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Posted by on Aug 21, 2009 in Health | 70 comments

Soothe My Worries About a “Public Option” Boondoggle. Please.

An interesting thread developed last night here on TMV, in which several people who are not ideologically sitting behind a firewall (“Public plan or nothing!” or “If the government touches it, it’s Socialism!”) tried to find areas of common ground on health care reform. We found several areas of agreement. However, we also heard from folks who think there are irreconcilable ideologies at work.

I concede the possibility, but I’m not ready to accept it as a foregone conclusion.

I’ve been accused of dishonesty because I’ve failed to acknowledge that I’m completely unwilling to accept anything that includes a public option. That’s false — but I do have very serious reservations.

They’re not rooted in irrational fears of socialism or “death panels” or disdain for the poor or racism or that we’ll be providing abortions to all or insurance to illegal immigrants. At the highest level, my reservations primarily stem from a desire to maintain as much authority as possible at the state / local levels, and from my strong feeling that on a national scale, public health care for all would become a boondoggle beyond anything ever seen before.

The first of those requires careful appraisal and a constant balancing act. Yes, we’ve grown enormously and society has changed. Yes, we have common national interests. No, we should not therefore should toss the baby with the bathwater every time we’re discussing complex issues and national policy. Aside from constitutional considerations, there are very good reasons why it makes excellent sense to keep decisions and delivery mechanisms at the state and local level.

Meanwhile, the Wall Street Journal’s description of the program in Maine hits right on my worries about a boondoggle today.

In 2003, the state to great fanfare enacted its own version of universal health care. Democratic Governor John Baldacci signed the plan into law with a bevy of familiar promises. By 2009, it would cover all of Maine’s approximately 128,000 uninsured citizens. System-wide controls on hospital and physician costs would hold down insurance premiums. There would be no tax increases. The program was going to provide insurance for everyone and save businesses and patients money at the same time. […snip]

Here’s how the program was supposed to work. Two government programs would cover the uninsured. First the legislature greatly expanded MaineCare, the state’s Medicaid program. Today Maine families with incomes of up to $44,000 a year are eligible; 22% of the population is now in Medicaid, roughly twice the national average.

Then the state created a “public option” known as DirigoChoice. (Dirigo is the state motto, meaning “I Lead.”) This plan would compete with private plans such as Blue Cross. To entice lower income Mainers to enroll, it offered taxpayer-subsidized premiums. […snip]

After five years, fiscal realities as brutal as the waves that crash along Maine’s famous coastline have hit the insurance plan. The system that was supposed to save money has cost taxpayers $155 million and is still rising.

A program that was supposed to save money by reducing health-care waste and inefficiencies has seen a 74% increase in premiums. But even those inflated payments can’t keep the program out of the red.

Please — read it all. The article isn’t full of hysteria or fear-mongering. It doesn’t hinge on partisanship. It’s talking about cause and effect, and describing how a specific plan has worked (or has not worked) — a plan that sounds (to me) VERY much like what’s being proposed.

So I have a question for the folks who have drawn a “public option” line in the sand: How do you feel about the Maine plan? Are you sure that what you’re pushing for won’t end up being a magnified version of their problems? Using this example, help me understand why you think things would work differently (i.e. better) when expanded to a national scale.

I’m not looking for impassioned arguments involving moral imperatives or Brother’s Keepers. I’m not trying to argue Federalism or Socialism in this post. I’m asking about cause and effect, and fiscal impact. I want to avoid a boondoggle.

If your answer is that we’ll tax the the top 1%, then — assuming that narrow population could manage it (and I don’t think they can) — what will you do when that non-static funding source dries up as the extremely high earners move into their retirement years? Or as their wealth fluctuates? Have you thought this all the way through?

You may feel that you’ve already explained this ad nauseum. If so, then I hope you’ll forgive me but it’s gotten lost in all the shouting.

I’m asking in good faith. Help me see why your insistence on the “public option” won’t break the system beyond any hope of functionality or recovery. Because I’m honestly worried that it will.

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