With the passing of Obamacare, many considered it the end of the public option. However, the public option just refuses to stay dead. On Tuesday, House Democrats introduced the “Public Option Deficit Reduction Act” to the upset of Republicans in the house. The reason for the anguish, however, was due to the GOP’s continuing drumming of fiscal responsibility, the bill has been structured as a deficit reduction measure of the very sort the GOP have demanded.

What they have done is to effectively open up Medicare, or an insurance system based on Medicare, to anyone in the nation. They used numbers generated by the Congressional Budget Office which demonstrated that such a measure would cut almost 20% of the projected national deficit. The way it would work is this: It would be a new health insurance system, using the Medicare payment and structure, but would be an opt-in for any person or company on the healthcare exchanges. This would create a low-cost competition to keep the big insurance companies costs in line, by using the private market and the way capitalism works.

The House Democrats do not expect this measure to pass with the GOP in firm control. However by pushing this, they now can put the Republicans into a very bad position. Now the GOP will be on the record as against cost control, on fighting for increasing the deficit, right before the very contentious 2014 midterm election. Just imagine the advertising, they can paint the Republican opposition as being against healthcare, against the private market, and being for increasing the deficit, all in the same stroke...

"using the Medicare payment and structure"


Spoke with another doctor over the holidays who is no longer accepting Medicare patients.

So what happens when there are no doctors willing to work at that payment schedule?

"For many Americans, government is the Inspector Clouseau of institutions – bungling and inept. But the record shows this is not true."

Although conservatives portray government as incompetent, public sector programs have actually amassed an admirable record of success in a wide variety of policy areas.

One of the most persistent myths about American government is that it has a poor record of achievement. Conservatives and libertarians have constantly promoted the idea that government fails more often than it succeeds. They have been telling Americans for years that government is an incompetent institution that has achieved little of real value in society. As one conservative critic put it: “The more important question is not why government is so big … but why with few exceptions, it fails in even its simplest tasks.”1 Another critic, Charles Murray, puts it even more bluntly: “The reality of daily life is that, by and large, the things the government does tend to be ugly, rude, slovenly – and not to work.”2 Or consider the bold challenge uttered by Rush Limbaugh on one of his radio shows: “With the exception of the military, I defy you to name one government program that has worked and alleviated the problem it was created to solve. Hhhmmmmmmm? I'm waiting. . . . Time's up.”3

The Stereotype: Government as Bungling and Inept

Many of us have bought into this image of government as a bungler – a bunch of bureaucrats that can’t do anything right. Ask most Americans and they will tell you: if you want something messed up, have the government do it. We’ve all heard the jokes:

Q: How many government bureaucrats does it take to screw in a light bulb?
A: Two. One to assure everyone that everything possible is being done while the other screws the bulb into the water faucet.

Q: How many government workers does it take to screw in a light bulb?
A: Two. One to screw it in and one to screw it up.

This popular view of government as a low-achieving screw-up is echoed in many surveys as well. When asked, “When the government in Washington decides to solve a problem, how much confidence do you have that the problem will be solved?” only four percent of Americans said “a lot.” Sixty-four percent said “none at all” or “just a little.” Of these, more than a three out of four said the reason was “government is incompetent” not that “those problems are often difficult to solve.”4 Surveys also show that a large majority of citizens (70%) believe that “government creates more problems than it solves."5 Clearly, for many Americans, government is the Inspector Clouseau of institutions.

But how accurate is this popular image of the government as a bumbling fool? Actually, this is largely a stereotype – one based primarily on myth and selective anecdotal evidence. Of course anyone can cite a number of failed government policies – such as the war on drugs or public housing programs. But it is wrong to leap from this kind of anecdotal evidence to the conclusion that government as a whole is inherently incompetent. The reality is this: most government programs are successful most of the time. By and large, the public sector does a good job providing clean water to drink, keeping the peace, sending out Social Security checks, reducing workplace injuries, ensuring aircraft safety, feeding the hungry, putting out fires, protecting consumers, and so on.

Once we begin to look at the actual performance of major government programs, we see that the vast majority of them have produced substantial improvement in the problem areas that they are addressing – they have produced successful results. This is not the conventional wisdom, but it is what the evidence shows if you bother to look at it. Let’s consider some of that evidence.

An Initial List of Government Achievements

Let’s start by taking up Rush Limbaugh’s challenge: can we name any government programs that have worked? Actually, that is quite easy to do. What follows is a short list of some of the federal government’s greatest accomplishments. These are policy programs that have not only worked, but have been very successful and have greatly improved the quality of life of most Americans.
Regulation of the Business Cycle. Until the financial crisis that began in 2008, most of us had forgotten how dependent we are on the federal government to prevent economic depressions. Since the 1930s, the government has used a variety of monetary and fiscal policies to limit the natural boom and bust cycles of the economy. Before government took on this responsibility, severe depressions were a routine and recurring problem in this country – occurring in 1819, 1837, 1857, 1873, 1893, 1907 and 1929. Thanks to government intervention, we have been able to avoid the enormous amount of human suffering caused by these massive economic meltdowns – the widespread joblessness, the destitution, the rampant hunger, the disease, the riots, the hopelessness and the despair. By any measure, eliminating these depressions and this misery has been one of the greatest – and often unheralded – achievements of our federal government.

Public Health Programs. A variety of programs run by the National Institutes of Health, the Centers for Disease Control and Prevention, and state and local Public Health departments have greatly improved the health of most Americans. For example, the scourges of polio, cholera, and smallpox have been effectively eradicated from this country – a huge achievement. And vaccination programs have reduced by 95% our risks of contracting potentially debilitating diseases like hepatitis B, measles, mumps, tetanus, rubella, and diphtheria. Federal funds spent on buying and distributing these vaccines have saved countless lives and the billions of dollars it would cost to treat these illnesses. In addition, the dedicated scientists who work for the CDC are all that stand between Americans and a potentially catastrophic epidemic imported from abroad. The most likely and worrisome threat is from a new and deadly strain of bird flu. The last deadly flu epidemic to hit the United States, in 1918, killed over 675,000 people in matter of months.

The Interstate Highway System. Started by the Eisenhower administration in the 1950s, this system now forms the backbone of long-distance travel and commerce in the United States. It makes up less than 1% of our highways, but carries almost a quarter of all roadway traffic. It has also allowed millions of Americans to move out of big cities and live in more pleasant suburban and small town environments. In addition, the interstate system has the benefit of being considerably safer than the old two-lane highways it replaced – saving hundreds of thousands of lives. Even some conservatives have been forced to admit the success of this building program, with George Will calling it “the most successful public works program in the history of the world." It’s hard to imagine the U.S. without this interstate highway system, and this system would not exist at all if it weren’t for the government.

Federal Deposit Insurance. Another government program we've taken totally for granted until recently is federal protection of our bank deposits. In bad economic times, banks are inherently vulnerable to destructive "runs" – where worried depositors all seek to take out their money at the same time. Before the FDIC, in the depression of the 1930s, over 5,000 banks went bust and millions of Americans lost their savings. The main reason we had no disastrous runs on banks (and money market funds) during the financial panic of 2008 was that government was there to guarantee those deposits.

Social Security and Medicare. Without these two government programs, growing old would be hell for many Americans. Before Social Security and Medicare, millions of the elderly were doomed to spend their retirement years in poverty and illness. Social Security has cut the rate of poverty for the elderly by over half – from 29% in 1966 to 10% today. Not surprisingly, financial columnist Jane Bryant Quinn has described Social Security as “arguably the U.S. government's greatest success.” Medicare has also been incredibly successful. It has doubled the number of the elderly covered by health insurance, so that 99% now enjoy that benefit. Without this form of “socialized” medicine, 15 million of our neediest citizens would be going without many vital medical services and many would have to choose between food and medicine. Older Americans are now living 20% longer, thanks in part to this effective program. These two programs have done more than anything else to relieve the pain and suffering of our elderly population.

GI Bill Without this program, the middle class as we know it would not exist. The GI Bill provided government funds for 16 million World War II and Korean veterans to attend college. It allowed my father to become the first one in his family to graduate college, to become an engineer, and to go on to build a middle-class life for our family. Historian David Kennedy has remarked that “GI Bill beneficiaries changed the face of higher education, dramatically raised the educational level and hence the productivity of the workforce, and in the process unimaginably altered their own lives.

Federal Housing Authority. The middle class housing building and buying boom in the United States was initially financed by cheap GI Bill housing loans and by Federal Housing Authority insurance of conventional home loans. In 1945, only 44% of Americans owned their own home. But thanks in large part to the FHA program that lowered interest rates and down payments, 63% of Americans owned a home by 1968. These homes have become a multi-generational source of wealth for tens of millions of Americans. The FHA still insures over $50 billion a year in mortgages, and remains especially important for low-income house buyers.

Consumer Protection. In reaction to increasing public pressure in the early 1970s, government began to pass legislation to protect consumers from shoddy and dangerous products. The Consumer Product Safety Commission remains the key agency enforcing these laws. The need it fills is still a vital one – products kill over 20,000 consumers a year and injure over 25 million more. It would be far worse if the CPSC did not recall hundreds of products every year. It is estimated that its activities produce $10 billion in savings on the health care bills, property damage, and other costs associated with these defective products...

Not everyone worships money, and thinks greed is virtuous like you and your kind. If that was the case, there'd be no doctors anywhere but the US, but yet, it's not the case, only in your delusional reality.

The only place that would really feel the pinch is the insurance companies being forced to compete with it. Medical insurance as it stood before Obamacare, was about one degree from being legal organized crime, now maybe two degrees after Obamacare. A public option, is anathema to conservatives, because the public, once given that option will overwhelmingly support it, just like they do Social Security.

Sorry but your tired old lies and misconceptions are failing, and will continue to do so because they aren't based in truth.

You know for that matter it's also pretty clear your mother never taught you "Can't never did anything". Constantly running around claiming erroneously that government can't solve any problem is a self fulfilling prophecy. This isn't to say that the current government is good at solving things as clearly it is not. The real trouble though lays in that, even if government could solve a problem, people like you don't want that to happen. That takes away what you worship, money in the hands of private interests. So what you do is actively try and make government fail, and you've succeeded for quite some time, but that's becoming more and more apparent to America, as evidenced by the last election.

The Dems ain't much better, but at least they aren't all about actively sabotaging what government does.

The simple fact is that conservatives, claim to want solutions, but as soon as the opposition comes up with one, then they say it's shit, regardless of if they had proposed the same or similar previously. It is the party of no, the party of lets try and insure the failure of government, so we can say "see we told ya so" and cash in.

Because they too believe healthcare should be accessible to anyone.

Unfortunately, this feels too optimistic. Many liberal philosophies would work great if human nature were as trustworthy as liberals claim, but it doesn't often turn out that way. And DTex provided some perfectly reasonable examples as to why it wouldn't in this case, examples that don't require doctors to be greedy bastards.

I feel you have this backwards. American Conservative philosophy wants to deregulate everything. For deregulation to work, we have to put faith in human nature to not use their free reign for ill purposes.

I feel you have this backwards. American Conservative philosophy wants to deregulate everything. For deregulation to work, we have to put faith in human nature to not use their free reign for ill purposes.

There will always be doctors willing to accept Medicare because not all doctors are blood sucking leaches. If they were they would all just practice plastic surgery and everyone above 50 would be dead.

Glad you got it broken down to two types.

So, do you think there will ever be a shortage of doctors accepting Medicare, and if so, how will this affect the level of care. Will Medicare have to adjust their payment schedule upward to keep qualified doctors?

The entire "doctors won't accept Medicare because it doesn't pay enough" is horseshit. Simple answer.......have Congress pass a law that pays them prevailing fees. It would still be cheaper than allowing the insurance companies to skim 20-30% off the top to pay their executive class exorbitant salaries and perks.

The only reason Medicare doesn't pay well is because Republicans in the House won't allow it to.

The entire "doctors won't accept Medicare because it doesn't pay enough" is horseshit. Simple answer.......have Congress pass a law that pays them prevailing fees. It would still be cheaper than allowing the insurance companies to skim 20-30% off the top to pay their executive class exorbitant salaries and perks.

The only reason Medicare doesn't pay well is because Republicans in the House won't allow it to.

Any documentation on your claim, or is it horseshit?