First let me say I'm a huge Nate Silver fan ... athough more for his baseball writings than for his work at 538.com. He's got a sharp mind that is well applied at picking apart polls, but his partisan blinders fail him when it comes to public policy. His latest on health care is a perfect case in point, including his jumping off point which is a complete misreading of George Will's recent column on the public plan. Silver quotes Will:
Assurances that the government plan would play by the rules that private insurers play by are implausible. Government is incapable of behaving like market-disciplined private insurers. Competition from the public option must be unfair because government does not need to make a profit and has enormous pricing and negotiating powers. Besides, unless the point of a government plan is to be cheaper, it is pointless: If the public option conforms to the imperatives that regulations and competition impose on private insurers, there is no reason for it.
Silver then translates: "Will's argument is apparently this: The government does not need to make a profit and will have greater leverage with providers; therefore it will deliver the same service for less money. That's unfair!"
Um, no. Here is a better translation: Since a public plan will have access to a bottomless pit of government bailouts, the prices the public plan charges consumers and the rates it reimburses health care providers at will be completely unmoored from market realities. It will cost public plan participants less, but taxpayers will end up paying a much higher tab.
Nate goes on: "I'm a big believer in the profit motive in 99 percent of all cases. If the government decided to open a non-profit hamburger stand, I doubt that it would compete successfully against Five Guys." And he later concludes: "If you've been reading me for a while, you'll know that, as compared with most self-described liberals, I'm unusually sympathetic toward the notion of the profit motive and private industry; I've defended Wall Street bankers and the AIG bonuses at various points during the financial crisis, among other things." And he has. Good for him. Like I said, I'm a fan. Nate then continues:
I think the profit motive is generally well worth it in terms of the incentives it creates to cut costs, develop new products, improve customer service, and so forth. But health insurance is not like those things.
OK. Why not? Nate explains:
Now, what's supposed to happen in the free market is that another company will come in and offer Frederick a better deal: they'll offer him the same coverage for $350 a month, accepting a smaller profit, and Frederick will happily take the deal. There are at least a couple of reasons, however, why this may not be happening in the insurance industry. The first is that Frederick might not realize he's paying $400 every month for insurance. That's because if he's like the majority of Americans, he's getting his insurance through his work, and except when the HR lady gave him a shiny brochure on his first day at the office, he's probably never thought very much about what this insurance is costing him in terms of foregone salary. This is particularly so because health insurance benefits, unlike other types of income, aren't taxed, and so Fredrick is less cognizant of them if show up on his paycheck at all. Not only, then, is the free market maxim of perfect information violated, but it's violated in such a way that creates artificial profits for the insurance industry: the government is effectively subsidizing every dollar that Frederick's company is willing to spend on his insurance benefit.
The profits the insurance industry is making, of course -- profits artificially boosted by an enormous backdoor tax subsidy -- don't seem to be buying the customer much of anything in terms of improved service or cost savings. On the contrary, health care costs are rising by as much as 9-10 percent per year, without any concomitant increase in the level of service. If JetBlue were raising the cost of its fares by 10 percent per year, they'd be out of business.
So let me get this straight: the health insurance market is failing because a huge government created back door tax subsidy is distorting the market and raising costs. I agree 100%!!! And so do most conservatives. So does Nate then advocate getting rid of this costly market distorting government subsidy? Not even close. See, Barack Obama campaigned hard against exactly that policy proposal. So Nate doesn't even consider changing it. Instead we get this:
CIGNA and Aetna have a lot of money pooled together and they've been around for awhile -- but they don't have as much money, nor have they been around as long, as the federal government. It's possible, certainly, that the profit motive in the insurance industry has driven more innovation than we're giving it credit for. But that isn't my bet, and it isn't George Will's: There's no obvious reason that the government couldn't provide more for less. And if we are wrong, we would find out soon enough: if the public option can't deliver more bang for the buck than private insurers, it wouldn't gain much market share from them, and Will will have nothing to worry about.
A couple of responses:
First, nowhere in this article does Nate explain why health insurance companies are any more greedy or incompetent than car, home, or life insurance companies. If the government is such a natural player in insurance markets, why isn't Nate advocating public plans for these insurance sectors?
Second, we have a track record for government run health plan. Its called Medicare. Its huge. Way bigger than CIGNA and Aetna combined. If low administrative costs and better leverage with providers were gonna lead to lower health care costs we would have seen them in Medicare. Instead we've seen the exact opposite: Medicare’s costs have risen far more than the costs of privately purchased care.
Finally, if passed a public plan would get tons of market share regardless of whatever "bang for the buck" it delivered. If health care providers were reimbursed at Medicare rates, U.S. employers would dump 119 million Americans off their current private health plan and into the government "option".
One doesn't have to be a crazy ideologue to look at AIG, Citibank, Freddie Mac, Fannie Mae, General Motors, and Chrysler and then question the federal governemnt's ability to administer a public plan without funding it by constantly printing money. One does have to be a blind partisan to look at Barack Obama's long held commitment to single payer health care and not believe that the public plan is just the next step to get there.