Your mission should you choose to accept it: design a new American health care system that can actually make it past Republicans and Blue Dogs in Congress, is affordable for every American, and controls costs in the long-term.
That's a pretty tall order, especially since most on this forum seem to favor a Canadian-style system, "Medicare for all". Like many of you, I'd like to see the same. However, given the clout of the insurance industry and the reluctance of Congress to create or increase a tax to fund such a system, I am always looking for the next best alternative.
I've flirted with the idea of Ezekiel Emanuel's voucherplan, and its most closely related cousin in Congress, the Wyden-Bennett Bill. Lately, I have become interested in another idea, first proposed in the Presidential Campaign by John Edwards, the so-called 'Public Option', that is, creating an alternative public plan that is not necessarily Medicare but is a publicly-run insurance plan to compete with all the private insurance plans out there. An excellent analysis of the public option can be found here.
Such pools, often called "exchanges," allow those without good employment-based insurance to choose among large private health plans, providing a basis for group pooling of medical risks similar to that provided by large employers. The public insurance option simply makes a public plan available alongside the private plans that can be enrolled in through the exchange. This plan will compete with private plans, ensuring an insurance product with broad choice of providers and encouraging private plans to match the administrative efficiencies, cost-control abilities, and quality-improvement capacities of public insurance.
Sounds great, doesn't it? The next best thing to single-payer could be a vibrant competing public plan that is accessible to all and forces private insurers to run more like they were in a single payer system. Of course, there is a question of cost: how much would be the premiums for the average American? The author of this white paper, Jacob Hacker, envisions a plan as such:
Monthly premiums for those enrolled through the workplace, including the self-employed, would be scaled to income, and cost sharing would be limited based on income: People in poverty would pay virtually nothing for their care. As a share of income, the maximum amount of allowable cost-sharing would be 2.5 percent for those between 100 and 150 percent of the federal poverty level, 5 percent for those between 150 and 300 percent of the poverty level, and 7.5 percent for those over 300 percent of the poverty level.
That sounds good too, much less of the $12,000/year premium the average family pays now for health insurance. Charging a premium for those who can afford it, while not ideal, would make it more politically palatable as the amount of taxes that would need to be raised would be less than under a single payer system.
So this seems like a pretty good compromise. Who could possible oppose a proposal for a public option that still leaves private insurers intact? You guessed it, the insurance industry. According to Paul Waldman, a senior fellow at Media Matters:
It's a beautiful dream, one that the insurance companies and their Republican allies in Congress will do everything in their power to crush. So the question is whether Obama will see the public option as something he will fight for, or as a useful bargaining chip to be sacrificed in order to get a bill through the Senate.
I'm sold on this idea. My question to you all is: would a well-funded Public Option be an acceptable consolation prize should we not be able to push through single payer, whether the public option exists in a 'mandates' or Ezekiel Emanuel-style system?