Why Is the Public Option So Controversial?

A couple years back I was at a Republican event and I discussed the issue of health care with another attendee. They mentioned that the Republican party was losing the debate over health care. It was the first time I had heard that. I have always followed the polling regarding health care, and consistently, the Republicans have not only been losing, but overwhelmingly.

One reason for this is that the Democrats have been able to sell a much better story. Forty five million people are uninsured. In a country as wealthy as ours, this is unacceptable, and so, we must created a health care system in which everyone enjoys the ability to get health insurance. Republicans speak about free markets, health savings accounts, and they bemoan socialized medicine. In the end, the Democrats always had the better story. As such, universal health care always polled well.

That's why on one level I am surprised that the issue of a public health care insurance option has become so contentious and controversial. After all, how exactly were we supposed to get to universal health care without the public health care option? Yet, that's exactly what has happened. All Republicans have lined up against it. Ben Nelson (D-Nebraska) has called it a deal breaker, and Mary Landrieu (D Louisiana) has also come out with reservations against the public option. You can expect other moderate Democrats to follow suit.

So, how is it that universal health care would poll so well for years and now suddenly becomes controversial? I believe that's because the issue has never faced the kind of scrutiny it does now. For instance, a recent Kaiser Health Poll found that over 60% of Americans favored a public health care option. At the same time, that number got cut in half to 32% when those same Americans were told that a public health care plan would enjoy an unfair advantage.

In other words, the public health care option sounds good in theory. It polls well when the debate is marginal. Once the details of the public health care plan are debated then the public is exposed to all the warts of the public health care option. Once that happens, the public overwhelming rejects the exact same idea. It's a microcosm of the health care debate in general. In theory, the public would like a plan that covers all Americans. Yet, once the details of how this is paid for are revealed, the public rejects it. Why do you think the Democrats have been so evasive on how exactly it will be paid?

The Democrats were winning the debate when it was carried mostly by slogans and soundbites. When it came down to simply promising that all Americans would have health insurance, the Democrats were winning. Now that the Democrats have to give details for how they plan on doing this, the public is rejecting the plan.

For another view on the same subject, William Kristol and Yuval Levin offer a similar perspective.