Not much. In fact, in everyday politics, the two are inseparable and mutually benefiting. As with most things, both sides are enjoying wringing their hands about what they seem to want us to think are major differences regarding healthcare. While the Right seems to be very upset about government healthcare, on the one hand, the Left seems to be worked up about corporate healthcare, on the other. It seems to me that we should try to discern the practical difference between the two and see what we are left with to root for, if anything.
Let me begin by dispelling two dangerous myths about this polemic: There is nothing “private” about private insurance and there is nothing “public” about a public option.
1. Against “private” insurance: When people choose their health benefits they are hardly presented with a plethora of options that are simply there for their private well-being. The options available are the result of a bureaucratic web of deliberations between corporations and employer (who, in many cases, are corporate). On the side of the employer, they usually want to find the lowest rate without compromising the quality of coverage, or, on the side of the provider, they want to find the highest rate with plenty of red tape to prevent too much coverage being guaranteed to maximize profits. When the employee makes their choice, this is not a private decision they are making. And, if the next term of negotiations wants to shift “private” options on them, they have no choice but to change.
2. Against the “public” option: This is actually less interesting to me than the previous myth. It is mostly the age-old political trick of invoking a generic public in order to help generate popular sentiment. Truth be told, the negotiations that will take place between the government and insurance providers will not be in the interest of people’s health, but, like the corporate negotiations, they will also be about credit and debits. The option to take the government care will usually be because people have no option and it will hardly be the coverage that the public has deemed best. The rich will continue to get better care wherever they can find it, and for good reason.
These two points assume that people have a job of some kind that offers benefits with premiums they can afford or that such a non-public option even exists for those who lack options. But the point remains that while the rhetoric has been between a so-called “public” and “private” option, the truth is that the healthcare debate is better described as a conflict between the government and corporations.
Given that they are very closely related in many ways, this should be troubling to all sides.
Nonetheless, there are real and serious differences between the two. Most importantly, access to coverage.
While government healthcare may implicate an entire society of taxpayers in decisions of that they find objectionable, it is hardly to say that the same thing doesn’t happen through corporate healthcare. In fact, if we take into consideration the broad structural effects of corporatism, it may be worst (from a certain view that I am not too sure whether I share or not). However, if we can say that both government and corporate healthcare are fundamentally prone to support things we find objectionable—which may even be the fact that either one of them exists at all!—then we must also remind ourselves that they both provide a significant good to society: care for the health of our bodies.
What we are left with is this: the government can provide this good to everyone and a corporation cannot, or at least refuses not to (I suppose it could if it wanted to). Here, the choice is simple; and I would make the converse choice if it were true. In other words, if a corporation offered universal insurance and the government resisted, I’d hold my nose and take the corporate side.
So, while we should not celebrate either the government or corporate healthcare, we must admit that the good they provide in their own tragically imperfect ways is best provided to all and not to a select few. There is nothing private or public about it. There is nothing innocent about it. It may be financially difficult. But, all things considered, the difference between government and corporate healthcare is that one can be universal and the other, as it currently stands, cannot.
Both government and corporate healthcare are troubling to me, but, for now, the government gets my vote. If a corporation offers a universal plan with better terms and conditions, then, I would change my mind for the exact same reasons.
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