Health Care Reform 101-Public Option
Public Health Option? Or Public Option? It's a World of Difference
Sep 22, 2009
There's a lot of semantic confusion in the health insurance reform debate. And in the shorthand that often occurs during complex legislative battles, pundits are suddenly talking about not just a "public option," but a “public health option." It's easy to see how the words got tangled, but public health and a public option are about as different as, oh, Johnny Apple and Robert Pear.
What is the Public Option?
The health care reform debate associated with the Obama administration has focused on a plan for insurance called the “public option.” And because the topic is health, it’s easy to understand why CNN, the New York Times and others have dubbed it, perhaps for the convenience of having a short headline, as “the public health option.”
But the public option under discussion — the precise details of which remain subject to haggling by both houses of Congress — is an insurance vehicle designed to enable those Americans who can’t get private insurance, Medicaid or Medicare, to buy affordable health insurance coverage.
In President Obama’s official remarks to a rare Joint Session of Congress on Health Care in September 2009, he was clearly discussing a public option for health insurance, not a public health option. He said, "...an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. (Applause.) Now, let me be clear. Let me be clear. It would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.”
In other words, the President's speech, above, was about insurance to cover a range of medical and health related expenses.
Similarly, the still-morphing "public option" is meant to extend health insurance coverage to those without it.
What is Public Health?
Then what is public health?
Public health is the science and profession that deals with the protection and improvement of the health of the community through organized community effort. Using tools such as immunizations, sanitation, quarantine, occupational and health and safety measures, and assurance of the healthfulness of air, water and food, and using the science of epidemiology, it aims to:
- Prevent epidemics and the spread of disease
- Protect against environmental hazards
- Prevent injuries
- Promote and encourage healthy behaviors and mental health
- Respond to disasters and assists communities in recovery
- Assure the quality and accessibility of health services Federal, state and local department and the professionals working in them pursue the above goals
At the federal level, the organizing entity is the Office of Public Health and Science (OPHS), within the US Department of Health. Note that this is not an insurance-related entity.
Among the many offices and tasks that OPHS is responsible for are the following: Offices of Disease Prevention and Health Promotion; Minority Health; Population Affairs; Women’s Health; the President's Council on Bioethics; the Advisory Committee on Blood Safety and Availability; the Presidential Council on HIV/AIDS; the Chronic Fatigue Syndrome Advisory Committee, as well Regional Health Administrators, Medical Reserve Corps and the National Vaccine Program.
Public health departments at various levels of government are responsible for the following kinds of initiatives. They:
- Monitor health status to identify community health problems
- Diagnose and investigate health problems and health hazards in the community
- Inform, educate, and empower people about health issues
- Mobilize community partnerships to identify and solve health problems
- Develop policies and plans that support individual and community health efforts
- Enforce laws and regulations that protect health and ensure safety
- Link people to needed personal health services and assure the provision of health care when otherwise unavailable
- Assure a competent public health and personal health care workforce
- Evaluate effectiveness, accessibility, and quality of personal and population-based health services
- Research for new insights and innovative solutions to health problems
- Monitor health status to identify and solve community health problems
Public Health and Public Health Option are Different
Confusing public health and the "public option" is a case of mistaken identity. Affordable health coverage provided by the government in the form of a so-called "public option" and “public health” are different ideas, serving different needs in different ways. There's semantic confusion between the two, however. The word "public" and "health" are both sometimes used to describe this new "public option" entity. (That's understandable, because the proposed insurance is for "health" expenses, and the payor would likely be the "public" through tax dollars.) To many observers, it seems reasonable (though a matter of intense debate) that public health could be well served by a public option — but that’s putting the apple before the pear.
Sources:
Proposing a Public Health Option as a ‘Safety Net’, by Robert Pear, New York Times September 19, 2009
Obama Strongly' Backs Public Health Option, Washington Times, June 3, 2000
President Obama's Remarks to Joint Session of Congress on Health Care, Office of the Press Secretary, September 9, 2009
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