The Public-Private Double Standard

As I explain in Priceless: Curing the Healthcare Crisis, there are many reasons why people disagree about healthcare policy. One obstacle to reaching an agreement is that many people don’t realize—or aren’t concerned—that they hold a double standard.

If a private insurance company denies a breast cancer patient a bone marrow transplant, that’s considered a moral outrage—even if the procedure is experimental and is later shown not to work. But if the Arizona Medicaid program denies people organ transplants that do work and do save lives, that is considered an unfortunate budget issue.

If 25,000 British cancer patients die every year because the National Health Service won’t buy the drugs that would have prolonged their lives and they cannot afford to pay for those drugs out of their own pockets, that is considered, again, an unfortunate budget problem. But if even one uninsured American dies prematurely because he or she cannot afford those very same drugs, that is ethically unacceptable.

What I am describing is, of course, a double standard. Many people in health policy, for example, viscerally dislike the idea of private Medicare Advantage plans, an alternative chosen by about one in four Medicare enrollees. Instead they would like to see everyone in conventional Medicare—a public plan. You would be amazed at how many otherwise knowledgeable people are completely unaware of the fact that Medicare is not actually run by the federal government. It’s run by private contractors, including such private insurers as Cigna and BlueCross.

The view that public insurance is good and private insurance is bad really amounts to saying that when BlueCross is called Medicare it is good and altruistic, but when the same company is called private insurer it is bad and selfish. It makes no sense, but there are a lot of people who think exactly that way.