In all the recent talk about US health care reform, one comparison
that hasn’t been made enough, IMO, is with public schools.
Yes, US public schools have their share of problems (don’t get me
started on students who can’t find the US on a map), but they do serve
two important functions: they’re a backstop and a floor.
Backstop: if, for whatever reason, you can’t send your kid to a
private school — perhaps your school of choice is too far away,
or too expensive, or the uniform clashes dreadfully with her hair, or
whatever — there’s always the public school option. That is, you
never have to choose between education you can’t afford and no
education, only between education and better education.
Right now, too many people are having to choose between health
insurance they can’t afford, and no health insurance.
Floor: private schools can remain in business only if they suck less
than public schools. If you’re of the “government can’t do anything
right” school of thought, this sets the bar low enough that it
shouldn’t be a problem.
But on the whole, public schools haven’t driven private schools out of
business, any more than public libraries killed off Blockbuster or
Netflix. the US Postal Service has killed off UPS and FedEx. In fact,
those two came along after the USPS, and thrived because USPS
was widely seen as being sucky.
So a government-run health insurance plan would define the lowest
level of quality that a plan would have to achieve. If your insurance
company sucks more than the federal government, you don’t deserve to
remain in business.
Backstop again: a lot of jobs that the government does are ones that
are unprofitable, but ought to be done. When No Child Left Behind
required schools to show how much bang they were giving for the
education buck, a lot of private schools tried to dump their special
needs students, simply because kids who need special attention or
staff training are less profitable than average kids. Public schools
don’t have that option. Again, by analogy, a public plan should cover
those people too unprofitable for private plans (I’m thinking Stephen
Hawking without the wealth and fame).
Now feel free to leave a comment saying how fucking obvious all of