The Public Plan and the Idiots Fallacy
Mark Schmitt has a very good piece on the history of the much talked about “public plan.” What’s interesting about the plan is show it was originally conceived as a piece of honest wonkery by Jacob Hacker, as a way to give Americans the benefits of government sponsored health care and to increase competition with private insurers, especially in places where one or two insurance companies dominated the market. And, as a piece of wonky health policy, the public plan wasn’t perfect, but made a lot of sense, and was more politically palatable than going for single payer.
But this was, weirdly enough, the root of the problem. The only real health care constituency on the left was the single payer constituency. And the public plan people decided to sell their plan — which, even if it passed in its original form as seen in the House, would not be anywhere near big or powerful enough to turn into single payer — as a back-door path to single payer:
But the downside is that the political process turns out to be as resistant to stealth single-payer as it is to plain-old single-payer. If there is a public plan, it certainly won’t be the kind of deal that could “become the dominant player.” So now this energetic, well-funded group of progressives is fired up to defend something fairly complex and not necessarily essential to health reform. (Or, put another way, there are plenty of bad versions of a public plan.) The symbolic intensity is hard for others to understand. But the intensity is understandable if you recognize that this is what they gave up single-payer for, so they want to win at least that much.
Basically, the very same interest groups and constituencies that made single payer a political impossibility weren’t going to be fooled by the public plan, especially when it’s promoters were openly telling liberals that the public plan would eventually lead to something like single payer. The insurance companies, medical device companies, pharma, hospitals everyone else aren’t complete and total idiots. Even though polls have shown that a large portion of the public supports a public plan, the political center of gravity on health care, which is largely determined the the bizarre nature of a 60 vote senate, seems to be around fairly extensive insurance regulations, some sort of mandate, subsidies for the poor, increases in Medicaid and a newly empowered Medicare panel. If, after all this huffing and puffing, a plan containing those policies is signed, liberals should be pretty happy. Also, it was about all anyone could expect.
