I remain continually confused by this critique. So Tyler posits that Medicare is unimpressive because it didn't cover prescription drugs for a very long time, and that's why we should stick with private insurance. I reply that Medicare was barred from doing so because insurers and pharmaceutical companies lobbied against it. Megan triumphantly argues that that's why we should stick with private insurers!
It's all a bit odd. Megan's chief point isn't without merit, but it rests on a different premise. The issue isn't whether "those problems will somehow magically fall away in their system." In fact, they will. Insurers will no longer block this government program from coming into being. The next set of problems Megan identifies -- that the plans will be too generous, or workers will want high wages, or bureaucrats will be overly cautious -- are different problems. Hell, they're not even different versions of the same problem. The first problem impedes a progressive program, the second set of problems enlarge it. And that's been the history of enacted welfare state programs -- vicious opposition to their creation, at which point they become largely (though not always) popular, bulletproof, and are often -- though again, not always -- expanded in ways I think useful.
In other words, not all public choice problems are created equal. So the analytical break point is whether you believe programs like Medicare or Social Security are fundamentally good programs that do a better job than their private sector counterparts. I argue frequently in the affirmative, taking Medicare itself, Medicare Part D's performance, and every other developed health system in the world as my examples. Indeed, I see the insurer's attempts to bar government competition as tacit confirmation of the point. Megan likely disagrees. That disagreement, however, is not the same as whether industry's ability to block program X is a an argument against overcoming their reluctance and implementing program X. Indeed, Megan submits that the the insurer's ability to block Medicare helps "make the current system suck," and then argues we should stick with the insurer's dominating everything. It's bizarre.
