Liberals in Congress say they want a public plan to compete
against private health insurance in order to give Americans more
choice and competition. Ponder that.
The reason that argument is so puzzling is that it is routinely
made by Congressmen who have been stalwart champions of a single
payer system of national health insurance. Single-payer means just
that. Government monopoly. No competition.
So, yes, it is hard to believe that officials who have whined
from time immemorial about the waste and inefficiency of multiple
private payers for health coverage would suddenly become champions
of personal freedom of choice and competition in health insurance
markets.
So, don't believe it.
In the House bill (H.R. 3200), there is no truly level playing
field for competition between the public plan and the private
health plans. While the bill says that the public plan will be
initially financed by appropriations for start up costs, it also
says that the Secretary of HHS can enter into contracts to
administer the public plan, just like the Secretary enters into
contracts with private firms to administer Medicare, but these
contracts cannot, in the words of the House bill, "involve the
transfer of insurance risk" to these private firms. In other words,
the taxpayer is on the hook for the risks of the public plan. The
bill says that the government plan must be self-supporting through
premiums. But since the purpose is to create a low-cost plan,
one can imagine that this will be quickly eroded, that the
government will not want to charge full freight, and future
Congresses will appropriate taxpayer money to bail it out.
Members of Congress will say that the public plan should compete
on its own, financed by its own premiums, and that it will be
allowed to fail. They say that. But they say a lot of things. It is
hard to believe that the public plan, another government sponsored
enterprise, like Fannie Mae and Freddie Mac, would be allowed to
fail. If automakers, AIG and other financial institutions are "too
big to fail", it strains the imagination that Congress would not
bail out its own creation, especially if it enrolls millions of
Americans who have been dumped out of their private health
insurance coverage. The Lewin Group, one of the nation's top
econometric firms, estimates that as many as 88 million Americans
would be shifted out of their employer's health insurance coverage
under the terms and conditions of the House bill. That is a large
consitutency for bailouts.
While the House bill provides that enrollees in the public plan
will have the same rights as Medicare beneficiaries have today,
that's not enough. Sure Medicare beneficiaries today have access to
the federal courts to secure their statutory entitlement, but
Medicare beneficiaries can't sue the Secretary of HHS for damages
for injury arising out of wrongful coverage denials decisions in
the same way they can sue private insurance executives. No way.
Private health plans are routinely subject to federal and state
laws governing torts and contracts, and private health plan
executives can be sued for violations of these laws. If Congress
wanted to really secure a level playing field, they would allow
ordinary Americans to sue the officers of the public plan for the
same reasons in the same way.
For a truly level playing field, there are even more laws that
would have to apply to the public plan as well as the private
plans: anti-trust laws, consumer protection and solvency rules in
any states where the public plan competes with private insurers,
and federal and state tax laws.
On the last day before the House recess, July 31st, Congressman
George Radanovich (R-Ca) offered an amendment in the House Energy
and Commerce Committee that would have subjected the public plan to
all the same rules and standards that apply to private health
plans, including the payment of state taxes. The Committee's
Democratic majority defeated the Radanovich amendment. So much for
the level playing field.
So, would Congress or could Congress create a level playing
field? To think so, in the face of the evidence, would require more
hope for a change in congressional behavior than normally sober
people can summon.
Robert
E. Moffit, Ph.D. is Director of the Center for Health Policy
Studies at The Heritage Foundation.