Updated March 26 at 12:25pm

Is a public option necessary to promote health insurance competition and lower prices?


President Barack Obama’s speech last week to a joint session of Congress brought the debate over health care reform back to the forefront of public discussion.

One of the sticking points is the issue of whether or not a public health insurance option, a la Medicare, should be part of the reform effort. Supporters says that it will keep insurance companies honest and help lower insurance costs, while opponents feel that it will just create an even larger government bureaucracy and have a deleterious effect on health care in the United States.

Where do you stand?


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As far as I'm concerned, private citizens should be free to pay whatever they want for private coverage. (The same is already true in all nations with public medicine, which is pretty much every other modern country in the world but the U.S.) I only ask that a public option also be available. It doesn't have to be spectacular, only available.

Right now, millions of us have no health insurance, mostly for reasons of cost. Health insurance premiums for many people are as great as rent or mortgage payments, or car or education payments. The practical reality is that a great number of Americans simply cannot afford coverage at all.

And much of coverage that is available, especially on the lower end of cost, is all but worthless. These 'sickness plans' pretty much only cover injury or acute illness, and often with serious restrictions. One of them that I briefly subscribed to refused to cover blood tests as part of routine health maintenance. What use is that kind of insurance? For what you pay, if you're reasonably healthy and careful, you're probably better off taking your chances, and many people do.

If what the big insurers claim is true, then it makes no sense for them to oppose a public option. In theory, they should be able to conduct business the same as before -- since obviously, the people not buying insurance from them right now probably won't later, either. I'm therefore forced to suspect other motives, and foremost in my mind is that they make money off the uninsured through guaranteed payments from health providers when something does happen to these people -- costs that they can scale at their pleasure, and which are in some way covered by the public.

In other words, we already have a public health option, it's just the worst one possible, at the highest cost possible. An up-front public option would give lower-wage people the means to address their health needs through a public process that's not wholly controlled by private companies, and in the end won't let them milk our broken system as much as they are right now. So I can easily understand why they're so opposed, once I see how it will affect them on that end. And that means that the people claiming that simple greed is driving this controversy aren't so far off the mark. After all, a strong majority of both providers and citizens want this; the only real resistance is coming from well-heeled lobbyists, and those who are opposed simply because this is unfolding under the administration of a man they don't like, which is no sane reason at all to oppose something good for the citizenry.

Comparisons to other nations with public health don't hold up under scrutiny. While Brits love to complain about NHS, none of them are suggesting it should be scrapped in favour of our system, which they readily admit is nightmarish from their perspective. And stories about Canadians waiting months for non-urgent or non-essential care ignore the fact that millions of Americans will go their whole lives without essential care.

Finally, it's long been known that despite the real cost of regular checkups and the like, preventative health maintenance greatly reduces both the physical and financial impact of lifelong care. This is great for insurers, but not so great for those whose stock figures depend on constant growth of medical profits.

Before we even get into the nitty-gritty of healthcare in the U.S., it's fair to ask if it's not morbid and morally questionable to profit from it in the first place. Undertakers are one thing -- everyone must die. But how many need die of curable, treatable, or preventable diseases, for much more money? The answer to that question may depend very much on who you ask, and what their connection is to the money stream of modern-day healthcare in our country.

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