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Who Will Run the Free Hot Dog Stand?

A Commentary By Susan Estrich

Friday, September 04, 2009

Watching conservatives cheer the demise of the "public option" has left me shaking my head.

Now, if this were a reality show -- "Who Wins Health Care?" -- it would all make sense. The conservatives turned the "public option" into the symbol of big, expensive government taking away your health care to give it to immigrants. I kid you not: This is exactly how I've heard it described in more than one television debate, which leaves you denying that you want to kill your mother (mine is already dead, but still).

It is not easy to beat back such an idea, particularly in a country that is full of people who are on edge to begin with about their economic security, and with reason.

So score this round for the conservatives. The country doesn't want (even) big(ger) government. The private sector does everything better. Deja vu all over again.

But is the private sector ready to run a free hot dog stand?

One of the best lines in recent political campaigns is the one where Democrats say that if the health insurance plan members of Congress get is good enough for them, it's good enough for everyone in America. Hooray. Sounds great.

Everyone in the country is not going to get the health care plan Congress gets.

Most members of Congress elect one of the "best" plans available to federal employees, which is to say, they choose to get their hot dogs by appointment from whatever stand they want. Like me, they go to the $5 stand or the $10 stand, the one with the doctor you know, same-day service, and new and expensive machines. For that, you make additional contributions and pay co-pays and deductibles. Even with really good insurance, you pay.

The 40-something million Americans who don't have health insurance are not going to be coming to my stand, whatever bill Congress passes. They can't afford it, and we certainly can't afford to pay for it for them. And, by the way, my insurance company isn't exactly looking for their business, especially if they're old (50 is old to them) or sick (gastritis counts as sick) or take prescription medicine regularly (above a certain age, who doesn't?).

It's not that insurance companies are a bunch of meanies who want to see people suffer. That's a good caricature for the game of "Who Wins Health Care?" But it doesn't happen to be true. They're business people trying to make a living. In a field where costs are constantly spiraling and everyone wants the best, can you blame people for not wanting more lousy risks in their pool? Nothing personal.

I never bought the idea that the "public option" was going to be so good that it would keep HMOs honest. It's a great theory. In practice, you just have to compare the waiting rooms at Kaiser to those at a public hospital like County-USC or Harbor-UCLA to know that there is no one sitting at County with a Kaiser card in their pocket.

We have a public option now. A friend's husband was just diagnosed with prostate cancer. They are American citizens. They both work. But neither of their jobs provides health insurance. They make too much money for Medicaid and way too little to afford the $12,000 it would have cost them to insure the family with a private insurer. Now, of course, no one would take them.

He went to Harbor, the public hospital, the public option. He sat there for about 14 hours, which wasn't so bad, and finally saw a doctor, who is ordering more tests, hopefully soon, and then they will see. At my hot dog stand, he would have had the tests already, and would have been examined by a surgeon skilled in the latest robotic techniques. He's not asking for that. He just doesn't want to die of something they routinely cure a few miles away.

So the conservatives win a round. Until they can answer the question of who is going to take care of my friend's husband, who cares?

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