The Postal Service and the Private Option

Many people are seizing on the poor reputation of the government-financed US Postal Service to argue against having a public health care option available.

To be clear, the government doesn't run the postal service anymore. They provide it a monopoly on first class letters, and they regulate what prices it can charge.

The postal service is criticized for having high costs and poor service. But there are a few facts to consider:

-- The Postal Service has to deliver letters everywhere for the same price. You can imagine that the costs of bringing a letter to a home in a farm community would be higher than to a suburban apartment complex with a common mail area. But the rural residents aren't charged extra for their "pre-existing condition."

-- The Postal Service isn't bad everywhere. When I lived in Chicago, we tried to avoid using USPS because of slow delivery and lost/stolen items. If you had an alcoholic patient whose brain was so addled you couldn't imagine him being able to bathe and feed himself, yet he was still holding a job, it would be with the Postal Service. (There was subsequently an investigation that found some carriers were dumping bags of mail in remote areas and taking the rest of the day off.) But in Philadelphia, service tends to be quite good, and I've had much worse experience with FedEx losing items. Since I have the option of both the private and the semi-public carriers, I can choose to send my packages by USPS since I'm happy with the service here.

Meanwhile, my health insurance options are getting worse. As a small business, our premiums are based on the health status and age of each employee in the plan. Our premiums have been going up rapidly while our copays and deductibles are rising. (Those same insurers aren't paying the doctors any more money, but we won't go there.) Many of our younger employees, who are single mothers and qualify for medical assistance due to family size, are choosing that option rather than pay their portion of the cost of employer coverage.

We would love to have the choices of getting our commercial insurance at the same cost as big businesses or of choosing to pay for a Medicare-type plan. But currently, our only option is commercial plans, and the bids they are submitting each year are all within a couple dollars of each other. Not surprisingly, many other businesses our size who are less committed to health care coverage would simply drop offering coverage altogether -- making the rates even higher for those who remain.

Competition is a natural way of keeping all the parties involved efficient. Yes, there need to be rules that prevent the government plan from being underpriced, just as there need to be rules to prevent commercial plans from shunting their sickest patients to the public plan (as now tends to happen under Medicare Advantage plans when insurers are allowed to put caps on services they offer, so the healthiest patients get as much as they need of a particular service but the sickest ones stop getting it covered mid-year).

That's just fine tuning. But we need to have the option.