recent, and more detailed, and more accurate) polls published by the very same polling organizations on your list, nor have you made the slightest effort to examine recent polls by mainstream polling organizations on the same subject, all of which are freely available online (and which you were repeatedly invited to inspect).

Nonetheless, when I have some time, I shall be happy to devote several hours to providing you with a detailed analysis of your “random” sampling of polls, which is neither random nor representative (nor timely, for that matter), and the suspect methodology used. It will be a lot of fun—and those polls you reference courtesy of Nate Silver (the man who could not find ethnic restaurants in Paris, and wrote about it on his blog) are simply too tempting to pass up an opportunity to skewer.

Exposing idiocy always provides pleasure.

I shall also point out how your “random” polls—and it is you who is doing the cherry-picking, not me—are neither random nor representative in the least and, moreover, do not even support the very conclusions you claim. Indeed, other, more reliable and more recent polls—put out by the very same organizations on your list, as well as by other polling firms—reach conclusions vastly different from those you claim.

However, all of this should be bloody obvious to you already.

Are you being deliberately obtuse?

I shall do so on my own blog, not on Professor Dorf’s turf.

On my blog, out of professional courtesy, I’ll keep Professor Buchanan’s name out of it

Unlike you, he had the good sense not to reiterate a risible proposition.

Robert said...

Drew80 seems to be a bit upset. I recommend sex and travel. Once he returns, it would be lovely if he could supply what has been several times now requested, viz., specifics to substantiate what thus far remain the same repeated conclusory ad hominem innuendos. In the meanwhile, those wondering what the polling data of the past six or so months suggest can readily visit the randomly selected websites to which I have linked, which run the gamut from Drew80's nemesis Silver, through NYT and Pew and the like, clear over to WSJ and Drew80's Bush pollster friend Rasmussen. And there are of course many more out there to be examined by any who remain in doubt about where the weight of public opinion lies. It ain't with the funny teabag people in Chinese-made tricorn hats.

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