More on the “Public Option” (Response to Jim Tryon)

Recently, one of Governor Richardson’s lead advisors on health care issues argued on the pages of the Albuquerque Journal that the so-called “public option” is the best fix for our health care system.

A national public option is perhaps the most important step in the reform process. What can a public option do to fix the well-identified problems? First, by being a good public option that is national in scope, it will allow for the creation of one large actuarial pool across state lines, thereby dispersing risk and allowing small state like New Mexico to take advantage of large pools.

Second, every American should be able to obtain coverage. This means coverage under a private plan, or coverage under a public plan. Patients should not be turned away because of a pre-existing medical condition and they should not be turned away because they cannot afford coverage.

Third, a good public option must include coverage of all essential medical services. This includes preventative care, maternity leave, disease management, and more.

Finally, a good public insurance option will enforce transparency and comparative costs across plans and providers, as well as report on benchmarks of quality and outcomes.

By “public option,” Tryon means “Medicare for all.” Of course, enlarging actuarial pools is a nice idea, but allowing patients to wait until they are sick in order to get insurance is like buying auto insurance after an accident. Nice idea, but hardly fair.

As he states in point three, a public option must be very robust. This is means that young people will be forced to pay more for costly insurance plans. No “bare bones” policies will be available and this likely means that my Health Savings Account will be eliminated as an option.

Of course, advocates of “Medicare for All” never mention the unfunded liabilities associated with Medicare. They also love to claim that a “public option” won’t crowd out private insurance because, “if the free market is so efficient, it should be able to compete with a government-subsidized plan.” Of course, they also fail to realize that simply taking money from unwilling taxpayers is, at least currently, very efficient. They don’t seem to believe that the “crowd out” effect (as it relates to demand) matters.

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