Liberal-in-Chief (and you know I say that with love) and Nobel Laurate Paul Krugman posted an excellent column today highlighting, as I'd hoped someone prominent would, the results of the New York Times/CBS New poll on healthcare, out this weekend.

I really recommend you read the column, as well as the article itself
but to summarize, it's mostly good news for congress people supporting a "public option" in the forthcoming health reform package. Most people apparently favor a government option, even if their taxes were nominally higher to pay for it. (Most also are satisfied with the care they have, a point sure to be seized upon by the Right.) Krugman, in touting the poll, makes the same argument Glenn Greenwald of Salon has been making - that the most likely thing to doom health care reform is not Republicans, who have on the order of a 25% approval rating nationally (and whose ranks of registrees include many who support a public health care option!) but so-called "centrist" Democrats. Like Greenwald, Krugman uses the poll to bolster his argument that the "center" is nowhere near where these Democrats claim it is. Most any politician could safely favor health reform with a tax-payer funded "public option" (one with some teeth), tell their constituents to their faces that they were likely to face small tax increases, and still be in safe political territory.

As usual, the comments for Krugman's column were at least as informative as the column itself. In reading the posts of some of the "naysayers" I tried not to be dismissive, but rather to understand their view point. After I skimmed about 50 "negative" comments (that is, comments by "public option averse" readers), some patterns emerged. Here, I think, are their primary arguments against...

-A public option will force insurance companies to compete on an unlevel playing field. We on the left like to say "if you're really a 'free market' proponent, why not let everyone - even the government - compete", but economic libertarians do raise a legitimate point: Aetna can't print money. These readers felt a philosophical discomfort with the idea that the government can compel the citizens to pay taxes, then turn around and use that money in a way that will put private insurance companies out of business. If you believe the USA was founded to be the bastion of the entrepreneur - free from the outstretched hand of the taxman that so hobbled the merchant class in old Europe - you probably see this as open warfare.

-Once the private insurance companies are out of business (a scenario most consider unlikely under an Obama administration, with its penchant for handling Big Business with "kid gloves" and passing regulations without teeth, but which many of us familiar with the single-payer systems in Canada, Taiwan, and Europe would nonetheless love to see) we will be stuck with what Krugman terms "Medicare for All." (This is exactly, I should add, what Krugman wants.) "Concerned readers" point to the current fiscally unsustainable path Medicare is on to make an argument that this is a bad thing.

-A public option will lead to rationing. Again, this assumes the insurance industry will go out of business, leaving government at the controls of everyone's health care. Readers point, with some legitimacy, to nominally longer waits for care Canadians endure in some cases.

-255 million people HAVE insurance, and they're happy with it. (I told you when I first mentioned the poll this would come back, didn't I?) On the surface there's nothing to argue with. Now, I don't want to paint all public-option-leery readers with the same brush, but some go on to claim that those without insurance "don't want insurance," for various reasons such as "they'd rather spend their money on booze."

Don't worry - I've got something to say about each of these. But I'm not interested in "proving wrong" anybody's argument. What's more fascinating to me is exploring these seeming disconnects - if everyone crying "the sky is falling" every time we talk about single payer health insurance is right, why are people in Canada and Taiwan and Switzerland so much healthier? Why do they live so much longer, and why do they pay so much less for health insurance?

So 255 million people in the US are insured. Like me. I've got the "gold plated" employer plan. Which means $20 copays for going to the doctor, which I can afford, as long as he's in network. Now, if they choose to call something a "test" instead of an "office visit" (for which there are no hard-and-fast rules: each medical practice can negotiate its own "definitions" with United Health Care), I get to pay $500 out-of-pocket toward my $2000 annual deductible. This January my doctor sent a blood test to an offsite lab, thinking it would save me money. The result? A $450 dollar bill in the mail. For a blood test.

And I've got it good.

So if you asked me in the survey "am I happy with my insurance?" I'd probably think about everybody less fortunate, and those specialists I get to see for $35, and answer "yes."

What I'd be less likely to mention (because maybe I don't see it) is the way the costs to my employer rise every year orders-of-magnitude faster than inflation, and how that affects my ability to get raises, let alone my company's ability to be competitive in the marketplace. (just think GM) Moreover, how many people who say they're happy have lived in Taiwan, where you get a government punch card, you go to any clinic, see a doctor immediately, and walk out with a prescription 45 minutes later? Will the government send you a letter like something from the American IRS if you're overusing your care? You bet. But nobody waits long for care, nobody is denied lifesaving care, and nobody goes bankrupt.

But a majority of Americans apparently already favors a public option, so maybe they've seen enough of what they're missing - through documentaries like Michael Moore's "Sicko" and Frontline's "Sick around the World."

Still, some are concerned that a single-payer system would face the same ballooning costs now threatening to engulf Medicare (which not all economists agree is the case, but let's give them the benefit of the doubt). But this argument ignores the role the insurance industry plays in running those costs up. Whether or not you believe insurance companies (a) should be able to earn the kind of profits it's earning by acting as a middle-man and (b) are even contributing to a large share of costs, it's hard to make the argument that if insurance companies didn't exist the government would run everything, and just look at Medicare, whose costs are so high because (at leat partially)...oh yeah…of the insurance companies. And in this business, something doesn't have to be a large percentage of the total cost to amount to substantial sums. The 1% people are talking about saving over the next ten years amounts to trillions.

Finally, some simply believe the government should not play a role in commerce at all, beyond (nominally) protecting us from invasion and enforcing contracts. To these people, health care - heck, anything - is a "privilege" and not a right. And their arguments do carry some weight. If you look at what preceded the "welfare states" in both the US and Europe, it was massive entrepreneurship and private economic growth, which caused tax revenues to grow. One could argue that only those with the luxury of standing on the backs of entrepreneurs get to talk about wellfare states. (True, liberals will argue that massive government spending - indeed, deficit spend on a scale not seen since the '40s, and not even approached by the current Obama budgets - and things like the GI Bill "set the stage" for that private economic growth...)

And it is with these people that I have a basic "agreement to disagree." I believe that in a nation where some people can achieve obscene wealth, there is a moral imperative to help the prosperity of all citizens. (And not just for moral reasons, but also for practical ones, relating to everything from the future competitiveness of our companies to keeping crime low.) But others see the role of government differently. And I can dig that.

It's just that Krugman's readers illustrated another point - those in favor of public plans routinely received about ten times as many votes as those against.