Summer Sale! Get unlimited digital access for 13 weeks for $13.
News Opinion Op-Eds

Bring back the 'public option'

The way health care is administered in the United States is unsustainable and in need of fundamental reengineering — right? During the 2008 presidential race, the country appeared to be in agreement on this point. But that all changed somewhere, somewhere after the election of a dark-skinned new president with a foreign-sounding name whom even proud Medicare card-carrying Americans were viscerally driven to deride as a socialist.

This was recently reported in The Hill: "The six largest investor-owned health insurance companies saw a 22 percent increase in combined net income in the third quarter, putting them on pace to break profit records for 2010." The president was castigated by loud little crowds around the country for championing the overwhelmingly popular idea of a publicly funded, public health insurance alternative to challenge the partly publicly funded, private health insurance companies' assertion that they simply cannot provide their services any cheaper. Rather than groundbreaking legislation, what we got was the president being caricatured on national television, in effigy, as The Joker — and health insurance executives laughed all the way to the bank.

According to a Kaiser Family Foundation paper, there are four recent occasions when private health spending per capita in the United States stopped its steady increasing and actually decreased: 1) The mid-1960s, with the passage of Medicare and Medicaid; 2) The early 1970s, with President Richard Nixon's wage and price controls; 3) The late 1970s, during the health insurance industry's "voluntary effort" in response to President Jimmy Carter's threatened cost-controlling regulations; and 4) The mid-1990s, with the introduction of managed care and another presidential threat: Bill and Hillary Clinton's attempts at health reform. (The chart of private health expenditures is humorously dramatic in its seismic shifts, as if plotting the position of a mouse quickly darting toward and away from the cheese against the presence and absence of the family cat.)

The major arguments against a public health insurance alternative are: quality of care (rationing!), waste (the government can't run anything!), and the American way of life (one huge step in the direction of an over-taxed, European-style welfare state!).

As economist Uwe E. Reinhardt points out, "rationing" is already a major problem in our current system, in the form of countless valid treatment requests that are routinely rejected by companies that simply do not wish to pay for them — not to mention all of the Americans who get little or no treatment because they have no insurance. The inevitable degree of rationing to be expected under a public health insurance program (shorter-than-desired hospital stays; reduced access to the latest, most expensive treatments; maybe waiting lists) is a reality of those unable to afford the more expensive insurers and the more luxuriant care they offer. This is precisely why it is ridiculous to assert that private insurers and their world-class coverage would disappear as a result of competition with a public program.

With regard to waste, according to, at least 7 percent of health care expenditures in general are for administrative costs (e.g., marketing, billing), while this same percentage for Medicare is less than 2 percent. The evil bureaucracy, it seems, runs a more efficient ship.

What of the slippery slope toward a lethargic society rooted in expensive, unearned entitlements as opposed to accomplishment, kind of like what you now see in parts of Europe? This is a valid concern. But we already have universal public health care here in the United States. A summary of all the local and federal legislation defining this program reads something like: "Citizens without Medicare, Medicaid or private health insurance are afforded absolutely no benefits until they experience an acute medical crisis, in which case they shall be admitted to the nearest emergency room and lavished with the most expensive treatments for the most serious illnesses arising out of a lifetime of no cheap, preventative care."

Access in the early adult years and regular interaction with health care professionals provided by a public insurance alternative would likely give people on the margins of society more awareness about their lives and their well-being — and more of a feeling of ownership and stewardship over their lives.

Americans have the right to a public defender when unable to afford flashy private defense attorneys, but we do not have the right to a public doctor. Thanks to the anti-"public option" hysteria of a very loud few that gravely wounded a great attempt at revolutionary health care reform, we are left with a huge increase, in the coming years, of public funds directed to the same profiteering, investor-owned companies. Maybe the anti-Obama forces have it exactly right by seeking to repeal "Obamacare" — so that it may be rewritten to finally include a public insurance alternative.

Scott Carroll is a writer in Baltimore. His email is

Copyright © 2015, The Baltimore Sun
Related Content
  • Description of president was wrong

    I was appalled to read the following description of the President of the United States in the opening paragraph of Scott Carroll's recent commentary in support of public health insurance ("Bring back the public health option," Dec. 12:

  • Fighting the medical-insurance complex

    As a practicing physician for more than 40 years, I read with interest Scott Carroll's commentary regarding health care reform ("Bring back the public health option," Dec. 12).

  • Clinton email dump: Snowden meets the National Enquirer

    Clinton email dump: Snowden meets the National Enquirer

    Get ready to blow a fuse on the popcorn machine. The U.S. State Department is playing WikiLeaks with the emails of former U.S. Secretary of State Hillary Clinton, who serves as co-president of the Republic of Clintonstan and also happens to be running for the U.S. presidency.

  • Mandel's civil rights legacy

    Mandel's civil rights legacy

    I have greatly appreciated the near-universal and thunderous praise bestowed upon former Gov. Marvin Mandel, who died on Sunday at the age of 95. Governor Mandel provided brilliant and visionary leadership during his 10 years as our governor, and many of his achievements, including the reorganization...

  • #PoliceLivesMatter

    The killing of Fox Lake, Ill., police Lt. Charles Joseph Gliniewicz had nothing to do with our hashtag politics about which lives matter.

  • The Syrian boy is the 'least brother' Jesus commanded us to care for

    The Syrian boy is the 'least brother' Jesus commanded us to care for

    A heartbreaking image of a Syrian boy was seen around the world this week. This boy should have been in pre-school, maybe kindergarten, but instead he lay dead on a beach in Turkey, drowned as his family fled the war that has devastated their country.

  • Discovering Twitter's purpose

    Discovering Twitter's purpose

    I'm 27 years old — and probably should have figured this out already — yet I've just realized how cool Twitter is.

  • The Horseshoe's successful first year

    The Horseshoe's successful first year

    In gambling, there are winners and losers. In the case of Baltimore's Horseshoe Casino, which recently celebrated its first anniversary, the big winners are the city and its taxpayers. Our company, Sage Policy Group Inc., recently conducted the first economic impact assessment of Baltimore's newest...