Schrödinger's ElephantThe brain-twisting paradoxes facing Republicans on health care reform.

(Continued from page 1)

PRINTDISCUSSE-MAILRSSRECOMMEND...SINGLE PAGE

FacebookMySpace Mixx Digg Reddit del.icio.us Furl Ma.gnolia SphereStumbleUponCLOSE

Another argument against the public option-as-competition is that its logical endpoint—and President Obama's stated best-case scenario—is a single-payer system. The result wouldn't be government forcing private companies to improve their services via fair competition. It would be government picking which private companies succeed and which ones fail. And that is hardly market competition.

Doesn't the government already run health care?

Next time someone tells you he'll leave the country if it institutes government-run health insurance, suggest he buy his plane ticket today. Almost half of all health care spending in the United States is already government spending—think Medicare, Medicaid, SCHIP, and other state health programs. Meanwhile, the private health insurance market is one of the most highly regulated sectors of the economy, both on the state and federal levels. "They're governed by telephone-book-sized books of regulations," says Robert Moffit of the Heritage Institute. States dictate medical underwriting rules—for example, they can prohibit insurance companies from denying coverage—as well as specify which benefits get included in private plans. So in that sense, almost all private health insurance is "government-run."

Sure, there's a lot more the government could do—force you to enroll, favor one plan over another, set rates, etc. But a blanket condemnation of government-run health care ignores the fact that America is already halfway there. As Blunt put it, "with the federal government already $1.8 trillion in debt, would you really put that institution that's already out of money in charge of your family's health care?" Too late.

Is it possible to achieve universal coverage without mandating it?

No matter what your vision for health care, chances are it has the word universal in it. Democrats want "universal health care." Republicans tout "universal access to affordable health care." But the latter isn't really universal. It's basically saying we should reduce costs far enough that anyone who wants it can afford it. No one will argue with that. The problem, though, is that insurance works best when everyone buys it. When they don't—and then get sick—everyone bears the cost. In order to make health care affordable, say Democrats, you have to eliminate the massive costs of treating people who aren't insured. The best way to do that is to force them to buy insurance.

Mandating insurance thus does two things: It maximizes the number of people who have coverage, and it reduces the cost of insuring everyone. Sure, no plan is completely universal. You'll always have some people who would rather pay a penalty than enroll. But if the goal is to insure as many people who want it as possible, you're going to get a lot closer by requiring it than incentivizing it.

Wasn't America's first universal health care legislation signed by a Republican?

Mitt Romney created a migraine for the GOP by passing Massachusetts' health care bill in 2006. He has since managed to blame the bill's downsides—namely, its cost overruns—on a liberal legislature. But it's harder for him to distance himself from the individual mandate. Now anytime Democrats need cover for mandating coverage, they can point out that even conservative Republican Mitt Romney supported it. (However, the Massachusetts plan does not include a public option.) Same with George W. Bush signing prescription drug legislation, the largest Medicare expansion in 40 years.

Of course, all these questions come with rejoinders or parallels for Democrats. Republicans may have trouble admitting that health care reform is necessary, but Democrats may have trouble saying they support a single-payer plan run by the government. If a public option really is market competition, then by supporting it, aren't Democrats implicitly agreeing that market competition can improve health care? And if the government already runs so much of our health care system, then why is it so broken?

These questions may be easier for Democrats than the other questions are for Republicans, partly because Democrats don't have to defend the status quo. Democrats also have first-mover advantage: Their proposals are driving the debate. Until Republicans come up with some plausible answers, they may find that most of America's health care paradoxes work against them.

PRINTE-MAILRECOMMEND...RSS

FacebookMySpace Mixx Digg Reddit del.icio.us Furl Ma.gnolia SphereStumbleUponCLOSE

Christopher Beam is a Slate political reporter. Follow him on Twitter.

Illustration by Mark Alan Stamaty.

SPONSORED CONTENT

• This Week's Bidenisms
  Collecting the vice president's gaffes and head-slappers.
  Jeremy Stahl | Dec. 4, 2009
• The Twitter Holdouts
  Why is more than half of Congress still not on Twitter?
  Christopher Beam | Dec. 3, 2009
• "The Snow Machine Pummeled Through the White-Dusted Plain Like a Jubilant Beaver"
  The results of Slate's "write like Sarah Palin" contest.
  Dec. 3, 2009
• Search for more Politics articles
• Subscribe to the Politics RSS feed
• View our complete Politics archive