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.
