The NYT had two excellent pieces on this subject yesterday. Richard Thaler's article is the best piece I have read on the public option. And he gives Republicans and Democrats alike some very good advice:
To the Republicans, I say this: If you can get real assurances that the public option has to break even, and that it will get no special deals from suppliers, let the Democrats have it but ask for concessions on tort reform in return. (That could actually save some money.) The resulting public plan will be too small to notice.
To the Democrats, I say this: If you want competition in health care, you won't get it if the public option can make deals its competitors can't. So either give the Republicans hard assurances that the public option would have to break even and not get special treatment, or, better yet, just give it up to ensure that some useful health care reform is passed. A public option is neither necessary nor sufficient for achieving the real goals of reform, and those goals are too important to risk losing the war.
And Sarah Lyall has a fine, balanced piece on what an American living in Britain makes of the NHS. Everything she says rings true to me, a Brit living in the United States.
The N.H.S. is great at emergency care, and great at pediatric care. My children have enjoyed thorough treatment for routine matters -- vaccines, eye tests and the like. A friend who had cancer received the same drugs and the same treatment, I was assured, as she would have in the United States. When, heartbreakingly, she died, her family was not left with tens of thousands of dollars of outstanding bills, or with the prospect of long, bitter fights with hardened insurance companies.
But there are limits. Without an endless budget, the N.H.S. does have to ration care, by deciding, for instance, whether drugs that might add a few months to the life of a terminal cancer patient are worth the money. Its hospitals are not always clean. It is bureaucratic. Its doctors and nurses are overworked. Patients sometimes are treated as if they were supplicants rather than consumers. Women in labor are advised to bring their own infant's diapers and their own cleaning products to the hospital. Sick people routinely have to wait for tests or for treatment.
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