The Public Option and The Grand Arc Of American Politics

by: Chris Bowers:

Contrary to popular belief, the United States actually spends just as much on social programs (pensions, health care, education, etc.) as just about any other country in the world. The key difference between the United States and other wealthy democracies is where the money comes from. Specifically, in the United States, many people pay for social services straight out of their pockets, rather than having the public sector (aka, the government) provide the services.

In 1960, the United States was equal to other wealthy democracies in terms of overall social spending from the public sector. During the 1960's, we continued to increase our nationa level of public sector spending through programs like Medicare and Medicaid. However, since that time, while other wealthy democracies experienced a vast increase in public sector social spending, the United States has experienced little change (PDF, page 4). What has changed in the United States is a vast increase in private spending on social programs. In 1980, the 4.4% of the United States GDP was private expenditure on things like health care and education, but by 2005 that number had increased to 9.4% (source: OECD). While other wealthy democracies increased their public sector spending on social programs, the United States increased its private sector spending on social programs.

A public health care option is the first major step required to redress this inequality. There is no such thing as health care reform without a public option. Lacking a public option, our health care system will continue on its current path of skyrocketing costs and inequality of access. We already have as much health care as other wealthy democracies--ours just costs to damn much and access to it is distributed unequally. Any health care reform without a public option should be actively opposed.

The grand arc of American politics over the last forty years is about inequality. Changing that arc requires a public health care option that is available to all Americans. Anything less does change the arc at all. We have to stop increasing private social spending a as a percentage of GDP.