You've probably already seen this, but the New York Times published a poll this weekend that showed overwhelming public support for a public health insurance option, and are willing to pay higher taxes for it:
Americans overwhelmingly support substantial changes to the health care system and are strongly behind one of the most contentious proposals Congress is considering, a government-run insurance plan to compete with private insurers, according to the latest New York Times/CBS News poll.
The poll found that most Americans would be willing to pay higher taxes so everyone could have health insurance and that they said the government could do a better job of holding down health-care costs than the private sector.
Yet the survey also revealed considerable unease about the impact of heightened government involvement, on both the economy and the quality of the respondents' own medical care. While 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt, 77 percent said they were very or somewhat satisfied with the quality of their own care.
Yup. Sounds about right. People want better insurance coverage, but are happy with their care. I know I've paraphrased Uwe Reinholdt on this topic a half-dozen times, but it's worth repeating here: the health-care crisis essentially is about how we pay for our health care, not with the care we receive.
Then, like me, you're probably frustrated by where health reform policy seems to be heading. Nate Silver:
The bottom line is that the health care debate is not really being played out in the court of public opinion. If it were, Congress would pass a robust plan with a public option that was funded by raising taxes on cigarettes, booze, and people making over $250,000, and we'd live happily ever after (or not). Rather, this is a behind-the-scenes fight at the committee level, where certain senators who have ample financial incentives to please the insurance industry have a disproportionate amount of control over the process.
I'm generally not one to carp about special interest money -- seeing politics through that lens is often an overly reductive formulation that serves as a catch-all excuse any time Congress does something you don't like. But on something like the public option, which has broad public support and which would probably reduce -- not increase -- the long-run bill to the taxpayers, it is just about the only way to explain what's going on in Washington.
(Silver today backs his assertion with statistical analysis.)
Not that I believe that special interest money is solely at fault here. For example, Paul Krugman is right on when he writes:
The real risk is that health care reform will be undermined by "centrist" Democratic senators who either prevent the passage of a bill or insist on watering down key elements of reform. I use scare quotes around "centrist," by the way, because if the center means the position held by most Americans, the self-proclaimed centrists are in fact way out in right field.
And while he does categorize Republicans as "spoilers" betting all-in on the failure of health care reform, I think he underestimates the power that they wield in the Senate. Yes, we're all quick to blame Democrats for the imperiled reform, but isn't that the result of lowered expectations? If we had real, responsive representation from the minority party, we'd have a workable plan. It's the Republican intransigence that's putting the Ben Nelsons ad Kent Conrads in the driver's seat.
And digby noticed that Blanche Lincoln decried a public option because it would "ursurp" competition in the market - only Blue Cross Blue Shield owns 75 percent of the market in Arkansas. To which Krugman responds:
The truth is that the notion of beneficial competition in the insurance industry is all wrong in the first place: insurers mainly compete by engaging in "risk selection" - that is, the most successful companies are those that do the best job of denying coverage to those who need it most. But in any case, Arkansas is in effect a one-insurer monopoly state, with no competition at all - unless a public plan is created.
In fact, I may have a new hypothesis about the political economy of the health care fight. One thing that's obvious, if you look at the balking Democrats I chided in today's column, is that almost all of them come from states with small population. These are also, by and large (pdf), states in which one or at most two private insurers dominate the market.
So here's a suggestion: while the opponents of a private plan say that they're trying to defend market competition, what they're actually doing is defending lucrative local monopolies.
Didn't Matt already point out that Blue Cross Blue Shield controls 75 percent of the market in Montana?
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