Private ‘Bureaucracy’ Is Why Healthcare Needs Public Option

(Originally published in "Brooklyn Daily Eagle")

By Raanan Geberer
Managing Editor
Brooklyn Daily Eagle

A recent ad on TV placed by a Republican front group raised alarm about President Obama’s new healthcare initiative. Among other things, it asked, “Do you want the freedom to choose your own doctor, or do you want that decision to be made for your by a government bureaucrat?”

First of all, we don’t really make all of our own healthcare decisions now. Maybe some of us, those who can afford fee-for-service plans, do, but the majority of people nowadays have HMO plans. Yes, we do have some decision-making power, but within a narrow range. You have to choose your doctor from within a list of the plan’s doctors, and if your health care plan changes, you have to change doctors, that’s all.

Another case in point is this “primary-care doctor” business. You don’t have the right to decide whether you should see a neurologist, a cardiologist, etc. You have to go to your primary-care doctor, and he or she decides. And your options are even more limited if you want mental-health care. I have even heard that in some instances doctors are penalized if they refer too many patients to specialists.

Who makes these decisions? Bureaucrats! No, not government bureaucrats, but bureaucrats in the offices of the healthcare offices. Moreover, those bureaucrats probably have very little, if any, medical training. So what is a “bureaucrat?” Among the definitions of “bureaucrat” given by Wikipedia are:

1. A hierarchy among offices, such that the authority and status are differentially distributed among actors, and

2. Formal and informal networks that connect organizational actors to one another through flows of information and patterns of cooperation.

Government agencies aren’t the only “bureaucracies,” not by a long shot. They’re not even the only inefficient bureaucracies! Enron had a bureaucracy, General Motors had a bureaucracy, Countrywide Mortgages had a bureaucracy, Bear Stearns had a bureaucracy, Chrysler had a bureaucracy, Citicorp had a bureaucracy, CVS and Rite Aid have bureaucracies, and the big insurance companies have their bureaucracies.

If, as corporate lobbyists and the Republican leadership would have you believe, only government bureaucrats were inefficient, General Motors would still be an up-and-coming company, mortgage companies would have rejected questionable mortgages out-of-hand, banks would still be making loans, and you wouldn’t have a glut of chain drugstores in some areas and none at all in other areas.

Yes, government bureaucrats are often inefficient. But to single out government as being the sole perpetrator of inefficiency is just a cover-up for the faults of the insurance companies’ own bureaucrats.