The Public Option and Ideology

Nate Silver provides a strong argument that opposition to a public plan as part of health care reform can only be justified based upon adherence to conservative ideology. After all, the facts clearly show that Medicare, the government plan that a public option would be modeled upon, provides health care coverage far more efficiently and economically than private insurance does–and even receives greater satisfaction in polls from beneficiaries.

The only  reasons to be strongly opposed to offering a public plan as an option would be either a financial interest in the insurance industry or a knee-jerk opposition to government action regardless of whether it is actually beneficial. Of course those who hold such views typically get their information from conservative sources which cherry pick the facts to show what they believe.

While Silver is right that opposition to a public plan is primarily based upon ideology, the same can also be said about those who see a public plan as crucial to the point of attacking supporters of health care reform who are wavering on this issue. Many who insist upon a public option are actually supporting this as a means of ultimately establishing a single payer system. Of course conservatives who believe that the private market is always better than government should have noting to fear as their ideology clearly argues that government cannot compete with the market. Silver points out that this is true in many areas, but health care coverage is different.

If health care reform was truly successful then a private option would not be necessary. There are really two reasons to insist upon a public plan. In many cases it is every bit as ideological as those who oppose the public plan. In other cases such support is based upon pragmatism, as many fear that, regardless of the laws that are passed, it will be impossible to prevent insurance companies from continuing to game the system to maximize profits by finding ways to deny needed care.

Update: Paul Krugman is kind to provide an example today of support for a public plan which is largely motivated by ideology. Obama, in contrast, provides an example of pragmatism in recognizing that it is foolish to risk reform by drawing lines in the sand. We saw where that got us with HillaryCare.

Sharyl Attkisson of CBS provides a good example of the misinformation which is being spread to attack the public plan. She writes:

And if you do choose a public plan, you may want to keep your favorite doctors but they may not want to keep you. Under government health care, they could be paid 20 to 30 percent less.

With suggestions that the public plan will pay at 10% over the Medicare rate (or even at Medicare rates in the worst case scenario) this fear mongering doesn’t hold up. As I noted when the first outlines of the Senate Health Choices Act were leaked out, this would be very beneficial to physicians in primary care. I noted that a quick review of reimbursement for common charges such as office calls showed that most private plans paid more than Medicare but by less than ten percent.

Primary care physicians would likely make more money from patients in the public plan than from employer-paid health care. It is likely that some subspecialties will come out behind, but as long as primary care physicians are doing better under the public plan than from private insurance there will not be major issues with regards to access to care. It is difficult for surgeons and subspecialists to refuse to accept referrals based upon insurance coverage, especially if a plan has many subscribers.

There are some physicians who do not accept Medicare, but there are also private plans I do not accept as they pay significantly less than Medicare. In making such comparisons it is also important to consider the cost of participating in a plan. While it is necessary to increase staffing due to the burdens imposed by some plans, Medicare is simple to bill to and pays reliably. With clams sent electronically to Medicare my collection rate is pretty close to 100%, with the rare rejections generally resolved after correcting a minor error in the initial claim.

Sanford Admits Affair

Mark Sanford’s disappearance had the feel of a political novel. Yesterday there was speculation that he was keeping his location secret because of participating in Naked  Hiking Day. While that would have provided new material for the late night comedians, that is far less embarrassing than the truth revealed today that he was having an affair.

Once it was revealed that he was actually in Buenos Aires and that his wife did not know his location it was easy to guess he was on a vacation with a woman. The political consequences are obvious. As Charles Cook wrote, “I think you’ve got one less contender for president.” Whether such an affair should be ignored as irrelevant to the duties of president or seen as a reflection on his character which disqualifies him, there is little doubt that few people other than John Edwards and Eliot Spitzer are  hoping  that Sanford survive this poltically.

Republican Comeback?

Politico is talking about the possibility of a Republican comeback, starting out with reasons why it sounds far-fetched:

For the first time since their 2006 election drubbing, top Republicans see signs — however faint — of a political resurgence over the next year.

At first blush, this sounds absurd. After all, polls show the GOP more unpopular than ever, and the John Ensign sex scandal serves as a vivid, real-time reminder of why many see the party as a collection of hypocrites.

But several trends suggest this optimism might not be as far-fetched as it seems.

Polls show that the GOP is wise to focus most of its attacks on spending, government intervention and job losses. (Those same polls show the public has low regard for Republicans on these issues, but it’s a significant development that President Barack Obama’s numbers are slipping in these areas, too.) And just as importantly, GOP leaders on Capitol Hill privately recognize the need to distance themselves a bit from George W. Bush, Dick Cheney, Sarah Palin and Newt Gingrich — even though they’ve done poor job of doing so thus far.

They think the Republicans have a chance if they concentrate on government spending:

Polls show that Obama’s chief vulnerability is public concern over the soaring deficit. And as the sticker shock of a trillion-dollar-plus health care plan takes hold, these concerns are only likely to grow.

Rep. Mark Kirk (R-Ill.) — long used to hearing complaints about Bush — says his moderate constituents have finally found something else to gripe about. “Now the dominant thing I hear from them is: ‘What is all this government spending?'” said Kirk, who is mulling a Senate run next year.

Squabbling over much else, Republicans are emboldened and united on this issue. In the House, they banded together last week to oppose a supplemental war funding bill because it included $5 billion for the International Monetary Fund — what one GOP member called a “global bailout.” They are gearing up to oppose Democratic plans to increase domestic spending this summer and fall.

Yes, this approach is more than a tad hypocritical. Under Bush, Republicans vastly expanded the size of government and whacked Democrats when they opposed war funding. But memories fade fast in politics, especially in this era of turbo-charged media.

The last paragraph shows one problem for the Republicans. While they love to talk about small government, the Republicans are every bit as much a party of big government as the Democrats. It is hardly a surprise that in a two-party country with a big government both parties are equally guilty of promoting this.

The key difference is that while both parties support big government, the Republicans support a government with less limitations on its power and increased interference in the lives of individuals. In order for the Republicans to try to win on the economy and government spending they have to hope that the voters forget everything else the Republicans stand for.

Even if they do manage to make the next election a referendum on the economy, the Republicans are hardly in good shape. They have to hope that voters have a very short memory and forget that the current economic crisis began under the Republicans and that Republican policies were a major factor in precipitating the crisis. Even long-time economic conservatives such as Richard Posner have acknowledged the problems which were created by deregulation of the financial industry.

You never know for certain how people will vote, and it is possible voters have a short memory. A present polls only show about 20% still supporting the Republicans, with virtually all groups now opposing them. The off-year elections in 2010 should offer advantages for the party out of power, especially as many Democrats are now defending traditionally Republican districts. It is still risky for the Republicans to count on the economy and government spending as issues. Numerous polls have showed public support for health care reform even if it costs more and results in higher taxes.

In general voters will vote Democratic when the economy is their main concern–which certainly makes sense considering the overall track record of the two parties. As they regularly ignore facts when they contradict their ideology and they stick to economic principles which simply do not work, an economic decline seem to be an inevitable consequence of Republican government. A majority of voters seems to feel this way.

Looking back at the 2008 presidential race, John McCain led in the polls after the conventions. I still felt confident that Obama would win, especially as McCain was riding a bounce due to interest in Sarah Palin which I though would eventually back fire against him. While confident that Obama would pull back ahead, it was not until the financial crisis began that Obama took a lead and was never in danger of losing the election. Voters who rejected the Republicans due to the economy in 2008 might be convinced to return, but it will be a very hard sell.

While Obama may or may not be right on individual decisions, a pragmatic president who will change course based upon facts is far preferable to Republicans who govern based upon blind devotion to ideology and deride a necessary change in policy as “flip-flopping.” The problem the Republicans face is that, while the Democrats are far from perfect, most voters feel the Republicans are far worse.