Within Reason

When President Obama took office in January, many Americans (including, of course, myself) breathed a sigh of relief. One of the big thoughts behind this sigh was that we had someone in charge of the executive branch who understood that government could be part of the solution to some of our domestic problems, particularly the tragedy of the American healthcare system. As the administration’s work on healthcare came to center stage in recent months, the debate has largely centered on whether or not the solution should include a “public” health insurance option or “public plan” and if so, how strong that option should be. The function of the public plan would be to provide an affordable, comprehensive alternative to private health insurance plans if those plans became too costly, too limited, or inaccessible due to job loss or other factors.

All of these issues are incredibly important and following the details of what might emerge is even pretty exciting for those of us in the nerdy minor leagues of health policy. Will there be a strong public plan, a weak one, a national healthcare co-op, an insurance exchange of private plans, or some mixture of all of the above? But lately I’ve become concerned that the debate as a whole shows that something far greater is at stake: whether we as a country still have the ability to do big things together.

Those of us in the U.S. who have spent time abroad or have friends from other countries know that there is something deeply dishonest about the criticisms of a public health insurance option. The critics claim it will be costly (which is true, but the alternative is more costly), that it will “ration” healthcare (which is also true, but the public plan is just an option and the idea that insurance companies do not ration services even more is absurd), but most importantly that government is bad at running things and it will be awful at running a healthcare plan. Stories populate the American media about how Canada’s system made someone wait for hip surgery or Britain’s problem with dental hygeine.

It’s also somewhat true that healthcare costs are rising in other countries and they are fighting to contain those costs. But the systems work. It is simply not true that government cannot run a healthcare system. They do so everyday all around the world. The critics have their facts wrong and the smarter ones know it. The best they can do is to claim that our government wouldn’t run a good healthcare system.

This is false as well, as the US government runs Medicare which is very popular and more efficient than any private plan. It also runs a healthcare system for veterans which is the most popular system in the country and an actual example of socialized medicine. Costs need to come down if these programs are to be sustainable, but private insurance doesn’t fare any better.

But the public option represents something even more than an effective solution to healthcare problems. The key part of the plan is that it is public. It is something we all come together to shape and support. It wouldn’t be an invention by a select group of wealthy Americans trying to make money, but something in which we all have a stake. It would be something we all did together. And rejecting a strong public option would be much more than opting for for a different, demonstrably worse way of paying for healthcare. It would be rejecting the idea that for something as important as the health of our fellow citizens, we are willing to work together.

If we decide that this isn’t a task that is worth doing together, it’s hard to imagine that we think it’s possible to do big things together any more (with the possible exception of war). It certainly doesn’t make sense to think that we might be incapable of providing quality, low-cost health insurance together, but capable of providing necessary, quality education for all of the nation’s children. Without the faith that we can work on big projects together, it’s hard to see the sense in which we are still a society.

Coming back to other countries who provide public healthcare options, I don’t think it’s a mistake that they take a great deal of pride in their systems. Sure, people have complaints but they also seem to realize that creating and supporting a system in which no one has to worry about receiving care is a tremendous accomplishment as a people. When open-heart surgery, paid for by the public plan, saves the life of a parent without wiping out a family’s college savings, we can all point and say, “I helped do that.” A private system doesn’t do that. Doing big things together makes societies stronger.

Passing a strong public plan would not single-handedly show that we can do things together again. The real test would start with maintaining the system. But given the current disconnectedness of American society, it’s a chance we can hardly afford to pass up.