Acton Commentary

Civilizing Discourse on the Public Option


There has been a great deal of debate about the shape of the so-called “public option,” a part of President Barack Obama’s health care reform plan that would address the tens of millions of uninsured workers in this country. In a nationally-televised speech last week the president clarified the purpose of this effort, but sadly his attempt to dispel myths about the public option was fraught with vagueness and contradiction.

The president intends the public option to be non-profit competitor to private insurance companies, one choice among many in a newly-established insurance “marketplace.” As the president said, those entrepreneurs and employees who are not able to afford insurance under the current system will be provided access to coverage “by creating a new insurance exchange — a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices.”

The key component of this marketplace exchange is the public option, which as a governmentally-administered plan would not be driven by the profit motives that guide private insurance companies. The success of the president’s marketplace hinges on the assumption that the public option will set the baseline level of coverage which private insurance companies will be forced to match if they want to “compete for millions of new customers.”

The claim that this public option will not be subsidized by government and “would have to be self-sufficient and rely on the premiums it collects” is belied by the subsequent assertion that leveraging the government’s bureaucratic apparatus will reduce costs for the public plan. Only by subsidizing the plan through governmental bureaucracy would the public option avoid “some of the overhead that gets eaten up at private companies by profits and excessive administrative costs and executive salaries.” Use of governmental resources amounts to a subsidy, and this is how President Obama hopes the option would “provide a good deal for consumers, and would also keep pressure on private insurers to keep their policies affordable and treat their customers better.”

The contradictory claims that the public option will not be subsidized by the government and yet will be able to make use of government resources to reduce paperwork and white-collar costs are only salient within a perspective that confuses the modifier “non-profit” with “governmentally-administered.” A marketplace in which private insurance companies compete with non-profit insurance companies already exists. Indeed, the government does not have to “create” such a marketplace but rather only needs to recognize the critical role played by institutions other than profit-driven corporations and tax-dependent governments.

By conflating non-profit status with the public option, the president’s proposal runs the risk of undermining the important work of the mediating institutions of social life: charitable organizations, churches, non-profit ministries, labor groups, and fraternal and volunteer societies. These groups, not the government, are the true “non-profits” that must be sustained and promoted if a vibrant health care marketplace is to exist.

Rather than pushing for a “public” option that relies on government bureaucracy to underwrite a competitor for private insurance companies, the president’s plan ought to call for greater “non-profit” or “charitable” options that arise out of the spontaneous and voluntary character of civil society.

While there are established non-profit insurance entities, like many members of the Blue Cross and Blue Shield Association, there are also newly burgeoning charitable and non-profit efforts that would be endangered if a new government-subsidized public option emerges. A recent WORLD Magazine report described the tenuous situation of health care sharing ministries (HCSMs), which could be excluded by the president’s plan. James Lansberry, president of the Alliance of Health Care Sharing Ministries, has said, “We are looking at complete obliteration of the ministries as they exist.” HCSMs like Samaritan Ministries International, Christian Care Medi-Share, and Christian Health Care Ministries currently represent about 34,000 families nationwide. And while there is great potential for this number to rise dramatically in the future, the value represented of these kinds of embryonic efforts lies not just in the numbers but especially in the diversity of grassroots and community-based efforts to meet health care needs.

The president has said that there is a great deal of constructive discussion still necessary, and has proposed a period of four years before the marketplace exchange comes into existence, “which will give us time to do it right.” There is good reason to hope that in the discussion over the next months and years a former community organizer will more clearly see that the health of our nation’s health care system depends on the vibrancy and diversity of charitable initiatives, voluntary organizations, and faith-based ministries. To do health care reform right, we need to deconstruct the spurious logic that juxtaposes corporate profits and governmental bureaucracy, and place mediating institutions where they belong: in the middle of the discussion.