Thursday, July 2, 2009

The Lever

In the face of polls showing significant public support for some kind of government-run "public" plan for health-care, what's a skeptic about the market-disrupting implications of such a plan to do? Dig a little deeper into the polling.

Aside from the distorting partisan numbers from this recent NYT poll (in which only 25% of respondents voted for McCain), this Washington Post-ABC News poll shows somewhat broad support for some kind of public option. At first blush, 62% of those polled support some kind of public plan. However, only 21% would support such a plan being run by the government (41% would prefer it to be run by some independent organization); those numbers already don't bode too well for supporters of government-run health-care.

And this level of support falls precipitously when respondents are asked to consider the hypothetical situation of this public plan driving many private insurers out of business, which many of the supporters of the public plan say it would do. Under that situation, public support plummets, from 62% to 37%. Opposition to the public plan climbs from 33% to 58%. That's a clear majority opposed to it.

The WP-ABC poll is not an outlier in this respect. This Kaiser poll from April 2009 shows a 67% majority in favor of some public option. But, "public option" supporters jumped ship when they were told that this plan could give the government "an unfair advantage over insurance companies." Support for the plan falls to 32%, and opposition to it doubles to 59%. While many Americans seem at first inclined to support some kind of "public option," they do not want this option to disrupt the free market of health insurance.

The advocates for the "public option," as they have declared again and again and again and again, have an endgame in mind, one for which the "public option" is a key vehicle: the destruction of much of the private insurance industry. Unfortunately for them, a clear majority of Americans do not support this goal. They want the private system of medical reformed, it seems, but not destroyed.

These poll results suggest that "public option" skeptics could be able to leverage popular support by drawing the public's attention to some of the very likely consequences of a market-distorting, government-subsidized "public option." If the "public option" would decimate private insurers, as Rep. Jan Schakowsky (D-IL) says, the public could very well turn against it. Making the public knowledgeable about the consequences of a badly designed public option could be a lever to pry away certain segments support for the option.

That said, there are other threats to competition in the health-care marketplace beyond certain variants of a "public option." The quasi-monopoly status of health-care coverage that seems to hold sway in many areas of the country (and the system of regulations that allows or encourages this result) offers another opportunity for reform in order to ensure that there is authentic market competition.