When "Public Options" Serve the Public—and When They Don't

Currently, there is nothing more controversial in President Barack Obama's health care reform proposal than the "public option."  Much of the controversy, of course, has been generated by private insurance companies, determined to safeguard their hefty profits, and by Republican politicians, eager to destroy anything that might redound to the benefit of the Democrats.  Even so, a little clear thinking on the subject of public programs might illuminate their advantages and disadvantages.

In fact, there are numerous "public options" in American life, with many of them rooted deep in the nation's history.  In the area of education, there are public schools; in recreation, public parks; in travel, public roads; in fire-fighting, public fire departments; in law enforcement, public police forces; in culture, public libraries; in transportation, public bus and train lines; in mail delivery, the post office; in sanitation, public water supply, plumbing, and sewers; in energy, public power; in old-age security, Social Security; in nutrition, public school lunch programs.  Where did the notion ever come from that public programs were somehow "un-American"?

Even in the disputed area of health care, there exist public hospitals, Medicare, Medicaid, the Veterans Administration, and the National Institutes of Health.

These and other public programs, while not perfect—and often challenged by private competitors—seem to work well enough most of the time.  If they did not, Americans would be clamoring to abolish them.  But, with the exception of the wealthy and their supporters, who dislike paying for their share of these social benefits through progressive taxation, most Americans seem reasonably contented with them.  And when they are not, they use their democratic rights to reform and refine public services until they get them into more acceptable shape.

But public services don't serve the public well when they are administered by dictatorships.  The reason is that, under authoritarian governments, the rulers are unaccountable to the ruled.  Therefore, public programs—however good they might look on paper—become subject to abuse by power-hungry and corrupt officials.  This is the sad story of the Soviet Union, a nation forged in a revolution dedicated to the liberation of humanity, but one that—thanks to its dictatorial nature—gradually adopted some of the most brutal and exploitative practices in the world.  Naturally, in these circumstances, public options became disaster zones.

Public options also serve the public poorly when they are subverted, often quite consciously, by their enemies.  Unable to win the battle to abolish public services, their critics and competitors have often tried to cripple them by imposing budget cuts, accompanied at times by stiff user fees.  Thus, many public colleges and universities, virtually free of cost only a few decades ago, now charge substantial tuition in order to survive.  This limits public access and, at the same time, has the happy result, from the standpoint of private educational institutions, of making public colleges and universities less financially competitive with their private counterparts.  The same pattern of deliberately starving the public sector can be found in areas like mass transit, health care, parks and recreational facilities, social welfare, legal services, and many others. 

A key justification for budget cutbacks is that government "can't afford" to maintain the public sector.  But why can't government afford such programs?  The reason, aside from the bloated U.S. military budget, is that conservative ideologues have pushed through dramatic tax cuts for the wealthy.  This practice has not only helped turn their millionaire patrons into billionaires, but has produced unbalanced budgets that are then used to justify cutting back public services.  And this, in turn, helps guarantee that the public sector fails to produce substantial benefits for the public.  What such ideologues avoid dealing with is their own culpability in this matter.  Nor do they say what would happen if there were no public sector at all, and Americans had to rely entirely on the generosity of private corporations to cope with their health, education, and welfare.

Overall, then, public options serve the public well to the degree that the public exercises effective control of the government.  Under dictatorial rule, the public almost inevitably gets the short end of the stick.  And even in democracies, public programs can sometimes be weakened when private interests use the influence provided by their vast wealth to exercise disproportionate power.  But where an active citizenry avails itself of its democratic rights to provide for the general welfare, public options work just fine.  Let's use and cherish them.