I’ve been touting the inclusion of a robust public health insurance option as the best tool in our quiver for improving the efficiency of our health care system—slowing the growth in costs without reducing growth in quality. Needless to say, the inclusion of such a plan in a health care exchange would be bad for the private insurance industry, so they oppose it. Fortunately, the public hates the private insurance industry, so it’s easy to attack insurer attacks on the public plan. Unfortunately for public plan advocates like me the American Medical Association also opposes a public plan.
On the merits, this shouldn’t tell you very much. The AMA represents the interests of medical doctors and, of course, medical doctors don’t really have a big interest in making health care more efficient. After all, what looks like inefficiency to health care wonks looks like “income” to doctors. Defense contractors don’t like procurement reform, and when school systems try to reform their labor practices to better reward quality teaching, teacher’s unions tend to oppose it. Such is life. Incumbent stakeholders don’t like change, but when you have an inefficient system—like health care in the United States—it’s often very helpful to push change that incumbent stakeholders don’t like.
For example, including a public plan that reimburses doctors at rates based on the Medicare schedule could save a lot of money. And as Igor Volsky emphasizes “if Congress requires all providers who accept Medicare to also accept patients with the new public option” you could probably coerce a large proportion of doctors into accepting these rates. But the upshot here is less money for doctors. Which doctors don’t want. And unfortunately for the country, unlike insurance companies doctors aren’t unpopular, so if I run around saying “Jay Rockefeller has a great idea and only doctors hate it” people are going to give me funny looks rather than cheer.