Coming back to this topic, the democratic proposals for a public option all seem to quite explicitly state that the public option must be totally self-sufficient (that is, cover its expenses via the premiums that it charges). Do you still think that it is a trojan horse to put private insurers out of business and institute single payer care? If so, how would that be likely to happen, assuming that the democrats aren't flatly lying that the public option won't be subsidized.

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They want socialism and they will lie to get it.

What I don't understand is why they don't just move? They can move to socialist France or Canada and have their socialism and eat it too. Instead, they stay here and try to shove it down my throat by force.

Well guess what? There is nowhere for freedom-loving people to go. We will make our stand here. I suggest you leave and leave soon.

I think we'll end up with a two tier health care system similar to the two tier education system. If you want private insurance, you will have to pay twice: once, forcibly, for the government subsidized insurance, and again for the private insurance. Most people won't be willing/able to pay twice, so most people will be stuck with the public option, and only the people willing/able to pay twice will be able to escape to private healthcare.

And I expect that the public healthcare system will be about as innovative, efficient, and well-run as the public schools.

Do advocates of a private insurance option have so little faith in their own case that they fear such competition?

Also – I'm a little surprised at your psychic powers. How can you know Obama is lying? There are lots of examples of mixed system for public health. Australia (first example that springs to mind) mixes a public option with very profitable companies that provide private 'gap' insurance. Social Security didn't destroy private savings companies. Last time I checked, the existence of a 'public option' police force hadn't crowded out Brinks, private detectives, or mall rent-a-cops. In fact, you can depend on these private providers precisely because there are cops there that will keep 'em honest / provide 'em with highly subsidized competition.

It seems to me Obama is completely sincere and I tend to agree with folk on his side who point out that the nature of economic incentives involved seems to undermine the utility of private markets in this case. It seems to me that the opposition is equally sincere and I tend to agree with some of it too. A draconian, The Only Option Is The Public Option scheme would be really, really anti-liberty.

But people … disagree about things. That's good.

On every front that could potentially trigger backlash over liberal overreach, Obama has been extremely cautious *in terms of appearance*. I'm not contending that his actual policy has been cautious — on many fiscal fronts, it certainly has not. But Obama has been taking great care to avoid any PR jerks to the left. His approach to all politically potent subjects has been heavily incrementalist.

A public plan that would inherently force out private insurers would be a violation of this strategy. Why? Because, as you say, Americans are adverse to sudden change. Any public plan that proves inherently superior to private insurance would spur sudden change and open Obama to accusations of overreach. Moreover, any plan that disrupted insurers' business in the near future would have disastrous economic implications, something Obama A) realizes and B) doesn't want to happen. Thus far, Obama has avoided doing anything that he thinks might damage his attempts to create a stable Democratic majority.

This isn't to say that some public plan down the road wouldn't crowd out private insurance. It's just to say that *this* one — whatever version comes out of this administration and this Congress, if any — will not. It won't be politically feasible to get a public plan that strong though at this time, and even if it were, Obama wouldn't want to. He's not about jerking the country to the left… he's about inching the country to the left, and convincing the country that that new, slightly more leftward spot is the same comfortable center they've always known. Single-payer health care is fundamentally incompatible with that.

Ezra Klein might try to create a Trojan Horse of a public plan if he were currently President, but he's not. Obama is. And Obama has neither the power nor the incentive to create a policy with “screws” that'll push people out of their plans. His goal is to get a public plan up and running, as a viable, if small, portion of the landscape, both so effectiveness research is easier, and so that conservatives can no longer speak as easily of the horrors of government-run health care.

I'm not suggesting that you're wrong to be cynical about Obama; I'm just suggesting that your cynicism is misaimed. Any policy that opens the door to single-payer is years and years down the road… liberals have many battles to fight before that one. And the first battle is the one Obama is fighting, and the one he purports to be fighting: the one to get a public plan up and running, one that's strong enough to exist but not so strong that it kills private insurers. I believe Obama is *devious* enough to concoct the conspiracy theory you put forward, but I don't think he is politically tone-deaf enough to go through with it. He moves incrementally. Health care will be no different.

If the advocates of the public option are wrong, nothing chances, and the private insurance market might improve. If they're right, the last major market for private health care in the world will go the same way that the last major market for the typewriter or private fire departments went.

Shorter Paul- It's OK for my side to engage in bait and switch political tactics if the switch is something worthwhile. I tend to believe honest debate is never OK, even if I do support the eventual goal of universal coverage.

I'm not sure who's “side” I'm on. I'm pretty convinced that the market for health care is the kind of market where adverse selection and moral hazard make entrepreneurial approaches inefficient. But I'm also pretty sure that health care is very cultural, and that freedom is maximized by something other than a “one size fits all” universal care system owned and run by the state.

I'm comfy with a “public option” for all the reasons its advocates ascribe to it. I'm also comfortable with a robust market for private insurance for all the reasons you might expect. I anticipate we'll end up with a layered system: universal, single payer option for basic and preventative care, a private market for those who can afford one, and the private market specializes in non-basic stuff … cosmetic surgery, private hospital rooms, in-home care.

“I want a public option. My HOPE is that it will outcompete private insurers to the point where they no longer exist; even if it doesn't, it will have some moderate benefits (transparency, etc). I'd LOVE for the public option to be as strong as possible, because I'd LOVE to see a single-payer system; however, depending on other factors (employer mandates, sufficiently large exchanges, etc.), a neutered public plan is still worthwhile.”

What's dishonest about that? It's an opinion you disagree with for perfectly defensible reasons, but there's no hypocrisy here that I can see, no sinister mustache-twirling behind the scenes. Many wonks (including Klein) don't even think the public vs. private debate is central to effective reform… why would they bother dissembling about it?