Beware the ‘Public Option’
How not to reform American health care.


On April 25, Sen. Ted Kennedy formally kicked off the great health-care debate of 2009 with an op-ed titled “My Call to Arms” in his hometown Boston Globe. In the article, he made the now-familiar case for government-guaranteed health insurance for all. But in an otherwise benign sentence, Kennedy let slip a troubling suggestion about the Democrats’ plans for a government takeover of health care.

Kennedy says the best way to guarantee universal access to quality care is “by giving Americans the option of enrolling in a public health-insurance plan, where coverage is provided in the public interest” (emphasis added). There’s only one problem: Health care isn’t public; it’s personal and private. It can’t be provided in the public interest for the simple reason that no doctor has ever cared for “the public.” Doctors care for patients. And health care, under any recognizable definition, can be provided only in the patient’s interest. Any law that empowers government to provide individual coverage in the public interest implicitly empowers government to deny individual coverage for the same reason.

Listening to President Obama, it is clear what he thinks the “public interest” in health care is: getting costs under control. During his economic speech at Georgetown University last month, Obama warned of the costs of our health-care system no fewer than ten times. During his address to a joint session of Congress in February, he mentioned the system’s costs eight times.

But here’s the thing: The government is the reason that health-care costs are spiraling out of control. Government now covers 100 million Americans. Medicare dominates the market, stifles competition, and sets arbitrary and unfair pricing standards that force Americans with private health insurance to pay more and more of the costs. Yet the plan favored by President Obama and the Democrats purports to control health-care costs by doubling the size of government health-care programs.

The so-called public option is a supposedly voluntary arrangement: a government-run insurance plan that will compete with private insurers. Supporters argue that the public option will not force anyone to do anything; it will merely provide an alternative to private insurance.

But government never competes in a private market; it takes the market over (how’s the mortgage-lending business doing these days?). The most comprehensive and reliable study of the public option, conducted by the Lewin Group, concluded that once the government enters the market, businesses will simply stop covering their employees. Whatever penalty fees they have to pay will be far less than the costs of insuring their employees.

The Lewin study estimated that of the 130 million Americans likely to enroll in the public option, 118 million will do so after losing their employer-sponsored plans. Add those 130 million to the 100 million now covered by Medicare, Medicaid, and other government programs, and we will have three-quarters of the American people dependent on the government for their medical care.

It is at this moment, in the very near and plausible future, that the tyranny of “coverage . . . provided in the public interest” will bare its teeth. With universal access mandated by law and without a competitive market to drive down costs, the only way for government to save money is by denying care to people whose health is deemed — you guessed it — not in the public interest. The only way to prevent expensive, breakthrough treatments from bankrupting the system is to limit access to them.

Every country with government-run health care rations that care. Patients wait weeks to see a doctor, months to see a specialist, and years to have routine procedures — all while they suffer with chronic illness, acute pain, and even metastasizing cancer. Unlucky patients who die on these waiting lists may be mourned by their families, but not necessarily by the depersonalized system of bureaucrats that politicians create primarily to control costs.

There are good, patient-centered solutions to America’s health-care challenges. Instead of the government-run public option, we should move toward a “personal option,” where we help individuals and families buy and own health-insurance plans that no government can take over or take away. Your health care should be administered by doctors and nurses who are focused on your health interests, not on the interests of politicians and bureaucrats in Washington.

Providing health care “in the public interest” will prove unimaginably expensive. But if the public option is ever enacted, millions of American families will learn quickly that its true costs cannot be measured in dollars.

– Jim DeMint is a Republican senator from South Carolina.