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Framing The Public Option Debate: It's Oversight, Baby!

Jacob Hacker is an exceptional mind and hits all the right notes when he discusses health care reform and the public option. This piece is a must-read

Jacob Hacker is an exceptional mind and hits all the right notes when he discusses health care reform and the public option. This piece is a must-read, but he doesn't stop there.

Check out what he says in the TNR on page two of his article.

This is a not a radical idea. In many areas of American commerce, private and government programs comfortably co-exist. FHA insured loans and non-FHA loans, Social Security and private pensions, public and private universities--all have long thrived side by side. Each side of the divide has strengths and weaknesses, but in every case the public sector is providing something the private sector cannot: A backup that's there if and when you need it; a benchmark for private providers; and a backstop to make sure costs don't spin out of control. Just as it is comforting to have Social Security in case your 401(k) evaporates or an FHA loan in case your credit score tanks, a new public plan provides an added level of protection against the vicissitudes of an unaccountable insurance market.

A public plan is about competition as well as choice. Even on a level playing field, the public plan will create discipline for private insurers that regulations alone simply cannot. Regulations require extensive monitoring and vigilance--and, as we know from careful study and long experience, private insurers will try to get around these rules. Having a tough public-spirited competitor means that the regulations do not have to do more work than can be expected of even the most nimble and powerful regulator, much less real-world regulators constantly subject to industry pressure, ideological attacks, and budgetary constraints. So the public plan is about more than choice and competition.

It is also about regulatory realism and restraint of the kind that, in other contexts, conservatives generally espouse. The goal of the public plan isn't to eliminate private insurance, or put government in charge of American medicine, or any of the other frightening futures that critics have painted. The goal is to create accountability for the public and private sectors alike while ensuring all Americans have affordable quality care. Sure, there will be tensions and difficult questions to resolve. But the alternative, as we've seen, would be far worse.

The whole article is a must-read. Imagine that, the public option would also serve as a watchdog against the entire health-care industry. If the public option were worthless, there wouldn't be a hissy-fit going on among conservatives and groups like the AMA. Jacob uses the very smart framing that the public option provides a little "law and order," and I thought conservatives were into being tough guys, no?

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