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When "Public Options" Serve the Public - and When They Don't

by: Lawrence S. Wittner, t r u t h o u t | Perspective

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Dr. Wittner points out that there is a successful "public option" in place for fire and police protection. (Photo: Thomas Hawk / Flickr)

    Currently, there is nothing more controversial in President Barack Obama's health care reform proposal than the "public option." Much of the controversy, of course, has been generated by private insurance companies, determined to safeguard their hefty profits, and by Republican politicians, eager to destroy anything that might redound to the benefit of the Democrats. Even so, a little clear thinking on the subject of public programs might illuminate their advantages and disadvantages.

    In fact, there are numerous "public options" in American life, with many of them rooted deep in the nation's history. In the area of education, there are public schools; in recreation, public parks; in travel, public roads; in fire-fighting, public fire departments; in law enforcement, public police forces; in culture, public libraries; in transportation, public bus and train lines; in mail delivery, the post office; in sanitation, public water supply plumbing, and sewers; in energy, public power; in old-age security, Social Security; in nutrition, public school lunch programs. Where did the notion ever come from that public programs were somehow "un-American"?

    Even in the disputed area of health care, there exist public hospitals, Medicare, Medicaid, the Veterans Administration and the National Institutes of Health.

    These and other public programs, while not perfect - and often challenged by private competitors - seem to work well enough most of the time. If they did not, Americans would be clamoring to abolish them. But, with the exception of the wealthy and their supporters, who dislike paying for their share of these social benefits through progressive taxation, most Americans seem reasonably contented with them. And when they are not, they use their democratic rights to reform and refine public services until they get them into more acceptable shape.

    But public services don't serve the public well when they are administered by dictatorships. The reason is that, under authoritarian governments, the rulers are unaccountable to the ruled. Therefore, public programs - however good they might look on paper - become subject to abuse by power-hungry and corrupt officials. This is the sad story of the Soviet Union, a nation forged in a revolution dedicated to the liberation of humanity, but one that - thanks to its dictatorial nature - gradually adopted some of the most brutal and exploitative practices in the world. Naturally, in these circumstances, public options became disaster zones.

    Public options also serve the public poorly when they are subverted, often quite consciously, by their enemies. Unable to win the battle to abolish public services, their critics and competitors have often tried to cripple them by imposing budget cuts, accompanied at times by stiff user fees. Thus, many public colleges and universities, virtually free of cost only a few decades ago, now charge substantial tuition in order to survive. This limits public access and, at the same time, has the happy result, from the standpoint of private educational institutions, of making public colleges and universities less financially competitive with their private counterparts. The same pattern of deliberately starving the public sector can be found in areas like mass transit, health care, parks and recreational facilities, social welfare, legal services, and many others.

    A key justification for budget cutbacks is that government "can't afford" to maintain the public sector. But why can't government afford such programs? The reason, aside from the bloated US military budget, is that conservative ideologues have pushed through dramatic tax cuts for the wealthy. This practice has not only helped turn their millionaire patrons into billionaires, but has produced unbalanced budgets that are then used to justify cutting back public services. And this, in turn, helps guarantee that the public sector fails to produce substantial benefits for the public. What such ideologues avoid dealing with is their own culpability in this matter. Nor do they say what would happen if there were no public sector at all, and Americans had to rely entirely on the generosity of private corporations to cope with their health, education and welfare.

    Overall, then, public options serve the public well to the degree that the public exercises effective control of the government. Under dictatorial rule, the public almost inevitably gets the short end of the stick. And even in democracies, public programs can sometimes be weakened when private interests use the influence provided by their vast wealth to exercise disproportionate power. But where an active citizenry avails itself of its democratic rights to provide for the general welfare, public options work just fine. Let's use and cherish them.

  

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Dr. Wittner is professor of history at the State University of New York/Albany. His latest book is "Confronting the Bomb: A Short History of the World Nuclear Disarmament Movement" (Stanford University Press).

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Note that many of the public

Note that many of the public programs mentioned are truly "public"-that is, personal data isn't collected. If a public option is "mandatory" (single payer), there will be cradle to grave data collection from individuals. You need to have a choice if you participate in a public program. Many people feel-correctly-that their privacy will be invaded if reform is botched.

I've seldom seen a more

I've seldom seen a more useless exercise in pontificating. Focus on what we need, not cautionary windbaggery. Plays into the hands of the interests you describe.

Private interests are indeed

Private interests are indeed using their vast wealth and the disproportionate power they exercise because of their contributions to politicians to prohibit a public insurance plan. Is term limits the only feasible method of opposing corporate control of the legislative process?

This article is timely. Many

This article is timely. Many people do fall through the cracks as the availability of health care is often unattainable. The propaganda is thick and has prevented me from making an informed decision on President Obama's proposal of Universal Health Care. After reading this thought provoking position,it inspires me to want to do my homework regarding "public option".

Dr. Wittner's arguments

Dr. Wittner's arguments about how public options fail to serve the public in a dictatorships is absurd in the context of the debate on public option raging in our country today. His observations on how private interests may subvert and obstruct the efficient functioning of a public option is germain, but that is no reason to avoid the public option. To the contrary, that point reinforces and further justifies the need for a public option in our healthcare system.

Thank you for an excellent

Thank you for an excellent article. The problem with the issue of Healthcare Reform is not that we do not need it, or that it has to be done. Yes we all need it, and yes, it has to be done for the country's sake. The real problem is that people, the voter, has stopped thinking and is letting the extremist, mostly right wingers, spread their crazy fears, with the sole purpose of not passing any reform that threatens their benefits and those of insurance and pharmaceutical companies. When is the middle class voter think and act like a rational human being?

Marvellous disillation of

Marvellous disillation of the problem. Well worth reading.

After years of Republican

After years of Republican administrations -- from Reagan through Bush II -- starving the public sector and failing to provide for its citizens in even the most dire circumstances -- especially apparent in the response to Katrina -- it's no wonder a small group of misinformed citizens consider the government the problem rather than the solution. Self-fulfilling failures.

Someone should read this

Someone should read this excellent article on Fox news. Perhaps then the R's might learn something

Thank God and Dr Wittner for

Thank God and Dr Wittner for his revealing essay on what is and is not public. If our Congress cannot see the rightness of universal single-pay health care, then the US ship is sinking fast into oblivion.

It's "slow fascism", slowly

It's "slow fascism", slowly but surely democratic controls are being subverted in every area. Have you noticed how many security companies there are now? Instead of a cop on every corner, there's An Ajax Security guard or an XYZ Security guard. Public transit is strapped, so we have instead 10 dollars per mile limos etc etc etc. As for the military, they are being replaced by "contractors" (read: mercenaries) Amazing how so many Americans can lie prostrate, trampled by hordes of corporate storm troopers and yet think that that state of affairs is "rugged individualism".

Thanks for a timely article

Thanks for a timely article considering the state of the US economy. I am wondering how many health insurance companies and their officers, have offshored their profits to avoid paying taxes. If so, it could prove quite embarrassing for the health insurance companies who have denied coverage or cut off coverage of those who get ill. I await a list of names.

Over the past fifteen years,

Over the past fifteen years, I have twice been treated for prostate cancer. The first time in the mid-90s diagnosis showed that I was not a good candidate for either of the most used options: surgery to remove the prostate and radiation, either external beam or by implanting radio-active seeds in the prostate itself. With my doctor's advice, I was referred to a clinical trial for cryosurgery. Twelve years later, when my PSA started to rise, I consulted with my doctors about options and choose to have external beam radiation. About that time, my spouse was diagnosed with ovarian cancer. Over the past two and a half years, she has been through many rounds of chemotherapy, surgery, radiation, more radiation, and most recently she has been part of a phase one trial of high-dose radiation combined with one of the new anti angiogenesis drugs that interferes with the cancer cells' ability to create new blood vessels. When the experimental drug proved to have beneficial effect, the doctors, hospital ethics board and drug manufacturer cooperated to allow her to continue on the experimental drug (not yet approved for use with ovarian cancer) which she has now been on for four months. She takes one pill twice a day at the cost of $185/pill, not one dime of which has been charged to the patient. (Do the math: that's about $50k so far). Neither of us has ever had to pay for any of these services out of our own pocket. Like everybody else, we pay through general taxes collected by two levels of government. Never have we had a moment's discussion with any health-care bureaucrat about our respective courses of treatment. Every step of the treatment plans for our respective cancers has been decided by us, the patients, and our doctors. This is how health care works under our public option, the single payer system in Canada.

According to the Rasmussen

According to the Rasmussen polling group (the most accurate for the past two elections) 57% of Americans would vote to totally replace the present Congress, and the majority of "likely voters" oppose healthcare reform as now presented. Why can't they start with one step at a time, like clearly defining four or five separate policies that all insuraNCE companies MUST OFFER. Then make it a rule that pre-existing conditions are accepted at all levels, Then Congress and all Federal workers must come under the same rules, with the same costs.

Here's a good civics lesson

Here's a good civics lesson that schools should be teaching students, but no longer do. Public schools have been politicized and shortchanged for so long that the ultimate goal has been accomplished. An uninformed fearful public has been manipulated into voting and acting against the best interests of themselves and their country. I guess we deserve what we get for being being apathetic and putting blinders on when viewing the world. Cheating and stealing by a select few has been ignored, laws and oversight remain unenforced. After Watergate bad actors went to prison. Not anymore. Wake up America! We've been robbed!

Well reasoned arguments, but

Well reasoned arguments, but the real trick is to balance between what is good for the country and the "bread and circuses" rule. I would like to see the 50 million uninsured/underinsured citizens in this country covered and costs go down. I'd like our public universities to return to the days when the average family could afford to send their kids to college. As an average citizen, I am angered at the influence that corporations have over my elected representatives. But I don't want to be pandered to, either. I don't want to be "thrown a bone" in order to make me more complacent to "reforms" later. I don't mind taking bad-tasting medicine now if the end result is that I feel good later. But that is anathema to both sides of the debate. The only real solution is to chuck it out and start over. And we all know that won't happen.

To expand on Luis C. Isaza's

To expand on Luis C. Isaza's comments above, Government of the people, for the people, by the people can only work when the people are able to think clearly for themselves or at least recognize clear thinking on the part of others. As an observer from outside your boarders, I ask, when are the American voters going to start thinking for themselves. Publicly run health insurance should be a right of citizenship. Every reason I have read by those who are opposed to public health insurance is in my opinion hogwash. As for the the fear that the government will be gathering data on you as expressed in one of the previous comments, the government is already gathering data on you from the time your birth is registered, through your years in school and each time you file your income tax to the day your death is registered.

Couldn't help throwing a dig

Couldn't help throwing a dig at the "evil rich people" who resent paying their share? They don't mind paying their share; they mind paying their share and the share of the 50% who pay less than 1% of the taxes, but consume a disproportionate share of the services. Exactly what do you think their share should be?

"Couldn't help throwing a

"Couldn't help throwing a dig" Personally, I'd rather work more, make more money and pay more taxes; then I'll give the government the money to help the poor and afflicted, that way, I don't have to physically go and help them myself. Call it lazy or whatever. I'd rather pay someone to do my charity work. Will that get me to heaven? Who knows.

Riposte to the last comment.

Riposte to the last comment. It is not how much you pay in taxes that counts but how much you have left to live on that counts. And the rich use public services more anyway, more water and sewer, their houses catch fire too, they demand better roads to get to and from their multiple dwellings with their multiple vehicles etc. I am sick and tired of the moaning about how much they pay in taxes. They have had a free rides since the founding of this one-time republic and it is time they paid their fair share. PS: we ordinary folk can read Thomas Frank's The Wrecking Crew for an expose of how we got to this miserable point in our history.

If you bought a used car

If you bought a used car from someone that turned out to be a lemon, then you find out that that sales person knew that it was a lemon when they sold it to you, a sales person who refuses to drive that model of car, would you buy another car from them when they told you it was a peach? Probably not (although the sales person might put a spin on it like how good lemon is for you). According to the Democrats and the Obamassia - the sales persons who sold us Social Security, Medicare, Medicaid, and the Veteran's Administration - and who refuse to use any of them - this government controlled health care is a peach. The problem is that this peach is rotten in the center.

THESE PEOPLE THAT DO NOT

THESE PEOPLE THAT DO NOT WANT THE PLAN do not have to take it. WHAT DO THEY NOT UNDERSTAND. I WANT IT AND WILL NEED IT BECAUSE I HAVE POST POLIO SYNDROME. I AM SORRY FOR GETTING IT A SECOND TIME BUT THERE IT IS. THOUSANDS HAVE TO DO BATTLE FOR A SECOND TIME. THIS ARTICLE IS GREAT AND TELLS TRUTH. ALL THESE PEOPLE WHO PROTEST AS THEY DO WILL ALWAYS TELL HOW SOMETHING WILL NOT WORK. THEY WILL HAVE A GRIMACE ON THEIR FACE AND YOU CAN PICK THEM OUT IN A CROWD WITH THEIR RED FACE AND ARMS A WAVING, A HERANG AND SPITAL FROM THEIR LIPS. TO GRANDMA, BE NOT AFRAID . I KNOW YOU ARE. NOT GOING TO HAPPEN TO YOU OR ME- 72- OR ANY ONE. IT IS ASHAME THAT PEOPLE HAVE PUT YOU THROUGH THIS. BUT THEN THESE ARE THE SAME ONES THAT SENT ARE KIDS TO IRAQ TO DIE. FOR WHAT, FOR WHAT. HAVE NOT PUT IN THE BUDGET TO TAKE CARE OF THE KIDS WHO ARE HURT, HOWS THAT ONE? I COULD GO ON. THANKS FOR THE TIMELY ARTICLE AND THINK "MY FRIEND"

Someone here said :"... Note

Someone here said :"... Note that many of the public programs mentioned are truly "public"-that is, personal data isn't collected ..." Sorry to burst your bubble, but those many public programs are paid for with property taxes, which do collect personal data on individuals in order to access said taxes. So what's the difference? There's no such thing as anonymous when it comes to government and taxes - they know who you are, where you live and where you work.

We Americans are in a

We Americans are in a circular problem. With notable exceptions, and to a degree, Big Money buys media ads to ingratiate themselves to the public and to the media, indirectly influencing the stories selected and opinions written which, in turn, influence voters to vote according to the biases thus acquired and strengthened, reelecting the very politicians who wrote the legislation that allowed this. How to break the cycle? Wake up, and then vote.

Dr. Wittner's position

Dr. Wittner's position clearly relates to passing a public health plan under a Democratic administration that has the best of intentions, only to have the plan "administered" down the road by a repressive, backward administration (George W. Bush's comes to mind), where everything is done to starve, undercut, and de-legitimize what would otherwise be a successful plan. This is a real-world scenario identifying the public's role in maintaining the institutions created for it's benefit. In other words, it's not enough to spend the effort to pass a public health plan, it must be monitored, revised, and maintained by the public, AND it's representatives.

Riposte to last comment:

Riposte to last comment: The public cannot "revise, monitor, and maintain" anything in place, nor, apprarently, neither can its representatives very often. The "Public" can barely get to the polls, let alone inform themselves well enough to participate in any real political discourse. With a little organization and a lot of hot air, look at the uproar over one sentence conservatives pounced on, which was part of lesson plan for teachers. Write a letter to show how you can help the president reach his goal. (I paraphrase.) What was his goal? To keep students in school. Some parents have forbade their children to participate in any discussion about the president's speech. What does that teach children? If you disagree with anyone's ideas, avoid any discussion. Run in fear if someone even sounds subversive or partisan. This was a minority, you say. What about the thousands of people who have followed suit, made the decision to keep their children home from school without examining the facts at all? How can we have any part in administering, monitoring, or maintaining a policy or law in place when the coporate media gives more time to rabid blathering than real discussion, and our schools continue down a path of testing instead of teaching critical thinking? Until the public is able to address these two issues, the status quo remains.

Thanks to the Canadians who

Thanks to the Canadians who post and share their experiences in the Canadian system, vs. the lies that are spread in the U.S. by the health insurance industry. Our standard of living has sunk so low in the U.S. People no longer realize what it's like to live in a nation where you are treated like a worthwhile human being with rights. Sometimes our only reminder from those who live in nations with universal systems, and people don't have to deal with anything other than the health issues themselves, when they arise. I've lived through many episodes of social change in the U.S. Throughout it all, I've been a person who supports civil rights, education, and I've been against every war this nation has been involved with since I was born. But I've never felt disgusted with my country, except for now, during this health care "debate". Of course, this also goes hand in hand with being proud that so many of my fellow Americans see the importance of universal care, support single payer or a public option, and so that all Americans can have health care. I hope we will all be able to stick together and make our voices heard over the ignorant din, and for a long enough and consistent enough period, to bring the U.S. into the 21st century of medicine. For there is no 21st century medicine in the U.S. if health care is not available to everyone without thought of health insurance or medical bills.

Regarding "Personal Data" -

Regarding "Personal Data" - what makes you think anything is private anymore? When you go to the doctor, with your employer paid insurance, you sign a document allowing your employer to have access to all your medical records. Have you looked at your home address on Zillow.com? There's your home pegged on a satellite map with aerial photos and more. Or Google your address, you are likely to find photos of your home from right outside your front door, complete with driving directions, If they aren't there yet, they will be. It's simply too late to live a normal life and fear having someone track you- you've been tracked from the day you were born. If you don't like it, maybe you can hide out in the wilds of Montana but otherwise, don't fool yourself. We deserve excellent health care for everyone - NOW - and these lame excuses are a waste of time. To "Midwest Tom" The very program that Congress and Federal Workers currently enjoy is exactly the program our President proposed to be the Public Option. DO YOUR HOMEWORK, PEOPLE!

The public option is also

The public option is also the most cost effective. When ever public services are privatized the cost goes up, often dramatically as with water and sewage, health care, and now the privatization of war with contract mercenaries making over $100,000 a year in place of $20,000 soldiers. Compare government provided health care in Canada and Europe which costs 7-10% of GRP as compared to 17% (expected to go to 20% in 2012) in the USA - and they cover all their people, not just the rich and the healthy. Compare mass transit options provided in Europe where people do not even need a car to go to work, school, shopping, or a vacation, to the sad situation in the USA where the auto companies fail inspite of trillions in subsidies for the highways and bridges and direct hand-outs.

Ditto to the 9/7/09 comment

Ditto to the 9/7/09 comment regarding personal data. What about the data the health insurance company has on you, and what they want to do with that data? Meaning, finding a reason, any reason, to deny your benefits based on a pre-existing condition, or something in your condition that releases them from any obligation to give you coverage. Besides, in a single payer plan, the care is privately delivered, and because you are covered there's no need to scrutinize your records, to begin with, even if they could. So the privacy concerns are really moreso in the reverse, and as it exists under our present system. Our bodies, our histories, in the hands of ruthless corporations only interested in how they can not pay for any health conditions, and most certainly NOT interested in how you and your fellow Americans can be kept well and alive.

A further comment: it's

A further comment: it's really weird how fatalistic some "progressives" are about their personal privacy. This is a fundamental human right, not a "privilege"; it need to be guarded jealously; Any health care "reform" needs to respect it. Most of the proposals aired so far don't (especially not "single-payer"). Medical care (including health insurance) is a very personal thing. It's offensive that the mob above wants to force people into a public system "whether they like it or not". This is fascism in pure form. Some people above seem to think you should accept privacy loss (some comments are pathetically funny). The examples they give are problems that need to be eliminated or prevented, not "lived with".

Let's give the public a

Let's give the public a reason to monitor it's government with a valuable public healthcare plan. A well-delivered plan will likely be supported by a large swath of Americans, like the seniors who declare: "keep your hands off my Medicare." We read the posts of Canadians who are proud of their system, and it's curious how few posts there are that condemn it. It's literally a step away. Medicare, etc. already administers almost 40% of American healthcare, let's take it world-class, and help some people who desperately need it. Now is the moment to make it a reality!

Dear Anonymous on 9/04 at

Dear Anonymous on 9/04 at 2:39: Yes, you evil rich should become responsible for cleaning up the mess you've made. You deserve healthcare, too, but you need to start shoring up the infrastructure that allows you to sleep without a mosquito net. YOU NEED TO PAY MORE TAXES. Once you've ante'd up, then we can all have single-payer, just like Congress - fee (the single-payer part, in case you work for an insurance company and actually believe you belong anywhere near this process) proportionate to what you make. Don't worry, you Anonymous coward, if you DO work for a "health insurance" company, someday you'll have to get a REAL job, then you'll be glad there's single-payer so that your worthless behind gets health care too.