President Obama seemed close to passing health care reform with a public option this fall — until Senator Joe Lieberman announced he’d filibuster any bill with a public option. Conservatives cheered, but progressives fumed the whole deal could fall apart.

Yet supporters of government-funded care should welcome Lieberman’s hostility. The current Senate version is a bad bill, and its threadbare public option probably won’t contain costs — but ironically not for the reasons Lieberman warns. It simply does too little to thwart private insurance monopolies.

Not all public options are created equal. In completely nationalized systems — like the United Kingdom and Spain — the government owns the hospitals, employs the doctors and otherwise sets the prices. In Canada, hospitals and doctors operate privately but government serves as a single-payer that underwrites all the bills. It only sounds radical until you realize that Medicare — which universally covers seniors and disabled Americans — works pretty much the same way.


However, the proposal Lieberman rejects looks nothing like these bold plans. Whittled down by lobbyists and conservatives, our public option applies only to those who can’t afford private health insurance. So if you have a plan through an employer — even if it’s horrible — you’re not eligible.

And since the uninsured ranks are thin, they’ll have less leverage against the insurance industry to lower costs than the rest of us. Some competition.

Although any reform is better than no reform, we shouldn’t settle for one that doesn’t control costs while extending coverage universally. But surely any free-market genius can agree that rigorous competition will make insurance companies work hard to lower costs and improve care.

Hey Joe, we did it with long-distance phone calls, why can’t we do it with health care?

– Mark Puleo is co-editor of the Brazilian Journal.

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