How to create a government-run, government-financed health insurance program without the government.

How to create a government-run, government-financed health insurance program without the government.

How to create a government-run, government-financed health insurance program without the government.

How to fix health policy.
Oct. 28 2009 11:49 AM

Squaring the Circle

The Senate's public-option talk turns baroque.

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Sen. Thomas R. Carper (D-Del.)
Tom Carper

"Sen. Thomas R. Carper (D-Del.) … has agreed to let debate begin on the measure but wants to make sure that any public option would be run by a nonprofit board, rather than the government, and that it would not be financed by taxpayers."

—" Centrists Unsure About Reid's Public Option," Washington Post, Oct. 28.

So OK, we get in a rocket ship and find an advanced species of space aliens, and we make them our slaves. And we say, "Space aliens, use your extremely high intelligence to construct a building in D.C. with durable minerals from your home planet." And they do it. Then we say, "Alien-slaves, process health claims for the previously uninsured." Only they can't process health claims without telephones or computers. To buy those we, uh, tell them to host an intergalactic bake sale. So now we've got the building and the telephones and the computers and they say, "Beep-beep, what's an insurance claim?" And we say, "I'll ask the questions around here—just do it." And then we say, "But wait, I almost forgot, first you need to set up a nonprofit board." And they say, "What's a nonprofit?" And we say, "Don't make me get Sen. Tom Carper down here to tell you himself. He's a very busy man, and he won't appreciate being interrupted." And they say, "What's a senator?" Or maybe they know what a senator is because in Star Wars that's what Emperor Palpatine is before he gets wrinkly and mean. So the space aliens create a nonprofit board composed of the more intelligent alien-slaves and then they use their advanced intelligence to figure out what insurance claims are, and that way we get a government health insurance program that doesn't spend taxpayer money and isn't controlled by the government.

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I'm exaggerating a little. Carper actually does envision granting the states seed money to create public-option programs, and it isn't necessarily absurd to ask these programs to operate on a "level playing field," i.e., become self-sustaining over time. Nor is a nonprofit management structure an inherently terrible idea (though I'll admit I've heard better). But let's not lose sight of the public option's basic idea. It is a government program because it would serve a public need. If the private sector were able to fill this need, it would already have done so. It's in the government's interest to make sure a public option provides necessary coverage to the uninsured at an affordable price. To achieve this, the government would need to maintain some measure of control over the program. You can't have a government program without a little … government. Let's stop pretending you can.

E-mail Timothy Noah at chatterbox@slate.com.