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The Left's Dirty Little Public-Option Secret

So, like a lot of people on the left and center-left (and, presumably, a fairly overwhelming majority of Americans), I’m pretty disappointed that the Senate Finance Committee took an axe to the public option yesterday. But, I have to say, unlike the deranged "death panel" and "enemies list" accusations, I think the right is actually on to something when it attacks the idea.

Today’s Times story more or less gives you the flavor of the criticisms:

Republicans on the committee unanimously opposed the public option, saying it was, in the words of Senator Orrin G. Hatch of Utah, “a Trojan horse for a single-payer system” in which the government would eventually control most health care. …

But Senator Charles E. Grassley of Iowa, the senior Republican on the committee, said a government insurance plan would have inherent advantages over private insurers. “Government is not a fair competitor,” Mr. Grassley said. “It’s a predator.” He predicted that “a government plan will ultimately force private insurers out of business,” reducing choices for consumers.

If, like me, you support the public option, your first instinct is to dismiss this stuff as typical GOP fear-mongering. But then you think about it and you’re kind of like: “Well, yeah, if we got a public option, I kind of would hope it eventually put private insurers out of business and led to a single-payer system.” Don't get me wrong--I’m a big fan of the free market. (Okay, a fan.) But it happens to be a complete disaster when it comes to health insurance, owing to problems like adverse selection. (Left to themselves, only unhealthy people would tend to buy insurance, which would drive up costs, which would cause the healthier among them to ditch their insurance, which would drive costs up further, etc., etc.)

Now, as Jonathan Cohn points out in his latest piece, it turns out you can deal with these problems in a private insurance system. But, as his Dutch example also demonstrates, doing so is incredibly convoluted and requires a ton of intrusive regulation. So, yeah, the idea of creating a public option as a Trojan Horse to end private insurance sounds pretty damn appealing. And I suspect most public-option proponents feel the same way--even if many of them, especially the ones in public office, can’t actually say so.