Steamboat Springs We are about to see whether democracy works. In the debate about health care, watch what happens to the public option. Currently, the elderly (Medicare) and the poor (Medicaid) have public health insurance.
Some Democrats in Congress and President Barack Obama want to add a public option for everyone.
First, some background. Health insurance companies are huge and profitable. They exist to make money for shareholders. They do not exist to make their customers healthy. Their stock is traded on an exchange, and investors will invest in them when they make a good return and will abandon them the minute they can make more money elsewhere.
For most businesses, a good product is the way to make money. This isn't as true for health insurance. The market "fails" in at least two ways in this industry. First, people don't usually buy their own health insurance. It comes with their job. So the people who make the purchasing decision do not balance their own health against the cost. They balance someone else's health. In a competitive business climate, this results in the lowest bid having a huge advantage.
The second way the market "fails" is that people are not knowledgeable insurance consumers. The contracts are arcane and jargon-filled. You don't know that your surgery is "experimental" until your company tells you they won't pay for it. It is not in their interest to standardize contracts to make comparison shopping easier.
The companies that succeed are the ones that have the best advertising, the largest number of exclusions, the highest co-pays and are the most aggressive in denying claims.
Failure to standardize, advertising, staff to deny claims, and profit for shareholders create huge costs. The percentage of industry income that serves no useful health purpose is 20 percent to 30 percent.
So the industry is terrified of a public option - terrified. They know that insurance can be provided at a lower cost. They think that a public option will put them out of business.
Their response could be to compete - standardize coverage and forms, reduce bureaucracy and sell a better product. But, based on past form, they will try to sabotage the public option first.
They will lie.
They will say that you won't be able to pick your doctor. They will say that health care will be rationed. They will say that you won't be able to get the newest pharmaceuticals.
It all will be lies, and in any case, no one needs to take the public option. It is just an option. If you are happy, you can keep what you have.
The insurance companies won't oppose the public option because it's bad. They will oppose it because they fear it will be good.
Yet, they have a fortune to spend on advertising, campaign contributions and lobbyists. Before they are done, they will have you believing that the public option is suicide.
Don't expect your elected officials to help. We have a lot of elected officials, but very few leaders. Few that would stand up to a wealthy interest that can make campaign contributions or advertise in a misleading way to constituents.
You will, I fear, see dreadful positions taken by politicians. "Let's delay the public option for years until we see if the industry voluntarily reforms. Let's confine the public option to businesses with fewer than 10 employees. Let's start it as a pilot program in one district."
These dodges may sound reasonable. With television-generated support, they all will be attractive rationalizations to politicians who have no courage or desire to actually lead.
Most elected officials skip the leadership part of the job. That is the risky part. That is the part that takes work and courage. It is the only part, though, that makes change. Elected officials skip this part because it requires asking people either to learn something or to change a position. It requires making people uncomfortable, and most won't risk it.
There will be a few, though, who have the courage to lead, who have the ability to educate their constituents and make them see that we can have something better if we think for ourselves.
At the end of the day, if we can't recognize the leaders with courage and support them, we will have what we have now.
Nothing good just happens.
Ken Gordon is a lawyer who served in the Colorado General Assembly for 16 years. During his legislative career, Gordon served as House Minority Leader, House Majority Leader and chairman of the Senate Judiciary Committee.