Published on
the Portland Press Herald (Maine)

It's a Public Service, so Health Care Should Be Publicly Funded

Is health any less central to our lives than defense, firefighting, or the interstate highways?

George N. McNeil

When I last wrote in this space about a health insurance public option, it was 2004.

I lamented the fact that more than 40 million Americans lacked health coverage and suggested that the private corporate model seemed incapable of righting this wrong. (My opinions on this topic remain my own, and do not reflect my employer's views.)

Since then we have endured five more years of fiddling with free market solutions -- while Rome is burning.

We are now told of some 46 million uninsured (National Coalition on Health Care), of 86.7 million who were uninsured at some time during 2007-2008 (Families USA). It is chilling that these numbers pre-date the current recession and thus represent a rather pathetic best case. And we are now witnessing the demise of venerable corporations like General Motors, a demise attributable in no small part to the crushing burden of purchasing health insurance for workers and retirees.

Our nation's manufacturing base operates at a profound disadvantage to those in countries with more extensive public funding of health care.

We are also told that a clear majority of Americans (65 percent) want systemic change in the funding of health care, including an expansion of the public option now represented by Medicare and Medicaid (Kaiser Family Foundation, June 2009). And yet, despite the mandate for change that seemed clear in the November elections, our political leaders continue to dither.

Sen. Olympia Snowe is praised for dipping a toe in the water with her standby option, a publicly funded plan to be implemented only if the private sector "fails to deliver."

How many more chances are these guys going to get?

Never far from the political debate is the drumbeat of fear and cries of "socialism."

The emotional impact of this has escaped the bounds of the debate and taken on a frightening flavor of paranoid backlash to the Obama administration's reformist initiatives.

While socialism in the Soviet idiom would be a terrible prospect, we would do well to recognize that in attenuated form it has been in our midst for ages.


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Public services such as police and firefighting simply do not lend themselves at all well to a private subscription model. Similarly, defense is best delivered by the federal government, as recent experience with Blackwater Corp. would remind us.

Our transportation infrastructure, for better or worse, is largely a product of public planning and funding.

Why not medicine? Is health any less central to our lives than the interstate highway system? Can we not agree that the denial of health care is simply not acceptable in the world's greatest democracy?

Critics of a public option are legion, and they point with justification to the inevitability of waste and inefficiency in government programs.

Yet, despite its imperfections, Medicare, the closest we have come to the socialist model, delivers about 95 cents on the premium dollar to actual health care, while private health insurance, after paying executives, shareholders and other administrative overhead, delivers about 84 cents (Council for Affordable Health Insurance, 2006).

Add to this the monumental cost incurred by hospitals and doctors' offices that have no choice but to hire armies of administrators (each delivering no health care) to manage the morass of conflicting insurance plans. The free market has given us a system of care that is nothing short of a Tower of Babel.

A March 2002 report from the U.S. General Accounting Office cited a statewide median of 28 licensed small group insurers, ranging from four in Hawaii to 77 in Indiana. To be sure, this has created a veritable jobs program for managers and bureaucrats, and this growth sector would be adversely affected if our health care dollars were reallocated to actual patient care.

This cadre of MBAs and others, relative newcomers to American health care, have become parasites at the feast.

They have the most to lose in reforming our dysfunctional system and have helped to orchestrate the chorus of fear about a public option.

It is my hope that we can marginalize the fear-mongers and accept the reality that the corporate model, while leading to fabulous riches for the few, has failed Americans.

Private choice deserves to survive (we are not, after all, the Soviet Union), but it is time to give up our broken system and to place public funding at the center of reform.

George N. McNeil, M.D., (e-mail: is a resident of Standish, Maine.

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