I understand all of the reasons people favor a strong public option in the health insurance reform bills percolating through Congress, and I know that it's an apostasy to say so, but my recent experiences with the health care industry make me deeply concerned about the public option.
My wife recently had a baby - born at 2:00 AM. By the middle of that day - less than 12 hours after the baby was born, it was clear that the hospital wanted us to leave. But my wife wanted to stay - and the hostpital couldn't send us home because federal law requires hospitals to let newborn mothers stay for at least 48 hours and insurers to pay for it.
What does this have to do with the public option? This law that gave us that 48 hours was passed by Congress in response to cost-driven abuses of the insurance industry. Its existence highlights the important role that legislative bodies play in setting limits on the natural cost-cutting efforts of insurers. We get these laws because such protections are popular and - crucually - they don't really cost legislators anything to enact.
But if there is a public option - especially a large and successful one - I worry that this dynamic will be altered. And while the public option is supposed to be financially independent - I don't really believe that will happen. And so the the government will have a financial incentive to minimize costs in a public option and Congress will now be conflicted - and will inevitably shun even popular patient protections in the name of saving money. And then who will be there to step in?