Pope Francis's Encyclical "Laudato Si'" - Part 2

In Part 1 of this series of posts, I talked about Pope Francis's 2015 encyclical, "Laudato Si'" ("Praise Be to You"). I referred to the passage:

How wonderful is the certainty that each human life is not adrift in the midst of hopeless chaos, in a world ruled by pure chance or endlessly recurring cycles!

That passage suggested to me that the Pope knows and cares about the modern sciences of chaos and complexity. The theories developed by those sciences hold that many natural systems are both dynamically changing (no surprise there) and mathematically quite nonlinear. Nonlinearity means that changes in the state of the system are ultimately unpredictable (chaos) and/or generative of brand new varieties of order (complex adaptive systems).

Complex adaptive systems produce ever greater complexity (the varied types of elements within the system) and yet surprising order and stability (a feature which chaotic systems lack). Life on Earth evolves as a complex adaptive system. Our species is here partly because of the self-organizing dynamics of such systems, not just because of Darwinian natural selection.

Pope Francis

That's a conclusion scientists of complexity can reach by studying "nature" and modeling it on computers. But Pope Francis points out that "nature" is a smaller and more limited concept than "creation," the handiwork of God. The theology of the Catholic Church, like that of many other churches and religions, is concerned with that bigger picture — while still affirming that scientific inquiry is a legitimate pursuit, of course.

At first blush, "Laudato Si'" impresses many readers as a document that is very, very far left, environmentally speaking. It is quite easy to conclude that Francis wants national governments and international bodies to take full charge in the fight against climate change and global warming. But I have to disagree with such a simplistic reading of the encyclical. I think the Pope is championing a much more nuanced approach than just ham-fisted top-down policies issued from the "commanding heights" of governments and international institutions.

* * *

My reason has to do with how complex adaptive systems are to be understood.

In the diagram above, the "agents" down below interact in a regular, rule-based way. As a result, those agents, taken as a group, generate a stable, orderly "pattern" that characterizes the system as a whole. For example, take a flock of birds:

The flock holds together in a stable arrangement (the "pattern") even as its shape shifts continuously as the flock flies along. The individual birds (the "agents") instinctively follow a simple rule (a "regularity") that says to maintain a set distance from each neighboring bird. Following that simple rule allows flocking to occur. The flock as a whole is a complex adaptive system, in that its changing shape somehow "knows" how to adapt to changing conditions such as the wind's direction and speed.

The point here is that complex, self-organizing systems such as the one shown in the earlier diagram have both upward-pointing arrows and downward-pointing arrows. The former emerge from the interacting of the agents as they conform to their rule-based regularities. The latter represent "feedback," originating from the overall pattern that is being generated, that is sent on back down to the agents — as when each member of a flock of birds seems to "know" how to adjust to a change in wind direction.

If conservatives' criticisms of "Laudato Si'" that it is some kind of radically leftist document are correct, then the implication is that the Pope is relying on just the downward-pointing arrows — supporting top-down approaches alone — in dealing with climate change. He accordingly must be rejecting solutions that endorse the bottom-up regularities of, specifically, market-driven capitalism.

* * *

This seems to be the gripe that New York Times columnist David Brooks has with "Laudato Si'." In my view of the encyclical, the Pope is saying in this encyclical that we Christians in particular, but also everyone else on Earth, have a spiritual and a moral duty to protect the planet. Scientific and practical considerations which the encyclical spells out dictate that we can't live up to that duty if we let our standard deference to free-market capitalism and the rights of private property trump ecological exigencies.

David Brooks

Mr. Brooks is often finely attuned to such spiritual and moral considerations. But in this case he challenges the Pope almost out of hand, writing: "Hardest to accept ... is the moral premise implied throughout the encyclical: that the only legitimate human relationships are based on compassion, harmony and love, and that arrangements based on self-interest and competition are inherently destructive."

But that's not quite what Pope Francis says. He doesn't actually claim that self-interest and competition are fundamentally destructive. He affirms, in fact, the value of private economic interests. But he also subordinates those interests to what he — echoing Pope (now Saint) John Paul II — calls "a social mortgage on all private property." Francis writes in paragraph 93, section VI of "Laudato Si'":

The principle of the subordination of private property to the universal destination of [human] goods, and thus the right of everyone to their use, is a golden rule of social conduct and [per John Paul II's Encyclical Letter 'Laborem Exercens'] 'the first principle of the whole ethical and social order'. The Christian tradition has never recognized the right to private property as absolute or inviolable, and has stressed the social purpose of all forms of private property. Saint John Paul II forcefully reaffirmed this teaching, stating [in his Encyclical Letter 'Centesimus Annus'] that 'God gave the earth to the whole human race for the sustenance of all its members, without excluding or favouring anyone'. These are strong words. He noted [in his Encyclical Letter 'Sollicitudo Rei Socialis'] that 'a type of development which did not respect and promote human rights – personal and social, economic and political, including the rights of nations and of peoples – would not be really worthy of man'. He clearly explained [in his 1979 'Address to Indigenous and Rural People'] that 'the Church does indeed defend the legitimate right to private property, but she also teaches no less clearly that there is always a social mortgage on all private property, in order that goods may serve the general purpose that God gave them'.

Accordingly, in certain situations "compassion, harmony and love" ought in fact to trump "arrangements based on self-interest and competition." This is what Francis is maintaining. And today's clear and present threat of human-caused global warming is one of those situations. That would seem to be a more nuanced summary of Francis's position than the one David Brooks posits.

The Pope's "social mortgage" approach to the matter is not, as Mr. Brooks claims, "relentlessly negative ... when describing institutions in which people compete for political power or economic gain." It is instead quite realistic, I'd say, given that in the eyes of our very real Creator God no person or people ought to be excluded from sharing in our planet's abundance.

The Pope would accordingly have governments and international institutions constrain free markets as needed to fight global warming and to keep developing nations with their less-well-off populations from suffering the brunt of its effects.

* * *

Buzzwords: The economy
as complex adaptive
system (click
to enlarge)

But what about the possibility of harnessing market forces that embody the "regularities" of supply and demand? Those are the forces, after all, that manifestly influence the behavior of "agents" (buyers and sellers) at the bottom level of a market-based economy, when the economy is seen as one type of complex adaptive system. What about shaping the operation of those forces as a way of combatting global warming? Might Pope Francis endorse such a possibility? Should David Brooks and other conservatives approve of "Laudato Si'," when cast in that light?

This post is already too long, though. I'll talk about those questions in my next post ...

Pope Francis's Encyclical "Laudato Si'" - Part 1

Pope Francis's 2015 encyclical "Laudato Si'" ("Praise Be to You") is a plea for people of good will — not just Catholics like me — to take climate change seriously as a global threat that calls for all of us to change our ways. The steady emission into the atmosphere of carbon dioxide and other greenhouse gases that are born of burning fossil fuels has to abate.

The Pope ties concern for the ecology of the Earth with religion's traditional concern for social justice: a preferential option for the poor. The poorer nations of the world are at once the most likely to suffer the harsh effects of global warming and the least responsible for creating the impending climate disaster in the first place.

We need accordingly to rein in our tendency in the richer nations to use the gifts of nature sheerly for generating wealth, as if Mother Nature were just a thing to be exploited by the few who are lucky enough to reap her economic benefits.

In the course of explaining the Catholic Church's stand against pillaging the environment, Pope Francis takes up the theology of creation rooted in the very first story of the Bible:

"In the first creation account in the Book of Genesis, God’s plan includes creating humanity. After the creation of man and woman, 'God saw everything that he had made, and behold it was very good' (Gen 1:31)."

Men and women are deemed "very good" — hence, social justice is a must. Everything that God made is likewise called "very good" — hence our duty to preserve and protect the Earth.

It is in the course of his discussion of creation theology that Francis says something I find quite interesting:

"How wonderful is the certainty that each human life is not adrift in the midst of hopeless chaos, in a world ruled by pure chance or endlessly recurring cycles!"

That sentence suggests certain theological implications of the recent insights of science into "chaos" and "complexity."

Graph illustrating
the "butterfly effect" in
chaotic systems actually
can look like a butterfly

Chaos theory has come to the fore in the last half century, following the discovery that the unpredictability of weather — and hence ultimately of the Earth's climate — stems from infinitesimal differences in "initial conditions." This is the "butterfly effect." Due to the mathematics of chaos, illustrated by the graph at above-left, a tiny butterfly flapping its wings in Rio can in theory produce a tornado in Reno. Accordingly, the computers we use to model such things can't predict weather beyond a few days into the future.

That's because weather is one of nature's many "nonlinear dynamical systems": basically, changes occur in the state of any nonlinear dynamical system according to mathematical functions that do not graph as a straight line. These changes that occur can be unpredictable in the long run. "Chaotic" instances of nonlinear dynamical systems — not all such systems are chaotic and unpredictable — diverge so much in their states' unfolding trajectories that beyond a short period of time their future simply cannot be known in advance.

"Chaotic systems are predictable for a while," says Wikipedia's article on chaos theory, "and then 'appear' to become random." Such systems, whether natural, manmade, or purely mathematical, exhibit what scientists today refer to as "chaos." This means that the systems are not, strictly speaking, "random"; their behavior is "deterministic." If we could but know their initial conditions with perfect exactitude, we could predict their successive states with equal exactitude from the present moment right up until the end of time.

When Pope Francis speaks of "endlessly recurring cycles," on the other hand, he is talking about the opposite of chaos: order. Science recognizes two types of order in the panoply of conceivable behavior patterns of nonlinear dynamical systems. One type of orderly behavior is what happens when a marble released along the inner surface of a coffee cup, near its rim, ultimately comes to rest. After rolling down and then back up the inside of the cup and repeating that behavior for quite a while, the marble ultimately sits motionless at the cup's bottom.

The second type of order is that of "endlessly recurring cycles." The Earth orbits the Sun each year in just such a seemingly endless cycle.

So we have orderly nonlinear dynamical systems, and we have chaotic ones. Out of the scientific study of chaotic behavior has more recently emerged a companion notion, the "theory of complexity." Complexity, in this usage, has to do with nonlinear dynamical systems that are capable of "self-organization."

A flock of birds is
a self-organizing system;
the flock is an "emergent property"
of individual birds keeping a set distance
from their immediate neighbors

We typically think that organization can be imposed on a network of interacting elements that make up a nonlinear dynamical system strictly "from the top down," as when a strong leader imposes order on a gaggle of squabbling factions. Yet graceful order quite surprisingly can emerge "from the bottom up." The question of how this can happen, and can combine and interact with top-down order, is the province of complexity theory.

Scientists studying complexity have discovered that such self-organized behavior takes place at the "edge of chaos." According to M. Mitchell Waldrop in his book Complexity: The Emerging Science at the Edge of Order and Chaos, the edge of chaos is "the constantly shifting battle zone between stagnation and anarchy, the one place where a complex system can be spontaneous, adaptive, and alive" (p. 12).

Nonlinear dynamical systems whose behavior exhibits spontaneous self-organization can be impelled from that beneficent edge over into the realm of outright chaos — it can happen when a Brazilian butterfly innocently flaps its wings — but can then, all by themselves, move out of chaos back over into the orderly regime. When that happens, the result is not always a return to the old, previously established order. It is rather the generation of a newer, more elaborate order. There is a concomitant gain in the system's "complexity" — the diversity or elaborateness of its interacting elements. This is, then, one meaning of the term "self-organized complexity."

Self-organized complexity is accordingly a third, quite unexpected kind of order. The order that arises in such a system is completely spontaneous. It is not static, as with a marble that eventually comes to rest at the bottom of a coffee cup, and it is not cyclical, as with a planet endlessly orbiting a star.

The human species, complexity science says, is a product of just such a process of spontaneous self-organization. That is, the evolution of life on Earth is not solely a matter of random DNA mutations sifted by Darwinian natural selection. There is something else going on. Earth's life is a "complex adaptive system" capable of generating, then preserving, self-organized, elegantly graceful, completely novel order.

So when Pope Francis says we are creatures of "infinite dignity" who are "made in God's image and likeness," and when in the same breath he says that "that each human life is not adrift in the midst of hopeless chaos, in a world ruled by pure chance or endlessly recurring cycles," he seems to be affirming insights of the recent sciences of chaos and complexity into the evolution of life on Earth. At the same time, he rejects the assumption many people make that Darwin's theory of evolution implies that no Creator God exists.

In future posts, I will talk more about how complexity theory furnishes a useful lens through which Pope Francis's "Laudato Si'" may be viewed.

The Dirty Truth about Plug-in Hybrids

The Dirty Truth about Plug-in Hybrids is an interactive version of an article in the July 2010 issue of Scientific American. Here's a key graphic from it (click to enlarge):

The article is about how soon-to-come plug-in autos such as the Nissan Leaf and Chevy Volt may put more carbon in the atmosphere than regular hybrids like the Toyota Prius, depending on what region of the country it is operated in. The plug-ins will either be all-electric (the Leaf) or will have gasoline-powered motors that start up to help charge their battery in a pinch (the Volt). Both types will have to be recharged, mainly or exclusively, by plugging into a power outlet in the owner's garage, though the Volt and other "hybrid" plug-ins can add to their per-charge range by burning gasoline in their gas-powered motors as needed.

At first blush, the less gasoline the plug-ins consume — those that consume any at all, that is — the cleaner and greener they would seem. An all-electric would seem greenest of all. But wait, says the article. Drawing electric power can cause more carbon pollution at the electric power generating facility than the cars save by burning less (or no) gas.

The Scientific American article says that there is wide variation among the regions of the United States as to the mix of energy sources used to make electricity: coal, natural gas, oil, renewables, etc. Depending on the mix, driving a plug-in in a particular region may actually put more carbon in the air than an entirely gasoline-powered hybrid like the Prius.

The same is true with respect to oil consumption, in that oil, or petroleum, is of course the source of gasoline. Even though a plug-in nominally consumes little or no gasoline, in regions where petroleum is used to generate electricity, the saving is again problematic.

As it turns out (see the graphic above) plug-ins do save on oil consumption in every region, vis-à-vis standard hybrids, but the saving is very slight in one particularly populous region: New York.

Meanwhile, the plug-ins' comparative carbon "footprint" varies from one region to the next. In no region is the carbon saving huge for either type of plug-in, but then again in no region do the plug-ins, of either type, put hugely more carbon in the air, either. In two regions, the Upper Midwest and the Mid-Atlantic, hybrid plug-ins help reduce carbon emissions, while all-electrics add to emissions. But in other regions, all-electrics are preferable to hybrid plug-ins, and in most of these, both are preferable to standard hybrids that don't plug in to electrical power sources at any time.

Of course, we can expect the mix of energy sources from which electricity is derived to change over the next several years. If climate-change legislation, via a carbon tax or a cap-and-trade system, puts a price on carbon, then electricity generators will gradually switch away from oil, coal, and natural gas to (say) wind farms and nuclear reactors. That would redraw the Scientific American map over time. A Leaf bought in 2011 may get a whole lot greener by, say, 2020.

Be that as it may, we all need to be aware that there is no such thing as a zero-emission car — not now. Decades from now, maybe.

Sarah Palin on Climate-gate

Former Alaska governor and GOP vice-presidential candidate Sarah Palin writes, in "Copenhagen's political science" on the op-ed page of today's The Washington Post:

With the publication of damaging e-mails from a climate research center in Britain, the radical environmental movement appears to face a tipping point. The revelation of appalling actions by so-called climate change experts allows the American public to finally understand the concerns so many of us have articulated on this issue.

Much as I hate to admit it, she makes a valid point in her op-ed: the recent publication of embarrassing e-mails filched from the Climatic Research Unit of the University of East Anglia in Britain is a game changer. This so-called "climate-gate" scandal undermines my own personal confidence in scientific projections about imminent global warming. It should undermine President Obama's as well, I think — unfortunately, just as the Copenhagen conference on climate change opens.

Let me be clear: even if global warming is a figment, I believe we should still transition to renewable energy sources as fast as possible. But the reason we ought to do so is that we need to develop sources of energy that (eventually) will be abundant and ultra-cheap to harvest: solar, wind, geothermal, and the like. With those resources fully in play — the technological hurdles of harvesting them having been overcome — America will have energy running out of its ears.

Our economy runs on energy, right? When clean electrons become cheap enough to replace dirty electrons that derive from coal, oil, gas, etc., we'll have the basis for hugely enlarged economic productivity. Everyone in America will benefit — once the industries that produce all the dirty electrons finally wither and die.

Ms. Palin misses that point: there are other compelling reasons, besides climate change, to go green, energy-wise.

Still and all, the debate has been framed otherwise. Efforts to reduce the greenhouse emissions of this country and others have been justified as prudential reactions to the threat of global warming. If that threat has been exaggerated by scientists' misfeasance — and it looks like it has — where does that leave us?

If key scientists have interfered with the customary avenues of peer review — and it looks like they have — doesn't that raise legitimate doubts about today's orthodoxy concerning imminent climate change?

I think it does.

The Straw That Stirs the Drink (Still Off-Topic)

Washington Post reporter Alec MacGillis wrote "A Guide to the Health Care Fight" for the Sunday Post's Outlook section on August 16, 2009. In it he said:

Dominating the whole [health care] debate is the question of whether to include a government-run insurance plan on the exchange. Proponents say such a measure — included in the House bill and the Senate health committee bill — would provide the uninsured with a guaranteed high-quality plan, in case insurers still try to game the rules to deny coverage or payments. They say it would also restrain the overall growth in costs. A low-priced competitor, the logic goes, would drive insurers to pressure doctors to deliver the most cost-effective care.

In today's newspaper, "Debate's Path Caught Obama by Surprise: Public Option Wasn't Intended as Major Focus" appears on the front page. It quotes "a senior White House adviser, who spoke on the condition of anonymity," who said:

"We've gotten to this point where health care on the left is determined by the breadth of the public option. I don't understand how that has become the measure of whether what we achieve is health-care reform."

Let me, then, summarize the whole pro-public plan position: I'd say there are two main reasons why the public option is indeed "the measure of ... health-care reform." One, it will keep private insurers from gaming the system. Two, it will "restrain the overall growth in costs."

I consider the second reason even more important than the first. To "drive insurers to pressure doctors to deliver the most cost-effective care" is to compel the restructuring of how health care is delivered in this country. Not how it is insured, necessarily, but how it is delivered. Today, doctors and other sources of health care charge for services rendered. Another MRI, another charge. What needs to happen is for providers to work together, avoid unnecessary, duplicative procedures, and get paid for results, not for services.

President Obama has said he won't insist on a public option, i.e., a nonprofit, government-run health insurer. He isn't "drawing a line in the sand" about a public option. He favors it but he has also said, "If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I'd be happy to do it that way."

Fine, but without a public option or a close substitute, driving down costs is problematic. So what might be a close substitute? MacGillis, in the Post:

To get Republican votes, the Senate Finance Committee's bill is likely to include member-owned cooperatives instead of a public option, though critics say those would lack competitive clout.

And, according to today's front-page story:

Republicans signaled Tuesday that dropping the public option would not garner additional GOP backing. Jon Kyl (Ariz.), the second-ranking Senate Republican leader, criticized an alternative idea of creating a private insurance cooperative, calling it a "Trojan horse" that was effectively the same as the public option.

"It doesn't matter what you call it, they want it to accomplish something Republicans are opposed to," he said.

Kyl's comments came as other conservative Republicans joined in to bash the co-ops idea. Rep. Tom Price (Ga.) said, "A co-op that is simply another name for a public option, or government-run plan, will be rejected by the American people."

Yesterday morning's Post juxtaposed these two articles: "Some Key Democrats Say Public Option is Essential to Health-Care Reform" and "Health Cooperatives Gain Backing as Alternative to Public Option." According to the latter, health co-ops might not even make it off the ground, assuming the eventual reform legislation authorizes them.

That's important, but what's truly key is that co-ops, if passed, might lack enough marketplace clout to drive health care into a more efficient delivery mode. The public option would do just that. My continuing attitude is that the public option amounts to the Reggie Jackson of health insurance reform: it's the straw that stirs the drink.

Off-Topic Yet Again: Mr. President, Please Don't Kill the Public Option!

Today I sent the following message to President Obama at the White House:

Re: Keep the public plan in health insurance reform, please

Dear Mr. President,

It's Sunday, Aug. 16, 2009, and as I was sipping my morning coffee I was pondering whether to donate money to Organizing for America in support of your health care reform program. I thought I'd first send a message to you saying I feared that as soon as I did so, you would back away from the public option which I feel is a sine qua non of reform.

Before I composed that message, I signed on to Yahoo! and learned that your Health and Human Services Secretary, Kathleen Sebelius, has on this very day, on CNN's "State of the Union," floated backing away from public insurance.

I'm oh-so-strongly opposed to that. As John Holahan and Linda J. Blumberg of the Urban Institute's Health Policy Center wrote in "Is the Public Plan Option a Necessary Part of Health Reform?":

"Due to the controversial nature of the public plan option, policymakers are considering alternatives that could be considered as possible compromises between liberals and conservatives. These alternatives include reducing the market power or ratesetting power of the public plan or creating nongovernmental, nonprofit entities that could produce their own insurance plans with negotiated provider payment rates. While these options are likely to have political appeal, it is important to recognize that the cost-containment potential of a public plan rests fully in its ability to leverage the power of the federal government as health care purchaser to encourage provider participation and reduce prevailing payment rates. Without taking advantage of that strength, the cost-containment potential of the public plan option or an alternative would be tremendously weakened."

Citing Mr. Holahan and Ms. Blumberg, a recent Washington Post article (Friday, August 7, 2009), "Democrats Weigh the Cost of Public Insurance," makes the point that:

" ... a public plan is essential to fiscal responsibility in a country where health-care spending has soared to $2.4 trillion per year. A public option such as that proposed by House Democrats, with prices initially set at 5 percent above Medicare rates but well below private insurer rates, would inject competition into markets that are now oligopolies: An American Medical Association study found that a single insurer controls more than half the market in 16 states and a third of it in 38 states.

"This competition, the thinking goes, would drive insurers to demand that medical providers find more cost-effective ways to deliver care, leading to innovations and the spread of well-integrated networks of salaried physicians in place of the costly fee-for-service approach that predominates today.

"As it stands, insurers can pass along rising medical costs in the form of higher premiums. But with a public option in the mix, providers would work with insurers to lower costs to keep the private insurers from going out of business. Providers would probably have little choice but to accept the public option but would not want it to gain too much of the market. Medicare does not offer this competitive dynamic because it covers only the elderly. ...

"The economists in this camp say a public option would not underprice insurers so aggressively as to drive them out of business — political pressures from medical providers would restrain Congress just as it is restrained today from limiting Medicare rates too much. Private insurers could still compete on service and would benefit from their deep ties in local markets.

"But the public plan would produce savings, [economists like Mr. Holahan and Ms. Blumberg] say. The Congressional Budget Office estimates that the House's public option would save $150 billion over the first 10 years. Without it, these economists say, the government would have to save money by cutting subsidies to the point that people would be unable to afford the coverage that they're required to buy."

Secretary Sebelius said on CNN that public insurance is "not the essential element." Mr. Holahan and Ms. Blumberg suggest that it is. I think Mr. Holahan and Ms. Blumberg are right, and Secretary Sebelius is wrong. For your administration to cave in on the public option is, I believe, pandering to the political right in hopes of getting a half-a-loaf reform bill passed ... and it will keep me from making that donation to Organizing for America. It will also end my erstwhile tendency to give you my strong, unwavering support in the various fights, such as that on climate change, that lie ahead on today's political agenda.

You can get my unwavering support back, Mr. President, but only if you back away from today's backing away, so to speak.

If you, like me, support health insurance reform that includes a government-run public option, I urge you, too, to write to President Obama at the White House and tell him so.

Still Off-Topic: Model Health Reform Public Plan on FEHB?

In Admittedly a Bit Off-Topic: A Public Plan, or Not? I strayed off the main topic of this blog: the environment and climate change legislation. Now, more of the same. My rationale is that the health-reform debate is so intense right now that no one is thinking about climate legislation.

The debate over health care reform/health insurance reform has indeed turned ugly. The "continental divide" between supporters and opponents of reform has at its very apex the question of a public option for health insurance. This option would, depending on who you ask, either open up Medicare, as presently constituted, to younger people or create a new, separate, government-run insurer that is something like (but not exactly like) Medicare.

The latter possibility is the one I discussed in the post I just mentioned. My assumptions were that premium rates would be set halfway between Medicare and private plans, and only people in certain categories would be allowed to join. Restricted access and rates above Medicare's would keep the plan from swamping the private insurance market, while allowing some competition between the public plan and private insurers. That competition would wind up putting pressure on health care providers, via private insurers, to restructure away from the omnipresent fee-for-service model that now drives health care costs skyward.


However, I shouldn't have so casually ignored another model that has been proposed for the public option: opening up the current Federal Employees Health Benefits Program to one and all.

FEHB, as the program name is abbreviated, provides yours truly, a retired federal employee, with health coverage. I am quite happy with the health insurance I get via FEHB, which comes from CareFirst BlueCross BlueShield of Maryland, a so-called Preferred Provider Organization or PPO. (A PPO is apparently a sort of fee-for-service plan that saves money by directing me to particular health care providers that have signed up to charge less.) My locally provided insurance coverage is, in turn, part of a national umbrella plan called FEP Blue (for "Federal Employee Program - BlueCross BlueShield").

If I stopped liking that coverage, each fall at "open season" I would be able to change. I could, if I liked, choose among straight fee-for-service plans, PPOs like the one I have, or health maintenance organizations (HMOs). There are, as well, "High Deductible Health Plans," "Consumer-Driven Health Plans,"Health Reimbursement Arrangements," and "Health Savings Accounts." Some of the options open to me are nationwide, and others are specific to my home state, Maryland.

Apparently, some of the political leaders who have spoken in favor of a public option have suggested opening up the Federal Employee Health Benefits program as one way to do it. According to this blog post, Senator Max Baucus (D-Montana), who heads the crucial Finance Committee, favors "keeping the public option 'on the table'," and FEHB expansion is one way he has spoken of for doing it.

It looks as if a great many of those who want a Medicare-style public option hate the idea of using an FEHB expansion in its stead. The blog post I just mentioned is a case in point, as are this post and this. The complaints are that FEHB is too expensive, since "100,000 federal workers don’t participate because they can’t pay the price"; FEHB just repackages private insurance, with its high overhead expenses and profit margins; and, as such, an FEHB expansion could not bend the cost curve down as well as a Medicare-style public option would do.


My thought is this: why not include a Medicare-style public option within an expanded FEHB umbrella program?

Call the Medicare-style public option "Medicare Plus," or MC+. MC+ would, I imagine, be just as supporters of a strong public option would hope. Of course, policymakers would have to decide how close to Medicare to make it — for example, would premium rates be right at the Medicare level, or halfway between Medicare and private insurance? But those are questions that would have to be faced if any sort of public option is implemented.

Meanwhile, MC+ would, like all other expanded-FEHB choices, be bought through whatever federal agency runs the program. FEHB is now run by the Office of Personnel Management (OPM), but opening it to non-federal employees would surely require putting it elsewhere. If it were me, I'd create an independent entity something like the Federal reserve to run it. I'll call whatever independent government entity administrates the program the Federal Health Board, or FHB.

The FHB, in administrating the program, would operate something like OPM does now. Mainly, it would negotiate with all of its insurance offerors (including whoever runs MC+) to get lower prices, which would typically originate with discounts from health care services providers — doctors, clinics, hospitals, etc.

Putting MC+ under the FHB would allow the latter to structure the whole umbrella program so that MC+ did not get "too big for its britches" and drive private insurers out of the marketplace. The FHB would, because it is independent of both the President and the Congress, not be subject to political pressures to liberalize MC+, which might ultimately sound the death knell for private health insurance.


A good question is, how would Joe and Jane Citizen pay for MC+ coverage? If they were currently in the FEHB program, either as current government employees or as retirees, they would have their paychecks or pension checks reduced by the amount of their regular contribution toward premiums — and the remaining cost of their coverage would come as a subsidy out of government operating expenditures.

But if Joe and Jane don't work for Uncle Sam, their expanded FHB coverage would have to be paid for in other ways. Likewise, any subsidy provided by the federal government toward the cost of Joe and Jane's health coverage would have to be handled differently.

Specifically, if Joe and Jane opted for MC+ coverage, the financial mechanics might have to be different than if they had the kind of coverage I have now.

My guess is that some or all of the MC+ premiums, for non-government employees, would be handled either as direct billings or in conjunction with filing income taxes. Subsidies could come as income tax credits or be paid directly into bank accounts.

These are details that would have to be worked out. But the main thing to keep in mind is that policymakers could bundle a Medicare-style public health care plan within an expansion of FEHB and get the benefits of both!