The Case For the Public Option

Question: How should we talk about universal healthcare?

Richard Gelles: I think we need to decide what are rights and what are privileges. I'm not in favor of big government handout redistribution of wealth. I think it's not going to work in our society. It's not going to get votes. But there are certain things that we might want to have a discussion about, such as, is health care a universal right? Is a quality education a universal right? Is having decent housing a universal right? And how do you fairly -- in a market economy -- achieve that cost-effectively? And I think we can do that, but I think there are other areas -- I think safety and wellbeing are universal rights, but other things probably not. I mean, we're not going to go to a socialistic society where each -- you know, going back to Marx -- each according to his or her needs. It's not going to happen. So this right and universality discussion has to be done in a society that is a market-driven society, where we don't want to reward certain behaviors because we think they're counterproductive to the kind of economic system we have.

Question: Should healthcare reform have a public option?

Richard Gelles: Oh, I think the public option is essential. Everyone is entitled to health care. Everyone isn't entitled to every test under the sun. When you dig down and look at Medicare, it's pretty obvious the biggest funding, the biggest cost of Medicare -- which, by the way, is an efficient program; let's say right now the administrative costs of Medicare are two percent. You find me a program that runs on a two percent overhead rate, and I'll say that's an effective program. But the money spent on health care is all back-ended; the majority of the money is spent in the last two years of life. And are we making that investment in quality of life, in extending life, or is it defensive medicine to make sure we don't get sued? And you know, I'm not talking about death panels, but I'm talking about evidence-based medicine. And also for the first two years of life, in Medicaid, evidence-based medicine. There's not a lot of point in investing millions of dollars to create a low-quality life. So the front end of life and the back end of life, yes, health care is an entitlement. But every possible form of health care isn't an entitlement.

Question: Has the welfare reform bill worked?

Richard Gelles: The welfare system -- and I worked, when I one year worked in Washington, on the welfare reform bill -- the welfare reform bill worked because it has a time limit, because it says welfare is a temporary right, not a permanent right. So even in this economic recession with unemployment going up, the welfare rolls are lower than they were in 1996. I think that's about as much reform as you're going to get. Where you need the reform, I think, is to -- people have to have a stake in society, and they get that by having home ownership. I'm -- I look back to the 1950s, and I think the American economy did the best when people were able to buy homes, and the consumer society thrived not by buying an extra plasma TV, but by buying all the utilities and appliances that go with home ownership. One of the great disasters of 2008-2009 is the decrease in home ownership as a result of the financial problems, the financial scandals, with the subprime mortgages.

Recorded on: October 29, 2009

The Dean of UPenn’s School of Social Policy argues that universal healthcare is basic human entitlement.

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