Standard Times

Conservatives can't have it both ways.

They can't pound their fists and roar that the federal government is inefficient and can't get anything right while making the opposite point that allowing the government to offer a public option for health insurance will mean private companies won't be able to compete on price.

But that is exactly what some conservatives are trying to do. They want voters to believe that the federal government is a bureaucratic swamp that drives up costs and should never be allowed to screw up a health system that constitutes one-sixth of the economy and works for a lot of people.

If you believe in small government — as conservatives say they do — then it is consistent with your philosophy that expanding the government's role in health care is inherently bad.

However, it then is impossible to sustain an argument that the federal government will deliver health insurance so cheaply that private companies will be unable to compete.

You can't have it both ways. The federal government is either efficient or inefficient. If you say it is inefficient compared to the marketplace, then you must believe that private businesses are equipped to sell health insurance more cheaply than the government ever could.

A majority of Americans believe that any health reform bill should include a public option. Why? Because those people have seen the inefficiencies and unfairness of the private health-care marketplace, which is skewed in part due to insurers' anti-trust exemptions. They have been denied coverage or have been unable to afford coverage. Or, they are insured through their employers and recognize that they are already paying the cost for the 40 million uninsured Americans through higher premiums resulting from hospital and doctor pass-along costs.

Even more telling is that nearly two-thirds of physicians in the United States favor a public option. And nobody has more of a financial stake in the success of health-care reform than do doctors.

It is certainly reasonable — if also cruel and selfish — for true conservatives to oppose health reform if they do not believe that access to health care is a fundamental right and that people who cannot afford to pay their own way should be left untreated.

For most people, however, access to good health care at a reasonable cost is central to the common good, and government has a role to play because the market has not done the job of delivering quality service at a reasonable price to tens of millions of their countrymen and women. And they look into the future and they see an economy crippled by ever-increasing health costs.

That's why they want a public option.

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