Government Run Programs

If you are like most people, you live in a community that includes a public sector employee. You might have befriended a few. Most go to work each day, arrive on time, work the entire day and return to their families, just like you do. While it is certainly true that people at the top of the public sector food chain make bad decisions, they are constrained (usually) by regulations that emanate from the legislation that created the program. Do you assume that your neighbors are incompetent? Do you assume that they are lazy? If your answers to those questions is "yes", have you ever had a conversation about what they do?

I was a public sector attorney for nearly 13 years. I worked on average a 10 hour day, including quite a few weekend days, took no lunch break and do not consider myself stupid. The agency paid me about half of what I could have made in the private sector to do the same kind of work. My colleagues, in general, worked just as hard. I also spent some time representing public school bus drivers and clerical staff. No one I ever met was lazy or incompetent.

The proposal to create a government-run option (yes, option) to compete with private health insurers has created a firestorm of protests among many different groups. The private health insurance industry is particularly rabid about stopping it. That ought to tell you something. They are afraid that they will have to compete and it will cost them a chunk of their profits that they have grown very accustomed to. Private insurers pay their CEOs and upper management far, far more than federal government scale salaries. Private executives get bonuses just like their contemporaries on Wall Street. They hire administrative types to do the grunt work which often involves telling their insured that the plan doesn't cover the procedure they need or that they have a pre-existing condition that will never be covered. Too many people have a horror story for me to believe that the private sector is so magical in delivering affordable, quality health care.

"Government run" does not always mean poorly run. It does not mean that everyone is asleep at their desks. It does mean that overhead costs are lower and it does mean that private sector insurers will have to hustle to be chosen over a public option. If we really care about getting insurance to everyone - which all by itself should spread risk and lower premiums for everyone in both the private and public sectors - we shouldn't dismiss it because of old prejudices about public employees.

Many of us entirely miss the point, which I have said before: you are already paying for universal "coverage". Forget about taxes for just a minute. Every time a person cannot pay a medical bill without using funds otherwise set aside to pay a mortgage payment, he or she risks foreclosure. Foreclosures that happen near you - in this case "near" could mean a block away or two miles away - chip away at your own house values, most Americans' biggest investment. If that doesn't wake us up, what about the people who do make the mortgage payments and fail to pay the hospital. Let's assume the hospital doesn't force the patient into bankruptcy. Their other option is to cut back on the care they deliver, either through lay-offs or closing practice areas in non-lucrative specialities. If they do force the patient to file for bankruptcy, we're back to vacant houses and all of the ugly things that are happening too often these days.

If you're worried that spendthrift patients who have medical problems and mortgages and no health insurance are the real problem, work to tighten credit markets to limit their ability to sink themselves into a sea of debt. It is silly but true that there were people out there who had more revolving credit than they earned in salary in a year.

The other important thing many of us forget is that WE are the government if we take the time and spend the energy to be involved in decision-making. Casting a vote every time you are asked to do so is a good start but there is so much more to a democracy than casting votes. Maybe we are too busy to do very much but if we all woke up a half hour earlier or went to sleep a half hour later and sent a few well-written email, it would tell our representatives that we are watching what they do much more closely than they think. It will matter when lobbyists come knocking on their door, threatening to fund another candidate if they don't tow the corporate line. At least they will be able to say that no amount of campaign contributions or lobbyist-paid phone banks could overcome the opinion of their constituency. Maybe some would be bold enough to say that out loud at a town hall meeting.