After the public option goes

After successfully slaying the single-payer dragon, the right next turned to the public option as a worthy successor to socialized medicine, and now it looks like they have beaten back this one too.

Perhaps the only worrisome sign for conservatives is Olympia Snowe’s affection for a so-called trigger. Snowe loves triggers. She wanted a trigger to automatically stop the Bush tax cuts should the deficit grow too large a few years ago, but that dog didn’t hunt then, and it is unlikely to hunt now.

Another idea that is floating out there is the so-called co-op plan. But neither the left nor the right think a co-op plan will work, and it rare that an idea that both sides hate gets enacted into law. Things get watered down in conference, but ideas that have no real support on either side don’t usually get to the final cut.

But what happens if the public option goes? What happens if President Barack Obama decides to pull the rug out from his most ardent supporters, decides not to go with a trigger and decides not to support a co-op plan? What happens then?

That is unclear.

Without the public option, the costs for the Democratic version of reform are still very high, probably over a trillion dollars. None of these versions does anything to bend the cost curve, with or without the public option. And as David Brooks points out in The New York Times today, none of the incremental plans fundamentally changes the way healthcare is delivered in this country.

Democrats and even Brooks want to magically remove the profit incentive from healthcare. But I don’t think that is either realistic or even desirable. Profit is what brings the best and the brightest into the field. Profit is what leads to life-saving drugs and biologics. Profit is what leads a surgeon to develop a new cutting-edge procedure or a chemist to develop a new cancer drug.

Profit should be a part of the equation. But what shouldn’t be part of the equation is the practice of overly defensive medicine based chiefly on valid concerns about frivolous lawsuits. If doctors continue to practice defensive medicine, which means taking unnecessary tests, doing unneeded procedures, prescribing unnecessary drugs, all because they are worried about being sued, we will never bend the cost curve.

And of course, we should do all that we can to change the system so that the ultimate goal is a healthy patient and not merely a healthy bank account for a doctor.

But the Congress has to tread a fine line here. If they take away the incentives in healthcare, we will have the worst elements of socialized medicine. If they fail to take the necessary steps to bend the cost curve, we have a country that will go bankrupt.

In his speech next week, the president is likely to signal that he is ready to ditch the public option. The question I have is: Where do we go from there?

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