Grassley specifies objections to public health care option

U.S. Sen. Chuck Grassley, who has emerged as the key Republican in the senate on health care reform because of his position as Ranking Member of the Finance Committee, published an op-ed today that enumerates his objections to including a government-run insurance option in broader health care reform efforts.  But nestled in the brief column are two glaring contradictions.

Of the “pitfalls” of a public health insurance option, Grassley writes:

A government-run option would have bureaucrats in Washington setting prices and determining which treatments are covered. It would cause 119 million Americans to shift from private coverage to the government plan, according to experts, and put America on the path toward an entirely government-run health care system. Doctors and hospitals already are paid less by Medicare and Medicaid, and they make up the difference by passing the cost onto their other patients.

If more people entered government plans, even more doctors would stop seeing Medicare, Medicaid and public plan patients. Employers would stop offering coverage because they could tell employees to get coverage from the government. Eventually, the government plan would overtake the market, and we’d have a Canadian-style system but without the ability that Canadians have to go to the United States for innovative treatments for cancer and other life-threatening illnesses.

Setting aside the canard that Canadians have worse health care than their southern neighbors, Grassley’s objections seem to stem from the fear that a public health insurance option would be so desirable that Americans would drop their private plans in droves if one became available.

If that’s true, then the second part of his argument, that a public health insurance system would lead to inadequate health care run by “bureaucrats in Washington,” doesn’t make much sense.  If a public option is inherently bad, why would so many people gravitate to it? (Don’t most people see their private insurance companies as giant, coldhearted bureaucracies anyway?)

But that’s not the only contradiction in Grassley’s piece.  Two paragraphs earlier, he writes, “We need stronger rules on insurers, such as requiring them to cover people and preventing higher premiums for pre-existing conditions.”  Wouldn’t that entail the federal government fixing prices and determining what medical conditions are covered?  The implementation of that proposal, like all other federal proposals, would require the work of much-maligned “bureaucrats in Washington.”

Though Grassley’s strong words seem to imply that he has made up his mind already, advocates of a public health insurance option might find at least one reason to remain optimistic: if a public plan could be crafted to avoid the sorts of pitfalls that Grassley considers inevitable (if, for instance, the public plan were administered by a quasi-non-governmental organization and required to reimburse providers at higher rates than Medicare and Medicaid), would he still have grounds to object?