Prometheus 6

Surrender first, then we'll negotiate.

Private insurers warned in a letter last week to Senate Health Chairman Edward M. Kennedy (D-Mass.) that expanding the government's role in health care would lead to "devastating consequences," including steep reductions in employer-sponsored health coverage.

Why? And so what? Build it right and anyone dumped by private insurance companies can just enroll in the new public insurace plan.

Ruth Marcus feels we're wasting time talking about it as though the government and the populace has a choice.

With insurance companies opposed to any public plan -- they sent a line-in-the-sand letter to President Obama last week -- the public plan that is likely to emerge from congressional negotiations is apt to be a diluted version (stubby tail) of what advocates seek.

She presents a series of bad arguments against a public insurance plan.

Let's assume that public plan advocates are not promoting it as a stalking horse for a purely government-run health insurance system and that it is possible to design a playing field that is not so tilted in favor of the public plan that private insurers will ultimately be driven out of business. The more the playing field is leveled, the more you wonder: Where, exactly, is the advantage in a public plan?

The advantage is in establishing a level playing field, which does not exist  now.

Is the health-care industry so uniquely impervious to effective regulation that -- even with insurers required to accept all applicants and not allowed to charge more for riskier enrollees -- a public plan is the only way to ensure that they compete on price rather than engage in covert cherry-picking to attract customers who will cost less? This seems an odd position for those who tend to be fans of regulatory regimes.

We are not looking to regulate for regulation's sake. We as a nation have long demonstrated a willingness to trust self regulation (I as a human think it's one of the more assinine ideas to capture the public fancy, but I got no juice like that).

And the answer to your question, Ruth, is yes. As evidence I present...the actual events that happened at every attempt to regulate them before th crash.

Is the health-care industry so uniquely anti-competitive that a public program is required to drive prices down? Advocates of a public plan argue that many markets are dominated by just a few insurers, and that even those insurers don't have enough muscle or motivation to extract lower prices from providers such as hospitals and specialists in increasingly concentrated markets.

That's because they focus their cost saving efforts on denying coverage. Humans are easier targets than fellow corporations.

They have the muscle, they lack the motivation.

In other words, to work, the public plan has to be able to set prices and, at least at the outset, require providers to participate if they want to remain eligible to accept Medicare patients. Does anyone think that is what's likely to emerge from Congress?

No.

If not, is this really where all the energy of those who want to ensure effective reform should be spent?

So we know who to fire next election season.