The (Iffy) Case Against a Public Option

The (Iffy) Case Against a Public Option

The (Iffy) Case Against a Public Option


Can successful universal health care be achieved without a public option? Earlier this week, Jonathan Cohn pointed to the example of The Netherlands, a country that relies exclusively on private insurers while providing coverage to all citizens. Surveys indicate that the Dutch are extremely satisfied with the quality of their system; studies have ranked the Netherlands ahead of countries such as Britain and Sweden (and, of course, The United States) in deaths prevented through access to timely and affordable medical care.

In other words, the Dutch system works. But as Cohn notes, the system’s success depends on something the United States lacks: "Private insurance in the Netherlands works because it operates more or less like a public utility. The Dutch government regulates industry practices tightly – more tightly than the reforms now moving through Congress propose to do in the United States."

Similar comparisons have been drawn with Switzerland, another country that has achieved universal coverage while relying mainly on private insurers. But here, too, the differences are as striking as the similarities – not least that the providers in Switzerland are nonprofits and that medical care is viewed as a social good, not a business. As the law professor and health care analyst Timothy Stoltzfus Jost told The Times earlier this week, "There is no government-run plan to compete with the private nonprofit plans. But health insurance is considered social insurance. It’s not a for-profit enterprise."

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