Many of us here on Daily Kos, in the blogging world, and in politics, see politics as a game. And often it is. But the Public Option is not just another chip on the table. In many ways, it's the game.
I've recently completed a PhD in Pharmacy, and my area of expertise in health policy and management. So indulge me, and let me explain in the perspective of a 26 yr practitioner and a newly minted academic on the inside of the "system" why this is crucial.
- Let me put one facet of the discussion to bed early. The United States does NOT have a health care system. That would assume that there is an overall strategy for the provision of health care. We don't, plain and simple. We have industries who sort of compete to sell health care products: hospitalizations, drugs, medical service, wheelchairs, etc. The only cooperation is a supply chain to move goods, outside of that, there is little to no coordination between these groups in any kind of strategy.
- It's expensive to provide good health care services. There is a large amount of education and training required, technology is constantly changing, and there are special considerations regarding sterility and allergy potential that are not found in most other industries, again adding to costs.
- The average consumer does not possess the ability to make informed treatment decisions, especially when they are injured or acutely ill. The ability to shop around for the best deal isn't possible for many medical goods and services, to do so could be fatal in many circumstances. No matter how much information is provided on the internet, books, etc, 98% of Americans will not be able systematically make good health care purchase decisions, no matter how much conservative health economists would lead you to believe this is possible. All of the health professions are charged with serving as patient advocates in the seeking of health care services, for which, in turn, patients give practitioners certain rights and restrictions in exchange for that advocacy.
- Since health care services are expensive and require agency of another person (in most cases) to be effective, another industry has developed ORIGINALLY to serve the best interest of the patients in terms of being protected from financial inability to obtain services- the risk sharing concept of insurance.
So how does this relate to the need for a public option?
Of the triad of patients, providers, and insurers, insurers are currently the most powerful. And while the original role of insurance providers was to diffuse financial risk among a group of individuals, allowing patients to receive treatment, the current insurance industry is geared to create profits for it's owners, while striving to deny treatment in many cases in order to maximize those profits. That goal is fundamentally in opposition to the original goal.
One of the ways the industry has accomplished this is by decreasing competition. In many areas of the country, 1 or 2 insurers hold 90+% of the market. Think about it- when was the last time you had a choice in your health insurance options beyond the products available from 1 company?
So we have an industry with all the symptoms of an oligopoly-monopoly. Limited choice, high cost, unresponsive to usual market forces.
At long last, here is where the Public Option is critical. The only market force that will drive the insurance companies to decrease prices is competition. Without an independent provider or insurance, one that has low operational expenses and the inability to collude with other company, there is no realistic way to manage costs. To enact the reforms regarding pre-existing conditions and dropping coverage without setting up competition, the current insurance firms will INCREASE their prices in order to continue the profit margin they currently enjoy. Thus resulting in even LESS coverage from employers, and more of the rainbow of issues that stem from health insurance costs- outsourced jobs, stagnant wages, business failures, MORE people uninsured.
So the Public Option is not merely a political bargaining chip, it's the keystone to any effort to reform the industry using a market bases approach, as counter-intuitive as it may sound.