The Public Option vs. Public Reason

Here's my latest column for The Week, in which I try to understand why the health care reform debate has had the same general dynamic since forever. In particular, I want to explain the transparent bullshit surrounding the “public option.” I wanted to be able to explain, for example, why Atrios says things like this:

Hopefully Chuck Schumer isn't just blowing smoke and there will be a [good] public plan in the final bill. Without it there really isn't much point to any of this. The public plan is the point. [empasis added.]

And the point of the public plan is what? To put competitive pressure on private plan providers, thereby controlling costs? Sure, because when you listen to left-leaning speakers talk about health-care reform in front of left-leaning audiences, they just won't shut up about how important it is to make sure consumers have more choices in the health plan market and about all the great ideas for making private-sector health plans more competitive! What's the point of new health reform if we don't end up with a better Aetna–one of those “skimmers who provide no useful service”?
For more public plan boredom, here I am puzzling over the point of it all with Ezra Klein.
Below we have a less circumspect Ezra Klein explaining the point of it to a friendly audience. (FYI, Some people might wish to point out that the following was recorded last summer before the elections, and so is really totally irrelevant, since it does not pertain to the strategy of any actual health legislation. So here's the larger context for Ezra's remarks, in case you're interested in evaluating that claim.)

And here's where the long Jacob Hacker quote in my column comes from:

Finally, here's my summary of the ruse behind our Social Security system, which I think is helpful in understanding what's going on now in the health-care reform debate. Here's my full Cato paper on Social Security, which goes on to make the case for a politics that takes the ideals of public reason and democratic transparency seriously.
Keep an eye out for the following dynamic in the debate. (1) Republicans push hard on the idea that a public option is a “trojan horse” or “back door” to single-payer. (2) Democrats loudly deny with exasperated, eye-rolling annoyance that the public option has anything whatsoever to do with backing into single-payer. (3) Republicans say, Well, okay. Then I guess you won't mind structuring the public plan in a way that will help ensure that it competes with, but can't use implicit and explicit government subsidies to crowd out, private plans. (4) Democrats freak out about a “neutered” or “watered-down” public plan. It just so happens, they say, that in order to work–to improve the quality of care and keep costs from rising–a government-run plan has to be set up in exactly the way you'd want to set it up if you were trying to crowd out the rest of the market. But we aren't trying to do that!!! (5) Republicans: Are too! (6) Democrats: Are not! (7) Republicans: Are too! (8) Democrats: Are not! ….
For the philosophically inclined, here's the Stanford Encyclopedia of Philosophy entry on publicity.

Author: Will Wilkinson

Vice President for Research at the Niskanen Center