The usual knock on government programs is that they're not as efficient as the private sector, which we're told can provide the same product for less money and with higher quality. Thus, it should be no big deal when the public and private collide because the private sector should prevail.
However, in providing health insurance, those rules clearly don't apply, which is why congressional Republicans and so-called "centrist" Democrats are going to such lengths to deny the American people access to a public option on health insurance.
Indeed, if a public option were to be piggybacked onto the existing Medicare bureaucracy, the chances for savings could be impressive for average Americans and the overall American economy.
Insurance middlemen could be eliminated; investigators who ferret out "preexisting conditions" wouldn't be needed; doctors could save on administrative costs; the burden on U.S. industry providing health benefits could be reduced; and more money could be freed to cover the nearly 50 million uninsured or for actual doctoring.
For a nation facing multiple fiscal crises - all complicated by the costs of health care - one might think that the most sure thing in the health care debate would be to allow a cost-saving public option, which as President Barack Obama says would help keep private health insurers "honest" regarding their promises to trim waste and control premiums.
According to a New York Times/CBS poll, that point is obvious to 72 percent of the American people who favor "offering everyone a government administered health insurance plan like Medicare that would compete with private health insurance plans."
It's also reflected in a study cited by Sen. Chuck Grassley, R-Iowa, and other insurance industry defenders saying that 119 million Americans would bolt from their private insurers to the public option if they were given the chance.
To put that figure in perspective, it is about two-thirds of Americans who have private insurance through their employers or as individuals. In other words, the industry's defenders say two of every three customers want out.
Though some analysts doubt the defection rate would reach 119 million, Grassley's argument is that Americans would so prefer a government-run plan that it would destroy the private insurance industry - and that therefore the public option simply can't be permitted.
Grassley's fear of 119 million Americans voting with their pocketbooks against private health insurance represents a remarkable admission of failure by the industry and its backers. It says, in effect, that the industry's treatment of its customers has been so highhanded over the decades that the industry can only survive if Americans are left with the unappetizing choice of private coverage or no coverage.
So, not only are the Republicans - and some Democrats - standing against the desires for 72 percent of the population but, in effect, they also are trying to lock in 119 million unhappy customers for a profit-making industry. To add another windfall for the insurance industry, Congress may compel the near 50 million uninsured to buy insurance under penalty of fines.
Even in the sorry history of special-interest-dominated Washington, it is rare for politicians to so blatantly adopt defense of a private industry over the will of the people.
One might think that Democrats would take this club and beat the Republicans over the head with it. The Democrats could argue that the public option is not only popular but could save money for struggling U.S. businesses by bringing down their health insurance costs and freeing up more money for investment and for the hiring of new workers.
One of the key factors that drove General Motors into bankruptcy was how its health insurance benefits for employees inflated the company's costs-per-worker total and thus hurt its competitiveness against rivals who operate in countries where the government pays for health care.
The public option issue also would seem ready-made for Democrats given that the New York Times/CBS poll found that a solid majority of Americans (57 percent) were willing to pay higher taxes so that all Americans could have "health insurance that they can't lose no matter what." [NYT, June 21, 2009]
Nevertheless, key "centrist" Democrats, such as Sens. Max Baucus of Montana and Kent Conrad of North Dakota, are ready to scuttle the public option to secure a few GOP votes so they can claim their plan is "bipartisan." Conrad has called for substituting a privately run, non-profit "cooperative" for the public option.
While Conrad's "cooperative," which would be ostensibly owned by its members, has some superficial appeal, it would require the creation of an entirely new bureaucracy - rather than relying on the government's existing infrastructure for Medicare - and would likely be run by high-paid executives recruited from the existing private insurance industry.
Critics of Conrad's plan also note that the cooperative would have far less leverage in negotiating lower prices from pharmaceutical companies and other parts of the medical industry, so the savings would be marginal - which is exactly why the idea appeals to industry groups.
Patrons and the People
It goes without saying that the medical-industry complex has made generous contributions to all the key lawmakers, especially those like Grassley and Baucus who are at the top of the influential Senate Banking Committee.
But the obsession of some Senate Democrats, like Conrad, to find "common ground" with Republicans seems to go beyond simply rewarding benefactors. Though it's clear that many, if not most, Republicans have a single-minded goal - to sabotage the Obama administration - Democrats nevertheless continue in their quest for the elusive "bipartisanship."
This quest goes on despite the fact that Republicans were trounced in the last two elections, are down to 40 senators, and are facing historically low approval ratings. Still, "centrist" Democrats insist on bending over backwards to accommodate the GOP desires, even when those desires fly in the face of popular opinion and do not represent the most sensible policies.
These Democrats - sometimes including President Obama - appear deeply influenced by Inside-the-Beltway chatter coming from pundits who still reflect the Ronald-Reagan-to-George-W.-Bush conventional wisdom that "government is the problem," that tax cuts are the answer to every question, and that "self-regulating markets" have made bureaucrats largely irrelevant.
Despite the nation's cascading crises - which can be traced to too little government, excessive tax cuts and a lack of sound regulation - the chattering class has not been shaken from its biases. So, the minority Republicans are given far more time and space than they reasonably deserve (and much more than minority Democrats got during George W. Bush's presidency).
Amid Republican charges of "socialism," the reaction of Democrats, like Baucus and Conrad, is to position themselves in what they must consider the safe center, earning praise from the pundits for their courageous willingness to stand up to the Democratic "base" - and to the overwhelming majority of Americans - in order to stop the public option.
But Baucus and Conrad will likely find that the safe center isn't so safe. When half-measures and half-baked compromises leave the American people disappointed or angry, the fault will be laid on the government's failure to do the job right.
And that failure will be cited by Republicans and the pundits as further proof of the superiority of the private sector.