Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The public option dissonance in health reform

Brad Wright, PhD
Policy
August 20, 2010
Share
Tweet
Share

Health reform will do a lot of things that most Americans don’t realize it will do, and it will not do a lot of things that many Americans mistakenly believe it will do.

One of the most recognizable components of health reform that didn’t actually become law is the public option. The public option was the lighting rod in the health reform debate. After all, it had a concise name, and was easily talked about–by both proponents and opponents–whereas the other minutiae of reform are difficult for most people to understand. It was seemingly at the epicenter of the debate over government’s role in our lives and our health care system, despite the fact that it might, some would argue, be the best chance of preserving our private insurance system.

But for all the attention it received, and all the attention it diverted from other aspects of reform, it didn’t make it into law. The question is why not? How is it that a major piece of legislation–one that succeeded where others had failed for decades–was able to be passed, while a minor piece of that legislation received so much attention and had to be eliminated in the end? The easy answer is Joe Lieberman, but I don’t think that’s the full story. After all, the legislation wouldn’t have cost significantly more with the public option intact, and it would have covered more people and given all Americans more, rather than fewer, choices. Well, perhaps that last point is debatable. Some felt strongly that the public option would have an unfair advantage that would lead to the collapse of the private insurance system and the implementation of a single-payer system. Maybe so. Of course, that ought only to happen if the people chose the public option over private insurance consistently.

What I think the fate of the public option demonstrates is the sharp distinction between policy and politics. You see, as policy, the public option makes a good deal of sense. Granted, it has not been implemented nationally in the United States, and therefore we have no real empirical evidence to demonstrate that it works, but we do have a sound understanding of economic theory, incentives, and markets that go a long way in predicting the outcome(s) of a public option. The public option actually draws on many–but not all–conservative principles. So, on policy grounds, at least some Republicans should have supported it.

But, on the other hand, we have politics. In that game, the “enemy” that is the other party cannot be allowed a victory, because even if the results are beneficial for the nation and its people, when the other side wins, you lose. The trick then, becomes to use politics, but make it appear like policy is the focus–to blur the dividing line between the two. When the opponents of health reform latched onto the public option–a piece of policy–they did so for political reasons, and they didn’t discuss the merits of the policy, but framed it with negative politics.

Thus, the public option was “socialized medicine,” a “government takeover,” and a “threat to our private insurance system.” These labels may evoke a visceral response, but what they don’t do is articulate any specifics of the public option–what it would or wouldn’t do. It’s effective politics, masquerading as policy, and it works. In fact, it works so well that I firmly believe that you could take a cute puppy or newborn baby, call it “socialized medicine” and watch sizable groups of people shun it. It’s a label–and while it may go nowhere in describing the content to which it is applied, it matters tremendously in determining how people respond to it.

And so it was with the public option. There were the strong supporters of a single-payer system who saw the public option as a major policy compromise made to navigate the politics of reform, and the strong opponents who painted the public option as the death of American capitalism to engender hostility among their constituents.

But here’s what I really believe: If the Republicans had been the ones to propose health reform, they could have included the public option without violating their public policy positions–and they wouldn’t have had to put up a nonsensical, albeit quite effective, political fight on that issue, because the Democrats would have welcomed the approach.

Brad Wright is a health policy doctoral student who blogs at Wright on Health.

Submit a guest post and be heard.

Prev

International medical graduates and their patient outcomes

August 20, 2010 Kevin 29
…
Next

OpenNotes and whether patients should see their medical notes

August 21, 2010 Kevin 5
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
International medical graduates and their patient outcomes
Next Post >
OpenNotes and whether patients should see their medical notes

ADVERTISEMENT

More by Brad Wright, PhD

  • If your hospital closes, does patient care suffer?

    Brad Wright, PhD
  • a desk with keyboard and ipad with the kevinmd logo

    We have the power to prevent disease. But we’re not using it.

    Brad Wright, PhD
  • a desk with keyboard and ipad with the kevinmd logo

    The uninsured rate has fallen, but it may soon rise

    Brad Wright, PhD

More in Policy

  • Unused IV catheters cost U.S. hospitals billions

    Piyush Pillarisetti
  • Why your health care dashboard isn’t working and how to fix it

    Dave Cummings, RN
  • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

    Robert E. White, Jr. & The Doctors Company
  • How new loan caps could destroy diversity in medical education

    Caleb Andrus-Gazyeva
  • Why transplant equity requires more than access

    Zamra Amjid, DHSc, MHA
  • Ideology, not evidence, fuels the anti-trans agenda

    Andie Riffer, PhD and Shawn E. Parra, LCSW, MSW
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Why doctors struggle with family caregiving and how to find grace [PODCAST]

      The Podcast by KevinMD | Podcast
    • Locum tenens: Reclaiming purpose, autonomy, and financial freedom in medicine

      Trevor Cabrera, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN can use worldwide [PODCAST]

      The Podcast by KevinMD | Podcast
    • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

      Yousuf Zafar, MD | Physician
    • Psychiatrist tests ketogenic diet for mental health benefits

      Zane Kaleem, MD | Conditions
    • The hidden rewards of a primary care career

      Jerina Gani, MD, MPH | Physician
    • Why physicians should not be their own financial planner

      Michelle Neiswender, CFP | Finance
    • Why doctors regret specialty choices in their 30s

      Jeremiah J. Whittington, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 12 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Why doctors struggle with family caregiving and how to find grace [PODCAST]

      The Podcast by KevinMD | Podcast
    • Locum tenens: Reclaiming purpose, autonomy, and financial freedom in medicine

      Trevor Cabrera, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN can use worldwide [PODCAST]

      The Podcast by KevinMD | Podcast
    • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

      Yousuf Zafar, MD | Physician
    • Psychiatrist tests ketogenic diet for mental health benefits

      Zane Kaleem, MD | Conditions
    • The hidden rewards of a primary care career

      Jerina Gani, MD, MPH | Physician
    • Why physicians should not be their own financial planner

      Michelle Neiswender, CFP | Finance
    • Why doctors regret specialty choices in their 30s

      Jeremiah J. Whittington, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The public option dissonance in health reform
12 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...