Puerto Rico and the "Public Option"

The phrase "health care reform" actually covers several different, interrelated problems. All of the problems are essentially financial. One problem is the high cost of medicine in the US, a consequence of unbridled capital-driven medicine. This will be hard to fix. The health insurance industry and the pharmaceutical industry are wealthy and powerful, and they will not go down without a fight. The "single payer" option is basically nationalization of health care. It would wipe out these for-profit industries. I support single-payer because a) I think health care is a civil right and b) the present system appears to be unsustainable. However 1) it does not look to me that single payer is politically feasible and 2) after all even us liberals must agree that such a radical change would put us well into the realm of unforeseen consequences and as a matter of fact I really hate bureaucracy: I hate it so much that I actually know how to spell it. If we are to have single payer, it will come at the end of a process that will take years.

However much of the borderline-hysterical opposition to health care reform is confusing two things: "single payer" and "public option." These are completely different issues. I believe that we will end up with some sort of public option in the US as a result of the push for reform that we are seeing now. But public option isn't anything like socializing health care. Public option is an entitlement program for people who cannot afford health insurance. It is an attempt to address the problem of over 40 million people, mostly women and children, who have no health insurance in the US today.

I live in Puerto Rico, and we've already got the public option here - we've had it for years. It's called La Reforma. Anyone can go on La Reforma who wants to, there are no income qualifications or anything like that. It is strictly a matter of choice. In fact even a state employee like me (I'm a professor at the state university) isn't on La Reforma. We've got Triple S, recently changed from Blue Cross. Our paycheck deductions vary depending on which of a couple of different options we choose. It's pretty good coverage that includes prescriptions, dentistry and even psychiatry. In other words, my family's health insurance is just like that of most of you states-side readers. As professional people we don't have anything to do with La Reforma.

Of course the public option could conceivably be competitive, just like the U.S. Post Office has been a competitive carrier for most of our lives. There was a junior professor here a few years ago, a young and single man who was living on a shoestring, and he actually took his chances with La Reforma in order to save the money in his paycheck. Like I said, anyone can choose it, rich or poor. But a parent or a middle-aged person or most of us would prefer better coverage. It's not about us. It's about the poor.

La Reforma is on the scruffy side. You can "choose" your doctor, but only from the list of doctors who accept the plan. That's no different from my family's private coverage, it's just that fewer doctors accept the public plan. There is a myth of "choice": we don't have a big problem, but we do encounter doctors and other health service providers from time to time who don't accept our plan. We get our meds at Walgreen's; Walgreen's doesn't accept La Reforma. Scruffy doctors, scruffy pharmacies, health care that's not as complete and not as high-quality as that of a family with employer insurance or private insurance. But better than no insurance at all. That's what the "public option" is: a minimal medical safety net for the poor. It's an absolute scandal that the US doesn't have it.