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The Right's Real Fear: Public Option Could Succeed—A Commentary by Sam Berger ’10

The following commentary was published in the Hartford Courant on October 21, 2009.

The Right's Real Fear: Public Option Could Succeed
By Sam Berger ’10

The debate over whether health care reform should include a public option continues to dominate the headlines. But the controversy around the public plan reveals that the health care debate is about more than just one-sixth of our economy — it's also a struggle between the stark ideology of the past and a modern understanding of the interplay between markets and government.

The public option, designed as a compromise between single-payer, government-provided health care and a strictly market-based system, is widely supported by Americans. The program would create competition in a heavily consolidated industry, allowing the government and individuals to save money while maintaining our existing health care system.

Yet, conservatives have responded to the public option with nearly unanimous opposition, calling it a "government takeover" that threatens the health insurance industry. Opponents of health care reform claim the plan will be a Trojan horse for a single-payer system, driving out private insurers and facilitating government-run health care.

But although a public option could be designed to undercut private insurers by charging below-market prices, it could just as easily be designed not to. Congress has proposed several ways the public plan could set rates, and there could be additional constraints, such as triggering a public option only if insurance companies fail to provide adequate coverage, or allowing individual states to opt to create their own public system.

Republican opposition might be explained as a strategy for winning the mid-term elections by transforming health care into President Barack Obama's Waterloo. But this misses the larger ideological issue at stake: Conservatives are concerned that a public plan would work.

Grover Norquist, one of the architects of the opposition to President Bill Clinton's health care plan, acknowledged as much more than 10 years ago: "Had the Democrats taken over health care [under Clinton], I think we would have become a social democracy and we could have never undone it."

Conservative pundit William Kristol also recognized the threat presented by Clinton's health care reform, saying at the time that it would "strike a punishing blow against Republican claims to defend the middle class by restraining government."

Government involvement would improve the health care system. An unregulated health care market doesn't work; industrialized nations with government programs spend less money for better health results. And current demands to protect Medicare reflect satisfaction with government involvement here at home.

Conservative fears of a Trojan horse are not entirely misplaced; the public option could change the political landscape simply by performing well. Rather than foster a government takeover of health care, an effective public option would foster the idea that targeted government intervention can be a force for good — a lesson Americans will be reminded of every time they go to the doctor.

This result would be anathema to the radical conservatives who currently have a stranglehold on the GOP. To them, government is always the problem, never the solution. But the world has changed since the conservatives' rise in the 1970s. Democrats have accepted a broader role for market competition in a whole host of fields, and have sought to combine market forces and government intervention to creatively address new challenges — and the public option is a perfect example.

In the face of these changes, knee-jerk opposition to government involvement is woefully out of tune with the problems facing our country, problems exacerbated by eight years of conservative anti-government rule. A robust public option could help move us past the old "government vs. market" debates and address more nuanced questions of where government intervention is appropriate and what type of intervention it should be.

Also, by demonstrating the shallowness of the anti-government view, health care reform could create room for a moderate wing of the Republican Party capable of honestly engaging with Democrats to craft bipartisan solutions, as they did with Medicare and civil rights legislation.

Sure, this might make the GOP a more viable political force, but who are Democrats to be afraid of a little competition?

Sam Berger, 26, of Amherst, N.Y., is a third-year student at Yale Law School. He is co-editor of the forthcoming book "Progress in Bioethics: Science, Policy and Politics" (MIT Press).