A Public Plan is the End All, Be All of Health Care Reform

The goal of health care reform is to provide universal access to affordable, quality health care to every American. There are two ways to achieve this goal. One is through the use of a public health insurance plan. There other is through a very highly regulated health insurance market.

It is technically possible to achieve real health care reform without a public plan. We can call this the Dutch or Swiss model. Switzerland pays a lot less for health care than the United States but still much more than most of the first world. What is required is a very highly regulated health care market. There would need to be a list of all conditions and procedures that must be covered; a limit on co-pays, out-of-network charges, out-of-pocket expenses, etc.; and rules preventing customer shopping and dropping. Premiums must be based on community risk. Hopefully there would be a special board or court to deal with insurance companies which refuse to pay for procedures.

The other way to achieve real health care reform is to simply offer a public plan option. All that is needed is to provide all Americans with the option to purchase a plan offered by the government. The plan would be affordable, low hassle, and wouldn't turn down anyone based on pre-existing conditions. The public plan could be modeled after Medicare or the health care plan that members of Congress have. Very little regulation would be needed for the private health insurance market. For-profit health insurance companies would need to offer plans as good as the public plan or they would slowly lose customers and market share.

Given the Republican party's nearly religious devotion to de-regulation, I fear for the longer term success of a highly regulated private-only health care market. The chance that a decade from now Republicans would start stripping many of the health care regulations that make the system work is very real. A popular public plan would be much more politically difficult to modify or eliminate.

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