Friday, June 26, 2009

Your Friday Wonks

Atrios: This Might Make It Harder For Us To Conduct Strip Searches Of 13 Year Old Girls

Nate Silver: The Environmental Indifference Point
Ezra Klein has an interesting catch on the new Washington Post poll, which asked people which asked people whether they'd be willing to pay a certain amount each month in additional electricity costs if it supported a cap-and-trade program that "significant lowered greenhouse gases".

When the monthly cost is $10, 56 percent supported cap-and-trade and 42 percent opposed it; when the cost is $25 per month, sentiment shifts to 44 percent in favor and 54 percent against.

Ezra drew a graph on this but let me draw my own, even wonkier one:

The indifference point works out to $18.75 per month, or $225 per year; that's when as many Americans apparently oppose cap-and-trade as support it. Meanwhile, the CBO recently estimated that the Waxman-Markey bill under consideration by the House would raise the average household's electricity bill by $175/year or $14.58/month as of 2020. That would qualify it as popular, although only barely so, with about 52 percent supporting and 45 percent opposed.

Obviously this is a highly speculative exercise for any number of reasons -- the margin of error in the polling, the margin of error in the CBO estimates (which the same conservatives who loved what the CBO had to say about health care suddenly find ample reason to doubt -- although truth be told, the economics of climate change tend to be pretty fuzzy), and so forth. But the sticker shock on this particular bill doesn't seem too bad, even if Americans aren't willing to dig too deeply into their pockets to tackle climate change overall.
Ezra Klein: An Insufficient Respect For Charts

Brian Beutler catches House Minority Leader John Boehner trying to make the graphical case against cap-and-trade. It's a doozy:


"This is how the process will work," said Boehner, although, as Brian archly observes, the chart describes no process whatsoever. It's just...boxes. Near to one another. This is what happens when you don't take charts sufficiently seriously. You'll notice that there's a legend in the bottom right corner explaining what the color of each box refers to. But it only defines four of the nine colors. Instead, each row looks like notes from a particularly boring round of Taboo. Row three, for instance, was clearly prompted by the clue "household expenses."

  • Beutler adds:

    "If you look at this chart, this is how this process will work," Boehner said, referring to the above illustration which outlines no process whatsoever. "With the EPA being in the middle, look at all of these different agencies that are involved. This is the most elaborate thing that I have seen and you know, I have been here a while and I've seen some pretty crazy things, but I have never seen anything this ridiculous."

    Family trees are also pretty complicated, so maybe Boehner thinks people should stop procreating.

    The Waxman-Markey bill does, of course, require the involvement of a great number of government agencies. But that's the nature of landmark legislation. I think over time, Boehner will find that "it's too hard!" isn't an objection that will really fly politically. But maybe I'm wrong.
Ezra Klein: Against the Big-Bang Theory of Legislation

Here's a fact: We will not save health care this year. Or next year. Or the next. Here's another one: We will not pass legislation capable of averting climate change this year. Or the next. Or the next.

We might pass legislation improving the health-care system, expanding coverage to tens of millions of people, and instituting some needed delivery-side reforms. We might pass a bill that begins to clamp down on the carbon we emit. But, as Tim Fernholz argues, it doesn't end here. After eight years of stasis on these issues, it begins here. Quoth Fernholz:

As we see a lot of big, landmark style bills coming to the floor in the coming months and stress out over whether they are "good" or "bad," failure or success, and instead look at legislating over the longer term as a process of constantly pushing toward better policy. Obviously, congress' institutional structure -- it's very hard to pass anything substantial or with any kind of speed -- creates an incentive geared towards achieving huge breakthroughs, since you may only get this chance -- and this majority -- once...But there's no law saying that Barack Obama and the rest of the Democrats can't take another bite at the health care apple -- or energy, or financial regulations, or whatever -- after the mid-terms or, hell, as soon as the first bill passes.

Tim's editor Mark Schmitt has also written along these lines. It's what he calls "the Audacity of Patience":

For all the romance of Franklin D. Roosevelt's first 100 days, history suggests that presidents do not get a mandate as a mechanical function of their electoral margin, but in fact they build it over time. They earn it not by winning but by governing. They assemble coalitions and use them again and again, and build institutions and make them work. While many good policies and necessary emergency measures were passed in the first 100 days of the New Deal, the innovations that lasted -- those that defined politics until Reagan -- came later, after FDR had consolidated power, forced the Supreme Court to accept a new set of assumptions about government's role in the economy, and won the 1934 mid-term election. Similarly, Reagan did not win a decisive mandate for conservative policies in 1980; rather, like Obama, he was the beneficiary of a coalition made up of equal parts support for his conservatism and revulsion at the previous administration's incompetence. It was not until August 1981, when he assembled bipartisan coalitions to pass his budget- and tax-cutting plans, that Reagan can be said to have had a mandate for conservative policies.

Mark doesn't mention this explicitly, but another force for revisiting legislation is that, sometimes, things work. And then we make them bigger. Medicaid, for instance, has grown over the years. So too has Social Security. And S-CHIP. And, for that matter, the FDIC. Passing legislation doesn't settle the argument over its worth. But seeing it in action can often go a ways towards answering the question. And if the answer is that this approach appears to ease the problem at an acceptable cost, we often build on it.

One way of understanding the health reform and cap-and-trade bills currently under consideration is as large-scale experiments of new(ish) policy approaches to enduring problems. Neither legislative initiative will be big enough to solve the problem it's meant to address. But both should be big enough to answer the question of whether they could solve their respective problems.

Ezra Klein has A Question of Priorities

As we speak, the Senate is toiling to cut the health care reform bill from $1.6 trillion to $1 trillion over 10 years. Health economist Uwe Reinhardt puts those numbers into context:

A price tag of $1.6 trillion seems immense if one contemplates the figure in the abstract. It is, however, only about 4 percent of the total cumulative health spending of $40 trillion, the amount government actuaries now project for the decade from 2010 to 2020. That is also less than the 6 to 7 percent that total national health spending has increased each year in the past decade.

And $1.6 trillion is only about 1 percent of the amount of G.D.P. that America can reasonably be expected to produce in the next decade (about $150 trillion to $170 trillion).

That 1 percent would not be lost to G.D.P., of course, because health spending is part of G.D.P. Rather, it would be a diversion of G.D.P. — away from other uses, and toward providing the otherwise uninsured with the peace of mind that comes with health insurance and access to timely health care. It would represent merely a change in the composition of G.D.P.

That last is an important point. The president has declared that health reform will be paid-for. The relevant committee chairmen have agreed. This isn't a question between borrowing $1 trillion or $1.6 trillion. It's a question of spending priorities. The president, for instance, has proposed limiting the itemized deduction rate to 28 percent for taxpayers making more than $250,000 (the rate for most of us is between 10 and 15 percent). This would raise more than $300 billion over 10 years.

But the Senate has been unimpressed by the proposal. A world, however, in which we cut coverage to bring costs under $1 trillion but leave the itemized deduction, is a world in which we have explicitly decided that we would prefer to spend that $300 billion helping wealthy Americans lower their tax bills rather than helping low-income Americans afford health insurance.


After months of legislative legwork, arm-twisting, and compromising, the Waxman-Markey energy reform legislation will likely get a vote on the House floor today. The NYT has a good editorial, urging its passage.

The American Clean Energy and Security Act would, for the first time, put a price on carbon emissions. The bill has shortcomings. But we believe that it is an important beginning to the urgent task of averting the worst damage from climate change. Approval would show that the United States is ready to lead and would pressure other countries to follow. Rejection could mean more wasted years and more damage to the planet. [...]

The centerpiece of the legislation is a provision that aims to cut America's production of greenhouse gases by 17 percent by 2020 and 83 percent by midcentury -- the minimum reductions scientists say are necessary to avert the worst consequences of climate change.

Its mechanism for doing so is a cap-and-trade system that would place a steadily declining ceiling on emissions while allowing emitters to trade permits, or allowances, to give them flexibility in meeting their targets. The point is to raise the cost of older, dirtier fuels while steering investments to cleaner ones.

The two seasoned politicians behind this bill -- Henry Waxman of California and Ed Markey of Massachusetts -- have also insisted on provisions that would mandate more efficient buildings, require cleaner energy sources like wind power and provide subsidies for new technologies.

The AP did a nice job putting together a Q&A with frequently asked questions about the bill. Of particular interest was its description of how the reform legislation will affect Americans' lives: "It fundamentally will change how we use, produce and consume energy, ending the country's love affair with big gas-guzzling cars and its insatiable appetite for cheap electricity. This bill will put smaller, more efficient cars on the road, swap smokestacks for windmills and solar panels, and transform the appliances you can buy for your home."

This is not to say, however, that it's nearly as progressive or as ambitious as it could be. Indeed, some of the chamber's most liberal Democrats (see Kucinich, Dennis) will oppose the bill for not going far enough. David Roberts added, "The green world is ... fluctuating between rage (kill it!), dread (we're screwed), and resignation (it's better than nothing)."

And even under optimistic scenarios, nearly everyone seems to agree that Waxman-Markey, if it passes the House, and if the Senate doesn't screw it up, and if it does what it's supposed to do, will still only be a first step in the right direction. No one is under any illusions that, if the bill becomes law, policymakers can just clap the dust off their hands and say, "Global warming? Problem solved."

But first steps still need to be taken, and Waxman-Markey is about the best bill anyone can hope for, all things considered.

So, is thing going to pass? In a 435-member House, 218 is the minimum necessary for passage. As of late yesterday, Waxman-Markey had 184 "yes" votes, and a whole lot of "maybes," with a lot of wrangling going on behind the scenes.

Republican leaders think the votes aren't there for passage; Democrats think it'll cross the finish line; and President Obama is doing his part to push those on the fence. We'll know soon enough, but keep in mind -- if the Democratic leadership is counting heads and can't find 218, they'll probably scrap today's vote and reschedule.

Tom Ricks: Why Pakistan is going down the tubes

John Schmidt, who used to be political counselor in the U.S. embassy in Islamabad, has a good piece in the new issue of Survival explaining why he thinks Pakistan is doomed, and why it is a fool's errand to expect the Pakistani political establishment to help the United States achieve its goals:

At the root of the country's problems is a feudal political establishment primarily interested in promoting and preserving its own narrow class interests and unable or unwilling to seriously address the myriad threats the country faces. Unless and until this dynamic changes, Pakistan cannot he counted on to help the United States in its struggle against the Taliban or even to stop the spread of radical Islam within its own borders. Unfortunately, there is nothing in the nature of Pakistani political culture, nor in the performance of the Pakistani political class since the founding of the state, that provides any grounds for optimism."

Basically, Schmidt argues, the country is a kleptocracy:

The highly contentious and sometimes violent nature of Pakistani politics does not reflect deep-seated differences of approach on policy issues, but rather a struggle between competing networks for the right to control state resources. . . . Although often regarded as a class apart, the Army functions in many ways like just another political party, keen to preserve its on prerogatives."

My thought: It's even harder to change the political culture of your allies than it is of your enemies.

Tom Ricks: Iraq, the unraveling (XII): Bombs away

On the eve of the pullout from cities, everything appears calm. Except in Mosul, which is a special case. As is Basra. And Kirkuk. And now east Baghdad.

A friend passes along this day report from the Iraqi capital:

1. Three mortar rounds landed in Abu Nawas Street close to the 14th of July bridge, the mortars landed on the residential area known as the solar energy apartments wounded three civilians and caused material damages to parked cars.

2. An IED exploded in Al Hurria Square in Karradah resulted the injury of three civilians

3. An IED exploded in Al Baladiyat area of E Baghdad targeting on foot patrol of Iraqi Army, Iraqi Army officer was killed and two civilians were injured

4. IED exploded in Orfali sector of Sadr city without casualties

5. An IED exploded near Al Shaab football stadium of E Baghdad targeting US Army convoy without knowing if it caused casualties

6. An IED exploded in AL Bayaa Bus Station of SW Baghdad resulted the death of 2 and injury of 4

7. An IED exploded near Al Shaab Football stadium also targeting US Army convoy in the same spot, resulted the burn out of one Humvee.

8. An IED in Ur injured two civilian injuries, and a magnetic IED attached to a van blew up and injured three more civilians. No end to it today, it seems."

I sure am glad this war is over.

Yglesias: The Hill’s Committee Disaster

Barack Obama is trying to kill the F-22. The relevant congressional committees, by contrast, are trying to keep the F-22 alive, and they’re doing it by shifting money out of nuclear waste cleanup. Now the Obama administration is threatening to veto the authorizing bill unless Congress obeys the request of his administration (and the Defense Department and analysts everywhere) to kill the damn thing. Stan Collender hails this move and rightly so.

But it’s also an illustration of America’s desperately dysfunctional institutional structure. One basic problem of democratic governance relates to concentrated interests versus diffuse ones. Organizing broad groups of people to advance the public interest in the face of entrenched opposition is difficult. And the committee structure is like it was designed to make this problem as bad as possible. The upshot of the way congress does business is that agriculture policy is made by a special minority of legislators who represent the interests of agricultural producers. And energy policy is made by legislators who represent the interests of energy producers. And defense policy is made by legislators who represent the interests of defense contractors. If you just announced an unexpected swap and had the Armed Services Committee set farm policy and the Agriculture Committee do procurement, you could get better results.

It used to be that institutional reform was an important priority for progressives and in the 1970s they managed to make some progress on curbing the authority of committee chairman. I think it would be smart to continue to put emphasis on that kind of thing—encouraging policy to be set by broad national governing coalitions rather than idiosyncratic committees that are easily captured by interest groups.

  • Think Progress: Despite a veto threat from the White House and against the wishes of Secretary of Defense Robert Gates, Congress yesterday “moved forward with plans to build more Lockheed Martin F-22 fighter jets.”

Sargent: Poll: Independents Trust Obama — Not GOP — On Big Issues

One of the running themes of this blog (and many others) is the deepening isolation of the GOP, which is partly fueled by the drift of independents towards President Obama and Dems.

I’ve now received some new polling that seems to bear this out: On four big issues, majoritites of independents trust Obama, while small minorities trust GOPers in Congress.

This week’s big Washington Post poll asked respondents who they trust to handle health care, the economy, the budget deficit, and terrorism. The poll didn’t include a partisan breakdown, but WaPo’s polling director sent it over to us, and here’s where indys stand:

* On health care, 51% of indys trust Obama, and 26% trust GOPers in Congress.

* On the economy, 51% of indys trust Obama, and 31% trust the GOP.

* On the budget deficit, 52% of indys trust Obama, and 30% trust the GOP.

* And on terrorism, 53% of indys trust Obama, and 36% trust the GOP.

To recap: On every one of these major issues — even terrorism — majorities of indys trust Obama, and small minorities trust Congressional Republicans. Given that pundits often wonder whether all-hallowed independents will be turned off by Obama’s ambitious agenda, you’d think this storyline would enter the media narrative.

One other thing: These numbers do not bear out what I suggested yesterday — the apparent movement of rank-and-file Republicans away from their leaders on key issues. In this breakdown, GOPers are strongly aligned with their leadership.

    Gearing up for his re-election campaign next year, Sen. Jim DeMint (R) of South Carolina, arguably the chamber's single most conservative member, is doing what all candidates in his position are doing: raising money and unveiling legislation.

    Here's his latest pitch to supporters:

    I believe the only way to take back our freedom is to return to the constitutional principles our founding fathers promised in 1776. It's upon those principles I announced my conservative alternative to President Obama's liberal healthcare plan just yesterday.

    I can't do all this alone.... I trust that conservative activists are willing to stand behind the ideas I've been pushing in Washington, so I've set a loft [sic] goal of raising $17,760 in $17.76 increments over the next five days.... All you have to do is click here and donate $17.76.

    I suppose this preoccupation with 1776 is a cute little fundraising gimmick, but it's also rather embarrassing. As Alex Koppelman explained this morning, "[T]he Constitution wasn't written until 1787, 11 years later. The Declaration of Independence was written in 1776, but it didn't contain 'the constitutional principles our founding fathers promised.' In fact, there was a whole other system of government in place in the U.S. before the Constitution was written."

    Given the constant references in DeMint's pitch, it seems like the kind of detail he's want to get right.

    And what about the Republican senator's "conservative alternative to President Obama's liberal healthcare plan"? Well, as DeMint sees it, Americans would be given vouchers -- $2,000 dollars for individuals, up to $5,000 for families -- to go buy private insurance. Voila, universal coverage.

    How would this lower health care costs? DeMint doesn't say, probably because it wouldn't lower costs at all. Instead of using competition to challenge insurers, DeMint would instead direct untold millions to insurance companies. He'd pay for it by scrapping TARP.

    What happens when TARP money runs out? DeMint doesn't know. What happens with Americans who can't get insurance because of pre-existing conditions? DeMint doesn't know. What's to stop employers from scrapping their own plans and simply telling their employees to take the DeMint voucher? DeMint doesn't know. What happens when costs continue to spiral out of control? DeMint doesn't know.

    Andrew Leonard said the South Carolina senator's "plan" takes us "to a Republican fantasy-land so devoid from any moorings in reality that one is forced, willy-nilly, to admire it, irrespective of its merits. It takes true chutzpah to pull something like this off."

Yglesias: Bayh Bunch Eager to Move on Education Reform

Self-described moderate Democrats aren’t always the blogosphere’s favorite kind of Senator, but this set of ideas laid out in a new letter from Senator Evan Bayh (D-IN) and nine of his colleagues (Tom Carper (D-DE), Blanche Lincoln (D-AR), Mary Landrieu (D-LA), Michael Bennet (D-CO), Joseph Lieberman (ID-CT), Bill Nelson (D-FL), Claire McCaskill (D-MO), Mark Warner (D-VA) and Herb Kohl (D-WI)). in the moderate Dems working group are important and correct:

Saying that “now is the time to explore new paths and reject stale thinking,” Bayh commended President Obama for his focus on teacher quality and noted a recent report by McKinsey and Company that highlights the achievement gaps that persist among various economic, regional and racial backgrounds in the United States and the gaps between American students and their peers in other industrialized nations. Based on this report, the senators noted that “had the United States closed the gap in education achievement with better-performing nations like Finland, Iceland, and Poland, our GDP could have been up to $2.3 trillion higher last year.”

In the letter, Bayh expressed support for new pay-for-performance teacher incentives and expansions of effective public charter schools. He also endorsed the Obama administration’s desire to extend student learning time to stay globally competitive and called for investments in state-of-the-art data systems so school systems can track student performance across grades, schools, towns and teachers.

There’s a lot packed into there, but fortunately I wrote a pretty long post on the McKinsey report back when it came out if you want to explore some of their key findings. Extended learning time is something that CAP has done alot of work on over the years. The basic idea is that we need to recognize that some children, particularly those from low-SES backgrounds and English language learners, simply present unusually difficult challenges and we ought to invest in the resources necessary to give them additional time in which to learn.

Pay-for-performance is always controversial, and of course the specific details of the proposal matter. But there’s tons of evidence that the gap in terms of student achievement outcomes between what the most effective and least effective teachers accomplish is enormous. Under the circumstances, anything we can do to help retain the most effective teachers, help encourage the most effective teachers to work where they can do the most good, and inspire the less effective teachers to either improve or move out of the profession can do a lot of good. CAP did two recent reports on teacher quality, one about tryingto find ways to assess teacher performance accurately and one about reformingtenure.

As we had opportunity to note the other day, health care and education are the growing parts of our economy. Under the circumstances, it’s vitally important to find ways to improve the performance of our health care and education institutions. On health care, there’s obviously a high-profile debate happening in congress right now. On education, the issue hasn’t been joined as squarely yet, but presumably it will be soon and the outcome will be critical. You can read the full letter here.

Seelye (NYT): Pastor Urges His Flock to Bring Guns to Church

LOUISVILLE, Ky. — Ken Pagano, the pastor of the New Bethel Church here, is passionate about gun rights. He shoots regularly at the local firing range, and his sermon two weeks ago was on “God, Guns, Gospel and Geometry.” And on Saturday night, he is inviting his congregation of 150 and others to wear or carry their firearms into the sanctuary to “celebrate our rights as Americans!” as a promotional flier for the “open carry celebration” puts it.

“God and guns were part of the foundation of this country,” Mr. Pagano, 49, said Wednesday in the small brick Assembly of God church, where a large wooden cross hung over the altar and two American flags jutted from side walls. “I don’t see any contradiction in this. Not every Christian denomination is pacifist.”

The bring-your-gun-to-church day, which will include a $1 raffle of a handgun, firearms safety lessons and a picnic, is another sign that the gun culture in the United States is thriving despite, or perhaps because of, President Obama’s election in November.
Sully does a great job gathering and sharing informed responses from his readers, especially on topics where he disagrees. He really serves as an honest broker.
Sully: The Public Plan: Dissents To The Dissent

This dissent produced quite the backlash. A sample of some of the better dissents to the dissent:

I am an antitrust lawyer with an economics degree, so analysis of monopolies is a big part of what I trained for and my job. The e-mail is mostly content-less gibberish. It shifts back and forth using the same “monopoly” label to describe three separate and analytically very different concepts, which are “monopoly” “exercise of monopoly power” and “monopsony.” If a public option plan eventually turns into a single-payer system because it gets the best prices or is subsidized, what we will have is a monopsony in the market for covered medical services, which unlike the exercise of monopoly power does not generally harm the public.

The talk about “suboptimal” amounts of medical coverage also makes no sense, because there is never a way an imperfect market can determine what the “optimum,” is, and even a perfect market will require us to adopt one of the typical definitions of “optimum” such as Pareto or Kaldor-Hicks, which I am happy to but many moral traditions would not agree with.

You can most clearly see the reasoning in the e-mail is faulty by thinking about current “single-payer” markets. Right now the government is the only domestic buyer of fighter jets and interstate overpasses. Can we therefore conclude using the same logic that the number of fighter jets and interstate overpasses produced is somehow “suboptimal”?

I’m not arguing for single-payer here. Rather I am arguing that people who attempt to make a priori arguments about economic policy using vague memories of freshman econ concepts are sprouting nonsense. Even the most general rules like “price controls don’t work” and “price-fixing always hurts consumers” are riddled with exceptions which require careful research to identify.

Another reader adds:

Your reader's dissent of the day regarding public option seems misinformed. His argument depends entirely on his false belief that the public option is advantaged by some government subsidy that isn't available to the multitude of private options. This is simply wrong. Proponents of the public option ranging from Senator Schumer to Jacob Hacker explicitly recommend against any special subsidy. Instead, all plans--private and public--would be funded by premiums.

Now, it might be possible to argue that a public plan is "subsidized" by not having to produce profits. This is absurd. Opponents of government programs often argue that private corporations have certain indispensable advantages--nimbleness, responsiveness to demand, innovation, etc. These supposed advantages don't magically disappear, do they? So the point is not whether a public or private insurer has a competitive advantage; it's whether those advantages benefit consumers and society. The best way to answer that question is to let competition for customers in a vigorous market decide. That's what the public option offers and that, in the end, is exactly what its opponents hope desperately to avoid.

Yet another reader:

Your reader dissent on the public option mischaracterizes the subsidy, and in doing so, fails to make a valid point. The public option is not what will be subsidized, but instead low- to middle-income individuals' purchase of health insurance. Effectively, under all the public option proposals floating around, those who can't afford coverage will receive a subsidy from the government (whether as a voucher or tax rebate) to buy health insurance on the market. They can buy the public option with their subsidy. They can buy a private plan with their subsidy. Whether the public plan will out-compete the private plans is a separate question, but your reader's description of the subsidy, and the corresponding analysis is fundamentally flawed.

Robert Reich makes this point (and others) at TPM.


The public plan won't be subsidized by taxpayer money. Sure, implementation of a public option would require some seed capital to set up the infrastructure for such an endeavor. But beyond that it should not receive any subsidies nor have I seen evidence to suggest it would. The reality is that the system is not competitive today and having a public option that's focused on cost containment and quality rather than profit margins would provide genuine competition to a market that badly needs it.

If we do not have a public option then any rules we put in place to contain costs will be routed around by insurers. If we say they can't charge more in premiums they'll raise out of pocket costs. If we say they can't raise out of pocket costs they'll cut benefits. It becomes this cat and mouse game where ultimately the costs are not contained in any meaningful way. Having a mandate will just make the situation worse by pumping more cash into a broken system without any means to insure that costs are ultimately reduced.

On the other hand, if we have a public option then we can actually deregulate the private insurers to a large extent. We can give them free reign to price their plans as they wish. We'd just have some requirements that prevented them from discriminating based on preexisting conditions and clearly disclose their pricing and coverage. As such they can raise premiums, lower premiums, offer different benefits packages, etc, and the government doesn't get put into a position of needing to regulate this. They just have to compete against what the public option is offering and they'll live or die based on the merits.

Second to last:

My brother runs a large multi-specialty (but mostly primary care) physician practice in a rural state.Their group is already on the verge of opting out of Medicare because of the low fee schedule, and because they are comfortable they have earned enough patient loyalty and other goodwill to survive as non-participating providers. If their group (representing about a third of the primary care physicians in the area) opted out of a “public option” plan it would be pretty difficult to sell that “public option” plan in that area. If the second large primary care practice in the area also opted out, then only the most price-conscious consumers would even consider buying the “public option” plan.

People are willing to pay more to have access to their own doctors, especially when the alternative is long waits for appointments and, often, lower quality care. If premium price savings come at the expense of quality and availability of care, then many consumers will base their buying decision on factors other than just the lowest premium. This would give the private insurers an opportunity to compete with the public option by courting providers (through higher reimbursement, risk sharing, etc.) to enable them to promise greater choice and higher quality. If anyone doubts the strength of these market forces, consider the continued existence of fee-for-service plans (usually higher cost) notwithstanding the advent of HMOs (lower cost but more restrictions on access to care).

Your dissenter might point out the large barriers to care. But ours is a wealthy country. If a "public option" actually got and used monopoly power in a way that led to the horrific rationing and degradation of care your dissenter anticipates, you can be sure a competing insurance company would be able to raise enough capital to enter (or re-enter) the market.

Last one:

You can make a (mostly) non-ideological argument against the public plan as follows - if it's so much better, everyone will choose it, and eventually there won't be any other providers. At that point /public sentiment/ will have been changed such that further political decisions are made (such as moving completely to single-payer, or preventing private companies from ever re-entering the market) that will eventually be disastrous and irrevocable.

Of course, that argument has an awful lot of ifs, and it pre-supposes that future politicians won't be able to make coherent arguments when necessary. Sure, it's POSSIBLE, but that's an awful lot to hang virulent opposition to the concept of a public plan.

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