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Susan Estrich: Who Will Run the Free Hot Dog Stand?

The private sector can't and won't replace the 'public option' of national health care

By Susan Estrich | Published on 09.07.2009

Watching conservatives cheer the demise of the “public option” has left me shaking my head.

Now, if this were a reality show — “Who Wins Health Care?” — it would all make sense. The conservatives turned the “public option” into the symbol of big, expensive government taking away your health care to give it to immigrants. I kid you not: This is exactly how I’ve heard it described in more than one television debate, which leaves you denying that you want to kill your mother (mine is already dead, but still).

Susan Estrich

It’s not easy to beat back such an idea, particularly in a country that is full of people who are on edge to begin with about their economic security, and with reason.

So score this round for the conservatives. The country doesn’t want (even) big(ger) government. The private sector does everything better. Deja vu all over again.

But is the private sector ready to run a free hot dog stand?

One of the best lines in recent political campaigns is the one where Democrats say that if the health-insurance plan members of Congress get is good enough for them, it’s good enough for everyone in America. Hooray. Sounds great.

Everyone in the country is not going to get the health-care plan Congress gets.

Most members of Congress elect one of the “best” plans available to federal employees, which is to say, they choose to get their hot dogs by appointment from whatever stand they want. Like me, they go to the $5 stand or the $10 stand, the one with the doctor you know, same-day service, and new and expensive machines. For that, you make additional contributions and pay co-pays and deductibles. Even with really good insurance, you pay.

The 40-something million Americans who don’t have health insurance are not going to be coming to my stand, whatever bill Congress passes. They can’t afford it, and we certainly can’t afford to pay for it for them. And, by the way, my insurance company isn’t exactly looking for their business, especially if they’re old (50 is old to them) or sick (gastritis counts as sick) or take prescription medicine regularly (above a certain age, who doesn’t?).

It’s not that insurance companies are a bunch of meanies who want to see people suffer. That’s a good caricature for the game of “Who Wins Health Care?” But it doesn’t happen to be true. They’re business people trying to make a living. In a field where costs are constantly spiraling and everyone wants the best, can you blame people for not wanting more lousy risks in their pool? Nothing personal.

I never bought the idea that the “public option” was going to be so good that it would keep HMOs honest. It’s a great theory. In practice, you just have to compare the waiting rooms at Kaiser to those at a public hospital such as Los Angeles County-USC Medical Center or Harbor-UCLA Medical Center to know that there is no one sitting at County with a Kaiser card in their pocket.

We have a public option now. A friend’s husband was just diagnosed with prostate cancer. They are U.S. citizens. They both work. But neither of their jobs provides health insurance. They make too much money for Medicaid and way too little to afford the $12,000 it would have cost them to insure the family with a private insurer. Now, of course, no one would take them.

He went to Harbor, the public hospital, the public option. He sat there for about 14 hours, which wasn’t so bad, and finally saw a doctor, who is ordering more tests, hopefully soon, and then they will see. At my hot dog stand, he would have had the tests already, and would have been examined by a surgeon skilled in the latest robotic techniques. He’s not asking for that. He just doesn’t want to die of something they routinely cure a few miles away.

So the conservatives win a round. Until they can answer the question of who is going to take care of my friend’s husband, who cares?

— Best-selling author Susan Estrich is the Robert Kingsley Professor of Law and Political Science at the USC Law Center and was campaign manager for 1988 Democratic presidential nominee Michael Dukakis. Click here to contact her.

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» Conservatives don't have answers on 09.07.09 @ 10:06 PM

You’re missing the point. The intention of conservatives is not to actually run government, but to run it into the ground. (Remember Grover “Drown Government” Norquist?) Their mission is to always to say “no” to anything new and anything that threatens the status quo. That might make sense if all people on the right were prosperous and enjoyed the benefits of the policies that the Republican party supports. Clearly, most card carrying conservatives are none of those things. The vast majority of them are middle class, working class or working poor that insist on voting against their own interests. Think of a Bush-Cheney campaign sign in front of a shotgun shack in the middle of nowhere and you get the idea. Don’t think for a minute that professional power brokers like James Baker, Karl Rove, Lee Atwater and Bush I and II don’t know the dynamic at play here. They delight in using patriotism, religion and images of military might to hoodwink the “unwashed masses” as they voter cage elections, rip off the taxpayer and lie about how their economic policies will affect the nation. What’s amazing is that it seems to continue to work as a political strategy.