What About This "Public Option"

Two posts ago (Paradoxes in the Health Care Debate), a reader posted a thoughtful comment, which included the following:

"As a lawyer, Barry, would you want to see the government subsidizing other lawyers in your area of specialty? Sure, you can compete with other private lawyers, but can you compete with lawyers being subsidized by the government? The government could lower their rates to zero if it so desires, which you cannot do."

This got me thinking.....the government DOES subsidize lawyers in the criminal law field. The government pays for lawyers for indigent defendants. This takes the form of legal aid, and in New York there is also an "18-B" panel, which represents criminal defendants when a conflict of interest prevents legal aid from representing a defendant. This subsidized lawyering directly competes with private criminal attorneys. Criminal law is not my specialty, but I know plenty of lawyers who do this work, and I have never heard a complaint about "competing with a government subsidized program". Let's look at a few reasons, and see if there are analogies to health care:

1. Some private criminal lawyers, but not all, are on the court appointed panel. They do this to subsidize their income, and because it is also a source for future "private" cases. Many criminal law attorneys derive a serious portion of their income from participating in the court appointed panels, and are PAID by this "government subsidized" program.

1(a) I suspect that many, but not all, doctors in private practice will choose to accept payment from the government option health plan. (They may be required to accept it, which seems right to me too). Will that plan be paying much less than the private insurance plans? I see how little my private insurer (GHI) pays my doctors under the present system. Sometimes it's embarrassing. I maintain that the public option will be a bonanza for many doctors in private practice, and for hospitals.

2. Some clients who would be eligible for legal aid or a court appointed lawyer ELECT to retain a private attorney. There are many reasons they may do this, but the obvious ones are better service, higher skill level, personal attention, and what may be at stake (their liberty). Clients pay extra for this if they (or their family) choose to, and they generally get value for their money.

2(a) I suspect that many, but not all, patients and health insurance buyers will ELECT to pay a premium to stay out of the public option and will pay for private insurance. There will be factors determining how many do this, but the main factors will be "how competitive is the price" and "how much better is the service". It will be all about competition, and the private insurers will be quite able to compete. It's just that as it presently stands, they'd prefer not to.

3. Even in the non-criminal areas of practice, there are times when lawyers compete with subsidized programs, and clients who can obtain legal services for zero cost. There are civil matters where clients can get legal services without paying, or by representing themselves. Housing Court is an example of this. People can pay a private attorney, but many either "can't afford it" or elect not to pay a private attorney. I don't have a problem with this. Legal clients have an option medical patients don't have, they can represent themselves, and some do.

3(a) Doctors already have "competition" from a subsidized source......the emergency rooms that do not turn people away. Who pays for these services? Some patients are on Medicare and Medicaid, some pay the hospital, some stiff the hospital. Where the ultimate cost falls is a big shell game, but if I had to guess at the biggest reason private health insurance is so expensive, its that the hospitals make up the difference on all the "stiffage" by banging the private insurance, who simply bangs it back to its customers. Like I said, a big shell game.

3(b) People without health insurance, and who are not old enough for Medicare, or poor enough for Medicaid, are different than poor legal clients in one important way. They can't be their own doctor. Instead, they either delay care, or go without it, or they face financial ruin when an emergency happens. All because of a shell game. A zero-sum gain shell game designed to benefit those presently running the game.

The "public option" makes for a fairer shell game.