The Downside of the Public Option

In what was a remarkable turnaround—and a huge victory for progressives—last week, the House of Representatives passed a health care reform bill that includes a provision for a government-run program, which would compete with private health insurance plans. The Democrats managed to include the provision for a "public option" in spite of the fact that 39 Democrats and all but one Republican voted against it. President Obama ultimately campaigned hard for the provision, telling Democratic lawmakers that when the bill passes, "each and every one of you will be able to look back and say, 'This was my finest moment in politics.'"

But progressive Democrats had to make a painful compromise in order to get a public option included in the health care bill. To garner enough votes, they had to agree to attach the Stupak amendment, which says that no funds authorized under the bill "may be used to pay for any abortion or to cover any part of the costs of any health care plan that includes abortion," except in cases involving rape or incest or in which the mother's life is in danger. As Timothy Noah explains, this amendment goes even further than existing prohibitions on using public money to pay for abortions, because not only would it forbid federal money to be used on abortions, but it would also prevent any private insurance plan that covers abortions from participating in the government program. That will make it difficult for any plan that includes abortion coverage—as more than 85 percent of private plans currently do—to compete, meaning that in practice it will probably be next to impossible to obtain abortion coverage even from private plans.


"Welcome to socialism," writes William Saletan. While the tea-bagger claim that a public health care plan like this one is tantamount to Soviet communism is ridiculous, conservative critics of a public option have a point when they argue that it would limit the choices currently available in the private market. Perhaps most progressives didn't realize that it means they would have to compromise too—in this case with people who don't want their tax dollars to pay for a procedure they find offensive. But that's the price we have to pay for public insurance. While the public option currently on the table is modest as far as socialized medicine goes, it does subsidize and standardize health insurance. And, as Saletan says, "when you do that, you invite public-sector problems into matters that used to be nobody's business."

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