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OpEd:

Financing a Healthcare Public Option



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publicOption



One of the concerns regarding the proposed healthcare reform, from both general critics and the ardent opposition, is the financing of an actual government-run insurance plan for millions of people - known as the "public option".  One on-the-table solution is taxing those who are considered to be the elite rich of America, but this obviously does not sit well with some of the most vocal and influential constituents for Congressmen of any political party.  There is, however, a better way.

The detrimental effect of not having a public option has been made clear elsewhere, but the actual projected cost of such a plan is approximately $1 trillion over the next ten years – that’s $100 billion each year for ten years.  While the proposals circle around the idea of taxing a small segment of the population, in addition to having minimal co-payments by those who use the plan, the simple fact is that this large potential expenditure does not have the fiduciary stability it needs – and yet the country is in desperate need of a public option for healthcare.

The Federal Government spends a considerable amount of money each year, and the general public has only the the faintest idea of where it goes, how it is used, or even whether it is spent effectively.  One such case is the yearly aid sent to Israel by American taxpayers, currently at the rate of $3 billion.   The typical, and only, argument for this large sum of money is that they are American allies - yet they are not, nor have recently been, involved in any of the American armed conflicts which other allies have participated in, and they oppose the logical, and American-supported, two-state solution with Palestinians.  Does America send billions in unrestricted funds yearly to England as an ally?  Or perhaps to Canada, Australia, Egypt, or Japan, all of which are other allies?  No.  The necessary funds to make such a piece of legislation more politically attractive can therefore begun to be found in a convenient location:  Israel.

This indefensible expense must obviously be put to an end, immediately, and the resultant savings can be usefully repurposed:  a healthcare public option.  If the costs of the public option are only 10% of the projections, entirely possible given the Congressional penchant for not understanding the number system and grossly overestimating costs, the cost is quickly reduced to $10 billion per year - a third of which can be financed by the amount formerly allocated to Israel.  Suddenly the public option seems less expensive than at first glance, especially when a single reallocation of funds can have such a large effect.

Other big-ticket expenses approved by Congress could be repurposed, just like the aid to Israel, for the benefit of the country.  It shouldn’t be entirely difficult, since close scrutiny of Congress’ spending habits reveals unnecessary expenses to the tune of millions, sometimes even billions, of American taxpayer dollars.  If there ever was evidence of their greed and check-writing abilities, the recent public embarrassment over wanting to spend $550 million on passenger planes for themselves is it – the plan was scrapped when the story went public.

Large numbers are notoriously difficult for the American people to comprehend, but this should be neither prohibit nor excuse not creating a government healthcare option to control the skyrocketing costs of the insurance industry.  If the Federal Government can spend $700 billion dollars, that they don’t have, on extremely risky bank bailout loans that may not ever be repaid in full, they should be able to find the money for the health and future of the American people.

It’s commonly known as pork barrel funding, unnecessary expenditures, and Congressional gluttony.

--- --- ---


Update (8/24/2009 2:25pm PST): It's come to my attention that I may have mislabeled this piece - it's not the "public option" that costs so much, but rather the reform package itself, with the option as a part of that.


Even though it's mistitled, this doesn't distract or change from the basic principle of relocating exorbitant and  unnecessary spending to finance the healthcare reform proposal, in addition to using co-payments and premiums.


Update (9/6/2009 12:30pm PST): This piece has been plagued with number problems, all stemming from my indecision on how to represent such large numbers:  full decimals, word descriptions, or abbreviated decimals?  Thanks to alexanderevodicka, the 10% bit has been restated to what I originally intended - not that the projections were overshot by 10%, but rather that "if the real costs were 10% of the projections..."



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  • alexanderevodicka
    You might have been mistaken when you claim if the costs of a public option are overestimated by 10% the cost to taxpayers would be $10 Billion instead of $100 Billion. Actually if costs are cut by 10% the savings is $10 Billion which still leaves $90 Billion un paid per year. Because 90% of $100 Billion still leaves us with $90 not $10 Billion.
  • Yes, you're right. This whole post has been plagued with math errors, all stemming from me not being able to decide, when writing, whether I should use full decimal numbers, word numbers, or abbreviated numbers.

    I've fixed it, but what I meant was:

    "If the costs of the public option are only 10% of the projections, entirely possible given the Congressional penchant for not understanding the number system and grossly overestimating costs"

    Thanks for pointing this out... pretty embarrassing mistake!

    --Kyle
  • Uh oh! (I'm really sorry Kyle!)

    The Fraser institute is a non-profit in Canada that does a lot of really great research on Canadian Health Care. One of their specific areas of research is the implicit costs of their health care system. A great deal of time is spent by Canadians waiting for care, this is because there are not enough doctors and there are too many people who want to see doctors (some call this rationing). Time spent waiting for care is unproductive time. It's time where a person isn't working and generating wealth. It's also time spent suffering. My point is this: Even if the public option cost only $1T, that's only accounting cost. There are other costs that have to be kept in mind.

    Mind you, that only really applies to single-payer systems like Canada, the NHS (the public option in the UK), VA, Medicare and Medicaid, and many other government programs that offer "free healthcare". "If you think health care is expensive now, wait till it's free!" (That was P. J. O'Rourke).

    That money is wasted elsewhere is bad. It's downright contemptible. However, that pork exists is an important problem that should be kept in mind. Is pork only passed by bad people? Maybe, but it's passed by nearly all congress people. Either there's a problem in Congress that makes good people spend bad money, or a problem that makes it nearly impossible to hire good people. Either case is bad and should be addressed before haphazardly putting another Trillion in these people's hands!

    In the mean time, we should look at addressing existing problems in health care finance (because the real problem is not in health care, it's in health care finance). Policies like those in New Jersey, where insurance companies cannot ask health questions, only hurt everyone (even though they were passed with good intentions; we all know what road was paved with those). If you can't ask health questions, people can go to the insurance company when they have problems and have their problems paid for by someone else (I recommend that all readers go to wikipedia and read the article on 'principles of insurance'); this creates an adverse selection problem. Nobody has incentive to buy insurance unless they're already sick. This drives up premium creating even less incentive for people to insure and more incentive for people to pass the buck. As a result, there are a lot of healthy people in New Jersey without insurance. This makes a great deal of sense for them, but it makes things look pretty grim to the rest of the country.
  • I agree, and I've actually expressed some of the same sentiments elsewhere. If we could solidly fix the insurance industry to where it would help people rather than be interested in screwing people, I'd be satisfied.

    But the reality is that in modern America, it's easier to spend a bunch of money to create an option that might not be the best but will force them to change, rather than passing legislation to require them to change.

    I don't like the idea of spending a bunch of money on a system that might not work, just like I think we should have let the auto industry fail. But at this point, we don't have much of a choice thanks to lobby groups and pocket-lining Congressmen.

    Also, I'm not so much arguing the details of the healthcare reform in this as to how it can be financed, sort of as a method of deflating the ranting and raving of many Republicans at the moment.

    But waiting for something to change isn't an option, and neither is hoping that Congress will one day wake up and decide that taking money, gifts, and whatever else from special interest groups is actually a conflict of interest and will start to pass legislation that is effective and proper.

    *That's* why I support a public option, but only as *part* of healthcare reform - a single brick doesn't repair a wall.

    See: http://www.kyle-brady.com/2009/07/16/american-l... and http://www.kyle-brady.com/2009/07/20/proposing-...

    --Kyle

    p.s. I'm going to get to your econ comments tomorrow... I ran out of time today.

    p.s.s. I love intelligent comments from people. It's when they're not interested in discussion that I get pissed.
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